Fit But Overweight Or Normal Weight But Unfit

Picture from Truenorthwellness

What if you were fit but overweight and even obese compared to being unfit but normal weight. Which do you think is better?

A new meta-analysis pooled results from 20 prospective cohorts thus investigating nearly 400,00 people (Weeldreyer et al, 2025). Participants were categorized by body mass index (BMI) as normal weight, overweight or obese. Their carodiorepiratory fitness (CRF) were measured by maximal exercise testing to determine if they were fit or unfit based on age adjusted VO2 max. This was to determine if BMI or CRF predicts mortality risk better.

This meta-analysis is different from earlier ones since it includes more women. It also has participants from a broader age range, geographic backgrounds and health status. Better statistics all round. Findings more generalizable and results more precise.

The reference group - normal weight and fit was compared to all other combinations. Compared to the reference group, those who were both overweight but fit and obese but fit, both groups had virtually the same risk of dying from any cause. About 4 percent lower and 11 percent higher respectively, which was not statistically significant. Being fit protected against being overweight and obese for all-cause mortality.

Not so good news for the unfit. Those who had normal weight but were unfit had a 92 percent higher all-cause mortality risk. The risk was similarly high for unfit and overweight (82 percent higher) and even higher for the unfit and obese (104 percent higher).

For cardiovascular disease mortality, the differences between weight categories were more pronounced. The fit but overweight had a 50 percent higher risk while those fit and obese had a 62 percent higher risk than fit individuals with normal weight. Note that neither was significant, although it meant that being fit protected one against the risk of dying from cardiovascular disease.

Now for those who were unfit for cardiovascular disease mortality, the numbers were not pretty, in fact they shyrocketed. 104 percent higher risk for normal weight, 158 percent for  overweight and 235 percent for the obese.

In short, being unfit more than doubled mortality risk for many cases, regardless of BMI, while being fit can netralize the impact of carrying extra weight.

These findings show that BMI alone is a weak predictor of health and improving cardiorespiratory fitness can cancel out much of the risks associated with a higher BMI.

Perhaps BMI is not a good indicator. One may have a high BMI and yet be muscular and fit - the Amercian football players in the NFL have high BMI values. They are classified as obese, but they are actually very fit and muscular.

Should we be more concerned with increasing fitness levels over weight loss during public health awareness? There seems to be more emphasis now on weight loss and eating less processed food rather than increasing physical activity. 

This study suggests boosting fitness levels should be at the top of the list, not just as a replacement for tackling obesity. Studies like this show that physical activity is definitely more important than diet for those who want to live to a ripe, old healthy age. Not to say that diet does not matter. But fitness is king. Perhaps our Ministry Of Health should angle some incentives?

Reference

Weeldreyer NR, De Guzman JC, Paterson C et al (2025). Cardiorespiratory Fitness, Body Mass Index And Mortality: A Systematic Review And Meta-Analysis. BJSM.59:339-346. DOI: 10.1136/bjsports-2024-108748

Strength Training Just As Important (If Not More) Than Aerobic Exercises

Lifting before running

After our two beautiful boys came along, my wife used to just run as there was not much time for any other exercise. She found big benefits from minimal running. It improved her mood and energy levels while also lowering her risk of heart disease and stroke.

After a few years of just running, she felt that her fitness level was stagnating and that she was losing strength. So earlier this year, (along with two friends), my wife has been doing twice weekly strength training sessions at the Holland Village F45  gym.

A recent study found strength training just as important (if not more than aerobic training) and can add years to your life. This is the largest study so far (over 80,000 adults) to compare mortality outcomes of different types of exercise people did.

Researchers found that strength training (both gym machines and body weight) decreased the risk of early death (23 percent) and cancer-related death (31 percent).

Earlier I wrote about how weight training can also help solve Singapore's diabetes problem as highlighted by our prime minister during the 2017 National Day Rally. This study lends more weight to my suggestions to help Singaporeans get healthier.

Moreover, the World Health Organization's (WHO) physical activity guidelines suggest 150 minutes of physical activities and two days of strength training every week.

Seems like my wife's twice weekly strength training sessions at the Holland Village F45 is spot on with WHO's guidelines.

For those intimidated by gyms, (be it costs or images of heavy weights), the researchers suggested that body weight exercises like sit-ups, push-ups, lunges and triceps dips done in your own home or local park can be just as beneficial.


Reference

Stamatakis E, Lee I, Bennie J et al (2017). Does Strength Promoting Exercise Confer Unique Health Benefits? A Pooled Analysis Of Eleven Population Cohorts With All-cause, Cancer, and Cardiovascular Mortality Endpoints. Am J Epidemiology. kwx345. https://doi.org/10.1093/aje/kwx345.

ST Article On The Benefits Of Being A Weekend Warrior

ST 270117

Sports Solutions wrote about the weekend warrior phenomenon exactly two weeks ago.

Today, Straits Times published about the same topic from The Washington Post taken from a JAMA Internal Medicine journal.

You can find the ST article on page A4 under the "Top of the news" section. Or you can read our blog's article here. Well, more reason to read our blogs.

So hopefully you can get a chance a exercise at least once in the next few days to reap the benefits.

And here's wishing everyone a Happy Chinese New Year.

The Weekend Warrior Phenomenon

Picture by Naval Surface Warriors from Flickr

We see a fair amount of "weekend warriors" in our clinics. By definition, a weekend warrior is a person who holds a regular 9-5 job and has a family to take care of on a daily basis. They are usually too busy to exercise on a week day so they try to cramp all their exercises on the week end.

In other words, these weekend warriors are compressing their total physical activity into one or two prolonged runs, bike sessions or a single vigorous basketball or football game each week.

We see them in our clinics because they are more likely to face a higher risk of sports-related injuries than people who exercise more often. This may be due to the fact that their sessions are more vigorous and are higher intensities compared to those who exercise more regularly.

However, published evidence from a large study of 63,591 adults showed that exercising even just once or twice per week  appears to be enough to significantly reduce all-cause mortality risk.

The risk of death from all causes was nearly 30 percent lower among weekend warrior adults compared to inactive adults. Risk of cardiovascular (or heart) death was 40 percent lower for weekend warriors while the risk of cancer death was 18 percent lower.

Among those who exercised regularly compared with the inactive group, risk of death from all causes were 35 percent, 41 percent for cardiovascular death and 21 percent for cancer death respectively.

As you can read, the researchers concluded that such fitness regimes (that are restricted to one or two days a week) can be almost as effective as those who require you to work out on a much more regular basis.

If you look at the stats more carefully, you'll see that the weekend warriors were mostly male and nearly half exercised only once a week. Almost 90 percent reported that their exercise occurred during vigorous sports like competitive running and cycling or team sports like football.

So even if you do not have the time to exercise in the week day, that single session you do on the weekend is gonna be of benefit too. And if you do get injured (hopefully you don't), you can come and get treated in our clinics.

Reference

O'Donovan G, Lee I, Hamer M et al (2017).Association Of "Weekend Warrior" And Other Time Physical Activity Patterns With Risks For All-cause, Cardiovascular Disease, And Cancer Mortality. JAMA Int Med.177(3): 335-342. DOI: 10.1001/jamainternmed.2016.8014