Cardiorespiratory Fitness Among Korean Adults: 2014-2015 Korea Institute of Sports Science Fitness Standards (KISS FitS) Project Saejong Park, Byoung-Goo Ko, Joo-Ho Song, Hong-Sun Song, Jin-Wook Chung, & Soo Hyun Park* Korea Institute of Sport Science ₂

Table 1. Baseline characteristics of the study participants Men Women Sample size, no. 906 1,100 Age, years 42.42 (13.44) 47.15 (11.76) Height, cm 171.56 (6.27) 158.37 (5.57) Weight, kg 73.39 (10.76) 58.66 (8.39) BMI, kg/m2 24.92 (3.07) 23.37 (3.17) Percent body fat, % 22.57 (5.99) 31.41 (6.38) Lean mass, kg 31.79 (4.11) 21.44 (2.58) WC, cm 86.65 (7.95) 81.73 (8.41) Resting SBP, mmhg 125.25 (11.70) 116.57 (13.74) Resting DBP, mmhg 79.72 (11.217) 74.11 (9.51) Triglyceride, mg/dl 126.99 (83.96) 97.78 (59.87) HDL-C, mg/dl 54.49 (13.78) 64.52 (14.88) Glucose, mg/dl 90.28 (18.50) 92.31 (17.94) Smoker, % 28.4 1.3 Sedentary lifestyle, % 47.1 51.0

Table 2. Exercise time (minutes and seconds) and estimated VO 2peak (ml/kg/min) levels based on maximal exercise testing in men No. Mean (SD) P for trends* Percentile 20th 95% CI 50th 95% CI 80th 95% CI Bruce treadmill exercise time (min:sec) All ages 906 10:43 (1:50) 9:11 9:05, 9:22 10:27 10:19, 11:00 12:10 12:05, 12:18 19-29 yrs 194 11:26 (1:47) 10:00 9:23, 10:04 11:17 11:01, 12:00 13:00 12:26, 13:17 30-39 yrs 158 11:18 (1:30) 10:04 10:00, 10:11 11:13 11:00, 11:35 12:24 12:06, 12:35 40-49 yrs 224 11:06 (1:39) <0.001 10:00 9:25, 10:03 11:01 10:30, 11:16 12:18 12:07, 12:34 50-59 yrs 253 10:03 (1:41) 9:00 8:13, 09:02 10:06 10:01, 10:14 11:19 11:07, 12:00 60-64 yrs 77 8:51 (1:30) 7:50 7:10, 8:04 9:01 8:28, 9:14 10:04 9:28, 10:23 Estimated VO 2peak (ml/kg/min) All ages 906 39.9 (6.2) 34.7 34.4, 35.3 39.0 38.6, 40.8 44.8 44.5, 45.2 19-29 yrs 194 42.3 (6.0) 37.5 35.1, 37.7 41.8 40.9, 44.2 47.6 45.6, 48.5 30-39 yrs 158 41.8 (5.0) 37.7 37.5, 38.2 41.6 40.8, 42.8 45.5 44.6, 46.4 40-49 yrs 224 41.2 (5.6) <0.001 37.5 35.5, 37.6 40.9 39.0, 41.7 45.2 44.5, 46.1 50-59 yrs 253 37.6 (5.6) 34.1 31.5, 34.3 37.8 37.5, 38.3 41.9 41.2, 44.2 60-64 yrs 77 33.6 (5.1) 30.2 28.0, 31.0 34.2 32.3, 34.9 37.7 35.7, 38.8 Table 3. Exercise time (minutes and seconds) and estimated VO 2peak (ml/kg/min) levels based on maximal exercise testing in women No. Mean (SD) P for trends* Percentile 20th 95% CI 50th 95% CI 80th 95% CI Bruce treadmill exercise time (min:sec) All ages 1100 8:28 (1:33) 7:03 7:01, 7:08 8:33 8:21, 9:00 10:00 9:33, 10:00 19-29 yrs 101 9:49 (1:14) 9:02 8:27, 9:16 10:01 9:48, 10:04 10:31 10:21, 11:05 30-39 yrs 197 9:09 (1:22) 8:00 7:42, 8:34 9:12 9:08, 9:28 10:06 10:10, 10:27 40-49 yrs 270 8:42 (1:23) <0.001 7:19 7:16, 7:50 9:02 9:00, 09:10 10:00 9:53, 10:04 50-59 yrs 345 8:01 (1:23) 7:00 6:47, 7:02 8:00 7:55, 8:12 9:14 9:06, 9:33 60-64 yrs 187 7:33 (1:52) 6:18 6:19, 6:40 7:14 7:11, 7:49 9:03 8:48, 9:17 Estimated VO 2peak (ml/kg/min) All ages 1100 29.5 (5.2) 24.7 24.6, 25.0 29.8 29.1, 31.3 34.7 33.1, 34.7 19-29 yrs 101 34.0 (4.2) 31.4 30.4, 31.9 34.7 32.9, 34.8 36.4 35.4, 38.2 30-39 yrs 197 31.8 (4.6) 28.0 26.0, 29.1 32.0 31.6, 32.4 35.0 34.7, 35.5 40-49 yrs 270 30.3 (4.7) <0.001 25.6 25.1, 25.3 31.4 31.3, 31.6 34.7 33.1, 34.8 50-59 yrs 345 28.0 (4.7) 24.6 22.8, 24.6 27.9 26.4, 28.3 32.1 31.5, 32.5 60-64 yrs 187 26.4 (5.1) 22.3 21.8, 22.6 25.4 24.9, 26.2 31.5 29.6, 32.0

