Elsevier

The Lancet

Volume 352, Issue 9130, 5 September 1998, Pages 759-762
The Lancet

Articles
Changes in physical fitness and changes in mortality

https://doi.org/10.1016/S0140-6736(98)02268-5Get rights and content

Summary

Background

Point estimates of physical fitness give important information on the risk of death in healthy people, but there is little information available on effects of sequential changes in physical fitness on mortality. We studied this latter aspect in healthy middle-aged men over a total follow-up period of 22 years.

Methods

2014 healthy men aged 40–60 years had a bicycle exercise test and clinical examination, and completed a questionnaire in 1972–75 (survey 1). This was repeated for 1756 (91%) of 1932 men still alive by Dec 31, 1982 (survey 2). The exercise scores were adjusted for age. The change in exercise scores between surveys was divided into quartiles (Q1=least fit, Q4=fittest). An adjusted Cox's proportional hazards model was used to study the association between changes in physical fitness and mortality, with the Q1 men used as controls.

Findings

By Dec 31, 1994, 238 (17%) of the 1428 men had died, 120 from cardiovascular causes. There were 37 deaths in the Q4 group (19 cardiovascular); their relative risks of death were 0·45 (95% CI 0·29–0·69) for any cause and 0·47 (0·26–0·86) for cardiovascular causes. There was a graded, inverse relation between changes in physical fitness and mortality irrespective of physical fitness status at survey 1.

Interpretation

Change in physical fitness in healthy middle-aged men is a strong predictor of mortality. Even small improvements in physical fitness are associated with a significantly lowered risk of death. If confirmed, these findings should be used to influence public health policy.

Introduction

Studies based on point estimates of physical fitness show that such estimates are a good long-term predictor of cardiovascular mortality and all-cause mortality in healthy people.1, 2, 3, 4, 5, 6, 7 However, these studies generally assume a homogenous decline in physical fitness with age throughout the population. Patterns of physical fitness may in fact vary between subgroups because of, for example, changes in physical activity and smoking habits over time: the Global Burden of Disease Study8 puts physical inactivity and smoking among the top ten risk factors that threaten global health. Information on changes in physical fitness and lifestyle may provide more information on long-term prognosis than can be obtained from a single estimate.

To study the relations between physical fitness, changes in physical fitness, and mortality, we tested the physical fitness of a group of apparently healthy middle-aged men. The men were tested on two occasions, with an interval of 7 years. Total follow-up time was 22 years.

Section snippets

Participants

2014 men aged 40–60 years took part in a baseline survey (survey 1) in 1972–75.9 Men were defined as “apparently healthy” if they had no evidence of heart disease, no diagnosed hypertension requiring drug treatment, and no diabetes mellitus, cancer, advanced pulmonary, renal, or liver disease, or other serious disorders, and were able to undertake a symptom-limited exercise test. 1756 (91%) of the men participated in a second identical survey in 1980–82 (survey 2), and our study uses these data.

Results

The results of survey 2 (table 1) show significant variation according to age-adjusted physical fitness in blood concentrations of triglycerides, heart rate, systolic blood pressure, body-mass index, amounts of physical activity, vital capacity, smoking status, and exercise-ECG findings. For all these variables, the highest quartile of physical fitness had the values indicating lowest risk. Total cholesterol concentration was not significantly associated with physical fitness. Between-group

Discussion

Our data from a group of healthy men show that not only fitness itself, but also the magnitude and direction of changes in fitness observed over a period of 7 years, give important information on the risk of death during a follow-up period of up to 15 years. Good physical fitness suggests the presence of normal cardiorespiratory function, efficient oxygen transport and uptake, muscular and skeletal function, and psychological fitness. Physical fitness may therefore be a good surrogate measure

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