Temporal Trends in the Cardiorespiratory Fitness of 2,525,827 Adults Between 1967 and 2016: A Systematic Review



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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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.

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GRT and NRL developed the research question and designed the study. GRT and NRL had full access to all the data in the study and take responsibility for the integrity of the data. GRT and NRL led the statistical analysis, synthesis of results, and writing of the report. All authors contributed to the interpretation of results, editing and critical reviewing of the final report, and approved the final report.

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Correspondence to Grant R. Tomkinson.

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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.


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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

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