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BMC Obes. 2018 Jan 31;5:5. doi: 10.1186/s40608-018-0183-7. eCollection 2018.

Association between cardiorespiratory fitness and metabolic risk factors in a population with mild to severe obesity.

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1School of Kinesiology and Health Science, York University, School of Kinesiology and Health Science, Toronto, M3J 1P3 Canada.
The Wharton Medical Clinic, Toronto, ON Canada.



Previous literature suggests the beneficial effects of fitness on abdominal obesity may be attenuated in obesity and abolished in severe obesity. It is unclear whether the beneficial association between fitness and health is similarly present in those with mild and severe obesity.


Patients from the Wharton Medical Clinic (n = 853) completed a clinical examination and maximal treadmill test. Patients were categorized into fit and unfit based on age- and sex-categories and body mass index (BMI) class (mild: ≤ 34.9 kg/m2, moderate: 35-39.9 kg/m2 or severe obesity: ≥ 40 kg/m2).


Within the sample, 41% of participants with mild obesity had high fitness whereas only 25% and 11% of the participants with moderate and severe obesity, respectively, had high fitness. BMI category was independently associated with most of the metabolic risk factors, while fitness was only independently associated with systolic blood pressure and triglycerides (P < 0.05). The prevalent relative risk for pre-clinical hypertension, hypertriglyceridemia and hypoalphalipoproteinemia and pre-diabetes was only elevated in the unfit moderate and severe obesity groups (P < 0.05), and fitness groups were only significantly different in their relative risk for prevalent pre-clinical hypertension within the severe obesity group (p = 0.03). High fitness was associated with smaller waist circumferences, with differences between high and low fitness being larger in those with severe obesity than mild obesity (Men: P = 0.06, Women: P = 0.0005).


Thus, in contrast to previous observations, the favourable associations of having high fitness and health may be similar if not augmented in individuals with severe compared to mild obesity.


Cardiorespiratory fitness; Metabolic risk factors; Obesity

Conflict of interest statement

All participants provided written informed consent knowing their decision to participate would not alter the care provided and that they could withdraw consent at any time. York University Institutional Review Board approved the study protocol used (Certificates: 2013–123 and #e2017–166).Not applicableSW is the founder and employee of WMC. The other authors have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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