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Am Heart J. 2018 Feb;196:156-162. doi: 10.1016/j.ahj.2017.08.022. Epub 2017 Sep 2.

Cardiorespiratory fitness versus physical activity as predictors of all-cause mortality in men.

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School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada.
Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford University School of Medicine, Stanford, CA.
Cardiology Department, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC.
School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada; Division of Endocrinology and Metabolism, School of Medicine, Queen's University, Kingston, Ontario, Canada. Electronic address:



Although both cardiorespiratory fitness (CRF) and physical activity (PA) are associated with mortality, whether they are associated with all-cause mortality independent of each other is unclear.


CRF was assessed by a maximal exercise test and PA was measured by self-report in 8,171 male veterans. The predictive power of CRF and PA, along with clinical variables, was assessed for all-cause mortality during a mean (±SD) follow-up 8.7 (4.4) years during which there were 1,349 deaths.


CRF was associated with mortality after adjusting for clinical variables and remained a strong predictor of mortality after further adjusting for PA (hazard ratio 0.85, 95% CI 0.83-0.87). PA was a significant predictor of mortality after controlling for clinical variables; however, the association was eliminated after further adjusting for CRF (hazard ratio 0.98, 95% CI 0.88-1.10). In CRF-stratified analysis, being active (≥150 min/wk) was not associated with mortality within the unfit or fit categories (P>.4). However, in PA-stratified analysis, subjects categorized as fit (≥7 metabolic equivalents [METS]) had a lower risk of mortality regardless of PA status (P<.001).


In adult men, PA was associated with mortality independent of established risk factors, but not CRF. Conversely, CRF remained a strong predictor of mortality independent of PA status and established risk factors.

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