Fig. 1. Distribution of estimated VO 2peak by age group for men (left) and women (right) in Korea Table 4. Estimated VO 2peak by sedentary lifestyle in men and women No. VO 2peak (ml//kg/minute) Mean (SD) P value Men Fig. 2. Estimated VO 2peak according to education level in men and women Activity Group 461 41.18(6.33) Sedentary Group 411 38.69(5.56) Women Activity Group 515 30.08(5.23) Sedentary Group 536 29.08(5.18) <0.001 0.002

Table 5. Odds ratios (95% CI) of the metabolism syndrome according to cardiorespiratory fitness levels* in men and women men Unadjusted Adjusted Variable N No. of Prevalence(%) OR 95%CI P value OR 95%CI P value low fit 164 51(31.1) 1 (reference) 1 (reference) mid fit 513 96(18.7) 0.510 0.343-0.760 <0.001 0.492 0.325-0.746 0.001 high fit 187 9(4.8) 0.112 0.053-0.236 0.001 0.127 0.059-0.274 <0.001 P for trend <0.001 women low fit 221 53(24.0) 1 (reference) 1 (reference) mid fit 650 110(16.9) 0.646 0.446-0.935 0.021 0.615 0.413-0.917 0.017 high fit 225 32(14.2) 0.526 0.324-0.854 0.009 0.495 0.293-0.837 0.009 P for trend <0.001

Fig. 3. Comparison of estimated VO 2peak between Koreans and Americans

American College of Sports Medicine. (2014). ACSM s Guidelines for Exercise Testing and Prescription. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins. Blair, S. N., Kampert, J. B., Kohl, H. W. 3rd., Barlow, C. E., Macera, C. A., Paffenbarger, R. S. Jr. & Gibbons, L.W. (1996). Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA, 276(3), 205-210. Blair, S. N., Kohl, H. W. 3rd., Paffenbarger, R. S., Clark, D. G., Cooper, K. H. & Gibbons, L. W. (1989). Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA, 262(17), 2395-2401. Bouchard, C., Dionne, F. T., Simoneau, J.A. & Boulay, M. R. (1992). Genetics of aerobic and anaerobic performances. Exercise Sports Science Review, 120, 27-58. Bruce, R. A., Kusumi, F. & Hosmer, D. (1973). Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease. American Heart Journal, 85(4), 546-562. Carnethon, M. R., Gidding, S. S., Nehgme, R., Sidney, S., Jacobs, D. R. & Liu K. (2003). Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. JAMA, 290(23), 3092-3100. Carnethon, M. R., Sternfeld, B., Schreiner, P. J., Jacobs, D. R., Lewis, C. E., Liu, K. & Sidney, S. (2009). Association of 20-year changes in cardiorespiratory fitness with incident type 2 diabetes: the coronary artery risk development in young adults (CARDIA) fitness study. Diabetes Care, 32(7), 1284-1288. Chae, C. H., Kim, S. H., Lee, C. Y. (2013). A study on gender differences in influencing factors of office workers Physical Activity. J Korean Acad Community Health Nurs, 24(3), 273-281. Cress, M. E. & Meyer, M. (2003). Maximal voluntary and functional performance levels needed for independence in adults aged 65 to 97 years. Physical Therapy, 83(1), 37-48. Duncan, G. E., Li, S. M. & Zhou, X. H. (2005). Cardiovascular fitness among U.S. adults: NHANES 1999-2000 and 2001-2002. Medicine and Science in Sports and Exercise, 37(8), 1324-1328. Earnest, C. P., Artero, E. G., Sui, X., Lee, D. C., Church, T. S. & Blair, S. N. (2013). Maximal estimated cardiorespiratory fitness, cardiometabolic risk factors, and metabolic syndrome in the aerobics center longitudinal study. Mayo Clinic Proceedings, 88(3), 259-270. Ekelund, L. G., Haskell, W. L., Johnson, J. L., Whaley, F. S., Criqui, M. H. & Sheps, D. S. (1988). Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The Lipid Research Clinics Mortality Follow-up Study. New England Journal Medicine, 319(21):1379-84. Eriksen, L., Grønbaek, M., Helge, J. W. & Tolstrup, J. S. (2015). Cardiorespiratory fitness in 16 025 adults aged 18-91 years and associations with physical activity and sitting time. Scandinavian journal of medicine & science in sports, Dec 17. [Epub ahead of print] Farrell, S. W., Kampert, J. B., Kohl, H. W. 3rd., Barlow, C. E., Macera, C. A,, Paffenbarger, R. S. & Gibbons, L. W., Blair, S. N. (1998). Influences of cardiorespiratory fitness levels and other predictors on cardiovascular disease mortality in men. Medicine and Science in Sports and Exercise, 30(6), 899-905. Fleg, J. L., Morrell, C. H., Bos, A. G., Brant, L. J., Talbot, L. A., Wright, J. G. & Lakatta, E. G. (2005). Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation, 112(5), 674-682. Jackson, A. S., Sui, X., Hébert, J. R., Church, T. S. & Blair, S. N. (2009). Role of lifestyle and aging on the longitudinal change in cardiorespiratory fitness. Archives of internal medicine, 169(19), 1781-1787. Jin, J. K. & Lim, S. K. (2015). The norm-referenced standard for physical fitness in middle-aged firefighters. Journal of Sports and Leisure Studies, 62, 785-794. Katzmarzyk, P. T., Church, T. S. & Blair, S. N. (2004). Cardiorespiratory fitness attenuates the effects of the metabolic syndrome on all-cause and cardiovascular disease mortality in men. Archives of Internal Medicine, 164(10), 1092-1097. Katzmarzyk, P. T., Church, T. S., Janssen, I., Ross, R. & Blair, S. N. (2005). Metabolic syndrome, obesity, and mortality: impact of cardiorespiratory fitness. Diabetes Care, 28(2), 391-397. Kim, W. K. (2011). The relationship among life habits, subjective health status, physical fitness of middle school Students. Journal of Sports an Leisure Studies, 43, 1023-1032.

