title: Fitness, Fatness, and Mortality: The FIT (Henry Ford Exercise Testing) Project.
abstract: The combined influence of fitness and fatness on mortality risk in diverse populations has not been adequately explored. Our aim was to assess the relative impact of exercise capacity and body mass index (BMI) on all-cause mortality.
  
  
  
  We included 29,257 men and women (mean age 53 years; 27% African American) from The Henry Ford Exercise Testing (FIT) Project without cardiovascular disease and diabetes mellitus at baseline. All patients completed a symptom-limited maximal treadmill stress test between 1991 and 2009. Patients were grouped for analysis by exercise capacity (≥10 metabolic equivalents of task [METs] and <10 METs) and obesity status (≥30 kg/m(2) and <30 kg/m(2)), forming 4 subgroups. Independent and joint associations of BMI and exercise capacity with all-cause mortality were assessed using Cox proportional hazard models.
  
  
  
  During a mean follow-up of 10.8 years, 1898 patients (6.5%) died. We observed a strong inverse association between exercise capacity (per 1 MET unit) and all-cause mortality (hazard ratio [95% confidence interval], 0.86 [0.85-0.88]). Body mass index (per 1 BMI unit) was inversely related to mortality (hazard ratio [95% confidence interval], 0.98 [0.97-0.99]). In joint analysis, the highest mortality risk was in the <10 METs/<30 kg/m(2) subgroup.
  
  
  
  Reduced exercise capacity was a strong independent risk factor for all-cause mortality in this racially diverse population. Given the comparatively limited impact of BMI, more emphasis should be placed on measuring exercise capacity and developing strategies for its improvement in cardiovascular disease prevention programs.
authors.affiliation: Department of Health, Physical Education, and Sport Studies, Winston Salem State University, NC. Electronic address: mcauleypa@wssu.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: McAuley
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Mich.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Mich.
authors.forename: Clinton A
authors.initials: CA
authors.lastname: Brawner
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Al Rifai
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Zeina A
authors.initials: ZA
authors.lastname: Dardari
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Mich.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Ehrman
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Mich; King Abdul Aziz Cardiac Center, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
mesh_terms: D015992:Body Mass Index; D005080:Exercise Test / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009765:Obesity / Q000401:mortality; D010809:Physical Fitness; D016016:Proportional Hazards Models
keywords: Body mass index; Exercise capacity; Mortality; Obesity