To estimate international and national temporal trends in the cardiorespiratory fitness (CRF) of adults, and to examine relationships between trends in CRF and trends in health-related, socioeconomic, and environmental indicators.
Data were obtained from a systematic search of studies that explicitly reported temporal trends in the CRF of apparently healthy adults aged 18–59 years. Sample-weighted temporal trends were estimated using best-fitting regression models relating the year of testing to mean CRF. Post-stratified population-weighted mean changes in percent and standardized CRF were estimated. Pearson’s correlations were used to describe associations between linear trends in CRF and linear trends in health-related, socioeconomic, and environmental indicators.
2,525,827 adults representing eight high- and upper-middle-income countries between 1967 and 2016 collectively showed a moderate decline of 7.7% (95% CI − 8.4 to − 7.0) or 1.6% per decade (95% CI − 1.7 to − 1.5). Internationally, CRF improved in the 1960s and 1970s, and progressively declined at an increasing rate thereafter. Declines were larger for men than for women, and for young adults (< 40 years) than for middle-aged adults (≥ 40 years). All countries experienced declines in CRF with a very strong negative correlation between CRF trends and obesity trends.
There has been a meaningful decline in the CRF of adults since 1980, which has progressively increased in magnitude over time, suggestive of a corresponding decline in population health. Continuous national and international surveillance systems are needed in order to monitor health and fitness trends, especially among low- and middle-income countries for which data do not currently exist. PROSPERO registration number: CRD42013003678.
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Ross R, Blair SN, Arena R, Church TS, Després J, Franklin BA, et al. 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. Circulation. 2016;134(24):e653–99.
Harber MP, Kaminsky LA, Arena R, Blair SN, Franklin BA, Myers J, et al. Impact of cardiorespiratory fitness on all-cause and disease-specific mortality: advances since 2009. Prog Cardiovasc Dis. 2017;60(1):11–20.
Armstrong N, Tomkinson G, Ekelund U. Aerobic fitness and its relationship to sport, exercise training and habitual physical activity during youth. Br J Sports Med. 2011;45(11):849–58.
Fletcher GF, Blair SN, Blumenthal J, Caspersen C, Chaitman B, Epstein S, et al. Statement on exercise. Benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation. 1992;86(1):340–4.
Blair SN, Kohl HW 3rd, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA. 1989;262(17):2395–401.
Berry JD, Willis B, Gupta S, Barlow CE, Lakoski SG, Khera A, et al. Lifetime risks for cardiovascular disease mortality by cardiorespiratory fitness levels measured at ages 45, 55, and 65 years in men The Cooper Center Longitudinal Study. J Am Coll Cardiol. 2011;57(15):1604–10.
Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.
Lakka TA, Venäläinen JM, Rauramaa R, Salonen R, Tuomilehto J, Salonen JT. Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction in men. N Engl J Med. 1994;330(22):1549–54.
Lee CD, Blair SN. Cardiorespiratory fitness and stroke mortality in men. Med Sci Sports Exerc. 2002;34(4):592–5.
Lee DC, Sui X, Ortega FB, Kim YS, Church TS, Winett RA, et al. Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women. Br J Sports Med. 2011;45(6):504–10.
McAuley P, Pittsley J, Myers J, Abella J, Froelicher VF. Fitness and fatness as mortality predictors in healthy older men: the Veterans Exercise Testing Study. J Gerontol A Biol Sci Med Sci. 2009;64(6):695–9.
Sui X, LaMonte MJ, Laditka JN, Hardin JW, Chase N, Hooker SP, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA. 2007;298(21):2507–16.
Crump C, Sundquist J, Winkleby MA, Sieh W, Sundquist K. Physical fitness among Swedish military conscripts and long-term risk for type 2 diabetes mellitus: a cohort study. Ann Intern Med. 2016;164(9):577–84.
Jensen MT, Holtermann A, Bay H, Gyntelberg F. Cardiorespiratory fitness and death from cancer: a 42-year follow-up from the Copenhagen Male Study. Br J Sports Med. 2017;51(18):1364–9.
Park MS, Chung SY, Chang Y, Kim K. Physical activity and physical fitness as predictors of all-cause mortality in Korean men. J Korean Med Sci. 2009;24(1):13–9.
Robsahm TE, Falk RS, Heir T, Sandvik L, Vos L, Erikssen JE, et al. Measured cardiorespiratory fitness and self-reported physical activity: associations with cancer risk and death in a long-term prospective cohort study. Cancer Med. 2016;5:2136–44.
