Skip to main content

Advertisement

SpringerLink
Log in

Low Cardiorespiratory Fitness in African Americans: A Health Disparity Risk Factor?

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Low cardiorespiratory fitness (CRF) is a well-established risk factor for all-cause and cardiovascular disease mortality. African Americans have higher rates of cardiovascular disease compared with their Caucasian counterparts. However, the extent to which lower CRF levels contribute to the excess risk in African Americans has not been fully explored. The purpose of this review is to: (i) explore the literature evaluating the relationship between CRF and mortality specifically in African American populations; and (ii) critically evaluate the studies which have compared CRF between African American and Caucasians in epidemiological studies and clinical trials. We have further discussed several potential mechanisms that may contribute to the observation of lower CRF levels in African American compared with Caucasian adults, including potential racial differences in physical activity levels, muscle fiber type distribution, and hemoglobin levels. If lower CRF is generally present in African Americans compared with Caucasians, and is of a clinically meaningful difference, this may represent an important public health concern.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121(4):586–613.

    Article  PubMed  Google Scholar 

  2. Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics—2010 update. Circulation. 2010;121(7):e46–215.

    Article  PubMed  Google Scholar 

  3. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–220.

    Article  PubMed  Google Scholar 

  4. Haskell WL, Lee I-M, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College Of Sports Medicine and The American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–34.

    Article  PubMed  Google Scholar 

  5. Garber CE, Blissmer B, Deschenes MR, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.

    Article  PubMed  Google Scholar 

  6. U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. 2008:1–3. http://www.health.gov/paguidelines/guidelines/default.aspx.

  7. Swift DL, Lavie CJ, Johannsen NM, et al. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J. 2013;77(2):281–92.

    Article  PubMed  Google Scholar 

  8. Kaminsky LA, Arena R, Beckie TM, et al. The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association. Circulation. 2013;127:652–62.

    Article  PubMed  Google Scholar 

  9. Lavie CJ, Kuruvanka T, Milani RV, et al. Exercise capacity in adult African-Americans referred for exercise stress testing: is fitness affected by race? Chest. 2004;126(6):1962–8.

    Article  PubMed  Google Scholar 

  10. Zeno SA, Kim-Dorner SJ, Deuster PA, et al. Cardiovascular fitness and risk factors of healthy African Americans and Caucasians. J Natl Med Assoc. 2010;102(1):28–35.

    PubMed  Google Scholar 

  11. Ceaser TG, Fitzhugh EC, Thompson DL, et al. Association of physical activity, fitness, and race: NHANES 1999–2004. Med Sci Sports Exerc. 2013;45(2):286–93.

    Article  PubMed  Google Scholar 

  12. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 8th ed. Baltimore: Lippincott Williams & Williams; 2010.

    Google Scholar 

  13. Midgley AW, McNaughton LR, Polman R, et al. Criteria for determination of maximal oxygen uptake: a brief critique and recommendations for future research. Sports Med. 2007;37(12):1019–28.

    Article  PubMed  Google Scholar 

  14. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.

    Article  CAS  PubMed  Google Scholar 

  15. Wang C-Y, Haskell WL, Farrell SW, et al. Cardiorespiratory fitness levels among us adults 20–49 years of age: findings from the 1999–2004 National Health and Nutrition Examination Survey. Am J Epidemiol. 2010;171(4):426–35.

    Article  PubMed  Google Scholar 

  16. Duncan GE, Li SM, Zhou XH. Cardiovascular fitness among US adults: NHANES 1999–2000 and 2001–2002. Med Sci Sports Exerc. 2005;37(8):1324–8.

    Article  PubMed  Google Scholar 

  17. Gulati M, Pandey DK, Arnsdorf MF, et al. Exercise capacity and the risk of death in women: the St James Women Take Heart Project. Circulation. 2003;108(13):1554–9.

    Article  PubMed  Google Scholar 

  18. Mora S, Redberg RF, Cui Y, et al. Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinics prevalence study. JAMA. 2003;290(12):1600–7.

