Cardiorespiratory Fitness, Alcohol, and Mortality in Men

The Cooper Center Longitudinal Study
  • Kerem Shuval
    Address correspondence to: Kerem Shuval, PhD, MPH, University of Texas School of Public Health, 6011 Harry Hines Blvd, Dallas TX 75390
    Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas Regional Campus, Dallas, Texas

    Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
    Search for articles by this author
  • Carolyn E. Barlow
    Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas Regional Campus, Dallas, Texas

    University of Texas Southwestern Medical Center at Dallas, The Cooper Institute, Dallas, Texas
    Search for articles by this author
  • Karen G. Chartier
    Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas Regional Campus, Dallas, Texas
    Search for articles by this author
  • Kelley Pettee Gabriel
    Austin Regional Campus, Austin, Texas
    Search for articles by this author


      Studies have found that higher levels of cardiorespiratory fitness and light to moderate alcohol intake reduce the risk for premature death. Scant evidence, however, exists assessing the joint effects of both measures on all-cause and cardiovascular disease (CVD) mortality.


      This study aims to examine the independent and joint effects of alcohol consumption and cardiorespiratory fitness on all-cause and cardiovascular-related mortality in a large cohort of men.


      This prospective study included 29,402 men who came to the Cooper Clinic (Dallas, TX) for a preventive medicine visit from 1973 to 2006. Data were analyzed in 2011. The primary exposure variables were tertiles of cardiorespiratory fitness and four categories of alcohol consumption, and the outcomes were all-cause and CVD mortality. Cox proportional hazards regression was used to model the association between alcohol intake, cardiorespiratory fitness, and all-cause and CVD mortality, controlling for potential confounders.


      A total of 1830 (all-cause) and 523 (CVD) deaths occurred in men over an average follow-up period of 17.4 years (SD=9.1). A linear relationship was observed (p<0.001) between increased fitness and reduced all-cause and CVD mortality. Specifically, moderate and high levels of fitness reduced the risk for all-cause mortality (HR=0.67, 95% CI=0.60, 0.74, and HR=0.57, 95% CI=0.49, 0.67, respectively) and CVD mortality in comparison to the low-fitness reference group (HR=0.70, 95% CI=0.57, 0.85; HR=0.54, 95% CI=0.40, 0.75, respectively), while controlling for alcohol intake and other covariates. A significant curvilinear relationship was found (p=0.01) between alcohol intake and all-cause mortality (but not CVD mortality), while controlling for fitness and other covariates. In a categoric examination of alcohol intake and mortality, adjusting for fitness and other confounders, there was no statistically significant effect of light drinking compared to heavy drinking on all-cause mortality or CVD mortality. An examination of the joint effects of fitness and alcohol on all-cause mortality showed that moderate and high fitness levels were protective against mortality irrespective of alcohol consumption levels. Few significant combined effects for CVD mortality reduction were found.


