CARDIORESPIRATORY FITNESS, VO2max, AND EXERCISE CAPACITY AS PREDICTORS OF CARDIOVASCULAR RISK AND MORTALITY: A NARRATIVE REVIEW
Abstract
Background. Cardiovascular disease is one of the leading causes of morbidity and mortality worldwide. Physical inactivity and sedentary behavior are important modifiable risk factors. Cardiorespiratory fitness (CRF), often expressed as VO2max, VO2peak, metabolic equivalents (METs), exercise capacity, or estimated CRF, has gained attention as a predictor of cardiovascular and overall health. Aim. This review evaluated the prognostic significance of CRF in relation to cardiovascular risk, cardiovascular outcomes, cardiovascular mortality, all-cause mortality, and premature mortality in adults. Materials and methods. This narrative review was based on English-language publications identified in PubMed and Google Scholar. Meta-analyses, systematic reviews, observational cohort studies, clinical reviews, expert statements, and interventional studies relevant to cardiorespiratory fitness, exercise capacity, cardiovascular prevention, mortality, and cardiac rehabilitation were included in the synthesis. Results. The reviewed evidence consistently indicates that higher CRF is associated with a lower risk of all-cause mortality, cardiovascular mortality, and cardiovascular events. This relationship has been observed using various assessment methods, including directly measured VO2max or VO2peak, treadmill-derived peak METs, exercise capacity, and estimated CRF. CRF also appears to have prognostic value in populations with obesity, diabetes, hypertension, coronary artery disease, and heart failure. Changes in CRF over time may be associated with changes in mortality risk. These findings support the interpretation of CRF as a modifiable prognostic marker. Conclusions. CRF should be regarded as a measure of physical performance as well as an indicator of cardiovascular, respiratory, metabolic, and functional health. Its assessment may support cardiovascular risk stratification, prevention, and rehabilitation strategies in adult populations.