title: Exercise capacity and mortality in older men: a 20-year follow-up study.
abstract: BACKGROUND
  Epidemiological findings, based largely on middle-aged populations, support an inverse and independent association between exercise capacity and mortality risk. The information available in older individuals is limited.
  
  
  RESULTS
  Between 1986 and 2008, we assessed the association between exercise capacity and all-cause mortality in 5314 male veterans aged 65 to 92 years (mean+/-SD, 71.4+/-5.0 years) who completed an exercise test at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, Calif. We established fitness categories based on peak metabolic equivalents (METs) achieved. During a median 8.1 years of follow-up (range, 0.1 to 25.3), there were 2137 deaths. Baseline exercise capacity was 6.3+/-2.4 METs among survivors and 5.3+/-2.0 METs in those who died (P<0.001) and emerged as a strong predictor of mortality. For each 1-MET increase in exercise capacity, the adjusted hazard for death was 12% lower (hazard ratio=0.88; confidence interval, 0.86 to 0.90). Compared with the least fit individuals (< or =4 METs), the mortality risk was 38% lower for those who achieved 5.1 to 6.0 METs (hazard ratio=0.62; confidence interval, 0.54 to 0.71) and progressively declined to 61% (hazard ratio=0.39; confidence interval, 0.32 to 0.49) for those who achieved >9 METs, regardless of age. Unfit individuals who improved their fitness status with serial testing had a 35% lower mortality risk (hazard ratio=0.65; confidence interval, 0.46 to 0.93) compared with those who remained unfit.
  
  
  CONCLUSIONS
  Exercise capacity is an independent predictor of all-cause mortality in older men. The relationship is inverse and graded, with most survival benefits achieved in those with an exercise capacity >5 METs. Survival improved significantly when unfit individuals became fit.
authors.affiliation: Cardiology Division, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA. peter.kokkinos@med.va.gov
authors.forename: Peter
authors.initials: P
authors.lastname: Kokkinos
authors.forename: Jonathan
authors.initials: J
authors.lastname: Myers
authors.forename: Charles
authors.initials: C
authors.lastname: Faselis
authors.forename: Demosthenes B
authors.initials: DB
authors.lastname: Panagiotakos
authors.forename: Michael
authors.initials: M
authors.lastname: Doumas
authors.forename: Andreas
authors.initials: A
authors.lastname: Pittaras
authors.forename: Athanasios
authors.initials: A
authors.lastname: Manolis
authors.forename: John Peter
authors.initials: JP
authors.lastname: Kokkinos
authors.forename: Pamela
authors.initials: P
authors.lastname: Karasik
authors.forename: Michael
authors.initials: M
authors.lastname: Greenberg
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.forename: Ross
authors.initials: R
authors.lastname: Fletcher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D015331:Cohort Studies; D015444:Exercise; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009026:Mortality; D010809:Physical Fitness; D016016:Proportional Hazards Models