Clinical Edge

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

Maximal Exercise Capacity and All-Cause Mortality

Mayo Clin Proc; ePub 2017 Feb 6; Brawner, et al

Change in maximal exercise capacity (MEC) in men and women referred for an exercise stress test is inversely related to risk of all-cause mortality, a recent study found. Consecutive patients (n=10,854; mean age 54 years; 43% women; 30% nonwhite) who completed 2 physician-referred exercise tests between January 2, 1991, and May 28, 2009, were included from the Henry Ford Exercise Testing (FIT) Project. Researchers found:

  • Increasing from low to intermediate or high fitness was associated with lower risk of all-cause mortality (aHR, 0.63) compared to patients with low fitness at both tests.
  • Each 1-MET increase in age- or sex-adjusted MEC between baseline and follow-up was associated with an aHR of 0.87 in men and 0.84 in women.
  • Similar HRs were observed in a subgroup with intermediate fitness at baseline.


Brawner CA, Al-Mallah MH, Erhman JK, Qureshi WT, Blaha MJ, Keteyian SJ. Change in maximal exercise capacity is associated with survival in men and women. [Published online ahead of print February 6, 2017]. Mayo Clin Proc. doi:10.1016/j.mayocp.2016.12.016.


We have known for at least 20 years that there is a relationship between fitness and a lower risk of hypertension, diabetes, cardiovascular disease, cardiovascular mortality and all-cause mortality.1,2 This relationship, which is noted in observational studies, could potentially represent the fact that people who are healthier tend to be more fit. However, the observation does not answer the relevant question of whether a person who is already in their mid-50s could benefit from starting an exercise program at that point if they have not been fit throughout their life to date. The remarkable study reviewed above addresses both of these questions. It demonstrates that it is unlikely that it is just that healthy people exercise more, but rather it is the exercise that matters in keeping people healthy since an improvement in exercise level leads to better health outcomes. Also of importance, the results clearly show the significant benefit of improving fitness in middle age, a message that is important for our patients to hear. —Neil Skolnik, MD

  1. Juraschek SP, Blaha MJ, Whelton SP, et al. Physical fitness and hypertension in a population at risk for cardiovascular disease: the Henry Ford Exercise Testing (FIT) Project. J Am Heart Assoc. 2014;3(6):e001268.
  2. Juraschek SP, Blaha MJ, Blumenthal RS, et al. Cardiorespiratory fitness and incident diabetes: the FIT (Henry Ford Exercise Testing) project. Diabetes Care. 2015;38(6):1075-1081.