Article

Exercise Capacity and Mortality among Men Referred for Exercise Testing

Stanford University, Palo Alto, California, United States
New England Journal of Medicine (Impact Factor: 55.87). 04/2002; 346(11):793-801. DOI: 10.1056/NEJMoa011858
Source: PubMed

ABSTRACT

Exercise capacity is known to be an important prognostic factor in patients with cardiovascular disease, but it is uncertain whether it predicts mortality equally well among healthy persons. There is also uncertainty regarding the predictive power of exercise capacity relative to other clinical and exercise-test variables.
We studied a total of 6213 consecutive men referred for treadmill exercise testing for clinical reasons during a mean (+/-SD) of 6.2+/-3.7 years of follow-up. Subjects were classified into two groups: 3679 had an abnormal exercise-test result or a history of cardiovascular disease, or both, and 2534 had a normal exercise-test result and no history of cardiovascular disease. Overall mortality was the end point.
There were a total of 1256 deaths during the follow-up period, resulting in an average annual mortality of 2.6 percent. Men who died were older than those who survived and had a lower maximal heart rate, lower maximal systolic and diastolic blood pressure, and lower exercise capacity. After adjustment for age, the peak exercise capacity measured in metabolic equivalents (MET) was the strongest predictor of the risk of death among both normal subjects and those with cardiovascular disease. Absolute peak exercise capacity was a stronger predictor of the risk of death than the percentage of the age-predicted value achieved, and there was no interaction between the use or nonuse of beta-blockade and the predictive power of exercise capacity. Each 1-MET increase in exercise capacity conferred a 12 percent improvement in survival.
Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for cardiovascular disease.

Download full-text

Full-text

Available from: Sara L Partington
  • Source
    • "The models inability to accurately identify fitness level in the low-fit subjects represent a potential concern, since low aerobic fitness is associated with increased prevalence of chronic disease as well as a higher mortality risk, e.g. cardiovascular disease and metabolic syndrome[3,4,48]. However, cross-classification accurately predicted approximately 91% of participants, in both sexes, within the nearest quintile of measured VO 2peak . "
    [Show abstract] [Hide abstract]
    ABSTRACT: Peak oxygen uptake (VO2peak) is seldom assessed in health care settings although being inversely linked to cardiovascular risk and all-cause mortality. The aim of this study was to develop VO2peak prediction models for men and women based on directly measured VO2peak from a large healthy population
    Full-text · Article · Jan 2016 · PLoS ONE
    • "Athlete: a working definition for medical and health sciences research It is largely recognized that being physically fit (Blair et al., 1989;Myers et al., 2002;Barry et al., 2014;Brito et al., 2014;Feldman et al., 2015) and adopting a regular exercise routine (Stofan et al., 1998;Blair & Haskell, 2006;Arem et al., 2015) are relevant attributes to a healthy status. While a conceptual distinction between physical activity and exercise was presented 30 years ago (Caspersen et al., 1985), a clear definition of the term athlete for scientific research is still missing. "

    No preview · Article · Jan 2016 · Scandinavian Journal of Medicine and Science in Sports
  • Source
    • "These data are also supported by Lee et al. (2003), who found an inverse association between the relative intensity of physical activity and risk of coronary heart disease among men not satisfying current physical activity recommendations. Peak oxygen uptake ( ˙ V O2peak ) is one of the strongest prognostic markers for future cardiovascular health and premature mortality (Myers et al. 2002; Keteyian et al. 2008; Nes et al. 2014). Interestingly , although physical activity levels are also associated with mortality, this association disappears after adjustment for ˙ V O2peak (Lee et al. 2011). "

    Preview · Article · Dec 2015 · The Journal of Physiology
Show more

Questions & Answers about this publication

  • Tom O'Dwyer added an answer in Exercise Intervention:
    After an exercise intervention program, which % of the V`O2 value defines a significant/ successful intervention through the exercise?

    Considering the variability in the V'o2response (regarding age, sex, genetics, etc.), is there any minimal percent value of improvement which one can consider significant for a successful intervention?

    Tom O'Dwyer

    Dear Julian, this is an interesting question. Others have responded in relation to determining a statistically significant change (or real change) using VO2max assessment to evaluate the impact of an exercise intervention. Depending on the cohort and the context you are working within, a statistically significant change may not be clinically important; the clinically significant change following an intervention might be quite different. For example, Myers et al. (2002) report that an increase in 1 MET (3.5 mL.min-1.kg-1) was associated with a 12% improvement in survival. The study (https://www.researchgate.net/publication/11469274_Exercise_capacity_and_mortality_among_men_referred_for_exercise_testing) includes an informative discussion on clinically significant MET (and VO2) values, which may be of interest.

    • Source
      [Show abstract] [Hide abstract]
      ABSTRACT: Exercise capacity is known to be an important prognostic factor in patients with cardiovascular disease, but it is uncertain whether it predicts mortality equally well among healthy persons. There is also uncertainty regarding the predictive power of exercise capacity relative to other clinical and exercise-test variables. We studied a total of 6213 consecutive men referred for treadmill exercise testing for clinical reasons during a mean (+/-SD) of 6.2+/-3.7 years of follow-up. Subjects were classified into two groups: 3679 had an abnormal exercise-test result or a history of cardiovascular disease, or both, and 2534 had a normal exercise-test result and no history of cardiovascular disease. Overall mortality was the end point. There were a total of 1256 deaths during the follow-up period, resulting in an average annual mortality of 2.6 percent. Men who died were older than those who survived and had a lower maximal heart rate, lower maximal systolic and diastolic blood pressure, and lower exercise capacity. After adjustment for age, the peak exercise capacity measured in metabolic equivalents (MET) was the strongest predictor of the risk of death among both normal subjects and those with cardiovascular disease. Absolute peak exercise capacity was a stronger predictor of the risk of death than the percentage of the age-predicted value achieved, and there was no interaction between the use or nonuse of beta-blockade and the predictive power of exercise capacity. Each 1-MET increase in exercise capacity conferred a 12 percent improvement in survival. Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for cardiovascular disease.
      Full-text · Article · Apr 2002 · New England Journal of Medicine