Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign

A new statement by the American Heart Association has been recently published suggesting the addition of cardiorespiratory fitness (CRF) for risk classification in patient management and to encourage strategies designed to reduce cardiovascular risk.

The purpose of this statement was to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research.

From the analysis of decades of research, the AHA panel states that "CRF provides independent and additive morbidity and mortality data that when added to traditional risk factors significantly improves CVD risk prediction. On the basis of these observations alone, not including CRF measurement in routine clinical practice fails to provide an optimal approach for stratifying patients according to risk".

The final recommendations are:

1. At a minimum, all adults should have CRF estimated each year using a nonexercise algorithm during their annual healthcare examination. Clinicians may consider the use of submaximal exercise tests or field tests as alternatives, because these involve individual-specific exercise responses.
2. Ideally, all adults should have CRF estimated using a maximal test, if feasible using Cardiopulmonary Exercise Testing (CPX), on a regular basis similar to other preventative services. The specific age of first assessment and schedule for follow-up are yet to be established. However, patients with higher CVD risk profiles should have an initial test at an earlier age and be tested more frequently than patients with lower risk profiles.
3. Adults with chronic disease should have CRF measured with a peak or symptom-limited CPX on a regular§ basis.

The article details are the following:

- Title: "Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association"
- Authors: Robert Ross, Steven N. Blair, Ross Arena, Timothy S. Church, Jean-Pierre Després, Barry A. Franklin, William L. Haskell, Leonard A. Kaminsky, Benjamin D. Levine, Carl J. Lavie, Jonathan Myers, Josef Niebauer, Robert Sallis, Susumu S. Sawada, Xuemei Sui, Ulrik Wisløff and On behalf of the American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Cardiovascular and Stroke Nursing; Council on Functional Genomics and Translational Biology; and Stroke Council
- Published in: Circulation November 29, 2016, Volume 134, Issue 22

The study is free to download at the following link: click here