Exercise Capacity and Mortality in Older Men: A 20-Year Follow-Up Study
Abstract
Background— Epidemiological findings, based largely on middle-aged populations, support an inverse and independent association between exercise capacity and mortality risk. The information available in older individuals is limited. Methods and Results— Between 1986 and 2008, we assessed the association between exercise capacity and all-cause mortality in 5314 male veterans aged 65 to 92 years (mean±SD, 71.4±5.0 years) who completed an exercise test at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, Calif. We established fitness categories based on peak metabolic equivalents (METs) achieved. During a median 8.1 years of follow-up (range, 0.1 to 25.3), there were 2137 deaths. Baseline exercise capacity was 6.3±2.4 METs among survivors and 5.3±2.0 METs in those who died ( P <0.001) and emerged as a strong predictor of mortality. For each 1-MET increase in exercise capacity, the adjusted hazard for death was 12% lower (hazard ratio=0.88; confidence interval, 0.86 to 0.90). Compared with the least fit individuals (≤4 METs), the mortality risk was 38% lower for those who achieved 5.1 to 6.0 METs (hazard ratio=0.62; confidence interval, 0.54 to 0.71) and progressively declined to 61% (hazard ratio=0.39; confidence interval, 0.32 to 0.49) for those who achieved >9 METs, regardless of age. Unfit individuals who improved their fitness status with serial testing had a 35% lower mortality risk (hazard ratio=0.65; confidence interval, 0.46 to 0.93) compared with those who remained unfit. Conclusions— Exercise capacity is an independent predictor of all-cause mortality in older men. The relationship is inverse and graded, with most survival benefits achieved in those with an exercise capacity >5 METs. Survival improved significantly when unfit individuals became fit.
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- Authors
- Kokkinos, P., Myers, J., Faselis, C., Panagiotakos, D. B., Doumas, M., Pittaras, A., Manolis, A., Kokkinos;, J. P., Karasik, P., Greenberg, M., Papademetriou, V., & Fletcher, R.
- Affiliations
- Georgetown University (US)
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.).
- ORCID
- Venue
- Circulation
- Published
- 2010-08-24
- Volume
- 122
- Issue
- 8
- Pages
- 790-797
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2118722447
- Cited by
- 328
- References
- 24
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 17 · 2023: 18 · 2022: 15 · 2021: 17 · 2020: 17 · 2019: 21 · 2018: 23 · 2017: 36 · 2016: 21 · 2015: 27 · 2014: 29 · 2013: 22 · 2012: 24
- FWCI
- 57.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK6 RX002477)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- exercise capacity, all-cause mortality, older men, peak metabolic equivalents, exercise testing, fitness improvement, mortality prediction, veterans
- MeSH terms
- Aged, Aged, 80 and over, Aging, Follow-Up Studies, Humans, Male, Mortality, Physical Fitness, Cohort Studies, Exercise, Proportional Hazards Models
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