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Compelling Study Shows High Levels of Fitness Equals Lowest All-Cause Mortality

October 31, 2018 by Elizabeth A. Joy, M.D., M.P.H., FACSM

A study recently published in JAMA Network Open looking at more than 120,000 adults who had a treadmill exercise test found that those who were at the highest level of cardiorespiratory fitness (aka, elite performers) had the lowest all-cause mortality rates. There was “no ceiling” on fitness and mortality; those with the highest fitness –2 standard deviations above the mean for age– had the lowest all-cause mortality.

The average age of study participants was 53 years, and 60 percent were male. The average length of follow up for the study was 8.4 years (range 4.3 to 13.4 years). “When compared with the lowest performers, elite performance was associated with an 80% reduction in mortality risk. In addition, the adjusted mortality risk of reduced performance was comparable to, if not significantly greater than, traditional clinical risk factors, such as coronary artery disease, diabetes, and smoking” the study said. The researchers also found that among those with high risk conditions such as coronary artery disease, diabetes, hypertension, and hyperlipidemia, all-cause mortality was inversely proportional to cardiorespiratory fitness and lowest in the elite performers. This was especially true for participants with high blood pressure. People with chronic high blood pressure but with high cardiorespiratory fitness had a reduced all-cause mortality when compared to people who had low cardiorespiratory fitness. 

Physical activity is the primary predictor of cardiorespiratory fitness, demonstrating that exercise is truly medicine. Physical activity levels should be assessed at every healthcare visit. Patients with insufficient physical activity levels should receive a physical activity prescription and then be referred to a person, program or place that can assist them in achieving recommended levels of physical activity. Additionally, we all need to work together to create environments and cultures in neighborhoods, workplaces, schools, etc to ensure access to physical activity.

1. Mandsager K, Harb S, Cremer P, et al. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Network Open. 2018;1(6):e183605. doi:10.1001/jamanetworkopen.2018.3605

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