Abstract
Objective
To determine population-attributable risk (PAR) and exposure impact number (EIN) for
mortality associated with impaired cardiorespiratory fitness (CRF), physical inactivity,
and other risk markers among veteran subjects.
Methods
The sample included 5890 male subjects (mean age 58±15) who underwent a maximal exercise
test for clinical reasons between January 1, 1992, and December 31, 2014. All-cause
mortality was the end point. Cox multivariable hazard models were performed to determine
clinical, demographic, and exercise-test determinants of mortality. Population-attributable
risks and EIN for the lowest quartile of CRF and for inactive behavior were analyzed,
accounting for competing events.
Results
There were 2728 deaths during a mean ± standard deviation follow-up period of 9.9±5.8
years. Having low CRF (<5.0 metabolic equivalents [METs]) was associated with an approximate
3-fold higher risk of mortality and a PAR of 12.9%. Each higher MET achieved on the
treadmill was associated with a 15% reduction in mortality (hazard ratio [HR]=0.85;
95% confidence interval [CI], 0.83 to 0.88; P<.001). Nearly half the sample was inactive, and these subjects had a 23% higher mortality
risk and a PAR of 8.8%. The least fit quartile (<5.0 METs) had relative risks of ≈6.0
compared with the most-fit group (HR=5.99; 95% CI, 4.9 to 7.3). The least-active tertile
had ≈2-fold higher risks of mortality vs the most active subjects (HR=1.9; 95% CI,
0.91 to 4.1). The lowest EIN was observed for low fitness (3.8; 95% CI, 3.4 to 4.3,
P<.001), followed by diabetes, smoking, hypertension, and physical inactivity (all
P<.001 except for diabetes, P=.008).
Conclusion
Both higher CRF and physical activity provide protection against all-cause mortality
in subjects referred for exercise testing for clinical reasons. Encouraging physical
activity with the aim of increasing CRF would have a significant impact on reducing
mortality.
Abbreviations and Acronyms:
CRF (cardiorespiratory fitness), EIN (exposure impact number), HHS (Health and Human Services), METs (metabolic equivalents), PAR (population-attributable risk), VETS (Veterans Exercise Testing Study)To read this article in full you will need to make a payment
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Article Info
Footnotes
Grant Support: No grant support was received for this article.
Potential Competing Interests: The authors report no competing interests.
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