Human development and gender inequality are associated with cardiorespiratory fitness: A global systematic review of VO2peak
Bibliographic record
Abstract
• A global systematic review of 24 countries identifies independent associations of Human Development Index (HDI) and Gender Inequality Index (GII) with cardiorespiratory fitness across age groups and sexes. • Peak oxygen uptake (V̇O 2peak ) values are higher in countries with middle- and high-HDI compared with low-HDI settings. • Greater gender inequality (higher GII) is associated with lower V̇O 2peak in both females and males. • The largest disparities in V̇O 2peak were found in young women between low- and high-GII countries, indicating that improvements in human development particularly benefit young females. Cardiorespiratory fitness (CRF) is a powerful predictor of mortality and chronic disease risk, yet global patterns and determinants of CRF remain poorly defined, particularly in females and underrepresented populations. We conducted a systematic review and quantitative synthesis of directly measured peak oxygen uptake (V̇O 2peak ) internationally and examined its association with human development and gender inequality. Studies were eligible if V̇O 2peak was assessed via direct gas analysis during maximal exercise testing, and if the countries had scores for the Human Development Index (HDI) and Gender Inequality Index (GII). Studies were identified through MEDLINE/PubMed, Embase, CINAHL, and Web of Science. Risks of bias were assessed by an adaptation of the Newcastle-Ottawa Scale. Multivariable linear regression models examined associations between V̇O 2peak , age, sex, exercise modality, HDI, GII, and study year. Data included 95 studies from 24 countries with HDI and GII scores, comprising 119,435 adults (42% females) with V̇O 2peak assessed via direct gas analysis during maximal exercise testing. The risk of bias was low. V̇O 2peak was positively associated with HDI ( β = 14.1) and negatively associated with GII ( β = –3.6). Slightly stronger associations were observed in females than males (HDI: β = 18.9 vs. β = 13.9, GII: β = –4.6 vs. β = –3.6). Young females in middle-HDI countries had higher V̇O 2peak than those in low-HDI countries (31.2 mL/kg/min vs . 28.5 mL/kg/min), with limited additional gains in high-HDI contexts. V̇O 2peak decreased with higher gender inequality, with the largest disparities observed in young females between high- and low-GII countries (32.8 mL/kg/min vs . 26.3 mL/kg/min). Global variation in CRF is tied to national levels of human development and gender equality. These findings support prioritizing structural and policy-level interventions that address social and gender disparities in physical activity access and health promotion. Studies from countries with lower HDI and information on ethnicity and socioeconomic status will bridge crucial gaps in understanding factors involved in global CRF levels.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.046 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.009 |
| Bibliometrics | 0.013 | 0.015 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".