    Article  CAS  PubMed  Google Scholar 

  19. Blair SN, Kohl HW, Paffenbarger RS, et al. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA. 1989;262(17):2395–401.

    Article  CAS  PubMed  Google Scholar 

  20. Katzmarzyk PT, Church TS, Blair SN. Cardiorespiratory fitness attenuates the effects of the metabolic syndrome on all-cause and cardiovascular disease mortality in men. Arch Intern Med. 2004;164(10):1092–7.

    Article  PubMed  Google Scholar 

  21. Church TS, LaMonte MJ, Barlow CE, et al. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med. 2005;165(18):2114–20.

    Article  CAS  PubMed  Google Scholar 

  22. Barlow CE, LaMonte MJ, FitzGerald SJ, et al. Cardiorespiratory fitness is an independent predictor of hypertension incidence among initially normotensive healthy women. Am J Epidemiol. 2006;163(2):142–50.

    Article  PubMed  Google Scholar 

  23. Rankinen T, Church TS, Rice T, et al. Cardiorespiratory fitness, BMI, and risk of hypertension: the hypgene study. Med Sci Sports Exerc. 2007;39(10):1687–92.

    Article  PubMed  Google Scholar 

  24. Ross R, Katzmarzyk PT. Cardiorespiratory fitness is associated with diminished total and abdominal obesity independent of body mass index. Int J Obes Relat Metab Disord. 2003;27(2):204.

    Article  CAS  PubMed  Google Scholar 

  25. Wong SL, Katzmarzyk PT, Nichaman MZ, et al. Cardiorespiratory fitness is associated with lower abdominal fat independent of body mass index. Med Sci Sports Exerc. 2004;36(2):286–91.

    Article  PubMed  Google Scholar 

  26. LaMonte MJ, Barlow CE, Jurca R, et al. Cardiorespiratory fitness is inversely associated with the incidence of metabolic syndrome: a prospective study of men and women. Circulation. 2005;112(4):505–12.

    Article  PubMed  Google Scholar 

  27. Shuval K, Finley CE, Chartier KG, et al. Cardiorespiratory fitness, alcohol intake, and metabolic syndrome incidence in men. Med Sci Sports Exerc. 2012;44(11):2125–31.

    Article  CAS  PubMed  Google Scholar 

  28. Laaksonen DE, Lakka H-M, Salonen JT, et al. Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome. Diabetes Care. 2002;25(9):1612–8.

    Article  PubMed  Google Scholar 

  29. Lynch J, Helmrich SP, Lakka TA, et al. Moderately intense physical activities and high levels of cardiorespiratory fitness reduce the risk of non-insulin-dependent diabetes mellitus in middle-aged men. Arch Intern Med. 1996;156(12):1307–14.

    Article  CAS  PubMed  Google Scholar 

  30. Sawada SS, Lee I-M, Muto T, et al. Cardiorespiratory fitness and the incidence of type 2 diabetes. Diabetes Care. 2003;26(10):2918–22.

    Article  PubMed  Google Scholar 

  31. Sieverdes JC, Sui X, Lee D-C, et al. Physical activity, cardiorespiratory fitness and the incidence of type 2 diabetes in a prospective study of men. Br J Sports Med. 2010;44(4):238–44.

    Article  PubMed  Google Scholar 

  32. Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women. JAMA. 2009;301(19):2024–35.

    Article  CAS  PubMed  Google Scholar 

  33. Zeno SA, Deuster PA, Davis JL, et al. Diagnostic criteria for metabolic syndrome: Caucasians versus African-Americans. Metab Syndr Relat Disord. 2010;8(2):149–56.

    Article  CAS  PubMed  Google Scholar 

  34. LaMonte MJ, Durstine JL, Yanowitz FG, et al. Cardiorespiratory fitness and c-reactive protein among a tri-ethnic sample of women. Circulation. 2002;106(4):403–6.

