GRINMADE Research Group, Faculty of Medicine, University of Antioquia, Carrera 51D No 62-29, Medellin, Colombia.
Centro Clínico y de Investigación SICOR (Soluciones Integrales en Riesgo Cardiovascular), Medellín, Colombia.
Eur J Appl Physiol. 2023 May;123(5):945-964. doi: 10.1007/s00421-022-05114-y. Epub 2023 Jan 23.
Given their importance in predicting clinical outcomes, cardiorespiratory fitness (CRF) and muscle status can be considered new vital signs. However, they are not routinely evaluated in healthcare settings. Here, we present a comprehensive review of the epidemiological, mechanistic, and practical bases of the evaluation of CRF and muscle status in adults in primary healthcare settings. We highlight the importance of CRF and muscle status as predictors of morbidity and mortality, focusing on their association with cardiovascular and metabolic outcomes. Notably, adults in the best quartile of CRF and muscle status have as low as one-fourth the risk of developing some of the most common chronic metabolic and cardiovascular diseases than those in the poorest quartile. The physiological mechanisms that underlie these epidemiological associations are addressed. These mechanisms include the fact that both CRF and muscle status reflect an integrative response to the body function. Indeed, muscle plays an active role in the development of many diseases by regulating the body's metabolic rate and releasing myokines, which modulate metabolic and cardiovascular functions. We also go over the most relevant techniques for assessing peak oxygen uptake as a surrogate of CRF and muscle strength, mass, and quality as surrogates of muscle status in adults. Finally, a clinical case of a middle-aged adult is discussed to integrate and summarize the practical aspects of the information presented throughout. Their clinical importance, the ease with which we can assess CRF and muscle status using affordable techniques, and the availability of reference values, justify their routine evaluation in adults across primary healthcare settings.
鉴于其在预测临床结局方面的重要性，心肺适能（CRF）和肌肉状况可被视为新的生命体征。然而，它们在医疗保健环境中并未常规评估。在这里，我们全面回顾了在初级保健环境中评估成年人 CRF 和肌肉状况的流行病学、机制和实践基础。我们强调了 CRF 和肌肉状况作为发病率和死亡率预测因素的重要性，重点关注它们与心血管和代谢结局的关联。值得注意的是，CRF 和肌肉状况处于最佳四分位的成年人患某些最常见的慢性代谢和心血管疾病的风险低至最差四分位的四分之一。我们还探讨了这些流行病学关联的生理机制。这些机制包括 CRF 和肌肉状况都反映了对身体功能的综合反应这一事实。事实上，肌肉通过调节身体的代谢率和释放调节代谢和心血管功能的肌因子，在许多疾病的发展中发挥着积极作用。我们还回顾了评估峰值摄氧量作为 CRF 替代指标的最相关技术，以及评估肌肉力量、质量和质量作为肌肉状况替代指标的技术。最后，讨论了一个中年成年人的临床病例，以整合和总结整个演示过程中的实用方面。它们在临床中的重要性、我们使用负担得起的技术评估 CRF 和肌肉状况的简便性以及参考值的可用性，证明了它们在初级保健环境中对所有成年人进行常规评估的合理性。