Sawada SS, Lee IM, Naito H, Kakigi R, Goto S, Kanazawa M, et al. Cardiorespiratory fitness, body mass index, and cancer mortality: a cohort study of Japanese men. BMC Public Health. 2014;14:1012.
Carnethon MR, Evans NS, Church TS, Lewis CE, Schreiner PJ, Jacobs DR Jr, et al. Joint associations of physical activity and aerobic fitness on the development of incident hypertension: coronary artery risk development in young adults. Hypertension. 2010;56(1):49–55.
Carnethon MR, Gidding SS, Nehgme R, Sidney S, Jacobs DR Jr, Liu K. Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. JAMA. 2003;290(23):3092–100.
Gill JM, Malkova D. Physical activity, fitness and cardiovascular disease risk in adults: interactions with insulin resistance and obesity. Clin Sci (Lond). 2006;110(4):409–25.
Gupta S, Rohatgi A, Ayers CR, Willis BL, Haskell WL, Khera A, et al. Cardiorespiratory fitness and classification of risk of cardiovascular disease mortality. Circulation. 2011;123(13):1377–83.
Holtermann A, Marott JL, Gyntelberg F, Søgaard K, Mortensen OS, Prescott E, et al. Self-reported cardiorespiratory fitness: prediction and classification of risk of cardiovascular disease mortality and longevity—a prospective investigation in the Copenhagen City Heart Study. J Am Heart Assoc. 2015;4(1):e001495.
Laukkanen JA, Rauramaa R, Salonen JT, Kurl S. The predictive value of cardiorespiratory fitness combined with coronary risk evaluation and the risk of cardiovascular and all-cause death. J Intern Med. 2007;262(2):263–72.
Myers J, Nead KT, Chang P, Abella J, Kokkinos P, Leeper NJ. Improved reclassification of mortality risk by assessment of physical activity in patients referred for exercise testing. Am J Med. 2015;128(4):396–402.
Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med. 2009;43(1):1–2.
Tomkinson GR, Olds TS. Field tests of fitness. In: Armstrong N, Van Mechelen W, editors. Paediatric exercise science and medicine. 2nd ed. Oxford: Oxford University Press; 2008. p. 109–28.
Tomkinson GR, Léger LA, Olds TS, Cazorla G. Secular trends in the performance of children and adolescents (1980–2000): an analysis of 55 studies of the 20 m shuttle run test in 11 countries. Sports Med. 2003;33(4):285–300.
Tomkinson GR, Olds TS. Secular changes in pediatric aerobic fitness test performance: the global picture. Med Sport Sci. 2007;50:46–66.
Tomkinson GR, Lang JJ, Tremblay MS. Temporal trends in the cardiorespiratory fitness of children and adolescents representing 19 high-income and upper middle-income countries between 1981 and 2014. Br J Sports Med. 2017. https://doi.org/10.1136/bjsports-2017-097982 (Epub ahead of print).
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.
Leger L. Aerobic performance. In: Docherty D, editor. Measurement in pediatric exercise science. Champaign: Human Kinetics; 1996. p. 183–223.
Tomkinson GR, Macfarlane D, Noi S, Dae-Yeon K, Wang Z, Hong R. Temporal changes in long-distance running performance of Asian children between 1964 and 2009. Sports Med. 2012;42(4):267–79.
Levy PS, Lemeshow S. Stratification random sampling: further issues. In: Levy PS, Lemeshow S, editors. Sampling of populations: methods and application. Hoboken: Wiley; 2008. p. 143–88.
United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2017 revision, key findings and advance tables. Working Paper. ESA/P/WP/248. New York: United Nations; 2017.
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.
United Nations Development Programme. Human Development Report 2016: human development for everyone. New York: United Nations Development Programme; 2016.
World Bank. DataBank: World development indicators. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators. Accessed 13 Aug 2018.
Craig CL, Shields M, Leblanc AG, Tremblay MS. Trends in aerobic fitness among Canadians, 1981 to 2007–2009. Appl Physiol Nutr Metab. 2012;37(3):511–9.
Dyrstad SM, Berg T, Tjelta LI. Secular trends in aerobic fitness performance in a cohort of Norwegian adolescents. Scand J Med Sci Sports. 2012;22(6):822–7.
Ekblom B, Engström L, Ekblom O. Secular trends of physical fitness in Swedish adults. Scand J Med Sci Sports. 2007;17(3):267–73.
