Association of the Frailty-to-Estimated Cardiorespiratory Fitness Ratio with Prevalent Stroke in Middle-Aged and Older Adults: A Cross-Sectional NHANES Study

He, Yingchao; Yuan, Wendi; Lv, Mingfeng; Yang, Yi; Xu, Yiya; Song, Zhiwei; Jiang, Xiaolin; Yang, Lvqing; Huang, Chenxi; Chen, Ying; Wang, Yinzhou

doi:10.3390/bioengineering13070750

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Association of the Frailty-to-Estimated Cardiorespiratory Fitness Ratio with Prevalent Stroke in Middle-Aged and Older Adults: A Cross-Sectional NHANES Study

by

Yingchao He

^1,2,†,

Wendi Yuan

^3,†

,

Mingfeng Lv

^4,†,

Yi Yang

³,

Yiya Xu

²,

Zhiwei Song

⁵,

Xiaolin Jiang

¹,

Lvqing Yang

⁴,

Chenxi Huang

⁴,

Ying Chen

^1,* and

Yinzhou Wang

^1,2,5,*

¹

Department of Neurology, Fuzhou University Affiliated Provincial Hospital, Gulou District, Fuzhou 350000, China

²

Shengli Clinical Medical College of Fujian Medical University, No. 88, Traffic Road, Gulou District, Fuzhou 350000, China

³

Institute of Artificial Intelligence, Xiamen University, No. 4221, Xiang’an South Road, Xiang’an District, Xiamen 361000, China

⁴

School of Informatics, Xiamen University, No. 4221, Xiang’an South Road, Xiang’an District, Xiamen 361000, China

⁵

Fujian Key Laboratory of Medical Analysis, Fujian Academy of Medical Sciences, No. 7, Wusi Road, Gulou District, Fuzhou 350000, China

^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Bioengineering 2026, 13(7), 750; https://doi.org/10.3390/bioengineering13070750 (registering DOI)

Submission received: 16 March 2026 / Revised: 23 May 2026 / Accepted: 25 May 2026 / Published: 26 June 2026

(This article belongs to the Section Biosignal Processing)

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Abstract

Stroke remains a major cause of disability worldwide, and population-level indicators that integrate multidimensional vulnerability with physiological reserve may provide useful perspectives for characterizing cerebrovascular health in aging populations. This cross-sectional study examined the association between the Frailty-to-estimated Cardiorespiratory Fitness Ratio (FCR) and self-reported prevalent stroke among middle-aged and older adults using NHANES 2011–2014 data. FCR was calculated as a 23-item modified Frailty Index divided by estimated cardiorespiratory fitness, providing an interpretable load-to-reserve measure that linked accumulated health deficits with estimated cardiorespiratory reserve. The final analytical sample included 3511 participants aged 45 years or older. Survey-weighted logistic regression models, sensitivity analyses, exploratory subgroup analyses, and spline models were used to evaluate the association. The weighted prevalence of self-reported prevalent stroke increased across FCR quartiles, from 2.2% in Q1 to 12.9% in Q4. In the conventional clinical adjustment model, participants in the highest FCR quartile had greater odds of self-reported prevalent stroke than those in the lowest quartile (OR = 6.13, 95% CI: 2.97–12.66;

p < 0.001

), with similar findings in the overlap-aware model (OR = 6.31, 95% CI: 3.07–12.97;

p < 0.001

). Log-transformed FCR was also consistently associated with greater odds of self-reported prevalent stroke across adjustment models, and spline analysis suggested a generally increasing association. These findings support FCR, particularly when modeled using quartiles or log-transformed values, as an interpretable integrative load-to-reserve construct associated with self-reported prevalent stroke, and suggest its potential relevance for population-based characterization of cerebrovascular health in aging adults.

Keywords: prevalent stroke; Frailty Index; estimated cardiorespiratory fitness; Frailty-to-estimated Cardiorespiratory Fitness Ratio; NHANES; cross-sectional study

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MDPI and ACS Style

He, Y.; Yuan, W.; Lv, M.; Yang, Y.; Xu, Y.; Song, Z.; Jiang, X.; Yang, L.; Huang, C.; Chen, Y.; et al. Association of the Frailty-to-Estimated Cardiorespiratory Fitness Ratio with Prevalent Stroke in Middle-Aged and Older Adults: A Cross-Sectional NHANES Study. Bioengineering 2026, 13, 750. https://doi.org/10.3390/bioengineering13070750

AMA Style

He Y, Yuan W, Lv M, Yang Y, Xu Y, Song Z, Jiang X, Yang L, Huang C, Chen Y, et al. Association of the Frailty-to-Estimated Cardiorespiratory Fitness Ratio with Prevalent Stroke in Middle-Aged and Older Adults: A Cross-Sectional NHANES Study. Bioengineering. 2026; 13(7):750. https://doi.org/10.3390/bioengineering13070750

Chicago/Turabian Style

He, Yingchao, Wendi Yuan, Mingfeng Lv, Yi Yang, Yiya Xu, Zhiwei Song, Xiaolin Jiang, Lvqing Yang, Chenxi Huang, Ying Chen, and et al. 2026. "Association of the Frailty-to-Estimated Cardiorespiratory Fitness Ratio with Prevalent Stroke in Middle-Aged and Older Adults: A Cross-Sectional NHANES Study" Bioengineering 13, no. 7: 750. https://doi.org/10.3390/bioengineering13070750

APA Style

He, Y., Yuan, W., Lv, M., Yang, Y., Xu, Y., Song, Z., Jiang, X., Yang, L., Huang, C., Chen, Y., & Wang, Y. (2026). Association of the Frailty-to-Estimated Cardiorespiratory Fitness Ratio with Prevalent Stroke in Middle-Aged and Older Adults: A Cross-Sectional NHANES Study. Bioengineering, 13(7), 750. https://doi.org/10.3390/bioengineering13070750

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Association of the Frailty-to-Estimated Cardiorespiratory Fitness Ratio with Prevalent Stroke in Middle-Aged and Older Adults: A Cross-Sectional NHANES Study

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