Mayo Clinic Proceedings Home

Comparative Relevance of Physical Fitness and Adiposity on Life Expectancy

A UK Biobank Observational Study

      Abstract

      Objective

      To investigate the extent to which 2 measures of physical fitness—walking pace and handgrip strength—are associated with life expectancy across different levels of adiposity, as the relative importance of physical fitness and adiposity on health outcomes is still debated.

      Patients and Methods

      Usual walking pace (self-defined as slow, steady/average, brisk), dynamometer-assessed handgrip strength, body mass index (BMI), waist circumference, and body-fat percentage determined at baseline in the UK Biobank prospective cohort study (March 13, 2006, to January 31, 2016). Life expectancy was estimated at 45 years of age.

      Results

      The median age and BMI of the 474,919 participants included in this analysis were 58.2 years and 26.7 kg/m 2, respectively; over a median follow-up of 6.97 years, 12,823 deaths occurred. Participants reporting brisk walking pace had longer life expectancies across all levels of BMIs, ranging from 86.7 to 87.8 years in women and 85.2 to 86.8 years in men. Conversely, subjects reporting slow walking pace had shorter life expectancies, being the lowest observed in slow walkers with a BMI less than 20 kg/m 2 (women: 72.4 years; men: 64.8 years). Smaller, less consistent differences in life expectancy were observed between participants with high and low handgrip strength, particularly in women. The same pattern of results was observed for waist circumference or body-fat percentage.

      Conclusion

      Brisk walkers were found to have longer life expectancies, which was constant across different levels and indices of adiposity. These findings could help clarify the relative importance of physical fitness and adiposity on mortality.

      Abbreviations and Acronyms:

      BMI ( body mass index), CI ( confidence interval), HR ( hazard ratio), IQR ( interquartile range), NHS ( National Health Service)
      To read this article in full you will need to make a payment

