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

Mandsager, Kyle; Harb, Serge C.; Cremer, Paul; Phelan, Dermot; Nissen, Steven E.; Jaber, Wael A.

doi:10.1001/jamanetworkopen.2018.3605

Cited by 310 publications

(241 citation statements)

References 51 publications

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“…This can possibly be explained by the confounding effect of maximum workload (exercise capacity), associated both with higher SBP (via greater cardiac output) 12,14,15 and with better survival. 27,28 Using the workload-indexed SBP response to exercise may circumvent this bias, accounting for both exercise capacity and SBP. 11 Whether the SBP/W-slope or peak SBP/W-ratio provide prognostic value remains to be elucidated, although recent data on the SBP/METslope in males were promising.…”

Section: Rationale For Using Workload-indexed Sbp Measuresmentioning

confidence: 99%

Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry

Hedman

Lindow

Elmberg

et al. 2020

European Journal of Preventive Cardiology

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Background Guidelines recommend considering workload in interpretation of the systolic blood pressure (SBP) response to exercise, but reference values are lacking. Design This was a retrospective, consecutive cohort study. Methods From 12,976 subjects aged 18–85 years who performed a bicycle ergometer exercise test at one centre in Sweden during the years 2005–2016, we excluded those with prevalent cardiovascular disease, comorbidities, cardiac risk factors or medications. We extracted SBP, heart rate and workload (watt) from ≥ 3 time points from each test. The SBP/watt-slope and the SBP/watt-ratio at peak exercise were calculated. Age- and sex-specific mean values, standard deviations and 90th and 95th percentiles were determined. Reference equations for workload-indexed and peak SBP were derived using multiple linear regression analysis, including sex, age, workload, SBP at rest and anthropometric variables as predictors. Results A final sample of 3839 healthy subjects ( n = 1620 female) were included. While females had lower mean peak SBP than males (188 ± 24 vs 202 ± 22 mmHg, p < 0.001), workload-indexed SBP measures were markedly higher in females; SBP/watt-slope: 0.52 ± 0.21 versus 0.41 ± 0.15 mmHg/watt ( p < 0.001); peak SBP/watt-ratio: 1.35 ± 0.34 versus 0.90 ± 0.21 mmHg/watt ( p < 0.001). Age, sex, exercise capacity, resting SBP and height were significant predictors of the workload-indexed SBP parameters and were included in the reference equations. Conclusions These novel reference values can aid clinicians and exercise physiologists in interpreting the SBP response to exercise and may provide a basis for future research on the prognostic impact of exercise SBP. In females, a markedly higher SBP in relation to workload could imply a greater peripheral vascular resistance during exercise than in males.

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Section: Rationale For Using Workload-indexed Sbp Measuresmentioning

confidence: 99%

Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry

Hedman

Lindow

Elmberg

et al. 2020

European Journal of Preventive Cardiology

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“…The gold standard of VO 2 measurement is cardiopulmonary exercise testing (CPET), as it allows for the evaluation of the cardiovascular (CV), respiratory, and muscular responses to maximal exercise encompassed under the term CRF [2]. Recently, CRF has been proposed as a vital sign due to its strong inverse association with all-cause and CV disease (CVD) mortality, which is stronger than many traditional risk factors such as type 2 diabetes mellitus (T2DM) and smoking [1,3], and independent of sex and race [4]. While CRF is best established as a predictor of all-cause-and CVD-specific mortality, it has also been associated with decreased mortality from test (6MWT), which is predictive of mortality in COPD patients.…”

