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Life sciences · Journal article
Medicine & Science in Sports & Exercise · August 18, 2026
Well-designed and adequately powered for the question it asks.
In a large community-dwelling cohort, lean mass is the strongest body composition correlate of cardiorespiratory fitness, explaining 44–48% of variance in peak VO₂ alongside age and height. The choice of indexing peak VO₂ to total body weight versus lean mass yields different conclusions about fitness in metabolically healthy obesity, suggesting that indexing method and lean mass merit consideration in fitness assessment.
Cross-sectional observational study. Framingham Heart Study (FHS) Generation 3/Omni-2 participants, community-dwelling adults with mean age 54 years, 53% women, mean BMI 27.8 kg/m².. n = 2,647. Framingham Heart Study (US-based cohort, location not specified beyond cohort name)..
Lean mass was the strongest correlate of CRF among body composition measures (FDR <5%) A 1 kg-higher lean mass was associated with 43 ml/min-higher absolute peak VO₂ Lean mass, age, and height accounted for 44–48% of variance in peak VO₂
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Clinicians should recognize that lean mass is a key determinant of measured cardiorespiratory fitness in middle-aged adults and consider how fitness is indexed when assessing individuals across the obesity spectrum. The finding that metabolically healthy obese individuals have similar fitness to non-obese counterparts when indexed to lean mass suggests that body composition and indexing method are critical for interpreting fitness data in obesity.
Large, well-designed cross-sectional study in a well-characterized community cohort with objective measures of body composition and cardiorespiratory fitness, providing clear associations between lean mass and CRF with implications for how fitness is indexed in obesity.
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Clinicians should recognize that lean mass is a key determinant of measured cardiorespiratory fitness in middle-aged adults and consider how fitness is indexed when assessing individuals across the obesity spectrum. The finding that metabolically healthy obese individuals have similar fitness to non-obese counterparts when indexed to lean mass suggests that body composition and indexing method are critical for interpreting fitness data in obesity.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Purpose: Cardiorespiratory fitness (CRF) is an integrative measure of physiologic health, but how CRF relates to different body composition components and cardiometabolic health in community-dwelling adults remains uncertain, especially in obesity. Methods: In Framingham Heart Study (FHS) Generation 3/Omni-2 participants, body composition measures from dual-energy X-ray absorptiometry (DXA) were related to peak oxygen uptake (VO 2 ) and complementary exercise phenotypes assessed via cardiopulmonary exercise testing in sex-stratified multivariable linear models. Secondary analyses examined correlates of peak VO 2 when indexed to total body weight or lean mass. Results: Among 2647 participants (53% women, mean age 54 years, body mass index [BMI] 27.8 kg/m 2 ), lean mass was the strongest correlate of CRF among body composition measures (FDR <5%) and, along with age and height, accounted for 44-48% of the variance in peak VO 2. A 1 kg-higher lean mass was associated with a 43 ml/min-higher absolute peak VO 2. While there was broad consistency across age, sex-based differences in the relations of body composition and CRF were observed, with women demonstrating stronger positive associations between CRF and fat mass compared to men. Peak VO 2 displayed distinct cardiometabolic correlates depending on whether it was indexed to total body weight versus lean mass: “metabolically healthy” obesity displayed lower peak VO 2 compared to “metabolically healthy” non-obesity with indexing to total body weight, but peak VO 2 was similar between these two categories with indexing to lean mass. Conclusions: Lean mass is the strongest correlate of CRF in middle-aged, community-dwelling individuals. Indexing peak VO 2 to lean versus total mass results in different conclusions regarding the intersections of CRF with obesity and metabolic health and emphasizes the role of cardiometabolic risk factors beyond obesity itself.
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