The relationship between cardiorespiratory fitness, cardiovascular risk factors and atherosclerosis

Cardiorespiratory fitness (CRF) refers to the ability of the cardiopulmonary system to supply oxygen to skeletal muscles during exercise. Regular physical activity optimizes these systems by physiologic means that not only decrease cardiovascular risk factors but also independently affect mortality. Importantly, CRF is an integrative measure of the effects of its upstream risk factors including physical activity and genetics. In this review, we summarize the main methods that are frequently used to estimate CRF. We cite findings from the major studies on CRF, which demonstrate a beneficial effect on prevalent cardiovascular risk factor burden, subclinical atherosclerosis, and incident adverse outcomes including death, myocardial infarction, stroke, and cancer. We conclude by suggesting the incorporation of CRF into clinical decision-making given the prognostic information it provides. •This review summarized the data on the favorable effects of cardiorespiratory fitness on cardiovascular risk factor burden (hypertension and diabetes).•High cardiorespiratory fitness is associated with reduced atherosclerosis burden and decreased, and adverse cardiovascular outcomes.•Cardiorespiratory fitness should be a useful aid to estimate and potentially reclassify risk of atherosclerotic cardiovascular events.