title: The current standard measure of cardiorespiratory fitness introduces confounding by body mass: the DR's EXTRA study.
abstract: OBJECTIVE
  Cardiorespiratory fitness is currently estimated by dividing maximal oxygen consumption (VO(2max)) by body weight (per-weight standard). However, the statistically correct way to neutralize the effect of weight on VO(2max) in a given population is adjustment for body weight by regression techniques (adjusted standard). Our objective is to quantify the bias introduced by the per-weight standard in a population distributed across different categories of body mass.
  
  
  METHODS
  This is a cross-sectional study.
  
  
  METHODS
  Baseline measures from participants of the Dose-Responses to Exercise Training Study (DR's EXTRA), 635 men (body mass index (BMI): 19-47 kg m⁻²) and 638 women (BMI: 16-49 kg m⁻²) aged 57-78 years who performed oral glucose tolerance tests and maximal exercise stress tests with direct measurement of VO(2max). We compare the increase in VO(2max) implied by the per-weight standard with the real increase of VO(2max) per kg body weight. A linear logistic regression model estimates odds for abnormal glucose metabolism (either impaired fasting glycemia or impaired glucose tolerance or Type 2 diabetes) of the least-fit versus most-fit quartile according to both per-weight standard and adjusted standard.
  
  
  RESULTS
  The per-weight standard implies an increase of VO(2max) with 20.9 ml min⁻¹ in women and 26.4 ml min⁻¹ in men per additional kg body weight. The true increase per kg is only 7.0 ml min⁻¹ (95% confidence interval: 5.3-8.8) and 8.0 ml min⁻¹ (95% confidence interval: 5.3-10.7), respectively. Risk for abnormal glucose metabolism in the least-fit quartile of the population is overestimated by 52% if the per-weight standard is used.
  
  
  CONCLUSIONS
  In comparisons across different categories of body mass, the per-weight standard systematically underestimates cardiorespiratory fitness in obese subjects. Use of the per-weight standard markedly inflates associations between poor fitness and co-morbidities of obesity.
authors: Kuopio Research Institute of Exercise Medicine, Kuopio, Finland.
authors: K
authors: K
authors: Savonen
authors: B
authors: B
authors: Krachler
authors: M
authors: M
authors: Hassinen
authors: P
authors: P
authors: Komulainen
authors: V
authors: V
authors: Kiviniemi
authors: T A
authors: TA
authors: Lakka
authors: R
authors: R
authors: Rauramaa
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight; D003430:Cross-Sectional Studies; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism / Q000503:physiopathology*; D010101:Oxygen Consumption; D015203:Reproducibility of Results