Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men.

OBJECTIVE To evaluate the relationship between changes in physical fitness and risk of mortality in men. DESIGN Prospective study, with two clinical examinations (mean interval between examinations, 4.9 years) to assess change or lack of change in physical fitness as associated with risk of mortality during follow-up after the subsequent examination (mean follow-up from subsequent examination, 5.1 years). SETTING Preventive medicine clinic. STUDY PARTICIPANTS Participants were 9777 men given two preventive medical examinations, each of which included assessment of physical fitness by maximal exercise tests and evaluation of health status. MAIN OUTCOME MEASURES All cause (n = 223) and cardiovascular disease (n = 87) mortality. RESULTS The highest age-adjusted all-cause death rate was observed in men who were unfit at both examinations (122.0/10,000 man-years); the lowest death rate was in men who were physically fit at both examinations (39.6/10,000 man-years). Men who improved from unfit to fit between the first and subsequent examinations had an age-adjusted death rate of 67.7/10,000 man-years. This is a reduction in mortality risk of 44% (95% confidence interval, 25% to 59%) relative to men who remained unfit at both examinations. Improvement in fitness was associated with lower death rates after adjusting for age, health status, and other risk factors of premature mortality. For each minute increase in maximal treadmill time between examinations, there was a corresponding 7.9% (P = .001) decrease in risk of mortality. Similar results were seen when the group was stratified by health status, and for cardiovascular disease mortality. CONCLUSIONS Men who maintained or improved adequate physical fitness were less likely to die from all causes and from cardiovascular disease during follow-up than persistently unfit men. Physicians should encourage unfit men to improve their fitness by starting a physical activity program.

[1]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[2]  B BALKE,et al.  An experimental study of physical fitness of Air Force personnel. , 1959, United States Armed Forces medical journal.

[3]  D. Cox.  Regression Models and Life-Tables , 1972 .

[4]  J. Ayres,et al.  A comparative analysis of four protocols for maximal treadmill stress testing. , 1976, American heart journal.

[5]  L. Wilhelmsen,et al.  Nine years' follow-up of a maximal exercise test in a random population sample of middle-aged men. , 1981, Cardiology.

[6]  K. Hossack,et al.  Enhanced risk assessment for primary coronary heart disease events by maximal exercise testing: 10 years' experience of Seattle Heart Watch. , 1983, Journal of the American College of Cardiology.

[7]  L. Cady,et al.  Physical fitness and subsequent myocardial infarction in healthy workers. , 1983, JAMA.

[8]  J. Erikssen,et al.  Coronary risk factors and incidence of coronary death in relation to physical fitness. Seven-year follow-up study of middle-aged and elderly men. , 1985, European Heart Journal.

[9]  J. Erikssen.  Physical fitness and coronary heart disease morbidity and mortality. A prospective study in apparently healthy, middle aged men. , 2009, Acta medica Scandinavica. Supplementum.

[10]  C. Caspersen,et al.  Physical activity and the incidence of coronary heart disease. , 1987, Annual review of public health.

[11]  M. Kornitzer,et al.  Protection against ischemic heart disease in the Belgian Physical Fitness Study: physical fitness rather than physical activity? , 1987, American journal of epidemiology.

[12]  D. Jacobs,et al.  Physical Fitness and Cardiovascular Disease Mortality , 1988 .

[13]  W L Haskell,et al.  Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The Lipid Research Clinics Mortality Follow-up Study. , 1988, The New England journal of medicine.

[14]  R S Paffenbarger,et al.  Physical fitness and all-cause mortality. A prospective study of healthy men and women. , 1989, JAMA.

[15]  M. Haan,et al.  Is there a role for prevention among the elderly? Epidemiological evidence from the Alameda County Study , 1989 .

[16]  P. Suadicani,et al.  Physical fitness or physical activity as a predictor of ischaemic heart disease? A 17‐year follow‐up in the Copenhagen Male Study , 1992, Journal of internal medicine.

[17]  K Rodahl,et al.  Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. , 1993, The New England journal of medicine.

[18]  R S Paffenbarger,et al.  The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. , 1993, The New England journal of medicine.

[19]  C. Bouchard,et al.  Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement , 1994 .

[20]  R S Paffenbarger,et al.  Changes in physical activity and other lifeway patterns influencing longevity. , 1994, Medicine and science in sports and exercise.