Physical Fitness as a Predictor of Cardiovascular Mortality in Asymptomatic North American Men
Abstract
Limited data are available on the relation between physical fitness and mortality from cardiovascular disease. We examined this question in a study of 4276 men, 30 to 69 years of age, whom we followed for an average of 8.5 years. Examinations at base line included assessment of conventional coronary risk factors and treadmill exercise testing. The heart rate during submaximal exercise (stage 2 of the exercise test) and the duration of exercise were used as measures of physical fitness. Men with incomplete data (n = 308) or who were using cardiovascular drugs (n = 213) were excluded from the analysis. Men who had clinical evidence of cardiovascular disease at base line (n = 649) were analyzed separately. Forty-five deaths from cardiovascular causes occurred among the remaining 3106 men. A lower level of physical fitness was associated with a higher risk of death from cardiovascular and coronary heart disease, after adjustment for age and cardiovascular risk factors. The relative risk of death from cardiovascular causes was 2.7 (95 percent confidence interval, 1.4 to 5.1; P = 0.003) for healthy men with an increment of 35 beats per minute in the heart rate during stage 2, and 3.0 (95 percent confidence interval, 1.6 to 5.5; P = 0.0004) for those with a decrement of 4.4 minutes in the exercise time spent on the treadmill. The corresponding values for death from coronary heart disease were 3.2 (95 percent confidence interval, 1.5 to 6.7; P = 0.003) and 2.8 (95 percent confidence interval, 1.3 to 6.1; P = 0.007), respectively. We conclude that a lower level of physical fitness is associated with a higher risk of death from coronary heart disease and cardiovascular disease in clinically healthy men, independent of conventional coronary risk factors.
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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 [31]
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 [31]
Each 2 standard deviation decrement in cardiorespiratory fitness (approximately 2-3 METs) was linked to a 2- to 5-fold increase in cardiovascular disease or all-cause death rates.
“each 2 standard deviation decrement in CRF (approximately 2–3 METs) was linked to a 2– to 5-fold increase in CVD or all-cause death rates [46]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [46]
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- Authors
- Ekelund, L.-G., Haskell, W. L., Johnson, J. L., Whaley, F. S., Criqui, M. H., Sheps, D. S., & Study, T. L. R. C. M. F.-U.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- National Institutes of Health (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1988-11-24
- Volume
- 319
- Issue
- 21
- Pages
- 1379-1384
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2338226229
- Cited by
- 682
- References
- 39
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 7 · 2023: 13 · 2022: 9 · 2021: 6 · 2020: 10 · 2019: 14 · 2018: 13 · 2017: 17 · 2016: 16 · 2015: 17 · 2014: 20 · 2013: 23 · 2012: 18
- FWCI
- 37.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hv012156-034, n01hv012160-043)
- National Heart, Lung, and Blood Institute (N01-HV 12156, N01-HV1-2160, N01-HV 12159)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- physical fitness, cardiovascular mortality, coronary artery disease, treadmill exercise testing, exercise duration, asymptomatic men, cardiovascular risk factors, mortality prediction
- MeSH terms
- Adult, Aged, Blood Pressure, Cardiovascular Diseases, Coronary Disease, Follow-Up Studies, Heart Rate, Humans, Male, Middle Aged, Physical Fitness, Prognosis, Risk Factors
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