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J Am Coll Cardiol. 2018 Aug 28;72(9):987-995. doi: 10.1016/j.jacc.2018.06.045.

Midlife Cardiorespiratory Fitness and the Long-Term Risk of Mortality: 46 Years of Follow-Up.

Author information

1
The Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
2
The Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark; The Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg, Denmark.
3
The Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
4
The Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark; The Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark.
5
The Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark; Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. Electronic address: magnustjensen@gmail.com.

Abstract

BACKGROUND:

A high cardiorespiratory fitness (CRF) level is recommended to promote healthy aging. However, the association between CRF and very-long-term prognosis is unclear, and reverse causation may bias results in studies with shorter follow-up.

OBJECTIVES:

This study investigated the association between CRF and mortality in middle-aged, employed men free of cardiovascular disease (CVD).

METHODS:

Participants from the Copenhagen Male Study, established in 1970 to 1971, were included and stratified into 4 age-adjusted maximal oxygen consumption (Vo2max) categories: below the lower limit of normal (lowest 5%); low normal (45%); high normal (45%); and above the upper limit of normal (top 5%). Vo2max was estimated by using a bicycle ergometer. Multivariable restricted mean survival time models were performed for all-cause and cardiovascular mortality using Danish national registers.

RESULTS:

A total of 5,107 men with a mean age of 48.8 ± 5.4 years were included in the study. During the 46 years of follow-up, 4,700 (92%) men died; 2,149 (42.1%) of the men died of CVD. Compared with below the lower limit of normal CRF, low normal CRF was associated with 2.1 years (95% confidence interval [CI]: 0.7 to 3.4; p = 0.002), high normal with 2.9 years (95% CI: 1.5 to 4.2; p < 0.001), and above upper limit of normal with 4.9 years (95% CI: 3.1 to 6.7; p < 0.001) longer mean life expectancy. Each unit increase in Vo2max was associated with a 45-day (95% CI: 30 to 61; p < 0.001) increase in longevity. Estimates for cardiovascular mortality were similar to all-cause mortality. Results were essentially unchanged when excluding individuals who died within the first 10 years of follow-up, suggesting a minimal role of reverse causation.

CONCLUSIONS:

CRF was significantly related to longevity over the course of 4 decades in middle-aged, employed men free of CVD. The benefits of higher midlife CRF extend well into the later part of life.

KEYWORDS:

cardiovascular mortality; cohort study; exercise test; longevity; middle-aged; physical fitness

PMID:
30139444
DOI:
10.1016/j.jacc.2018.06.045

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