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April 12, 1995, Vol 273, No. 14 >
ARTICLE | April 12, 1995

Changes in Physical Fitness and All-Cause Mortality: Title and subTitle BreakA Prospective Study of Healthy and Unhealthy Men FREE

Steven N. Blair, PED; Harold W. Kohl, III, PhD; Carolyn E. Barlow, MS; Ralph S. Paffenbarger, Jr, MD, DrPH; Larry W. Gibbons, MD, MPH; Caroline A. Macera, PhD
[+] Author Affiliations

Reprint requests to Division of Epidemiology, Cooper Institute for Aerobics Research, 12330 Preston Rd, Dallas, TX 75230 (Dr Blair).


JAMA. 1995;273(14):1093-1098. doi:10.1001/jama.1995.03520380029031
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References

Objective.  —To evaluate the relationship between changes in physical fitness and risk of mortality in men.

Design.  —Prospective study, with two clinical examinations (mean interval between examinations, 4.9 years) to assess change or lack of change in physical fitness as associated with risk of mortality during follow-up after the subsequent examination (mean follow-up from subsequent examination, 5.1 years).

Setting.  —Preventive medicine clinic.

Study Participants.  —Participants were 9777 men given two preventive medical examinations, each of which included assessment of physical fitness by maximal exercise tests and evaluation of health status.

Main Outcome Measures.  —All-cause (n=223) and cardiovascular disease (n=87) mortality.

Results.  —The highest age-adjusted all-cause death rate was observed in men who were unfit at both examinations (122.0/10 000 man-years); the lowest death rate was in men who were physically fit at both examinations (39.6/10000 man-years). Men who improved from unfit to fit between the first and subsequent examinations had an age-adjusted death rate of 67.7/10 000 man-years. This is a reduction in mortality risk of 44% (95% confidence interval, 25% to 59%) relative to men who remained unfit at both examinations. Improvement in fitness was associated with lower death rates after adjusting for age, health status, and other risk factors of premature mortality. For each minute increase in maximal treadmill time between examinations, there was a corresponding 7.9% (P=.001) decrease in risk of mortality. Similar results were seen when the group was stratified by health status, and for cardiovascular disease mortality.

Conclusions.  —Men who maintained or improved adequate physical fitness were less likely to die from all causes and from cardiovascular disease during follow-up than persistently unfit men. Physicians should encourage unfit men to improve their fitness by starting a physical activity program.(JAMA. 1995;273:1093-1098)

REFERENCES

1 +
Bruce RA, Hossack KF, DeRouen TA, Hofer V.  Enhanced risk assessment for primary coronary heart disease events by maximal exercise testing: 10 years' experience of Seattle Heart Watch. J Am Coll Cardiol . 1983;;2:565-573.
2 +
Ekelund L-G, Haskell WL, Johnson JL, Whaley FS, Criqui MH, Sheps DS.  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 . 1988;; 319:1379-1384.
3 +
Erikssen J.  Physical fitness and coronary heart disease morbidity and mortality: a prospective study in apparently healthy, middle-aged men. Acta Med Scand Suppl . 1986;;711:189-192.
4 +
Hein HO, Suadicani P, Gyntelberg F.  Physical fitness or physical activity as a predictor of ischaemic heart disease? a 17-year follow-up in the Copenhagen Male Study. J Intern Med . 1992;;232: 471-479.
5 +
Lie H, Mundal R, Erikssen J.  Coronary risk factors and incidence of coronary death in relation to physical fitness: seven-year follow-up study of middle-aged and elderly men. Eur Heart J . 1985;; 6:147-157.
6 +
Peters RK, Cady LD Jr, Bischoff DP, Bernstein L, Pike MC.  Physical fitness and subsequent myocardial infarction in healthy workers. JAMA . 1983;; 249:3052-3056.
7 +
Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R, Rodahl K.  Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med . 1993;;328:533-537.
8 +
Slattery ML, Jacobs DR Jr.  Physical fitness and cardiovascular disease mortality: the US Railroad Study. Am J Epidemiol . 1988;;127:571-580.
9 +
Sobolski J, Kornitzer M, De Backer G, et al.  Protection against ischemic heart disease in the Belgian Fitness Study: physical fitness rather than physical activity? Am J Epidemiol . 1987;;125:601-610.
10 +
Wilhelmsen L, Bjure J, Ekström-Jodal B, et al.  Nine years' follow-up of a maximal exercise test in a random population sample of middle-aged men. Cardiology . 1981;;68( (suppl 2) ):1-8.
11 +
Powell KE, Thompson PD, Caspersen CJ, Kendrick JS.  Physical activity and the incidence of coronary heart disease. Annu Rev Public Health . 1987;; 8:253-287.
12 +
Blair SN, Kohl HW III, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW.  Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA . 1989;;262:2395-2401.
13 +
Balke B, Ware RW.  An experimental study of 'physical fitness' of Air Force personnel. U S Armed Forces Med J . 1959;;10:675-688.
14 +
Pollock ML, Bohannon RL, Cooper KH, et al.  A comparative analysis of four protocols for maximal treadmill stress testing. Am Heart J . 1976;;92: 39-46.
15 +
Kaplan EL, Meier P.  Nonparametric estimation from incomplete observations. J Am Stat Assoc . 1958;;53:457-481.
16 +
Cox DR.  Regression models and life tables. J R Stat Soc . 1972;;34:187-220.
17 +
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiological Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982;:300-307.
18 +
American College of Sports Medicine.  The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc . 1990;;22:265-274.
19 +
Bouchard C, Perusse L.  Heredity, activity level, fitness, and health.  In: Bouchard C, Shephard RJ, Stephens T, eds. Physical Activity, Fitness, and Health . Champaign, Ill: Human Kinetics; 1994;:106-118.
20 +
Paffenbarger RS Jr, Hyde RT, Wing AL, Lee I-M, Jung DL, Kampert JB.  The association of changes in physical-activity level and other life-style characteristics with mortality among men. N Engl J Med . 1993;;328:538-545.
21 +
Paffenbarger RS Jr, Kampert JB, Lee I-M, Hyde RT, Leung RW, Wing AL.  Changes in physical activity and other lifeway patterns influencing longevity. Med Sci Sports Exerc . 1994;;26:857-865.
22 +
Kaplan GA, Haan MN.  Is there a role for prevention among the elderly? epidemiological evidence from the Alameda County Study.  In: Ory MG, Bond K, eds. Aging and Health Care: Social Science and Policy Perspectives . London, England: Tavistock Publications; 1989;:27-51.
23 +
Bouchard C, Shephard RJ, Stephens T, eds. Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement . Champaign, Ill: Human Kinetics; 1994;.

