創新與創業精神個案分享趨勢科技專家服務

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This study examined the association between cardiorespiratory fitness, adiposity, and mortality in older adults. It found that higher fitness levels were associated with lower mortality rates regardless of body composition. Specifically, even obese individuals had lower mortality if they were fit compared to unfit normal-weight or lean individuals. The study also found a J-shaped relationship between BMI and mortality both before and after adjusting for fitness levels.

Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults JAMA December 5, 2007

Background 32% of Americans are obese Obesity is associated with a number of health problems Vast majority of people do not exercise These trends worsen with aging There is little data regarding associations among obesity, physical activity and mortality What is more important, fat or fitness?

Methods Objective: determine the association among cardiorespiratory fitness, adiposity and mortality on older adults Cohort Study: prospective study of 2,603 adults > 60 yrs Had to achieve 85% HR on treadmill test to be included Patients grouped into quintiles based on duration of test Also grouped by BMI, waist circumference, body fat % and fat free mass Patients completed a comprehensive health evaluation, physical exam, blood lipids and glucose and EKG

Methods Cont. Used METS (metabolic equivalent tasks) based on treadmill speed and grade to standardize interpretation Outcome was all-cause mortality Multivariate analysis performed using age, sex, exam year, smoking, abnormal exercise EKG and chronic medical conditions

Table I - Highlights 20% women BMI and waist circumference was the same for both groups Treadmill time was 2 minutes less in decedents HDL was 4 pts higher in survivors, as was incidence of hypercholesterolemia Smoking was 5% more prevalent in decedents

Table II - Highlights Opposing trend in fitness quintile for lowest and highest BMI groups HDL directly correlated w/ fitness quintile Except in lowest quintile, smoking inversely correlated w/ fitness Except in highest quintile, hypertension and cholesterol directly correlated w/ fitness One BMI > 35 actually made it 18 minutes

Table IV - Highlights J-shaped relationship between BMI and mortality EKG changes, chronic medical conditions and waist circumference correlate w/ mortality Percent body fat and fat free mass did not

Table V Hazard ratios for fitness and adiposity -> results show better fitness = better mortality Initially adjusted for 1) age, sex, EKG changes, smoking, exam year and medical conditions Additional adjustments for 2) BMI, 3) waist circumference, 4) percent body fat and 5) fat-free mass did not change the results

Study Limitations Cohort -> possibility of confounders Homogeneous study group (white, educated, middle and upper class) No info about diet or medication use Fitness tested only once at outset of study Does not really address association between a spot fitness check and daily cardiovascular exercise Small number of women and few deaths within this group

Conclusions Fitness is a strong predictor of overall mortality independent of body composition Assuming an otherwise healthy individual, there is no association betw abdominal obesity and mortality when adjusted for fitness Fit individuals who are obese had lower mortality than unfit normal-weight or lean individuals Fat distribution and frame size may be more important than adiposity There is a J-shaped relationship betw BMI and mortality, both before and after adjusting for fitness

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Exercise or exercise and diet for preventing type 2 dmDiabetes for all

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1. Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults JAMA December 5, 2007

2. Background 32% of Americans are obese Obesity is associated with a number of health problems Vast majority of people do not exercise These trends worsen with aging There is little data regarding associations among obesity, physical activity and mortality What is more important, fat or fitness?

3. Methods Objective: determine the association among cardiorespiratory fitness, adiposity and mortality on older adults Cohort Study: prospective study of 2,603 adults > 60 yrs Had to achieve 85% HR on treadmill test to be included Patients grouped into quintiles based on duration of test Also grouped by BMI, waist circumference, body fat % and fat free mass Patients completed a comprehensive health evaluation, physical exam, blood lipids and glucose and EKG

4. Methods Cont. Used METS (metabolic equivalent tasks) based on treadmill speed and grade to standardize interpretation Outcome was all-cause mortality Multivariate analysis performed using age, sex, exam year, smoking, abnormal exercise EKG and chronic medical conditions

5. Results

6. Table I - Highlights 20% women BMI and waist circumference was the same for both groups Treadmill time was 2 minutes less in decedents HDL was 4 pts higher in survivors, as was incidence of hypercholesterolemia Smoking was 5% more prevalent in decedents

7. Table II - Highlights Opposing trend in fitness quintile for lowest and highest BMI groups HDL directly correlated w/ fitness quintile Except in lowest quintile, smoking inversely correlated w/ fitness Except in highest quintile, hypertension and cholesterol directly correlated w/ fitness One BMI > 35 actually made it 18 minutes

8. Table IV - Highlights J-shaped relationship between BMI and mortality EKG changes, chronic medical conditions and waist circumference correlate w/ mortality Percent body fat and fat free mass did not

9. Table V Hazard ratios for fitness and adiposity -> results show better fitness = better mortality Initially adjusted for 1) age, sex, EKG changes, smoking, exam year and medical conditions Additional adjustments for 2) BMI, 3) waist circumference, 4) percent body fat and 5) fat-free mass did not change the results

10. Study Limitations Cohort -> possibility of confounders Homogeneous study group (white, educated, middle and upper class) No info about diet or medication use Fitness tested only once at outset of study Does not really address association between a spot fitness check and daily cardiovascular exercise Small number of women and few deaths within this group

11. Conclusions Fitness is a strong predictor of overall mortality independent of body composition Assuming an otherwise healthy individual, there is no association betw abdominal obesity and mortality when adjusted for fitness Fit individuals who are obese had lower mortality than unfit normal-weight or lean individuals Fat distribution and frame size may be more important than adiposity There is a J-shaped relationship betw BMI and mortality, both before and after adjusting for fitness

12. FIN

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