title: Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study.
abstract: BACKGROUND
  The combined associations of changes in cardiorespiratory fitness and body mass index (BMI) with mortality remain controversial and uncertain.
  
  
  RESULTS
  We examined the independent and combined associations of changes in fitness and BMI with all-cause and cardiovascular disease (CVD) mortality in 14 345 men (mean age 44 years) with at least 2 medical examinations. Fitness, in metabolic equivalents (METs), was estimated from a maximal treadmill test. BMI was calculated using measured weight and height. Changes in fitness and BMI between the baseline and last examinations over 6.3 years were classified into loss, stable, or gain groups. During 11.4 years of follow-up after the last examination, 914 all-cause and 300 CVD deaths occurred. The hazard ratios (95% confidence intervals) of all-cause and CVD mortality were 0.70 (0.59-0.83) and 0.73 (0.54-0.98) for stable fitness, and 0.61 (0.51-0.73) and 0.58 (0.42-0.80) for fitness gain, respectively, compared with fitness loss in multivariable analyses including BMI change. Every 1-MET improvement was associated with 15% and 19% lower risk of all-cause and CVD mortality, respectively. BMI change was not associated with all-cause or CVD mortality after adjusting for possible confounders and fitness change. In the combined analyses, men who lost fitness had higher all-cause and CVD mortality risks regardless of BMI change.
  
  
  CONCLUSIONS
  Maintaining or improving fitness is associated with a lower risk of all-cause and CVD mortality in men. Preventing age-associated fitness loss is important for longevity regardless of BMI change.
authors.affiliation: Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA. lee23@mailbox.sc.edu
authors.forename: Duck-chul
authors.initials: DC
authors.lastname: Lee
authors.forename: Xuemei
authors.initials: X
authors.lastname: Sui
authors.forename: Enrique G
authors.initials: EG
authors.lastname: Artero
authors.forename: I-Min
authors.initials: IM
authors.lastname: Lee
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Church
authors.forename: Paul A
authors.initials: PA
authors.lastname: McAuley
authors.forename: Fatima C
authors.initials: FC
authors.lastname: Stanford
authors.forename: Harold W
authors.initials: HW
authors.lastname: Kohl
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology / Q000517:prevention & control*; D002320:Cardiovascular Physiological Phenomena; D015444:Exercise / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008168:Lung / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013997:Time Factors