Send to:

Choose Destination
See comment in PubMed Commons below
Prog Cardiovasc Dis. 2014 Jan-Feb;56(4):434-40. doi: 10.1016/j.pcad.2013.09.006. Epub 2013 Oct 11.

Contribution of cardiorespiratory fitness to the obesity paradox.

Author information

  • 1Department of Human Performance and Sport Sciences, Winston-Salem State University, Winston-Salem, NC, USA. Electronic address:
  • 2Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA.


Until recently, cardiorespiratory fitness (CRF) has been overlooked as a potential modifier of the inverse association between obesity and mortality (the so-called obesity paradox), observed in patients with known or suspected cardiovascular (CV) disease. Evidence from five observational cohort studies of 30,104 patients (87% male) with CV disease indicates that CRF significantly alters the obesity paradox. There is general agreement across studies that the obesity paradox persists among patients with low CRF, regardless of whether adiposity is assessed by body mass index, waist circumference, or percentage body fat. However, among patients with high CRF, risk of all-cause mortality is lowest for the overweight category in some, but not all, studies, suggesting that higher levels of fitness may modify the relationship between body fatness and survival in patients manifesting an obesity paradox. Further study is needed to better characterize the joint contribution of CRF and obesity on mortality in diverse populations.

© 2014.


%BF; ACLS; Aerobics Center Longitudinal Study; BMI; CHD; CRF; CV; Cardiorespiratory fitness; Coronary heart disease; HF; HR; MET; Obesity paradox; VETS; Veterans Exercise Testing Study; WC; WHR; body fat; body mass index; cardiorespiratory fitness; cardiovascular; coronary heart disease; hazard ratio; heart failure; metabolic equivalent; waist circumference; waist-to-hip ratio

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk