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Men who maintained or improved adequate physical fitness were less likely to die from all causes and from cardiovascular disease during follow-up than persistently unfit men. Physicians should encourage unfit men to improve their fitness by starting a physical activity program.

OBJECTIVE -To quantify the relation of fitness to mortality among men with diabetes, adjusted for BMI and within levels of BMI.RESEARCH DESIGN AND METHODS -In this observational cohort study, we calculated all-cause death rates in men with diabetes across quartiles of fitness and BMI categories. Study participants were 2,196 men with diabetes (average age 49.3 years, SD 9.5) who underwent a medical examination, including a maximal exercise test, during 1970 to 1995, with mortality follow-up to 31 December 1996.RESULTS -We identified 275 deaths during 32,161 person-years of observation. Risk of all-cause mortality was inversely related to fitness. For example, in the fully adjusted model, the risk of mortality was 4.5 (2.6 -7.6), 2.8 (1.6 -4.7), and 1.6 (0.93-2.76) for the first, second, and third fitness quartiles, respectively, with the fourth quartile (highest fitness level) as the referent (P for trend Ͻ0.0001). There was no significant trend across BMI categories for mortality after adjustment for fitness. Similar results were found when the fitness-mortality relation was examined within levels of body composition. In normal-weight men with diabetes, the relative risks of mortality were 6.6 (2.8 -15.0), 3.2 (1.4 -7.0), and 2.2 (1.1-4.6) for the first, second, and third quartiles of fitness, respectively, as compared with the fourth quartile (P for trend Ͻ0.0001). We found similar results in the overweight and obese weight categories.CONCLUSIONS -There was a steep inverse gradient between fitness and mortality in this cohort of men with documented diabetes, and this association was independent of BMI. Diabetes Care 27:83-88, 2004W hile the importance of physical activity and weight loss in the prevention of diabetes is now well established by randomized clinical trials, few studies have examined the relative contribution of weight and physical activity on morbidity and mortality in individuals with diabetes (1,2). A better understanding of the relative contributions of weight control and physical activity to mortality may guide clinical recommendations.We previously reported that low cardiorespiratory fitness and physical inactivity are independent predictors of allcause and cardiovascular disease (CVD) mortality in men with type 2 diabetes (3). However, this study examined these exposures in multivariable models and, thus, did not allow for evaluation of the relative values of physical activity, fitness, or weight as mortality predictors. We have performed additional follow-up and can now extend our previous work by examining the relation of fitness and mortality within BMI categories.The primary aims of this study of men with diabetes were to examine 1) the risk of mortality associated with fitness and BMI when examined as continuous and categorical variables and 2) the doseresponse relationship between fitness and mortality both with adjustment for BMI and within levels of BMI. RESEARCH DESIGN AND METHODS -The Aerobics CenterLongitudinal Study (ACLS) is a prospective epidemiologic investigation. Participan...

Among men and women in the ACLS, relative increases in maximal CR fitness and habitual physical activity are cross-sectionally associated with lower depressive symptomatology and greater emotional well-being. Prospective epidemiological studies and controlled clinical trials are needed to identify the minimal and optimal levels of physical activity and CR fitness associated with various mental health benefits in different segments of the general population.

In this cohort of men with diabetes, low fitness level was associated with increased risk of CVD mortality within normal weight, overweight, and class 1 obese weight categories.