# Cardiorespiratory fitness attenuates the association between psychosocial stress and cardiometabolic risk – Results from the SCAPIS population

## TL;DR

Higher cardiorespiratory fitness reduces the negative effects of stress on heart and metabolic health in middle-aged people.

## Contribution

This study shows cardiorespiratory fitness moderates stress-related cardiometabolic risk in a population-based sample.

## Key findings

- High stress is linked to lower cardiorespiratory fitness and worse cardiometabolic profiles.
- Cardiorespiratory fitness reduces stress-related increases in waist circumference and blood pressure.
- The protective effect of fitness is stronger in people with high stress.

## Abstract

Low cardiorespiratory fitness (CRF) and high psychosocial stress can contribute to cardiovascular disease. CRF is a strong predictor of cardiovascular outcomes, yet population-based evidence on whether CRF buffers stress-related risk remains limited. This study aims to (1) examine associations between CRF, stress, and cardiometabolic risk; (2) assess whether CRF moderates the relationship between stress and cardiometabolic risk; and (3) explore whether associations between CRF and cardiometabolic risk are stronger among high-stress individuals.

We included 4,207 healthy, middle-aged participants from the Swedish CArdioPulmonary bioImage Study (SCAPIS), conducted 2013–2018. CRF was estimated using submaximal cycle testing (ml/min/kg). Perceived psychosocial stress was measured using a single self-reported item dichotomised into “low” and “high”. Ten cardiometabolic outcomes were assessed, including waist circumference, BMI, and blood pressure. Cross-sectional associations were analysed in R, using t-tests and multiple linear regression.

Individuals reporting high stress had lower CRF (−1.7 ml/min/kg, p < .001) and less favourable cardiometabolic profiles. CRF moderated the relationship between stress and waist circumference, BMI, systolic- and diastolic blood pressure. For each 1 ml/min/kg higher CRF, the stress-related association was reduced by 0.17 cm in waist circumference (p < .001), 0.06 kg/m2 in BMI (p < .001), 0.18 mmHg in systolic blood pressure (p = .030), and 0.13 mmHg in diastolic blood pressure (p = .020). Associations were 13–25% stronger in the high-stress group.

Higher CRF attenuated the association between psychosocial stress and cardiometabolic risk. Promoting physical activity to improve CRF could be important during periods of high stress to counteract stress-related cardiometabolic deterioration.