Section: Introductionmentioning

confidence: 99%

Lifestyle Interventions with a Focus on Nutritional Strategies to Increase Cardiorespiratory Fitness in Chronic Obstructive Pulmonary Disease, Heart Failure, Obesity, Sarcopenia, and Frailty

et al. 2019

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Cardiorespiratory fitness (CRF) is an independent predictor for all-cause and disease-specific morbidity and mortality. CRF is a modifiable risk factor, and exercise training and increased physical activity, as well as targeted medical therapies, can improve CRF. Although nutrition is a modifiable risk factor for chronic noncommunicable diseases, little is known about the effect of dietary patterns and specific nutrients on modifying CRF. This review focuses specifically on trials that implemented dietary supplementation, modified dietary pattern, or enacted caloric restriction, with and without exercise training interventions, and subsequently measured the effect on peak oxygen consumption (VO 2 ) or surrogate measures of CRF and functional capacity. Populations selected for this review are those recognized to have a reduced CRF, such as chronic obstructive pulmonary disease, heart failure, obesity, sarcopenia, and frailty. We then summarize the state of existing knowledge and explore future directions of study in disease states recently recognized to have an abnormal CRF.

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“…In humans, exercise can be correlated with longevity [35][36][37][38], and thus we compared relative survival of 3+3+2+2 exercised and non-exercised populations to address overall health. Our survival assays revealed that a 3+3+2+2 swim exercise regimen does not change the maximum lifespan of C. elegans population ( Fig.…”

Section: Mid-life Survival Is Increased In Swim-exercised C Elegansmentioning

confidence: 99%

“…exercise studies support that exercise can reduce mortality risk and increase longevity of healthy subjects, patients, and elite athletes, although some studies suggest a negative or neutral association between exercise and lifespan in humans [35][36][37][38]. Thus, a fair generalization may be that the extent of the exercise benefits is variable and dependent in part on the type of exercise, the population studied, and the particular outcomes recorded.…”

Section: Early Life Exercise Can Extend Median Lifespan Of An Active mentioning

confidence: 99%

Swim exercise in C. elegans extends neuromuscular and intestinal healthspan, enhances learning ability, and protects against neurodegeneration

Laranjeiro

Harinath

Hewitt

et al. 2019

Preprint

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Exercise can protect against cardiovascular disease, neurodegenerative disease, diabetes, cancer, and age-associated declines in muscle, immune, and cognitive function. In fact, regular physical exercise is the most powerful intervention known to enhance robustness of health and aging.Still, the molecular and cellular mechanisms that mediate system-wide exercise benefits remain poorly understood, especially as applies to "off target" tissues that do not participate directly in training activity. Elaborating molecular mechanisms of whole-animal exercise benefits is therefore of considerable importance to human health. The development of exercise protocols for short-lived genetic models holds great potential for deciphering fundamental mechanisms of exercise trans-tissue signaling during the entire aging process. Here, we report on the optimization of a long-term swim exercise protocol for C. elegans and we demonstrate its benefits to diverse aging tissues, even if exercise occurs only during a restricted phase during early adulthood. We found that multiple daily swim sessions are essential for exercise adaptation in C. elegans, leading to body wall muscle improvements in structural gene expression, locomotory performance, and mitochondrial morphology. Swim exercise training enhances whole-animal health parameters such as mitochondrial respiration and mid-life survival and increases the functional healthspan of pharynx and intestine. Importantly, we show that swim exercise also enhances nervous system health: exercise increases learning ability of adult animals and protects against neurodegeneration in C. elegans models of tauopathy, Alzheimer's disease, and Huntington's disease. An important point is that swim training only during C. elegans early adulthood induces long-lasting systemic benefits that in several cases are still detectable well into mid-life. Overall, our data reveal the broad impact of swim exercise in promoting extended healthspan of multiple C. elegans tissues, underscore the potency of early exercise experience to influence long-term health (even after cessation of exercise), and establish the foundation for exploiting the powerful advantages of this genetic model to dissect the exercise-dependent molecular circuitry that confers long-lasting system-wide health benefits to aging or diseased adults.

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

Abstract: This study assesses the association between cardiorespiratory fitness and long-term mortality in adults undergoing exercise treadmill testing.

Cited by 310 publications

References 51 publications

Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry

Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry

Lifestyle Interventions with a Focus on Nutritional Strategies to Increase Cardiorespiratory Fitness in Chronic Obstructive Pulmonary Disease, Heart Failure, Obesity, Sarcopenia, and Frailty

Swim exercise in C. elegans extends neuromuscular and intestinal healthspan, enhances learning ability, and protects against neurodegeneration

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