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Prog Cardiovasc Dis. 2014 Jan-Feb;56(4):382-90. doi: 10.1016/j.pcad.2013.09.002. Epub 2013 Oct 11.

Fitness vs. fatness on all-cause mortality: a meta-analysis.

Author information

  • 1Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN. Electronic address:
  • 2Health Science, Saginaw Valley, State University, University Center, MI.
  • 3Exercise Science, University of South Carolina, Columbia, SC.
  • 4Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.
  • 5Exercise Science, University of South Carolina, Columbia, SC; Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.


The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.

© 2013.


All-cause mortality; BMI; Body mass index; CRF; Cardiorespiratory fitness; Fitness and fatness; Obesity paradox; PA; body mass index; cardiorespiratory fitness; physical activity

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