METHODS article
Front. Cardiovasc. Med.
Sec. Cardiovascular Epidemiology and Prevention
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1577931
Translation of Clinical Practice to Research: The VETS and ETHOS Epidemiologic Prospective Cohorts
Provisionally accepted
- 1VA Palo Alto Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Palo Alto, United States
- 2Washington DC VA Medical Center, United States Department of Veterans Affairs, Washington D.C., District of Columbia, United States
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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 5-7 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.
Keywords: exercise testing, exercise testing (CPET), cardiovascular disease, cardiorespiratory fitness, Epidemiology
Received: 17 Feb 2025; Accepted: 02 Jun 2025.
Copyright: © 2025 MYERS, Kokkinos, Samuel, Faselis, Fletcher and Froelicher. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: JONATHAN MYERS, VA Palo Alto Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Palo Alto, United States
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