Psychological well-being, cardiorespiratory fitness, and long-term survival.
BACKGROUND
Psychological well-being is associated with mortality/survival. Although cardiorespiratory fitness (CRF) is one of the strongest predictors of mortality, studies examining the relationship between well-being and survival seldom account for the possible effects of CRF.


OBJECTIVE
This study examined the independent associations of psychological well-being components (low level of negative emotion and high level of positive emotion) and CRF, as well as their combined effects, with survival.


METHODS
Participants (N=4888) were examined in 1988-1997 and followed up for a median period of ∼15 years (212 deaths, 4.3%). CRF was assessed by a maximal exercise test on a treadmill. Low-level negative emotion was defined as the minimum score of the negative emotion subscale of the CES-D scale and high-level positive emotion as the maximum score of the positive emotion subscale. Results are presented as hazard ratios (95% CIs). Data were analyzed in 2009.


RESULTS
After adjustment for a set of established risk factors, men and women with low levels of negative emotion had lower risk of death than those with higher levels of negative emotion, 0.66 (95% CI=0.50, 0.87). The association persisted after additional adjustment for CRF and positive emotion. High level of positive emotion was not associated with survival. A high level of CRF independently predicted lower risk of death, 0.54 (95% CI=0.37, 0.79), compared to a low level of CRF. The risk of death in participants with both a low level of negative emotion and a high level of CRF was 0.37 (95% CI=0.22, 0.63), compared to their peers with higher levels of negative emotion/low levels of CRF.


CONCLUSIONS
Low levels of negative emotion and high levels of CRF are independent predictors of long-term survival in men and women. A strong combined effect was observed, as individuals with both a low level of negative emotion and a high level of CRF had a 63% lower risk of premature death than those with higher levels of negative emotion and a low level of CRF.
Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden. ortegaf@ugr.es
Francisco B
FB
Ortega
Duck-chul
DC
Lee
Xuemei
X
Sui
Laura D
LD
Kubzansky
Jonatan R
JR
Ruiz
Meghan
M
Baruth
Manuel J
MJ
Castillo
Steven N
SN
Blair
D015992:Body Mass Index; D002320:Cardiovascular Physiological Phenomena; D005080:Exercise Test; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010101:Oxygen Consumption; D010549:Personal Satisfaction; D010807:Physical Endurance; D010809:Physical Fitness; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012143:Respiratory Physiological Phenomena