Cardiorespiratory fitness, inflammation and risk of chronic obstructive pulmonary disease: A cohort study

Setor K Kunutsor*, Sae Young Jae, Timo Mäkikallio, Jari A Laukkanen

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review


Purpose: Chronic obstructive pulmonary disease (COPD) is characterized by chronic lung inflammation. The relationship between cardiorespiratory fitness (CRF) and COPD has not been well characterized. We aimed to evaluate the independent and joint associations of inflammation (measured by high sensitivity C-reactive protein, hsCRP) and CRF with COPD risk in a cohort of Caucasian men.
Methods: In 2,274 men aged 42-61 yr at baseline, serum hsCRP was measured using an immunometric assay and CRF was assessed using a respiratory gas exchange analyser. hsCRP was categorized as normal and high (≤ 3 and >3 mg/L, respectively) and CRF as low and high. We corrected for within-person variability in exposure levels using repeat measurements taken several years apart.
Results: A total of 116 COPD cases occurred during a median follow-up of 26.0 yr. The age-adjusted regression dilution ratio (95% CIs) of hsCRP and CRF was 0.57 (0.50-0.64) and 0.58 (0.53-0.64), respectively. Comparing high vs normal hsCRP, the multivariable-adjusted HR (95% CI) for COPD was 1.79 (1.20-2.68). COPD risk decreased continuously with increasing CRF (p-value for nonlinearity=0.94). The multivariable-adjusted HR (95% CI) for COPD per 1 SD increase in CRF was 0.75 (0.60-0.95). Compared with men with normal hsCRP-low CRF, high hsCRP-low CRF was associated with an increased COPD risk 1.80 (1.12-2.89), with no evidence of an association for high hsCRP-high CRF and COPD risk 1.35 (0.68 – 2.69).
Conclusions: hsCRP and CRF are each independently associated with COPD risk. However, high CRF levels attenuate the increased risk of COPD related to high hsCRP levels.

Original languageEnglish
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Publication statusAccepted/In press - 22 Nov 2021


  • cardiorespiratory fitness
  • inflammation
  • chronic obstructive pulmonary disease
  • cohort study


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