    Article  CAS  PubMed  Google Scholar 

  35. Gaillard TR, Sherman WM, Devor ST, et al. Importance of aerobic fitness in cardiovascular risks in sedentary overweight and obese African-American women. Nurs Res. 2007;56(6):407–15.

    Article  PubMed  Google Scholar 

  36. Kokkinos P, Myers J, Kokkinos JP, et al. Exercise capacity and mortality in black and white men. Circulation. 2008;117(5):614–22.

    Article  PubMed  Google Scholar 

  37. Kokkinos P, Myers J, Nylen E, et al. Exercise capacity and all-cause mortality in African American and Caucasian men with type 2 diabetes. Diabetes Care. 2009;32(4):623–8.

    Article  PubMed  Google Scholar 

  38. Arena R, Myers J, Abella J, et al. Prognostic characteristics of cardiopulmonary exercise testing in Caucasian and African American patients with heart failure. Congest Heart Fail. 2008;14(6):310–5.

    Article  PubMed  Google Scholar 

  39. Cortright RN, Sandhoff KM, Basilio JL, et al. Skeletal muscle fat oxidation is increased in African-American and white women after 10 days of endurance exercise training. Obesity. 2006;14(7):1201–10.

    Article  CAS  PubMed  Google Scholar 

  40. Glass JN, Miller WC, Szymanski LM, et al. Physiological responses to weight-loss intervention in inactive obese African-American and Caucasian women. J Sports Med Phys Fitness. 2002;42(1):56–64.

    CAS  PubMed  Google Scholar 

  41. Suminski RR, Robertson RJ, Goss FL, et al. Peak oxygen consumption and skeletal muscle bioenergetics in African-American and Caucasian men. Med Sci Sports Exerc. 2000;32(12):2059–66.

    Article  CAS  PubMed  Google Scholar 

  42. Walker AJ, Bassett DR, Duey WJ, et al. Cardiovascular and plasma catecholamine responses to exercise in blacks and whites. Hypertension. 1992;20(4):542–8.

    Article  CAS  PubMed  Google Scholar 

  43. Sanders LF, Duncan GE. Population-based reference standards for cardiovascular fitness among US adults: NHANES 1999–2000 and 2001–2002. Med Sci Sports Exerc. 2006;38(4):701–7.

    Article  PubMed  Google Scholar 

  44. Wang Y, Tuomilehto J, Jousilahti P, et al. Occupational, commuting, and leisure-time physical activity in relation to heart failure among Finnish men and women. J Am Coll Cardiol. 2010;56(14):1140–8.

    Article  PubMed  Google Scholar 

  45. Wilbur J, Miller AM, Chandler P. Recruitment and cardiovascular risk characteristics of African American and Caucasian midlife women. J Cardiovasc Nurs. 2001;15(3):88–104.

    Article  CAS  PubMed  Google Scholar 

  46. Arena R, Fei D-Y, Arrowood JA, et al. Influence on aerobic fitness on aortic stiffness in apparently healthy Caucasian and African-American subjects. Int J Cardiol. 2007;122(3):202–6.

    Article  PubMed  Google Scholar 

  47. Howard EN, Frierson GM, Willis BL, et al. The impact of race and higher socioeconomic status on cardiorespiratory fitness. Med Sci Sports Exerc. Epub 2013 May 21 (in press).

  48. Sidney S, Haskell WL, Crow R, et al. Symptom-limited graded treadmill exercise testing in young adults in the CARDIA study. Med Sci Sports Exerc. 1992;24(2):176–83.

    Article  Google Scholar 

  49. Hunter GR, Chandler-Laney PC, Brock DW, et al. Fat distribution, aerobic fitness, blood lipids, and insulin sensitivity in African-American and European-American women. Obesity. 2010;18(2):274–81.

    Article  CAS  PubMed  Google Scholar 

  50. Hunter GR, Weinsier RL, Darnell BE, et al. Racial differences in energy expenditure and aerobic fitness in premenopausal women. Am J Clin Nutr. 2000;71(2):500–6.