      References

        • Kennedy A.B.
        • Lavie C.J.
        • Blair S.N.
        Fitness or fatness: which is more important?.
        JAMA. 2018; 319: 231-232
        • Blair S.N.
        • Kohl 3rd, H.W.
        • Paffenbarger Jr., R.S.
        • Clark D.G.
        • Cooper K.H.
        • Gibbons L.W.
        Physical fitness and all-cause mortality: a prospective study of healthy men and women.
        JAMA. 1989; 262: 2395-2401
        • Barry V.W.
        • Caputo J.L.
        • Kang M.
        The Joint Association of Fitness and Fatness on Cardiovascular Disease Mortality: a meta-analysis.
        Prog Cardiovasc Dis. 2018; 61: 136-141
        • Ortega F.B.
        • Cadenas-Sanchez C.
        • Migueles J.H.
        • et al.
        Role of physical activity and fitness in the characterization and prognosis of the metabolically healthy obesity phenotype: a systematic review and meta-analysis.
        Prog Cardiovasc Dis. 2018; 61: 190-205
        • Moholdt T.
        • Lavie C.J.
        • Nauman J.
        Sustained physical activity, not weight loss, associated with improved survival in coronary heart disease.
        J Am Coll Cardiol. 2018; 71: 1094-1101
        • Lavie C.J.
        • Kokkinos P.
        • Ortega F.B.
        Survival of the fittest: promoting fitness throughout the life span.
        Mayo Clin Proc. 2017; 92: 1743-1745
        • Lavie C.J.
        • Laddu D.
        • Arena R.
        • Ortega F.B.
        • Alpert M.A.
        • Kushner R.F.
        Healthy weight and obesity prevention: JACC Health Promotion Series.
        J Am Coll Cardiol. 2018; 72: 1506-1531
        • Fletcher G.F.
        • Landolfo C.
        • Niebauer J.
        • Ozemek C.
        • Arena R.
        • Lavie C.J.
        Promoting physical activity and exercise: JACC Health Promotion Series.
        J Am Coll Cardiol. 2018; 72: 1622-1639
        • Iannuzzi-Sucich M.
        • Prestwood K.M.
        • Kenny A.M.
        Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M772-M777
        • Kim H.
        • Suzuki T.
        • Kim M.
        • et al.
        Incidence and predictors of sarcopenia onset in community-dwelling elderly Japanese women: 4-year follow-up study.
        J Am Med Dir Assoc. 2015; 16: 85.e1-85.e8
        • Aune D.
        • Sen A.
        • Prasad M.
        • et al.
        BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants.
        BMJ. 2016; 353: i2156
        • Royston P.
        Estimating the treatment effect in a clinical trial using difference in restricted mean survival time.
        Stata J. 2015; 15: 1098-1117
        • Dehbi H.M.
        • Royston P.
        • Hackshaw A.
        Life expectancy difference and life expectancy ratio: two measures of treatment effects in randomised trials with non-proportional hazards.
        BMJ. 2017; 357: j2250
        • Hernan M.A.
        The hazards of hazard ratios.
        Epidemiology. 2010; 21: 13-15
        • Royston P.
        • Lambert P.C.
        Flexible Parametric Survival Analysis Using Stata: Beyond the Cox Model.
        Stata Press, College Station, TX2011
        • Spiegelhalter D.
        Risk and uncertainty communication.
        Annu Rev Stat Appl. 2017; 4: 31-60
        • Holtermann A.
        • Marott J.L.
        • Gyntelberg F.
        • et al.
        Self-reported cardiorespiratory fitness: prediction and classification of risk of cardiovascular disease mortality and longevity: a prospective investigation in the Copenhagen City Heart Study.
        J Am Heart Assoc. 2015; 4: e001495
        • Janssen I.
        • Carson V.
        • Lee I.M.
        • Katzmarzyk P.T.
        • Blair S.N.
        Years of life gained due to leisure-time physical activity in the U.S.
        Am J Prev Med. 2013; 44: 23-29
        • Moore S.C.
        • Patel A.V.
        • Matthews C.E.
        • et al.
        Leisure time physical activity of moderate to vigorous intensity and mortality: a large pooled cohort analysis.
        PLoS Med. 2012; 9: e1001335
        • Finkelstein E.A.
        • Brown D.S.
        • Wrage L.A.
        • Allaire B.T.
        • Hoerger T.J.
        Individual and aggregate years-of-life-lost associated with overweight and obesity.
        Obesity (Silver Spring). 2010; 18: 333-339
        • Fontaine K.R.
        • Redden D.T.
        • Wang C.
        • Westfall A.O.
        • Allison D.B.
        Years of life lost due to obesity.
        JAMA. 2003; 289: 187-193
      1. UK Biobank: Protocol for a large-scale prospective epidemiological resource. UK Bioband Coordinating Centre, Stockport, Cheshire, UK2007
      2. UK Biobank.
      3. UK Biobank.
        https://www.ukbiobank.ac.uk/
        Date accessed: May 18, 2018
        • Easton D.F.
        • Peto J.
        • Babiker A.G.
        Floating absolute risk: an alternative to relative risk in survival and case-control analysis avoiding an arbitrary reference group.
        Stat Med. 1991; 10: 1025-1035
        • Plummer M.
        Improved estimates of floating absolute risk.
        Stat Med. 2004; 23: 93-104
        • National Institutes of Health
        Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report.
        Obesity Res. 1998; 6: S51-S209
        • Carstensen B.
        • Plummer M.
        • Laara E.
        • Hills M.
        Epi: a package for statistical analysis in epidemiology version 2.30.
        R Package Version. 2008; 1
        • Leong D.P.
        • Teo K.K.
        • Rangarajan S.
        • et al.
        Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study.
        Lancet. 2015; 386: 266-273
        • Kodama S.
        • Saito K.
        • Tanaka S.
        • et al.
        Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis.
        JAMA. 2009; 301: 2024-2035
        • Cooper R.
        • Kuh D.
        • Hardy R.
        Objectively measured physical capability levels and mortality: systematic review and meta-analysis.
        BMJ. 2010; 341: c4467
        • Yates T.
        • Zaccardi F.
        • Dhalwani N.N.
        • et al.
        Association of walking pace and handgrip strength with all-cause, cardiovascular, and cancer mortality: a UK Biobank observational study.
        Eur Heart J. 2017; 38: 3232-3240
        • Paffenbarger Jr., R.S.
        • Blair S.N.
        • Lee I.M.
        A history of physical activity, cardiovascular health and longevity: the scientific contributions of Jeremy N. Morris, DSc, DPH, FRCP.
        Int J Epidemiol. 2001; 30: 1184-1192
        • At J.
        • Bryce R.
        • Prina M.
        • et al.
        Frailty and the prediction of dependence and mortality in low- and middle-income countries: a 10/66 population-based cohort study.
        BMC Med. 2015; 13: 138
        • Syddall H.E.
        • Westbury L.D.
        • Cooper C.
        • Sayer A.A.
        Self-reported walking speed: a useful marker of physical performance among community-dwelling older people?.
        J Am Med Dir Assoc. 2015; 16: 323-328
        • DeFina L.F.
        • Haskell W.L.
        • Willis B.L.
        • et al.
        Physical activity versus cardiorespiratory fitness: two (partly) distinct components of cardiovascular health?.
        Prog Cardiovasc Dis. 2015; 57: 324-329
        • Flegal K.M.
        • Ioannidis J.P.A.
        A meta-analysis but not a systematic review: an evaluation of the Global BMI Mortality Collaboration.
        J Clin Epidemiol. 2017; 88: 21-29
        • Flegal K.M.
        • Kit B.K.
        • Orpana H.
        • Graubard B.I.
        Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.
        JAMA. 2013; 309: 71-82
        • Di Angelantonio E.
        • Bhupathiraju Sh.N.
        • Wormser D.
        • et al.
        Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents.
        Lancet. 2016; 388: 776-786
        • Pandey A.
        • Patel K.V.
        • Lavie C.J.
        Obesity, central adiposity, and fitness: understanding the obesity paradox in the context of other cardiometabolic parameters.
        Mayo Clin Proc. 2018; 93: 676-678
        • Carbone S.
        • Lavie C.J.
        • Arena R.
        Obesity and heart failure: focus on the obesity paradox.
        Mayo Clin Proc. 2017; 92: 266-279
        • Piche M.E.
        • Poirier P.
        • Lemieux I.
        • Despres J.P.
        Overview of epidemiology and contribution of obesity and body fat distribution to cardiovascular disease: an update.
        Prog Cardiovasc Dis. 2018; 61: 103-113