Physical fitness and all-cause mortality. A prospective study of healthy men and women.
Level 3 - non-randomized controlled study
Prospective observational cohort study measuring baseline fitness and subsequent mortality.
PubMed 2795824 · doi:10.1001/jama.262.17.2395
What was done
A prospective cohort study of 10,224 men and 3,120 women who underwent a preventive medical examination that included physical fitness assessment via a maximal treadmill exercise test. Participants were followed for an average of slightly more than 8 years (totaling 110,482 person-years) to track all-cause and cause-specific (cardiovascular disease and cancer) mortality across physical fitness quintiles, adjusting for age, smoking habit, cholesterol level, systolic blood pressure, fasting blood glucose, parental history of coronary heart disease, and follow-up interval.
What was found
During follow-up, 240 deaths occurred in men and 43 in women. Age-adjusted all-cause mortality rates declined across fitness quintiles from the least-fit to the most-fit groups: from 64.0 to 18.6 per 10,000 person-years in men (slope: -4.5), and from 39.5 to 8.5 per 10,000 person-years in women (slope: -5.5). These trends remained statistically significant after adjusting for age, smoking, cholesterol, blood pressure, fasting glucose, and family history. Lower mortality rates in higher fitness categories were also observed specifically for cardiovascular disease and cancer of combined sites.
Why it matters
This landmark study demonstrates that objectively measured physical fitness is a powerful and independent predictor of all-cause, cardiovascular, and cancer mortality in both men and women.
Limits
The cohort comprised healthy individuals presenting for preventive medical examinations, limiting generalizability to broader socioeconomic or clinical populations. Fitness was assessed only once at baseline, so changes in fitness over time were not captured. The absolute number of female deaths was relatively small (43 deaths), limiting statistical precision in women. As an observational study, residual confounding cannot be entirely excluded.
Cited by
- supports Steven Blair and his team showed in large databases starting in the late 1980s that cardiorespiratory fitness and VO2 max predicted longevity better than traditional clinical markers like blood pressure and cholesterol.