Association of estimated cardiorespiratory fitness with circadian syndrome: A cross-national analysis of two large aging cohorts

Dec 23, 2025Sleep medicine

Link between estimated heart and lung fitness and circadian syndrome in older adults across countries

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Abstract

Higher estimated cardiorespiratory fitness (eCRF) is associated with lower odds of prevalent Circadian Syndrome (CircS) in two large aging populations.

In the China Health and Retirement Longitudinal Study (CHARLS), high eCRF showed an odds ratio of 0.12 for prevalent CircS.
In the English Longitudinal Study of Ageing (ELSA), high eCRF had an odds ratio of 0.16 for prevalent CircS.
Longitudinally, higher baseline eCRF is linked to a lower risk of developing CircS in both CHARLS (hazard ratio 0.38) and ELSA (hazard ratio 0.45).
The relationship between eCRF and CircS demonstrated a linear dose-response in CHARLS but a non-linear pattern in ELSA.
The association between eCRF and CircS was significantly influenced by sex in ELSA, being stronger in females.

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BACKGROUND: Promoting healthy aging requires identifying modifiable factors that can preserve physiological regulation. Cardiorespiratory fitness (CRF), a key pillar of healthspan, and Circadian Syndrome (CircS), an emerging marker of systemic dysregulation, are both strongly linked to health outcomes, yet their direct relationship is unknown. This study aimed to investigate the cross-sectional and longitudinal associations between estimated CRF (eCRF) and CircS in two large, distinct aging populations.

METHODS: This population-based study utilized data from the China Health and Retirement Longitudinal Study (CHARLS; n = 3116) and the English Longitudinal Study of Ageing (ELSA; n = 7039). Associations were evaluated using logistic regression for prevalent CircS and Cox proportional hazards models for incident CircS. Covariate selection for these models was guided by a Directed Acyclic Graph (DAG). Restricted cubic splines were used to model non-linear associations, and stratified analyses were conducted to identify potential effect modifiers.

RESULTS: A total of 10,155 participants were included. Cross-sectionally, higher eCRF was robustly associated with lower odds of prevalent CircS in both CHARLS (OR for high vs. low: 0.12, 95 %CI 0.10-0.15) and ELSA (OR: 0.16, 95 %CI 0.14-0.18), with a linear dose-response in CHARLS but a non-linear one in ELSA. Longitudinally, higher baseline eCRF was associated with a lower risk of incident CircS in both the CHARLS (HR: 0.38, 95 %CI 0.25-0.56) and the ELSA cohorts (HR: 0.45, 95 %CI 0.36-0.56). The association in ELSA was significantly modified by sex (P-interaction<0.001), being stronger in females; this interaction was observed in both cross-sectional and longitudinal analyses.

CONCLUSION: Higher eCRF is associated with both a lower prevalence and reduced long-term incidence of CircS in both Chinese and English older adults. However, the characteristics of this association, including dose-response patterns and modification by sex, appear to be population-dependent.

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Association of estimated cardiorespiratory fitness with circadian syndrome: A cross-national analysis of two large aging cohorts

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