Back to other Article Summaries
Relevance of Fitness to Mortality Risk in Men Receiving Contemporary Medical Care
Stephen W. Farrell, Laura F. DeFina, Nina B. Radford, David Leonard, Carolyn E. Barlow, Andjelka Pavlovic, Benjamin L. Willis, William L. Haskell and I-Min Lee
Summary By: Adriana C. Mares - Founder & President, The Institute of Cardiology at El Paso
Overall Study Question:
What is the association between fitness and mortality among men in earlier and contemporary time periods?
Background:
Cardiorespiratory fitness (CRF) reflects the body’s ability to transport oxygen during sustained physical activity. Physical activity is a behavior that can potentially improve CRF. Significant advances and disease prevention detection and treatment since 1989 have modified this inverse association between CRF and mortality (1).
Study Summary:
The Cooper Center Longitudinal Study (CCLS) primarily took place in conjunction with the Cooper Clinic™ also known at the Cooper Aerobics Health & Wellness Clinic in Dallas, Texas (2). In total, 47,862 men completed baseline examinations that consisted of a maximal treadmill test and were categorized as low fit, moderate fit, or high fit using Cooper Clinic normative data. During 1971 to 1991, cohort 1 (n = 24,475) was examined and followed for mortality through 1992. During 1992 to 2013, cohort 2 (n = 23,387) was examined with follow-up through 2014. There was a significant inverse relationship between fitness categories and all-cause mortality (HR: 1.0, 0.60, and 0.53 in cohort 1 and HR: 1.0, 0.76, and 0.52 in cohort 2) and CVD mortality (HR: 1.0, 0.55, and 0.43 in cohort 1 and HR: 1.0, 0.84, and 0.52 in cohort 2) (p trend <0.001 for all). Notably, a significant relationship between fitness categories and cancer mortality was observed in cohort 1 (HR: 1.0, 0.62, and 0.48; p < 0.001), compared to cohort 2 (HR: 1.0, 1.08, and 0.74; p = 0.19) which relationship was absent. Per 1-MET increment in fitness, HRs for all-cause mortality, similar to CVD and cancer mortality, were 0.86 with 95% confidence interval: 0.82 to 0.90 in cohort 1 and 0.87 with 95% confidence interval: 0.83 to 0.91 in cohort 2 (p < 0.001 for both). Let alone, in the more contemporary cohort, each 1-MET increment in fitness was associated with a 13%, 16%, and 9% decreased risk of all-cause, CVD, and cancer mortality, respectively. Overall, in an earlier compared to a contemporary cohort of men, fitness continues to be significantly and inversely associated with mortality. Aligned with the American Heart Association Position Statement, the study supports the importance of assessment of fitness by measuring, estimating, or counseling its benefits with the patient during routine health assessments (3, 4).
My Insights:
As reported in the CCLS, there is a persisting inverse association between fitness and mortality in men that strengthens the benefit of physical activity. Perhaps during the same time of the CCLS, specially seen in the lower rates for all-cause, CVD, and cancer mortality in cohort 2, could be accredited to new medical technologies, increased medical screening, and treatment in the reduction of tobacco use (5). Metabolic equivalent increment, indeed, reduces risk mortality in CVD just as in cancer. This comes to show the shared benefits of physical activity externally from cardiovascular health, possibly through a common pathway that may involve chronic inflammation, microvasculature, and oxidative stress. Provided that all study participants consisted of men, to address gender disparities in heart disease, future CCLS cohort studies should include women. Fascinatingly, despite conducting a study within two different time periods still, fitness revealed to be a strong predictor for risk mortality. Granted this, clinicians and organizations should aim to promote the importance of physical activity by encouraging individuals to join the movement to Living a Longer, Healthier, and Happier Life!
Relevance of Fitness to Mortality Risk in Men Receiving Contemporary Medical Care
Stephen W. Farrell, Laura F. DeFina, Nina B. Radford, David Leonard, Carolyn E. Barlow, Andjelka Pavlovic, Benjamin L. Willis, William L. Haskell and I-Min Lee
Summary By: Adriana C. Mares - Founder & President, The Institute of Cardiology at El Paso
Overall Study Question:
What is the association between fitness and mortality among men in earlier and contemporary time periods?
Background:
Cardiorespiratory fitness (CRF) reflects the body’s ability to transport oxygen during sustained physical activity. Physical activity is a behavior that can potentially improve CRF. Significant advances and disease prevention detection and treatment since 1989 have modified this inverse association between CRF and mortality (1).
