VO<sub>2</sub>max-Based Physical Fitness Categories in a Brazilian Population with Supposed High Socioeconomic Status and without Structural Heart Disease

Rossi Neto, João Manoel; Tebexreni, Antonio Sergio; Alves, Alexandre Novakoski F.; Abreu, Floriana Bertini; Nishio, Priscilla Ayumi; Thomazi, Mauricio Cruz; Antelmi, Ivana; Smanio, Paola Emanuela P.

doi:10.36660/abc.20190189

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Original Article • Arq. Bras. Cardiol. 115 (3) • Sept 2020 • https://doi.org/10.36660/abc.20190189 copy

VO₂max-Based Physical Fitness Categories in a Brazilian Population with Supposed High Socioeconomic Status and without Structural Heart Disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

The most widely used data for cardiorespiratory fitness (CRF) referrals are from the Cooper Clinic, which uses calculated maximal oxygen uptake (VO₂max) values.

Objective

To develop CRF values from cardiopulmonary exercise testing (CPX) in a Brazilian population with high socioeconomic level and free of structural heart disease. VO₂max testing results were compared with the Cooper Clinic and FRIEND Registry data.

Methods

CPX data from consecutive individuals between January 1,2000, and May 31,2016 were used in this study. Inclusion criteria were: VO₂max by a pre-specified definition. We built a CRF chart according to VO₂max percentiles: very poor (≤20%), poor (20-40%), fair (40-60%), good (60-80%), excellent (80-90%), and superior (≥90%). Kappa correlation was used to analyze our data in comparison with that of the other two databases. Statistical tests with p<0.005 were considered significant.

Results

Final cohort included 18,186 tests: 12,552 men, 5,634 women (7–84 years). The most recurrent response was “good” (20.2%). There was a mean difference in weight, height, body mass index (BMI), and age in the CRF chart. An inverse correlation existed between VO₂max and age, weight, and BMI. Using a linear regression and these variables, a predictive equation was developed for VO₂max. Our findings differed from that of the other databases.

Conclusion

We developed a classification for CRF and found higher values in all classification ranges of functional capacity in contrast to the Cooper Clinic and FRIEND Registry. Our findings offer a more accurate interpretation of ACR in this large Brazilian population sample when compared to previous standards based on the estimated VO2max. (Arq Bras Cardiol. 2020; 115(3):468-477)

Physical Activity; Exercise; Cooper Test; Social Class; Endurance Training; Physical Endurance; Life Style Healthy

	Age group (y)*
	<19	20-29	30-39	40-49	50-69	60-69	70-79	ALL
Men	n=403	n=1201	n=4427	n=4383	n=1728	n=362	n=48	n=12552
Age (y)	16.2±2.2	25.7±2.8	35.0±2.8	44.0±2.8	53.4±2.7	63.3±2.7	72.4±2.5	40.2±10.2
Height	175.8±9.7	177.9±6.8	177.9±6.7	177.3±6.6	176.4±6.2	174.8±6.4	173.0±6.7	177.3±6.8
Weight	72.1±15.8	80.2±11.8	82.8±11.4	82.8±11.6	82.3±11.1	81.1±11.5	79.3±9.1	82.1±11.8
BMI	23.2±4.0	25.3±3.1	26.1±3.0	26.3±3.1	26.5±3.2	26.5±3.2	26.5±2.9	26.1±3.2
VO₂max	48.7±8.0	45.0±7.5	43.5±7.9	41.6±7.8	38.6±7.9	33.7±7.1	28.7±6.7	42. ±8.3
% Var		-7,6	-3,3	-4,4	-7,2	-12,7	-14,8
Women	n=123	n=732	n=2028	n=1985	n=624	n=128	n=14	n=5634
Age (y)	16.0±2.4	25.9±2.6	34.9±2.8	43.9±2.7	53.4±2.7	63.5±2.7	72.3±1.8	39.3±9.7
Height	163.7±7.4	164.8±6.3	164.4±6.0	163.5±5.9	162.8±5.9	160.8±5.4	158.1±5.6	163.8±6.1
Weight	60.7±12.3	61.0±9.1	62.1±9.8	62.5±9.2	62.9±9.9	62.6±9.8	64.5±9.9	62.2±9.6
BMI	22.5±3.9	22.4±3.0	23.0±3.3	23.4±3.1	23.7±3.3	24.2±3.6	26.1±5.0	23.2±3.2
VO₂max	38.2±7.9	36.9±6.6	36.0±7.0	34.7±7.1	31.4±6.5	26.5±5.7	23.4±5.9	35.0±7.3
% Var		-3,4	-2,4	-3,6	-9,5	-15,6	-11,7

