Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Reduced Exercise Capacity and All-Cause Mortality

Am J Med; 2016 Sep; McAuley, Blaha, et al

Reduced exercise capacity, and not body mass index (BMI), was a strong independent risk factor for all-cause mortality in a racially diverse population, a recent study found. The FIT (Henry Ford Exercise Testing) Project included 29,257 men and women (mean age 53 years; 27% African American) without cardiovascular disease (CVD) and diabetes mellitus at baseline. All patients completed a symptom-limited maximal treadmill stress test between 1991 and 2009. The study sought to assess the relative impact of exercise capacity and BMI on all-cause mortality. Researchers found:

• 1,898 patients (6.5%) died during mean follow-up of 10.8 years.

• There was a strong inverse association between exercise capacity and all-cause mortality (HR, 0.86).

• BMI was inversely related to mortality (HR, 0.98).

• The highest mortality risk was in the <10 metabolic equivalents of risk (METs)/<30 kg/m2 subgroup.

Citation: McAuley PA, Blaha MJ, Keteyian SJ, et al. Fitness, fatness, and mortality: The FIT (Henry Ford Exercise Testing) Project. Am J Med. 2016;129(9):960-965. doi:10.1016/j.amjmed.2016.04.007.

Commentary: The goal of this study is to evaluate the independent and combined effects of both exercise and BMI on total mortality. Much research has shed light on the relationship between obesity and the development of many chronic diseases including hypertension, dyslipidemia, type 2 diabetes mellitus (diabetes), coronary heart disease (CHD), osteoarthritis, sleep apnea and respiratory problems, and some cancers.1 Given this strong relationship, it has often been assumed that the health effect of a lack of exercise is through it being a main contributor to obesity. A dramatic chart in the article shows that survival over 20 years is dramatically better in those who could exercise at a level of MET >10, regardless of BMI category, than those with an exercise level of MET <10. This study powerfully demonstrates that exercise has a strong beneficial effect on total mortality separate from its effect on BMI and that the influence of exercise on mortality appears to be greater than the influence of excess weight on mortality. —Neil Skolnik, MD

1. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102-38. doi:10.1161/01.cir.0000437739.71477.ee.

Citation:

McAuley PA, Blaha MJ, Keteyian SJ, et al. Fitness, fatness, and mortality: The FIT (Henry Ford Exercise Testing) Project. Am J Med. 2016;129(9):960-965. doi:10.1016/j.amjmed.2016.04.007.

Commentary:

The goal of this study is to evaluate the independent and combined effects of both exercise and BMI on total mortality. Much research has shed light on the relationship between obesity and the development of many chronic diseases including hypertension, dyslipidemia, type 2 diabetes mellitus (diabetes), coronary heart disease (CHD), osteoarthritis, sleep apnea and respiratory problems, and some cancers.1 Given this strong relationship, it has often been assumed that the health effect of a lack of exercise is through it being a main contributor to obesity. A dramatic chart in the article shows that survival over 20 years is dramatically better in those who could exercise at a level of MET >10, regardless of BMI category, than those with an exercise level of MET <10. This study powerfully demonstrates that exercise has a strong beneficial effect on total mortality separate from its effect on BMI and that the influence of exercise on mortality appears to be greater than the influence of excess weight on mortality. —Neil Skolnik, MD

1. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102-38. doi:10.1161/01.cir.0000437739.71477.ee.

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