Cink RE, Thomas TR. Validity of the Åstrand-Ryhming nomogram for predicting maximal oxygen intake. Br J Sports Med. 1981;15(3):182–5.
Mayorga-Vega D, Bocanegra-Parrilla R, Ornelas M, Viciana J. Criterion-related validity of the distance- and time-based walk/run field tests for estimating cardiorespiratory fitness: a systematic review and meta-analysis. PLoS One. 2016;11(3):e0151671.
Weller IM, Thomas SG, Gledhill N, Paterson D, Quinney A. A study to validate the modified Canadian Aerobic Fitness Test. Can J Appl Physiol. 1995;20(2):211–21.
NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377–96.
Cureton KJ, Sparling PB, Evans BW, Johnson SM, Kong UD, Purvis JW. Effect of experimental alterations in excess weight on aerobic capacity and distance running performance. Med Sci Sports. 1978;10(3):194–9.
Goran M, Fields DA, Hunter GR, Herd SL, Weinsier RL. Total body fat does not influence maximal aerobic capacity. Int J Obes Relat Metab Disord. 2000;24(7):841–8.
Olds TS, Ridley K, Tomkinson GR. Declines in aerobic fitness: are they only due to increasing fatness? Med Sport Sci. 2007;50:226–40.
Cureton KJ, Boileau RA, Lohman TG, Misner JE. Determinants of distance running performances in children: analysis of a path model. Res Q. 1977;48(2):270–9.
Dollman J, Olds T, Norton K, Stuart D. The evolution of fitness and fatness in 10–11-year-old Australian schoolchildren: changes in distributional characteristics between 1985 and 1997. Pediatr Exerc Sci. 1999;11(2):108–21.
Olds T, Dollman J. Are changes in distance-run performance of Australian children between 1985 and 1997 explained by changes in fatness? Pediatr Exerc Sci. 2004;16(3):201–9.
Kennedy AB, Lavie CJ, Blair SN. Fitness or fatness: which is more important? JAMA. 2018;319(3):231–2.
Oktay AA, Lavie CJ, Kokkinos PF, Parto P, Pandey A, Ventura HO. The interaction of cardiorespiratory fitness with obesity and the obesity paradox in cardiovascular disease. Prog Cardiovasc Dis. 2017;60(1):30–44.
Albon HM, Hamlin MJ, Ross JJ. Secular trends and distributional changes in health and fitness performance variables of 10–14-year-old children in New Zealand between 1991 and 2003. Br J Sports Med. 2010;44(4):263–9.
Knapik JJ, Sharp MA, Steelman RA. Secular trends in the physical fitness of United States Army recruits on entry to service, 1975–2013. J Strength Cond Res. 2017;31(7):2030–52.
Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380(9838):247–57.
Sallis JF, Bull F, Guthold R, Heath GW, Inoue S, Kelly P, et al. Progress in physical activity over the Olympic quadrennium. Lancet. 2016;388(10051):1325–36.
Juneau CE, Potvin L. Trends in leisure-, transport-, and work-related physical activity in Canada 1994–2005. Prev Med. 2010;51(5):384–6.
Knuth AG, Hallal PC. Temporal trends in physical activity: a systematic review. J Phys Act Health. 2009;6(5):548–59.
Devonshire-Gill KR, Norton KI. Australian adult physical activity sufficiency trend data: positive, prevalent, and persistent changes 2002–2012. J Phys Act Health. 2018;15(2):117–26.
Brownson RC, Boehmer TK, Luke DA. Declining rates of physical activity in the United States: what are the contributors? Annu Rev Public Health. 2005;26:421–43.
Stamatakis E, Chaudhury M. Temporal trends in adults’ sports participation patterns in England between 1997 and 2006: the Health Survey for England. Br J Sports Med. 2008;42(11):901–8.
Booth VM, Rowlands AV, Dollman J. Physical activity temporal trends among children and adolescents. J Sci Med Sport. 2015;18(4):418–25.
Ekelund U, Tomkinson G, Armstrong N. What proportion of youth are physically active? Measurement issues, levels and recent time trends. Br J Sports Med. 2011;45(11):859–65.
Kalman M, Inchley J, Sigmundova D, Iannotti RJ, Tynjälä JA, Hamrik Z, et al. Secular trends in moderate-to-vigorous physical activity in 32 countries from 2002 to 2010: a cross-national perspective. Eur J Public Health. 2015;25(S2):37–40.
World Health Organization. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010.
