title: Change in Maximal Exercise Capacity Is Associated With Survival in Men and Women.
abstract: To describe the relationship between change in maximal exercise capacity (MEC) over time and risk of all-cause mortality separately in men and women.
  
  
  
  Consecutive patients (n=10,854; mean ± SD age, 54±11 years; 43% women; 30% nonwhite) who completed 2 physician-referred exercise tests between January 2, 1991, and May 28, 2009, were identified from the Henry Ford Exercise Testing (FIT) Project. The MEC was quantified in metabolic equivalents of task (METs) calculated from peak workload on a treadmill and adjusted to the equivalent for a 50-year-old man. Multivariable Cox proportional hazards regression was performed to assess risk of all-cause mortality associated with change in MEC based on (1) change from age-/sex-adjusted low fitness (<8 METs) to intermediate or high fitness and (2) an absolute change in METs.
  
  
  
  Relative to patients with low fitness at both tests, increasing from low to intermediate or high fitness was associated with lower risk of all-cause mortality (adjusted hazard ratio [aHR] = 0.63 [95% CI, 0.45-0.87] in men and 0.56 [95% CI, 0.34-0.91] in women). Each 1-MET increase in age-/sex-adjusted MEC between baseline and follow-up was associated with an aHR of 0.87 (95% CI, 0.84-0.91) in men and 0.84 (95% CI, 0.79-0.89) in women, with no significant interaction by sex (P=.995). Similar aHRs were observed in a subgroup with intermediate fitness at baseline.
  
  
  
  In men and women referred for an exercise stress test, change in MEC over time is inversely related to risk of all-cause mortality.
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI. Electronic address: Cbrawne1@hfhs.org.
authors.forename: Clinton A
authors.initials: CA
authors.lastname: Brawner
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Ehrman
authors.affiliation: Department of Cardiology, Wake Forest University, Winston-Salem, NC.
authors.forename: Waqas T
authors.initials: WT
authors.lastname: Qureshi
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
mesh_terms: D000072599:Cardiorespiratory Fitness / Q000502:physiology*; D002423:Cause of Death; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010807:Physical Endurance / Q000502:physiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D017678:Sex Distribution; D016019:Survival Analysis