Advertisement

Determinants of Racial/Ethnic Differences in Cardiorespiratory Fitness (from the Dallas Heart Study)

      Previous studies have demonstrated ethnic/racial differences in cardiorespiratory fitness (CRF). However, the relative contributions of body mass index (BMI), lifestyle behaviors, socioeconomic status (SES), cardiovascular (CV) risk factors, and cardiac function to these differences in CRF are unclear. In this study, we included 2,617 Dallas Heart Study participants (58.6% women, 48.6% black; 15.7% Hispanic) without CV disease who underwent estimation of CRF using a submaximal exercise test. We constructed multivariable-adjusted linear regression models to determine the association between race/ethnicity and CRF, which was defined as peak oxygen uptake (ml/kg/min). Black participants had the lowest CRF (blacks: 26.3 ± 10.2; whites: 29.0 ± 9.8; Hispanics: 29.1 ± 10.0 ml/kg/min). In multivariate analysis, both black and Hispanic participants had lower CRF after adjustment for age and gender (blacks: Std β = −0.15; p value ≤0.0001, Hispanics: Std β = −0.05, p value = 0.01; ref group: whites). However, this association was considerably attenuated for black (Std β = −0.04, p value = 0.03) and no longer significant for Hispanic ethnicity (p value = 0.56) after additional adjustment for BMI, lifestyle factors, SES, and CV risk factors. Additional adjustment for stroke volume did not substantially change the association between black race/ethnicity and CRF (Std β = −0.06, p value = 0.01). In conclusion, BMI, lifestyle, SES, and traditional risk factor burden are important determinants of ethnicity-based differences in CRF.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Berry J.D.
        • Pandey A.
        • Gao A.
        • Leonard D.
        • Farzaneh-Far R.
        • Ayers C.
        • DeFina L.
        • Willis B.
        Physical fitness and risk for heart failure and coronary artery disease.
        Circ Heart Fail. 2013; 6: 627-634
        • Pandey A.
        • Garg S.
        • Khunger M.
        • Darden D.
        • Ayers C.
        • Kumbhani D.J.
        • Mayo H.G.
        • de Lemos J.A.
        • Berry J.D.
        Dose-response relationship between physical activity and risk of heart failure: a meta-analysis.
        Circulation. 2015; 132: 1786-1794
        • Pandey A.
        • Patel M.
        • Gao A.
        • Willis B.L.
        • Das S.R.
        • Leonard D.
        • Drazner M.H.
        • de Lemos J.A.
        • DeFina L.
        • Berry J.D.
        Changes in mid-life fitness predicts heart failure risk at a later age independent of interval development of cardiac and noncardiac risk factors: the Cooper Center Longitudinal Study.
        Am Heart J. 2015; 169 (e291): 290-297
        • Ceaser T.G.
        • Fitzhugh E.C.
        • Thompson D.L.
        • Bassett Jr., D.R.
        Association of physical activity, fitness, and race: NHANES 1999-2004.
        Med Sci Sports Exerc. 2013; 45: 286-293
        • Duncan G.E.
        • Li S.M.
        • Zhou X.H.
        Cardiovascular fitness among U.S. adults: NHANES 1999-2000 and 2001-2002.
        Med Sci Sports Exerc. 2005; 37: 1324-1328
        • Sanders L.F.
        • Duncan G.E.
        Population-based reference standards for cardiovascular fitness among U.S. adults: NHANES 1999-2000 and 2001-2002.
        Med Sci Sports Exerc. 2006; 38: 701-707
        • Swift D.L.
        • Staiano A.E.
        • Johannsen N.M.
        • Lavie C.J.
        • Earnest C.P.
        • Katzmarzyk P.T.
        • Blair S.N.
        • Newton Jr., R.L.
        • Church T.S.
        Low cardiorespiratory fitness in African Americans: a health disparity risk factor?.
        Sports Med. 2013; 43: 1301-1313
        • Howard E.N.
        • Frierson G.M.
        • Willis B.L.
        • Haskell W.L.
        • Powell-Wiley T.M.
        • Defina L.F.
        The impact of race and higher socioeconomic status on cardiorespiratory fitness.
        Med Sci Sports Exerc. 2013; 45: 2286-2291
        • Victor R.G.
        • Haley R.W.
        • Willett D.L.
        • Peshock R.M.
        • Vaeth P.C.
        • Leonard D.
        • Basit M.
        • Cooper R.S.
        • Iannacchione V.G.
        • Visscher W.A.
        • Staab J.M.
        • Hobbs H.H.
        • Dallas Heart Study Investigators
        The Dallas Heart Study: a population-based probability sample for the multidisciplinary study of ethnic differences in cardiovascular health.
        Am J Cardiol. 2004; 93: 1473-1480
        • Chang A.Y.
        • Oshiro J.
        • Ayers C.
        • Auchus R.J.
        Influence of race/ethnicity on cardiovascular risk factors in polycystic ovary syndrome, the Dallas Heart Study.
        Clin Endocrinol (Oxf). 2016; 85: 92-99
        • Lakoski S.G.
        • Kozlitina J.
        Ethnic differences in physical activity and metabolic risk: the Dallas Heart Study.
        Med Sci Sports Exerc. 2014; 46: 1124-1132
        • Colley R.C.
        • Tremblay M.S.
        Moderate and vigorous physical activity intensity cut-points for the Actical accelerometer.
        J Sports Sci. 2011; 29: 783-789
        • Heil D.P.
        Predicting activity energy expenditure using the Actical activity monitor.
