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Assessing Cardiorespiratory Fitness to Avoid CVD

Circulation; ePub 2016 Nov 21; Ross, et al

The American Heart Association (AHA) has issued a scientific statement on the importance of assessing cardiorespiratory fitness (CRF) in clinical practice. The statement is intended to increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. It also notes that the addition of CRF for risk classification presents health professionals with opportunities to improve patient management and encourage lifestyle-based strategies designed to reduce CV risk. General recommendations for measurement of CRF during routine clinical visits included in the statement are:

  • At a minimum, all adults should have CRF estimated each year using a nonexercise algorithm during their annual healthcare examination. Clinicians may consider the use of submaximal exercise tests or field tests as alternatives, because these involve individual-specific exercise responses.
  • CRF can be estimated using cardiopulmonary exercise testing (CPX), or other forms of treadmill exercise testing. This should be repeated on a regular basis similar to other preventative services. The specific age of first assessment and schedule for follow-up are yet to be established. However, patients with higher CVD risk profiles should have an initial test at an earlier age and be tested more frequently than patients with lower risk profiles.
  • Adults with chronic disease should have CRF measured with a peak or symptom-limited CPX on a regular basis.


Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: A case for fitness as a clinical vital sign. [Published online ahead of print November 21, 2016]. Circulation. doi:10.1161/CIR.0000000000000461.


There is a large body of evidence that CRF is a stronger predictor of cardiovascular outcomes and mortality than established risk factors such as smoking, hypertension, high cholesterol, and even diabetes. The addition of CRF to traditional risk assessment improves the predictive value for the development of CV outcomes. In addition, CRF provides an opportunity for intervention since it is a modifiable risk factor. Physician advice may lead a patient to begin exercising and decrease CV risk.1 The recommendations to do treadmill exercise testing are unlikely to be implemented routinely anytime soon, but assessment of fitness by asking patients about their activity and exercise level is important. Hopefully this AHA scientific statement will encourage us all to do this more often as a part of our routine in-office assessments. —Neil Skolnik, MD

  1. US Preventive Services Task Force. USPSTF final recommendation statement. Healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: Behavioral counseling.