# Translation of clinical practice to research: the VETS and ETHOS epidemiologic prospective cohorts

## TL;DR

Long-term studies ETHOS and VETS show that higher cardiorespiratory fitness is linked to better health outcomes and lower chronic disease risk.

## Contribution

Long-term tracking of cardiorespiratory fitness and health outcomes in large cohorts to inform public health guidelines.

## Key findings

- Higher cardiorespiratory fitness is inversely associated with chronic diseases like cardiovascular disease and cancer.
- Improvements in fitness over time correlate with better health outcomes, while declines worsen outcomes.
- CRF is linked to reduced healthcare costs and supports recommendations for physical activity promotion.

## Abstract

For >30 years, the Exercise Testing and Health Outcomes Study (ETHOS) and the Veterans Exercise Testing Study (VETS) cohorts have contributed significantly to the understanding of the association between cardiorespiratory fitness (CRF), health outcomes, and the prevention of chronic disease. Multiple reports from these studies have consistently shown an inverse and graded association between higher CRF and the incidence of chronic conditions including cardiovascular disease, site-specific cancers, chronic kidney disease, rhythm disturbances, and neurological conditions. In addition, higher CRF is inversely related to health care costs. Among individuals whose CRF level improves over periods of time ranging from 5 to 7 years, improvements in health outcomes have been observed, and the converse is true among those who decrease CRF over time. The Veterans Administration Health Care System (VAHCS) has pioneered electronic medical records that have facilitated epidemiologic research and have provided the foundation for the ETHOS and VETS cohorts. The VAHCS is particularly suited for epidemiologic studies because patients can be accurately traced through VAHCS benefits services. These studies have helped formulate guidelines on exercise testing as well as recommendations from national and international health organizations on physical activity. In addition, they have provided strong support for efforts to reduce sedentary behavior, promote physical activity, and enhance CRF by public health organizations and healthcare systems in order to reduce the risk of chronic disease. This paper outlines the development of the ETHOS and VETS cohorts and highlights key studies contributing to our understanding of CRF as a critical health determinant.