      Alcohol consumption did not significantly modify the association between fitness and mortality in this large cohort of men.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Blair S.N.
        • Kohl III, H.W.
        • Paffenbarger Jr, R.S.
        • Clark D.G.
        • Cooper K.H.
        • Gibbons L.W.
        Physical fitness and all-cause mortality: a prospective study of healthy men and women.
        JAMA. 1989; 262: 2395-2401
        • Wei M.
        • Kampert J.B.
        • Barlow C.E.
        • et al.
        Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men.
        JAMA. 1999; 282: 1547-1553
        • Thompson A.M.
        • Church T.S.
        • Janssen I.
        • Katzmarzyk P.T.
        • Earnest C.P.
        • Blair S.N.
        Cardiorespiratory fitness as a predictor of cancer mortality among men with pre-diabetes and diabetes.
        Diabetes Care. 2008; 31: 764-769
        • Farrell S.W.
        • Cortese G.M.
        • LaMonte M.J.
        • Blair S.N.
        Cardiorespiratory fitness, different measures of adiposity, and cancer mortality in men.
        Obesity (Silver Spring). 2007; 15: 3140-3149
        • Physical Activity Guidelines Advisory Committee
        Physical Activity Guidelines Advisory Committee report, 2008.
        DHHS, Washington DC2008
        • Kodama S.
        • Saito K.
        • Tanaka S.
        • et al.
        Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis.
        JAMA. 2009; 301: 2024-2035
        • Sasaki S.
        Alcohol and its relation to all-cause and cardiovascular mortality.
        Acta Cardiol. 2000; 55: 151-156
        • Gronbaek M.
        Alcohol, type of alcohol, and all-cause and coronary heart disease mortality.
        Ann N Y Acad Sci. 2002; 957: 16-20
        • Gmel G.
        • Gutjahr E.
        • Rehm J.
        How stable is the risk curve between alcohol and all-cause mortality and what factors influence the shape?.
        Eur J Epidemiol. 2003; 18: 631-642
        • Batty G.D.
        • Lewars H.
        • Emslie C.
        • Gale C.R.
        • Hunt K.
        Internationally recognized guidelines for “sensible” alcohol consumption: is exceeding them actually detrimental to health and social circumstances?.
        J Public Health (Oxf). 2009; 31: 360-365
        • Mukamal K.J.
        • Chen C.M.
        • Rao S.R.
        • Breslow R.A.
        Alcohol consumption and cardiovascular mortality among U.S. adults, 1987 to 2002.
        J Am Coll Cardiol. 2010; 55: 1328-1335
        • Ronksley P.E.
        • Brien S.E.
        • Turner B.J.
        • Mukamal K.J.
        • Ghali W.A.
        Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis.
        BMJ. 2011; 342: d671
        • Mukamal K.J.
        • Chiuve S.E.
        • Rimm E.B.
        Alcohol consumption and risk for coronary heart disease in men with healthy lifestyles.
        Arch Intern Med. 2006; 166: 2145-2150
        • Joosten M.M.
        • Grobbee D.E.
        • van der A.D.
        • Verschuren W.M.
        • Hendriks H.F.
        • Beulens J.W.
        Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes.
        Am J Clin Nutr. 2010; 91: 1777-1783
        • LaMonte M.J.
        • Barlow C.E.
        • Jurca R.
        • Kampert J.B.
        • Church T.S.
        • Blair S.N.
        Cardiorespiratory fitness is inversely associated with the incidence of metabolic syndrome: a prospective study of men and women.
        Circulation. 2005; 112: 505-512
        • Pollock M.L.
        • Bohannon R.L.
        • Cooper K.H.
        • et al.
        A comparative analysis of four protocols for maximal treadmill stress testing.
        Am Heart J. 1976; 92: 39-46
        • Barlow C.E.
        • FitzGerald S.J.
        • Kampert J.B.
        • Perrin J.L.
        • Blair S.N.
        Cardiorespiratory fitness is an independent predictor of hypertension incidence among initially normotensive healthy women.
        Am J Epidemiol. 2006; 163: 142-150
        • Wei M.
        • Gibbons L.W.
        • Mitchell T.L.
        • Kampert J.B.
        • Blair S.N.
        Alcohol intake and incidence of type 2 diabetes in men.
        Diabetes Care. 2000; 23: 18-22
        • DHHS and U.S. Department of Agriculture
        Dietary Guidelines for Americans, 2005.
        6th ed. U.S. Government Printing Office, Washington DC2005
        • Church T.S.
        • LaMonte M.J.
        • Barlow C.E.
        • Blair S.N.
        Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes.
        Arch Intern Med. 2005; 165: 2114-2120
        • Myers J.
        • Prakash M.
        • Froelicher V.
        • Do D.
        • Partington S.
        • Atwood J.E.
        Exercise capacity and mortality among men referred for exercise testing.
        N Engl J Med. 2002; 346: 793-801
        • Lee D.C.
        • Artero E.G.
        • Sui X.
        • Blair S.N.
        Mortality trends in the general population: the importance of cardiorespiratory fitness.
        J Psychopharmacol. 2010; 24: 27-35
        • Blair S.N.
        • Kampert J.B.
        • Kohl H.W.
        • et al.
        Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women.
        JAMA. 1996; 276: 205-210
        • Rimm E.B.
        • Williams P.
        • Fosher K.
        • Criqui M.
        • Stampfer M.J.
        Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors.
        BMJ. 1999; 319: 1523-1528
        • Howie E.K.
        • Sui X.
        • Lee D.C.
        • Hooker S.P.
        • Hebert J.R.
        • Blair S.N.
        Alcohol consumption and risk of all-cause and cardiovascular disease mortality in men.
        J Aging Res. 2011; 2011: 805062
        • Pedersen J.O.
        • Heitmann B.L.
        • Schnohr P.
        • Gronbaek M.
        The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality.
        Eur Heart J. 2008; 29: 204-212
        • Pettee Gabriel K.
        • Morrow Jr, J.R.
        • Woolsey A.
        Framework for physical activity as a complex and multidimensional behavior.
        J Phys Act Health. 2012; 9: S11-S18
        • Rehm J.
        • Room R.
        • Graham K.
        • Monteiro M.
        • Gmel G.
        • Sempos C.T.
        The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview.
        Addiction. 2003; 98: 1209-1228