    CAS  PubMed  Google Scholar 

  51. Hunter GR, Weinsier RL, Mccarthy JP, et al. Hemoglobin, muscle oxidative capacity, and VO2max in African-American and Caucasian women. Med Sci Sports Exerc. 2001;33(10):1739–43.

    Article  CAS  PubMed  Google Scholar 

  52. Hunter GR, Weinsier RL, Zuckerman PA, et al. Aerobic fitness, physiologic difficulty and physical activity in black and white women. Int J Obes Relat Metab Disord. 2004;28(9):1111–7.

    Article  CAS  PubMed  Google Scholar 

  53. Skinner JS, Jaskólski A, Jaskólska A, et al. Age, sex, race, initial fitness, and response to training: the heritage family study. J Appl Physiol. 2001;90(5):1770–6.

    CAS  PubMed  Google Scholar 

  54. Carpenter WH, Fonong T, Toth MJ, et al. Total daily energy expenditure in free-living older African-Americans and Caucasians. Am J Physiol Endocrinol Metab. 1998;274(1):E96–101.

    CAS  Google Scholar 

  55. Brown RV, Kral BG, Yanek LR, et al. Ethnic-specific determinants of exercise capacity in a healthy high-risk population. Med Sci Sports Exerc. 2012;44(6):1150–6.

    Article  PubMed  Google Scholar 

  56. Swift DL, Johannsen NM, Lavie CJ, et al. Racial differences in the response of cardiorespiratory fitness to aerobic exercise training in Caucasian and African American postmenopausal women. J Appl Physiol. 2013;114(10):1375–82.

    Article  CAS  PubMed  Google Scholar 

  57. Estacio RO, Wolfel EE, Regensteiner JG, et al. Effect of risk factors on exercise capacity in NIDDM. Diabetes. 1996;45(1):79–85.

    Article  CAS  PubMed  Google Scholar 

  58. Ribisl PM, Lang W, Jaramillo SA, et al. Exercise capacity and cardiovascular/metabolic characteristics of overweight and obese individuals with type 2 diabetes. Diabetes Care. 2007;30(10):2679–84.

    Article  PubMed  Google Scholar 

  59. Hinson HE, Patterson SL, Macko RF, et al. Reduced cardiovascular fitness and ambulatory function in Black and White stroke survivors. Ethn Dis. 2007;17(4):682–5.

    PubMed  Google Scholar 

  60. Myslivecek PR, Brown CA, Wolfe LA. Effects of physical conditioning on cardiac autonomic function in healthy middle-aged women. Can J Appl Physiol-Rev Can Physiol Appl. 2002;27(1):1–18.

    Article  Google Scholar 

  61. Lavie CJ, Milani RV. Metabolic equivalent (MET) inflation—not the MET we used to know. J Cardiopulm Rehabil Prev. 2007;27(3):149–50.

    Article  PubMed  Google Scholar 

  62. Osman AF, Mehra MR, Lavie CJ, et al. The incremental prognostic importance of body fat adjusted peak oxygen consumption in chronic heart failure. J Am Coll Cardiol. 2000;36(7):2126–31.

    Article  CAS  PubMed  Google Scholar 

  63. Marshall SJ, Jones DA, Ainsworth BE, et al. Race/ethnicity, social class, and leisure-time physical inactivity. Med Sci Sports Exerc. 2007;39(1):44–51.

    Article  PubMed  Google Scholar 

  64. Tucker JM, Welk GJ, Beyler NK. Physical activity in US adults: compliance with the physical activity guidelines for Americans. Am J Prev Med. 2011;40(4):454–61.

    Article  PubMed  Google Scholar 

  65. Troiano RP, Berrigan D, Dodd KW, et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–8.

    Article  PubMed  Google Scholar 

  66. Suminski RR, Mattern CO, Devor ST. Influence of racial origin and skeletal muscle properties on disease prevalence and physical performance. Sports Med. 2002;32(11):667–73.

