Fit and Tipsy?

The Interrelationship Between Cardiorespiratory Fitness and Alcohol Consumption and Dependence

Kerem Shuval; David Leonard; Karen G. Chartier; Carolyn E. Barlow; Bob M. Fennis; David L. Katz; Katelyn Abel; Stephen W. Farrell; Andjelka Pavlovic; Laura F. Defina


Med Sci Sports Exerc. 2022;54(1):113-119. 

In This Article

Abstract and Introduction


Purpose: To examine whether higher levels of cardiorespiratory fitness are related to increased alcohol consumption and dependence among a large sample of adults attending a preventive medicine clinic.

Methods: A cross-sectional study of 38,653 apparently healthy patients who visited the Cooper Clinic (Dallas, TX) for preventive medical examinations (1988–2019) and enrolled in the Cooper Center Longitudinal Study. The primary independent variable was cardiorespiratory fitness, based on a maximal treadmill test, and the dependent variables were alcohol consumption and dependence (self-reported). The relations between fitness category (low, moderate, high) and alcohol consumption (low, moderate, heavy) and suggested alcohol dependence (Cut down, Annoyed, Guilty, Eye opener score ≥2) among women and men were estimated via multivariable regression while adjusting for covariates (e.g., age, birth year cohort, marital status, and body mass index).

Results: Women within the moderate and high fitness categories had 1.58 (95% confidence interval [CI], 1.32–1.91) and 2.14 (95% CI, 1.77–2.58) greater odds of moderate/heavy alcohol consumption, respectively, in comparison to their low fitness counterparts. Similarly, moderate and high fit men had 1.42 (95% CI, 1.30–1.55) and 1.63 (95% CI, 1.49–1.80) times greater odds of moderate-to-heavy alcohol consumption, respectively, in comparison to the low fitness group. In addition, among men who were heavy drinkers (but not women), higher fitness levels were related to lower rates of suggested alcohol dependence. Specifically, these men had 45.7%, 41.7%, and 34.9% proportions of clinically relevant alcohol problems across low, moderate, and high fitness categories (adjusted P for trend <0.001).

Conclusions: Higher fitness levels are significantly related to greater alcohol consumption among a large cohort of adult patients. Interventions focusing on increasing fitness (via physical activity promotion) might consider concurrently aiming to reduce alcohol consumption.


The benefits of engaging in health promoting physical activity have been well established.[1] Numerous health benefits are gained by meeting physical activity guidelines, which necessitate participating in at least 150 min of moderate-intensity physical activity or 75 min of vigorous-intensity physical activity weekly or an equivalent combination.[1] These benefits include reduced risk for numerous chronic diseases (e.g., type 2 diabetes, cardiovascular disease, some cancers) and lower risk for mortality from all-cause, cardiovascular disease and cancer.[1–4] Habitually partaking in physical activity also leads to higher levels of cardiorespiratory fitness (henceforth "fitness"), which is a distinct component of cardiovascular health.[5–7] In comparison, the relationship between alcohol consumption and morbidity, as well as mortality, is not as straightforward. Light (three or less drinks per week for women and men) and moderate levels of alcohol consumption (i.e., >3–7 and >3–14 weekly drinks for women and men, respectively, age 18–64 yr) are related to lower risk of coronary heart disease and cardiovascular disease mortality.[8,9] In contrast, heavy alcohol consumption (>7 and >14 drinks a week for women and men, respectively, age 18–64 yr) is associated with increased risk for cardiovascular disease morbidity and mortality.[8] In addition, there is established scientific evidence that any level of alcohol consumption (even light) can cause several cancers.[10]

The United States Preventive Service Task Force recommends screening for unhealthy alcohol consumption and encourages providing brief counseling to those engaged in hazardous drinking.[11,12] Similarly, the United States Preventive Service Task Force recommends physical activity counseling particularly to patients with cardiovascular disease risk factors, and to a lesser degree to those without.[13,14] Other organizations, such as the American College of Sports Medicine in conjunction with the American Medical Association, call for physical activity to be regarded as a "vital sign," thereby assessing it routinely in primary care.[15–17] This will enable identifying patients who are inactive and in need for effective counseling. Correspondingly, it is important to determine hazardous drinking patterns to promptly modify this maladaptive behavior, with the goal of improving health outcomes. Indeed, screening and surveillance of physical inactivity, fitness, and excessive drinking are important at clinical and population levels because it assists in planning, designing, and implementing pertinent intervention programs.[18,19]

Interventions in primary care often emphasize promoting a positive health behavior (e.g., physical activity)[20] or decreasing a negative behavior (e.g., drinking),[21] without consideration of the possible interrelationship between the two. Positive health behaviors tend to cluster together, such as exercising and eating a healthful diet (when trying to lose weight), whereas light drinking (or abstaining from alcohol) is often not regarded as a health promoting behaviour.[22,23] Interestingly, studies examining the nexus of physical activity and alcohol consumption have found that participation in sports and other physical activities are related to increased drinking in college athletes and nonathletes alike.[24] These studies, however, used self-reported measures of physical activity, which are subject to overreporting because of social desirability,[25] and few studies have focused on community dwelling adults who could benefit from screening and behavior modification counseling by primary care providers in the clinical setting. This is of particular importance because over 80% of Americans visit a health care provider for a checkup annually, which is a key opportunity for preventive medicine lifestyle interventions.[15,26,27] Thus, in the current study, we examine whether higher levels of objectively measured fitness are related to increased alcohol consumption and dependence, among a large sample of apparently healthy adults, attending a preventive medicine clinic. Study findings could illuminate existing interrelationships and provide insight into designing future interventions in primary care.