title: Cardiovascular fitness and mortality after contemporary cardiac rehabilitation.
abstract: OBJECTIVE
  To assess the association between cardiorespiratory fitness (CRF) and outcomes in a cardiac rehabilitation (CR) cohort.
  
  
  METHODS
  We conducted a retrospective study of 5641 patients (4282 men [76%] and 1359 women [24%]; mean ± SD age, 60.0±10.3 years) with coronary artery disease who participated in CR between July 1, 1996, and February 28, 2009. Based on peak metabolic equivalents (METs), patients were classified as low fitness (LFit) (<5 METs), moderate fitness (5-8 METs), or high fitness (>8 METs).
  
  
  RESULTS
  Baseline fitness predicted long-term mortality: relative to the LFit group, patients with moderate fitness had an adjusted hazard ratio of 0.54 (95% CI, 0.42-0.69), and those with high fitness a hazard ratio of 0.32 (95% CI, 0.24-0.44). Improvement in CRF at 12 weeks was associated with decreased overall mortality, with a 13% point reduction with each MET increase (P<.001) and a 30% point reduction in those who started with LFit. At 1 year, each MET increase in CRF was associated with a 25% point reduction in overall mortality in the whole group (P<.001).
  
  
  CONCLUSIONS
  In this study of contemporary CR patients, higher baseline fitness predicted lower mortality. The novel finding was that improvement in fitness during a CR program and improvements that persisted at 1 year were also associated with decreased mortality, most strongly in patients who start with LFit.
authors: Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
authors: Billie-Jean
authors: BJ
authors: Martin
authors: Ross
authors: R
authors: Arena
authors: Mark
authors: M
authors: Haykowsky
authors: Trina
authors: T
authors: Hauer
authors: Leslie D
authors: LD
authors: Austford
authors: Merril
authors: M
authors: Knudtson
authors: Sandeep
authors: S
authors: Aggarwal
authors: James A
authors: JA
authors: Stone
mesh_terms: D000368:Aged; D002170:Canada; D003324:Coronary Artery Disease / Q000401:mortality / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D055686:Metabolic Equivalent; D008875:Middle Aged; D010809:Physical Fitness; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis