Fitness versus physical activity patterns in predicting mortality in men

doi:10.1016/j.amjmed.2004.06.047

The American Journal of Medicine

Volume 117, Issue 12, 15 December 2004, Pages 912-918

https://doi.org/10.1016/j.amjmed.2004.06.047 Get rights and content

Purpose

To compare the contributions of fitness level and physical activity patterns to all-cause mortality.

Methods

Of 6213 men referred for exercise testing between 1987 and 2000, 842 underwent an assessment of adulthood activity patterns. The predictive power of exercise capacity and activity patterns, along with clinical and exercise test data, were assessed for all-cause mortality during a mean (±SD) follow-up of 5.5 ± 2 years.

Results

Expressing the data by age-adjusted quartiles, exercise capacity was a stronger predictor of mortality than was activity pattern (hazard ratio [HR] = 0.56; 95% confidence interval [CI]: 0.38 to 0.83; P < 0.001). In a multivariate analysis that considered clinical characteristics, risk factors, exercise test data, and activity patterns, exercise capacity (HR per quartile = 0.62; CI: 0.47 to 0.82; P < 0.001) and energy expenditure from adulthood recreational activity (HR per quartile = 0.72; 95% CI: 0.58 to 0.89; P = 0.002) were the only significant predictors of mortality; these two variables were stronger predictors than established risk factors such as smoking, hypertension, obesity, and diabetes. Age-adjusted mortality decreased per quartile increase in exercise capacity (HR for very low capacity = 1.0; HR for low = 0.59; HR for moderate = 0.46; HR for high = 0.28; P < 0.001) and physical activity (HR for very low activity = 1.0; HR for low = 0.63; HR for moderate = 0.42; HR for high = 0.38; P < 0.001). A 1000-kcal/wk increase in activity was approximately similar to a 1 metabolic equivalent increase in fitness; both conferred a mortality benefit of 20%.

Conclusion

Exercise capacity determined from exercise testing and energy expenditure from weekly activity outperform other clinical and exercise test variables in predicting all-cause mortality.

Section snippets

Sample

The sample was drawn from 6213 consecutive men (mean [±SD] age, 59 ± 11 years) who were referred for exercise testing for clinical reasons between April 1987 and July 2000. Of these, a subgroup of 842 subjects underwent a detailed evaluation of current and past activity patterns. The subgroup represented a convenience sample tested on a particular day of the week in which research assistants were assigned to oversee the data collection.

Exercise testing

The exercise laboratory was directed in a consistent

Results

In the convenience subgroup, the mean (±SD) follow-up period was 5.5 ± 2.0 years, and the average annual mortality was 2%. A total of 1256 deaths occurred during follow-up in the total group of subjects (n = 6213) undergoing exercise testing; 89 occurred among those in the subgroup who had physical activity patterns assessed. No major complications occurred during testing, although sustained ventricular tachycardia occurred during 1.3% of the exercise tests. In the subgroup, 230 patients had

Discussion

Our results demonstrate that both exercise capacity and energy expenditure from adulthood recreational physical activity are inversely associated with all-cause mortality in patients referred for exercise testing. These two variables were stronger predictors of mortality than other clinical and exercise data; in multivariate analyses, they outperformed established risk factors such as smoking, hypertension, hyperlipidemia, and diabetes. However, exercise capacity was a stronger predictor of

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Clinical studiesFitness versus physical activity patterns in predicting mortality in men

Purpose

Methods

Results

Conclusion

Section snippets

Sample

Exercise testing

Results

Discussion

Am Heart J.

Am J Cardiol.

J Am Coll Cardiol.

Am J Cardiol.

Primary Care

J Am Coll Cardiol.

Physical activity and public healtha recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine

JAMA

Physical Activity and HealthA Report of the Surgeon General

NIH Consensus Development Panel on Physical Activity and Cardiovascular Health

JAMA

Exercise capacity and mortality among men referred for exercise testing

N Engl J Med.

Exercise capacity and the risk of death in womenthe St James Women Take Heart Project

Circulation

Prognostic value of treadmill exercise testing in elderly persons

Ann Intern Med.

Heredity, activity level, fitness, and health

Physical fitness and activity as separate heart disease risk factorsa meta analysis

Med Sci Sports Exerc.

Physical fitness and activity as separate heart disease risk factorsa meta analysis

Med Sci Sports Exerc.

Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men; the Lipid Research Clinics Mortality Follow-up Study

N Engl J Med.

Physical fitness and all-cause mortality. A prospective study of healthy men and women

JAMA

Clinical studies
Fitness versus physical activity patterns in predicting mortality in men