        Res Q Exerc Sport. 2006; 77: 64-80
        • Hooker S.P.
        • Feeney A.
        • Hutto B.
        • Pfeiffer K.A.
        • McIver K.
        • Heil D.P.
        • Vena J.E.
        • Lamonte M.J.
        • Blair S.N.
        Validation of the Actical activity monitor in middle-aged and older adults.
        J Phys Act Health. 2011; 8: 372-381
        • Neeland I.J.
        • Gupta S.
        • Ayers C.R.
        • Turer A.T.
        • Rame J.E.
        • Das S.R.
        • Berry J.D.
        • Khera A.
        • McGuire D.K.
        • Vega G.L.
        • Grundy S.M.
        • de Lemos J.A.
        • Drazner M.H.
        Relation of regional fat distribution to left ventricular structure and function.
        Circ Cardiovasc Imaging. 2013; 6: 800-807
        • Romeo S.
        • Kozlitina J.
        • Xing C.
        • Pertsemlidis A.
        • Cox D.
        • Pennacchio L.A.
        • Boerwinkle E.
        • Cohen J.C.
        • Hobbs H.H.
        Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease.
        Nat Genet. 2008; 40: 1461-1465
        • Friedman D.J.
        • Kozlitina J.
        • Genovese G.
        • Jog P.
        • Pollak M.R.
        Population-based risk assessment of APOL1 on renal disease.
        J Am Soc Nephrol. 2011; 22: 2098-2105
        • Bouchard C.
        • Sarzynski M.A.
        • Rice T.K.
        • Kraus W.E.
        • Church T.S.
        • Sung Y.J.
        • Rao D.C.
        • Rankinen T.
        Genomic predictors of the maximal O(2) uptake response to standardized exercise training programs.
        J Appl Physiol (1985). 2011; 110: 1160-1170
        • Roger V.L.
        • Go A.S.
        • Lloyd-Jones D.M.
        • Benjamin E.J.
        • Berry J.D.
        • Borden W.B.
        • Bravata D.M.
        • Dai S.
        • Ford E.S.
        • Fox C.S.
        • Fullerton H.J.
        • Gillespie C.
        • Hailpern S.M.
        • Heit J.A.
        • Howard V.J.
        • Kissela B.M.
        • Kittner S.J.
        • Lackland D.T.
        • Lichtman J.H.
        • Lisabeth L.D.
        • Makuc D.M.
        • Marcus G.M.
        • Marelli A.
        • Matchar D.B.
        • Moy C.S.
        • Mozaffarian D.
        • Mussolino M.E.
        • Nichol G.
        • Paynter N.P.
        • Soliman E.Z.
        • Sorlie P.D.
        • Sotoodehnia N.
        • Turan T.N.
        • Virani S.S.
        • Wong N.D.
        • Woo D.
        • Turner M.B.
        • American Heart Association Statistics Committee and Stroke Statistics Subcommittee
        Executive summary: heart disease and stroke statistics–2012 update: a report from the American Heart Association.
        Circulation. 2012; 125: 188-197
        • Ama P.F.
        • Simoneau J.A.
        • Boulay M.R.
        • Serresse O.
        • Theriault G.
        • Bouchard C.
        Skeletal muscle characteristics in sedentary black and Caucasian males.
        J Appl Physiol (1985). 1986; 61: 1758-1761
        • Bassett Jr., D.R.
        • Howley E.T.
        Limiting factors for maximum oxygen uptake and determinants of endurance performance.
        Med Sci Sports Exerc. 2000; 32: 70-84
        • Hasson B.R.
        • Apovian C.
        • Istfan N.
        Racial/ethnic differences in insulin resistance and beta cell function: relationship to racial disparities in type 2 diabetes among African Americans versus Caucasians.
        Curr Obes Rep. 2015; 4: 241-249
        • Hunter G.R.
        • Weinsier R.L.
        • Zuckerman P.A.
        • Darnell B.E.
        Aerobic fitness, physiologic difficulty and physical activity in black and white women.
        Int J Obes Relat Metab Disord. 2004; 28: 1111-1117
        • Berry J.D.
        • Willis B.
        • Gupta S.
        • Barlow C.E.
        • Lakoski S.G.
        • Khera A.
        • Rohatgi A.
        • de Lemos J.A.
        • Haskell W.
        • Lloyd-Jones D.M.
        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: 1604-1610
        • Carnethon M.R.
        • Gulati M.
        • Greenland P.
        Prevalence and cardiovascular disease correlates of low cardiorespiratory fitness in adolescents and adults.
        JAMA. 2005; 294: 2981-2988
        • Tanaka H.
        • Monahan K.D.
        • Seals D.R.
        Age-predicted maximal heart rate revisited.
        J Am Coll Cardiol. 2001; 37: 153-156
        • Swank A.M.
        • Serapiglia L.
        • Funk D.
        • Adams K.J.
        • Durham M.
        • Berning J.M.
        Development of a branching submaximal treadmill test for predicting VO2max.
        J Strength Cond Res. 2001; 15: 302-308
        • Town G.
        • Golding L.
        Treadmill test to predict maximum aerobic capacity.
        J Phys Educ. 1977; 74: 6-8
        • Mitros M.
        • Gabriel K.P.
        • Ainsworth B.
        • Lee C.
        • Herrmann S.
        • Campbell K.
        • Swan P.
        Comprehensive evaluation of a single-stage submaximal treadmill walking protocol in healthy, middle-aged women.
        Eur J Appl Physiol. 2011; 111: 47-56