Study Summary:
The Cooper Center Longitudinal Study (CCLS) primarily took place in conjunction with the Cooper Clinic™ also known at the Cooper Aerobics Health & Wellness Clinic in Dallas, Texas (2). In total, 47,862 men completed baseline examinations that consisted of a maximal treadmill test and were categorized as low fit, moderate fit, or high fit using Cooper Clinic normative data. During 1971 to 1991, cohort 1 (n = 24,475) was examined and followed for mortality through 1992. During 1992 to 2013, cohort 2 (n = 23,387) was examined with follow-up through 2014. There was a significant inverse relationship between fitness categories and all-cause mortality (HR: 1.0, 0.60, and 0.53 in cohort 1 and HR: 1.0, 0.76, and 0.52 in cohort 2) and CVD mortality (HR: 1.0, 0.55, and 0.43 in cohort 1 and HR: 1.0, 0.84, and 0.52 in cohort 2) (p trend <0.001 for all). Notably, a significant relationship between fitness categories and cancer mortality was observed in cohort 1 (HR: 1.0, 0.62, and 0.48; p < 0.001), compared to cohort 2 (HR: 1.0, 1.08, and 0.74; p = 0.19) which relationship was absent. Per 1-MET increment in fitness, HRs for all-cause mortality, similar to CVD and cancer mortality, were 0.86 with 95% confidence interval: 0.82 to 0.90 in cohort 1 and 0.87 with 95% confidence interval: 0.83 to 0.91 in cohort 2 (p < 0.001 for both). Let alone, in the more contemporary cohort, each 1-MET increment in fitness was associated with a 13%, 16%, and 9% decreased risk of all-cause, CVD, and cancer mortality, respectively. Overall, in an earlier compared to a contemporary cohort of men, fitness continues to be significantly and inversely associated with mortality. Aligned with the American Heart Association Position Statement, the study supports the importance of assessment of fitness by measuring, estimating, or counseling its benefits with the patient during routine health assessments (3, 4).
My Insights:
As reported in the CCLS, there is a persisting inverse association between fitness and mortality in men that strengthens the benefit of physical activity. Perhaps during the same time of the CCLS, specially seen in the lower rates for all-cause, CVD, and cancer mortality in cohort 2, could be accredited to new medical technologies, increased medical screening, and treatment in the reduction of tobacco use (5). Metabolic equivalent increment, indeed, reduces risk mortality in CVD just as in cancer. This comes to show the shared benefits of physical activity externally from cardiovascular health, possibly through a common pathway that may involve chronic inflammation, microvasculature, and oxidative stress. Provided that all study participants consisted of men, to address gender disparities in heart disease, future CCLS cohort studies should include women. Fascinatingly, despite conducting a study within two different time periods still, fitness revealed to be a strong predictor for risk mortality. Granted this, clinicians and organizations should aim to promote the importance of physical activity by encouraging individuals to join the movement to Living a Longer, Healthier, and Happier Life!
References
1. A Case for Fitness as a Clinical Vital Sign. Importance of Assessing Cardiorespiratory Fitness in Clinical Practice. https://professional.heart.org/professional/ScienceNews/UCM_490293_Importance-of-Assessing-Cardiorespiratory-Fitness-in-Clinical-Practice.jsp. Accessed April 3, 2020.
2. Cooper Aerobics. Cooper Aerobics. https://www.cooperaerobics.com/Cooper-Clinic.aspx. Accessed April 3, 2020.
3. Farrell SW, Defina LF, Radford NB, et al. Relevance of Fitness to Mortality Risk in Men Receiving Contemporary Medical Care. Journal of the American College of Cardiology. 2020;75(13):1538-1547. doi:10.1016/j.jacc.2020.01.049.
4. Mukherjee DP. Relevance of Fitness to Mortality Risk in Men Receiving Contemporary Medical Care. https://www.acc.org/latest-in-cardiology/journal-scans/2020/04/01/14/34/relevance-of-fitness-to-mortality-risk-in-men. Published March 26, 2020. Accessed March 27, 2020.
5. Fuster V. Apple Podcasts Preview. Apple Podcasts Preview. March 2020. https://podcasts.apple.com/us/podcast/relevance-fitness-to-mortality-risk-in-men-receiving/id932118437?i=1000469990979.
Back to other Article Summaries
1. A Case for Fitness as a Clinical Vital Sign. Importance of Assessing Cardiorespiratory Fitness in Clinical Practice. https://professional.heart.org/professional/ScienceNews/UCM_490293_Importance-of-Assessing-Cardiorespiratory-Fitness-in-Clinical-Practice.jsp. Accessed April 3, 2020.
2. Cooper Aerobics. Cooper Aerobics. https://www.cooperaerobics.com/Cooper-Clinic.aspx. Accessed April 3, 2020.
3. Farrell SW, Defina LF, Radford NB, et al. Relevance of Fitness to Mortality Risk in Men Receiving Contemporary Medical Care. Journal of the American College of Cardiology. 2020;75(13):1538-1547. doi:10.1016/j.jacc.2020.01.049.
4. Mukherjee DP. Relevance of Fitness to Mortality Risk in Men Receiving Contemporary Medical Care. https://www.acc.org/latest-in-cardiology/journal-scans/2020/04/01/14/34/relevance-of-fitness-to-mortality-risk-in-men. Published March 26, 2020. Accessed March 27, 2020.
5. Fuster V. Apple Podcasts Preview. Apple Podcasts Preview. March 2020. https://podcasts.apple.com/us/podcast/relevance-fitness-to-mortality-risk-in-men-receiving/id932118437?i=1000469990979.
Back to other Article Summaries