Cardiorespiratory Fitness, Inflammation, and the Incident Risk of Pneumonia: Inflammation and cardiorespiratory fitness with pneumonia

Sae Young Jae*, Kevin Heffernan, Sudhir Kurl, Setor K Kunutsor, Chul-Ho Kim, Bruce Johnson, Barry A. Franklin, Jari Laukkanen

*Corresponding author for this work

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

7 Citations (Scopus)


Introduction: Both inflammation and cardiorespiratory fitness (CRF) are each associated with the risk of respiratory infections. To clarify the hypothesis that CRF attenuates the incident risk of pneumonia due to inflammation, we conducted a prospective study examining the independent and joint associations of inflammation and CRF on the risk of pneumonia in a population sample of 2,041 middle-aged men.

Methods: CRF was directly measured by peak oxygen uptake (VO2peak) during progressive exercise testing to volitional fatigue, and categorized into tertiles. Inflammation was defined by high sensitivity C-reactive protein (hsCRP). Pneumonia cases were identified by internal medicine physicians using the International Classification of Diseases codes in clinical practice.

Results: During a median follow-up of 27 yr, 432 pneumonia cases were recorded. High hsCRP and CRF were associated with a higher risk (HR 1.38, 95% CI 1.02-1.88) and a lower risk of pneumonia (HR 0.55, 0.39-0.76) after adjusting for potential confounders, respectively. Compared with normal hsCRP-Fit, moderate to high hsCRP-Unfit had an increased risk of pneumonia (HR 1.63, 1.21-2.20), but moderate to high hsCRP-Fit was not associated with an increased risk of pneumonia (HR 1.25, 0.93-1.68).

Conclusions: High CRF attenuates the increased risk of pneumonia due to inflammation. These findings have potential implications for the prevention of respiratory infection characterized by systemic inflammation, such as COVID-19.
Original languageEnglish
Pages (from-to)199-201
Number of pages3
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Issue number3
Early online date4 Feb 2021
Publication statusPublished - May 2021

Bibliographical note

Funding Information:
We thank the staff of the Kuopio Research Institute of Exercise Medicine and the Research Institute of Public Health, and University of Eastern Finland, Kuopio, Finland, for data collection in this study.

Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.


  • C-reactive protein
  • cardiorespiratory fitness
  • pneumonia


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