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Sudhir Kurl, MD; Jari A. Laukkanen, MD; Rainer Rauramaa, MD, PhD, MSc; Timo A. Lakka, MD, PhD; Juhani Sivenius, MD, PhD; Jukka T. Salonen, MD, PhD, MScPH

Arch Intern Med. 2003;163:1682-1688.

Background  Low cardiorespiratory fitness is considered to be a major public health problem. We examined the relationship of cardiorespiratory fitness, as indicated by maximum oxygen consumption (O₂max) with subsequent incidence of stroke. We also compared O₂max with conventional risk factors as a predictor for future strokes.

Methods  Population-based cohort study with an average follow-up of 11 years from Kuopio and surrounding communities of eastern Finland. Of 2011 men with no stroke or pulmonary disease at baseline who participated in the study, 110 strokes occurred, of which 87 were ischemic. The O₂max was measured directly during exercise testing at baseline.

Results  The relative risk for any stroke in unfit men (O₂max, <25.2 mL/kg per minute) was 3.2 (95% confidence interval [CI], 1.71-6.12; P<.001; P<.001 for the trend across the quartiles); and for ischemic stroke, 3.50 (95% CI, 1.66-7.41; P = .001; P<.001 for trend across the quartiles), compared with fit men (O₂max, >35.3 mL/kg per minute), after adjusting for age and examination year. The associations remained statistically significant after further adjustment for smoking, alcohol consumption, socioeconomic status, energy expenditure of physical activity, prevalent coronary heart disease, diabetes, systolic blood pressure, and serum low-density lipoprotein cholesterol level for any strokes or ischemic strokes. Low cardiorespiratory fitness was comparable with systolic blood pressure, obesity, alcohol consumption, smoking, and serum low-density lipoprotein cholesterol level as a risk factor for stroke.

Conclusions  Our findings show that low cardiorespiratory fitness was associated with an increased risk for any stroke and ischemic stroke. The O₂max was one of the strongest predictors of stroke, comparable with other modifiable risk factors.

From the Research Institute of Public Health (Drs Kurl, Laukkanen, Lakka, and Salonen) and the Kuopio Research Institute of Exercise Medicine and Department of Physiology (Drs Laukkanen, Rauramaa, and Lakka), University of Kuopio, the Department of Clinical Physiology and Nuclear Medicine (Dr Rauramaa), and the Department of Neurology and Brain Research and Rehabilitation Centre Neuron (Dr Sivenius), University Hospital of Kuopio, Kuopio, Finland; and the Inner Savo Health Centre, Suonenjoki, Finland (Dr Salonen). The authors have no relevant financial interest in this article.

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