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Physical Fitness Level: Best Predictor of Death in Men


The public knows that tobacco is deadly. Health professionals need to help spread the word that physical inactivity can also kill. How hard a man can or cannot exercise is a better predictor of his mortality than how many packs of cigarettes he has smoked in his lifetime. This finding was one of many from a large study of men referred for treadmill exercise testing.

Researchers from Stanford University and the Veteran Affairs Palo Alto Health Care System studied 6,213 men referred for exercise testing for clinical reasons, then followed them for over 6 years to measure how well physical fitness level can predict mortality.

Of the men tested, 3,678 had a history of abnormal exercise-test results and/or heart disease. The other 2,534 had normal test results and no heart disease. During 6 years of follow-up, 1,256 men died.

Photo of two older men jogging.

After adjustment for age, the best predictor of death among all subjects was peak excercise capacity...

After adjusting for age, the best predictor of death among all subjects was peak exercise capacity, measured in metabolic equivalents, or MET (one MET is about how much energy a person expends while sitting quietly). The next best predictor for healthy subjects—those without heart disease—was pack-years of smoking. For subjects who have heart disease, suffering from heart failure or a heart attack were the second and third best predictors of death. Pack-years of smoking was the fourth best predictor.

Among all subjects, researchers calculated that a 1-MET increase in exercise capacity yielded a 12 percent improvement in survival. In this study, subjects were placed into one of five groups based on MET values from less than 5 to over 8. Researchers found that subjects whose exercise capacity was less than 5 MET had double the risk of death from any cause than subjects whose exercise capacity was more than 8 MET.

Although there was a large difference between risk of death from the lowest to the highest scoring MET group, the greatest differences in mortality rates were seen between the least fit and the next least fit subjects. This illustrates that the greatest public health gains can be made by getting the least fit to be more active.

The study authors suggest that health professionals encourage more physical activity to lower the risk of death in all patients. In counseling patients who have heart disease, increased exercise should be given as much attention as controlling blood pressure, treating diabetes, and quitting smoking. The authors also caution that study results can only be applied to men, as exercise test results have been shown to be different between men and women.

The full report appears in the March 14, 2002 New England Journal of Medicine and can be accessed at s


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