INTRODUCTION: High quality cardiopulmonary resuscitation (CPR) is crucial for patients experiencing cardiac arrest. CPR quality declines within the first few minutes of a CPR bout. Limited research has examined the extent to which a rescuer's physical fitness predicts high quality CPR performance. It is also unknown how CPR quality is affected during both a realistic duration protocol and when rescuers switch compressors every two minutes, as recommended by the American Heart Association (AHA). The purpose of the present study is to determine the extent to which different measures of physical fitness predict high quality CPR performance when rescuers follow current CPR guidelines. METHODS: Subjects underwent a fitness assessment evaluating lower back muscular endurance, abdominal muscular endurance, upper body muscular strength, and upper body anaerobic power. At least 24 hours later, subjects returned to the laboratory for CPR testing. CPR quality was determined by compression rate (>100/minute), compression depth (>2 inches, or 50mm), and adequate (full) chest recoil between compressions. A CPR Quality Score was developed as the product of compression rate and depth. RESULTS: Thirty-three of 42 subjects were able to achieve a CPR Quality Score greater than 5000, the minimum needed to meet AHA recommendations. Higher anaerobic power and bench press scores were predictive of both high CPR Quality Scores (R2=0.47) and compression depth (R2=0.47). Gender (female) was predictive of better chest compression recoil percentages (R2=0.15). CONCLUSION: Most rescuers can maintain high quality CPR if given two minute breaks between cycles. Rescuers with high anaerobic fitness and muscular strength may be able to provide higher quality CPR.