Sex Differences in Cardiorespiratory Fitness and All-Cause Mortality: The Henry Ford ExercIse Testing (FIT) Project

Overview

Journal Mayo Clin Proc

Specialty General Medicine

Date 2016 May 11

PMID 27161032

Citations 39

Authors

Mouaz H Al-Mallah

Stephen P Juraschek

Seamus Whelton

Zeina A Dardari

Jonathan K Ehrman

Erin D Michos

Roger S Blumenthal

Khurram Nasir

Waqas T Qureshi

Clinton A Brawner

Steven J Keteyian

Michael J Blaha

Affiliations

Soon will be listed here.

Abstract

Objective: To determine whether sex modifies the relationship between fitness and mortality.

Patients And Methods: We included 57,284 patients without coronary artery disease or heart failure who completed a routine treadmill exercise test between 1991 and 2009. We determined metabolic equivalent tasks (METs) and linked patient records with mortality data via the Social Security Death Index. Multivariable Cox regression was used to determine the association between sex, fitness, and all-cause mortality.

Results: There were 29,470 men (51.4%) and 27,814 women (48.6%) with mean ages of 53 and 54 years, respectively. Overall, men achieved 1.7 METs higher than women (P<.001). During median follow-up of 10 years, there were 6402 deaths. The mortality rate for men in each MET group was similar to that for women, who achieved an average of 2.6 METs lower (P=.004). Fitness was inversely associated with mortality in both men (hazard ratio [HR], 0.84 per 1 MET; 95% CI, 0.83-0.85) and women (HR, 0.83 per 1 MET; 95% CI, 0.81-0.84). This relationship did not plateau at high or low MET values.

Conclusion: Although men demonstrated 1.7 METs higher than women, their survival was equivalent to that of women demonstrating 2.6 METs lower. Furthermore, higher MET values were associated with lower mortality for both men and women across the range of MET values. These findings are useful for tailoring prognostic information and lifestyle guidance to men and women undergoing stress testing.

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References

Stratford P, Wainwright A, Kennedy D . An example of end-digit preference in physiotherapy practice. Physiother Can. 2014; 65(3):276-8. PMC: 3740993. DOI: 10.3138/ptc.2012-42. View

Hopkins S, Barker R, Brutsaert T, Gavin T, Entin P, Olfert I . Pulmonary gas exchange during exercise in women: effects of exercise type and work increment. J Appl Physiol (1985). 2000; 89(2):721-30. DOI: 10.1152/jappl.2000.89.2.721. View

Gulati M, Shaw L, Thisted R, Black H, Merz C, Arnsdorf M . Heart rate response to exercise stress testing in asymptomatic women: the st. James women take heart project. Circulation. 2010; 122(2):130-7. DOI: 10.1161/CIRCULATIONAHA.110.939249. View

Troiano R, Berrigan D, Dodd K, Masse L, Tilert T, McDowell M . Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2007; 40(1):181-8. DOI: 10.1249/mss.0b013e31815a51b3. View

Sui X, LaMonte M, Laditka J, Hardin J, Chase N, Hooker S . Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA. 2007; 298(21):2507-16. PMC: 2692959. DOI: 10.1001/jama.298.21.2507. View

. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106(25):3143-421. View

Gulati M, Pandey D, Arnsdorf M, Lauderdale D, Thisted R, Wicklund R . Exercise capacity and the risk of death in women: the St James Women Take Heart Project. Circulation. 2003; 108(13):1554-9. DOI: 10.1161/01.CIR.0000091080.57509.E9. View

Al-Mallah M, Keteyian S, Brawner C, Whelton S, Blaha M . Rationale and design of the Henry Ford Exercise Testing Project (the FIT project). Clin Cardiol. 2014; 37(8):456-61. PMC: 6649579. DOI: 10.1002/clc.22302. View

Rockwood K, Howlett S, MacKnight C, Beattie B, Bergman H, Hebert R . Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging. J Gerontol A Biol Sci Med Sci. 2005; 59(12):1310-7. DOI: 10.1093/gerona/59.12.1310. View

10.

Drygas W, Jegler A, KUNSKI H . Study on threshold dose of physical activity in coronary heart disease prevention. Part I. Relationship between leisure time physical activity and coronary risk factors. Int J Sports Med. 1988; 9(4):275-8. DOI: 10.1055/s-2007-1025021. View

11.

Schwartz J, Katz S, Fegley R, Tockman M . Sex and race differences in the development of lung function. Am Rev Respir Dis. 1988; 138(6):1415-21. DOI: 10.1164/ajrccm/138.6.1415. View

12.

Harms C . Does gender affect pulmonary function and exercise capacity?. Respir Physiol Neurobiol. 2006; 151(2-3):124-31. DOI: 10.1016/j.resp.2005.10.010. View

13.

Weltman A, Weltman J, Hartman M, Abbott R, Rogol A, Evans W . Relationship between age, percentage body fat, fitness, and 24-hour growth hormone release in healthy young adults: effects of gender. J Clin Endocrinol Metab. 1994; 78(3):543-8. DOI: 10.1210/jcem.78.3.8126124. View

14.

Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R, RODAHL K . Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med. 1993; 328(8):533-7. DOI: 10.1056/NEJM199302253280803. View

15.

. Prevalence of regular physical activity among adults--United States, 2001 and 2005. MMWR Morb Mortal Wkly Rep. 2007; 56(46):1209-12. View

16.

Singh-Manoux A, Gueguen A, Ferrie J, Shipley M, Martikainen P, Bonenfant S . Gender differences in the association between morbidity and mortality among middle-aged men and women. Am J Public Health. 2008; 98(12):2251-7. PMC: 2636514. DOI: 10.2105/AJPH.2006.107912. View

17.

Shiroma E, Lee I . Physical activity and cardiovascular health: lessons learned from epidemiological studies across age, gender, and race/ethnicity. Circulation. 2010; 122(7):743-52. DOI: 10.1161/CIRCULATIONAHA.109.914721. View

18.

Crimmins E, Kim J, Sole-Auro A . Gender differences in health: results from SHARE, ELSA and HRS. Eur J Public Health. 2010; 21(1):81-91. PMC: 3023013. DOI: 10.1093/eurpub/ckq022. View

19.

Wang C, Haskell W, Farrell S, LaMonte M, Blair S, Curtin L . Cardiorespiratory fitness levels among US adults 20-49 years of age: findings from the 1999-2004 National Health and Nutrition Examination Survey. Am J Epidemiol. 2010; 171(4):426-35. DOI: 10.1093/aje/kwp412. View

20.

Mora S, Redberg R, Cui Y, Whiteman M, Flaws J, Sharrett A . Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinics prevalence study. JAMA. 2003; 290(12):1600-7. DOI: 10.1001/jama.290.12.1600. View