A1 Journal article (refereed)
Prognostic Relevance of Cardiorespiratory Fitness as Assessed by Submaximal Exercise Testing for All-Cause Mortality : A UK Biobank Prospective Study (2020)


Laukkanen, Jari A.; Kunutsor, Setor K.; Yates, Thomas; Willeit, Peter; Kujala, Urho M.; Khan, Hassan; Zaccardi, Francesco (2020). Prognostic Relevance of Cardiorespiratory Fitness as Assessed by Submaximal Exercise Testing for All-Cause Mortality : A UK Biobank Prospective Study. Mayo Clinic Proceedings, 95 (5), 867-878. DOI: 10.1016/j.mayocp.2019.12.030


JYU authors or editors


Publication details

All authors or editors: Laukkanen, Jari A.; Kunutsor, Setor K.; Yates, Thomas; Willeit, Peter; Kujala, Urho M.; Khan, Hassan; Zaccardi, Francesco

Journal or series: Mayo Clinic Proceedings

ISSN: 0025-6196

eISSN: 1942-5546

Publication year: 2020

Volume: 95

Issue number: 5

Pages range: 867-878

Publisher: Elsevier; Mayo Foundation for Medical Education and Research

Publication country: United States

Publication language: English

DOI: https://doi.org/10.1016/j.mayocp.2019.12.030

Open Access: Publication channel is not openly available


Abstract

Objective

To investigate whether the inverse associations of cardiorespiratory fitness (CRF) with all-cause and cardiovascular mortality in the general population vary among individuals who are at different levels of pretest risk.

Patients and Methods
Cardiorespiratory fitness was assessed through submaximal bicycle tests in 58,892 participants aged 40 to 69 years who completed baseline questionnaires between January 1, 2006, and December 31, 2010, in the UK Biobank Prospective Study. Participants were categorized into risk categories, which determined allocation to an individualized bicycle protocol. The groups at minimal risk (category 1), small risk (category 2), and medium risk (category 3) were tested at 50%, 35% of the predicted maximal workload, and constant level, respectively. We investigated associations of CRF with mortality across different levels of pretest risk and determined whether CRF improves risk prediction.

Results
During a median follow-up of 5.8 years, 936 deaths occurred. Cardiorespiratory fitness was linearly associated with mortality risk. Comparing extreme fifths of CRF, the multivariable-adjusted hazard ratios (95% CIs) for mortality were 0.63 (0.52-0.77), 0.54 (0.36-0.82), 0.81 (0.46-1.43), and 0.58 (0.48-0.69) in categories 1, 2, and 3 and overall population, respectively. The addition of CRF to a 5-year mortality risk score containing established risk factors was associated with a C-index change (0.0012; P=.49), integrated discrimination improvement (0.0005; P<.001), net reclassification improvement (+0.0361; P=.005), and improved goodness of fit (likelihood ratio test, P<.001). Differences in 5-year survival were more pronounced across levels of age, smoking status, and sex.

Conclusion
Cardiorespiratory fitness, assessed by submaximal exercise testing, improves mortality risk prediction beyond conventional risk factors and its prognostic relevance varies across cardiovascular risk levels.


Keywords: mortality; forecasts; risk factors; physical fitness; fitness tests


Contributing organizations


Ministry reporting: Yes

Reporting Year: 2020


Last updated on 2020-09-07 at 23:12