Physical Fitness and All-Cause Mortality: A Prospective Study of Healthy Men and Women
Abstract
We studied physical fitness and risk of all-cause and cause-specific mortality in 10 224 men and 3120 women who were given a preventive medical examination. Physical fitness was measured by a maximal treadmill exercise test. Average follow-up was slightly more than 8 years, for a total of 110 482 person-years of observation. There were 240 deaths in men and 43 deaths in women. Age-adjusted all-cause mortality rates declined across physical fitness quintiles from 64.0 per 10 000 person-years in the least-fit men to 18.6 per 10 000 person-years in the most-fit men (slope, —4.5). Corresponding values for women were 39.5 per 10 000 person-years to 8.5 per 10 000 person-years (slope, —5.5). These trends remained after statistical adjustment for age, smoking habit, cholesterol level, systolic blood pressure, fasting blood glucose level, parental history of coronary heart disease, and follow-up interval. Lower mortality rates in higher fitness categories also were seen for cardiovascular disease and cancer of combined sites. Attributable risk estimates for all-cause mortality indicated that low physical fitness was an important risk factor in both men and women. Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer. (JAMA. 1989;262:2395-2401)
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The additive survival benefits when progressing from 'good' to 'excellent' cardiorespiratory fitness levels are small.
“Finally, since the additive survival benefits when progressing from “good” to “excellent” CRF levels are small [ 54 , 57 ], achieving “good” fitness levels should be a primary goal or objective.”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [54]
An exercise capacity or cardiorespiratory fitness ≤5 METs is associated with the poorest prognosis, signifying the least fit population cohort (bottom quintile or 20%).
“Third, an exercise capacity or CRF ≤5 METs is associated with the poorest prognosis, signifying the least fit population cohort (i.e., the bottom quintile or 20%) [ 19 , 54 , 55 ].”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [54]
Low cardiorespiratory fitness, as measured by VO2 max, has been associated with increased risk of chronic disease and all-cause mortality.
“Low CRF, as measured by VO2 max, has been associated with increased risk of chronic disease and all-cause mortality [144, 145].”
From Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis (2019) · cites this paper as [144]
Regular exercise is associated with a reduction in the long-term risk of coronary events.
“numerous studies5,24-31 have found that regular exercise is associated with a reduction in the long-term risk of coronary events.”
From Triggering of Acute Myocardial Infarction by Heavy Physical Exertion -- Protection against Triggering by Regular Exertion (1993) · cites this paper as [30]
People who exercise regularly have a lower baseline risk of myocardial infarction.
“People who exercise regularly not only have a lower base-line risk of myocardial infarction, but as demonstrated by this study, they also have a lower relative risk that an infarction will be triggered by heavy physical exertion.”
From Triggering of Acute Myocardial Infarction by Heavy Physical Exertion -- Protection against Triggering by Regular Exertion (1993) · cites this paper as [30]
The optimal aerobic fitness level is 34 ml/kg/min for men and 32.2 ml/kg/min for women, beyond which no additional mortality benefit is observed.
“The study identified an optimal aerobic fitness level of 34 ml/kg/min for men and 32.2 ml/kg/min for women, beyond which no additional mortality benefit was observed [37]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [37]
Higher levels of physical fitness, as indicated by maximal oxygen uptake (VO2 max) values, were associated with reduced all-cause mortality, in a dose-dependent manner.
“higher levels of physical fitness, as indicated by maximal oxygen uptake (VO2 max) values, were associated with reduced all-cause mortality, in a dose-dependent manner [37]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [37]
The risk reduction per 1 MET increase in measured cardiorespiratory fitness is associated with a 10-30% reduction in adverse cardiovascular events.
“the risk reduction per 1 MET increase in measured CRF is associated with a 10–30% reduction in adverse cardiovascular events [37,48,49]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [37]
Higher levels of physical fitness, as indicated by VO2 max, are associated with reduced all-cause mortality in a dose-dependent manner.
“The classical study by Blair et al. [37] demonstrated that higher levels of physical fitness, as indicated by maximal oxygen uptake (VO2 max) values, were associated with reduced all-cause mortality, in a dose-dependent manner [37].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [37]
Previous studies of cardiorespiratory fitness and mortality have not specifically identified or analyzed patients with extremely high cardiorespiratory fitness.
“Previous studies4,5,7 of CRF and mortality have not specifically identified or analyzed patients with extremely high CRF, and it remains unclear whether there is an upper limit of CRF above which no further benefit or even harm is seen.”
From Association of Cardiorespiratory Fitness with Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing (2018) · cites this paper as [4]
Regular exercise and/or physical activity instigates beneficial effects in obesity, metabolic syndrome, type 2 diabetes, nonalcoholic fatty liver disease, cardiovascular disease and some cancers, and reduces overall mortality, often independent of weight loss.
“Regular exercise and/or PA has been demonstrated to instigate beneficial effects in obesity, metabolic syndrome, type 2 diabetes (T2D), nonalcoholic fatty liver disease (NAFLD), cardiovascular disease (CVD), some cancers, and to reduce overall mortality, which is often independent of weight loss.8,9”
From Reduced physical activity in young and older adults: Metabolic and musculoskeletal implications (2019) · cites this paper as [9]
The amount of daily physical activity, leisure time physical activity and physical fitness level are negatively correlated with mortality due to cerebrovascular disease and cancer, as well as all-cause mortality.
“The amount of daily physical activity, leisure time physical activity and physical fitness level have been found to be negatively correlated with morality due to cerebrovascular disease and cancer, as well as all-cause mortality in studies conducted worldwide596–606) and cohort studies in Japan577).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [599]
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Cited by 2,658
- Authors
- Blair, S. N.
- Corresponding author
- Blair, Steven N.
- ORCID
- Blair, Steven N.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1989-11-03
- Volume
- 262
- Issue
- 17
- Pages
- 2395
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W4320300836
- Cited by
- 2,658
- References
- 0
- Citations by year
- 2026: 47 · 2025: 64 · 2024: 65 · 2023: 81 · 2022: 85 · 2021: 92 · 2020: 96 · 2019: 120 · 2018: 124 · 2017: 91 · 2016: 114 · 2015: 121 · 2014: 102 · 2013: 109 · 2012: 77
- FWCI
- 23.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- physical fitness, all-cause mortality, cardiovascular mortality, cancer mortality, treadmill exercise testing, cardiovascular risk factors, sex differences, attributable risk, preventive medical examinations
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