Johan S R Clausen1, Jacob L Marott2, Andreas Holtermann3, Finn Gyntelberg4, Magnus T Jensen5. 1. The Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark. 2. The Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark; The Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg, Denmark. 3. The Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. 4. The Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark; The Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark. 5. The Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark; Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. Electronic address: magnustjensen@gmail.com.
Abstract
BACKGROUND: A high cardiorespiratory fitness (CRF) level is recommended to promote healthy aging. However, the association between CRF and very-long-term prognosis is unclear, and reverse causation may bias results in studies with shorter follow-up. OBJECTIVES: This study investigated the association between CRF and mortality in middle-aged, employed men free of cardiovascular disease (CVD). METHODS: Participants from the Copenhagen Male Study, established in 1970 to 1971, were included and stratified into 4 age-adjusted maximal oxygen consumption (Vo2max) categories: below the lower limit of normal (lowest 5%); low normal (45%); high normal (45%); and above the upper limit of normal (top 5%). Vo2max was estimated by using a bicycle ergometer. Multivariable restricted mean survival time models were performed for all-cause and cardiovascular mortality using Danish national registers. RESULTS: A total of 5,107 men with a mean age of 48.8 ± 5.4 years were included in the study. During the 46 years of follow-up, 4,700 (92%) men died; 2,149 (42.1%) of the men died of CVD. Compared with below the lower limit of normal CRF, low normal CRF was associated with 2.1 years (95% confidence interval [CI]: 0.7 to 3.4; p = 0.002), high normal with 2.9 years (95% CI: 1.5 to 4.2; p < 0.001), and above upper limit of normal with 4.9 years (95% CI: 3.1 to 6.7; p < 0.001) longer mean life expectancy. Each unit increase in Vo2max was associated with a 45-day (95% CI: 30 to 61; p < 0.001) increase in longevity. Estimates for cardiovascular mortality were similar to all-cause mortality. Results were essentially unchanged when excluding individuals who died within the first 10 years of follow-up, suggesting a minimal role of reverse causation. CONCLUSIONS: CRF was significantly related to longevity over the course of 4 decades in middle-aged, employed men free of CVD. The benefits of higher midlife CRF extend well into the later part of life.
BACKGROUND: A high cardiorespiratory fitness (CRF) level is recommended to promote healthy aging. However, the association between CRF and very-long-term prognosis is unclear, and reverse causation may bias results in studies with shorter follow-up. OBJECTIVES: This study investigated the association between CRF and mortality in middle-aged, employed men free of cardiovascular disease (CVD). METHODS:Participants from the Copenhagen Male Study, established in 1970 to 1971, were included and stratified into 4 age-adjusted maximal oxygen consumption (Vo2max) categories: below the lower limit of normal (lowest 5%); low normal (45%); high normal (45%); and above the upper limit of normal (top 5%). Vo2max was estimated by using a bicycle ergometer. Multivariable restricted mean survival time models were performed for all-cause and cardiovascular mortality using Danish national registers. RESULTS: A total of 5,107 men with a mean age of 48.8 ± 5.4 years were included in the study. During the 46 years of follow-up, 4,700 (92%) men died; 2,149 (42.1%) of the men died of CVD. Compared with below the lower limit of normal CRF, low normal CRF was associated with 2.1 years (95% confidence interval [CI]: 0.7 to 3.4; p = 0.002), high normal with 2.9 years (95% CI: 1.5 to 4.2; p < 0.001), and above upper limit of normal with 4.9 years (95% CI: 3.1 to 6.7; p < 0.001) longer mean life expectancy. Each unit increase in Vo2max was associated with a 45-day (95% CI: 30 to 61; p < 0.001) increase in longevity. Estimates for cardiovascular mortality were similar to all-cause mortality. Results were essentially unchanged when excluding individuals who died within the first 10 years of follow-up, suggesting a minimal role of reverse causation. CONCLUSIONS: CRF was significantly related to longevity over the course of 4 decades in middle-aged, employed men free of CVD. The benefits of higher midlife CRF extend well into the later part of life.
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