Author + information
- Received May 28, 2018
- Accepted June 12, 2018
- Published online August 20, 2018.
- Johan S.R. Clausen, MDa,
- Jacob L. Marott, MSca,b,
- Andreas Holtermann, PhDa,c,d,
- Finn Gyntelberg, MD, DMSca,b,c and
- Magnus T. Jensen, MD, PhDa,e,f,∗ (, )@uni_copenhagen@Rigshospitalet@HerlevGentofte@NFAnyheder@UniSouthDenmark@MagnusTJensenMD
- aThe Copenhagen Male Study, Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
- bThe Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg, Denmark
- cNational Research Centre for the Working Environment, Copenhagen, Denmark
- dDepartment of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- eDepartment of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
- fDepartment of Cardiology, Rigshospitalet, Copenhagen, Denmark
- ↵∗Address for correspondence:
Dr. Magnus T. Jensen, Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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.
The Copenhagen Male Study was supported by grants from the King Christian X Foundation, The Danish Medical Research Council, The Danish Heart Foundation, and the Else & Mogens Wedell-Wedellsborg Foundation, which had no role in the present study. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 28, 2018.
- Accepted June 12, 2018.
- 2018 American College of Cardiology Foundation