Higher aerobic fitness linked to longevity and better quality of life

A new study from Cleveland clinic found that increased cardiorespiratory fitness (CRF) or aerobic fitness is associated with lower long-term all-cause mortality with no upper limit observed for the amount of exercise. Patients who demonstrated extreme CRF (≥2 SDs above the mean for age and sex) was at the lowest risk of adjusted all-cause mortality as compared to other performance groups.

People with poor aerobic fitness face the same likelihood of dying as that due to chronic diseases like diabetes, hypertension and cardiovascular disease note the researchers of this retrospective study published in the Journal of the American Medical Association Network Open.

This retrospective study recruited the largest reported cohort of 122 007 patients between Jan. 1, 1991, and Dec. 31, 2014, who underwent Exercise treadmill testing (ETT) at a tertiary care center. ETT eliminates the bias introduced due to self-reporting and is the most widely used method to measure the CRF.

Demographics and other co-morbidities were noted at the time of undergoing specified stress test under the supervision of exercise physiologist. Patients were classified into performance group by age- and sex-associated cutoffs as follows: elite (≥97.7th percentile), high (75th-97.6th percentile), above average (50th-74th percentile), below average (25th-49th percentile), and low (<25th percentile).

The mean age was 53.4years, and about 60% were male. As the performance level increased, the associated co-morbidities decreased except for hyperlipidemia (present in 30% of elite performers).

After multivariate analysis, it was seen that at any given point of time, patients in the elite group were 80% less likely to die as compared to patients with low CRF (elite vs. low: adjusted HR, 0.20; 95% CI, 0.16-0.24; P < .001). The survival benefit was more evident in older patients (70 and more) and those with hypertension. Long-term survival was adjusted for a patient’s age, sex, height, weight, BMI, medications, and comorbidities.

Hypertensive patients in the elite group were 30% less likely to suffer mortality as compared to those in the high-performance group (75th-97.6th percentile).

Patients with lowest aerobic fitness (<25th percentile) faced risks that were comparable or more than patients with chronic disease like CVD (24% more), diabetes (40% more) and smoking (40% more). 

These findings highlight the importance of aerobic fitness concerning prolonging life and improving the quality of life. This study reinforces the results of previous studies that have demonstrated the benefits of achieving CRF.

“Aerobic fitness is something that most patients can control. And we found in our study there is no limit to how much exercise is too much,” said Wael Jaber, M.D., Cleveland Clinic cardiologist and senior author of the study in a news release.  “Everyone should be encouraged to achieve and maintain high fitness levels.”

It also stresses the importance of continued high-level physical activity in older adults and the benefits of maintaining the highest aerobic fitness. Some recent studies have demonstrated an association between extreme high level of exercise and an increased incidence of atrial fibrillation, coronary artery calcification, myocardial fibrosis, and aortic dilation. However, it is not clear whether these findings are a simple physiological adaptation or because of cardiovascular pathology.

“We were particularly interested in the relationship between extremely high fitness and mortality,” said Kyle Mandsager, M.D., an electrophysiology fellow at Cleveland Clinic and the lead author of the study.  “This relationship has never been looked at using objectively measured fitness, and on such a large scale.”

The authors conclude, “Cardiorespiratory fitness is a modifiable indicator of long-term mortality, and health care professionals should encourage patients to achieve and maintain high levels of fitness.”

Full text

Cleveland clinic news release

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