Cardiorespiratory Fitness and Colorectal Cancer Incidence in US Veterans: A Cohort Study

Aamir Ali, Veterans Affairs Medical Center, Washington, DC; Capital Digestive Care, Washington, DC.
Dominique E. Howard, Veterans Affairs Medical Center, Washington, DC; Capital Digestive Care, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC.
Immanuel Babu Samuel, Veterans Affairs Medical Center, Washington, DC; War Related Illness and Injury Study Center, Veterans Affairs Medical Center, Washington, DC.
Rayelynn Murphy, Veterans Affairs Medical Center, Washington, DC.
Andreas Pittaras, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC.
Sara Campbell, Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, New Brunswick, NJ.
Olivia M. Becker, Veterans Affairs Medical Center, Washington, DC; Uniformed Services University, Washington, DC.
Nikola Mrkoci, Veterans Affairs Medical Center, Washington, DC.
Jonathan Myers, New York University, Prehealth Studies Program, New York, New York; Veterans Affairs Palo Alto Health Care System and Stanford University, Palo Alto, CA.
Carl Lavie, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA.
Alexandos Ladas, Veterans Affairs Medical Center, Washington, DC.
Charles Faselis, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC; Uniformed Services University, Washington, DC.
Peter Kokkinos, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, New Brunswick, NJ. Electronic address: peter.kokkinos@va.gov.

Document Type

Journal Article

Publication Date

7-28-2025

Journal

Mayo Clinic proceedings

DOI

10.1016/j.mayocp.2025.03.015

Abstract

OBJECTIVE: To evaluate the association between cardiorespiratory fitness (CRF), objectively measured by standardized exercise treadmill test (ETT), and colorectal cancer incidence. METHODS: The study involved 643,583 US veterans nationwide (41,968 women) from the Exercise Testing and Health Outcomes Study (ETHOS) cohort. None had cancer diagnosis before ETT or had cancer other than colorectal after ETT. Participants completed an ETT (Bruce) with no evidence of ischemia and were stratified into CRF categories (quintiles) based on peak metabolic equivalents (METs) achieved: least fit (n=119,673; METs: 4.8±1.5), low fit (n=157,059; METs: 7.3±1.4), moderate fit (n=122,194; METs: 8.6±1.4), fit (n=170,324; METs: 10.5±1.0), and high fit (n= 74,333; METs: 13.6±1.8). RESULTS: During a median follow-up period of 10.0 years, totaling 6,632,561 person-years, 8190 participants had colorectal cancer (12.4 events per 10,000 person-years). Cardiorespiratory fitness was inversely associated to colorectal cancer risk, independent of comorbidities, with a 9% risk reduction per 1-MET higher in CRF (hazard ratio [HR], 0.91; 95% CI, 0.90 to 0.92), for men and women and across all races. Compared with least fit, the risk of those in the next CRF category (low fit) was 14% lower (HR, 0.86; 95% CI, 0.81 to 0.91). The risk declined progressively with increased CRF and was 57% lower (HR, 0.43; 95% CI, 0.29 to 0.48) for those in the high-fit group. CONCLUSION: We observed an inverse and graded association between CRF and colorectal cancer incidence, across races and sexes, independent of comorbidities. The lower risk was evident in those with a peak CRF of approximately 8.5 to 10.5 METs, a relatively moderate CRF status attainable by most middle-aged and older individuals.

Department

Medicine

Link to Full Text

Share

COinS