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Interactive Effects of Aerobic Fitness, Strength, and Obesity on Mortality in Men

Published:November 14, 2016DOI:https://doi.org/10.1016/j.amepre.2016.10.002

      Introduction

      Low aerobic fitness, low muscular strength, and obesity have been associated with premature mortality, but their interactive effects are unknown. This study examined interactions among these common, modifiable factors, to help inform more-effective preventive interventions.

      Methods

      This national cohort study included all 1,547,478 military conscripts in Sweden during 1969–1997 (97%−98% of all men aged 18 years each year). Aerobic fitness, muscular strength, and BMI measurements were examined in relation to all-cause and cardiovascular mortality through 2012 (maximum age, 62 years). Data were collected/analyzed in 2015–2016.

      Results

      Low aerobic fitness, low muscular strength, and obesity at age 18 years were independently associated with higher all-cause and cardiovascular mortality in adulthood. The combination of low aerobic fitness and muscular strength (lowest versus highest tertiles) was associated with twofold all-cause mortality (adjusted hazard ratio=2.01; 95% CI=1.93, 2.08; p<0.001; mortality rates per 100,000 person years, 247.2 vs 73.8), and 2.6-fold cardiovascular mortality (2.63; 95% CI=2.38, 2.91; p<0.001; 43.9 vs 8.3). These factors also had positive additive and multiplicative interactions in relation to all-cause mortality (their combined effect exceeded the sum or product of their separate effects; p<0.001), and were associated with higher mortality even among men with normal BMI.

      Conclusions

      Low aerobic fitness, low muscular strength, and obesity at age 18 years were associated with increased mortality in adulthood, with interactive effects between aerobic fitness and muscular strength. Preventive interventions should begin early in life and include both aerobic fitness and muscular strength, even among those with normal BMI.
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      References

        • Forouzanfar M.H.
        • Alexander L.
        • et al.
        • Global Burden of Disease and Risk Factors Collaborators
        Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2015; 386: 2287-2323https://doi.org/10.1016/S0140-6736(15)00128-2
        • Hallal P.C.
        • Andersen L.B.
        • Bull F.C.
        • et al.
        Global physical activity levels: surveillance progress, pitfalls, and prospects.
        Lancet. 2012; 380: 247-257https://doi.org/10.1016/S0140-6736(12)60646-1
        • Ng M.
        • Fleming T.
        • Robinson M.
        • et al.
        Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2014; 384: 766-781https://doi.org/10.1016/S0140-6736(14)60460-8
        • Lee I.M.
        • Shiroma E.J.
        • Lobelo F.
        • et al.
        Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.
        Lancet. 2012; 380: 219-229https://doi.org/10.1016/S0140-6736(12)61031-9
        • Woodcock J.
        • Franco O.H.
        • Orsini N.
        • Roberts I.
        Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies.
        Int J Epidemiol. 2011; 40: 121-138https://doi.org/10.1093/ije/dyq104
        • Samitz G.
        • Egger M.
        • Zwahlen M.
        Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies.
        Int J Epidemiol. 2011; 40: 1382-1400https://doi.org/10.1093/ije/dyr112
        • Williams P.T.
        Physical fitness and activity as separate heart disease risk factors: a meta-analysis.
        Med Sci Sports Exerc. 2001; 33: 754-761https://doi.org/10.1097/00005768-200105000-00012
        • Swift D.L.
        • Lavie C.J.
        • Johannsen N.M.
        • et al.
        Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention.
        Circ J. 2013; 77: 281-292https://doi.org/10.1253/circj.CJ-13-0007
        • Barry V.W.
        • Baruth M.
        • Beets M.W.
        • et al.
        Fitness vs. fatness on all-cause mortality: a meta-analysis.
        Prog Cardiovasc Dis. 2014; 56: 382-390https://doi.org/10.1016/j.pcad.2013.09.002
        • Sui X.
        • LaMonte M.J.
        • Laditka J.N.
        • et al.
        Cardiorespiratory fitness and adiposity as mortality predictors in older adults.
        JAMA. 2007; 298: 2507-2516https://doi.org/10.1001/jama.298.21.2507
        • 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: 1547-1553https://doi.org/10.1001/jama.282.16.1547
        • Ruiz J.R.
        • Sui X.
        • Lobelo F.
        • et al.
        Association between muscular strength and mortality in men: prospective cohort study.
        BMJ. 2008; 337: a439https://doi.org/10.1136/bmj.a439
        • Ortega F.B.
        • Silventoinen K.
        • Tynelius P.
        • Rasmussen F.
        Muscular strength in male adolescents and premature death: cohort study of one million participants.
        BMJ. 2012; 345: e7279https://doi.org/10.1136/bmj.e7279
        • Volaklis K.A.
        • Halle M.
        • Meisinger C.
        Muscular strength as a strong predictor of mortality: a narrative review.
        Eur J Intern Med. 2015; 26: 303-310https://doi.org/10.1016/j.ejim.2015.04.013
        • Flegal K.M.
        • Kit B.K.
        • Orpana H.
        • Graubard B.I.
        Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.
        JAMA. 2013; 309: 71-82https://doi.org/10.1001/jama.2012.113905
        • Crump C.
        • Sundquist J.
        • Winkleby M.A.
        • Sieh W.
        • Sundquist K.
        Physical fitness among Swedish military conscripts and long-term risk for type 2 diabetes mellitus: a cohort study.
        Ann Intern Med. 2016; 164: 577-584https://doi.org/10.7326/M15-2002
        • Crump C.
        • Sundquist J.
        • Winkleby M.A.
        • Sundquist K.
        Interactive effects of physical fitness and body mass index on the risk of hypertension.
        JAMA Intern Med. 2016; 176: 210-216https://doi.org/10.1001/jamainternmed.2015.7444
        • Crump C.
        • Sundquist J.
        • Winkleby M.A.
        • Sundquist K.
        Interactive effects of physical fitness and body mass index on risk of stroke: a national cohort study.
        Int J Stroke. 2016; 11: 683-694https://doi.org/10.1177/1747493016641961
        • Nordesjo L.
        • Schele R.
        Validity of an ergometer cycle test and measures of isometric muscle strength when predicting some aspects of military performance.
        Swedish J Defence Med. 1974; 10: 11-23
        • Patton J.F.
        • Vogel J.A.
        • Mello R.P.
        Evaluation of a maximal predictive cycle ergometer test of aerobic power.
        Eur J Appl Physiol Occup Physiol. 1982; 49: 131-140https://doi.org/10.1007/BF00428971
        • Andersen K.
        • Rasmussen F.
        • Held C.
        • et al.
        Exercise capacity and muscle strength and risk of vascular disease and arrhythmia in 1.1 million young Swedish men: cohort study.
        BMJ. 2015; 351: h4543https://doi.org/10.1136/bmj.h4543
        • Hook O.
        • Tornvall G.
        Apparatus and method for determination of isometric muscle strength in man.
        Scand J Rehabil Med. 1969; 1: 139-142
        • Ogden C.L.
        • Flegal K.M.
        Changes in terminology for childhood overweight and obesity.
        Natl Health Stat Report. 2010; : 1-5
        • Hoehner C.M.
        • Allen P.
        • Barlow C.E.
        • et al.
        Understanding the independent and joint associations of the home and workplace built environments on cardiorespiratory fitness and body mass index.
        Am J Epidemiol. 2013; 178: 1094-1105https://doi.org/10.1093/aje/kwt111
        • Doubeni C.A.
        • Schootman M.
        • Major J.M.
        • et al.
        Health status, neighborhood socioeconomic context, and premature mortality in the United States: The National Institutes of Health-AARP Diet and Health Study.
        Am J Public Health. 2012; 102: 680-688https://doi.org/10.2105/AJPH.2011.300158
        • Ramsay S.E.
        • Morris R.W.
        • Whincup P.H.
        • et al.
        The influence of neighbourhood-level socioeconomic deprivation on cardiovascular disease mortality in older age: longitudinal multilevel analyses from a cohort of older British men.
        J Epidemiol Community Health. 2015; 69: 1224-1231https://doi.org/10.1136/jech-2015-205542
        • Crump C.
        • Sundquist K.
        • Sundquist J.
        • Winkleby M.A.
        Neighborhood deprivation and psychiatric medication prescription: a Swedish national multilevel study.
        Ann Epidemiol. 2011; 21: 231-237https://doi.org/10.1016/j.annepidem.2011.01.005
        • Rubin D.B.
        Multiple Imputation for Nonresponse in Surveys.
        Wiley, New York1987https://doi.org/10.1002/9780470316696
        • Vanderweele T.J.
        • Knol M.J.
        A tutorial on interaction.
        Epidemiol Methods. 2014; 3: 33-72https://doi.org/10.1515/em-2013-0005
        • Li R.
        • Chambless L.
        Test for additive interaction in proportional hazards models.
        Ann Epidemiol. 2007; 17: 227-236https://doi.org/10.1016/j.annepidem.2006.10.009
        • Knol M.J.
        • Egger M.
        • Scott P.
        • Geerlings M.I.
        • Vandenbroucke J.P.
        When one depends on the other: reporting of interaction in case-control and cohort studies.
        Epidemiology. 2009; 20: 161-166https://doi.org/10.1097/EDE.0b013e31818f6651
        • Greenland S.
        Interactions in epidemiology: relevance, identification, and estimation.
        Epidemiology. 2009; 20: 14-17https://doi.org/10.1097/EDE.0b013e318193e7b5
        • Beaglehole R.
        • Bonita R.
        • Horton R.
        • et al.
        Priority actions for the non-communicable disease crisis.
        Lancet. 2011; 377: 1438-1447https://doi.org/10.1016/S0140-6736(11)60393-0
        • Vuori I.M.
        • Lavie C.J.
        • Blair S.N.
        Physical activity promotion in the health care system.
        Mayo Clin Proc. 2013; 88: 1446-1461https://doi.org/10.1016/j.mayocp.2013.08.020
        • Sallis R.
        • Franklin B.
        • Joy L.
        • et al.
        Strategies for promoting physical activity in clinical practice.
        Prog Cardiovasc Dis. 2015; 57: 375-386https://doi.org/10.1016/j.pcad.2014.10.003
        • Carlson S.A.
        • Fulton J.E.
        • Pratt M.
        • Yang Z.
        • Adams E.K.
        Inadequate physical activity and health care expenditures in the United States.
        Prog Cardiovasc Dis. 2015; 57: 315-323https://doi.org/10.1016/j.pcad.2014.08.002
        • Artero E.G.
        • Lee D.C.
        • Lavie C.J.
        • et al.
        Effects of muscular strength on cardiovascular risk factors and prognosis.
        J Cardiopulm Rehabil Prev. 2012; 32: 351-358https://doi.org/10.1097/HCR.0b013e3182642688
        • DeFina L.F.
        • Haskell W.L.
        • Willis B.L.
        • et al.
        Physical activity versus cardiorespiratory fitness: two (partly) distinct components of cardiovascular health?.
        Prog Cardiovasc Dis. 2015; 57: 324-329https://doi.org/10.1016/j.pcad.2014.09.008
        • Myers J.
        • McAuley P.
        • Lavie C.J.
        • et al.
        Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status.
        Prog Cardiovasc Dis. 2015; 57: 306-314https://doi.org/10.1016/j.pcad.2014.09.011
        • Dyrstad S.M.
        • Aandstad A.
        • Hallen J.
        Aerobic fitness in young Norwegian men: a comparison between 1980 and 2002.
        Scand J Med Sci Sports. 2005; 15: 298-303https://doi.org/10.1111/j.1600-0838.2005.00432.x