LaMonte, M. J., Barlow, C. E., Jurca, R., Kampert, J. B., Church, T. S. & Blair, S. N. (2005). Cardiorespiratory fitness is inversely associated with the incidence of metabolic syndrome: a prospective study of men and women. Circulation, 112(4), 505-512. Lee, H. & Kim, B. H. (2016). Physical activity disparities by socioeconomic status among metabolic syndrome patients: The Fifth Korea National Health and Nutrition Examination Survey. Journal of Exercise Rehabilitation, 12(1), 10-14. Park, S., Park, S. H., Lee, M. H. & Ahn H. J. (2014). Validation of prediction equations for VO 2max using bruce protocol. The Korean Journal of Measurement and Evaluations in Physical Education and Sport Science, 16(3), 41-50. Piirtola, M., Kaprio, J., Kujala, U. M., Heikkilä, K., Koskenvuo, M., Svedberg, P., Silventoinen, K. & Ropponen, A. (2016). Association between education and future leisure-time physical inactivity: a study of Finnish twins over a 35-year follow-up. BMC Public Health, 16(1), 720. Sanders, L. F. & Duncan, G. E. (2006). Population-based reference standards for cardiovascular fitness among U.S. adults: NHANES 1999-2000 and 2001-2002. Medicine and Science in Sports and Exercise, 38(4), 701-707. So, W. Y. & Choi, D. H. (2009). The difference of fitness level according to blood pressure in korean men. Korean Journal of Health Promotion and Disease Prevention, 9(2), 122-128. Stevens, J., Cai, J., Evenson, K. R. & Thomas, R. (2002). Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. American Journal of Epidemiology, 156(9), 832-841. Sui, X., Hooker, S. P., Lee, I. M., Church, T. S., Colabianchi, N., Lee, C. D. & Blair, S. N. (2008). A prospective study of cardiorespiratory fitness and risk of type 2 diabetes in women. Diabetes Care, 31(3), 550-555. The EP. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evluation, and Treatment of High Blood Cholesterol in Adult Treatment Panel III). JAMA, 285, 2486-2497. Wang, C. Y., Haskell, W. L., Farrell, S. W., Lamonte, M. J., Blair, S. N., Curtin, L. R., Hughes, J. P.& Burt, V. L. (2010). Cardiorespiratory fitness levels among US adults 20-49 years of age: findings from the 1999-2004 National Health and Nutrition Examination Survey. American Journal of Epidemiology, 171(4), 426-435.