Many years ago I worked as a cardiac dietitian in a mid-sized hospital with an active cardiovascular disease unit. I remember many of the patients I worked with but two female patients clearly stand out in my memory.
One was Betty, a thin, white, well-educated 69 year old woman. Her family was shocked that she had had a myocardia infarction (heart attack) because someone like her who was "in good shape" couldn't possibly have heart disease. Her recovery was slow and difficult and it took six months for her to return to her normal lifestyle.
The other patient was Dottie, a large-sized 77 year old white woman who raised five children on a farm in eastern Colorado. She never had a "real job" but she was active and strong from taking care of the farm, her kids, and a large garden that she was very proud of. She also had a heart attack but recovered easily and was back on the farm within 12 weeks.
If you looked at Betty and Dottie, you would probably think that Betty was healthier because she was thin. Dottie's BMI put her in the obese category and she had a higher amount of body fat than Betty. But Dottie had a higher "cardiorespiratory fitness" level (CRF), from her years of working on the farm, and Betty had a low CRF because she was sedentary. This clearly showed me that you cannot judge someone's fitness by their size or weight!
What exactly is CRF? It refers to the ability of the circulatory and respiratory systems to supply oxygen to the body during physical activity. CRF also relates to an individual's ability to perform daily tasks, such as carrying groceries, riding a bicycle, or playing tennis.
How do you measure CRF? A VO2 max test is the most reliable way to measure CRF, but there are also field tests, such as the Rockport One-Mile Walk Test and the Three Minute Step Test that are simple and can be self-administered. While these tests are not quite as accurate as a VO2 max text, they can provide you with a good idea of your current fitness level.
CRF is a critical component of heart health, yet it often goes overlooked. People tend to focus on traditional risk factors such as smoking, high blood pressure, cholesterol, and obesity when thinking about heart disease, but in reality, CRF is a better predictor of heart disease and death than obesity (1,2,3).
In fact, numerous studies have shown that people who are obese but have a high CRF level outlive those who are thin and have a low fitness level (3,4,5). In other words, it's better to be fit and fat than skinny and unfit! Research has also shown that CRF plays a significant role in preventing other diseases like hypertension, diabetes, and some forms of cancer (6).
Although weight loss might help some people to be active, research shows that most people are unable to maintain their weight loss. This is why a growing number of health professionals (including myself) believe that improving CRF, regardless of whether weight loss occurs or not, is a better approach to reducing heart disease risk than pursuing weight loss. If weight loss occurs and is maintained, it's icing on the cake.
This is why I created Women in Motion for my doctoral thesis at Colorado State University. I was tired of doing weight loss counseling when most of my clients would regain the weight they lost after working with me. I realized that they didn't fail at dieting; dieting failed them.
I decided to try a new method for helping women reduce their risk for chronic health conditions without the added stress of dieting by using a weight-neutral approach to active living and improved CRF, as shown in the diagram by Gaesser and Angad below (6). The program not only focused on CRF, but also placed a strong emphasis on improved nutrition and strength training, as both are key components of overall health and quality of life.
Thus, the ultimate goal for Women in Motion is two-fold: to reduce the risk of chronic health conditions through increased physical strength and fitness, and to enhance the quality of life for the participants by making daily activities easier and allowing them to do the things they wanted to do.
So, if you're a woman and you want to live a long active life, being physically capable of doing the activities that bring you joy, consider joining Women in Motion! In other words, be like Dottie, not Betty!
1) Laukkanen JA, Kurl S, Salonen R, Rauramaa R, Salonen JT. The predictive value of cardiorespiratory fitness for cardiovascular events in men with various risk profiles: a prospective population-based cohort study. Eur Heart J. 2004; 25:1428–1437. doi: 10.1016/j.ehj.2004.06.013.
2) Barry, VW, Baruth, M, Beets, MW, Durstine, JL, Liu, J, and Blair, SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Prog. Cardiovasc. Dis. 2014; 56, 382–390.
3) Blair SN, Kohl HW, Paffenbarger RS, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA. 1989; 262:2395–2401.
4) Sui X, LaMonte MJ, Blair SN. Cardiorespiratory fitness as a predictor of nonfatal cardiovascular events in asymptomatic women and men. Am J Epidemiol. 2007; 165:1413–1423. doi: 10.1093/aje/kwm031.
5) Sawada SS, Lee IM, Naito H, Kakigi R, Goto S, Kanazawa M, Okamoto T, Tsukamoto K, Muto T, Tanaka H, Blair SN. Cardiorespiratory fitness, body mass index, and cancer mortality: a cohort study of Japanese men. BMC Public Health. 2014; 14:1012. doi: 101186/1471-2458-14-1012.
6) Lee DC, Artero EG, Sui X, Blair SN. Mortality trends in the general population: the importance of cardiorespiratory fitness.J Psychopharmacol. 2010; 24(suppl):27–35.
7) Gaessar, G, Angad, Siddhartha S. Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks. iScience 24, 102995, 2021.