Original articleChange in Maximal Exercise Capacity Is Associated With Survival in Men and Women
Section snippets
Study Design
The Henry Ford Exercise Testing (FIT) Project is a retrospective observational study based on administrative and electronic medical record data. Design details of the FIT Project have been published previously.17 The FIT Project comprises consecutive patients 18 years and older who performed a physician-referred exercise stress test between January 2, 1991, and May 28, 2009, at Henry Ford Hospital and affiliated medical centers in Detroit, Michigan, and the metropolitan area. In the present
Results
Characteristics of the cohort at baseline are shown in Table 1. Compared with men, a lower percentage of women were of white race, recent tobacco smokers, classified as low fitness, and dyslipidemic at baseline. On average, women had lower METs than men at baseline but higher METs when adjusted to the equivalent for a 50-year-old man. Median time between baseline and follow-up exercise stress tests was 3.8 years (interquartile range [IQR], 2.3-6.2 years) in men and 3.9 years (IQR, 2.3-6.1
Discussion
In both men and women who completed 2 physician-referred exercise stress tests at least 12 months apart, maintaining or improving MEC above an age-/sex-adjusted low fitness category (equivalent to <8 METs for a 50-year-old man) was independently associated with a lower risk for all-cause mortality compared with patients who remained in a low fitness category. Compared with patients with low fitness at both tests, increasing MEC from low to intermediate or high fitness was associated with a 37%
Conclusion
In individuals referred for an exercise stress test, change in MEC over time is inversely related to risk of all-cause mortality. Based on low fitness defined as less than 9 METs and less than 7 METs at age 40 years, less than 8 METs and less than 6 METs at age 50 years, and less than 7 METs and less than 5 METs at age 60 years for men and women, respectively; increasing MEC above low fitness is associated with reduced all-cause mortality risk. These data support the importance of encouraging
References (42)
- et al.
Maximal estimated cardiorespiratory fitness, cardiometabolic risk factors, and metabolic syndrome in the aerobics center longitudinal study
Mayo Clin Proc
(2013) - et al.
Cardiorespiratory fitness and metabolic risk
Am J Cardiol
(2012) - et al.
Exercise capacity and risk of chronic kidney disease in US veterans: a cohort study
Mayo Clin Proc
(2015) - et al.
Maximal exercise testing variables and 10-year survival: fitness risk score derivation from the FIT Project
Mayo Clin Proc
(2015) - et al.
Prognostic value of exercise capacity in patients with coronary artery disease: the FIT (Henry Ford ExercIse Testing) project
Mayo Clin Proc
(2014) - et al.
Changes in physical fitness and changes in mortality
Lancet
(1998) - et al.
Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease
Am Heart J
(1973) - et al.
Sex differences in cardiorespiratory fitness and all-cause mortality: the Henry Ford ExercIse Testing (FIT) Project
Mayo Clin Proc
(2016) - et al.
Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status
Prog Cardiovasc Dis
(2015) - et al.
Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy
Lancet
(2012)
Effect of structured home-based exercise on walking ability in patients with peripheral arterial disease: a meta-analysis
Ann Vasc Surg
Relationship between exercise workload during cardiac rehabilitation and outcomes in patients with coronary heart disease
Am J Cardiol
Comparison of the ramp versus standard exercise protocols
J Am Coll Cardiol
Electrocardiographic changes during exercise in asymptomatic men: 3-year follow-up
Can Med Assoc J
Physical fitness and hypertension in a population at risk for cardiovascular disease: the Henry Ford ExercIse Testing (FIT) Project
J Am Heart Assoc
Cardiorespiratory fitness and incident diabetes: the FIT (Henry Ford ExercIse Testing) project
Diabetes Care
Cardiorespiratory fitness and risk of incident atrial fibrillation: results from the Henry Ford Exercise Testing (FIT) Project
Circulation
Relationship between aerobic fitness and progression of coronary atherosclerosis
Heart Vessels
Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis
JAMA
Exercise capacity and mortality in older men: a 20-year follow-up study
Circulation
Physical fitness and risk for heart failure and coronary artery disease
Circ Heart Fail
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2022, American Journal of MedicineCitation Excerpt :Importantly, it is an integrative measure influenced by several factors including physical activity habits, obesity, genetics, and traditional risk factors. Over the past 4 decades, numerous studies have demonstrated a favorable effect of cardiorespiratory fitness on long-term adverse outcomes.5-12 Higher cardiorespiratory fitness is associated with a reduction in cardiovascular disease risk factors, major adverse cardiac events, and overall mortality.13,14
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2021, Mayo Clinic ProceedingsCitation Excerpt :In our risk factor–based analyses, we did not examine how well an individual’s CVD risk factors were controlled, although adjustment for risk factor treatment with medication did not significantly change the results. In addition, we did not examine change in fitness over time, although we have previously demonstrated that most individuals have a stable relative fitness level during at least 4 years of follow-up.57 Strengths of this analysis include that more than 50% of patients were women, and patients were observed for an average of 9.4 years.
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2021, Mayo Clinic ProceedingsCitation Excerpt :Second, exercise capacity may have changed between the time of the exercise tests and SARS-CoV-2 infection (median, 2.1 years). However, in a previous study, we reported18 that during a median of 3.8 years between two exercise tests, there was minimal change in exercise capacity among men (median, 0.3 METs; 25th-75th percentile, −2.1 to 0.6 METs). Similar values were observed in women.
Potential Competing Interests: Dr Blaha reports receiving grants from Aetna Foundation, the American Heart Association, the National Institutes of Health, and the Food and Drug Administration; and receiving personal fees from and serving on the advisory boards of Novartis, Amgen, Akcea, Luitpold Pharmceuticals, Pozen, and the American College of Cardiology.