Physical fitness is a modifiable predictor of early cardiovascular death: A 35-year follow-up study of 2014 healthy middle-aged men

Abstract

Background Physical fitness has been shown to predict cardiovascular death during long-term follow-up. In the present study we aimed to investigate how physical fitness and other cardiovascular risk factors at middle-age influenced the risk of cardiovascular death during the early (0-11 years), intermediate (12-23 years) and late (24-35 years) parts of a 35-year observation period. Methods and results Age-adjusted physical fitness was calculated in 2014 apparently healthy, middle-aged men after maximal bicycle electrocardiogram-tests in 1972-1975 (Survey 1) and 1979-1982 (Survey 2). The men were assessed through 35 years after Survey 1, and 28 years after Survey 2 by Cox proportional hazards models. Low Survey 1 physical fitness was independently associated with increased risks of early and intermediate, but not late, cardiovascular death. Survey 1 to Survey 2 change in physical fitness, age, smoking status, systolic blood pressure and cholesterol impacted cardiovascular death risks in all periods. Family history of coronary heart disease impacted early and intermediate, but not late, cardiovascular death. Conclusions Most classical cardiovascular risk factors were strong predictors of early, intermediate and late cardiovascular death. Physical fitness measured at median age 50 years was independently associated with risk of early cardiovascular death, but the association weakened as time progressed. Change in physical fitness during middle-age impacted cardiovascular death risk in a full lifetime perspective. Thus, our data suggest that physical fitness is a modifiable cardiovascular risk factor with limited duration in contrast to the sustained impact of smoking, blood pressure and cholesterol on cardiovascular mortality.

Compositional analysis of the association between mortality and 24-hour movement behaviour from NHANES

“…Although using a prospective measure such as mortality (combined with covariates linked to the individual's state of health at commencement) provides stronger support for a causal relationship than an ordinary crosssectional study, the possibility remains that population effects are being conflated with, or confused for, a causal effect. Recent work (35) suggests that the health benefits of physical activity have limited duration, and it is plausible the levels of physical activity for individuals in the NHANES study will have declined at different rates as the individuals age, making the need for longitudinal data even greater. In addition, the absence of objective data on sleep time has compelled us to rely on a mixture of self-reported data and accelerometer data that are probably not wholly consistent, leading to potential inaccuracies in the individual compositions.…”

Physical inactivity and cardiovascular disease at the time of coronavirus disease 2019 (COVID-19)

“…3 Recent evidences also attest to the benefits of regular physical activity on survival. [4][5][6] Leisure-time physical activity has been negatively correlated with the risk of cardiovascular mortality independently from age, sex and presence or lack of pre-existing cardiovascular disease. 5 Physical fitness has been independently associated with risk of early cardiovascular death in the population aged 50 years or older, which suggests that physical fitness may not only modulate cardiovascular death risk, but that it may also be improved by practising regular physical exercise.…”

“…5 Physical fitness has been independently associated with risk of early cardiovascular death in the population aged 50 years or older, which suggests that physical fitness may not only modulate cardiovascular death risk, but that it may also be improved by practising regular physical exercise. 6 Limited physical activity or, even more worrisome, inability to take a regular walk out of one's home as a consequence of strict quarantine, may be associated with a kaleidoscope of unfavourable metabolic effects that would dramatically increase the risk of many severe and disabling disorders such as diabetes, 7 cancer, 8 osteoporosis 9 and cardiovascular disease. 10 Reductions in physical activity may also affect one's mental health, which may be experienced as unpleasant emotions such as sadness, anger, frustration and/or irritation.…”

Editor’s Presentation

“…5 Physical exercise is an important component of a lifestyle approach for preventing and managing hypertension, alone or in combination with pharmacological therapy. 6,7 A small report is here suggesting that this intervention should be personalised and adapted to each individual. In fact, different exercise modalities elicit very different changes on blood pressure variability while they induce similar reductions of blood pressure values.…”