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1 +
Bruce RA, Hossack KF, DeRouen TA, Hofer V.  Enhanced risk assessment for primary coronary heart disease events by maximal exercise testing: 10 years' experience of Seattle Heart Watch. J Am Coll Cardiol . 1983;;2:565-573.
2 +
Ekelund L-G, Haskell WL, Johnson JL, Whaley FS, Criqui MH, Sheps DS.  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 . 1988;; 319:1379-1384.
3 +
Erikssen J.  Physical fitness and coronary heart disease morbidity and mortality: a prospective study in apparently healthy, middle-aged men. Acta Med Scand Suppl . 1986;;711:189-192.
4 +
Hein HO, Suadicani P, Gyntelberg F.  Physical fitness or physical activity as a predictor of ischaemic heart disease? a 17-year follow-up in the Copenhagen Male Study. J Intern Med . 1992;;232: 471-479.
5 +
Lie H, Mundal R, Erikssen J.  Coronary risk factors and incidence of coronary death in relation to physical fitness: seven-year follow-up study of middle-aged and elderly men. Eur Heart J . 1985;; 6:147-157.
6 +
Peters RK, Cady LD Jr, Bischoff DP, Bernstein L, Pike MC.  Physical fitness and subsequent myocardial infarction in healthy workers. JAMA . 1983;; 249:3052-3056.
7 +
Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R, Rodahl K.  Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med . 1993;;328:533-537.
8 +
Slattery ML, Jacobs DR Jr.  Physical fitness and cardiovascular disease mortality: the US Railroad Study. Am J Epidemiol . 1988;;127:571-580.
9 +
Sobolski J, Kornitzer M, De Backer G, et al.  Protection against ischemic heart disease in the Belgian Fitness Study: physical fitness rather than physical activity? Am J Epidemiol . 1987;;125:601-610.
10 +
Wilhelmsen L, Bjure J, Ekström-Jodal B, et al.  Nine years' follow-up of a maximal exercise test in a random population sample of middle-aged men. Cardiology . 1981;;68( (suppl 2) ):1-8.
11 +
Powell KE, Thompson PD, Caspersen CJ, Kendrick JS.  Physical activity and the incidence of coronary heart disease. Annu Rev Public Health . 1987;; 8:253-287.
12 +
Blair SN, Kohl HW III, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW.  Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA . 1989;;262:2395-2401.
13 +
Balke B, Ware RW.  An experimental study of 'physical fitness' of Air Force personnel. U S Armed Forces Med J . 1959;;10:675-688.
14 +
Pollock ML, Bohannon RL, Cooper KH, et al.  A comparative analysis of four protocols for maximal treadmill stress testing. Am Heart J . 1976;;92: 39-46.
15 +
Kaplan EL, Meier P.  Nonparametric estimation from incomplete observations. J Am Stat Assoc . 1958;;53:457-481.
16 +
Cox DR.  Regression models and life tables. J R Stat Soc . 1972;;34:187-220.
17 +
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiological Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982;:300-307.
18 +
American College of Sports Medicine.  The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc . 1990;;22:265-274.
19 +
Bouchard C, Perusse L.  Heredity, activity level, fitness, and health.  In: Bouchard C, Shephard RJ, Stephens T, eds. Physical Activity, Fitness, and Health . Champaign, Ill: Human Kinetics; 1994;:106-118.
20 +
Paffenbarger RS Jr, Hyde RT, Wing AL, Lee I-M, Jung DL, Kampert JB.  The association of changes in physical-activity level and other life-style characteristics with mortality among men. N Engl J Med . 1993;;328:538-545.
21 +
Paffenbarger RS Jr, Kampert JB, Lee I-M, Hyde RT, Leung RW, Wing AL.  Changes in physical activity and other lifeway patterns influencing longevity. Med Sci Sports Exerc . 1994;;26:857-865.
22 +
Kaplan GA, Haan MN.  Is there a role for prevention among the elderly? epidemiological evidence from the Alameda County Study.  In: Ory MG, Bond K, eds. Aging and Health Care: Social Science and Policy Perspectives . London, England: Tavistock Publications; 1989;:27-51.
23 +
Bouchard C, Shephard RJ, Stephens T, eds. Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement . Champaign, Ill: Human Kinetics; 1994;.

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