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DOES PHYSICAL
FITNESS REDUCE THE RISK OF DEATH? (February 2002) At a time when we are being told the only exercise you need to reduce heart attack risk by 50 percent is a casual, slow-paced walk twice a week, it is well to review a recent article from Finland that examined deaths in relation to cardiac fitness in 1,294 men average age 52 years, followed for almost eleven years. The measurement at baseline was maximal oxygen uptake during exercise. The lowest intensity exercise was the equivalent of brisk walking (one mile every twenty minutes). The highest was the equivalent of pretty fast running. Those who were fittest had a reduced risk of death from heart attack and stroke, cancer, and lung disease. The investigators note that cardiac fitness is as protective as not smoking, having low normal blood pressure, and weight control. Commentary: This is a good study, but the results are based on a relatively small number of deaths (only 42 with heart disease or stroke). Furthermore, cardiac fitness was measured only at baseline, not repeatedly during the long followup period. When men were divided into four groups based on cardiac fitness, it was evident the four groups differed in a lot of ways - smoking, exercise, body mass index, blood pressure, and cholesterol levels. The authors tried to adjust for the differences, but it is not clear they could; therefore, the reduction in deaths in the fittest men could be due, at least in part, to something other than their cardiac fitness. Despite the reservations, the study was well conducted, and the conclusions about heart attacks and strokes are quite consistent with a lot of other studies. Ratings:
When all the studies are taken together, there can be virtually no doubt that vigorous enough exercise to produce heart muscle fitness (cardiac fitness) offers considerable protection against both fatal and non-fatal heart attacks.
for the role of fitness in protecting against deaths from cancer or lung disease. The group doing the least exercise still did the equivalent of brisk walking during the oxygen uptake test. Although this study cannot be compared with those looking at regular brisk (one mile every twenty minutes) or casual (one mile every thirty minutes or slower) walking and heart attack, it still makes you wonder whether the benefits of casual walking are overstated. A sensible position would seem to be - the ideal is to achieve real heart muscle fitness. That requires a lot of vigorous exercise. There is a lot of support for this concept. - next best is moderate exercise - at least forty-five minutes a day several times a week of brisk walking (one mile every twenty minutes or better), or other moderately vigorous activity, such as slow jogging, doubles tennis, heavy yard work. - casual walking one hour two to three times a week may work, but then again, it may not. Laukkanen, J.A., et al. Cardiovascular fitness as a predictor of mortality in men. Archives Internal Medicine. Vol 161 (March 26) Pgs 825-831. 2001.
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