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Exercise, Fitness, and Mortality

Mark R. Goldstein, MD
JAMA. 1990;263(15):2047. doi:10.1001/jama.1990.03440150051013.
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To the Editor.—  Blair et al1 provide evidence that low levels of physical fitness, defined by treadmill exercise performance, are a risk factor for future cardiovascular mortality, cancer mortality, and all-cause mortality in a population of predominantly white, middle-aged men and women. They suggest that if all unfit persons became fit there would be a significant reduction in the death rate.The observed decrease in cancer mortality is intriguing. Possibly preclinical cancer can influence performance on the treadmill by humoral, metabolic, and/or other factors. If so, the exclusion from analysis of cancer deaths that occur within 4 years of baseline should eliminate the probability of a confounding preclinical cancer effect. If most cancer mortality occurred during the first few years after treadmill testing, it would be suggestive of the poor treadmill performance that results from a preclinical cancer effect. Perhaps the authors can provide data on cancer mortality in


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