Fleury	%	p-value
Very weak	19.8%	0.280
Weak	20.0%	0.650
Fair	20.0%	0.640
Good	20.2%	Ref.
Excellent	9.8%	<0.001
Superior	10.2%	<0.001

	VO2max
	Corr (r)	p-value
Weight (Kg)	-7.5%	<0.001
Height (cm)	25.0%	<0.001
BMI (kg/m²)	-27.9%	<0.001
Age (years)	-28.4%	<0.001

Fleury Classification		Mean	SD	Min	Max	CI	p-value
Weight	Very weak	84.16	16.86	18.8	158.0	0.55	<0.001
	Weak	77.65	14.27	33.3	137.0	0.46
	Fair	75.42	13.27	36.0	185.0	0.43
	Good	72.79	12.12	32.0	117.0	0.39
	Excellent	70.96	11.84	12.5	105.0	0.54
	Superior	68.79	10.96	32.0	100.0	0.50
Height	Very weak	1.74	0.09	1.37	2.06	0.003	<0.001
	Weak	1.73	0.09	1.38	2.05	0.003
	Fair	1.73	0.09	1.17	2.00	0.003
	Good	1.73	0.09	1.42	2.05	0.003
	Excellent	1.73	0.09	1.42	2.05	0.004
	Superior	1.72	0.09	1.30	1.97	0.004
BMI	Very weak	27.76	4.22	5.8	48.4	0.14	<0.001
	Weak	25.72	3.25	16.9	39.2	0.10
	Fair	24.93	3.03	10.3	72.3	0.10
	Good	24.17	2.56	15.9	39.5	0.08
	Excellent	23.66	2.47	4.7	31.9	0.11
	Superior	22.99	2.20	16.3	34.5	0.10
Age	Very weak	40.38	10.13	9.0	77.0	0.33	0.027
	Weak	39.97	10.10	7.0	79.0	0.33
	Fair	39.91	10.20	11.0	79.0	0.33
	Good	39.71	10.10	10.0	77.0	0.32
	Excellent	39.89	9.99	11.0	74.0	0.46
	Superior	39.50	9.85	11.0	73.0	0.45

		Very weak	Weak	Fair	Good	Excellent
Weight	Weak	<0.001
	Fair	<0.001	<0.001
	Good	<0.001	<0.001	<0.001
	Excellent	<0.001	<0.001	<0.001	<0.001
	Superior	<0.001	<0.001	<0.001	<0.001	<0.001
Height	Weak	0.430
	Fair	0.945	0.932
	Good	0.064	0.946	0.429
	Excellent	0.005	0.295	0.049	0.753
	Superior	<0.001	0.042	0.003	0.248	0.983
BMI	Weak	<0.001
	Fair	<0.001	<0.001
	Good	<0.001	<0.001	<0.001
	Excellent	<0.001	<0.001	<0.001	<0.001
	Superior	<0.001	<0.001	<0.001	<0.001	<0.001
Age	Weak	0.495
	Fair	0.338	1.000
	Good	0.050	0.883	0.959
	Excellent	0.518	1.000	1.000	0.991
	Superior	0.025	0.570	0.705	0.976	0.857

		Very weak	Weak	Fair	Good	Excellent	Superior	Total	p-value
		%	%	%	%	%	%	%
Sex	Female	30.8	31.1	30.6	30.9	31.7	30.7	30.9	0.979
Sex	Male	69.2	68.9	69.4	69.1	68.3	69.3	69.1	0.979
Age Groups	<19	2.9	2.8	2.9	2.9	2.9	2.8	2.9	1.000
	20-29	10.6	10.6	10.6	11.0	9.8	10.5	10.6
	30-39	35.2	35.5	35.3	35.1	35.4	35.6	35.3
	40-49	35.2	35.1	34.8	35.0	35.3	35.1	35.1
	50-59	13.0	13.0	13.0	12.9	13.2	13.0	13.0
	60-69	2.7	2.5	3.0	2.7	3.0	2.7	2.8
	70-79	0.3	0.4	0.4	0.4	0.4	0.3	0.4