    Article  PubMed  Google Scholar 

  67. Ama PF, Simoneau JA, Boulay MR, et al. Skeletal muscle characteristics in sedentary Black and Caucasian males. J Appl Physiol. 1986;61(5):1758–61.

    CAS  PubMed  Google Scholar 

  68. Tanner CJ, Barakat HA, Dohm GL, et al. Muscle fiber type is associated with obesity and weight loss. Am J Physiol Endocrinol Metab. 2002;282(6):E1191–6.

    CAS  PubMed  Google Scholar 

  69. Blair SN, Kohl HW III, Barlow CE, et al. Changes in physical fitness and all-cause mortality: a prospective study of healthy and unhealthy men. JAMA. 1995;273(14):1093–8.

    Article  CAS  PubMed  Google Scholar 

  70. Erikssen G, Liestol K, Bjornholt J, et al. Changes in physical fitness and changes in mortality. Lancet. 1998;352(9130):759–62.

    Article  CAS  PubMed  Google Scholar 

  71. D-C Lee, X Sui, EG Artero, et al. Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study. Circulation. 2011;124(23):2483–90.

    Article  Google Scholar 

  72. Duey WJ, O’Brien WL, Crutchfield AB, et al. Effects of exercise training on aerobic fitness in African-American females. Ethn Dis. 1998;8(3):306–11.

    CAS  PubMed  Google Scholar 

  73. Stephens Q, Kirby T, Buckworth J, et al. Aerobic exercise improves cardiorespiratory fitness but does not reduce blood pressure in prehypertensive African American women. Ethn Dis. 2007;17(1):55–8.

    PubMed  Google Scholar 

  74. Bouchard C, Rankinen T. Individual differences in response to regular physical activity. Med Sci Sports Exerc. 2001;33(6):S446–51.

    Article  CAS  PubMed  Google Scholar 

  75. Sidney S, Sternfeld B, Haskell WL, et al. Seven-year change in graded exercise treadmill test performance in young adults in the CARDIA study. Cardiovascular risk factors in young adults. Med Sci Sports Exerc. 1998;30(3):427–33.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the NIH T-32 postdoctoral fellowship (Obesity from Genes to Man) which supports the salary and training of Drs Damon Swift and Amanda Staiano. Dr. Katzmarzyk is supported, in part, by the Louisiana Public Facilities Authority Endowed Chair in Nutrition.

Conflict of interest

The authors have no conflicts of interests to disclose.

Author information

Authors and Affiliations

  1. Department of Kinesiology, East Carolina University, 107 FITT Building, Greenville, NC, 27858, USA

    Damon L. Swift

  2. Department of Preventive Medicine, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA

    Neil M. Johannsen, Carl J. Lavie & Timothy S. Church

  3. Department of Population Science, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA

    Amanda E. Staiano & Peter T. Katzmarzyk

  4. Department of Physical Activity and Ethnic Minority Health, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA

    Robert L. Newton Jr.

  5. Department for Health, University of Bath, Bath, UK

    Conrad P. Earnest

  6. Department of Kinesiology, Louisiana State University, Baton Rouge, LA, 70803, USA

    Neil M. Johannsen

  7. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, 70121, USA

    Carl J. Lavie

  8. Department of Exercise Science and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, 29208, USA

    Steven N. Blair

Authors
  1. Damon L. Swift
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amanda E. Staiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neil M. Johannsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carl J. Lavie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Conrad P. Earnest
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter T. Katzmarzyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steven N. Blair
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robert L. Newton Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Timothy S. Church
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Damon L. Swift.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Swift, D.L., Staiano, A.E., Johannsen, N.M. et al. Low Cardiorespiratory Fitness in African Americans: A Health Disparity Risk Factor?. Sports Med 43, 1301–1313 (2013). https://doi.org/10.1007/s40279-013-0092-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-013-0092-3

Keywords

Search

Navigation