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Low aerobic capacity in middle-aged men associated with increased mortality rates during 45 years of follow-up

Journal article
Authors Per Ladenvall
Carina Ulla Persson
Zacharias Mandalenakis
Lars Wilhelmsen
Gunnar Grimby
K. Svardsudd
Per-Olof Hansson
Published in European Journal of Preventive Cardiology
Volume 23
Issue 14
Pages 1557-1564
ISSN 2047-4873
Publication year 2016
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1557-1564
Language en
Keywords Exercise testing, epidemiology, mortality, aerobic capacity, exercise capacity, coronary risk-evaluation, all-cause mortality, cardiorespiratory, fitness, physical-fitness, cardiovascular events, heart-disease, healthy-men, cause death, exercise, metaanalysis, Cardiovascular System & Cardiology
Subject categories Clinical Medicine


Background Low aerobic capacity has been associated with increased mortality in short-term studies. The aim of this study was to evaluate the predictive power of aerobic capacity for mortality in middle-aged men during 45-years of follow-up. Design The study design was a population-based prospective cohort study. Methods A representative sample from Gothenburg of men born in 1913 was followed from 50-99 years of age, with periodic medical examinations and data from the National Hospital Discharge and Cause of Death registers. At 54 years of age, 792 men performed an ergometer exercise test, with 656 (83%) performing the maximum exercise test. Results In Cox regression analysis, low predicted peak oxygen uptake (VO2max), smoking, high serum cholesterol and high mean arterial blood pressure at rest were significantly associated with mortality. In multivariable analysis, an association was found between predicted VO2max tertiles and mortality, independent of established risk factors. Hazard ratios were 0.79 (95% confidence interval (CI) 0.71-0.89; p<0.0001) for predicted VO2max, 1.01 (1.002-1.02; p<0.01) for mean arterial blood pressure, 1.13 (1.04-1.22; p<0.005) for cholesterol, and 1.58 (1.34-1.85; p<0.0001) for smoking. The variable impact (Wald's (2)) of predicted VO2max tertiles (15.3) on mortality was secondary only to smoking (31.4). The risk associated with low predicted VO2max was evident throughout four decades of follow-up. Conclusion In this representative population sample of middle-aged men, low aerobic capacity was associated with increased mortality rates, independent of traditional risk factors, including smoking, blood pressure and serum cholesterol, during more than 40 years of follow-up.

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