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As you increase your ability to exercise—increase your fitness—you are decreasing in a step-wise fashion the risk of death.” Peter Kokkinos, MD, HealthDay News, January 23, 2008

Live Fit, Live Long

The more fit you are the better. Striving to improve and be the best you can be makes training satisfying and fun—so you keep doing it. You become more fit and you live longer. This is basically the conclusion of a study released January 23, 2008, in the online edition of Circulation, the journal of the American Heart Association. “The major finding is that for all sorts of people, as one increases his exercise capacity based on an exercise treadmill test, there is an inverse drop [in death risk] in a dose response fashion,” lead researcher Peter Kokkinos told Heartwire, a professional news service of WebMD. In short, the more fit you are the less likely you are to die. This happens in a direct, one-for-one manner—fitness up, mortality down.  

We’ve know for a long time that exercise can dramatically prolong life. What makes this study special is its size and diversity. The study was government sponsored and the largest of its kind. Earlier studies involved mostly white subjects from higher socioeconomic classes.

Kokkinos and his colleagues followed 15,660 black and white male veterans for an average of 7.5 years after completion of a treadmill test to measure their exercise capacity. The participants were treated in Palo Alto, California, or Washington, D.C., and ranged in age from 47 to 71 (mean age 59); they were more than 40% black. Some had cardiovascular disease and some didn’t. One third were obese.

The men were divided into four fitness categories based on their treadmill performance in METS or metabolic equivalents. (One MET is the oxygen uptake capacity when a person is at rest.) Those topping out at less than 5 METS were classified “low” fitness, 5 to 7 METS “moderate” fitness, 7.1 to 10 “high” fitness, and more than 10 “very high” fitness. Annual mortality was 3.3%, for a total of 3912 deaths over the course of the study.

Results were as follows:

1) Exercise capacity was the strongest predictor of death; for both black and white men, fitness level was more powerful than age, cardiovascular risk factors, blood pressure or body mass index in predicting the risk of death.

2) Risk of death was reduced by an average of 13% for every 1-MET increase in exercise capacity; the mortality reduction per MET was 14% for blacks and 12% for whites.

3) The risk of death went down with each step up in fitness category; those classified as moderately fit (5 to 7 METS) had a 20% lower risk of death compared to low-fit men (<5 METS). High-fit men (7.1 to 10 METS) had a 50% lower risk, and those with very high fitness reduced their risk of dying by 70%. Put another way, the relative risk of death went progressively lower with each step up in fitness: 1.0 for low fitness, 0.80 for moderate fitness, 0.51 for high, and 0.31 for very high. I short, the odds of survival for the fittest men were more than 3 times better than for the least fit men. 

What about women? “Although we don’t know from this research that this applies to women as well, there’s no reason to suspect that it wouldn’t,” Alice Lichtenstein, director of the Cardiovascular Nutrition Lab at Tufts University, told HealthDay News. 

The practice tip for physicians, according to the researchers, is to pay as much attention to a patients’ fitness as to other major risk factors, such as age, CV risk factors, and body weight.

“Everyone needs to get involved to get this nation going again, because we are the fattest nation, the most sedentary nation in the world,” Dr. Kokkinos told Heartwire. “We could do something like walking for thirty minutes a day and reap major benefits,” he added. “For god’s sake, if we could walk on the moon, we can certainly walk on earth.”

Exercise Prescription

The 2007 guidelines from the American College of Sports Medicine and the American Heart Associate give specific suggestions on what else you can do to become more fit.

For the average healthy adult, the minimum requirement is moderate intensity exercise (brisk walking) for 30 minutes five days a week or vigorous exercise (running, basketball, singles tennis) for 20 minutes three days a week. You can also mix it up by combining moderate and intense exercise. For example, walk for 30 minutes twice a week and jog for 20 minutes on two other days. Working out more, however, will increase the benefits.

To lose weight or maintain weight loss, 60 to 90 minutes of daily activity is recommended.

Strength training (8 to 10 different exercises) two or three times a week is recommended to prevent loss of muscle and bone, and make daily activities easier.

Stretching and balancing exercises are also recommended whenever you exercise. This is especially important for those over 65, but good advice for young people as well.

Any amount of exercise at any intensity is better than none, of course. The key is to do something most days, and add things you enjoy as your fitness improves. Most people do best with a variety of activities to keep them interested and motivated.

You’ll find many more details on staying fit, lean and healthy in my book Great Expectations.

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