Estimating Cardiorespiratory Fitness Without Exercise Testing or Physical Activity Status in Healthy Adults: Regression Model Development and Validation

Robert Sloan*, Marco Visentini-Scarzanella, Susumu Sawada, Xuemei Sui, Jonathan Myers

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

3 Citations (Scopus)


Background: Low cardiorespiratory fitness (CRF) is an independent predictor of morbidity and mortality. Most health care settings use some type of electronic health record (EHR) system. However, many EHRs do not have CRF or physical activity data collected, thereby limiting the types of investigations and analyses that can be done. Objective: This study aims to develop a nonexercise equation to estimate and classify CRF (in metabolic equivalent tasks) using variables commonly available in EHRs. Methods: Participants were 42,676 healthy adults (female participants: n=9146, 21.4%) from the Aerobics Center Longitudinal Study examined from 1974 to 2005. The nonexercise estimated CRF was based on sex, age, measured BMI, measured resting heart rate, measured resting blood pressure, and smoking status. A maximal treadmill test measured CRF. Results: After conducting nonlinear feature augmentation, separate linear regression models were used for male and female participants to calculate correlation and regression coefficients. Cross-classification of actual and estimated CRF was performed using low CRF categories (lowest quintile, lowest quartile, and lowest tertile). The multiple correlation coefficient (R) was 0.70 (mean deviation 1.33) for male participants and 0.65 (mean deviation 1.23) for female participants. The models explained 48.4% (SE estimate 1.70) and 41.9% (SE estimate 1.56) of the variance in CRF for male and female participants, respectively. Correct category classification for low CRF (lowest tertile) was found in 77.2% (n=25,885) of male participants and 74.9% (n=6,850) of female participants. Conclusions: The regression models developed in this study provided useful estimation and classification of CRF in a large population of male and female participants. The models may provide a practical method for estimating CRF derived from EHRs for population health research.

Original languageEnglish
Article numbere34717
JournalJMIR Public Health and Surveillance
Issue number7
Publication statusPublished - 2022 Jul 1


  • EHR
  • cardiorespiratory
  • electronic health record
  • epidemiology
  • fitness
  • nonexercise equation
  • nonexercise estimated cardiorespiratory fitness
  • physical activity
  • public health
  • regression model
  • surveillance

ASJC Scopus subject areas

  • Health Informatics
  • Public Health, Environmental and Occupational Health


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