MALE
Age	Ref	Very weak	Weak	Fair	Good	Excellent	Superior
<19	F C	≤42,5 ≤35,0	42,6-46,8 35,1-38,3	46,9- 51,1 38,4-45,1	51,2- 55,6 45,25-50,9	55,7-58,6 51,0-55,9	≥58,7 ≥56,0
20-29	F C K	≤38,6 ≤33,0 ≤33,2	38,7-42,8 33,1-36,4 33,0-38,3	42,9-46,4 36,5-42,4 38,4-44,5	46,5-51,8 42,5-46,4 44,6-51,4	51,9-55,2 46,5-52,4 51,5-55,5	≥55,3 ≥52,5 ≥55,6
30-39	F C K	≤36,5 ≤31,5 ≤25,4	36,6-41,4 31,6-35,4 25,5-28,1	41,5-45,3 35,5-40,9 28,9-31,1	45,4-50,3 41,0-44,9 31,2-36,2	50,4-53,5 45,0-49,4 36,3-41,7	≥53,6 ≥49,5 ≥41,8
40-49	F C K	≤34,7 ≤30,2 ≤22,2	34,8-39,5 30,3-33,5 22,3-25,4	39,6-43,5 33,6-38,9 25,5-28,6	43,6-48,1 39,0-43,7 28,7-34,2	48,2-51,7 43,8-48,0 34,3-37,1	≥51,8 ≥48,1 ≥37,2
50-59	F C K	≤31,4 ≤26,1 ≤21,5	31,5-36,3 26,2-30,9 21,6-24,8	36,4-40,5 31,0-35,7 24,9-28,2	40,6-45,0 35,8-40,9 28,3-30,7	45,1-49,0 41,0-45,3 30,8-34,0	≥49,1 ≥45,4 ≥34,1
60-69 > 60 60-69	F C K	≤27,0 ≤20,5 ≤19,0	27,1-31,3 20,6-26,0 19,1-22,4	31,4-35,3 26,1-32,2 22,5-23,2	35,4-39,2 32,3-36,4 23,3-26,7	39,3-42,7 36,5-44,2 26,7-29,9	≥42,8 ≥44,3 ≥30,0
70-79	F K	≤22,6 ≤16,7	22,7-26,1 16,8-18,5	26,2-29,9 18,6-20,4	30,0-34,7 20,5-24,5	34,8-37,3 24,6-28,1	≥37,4 ≥28,2
FEMALE
Age	Ref	Very weak	Weak	Fair	Good	Excellent	Superior
<19	F C	≤31,7 ≤25,0	31,8-34,9 25,1-30,9	35,0-39,1 31,0-34,9	39,2-44,0 35,0-38,9	44,1-48,2 39,0-41,9	≥48,3 ≥42,0
20-29	F C K	≤31,1 ≤23,6 ≤21,6	31,2-34,9 23,7-28,9 21,7-28,1	35,0-38,2 29,0-32,9 28,2-33,6	38,3-42,6 33,0-36,9 33,7-38,8	42,7-45,6 37,0-40,9 38,9-42,6	≥45,7 ≥41,0 ≥42,7
30-39	F C K	≤29,9 ≤22,8 ≤17,0	30,0-33,7 22,9-26,9 17,1-20,1	33,8-37,2 27,0-31,3 20,2-22,5	37,3-42,1 31,4-35,6 22,6-26,0	42,2-45,2 35,7-40,0 26,1-30,0	≥45,3 ≥40,1 ≥30,1
40-49	F C K	≤28,3 ≤21,0 ≤15,8	28,4-32,2 21,1-24,4 15,9-18,4	32,3-36,2 24,5-28,9 18,5-20,7	36,3-41,0 29,0-32,8 20,8-23,4	41,1-44,2 32,9-36,9 23,5-26,2	≥44,3 ≥37,0 ≥26,3
50-59	F C K	≤25,4 ≤20,2 ≤14,9	25,5-28,8 20,3-22,7 15,0-16,6	28,9-32,4 22,8-26,9 16,7-18,2	32,5-36,8 27,0-31,4 18,3-20,7	36,9-40,8 31,5-35,7 20,8-22,6	≥40,9 ≥35,8 ≥22,7
60-69 > 60 60-69	F C K	≤21,3 ≤17,5 ≤14,0	21,4-23,4 17,6-20,1 14,1-15,4	23,5-27,0 20,2-24,4 15,5-16,7	27,1-31,5 24,5-30,2 16,8-18,8	31,6-34,3 30,3-31,4 18,9-20,5	≥34,4 ≥31,5 ≥20,6
70-79	F K	≤17,6 ≤12,8	17,7-19,7 12,9-14,2	19,8-23,2 14,3-15,4	23,3-27,9 15,5-16,9	28,0-32,8 17,0-18,0	≥32,9 ≥18,1

	Kappa	p-valor
Cooper	0.008	0.014
Friend	0.015	<0.001

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VO2max-Based Physical Fitness Categories in a Brazilian Population with Supposed High Socioeconomic Status and without Structural Heart Disease

Abstract

Background

Objective

Methods

Results

Conclusion

VO₂max-Based Physical Fitness Categories in a Brazilian Population with Supposed High Socioeconomic Status and without Structural Heart Disease