World Health Organization. Global action plan on physical activity 2018–2030: more active people for a healthier world. Geneva: World Health Organization; 2018.
Lang JJ, Wolfe Phillips E, Orpana HM, Tremblay MS, Ross R, Ortega FB, et al. Field-based measurement of cardiorespiratory fitness as a way to evaluate physical activity interventions in very high-, high-, middle-, and low-income countries. Bull World Health Organ. 2018;96:794–6.
Ding D, Lawson KD, Kolbe-Alexandar TL, Finkelstein EA, Katzmarzyk PT, Mechelen W, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet. 2016;388(10051):1311–24.
Willis BL, Morrow JR Jr, Jackson AW, Defina LF, Cooper KH. Secular change in cardiorespiratory fitness of men: Cooper Center Longitudinal Study. Med Sci Sports Exerc. 2011;43(11):2134–9.
Kokkinos P, Faselis C, Myers J, Sui X, Zhang J, Blair SN. Age-specific exercise capacity threshold for mortality risk assessment in male veterans. Circulation. 2014;130(8):653–8.
International Olympic Committee. IOC factsheet: women in the Olympic movement—update January 2016. https://stillmed.olympic.org/Documents/Reference_documents_Factsheets/Women_in_Olympic_Movement.pdf. Accessed 28 Mar 2018.
Lindahl B, Stegmayr B, Johansson I, Weinehall L, Hallmans G. Trends in lifestyle 1986–99 in a 25- to 64-year-old population of the Northern Sweden MONICA project. Scand J Public Health. 2003;31(S61):31–7.
Robinson JP, Godbey G. Time for life: the surprising ways Americans use their time. University Park: Pennsylvania State University Press; 1999.
Simmons G, Jackson R, Swinburn B, Yee RL. The increasing prevalence of obesity in New Zealand: is it related to recent trends in smoking and physical activity? N Z Med J. 1996;109(1018):90–2.
Stamatakis E, Ekelund U, Wareham NJ. Temporal trends in physical activity in England: the Health Survey for England 1991 to 2004. Prev Med. 2007;45(6):416–23.
United Nations. Sustainable Development Goals: 17 goals to transform our world. Goal 5: Achieve gender equality and empower all women and girls. http://www.un.org/sustainabledevelopment/gender-equality/. Accessed 28 Mar 2018.
Olds T, Maher C, Zumin S, Péneau S, Lioret S, Castetbon K, et al. Evidence that the prevalence of childhood overweight is plateauing: data from nine countries. Int J Pediatr Obes. 2011;6(5–6):342–60.
McNaughton L, Morgan R, Smith P, Hannan G. An investigation into the fitness levels of Tasmanian primary schoolchildren. ACHPER Healthy Lifestyles J. 1996;43(1):4–10.
Santtila M, Kyröläinen H, Vasankari T, Tiainen S, Palvalin K, Häkkinen A, et al. Physical fitness profiles in young Finnish men during the years 1975–2004. Med Sci Sports Exerc. 2006;38(11):1990–4.
Katzmarzyk PT, Mason C. The physical activity transition. J Phys Act Health. 2009;6(3):269–80.
Lang JJ, Tomkinson GR, Janssen I, Ruiz JR, Ortega FB, Léger L, et al. Making a case for cardiorespiratory fitness surveillance among children and youth. Exerc Sport Sci Rev. 2018;46(2):66–75.
Nauman J, Tauschek LC, Kaminsky LA, Nes BM, Wisløff U. Global fitness levels: findings from a web-based surveillance report. Prog Cardiovasc Dis. 2017;60(1):78–88.
We would like to thank the authors of the included studies for generously clarifying details of their studies and/or for providing additional data. We would also like to thank Dr. Dae-Yeon Kim, Dr. Yang Liu, Dr. Tetsuhiro Kidokoro, Dr. Shingo Noi, and Dr. Koya Suzuki for their assistance with the national fitness data from China, Japan and the Republic of Korea.
Conflict of interest
Nicholas R. Lamoureux, John S. Fitzgerald, Kevin I. Norton, Todd Sabato, Mark S. Tremblay, and Grant R. Tomkinson declare that they have no conflict of interest.
No funding was received for this project.
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Lamoureux, N.R., Fitzgerald, J.S., Norton, K.I. et al. Temporal Trends in the Cardiorespiratory Fitness of 2,525,827 Adults Between 1967 and 2016: A Systematic Review. Sports Med 49, 41–55 (2019). https://doi.org/10.1007/s40279-018-1017-y