High cardiorespiratory fitness reduces veterans’ death risk regardless of age, sex, race
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In a cohort of U.S. veterans, high cardiorespiratory fitness was linked to lower risk for mortality across all age, sex and race groups, researchers reported.
In addition, extreme cardiorespiratory fitness was not associated with mortality.
The researchers followed 750,302 U.S. veterans aged 30 to 95 years at baseline (mean age, 61 years) for a median of 10.2 years and a total of 7,803,861 person-years. Participants were stratified into age- and sex-specific cardiorespiratory fitness categories as determined by results of a standardized exercise treadmill test expressed as metabolic equivalents of task (METs).
“To our knowledge, no studies have examined the risk associated with extreme cardiorespiratory fitness assessed objectively by exercise treadmill test across the age spectrum, particularly in those 70 years of age,” Peter Kokkinos, PhD, physiologist in the cardiology department at the Washington VA Medical Center and professor of kinesiology and health and director of the Center for Exercise and Aging at Rutgers University, and colleagues wrote. “Most of the available evidence in this area is based on studies conducted among predominantly white populations with limited information available for other races, especially Native Americans.”
Inverse association
During the study period, 174,807 participants died, for a rate of 22.4 deaths per 1,000 person-years.
Cardiorespiratory fitness was inversely associated with mortality in all age, sex and race groups, Kokkinos and colleagues found. For every 1 MET increase, the adjusted HR for mortality was 0.86 (95% CI, 0.85-0.87; P < .001), which was consistent by race and sex, they wrote.
In addition, there was no evidence that extreme fitness increased risk for mortality.
The lowest risk for mortality was achieved at 14 METs for both men (HR = 0.24; 95% CI, 0.23-0.25) and women (HR = 0.23; 95% CI, 0.17-0.29), according to the researchers.
Compared with extremely fit individuals, defined as those in the 98th percentile of METs, the least-fit individuals, defined as those in the 20th percentile of METs, had fourfold elevated risk for mortality (HR = 4.09; 95% CI, 3.9-4.2), Kokkinos and colleagues found.
Support for cardiorespiratory fitness
“This study by Kokkinos et al not only supports the large body of evidence on the importance of cardiorespiratory fitness for CVD risk but also provides considerable data from a substantial cohort of U.S. veterans and a very diverse population regardless of age, sex, race and ethnicity, supporting the importance of cardiorespiratory fitness across various U.S. populations, with no increased risk at very high cardiorespiratory fitness,” Carl J. Lavie Jr., MD, medical director of cardiac rehabilitation and prevention and director of exercise laboratories at the John Ochsner Heart and Vascular Institute, Ochsner Clinical School – The University of Queensland School of Medicine, New Orleans, and colleagues wrote in a related editorial. “Although some studies have suggested a threshold of harm or at least loss of benefit at very high levels of physical activity and exercise, whereas others have not, there does not seem to be any loss of benefit or harm at very high cardiorespiratory fitness.”
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