CHANGES IN PHYSICAL-FITNESS AND ALL-CAUSE MORTALITY - A PROSPECTIVE-STUDY OF HEALTHY AND UNHEALTHY MEN

Objective.-To evaluate the relationship between changes in physical fi tness and risk of mortality in men. Design.-Prospective study, with tw o clinical examinations (mean internal between examinations, 4.9 years ) to assess change or lack of change in physical fitness as associated with risk of mortality during follow-up after the subsequent examinat ion (mean follow-up from subsequent examination, 5.1 years). Setting.- Preventive medicine clinic. Study Participants.-Participants were 9777 men given two preventive medical examinations, each of which included assessment of physical fitness by maximal exercise tests and evaluati on of health status. Main Outcome Measures.-All-cause (n=223) and card iovascular disease (n=87) mortality. Results.-The highest age-adjusted all-cause death rate was observed in men who were unfit at both exami nations (122.0/10000 man-years); the lowest death rate was in men who were physically fit at both examinations (39.6/10000 man-years). Men w ho improved from unfit to fit between the first and subsequent examina tions had an age-adjusted death rate of 67.7/10 000 man-years. This is a reduction in mortality risk of 44% (95% confidence internal, 25% to 59%) relative to men who remained unfit at both examinations, Improve ment in fitness was associated With lower death rates after adjusting for age, health status, and other risk factors of premature mortality, For each minute increase in maximal treadmill time between examinatio ns, there was a corresponding 7.9% (P=.001) decrease in risk of mortal ity. Similar results were seen when the group was stratified by health status, and for cardiovascular disease mortality. Conclusions.-Men wh o 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.