title: Midlife Cardiorespiratory Fitness, Incident Cancer, and Survival After Cancer in Men: The Cooper Center Longitudinal Study.
abstract: OBJECTIVE
  Cardiorespiratory fitness (CRF) as assessed by formalized incremental exercise testing is an independent predictor of numerous chronic diseases, but its association with incident cancer or survival following a diagnosis of cancer has received little attention.
  
  
  OBJECTIVE
  To assess the association between midlife CRF and incident cancer and survival following a cancer diagnosis.
  
  
  METHODS
  This was a prospective, observational cohort study conducted at a preventive medicine clinic. The study included 13 949 community-dwelling men who had a baseline fitness examination. All men completed a comprehensive medical examination, a cardiovascular risk factor assessment, and incremental treadmill exercise test to evaluate CRF. We used age- and sex-specific distribution of treadmill duration from the overall Cooper Center Longitudinal Study population to define fitness groups as those with low (lowest 20%), moderate (middle 40%), and high (upper 40%) CRF groups. The adjusted multivariable model included age, examination year, body mass index, smoking, total cholesterol level, systolic blood pressure, diabetes mellitus, and fasting glucose level. Cardiorespiratory fitness levels were assessed between 1971 and 2009, and incident lung, prostate, and colorectal cancer using Medicare Parts A and B claims data from 1999 to 2009; the analysis was conducted in 2014.
  
  
  METHODS
  The main outcomes were (1) incident prostate, lung, and colorectal cancer and (2) all-cause mortality and cause-specific mortality among men who developed cancer at Medicare age (≥65 years).
  
  
  RESULTS
  Compared with men with low CRF, the adjusted hazard ratios (HRs) for incident lung, colorectal, and prostate cancers among men with high CRF were 0.45 (95% CI, 0.29-0.68), 0.56 (95% CI, 0.36-0.87), and 1.22 (95% CI, 1.02-1.46), respectively. Among those diagnosed as having cancer at Medicare age, high CRF in midlife was associated with an adjusted 32% (HR, 0.68; 95% CI, 0.47-0.98) risk reduction in all cancer-related deaths and a 68% reduction in cardiovascular disease mortality following a cancer diagnosis (HR, 0.32; 95% CI, 0.16-0.64) compared with men with low CRF in midlife.
  
  
  CONCLUSIONS
  There is an inverse association between midlife CRF and incident lung and colorectal cancer but not prostate cancer. High midlife CRF is associated with lower risk of cause-specific mortality in those diagnosed as having cancer at Medicare age.
authors.affiliation: Vermont Cancer Center, Division of Hematology/Oncology, University of Vermont, Burlington.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Lakoski
authors.affiliation: The Cooper Institute, Dallas, Texas.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Willis
authors.affiliation: The Cooper Institute, Dallas, Texas.
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Barlow
authors.affiliation: The Cooper Institute, Dallas, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Leonard
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
authors.forename: Ang
authors.initials: A
authors.lastname: Gao
authors.affiliation: The Cooper Institute, Dallas, Texas.
authors.forename: Nina B
authors.initials: NB
authors.lastname: Radford
authors.affiliation: The Cooper Institute, Dallas, Texas.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Farrell
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
authors.affiliation: The Cooper Institute, Dallas, Texas.
authors.forename: Laura F
authors.initials: LF
authors.lastname: DeFina
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Lee W
authors.initials: LW
authors.lastname: Jones
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D005080:Exercise Test; D006304:Health Status; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D010809:Physical Fitness; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology