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Fitness and Mortality in Men During Two Different Eras
Study Questions:
Does the inverse association between fitness and mortality persist in the current medical era of aggressive screening, risk factor modification, and newer treatment options?
Methods:
The investigators conducted the CCLS (Cooper Center Longitudinal Study) to examine prospectively the association of health behaviors and chronic disease biomarkers with clinical outcomes in adult men and women. A total of 47,862 men completed baseline examinations, including a maximal treadmill test. Cohort 1 (n = 24,475) was examined during 1971-1991 and followed for mortality through 1992. Cohort 2 (n = 23,387) was examined during 1992-2013 with follow-up through 2014. Men were categorized as low fit, moderate fit, or high fit using Cooper Clinic normative data. Hazard ratios (HRs) for all-cause, cardiovascular disease (CVD), and cancer mortality were determined across fitness categories in the two cohorts.
Results:
A significant inverse trend between fitness categories and all-cause (HR: 1.0, 0.60, and 0.53 in cohort 1 and HR: 1.0, 0.76, and 0.52 in cohort 2) and cardiovascular disease mortality (HR: 1.0, 0.55, and 0.43 in cohort 1 and HR: 1.0, 0.84, and 0.52 in cohort 2) was observed (p trend < 0.001 for all). The trend across fitness categories and cancer mortality was significant for cohort 1 (HR: 1.0, 0.62, and 0.48; p < 0.001), but not for cohort 2 (HR: 1.0, 1.08, and 0.74; p = 0.19). HRs for all-cause mortality were 0.86 (95% confidence interval, 0.82-0.90) and 0.87 (95% confidence interval, 0.83-0.91) per 1-MET increment in fitness for cohorts 1 and 2, respectively (p < 0.001 for both). Similar values were seen for CVD and cancer mortality.
Conclusions:
The authors concluded that despite significant advances in disease prevention, detection, and treatment, the inverse association between fitness and mortality remains consistent in a contemporary cohort of men.
Perspective:
This longitudinal study reports that notwithstanding substantial decreases in US mortality rates over the past 3 decades, fitness remains significantly and inversely associated with mortality risk in a contemporary cohort of men when compared with its impact in an earlier cohort. Furthermore, each 1-MET increment in fitness was associated with a 13%, 16%, and 9% decreased risk of all-cause, CVD, and cancer mortality, respectively, in the more contemporary cohort. Overall, these results support the American Heart Association Position Statement regarding the assessment of fitness as a clinical vital sign. Clinicians need to counsel patients on the benefits of physical activity, and consider measuring or estimating fitness level during routine health assessments.
Clinical Topics: Cardio-Oncology, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Exercise, Sports and Exercise and ECG and Stress Testing
Keywords: Cardiotoxicity, Cardiovascular Diseases, Chronic Disease, Exercise, Exercise Test, Health Behavior, Metabolic Syndrome, Neoplasms, Physical Fitness, Primary Prevention, Risk Factors, Risk Reduction Behavior
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