Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing.

ABSTRACT:

Importance

Adverse cardiovascular findings associated with habitual vigorous exercise have raised new questions regarding the benefits of exercise and fitness.

Objective

To assess the association of all-cause mortality and cardiorespiratory fitness in patients undergoing exercise treadmill testing.

Design, setting, and participants

This retrospective cohort study enrolled patients at a tertiary care academic medical center from January 1, 1991, to December 31, 2014, with a median follow-up of 8.4 years. Data analysis was performed from April 19 to July 17, 2018. Consecutive adult patients referred for symptom-limited exercise treadmill testing were stratified by age- and sex-matched cardiorespiratory fitness into performance groups: low (<25th percentile), below average (25th-49th percentile), above average (50th-74th percentile), high (75th-97.6th percentile), and elite (?97.7th percentile).

Exposures

Cardiorespiratory fitness, as quantified by peak estimated metabolic equivalents on treadmill testing.

Main outcomes and measures

All-cause mortality.

Results

The study population included 122?007 patients (mean [SD] age, 53.4?[12.6] years; 72 173 [59.2%] male). Death occurred in 13?637 patients during 1.1 million person-years of observation. Risk-adjusted all-cause mortality was inversely proportional to cardiorespiratory fitness and was lowest in elite performers (elite vs low: adjusted hazard ratio [HR], 0.20; 95% CI, 0.16-0.24; P?Conclusions and relevanceCardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit. Extremely high aerobic fitness was associated with the greatest survival and was associated with benefit in older patients and those with hypertension. Cardiorespiratory fitness is a modifiable indicator of long-term mortality, and health care professionals should encourage patients to achieve and maintain high levels of fitness.

SUBMITTER: Mandsager K 

PROVIDER: S-EPMC6324439 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature