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Jari A. Laukkanen, MD; Timo A. Lakka, MD, PhD; Rainer Rauramaa, MD, PhD, MSc; Raimo Kuhanen, MSc; Juha M. Venäläinen, MD; Riitta Salonen, MD, PhD; Jukka T. Salonen, MD, PhD, MScPH

Arch Intern Med. 2001;161:825-831.

Objective  To examine the relations of cardiorespiratory fitness, as measured by maximal oxygen uptake and exercise test duration at the initiation of the study, with overall, cardiovascular disease (CVD)–related, and non–CVD-related mortality.

Methods  A population-based cohort study of 1294 men with no CVD, pulmonary disease, or cancer at baseline in Kuopio and surrounding communities in eastern Finland. During an average follow-up of 10.7 years, there were 124 overall, 42 CVD-related, and 82 non–CVD-related deaths.

Results  The relative risk of overall death in unfit men (maximal oxygen uptake <27.6 mL/kg per minute) was 2.76 (95% confidence interval, 1.43-5.33) (P = .002), and the relative risk of CVD-related death was 3.09 (95% confidence interval, 1.10-9.56) (P = .05), compared with fit men (maximal oxygen uptake >37.1 mL/kg per minute) after adjusting for age, examination years, smoking, and alcohol consumption. The relative risk of non–CVD-related death in unfit men was almost the same magnitude as for overall death. Furthermore, adjustment for serum lipid levels, blood pressure, plasma fibrinogen level, diabetes, and fasting serum insulin level did not weaken these associations significantly. Exercise test duration also had a strong inverse relation to overall, CVD-related, and non–CVD-related mortality. Poor cardiorespiratory fitness was comparable with elevated systolic blood pressure, smoking, obesity, and diabetes in importance as a risk factor for mortality.

Conclusions  Cardiorespiratory fitness had a strong, graded, inverse association with overall, CVD-related, and non–CVD-related mortality. Maximal oxygen uptake and exercise test duration represent the strongest predictors of mortality.

From the Research Institute of Public Health (Drs Laukkanen, Lakka, R. Salonen, and J. T. Salonen) and the Department of Community Health and General Practice, University of Kuopio (Drs R. Salonen and J. T. Salonen); Inner Savo Health Center (J. T. Salonen); and the Kuopio Research Institute of Exercise Medicine (Drs Rauramaa and Venäläinen and Mr Kuhanen), Kuopio, Finland.

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