Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults

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Slide 1 : Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults Xuemei Sui, Michael J. LaMonte, James N. Laditka, James W. Hardin, Nancy Chase, Steven P. Hooker & Steven N. Blair Sui X et al, JAMA. 2007;298(21):2507-2516.
Slide 2 : Aerobics Center Longitudinal Study (Cooper Clinic, Dallas, TX) – 13,344 Middle-aged Patients: 8 year follow-up All-cause mortality Blair SN et al, JAMA 1989 Fitness:
Slide 3 : Cumulative Survival By Exercise Capacity among Men Myers J et al. N Engl J Med 2002 6,213 consecutive men referred for exercise testing Age:59±11 yrs Follow-up: 6.2 years 1,256 Deaths
Slide 4 : Associations between body composition, anthropometry and mortality in women Dolan CM et al. Am J Public Health 2007 8,029 women (= 65 years) Exposures: BMI, waist girth, lean mass, fat mass, percent body fat Follow-up: 8 years 945 Deaths
Slide 5 : Obesity, Physical Activity, and Mortality in an Elderly Cohort Adjusted HR* *adjusted for age, sex, education, ever-drinking alcohol, ever smoking, PA **adjusted for age, sex, education, ever-drinking alcohol, ever smoking, BMI P for linear trend<0.001 Schooling CM et al, Arch Intern Med, 2006 Body Mass Index Physical Activity (m/d) Adjusted HR** P for linear trend<0.001 54,088 older adults (= 65 years) Exposures: BMI, and self-reported physical activity Follow-up: 4.1 years 3,819 Deaths
Slide 6 : Background Inactivity and excessive body weight are major public health problems. Cardiorespiratory fitness (fitness), an objective reproducible measure that reflects the function consequences of recent physical activity habits, diasese status, and genetics, has been found to predict mortality.
Slide 7 : Background (con) However no study has been conducted on the independent and joint associations among fitness, various clinical measures of adiposity, and mortality in older women and men. The purpose of this study was to examine these associations in a cohort of older adults enrolled in the ACLS.
Slide 8 : Methods The study sample consisted of 2,087 men and 516 women aged 60 and older who completed a baseline clinical examination between 1979 and 2001 at the Cooper Clinic (Dallas, TX). Inclusion criteria: a maximal treadmill test at baseline, during which they must have achieved at least 85% of their age-predicted maximal heart rate (220 minus age in years) Exclusion criteria: BMI<18.5 at baseline and those younger than 60 years All-cause death was the primary outcome and was verified with the National Death Index. Participants were followed up for a mean of 12.0 years ± 6.4 (standard deviation), with a range of 0.2-24.6 years.
Slide 9 : Baseline Characteristics According to Vital Status, ACLS, 1979-2003 <0.001 8±2 9±2 Maximal Metabolic Equivalents (METs) 0.29 26±4 26±4 Body Mass Index (kg/m2) Decedents N=450 Survivors N=2,153 <0.001 12 22 Female Gender (%) <0.001 66±5 64±5 Age (in years) Sui X et al, JAMA 2007 0.98 90±23 90±19 Waist circumference (in cm) <0.001 34 41 Hypercholesterolemia (%) <0.001 55 46 Hypertension (%) 0.17 12 10 Diabetes Mellitus (%) <0.001 13 8 Current Smoker (%) <0.001 31 24 Metabolic syndrome (%) 0.76 25 25 Physically Inactive (%) <0.001 28 19 Abnormal ECG during exercise (%) <0.001 10 4 Cardiovascular disease (%) <0.001 11±5 13±5 Treadmill Time (in minutes) 0.67 27±6 27±5 Percent body fat 0.89 59±9 58±10 Fat-free mass (in kg) P Value
Slide 10 : Risk of All-cause Mortality Rates Across Adiposity and Fitness Exposure Groups in Older Adults
Slide 11 : Body Mass Index and All-cause Mortality Rates in Adults 60+, ACLS (N=2,603) Death rate*/1,000 person-years *Rates adjusted for age, sex and exam year Deaths 192 196 50 12 P for quadratic trend=0.01 Sui X et al, JAMA 2007 Body Mass Index
Slide 12 : Waist Circumference and All-cause Mortality Rates in Adults 60+, ACLS (N=2,603) Death rate*/1,000 person-years *Rates adjusted for age, sex and exam year Deaths 335 115 P for difference =0.004 Sui X et al, JAMA 2007 Waist Circumference (cm)
Slide 13 : Percent Body Fat and All-cause Mortality Rates in Adults 60+, ACLS (N=2,603) Death rate*/1,000 person-years *Rates adjusted for age, sex and exam year Deaths 180 262 P for difference =0.51 Sui X et al, JAMA 2007 Percent Body Fat
Slide 14 : Fat-free Mass and All-cause Mortality Rates in Adults 60+, ACLS (N=2,603) Death rate*/1,000 person-years *Rates adjusted for age, sex and exam year Deaths 72 111 95 83 81 P for linear trend=0.10 Sui X et al, JAMA 2007 Fat-free Mass (kg) Quintiles
Slide 15 : Fitness and All-cause Mortality Rates in Adults 60+, ACLS (N=2,603) Death rate*/1,000 person-years *Rates adjusted for age, sex and exam year Deaths 106 98 95 90 61 P for linear trend<0.001 Sui X et al, JAMA 2007 Fitness quintiles based on treadmill time (minutes)
Slide 16 : Independent Association between Fitness and Risk of All-cause Mortality in Older Adults
Slide 17 : Adjusted HRs by Fitness Quintiles for All-cause Mortality in Adults 60+, ACLS (N=2,603) Adjusted HR Model 1 adjusted for age, sex, exam year, smoking, abnormal exercise ECG responses, and baseline health conditions (CVD, HTN, DM, and hypercholesterolemia, present or not for each); Model 2 adjusted for covariates listed for model 1 plus BMI; Model 3 adjusted for covariates listed for model 1 plus waist circumference; Model 4 adjusted for covariates listed for model 1 plus percent body fat; Model 5 adjusted for covariates listed for model 1 plus fat-free mass. All P for linear trend. P<0.001 P<0.001 P<0.001 P<0.001 P<0.001 Sui X et al, JAMA 2007 Fitness Quintiles:
Slide 18 : Independent Association between Various Adiposity Measures and Risk of All-cause Mortality in Older Adults
Slide 19 : Adjusted HRs by BMI Groups for All-cause Mortality in Adults 60+, ACLS (N=2,603) Adjusted HR Model 1 adjusted for age, sex, exam year, smoking, abnormal exercise ECG responses, and baseline health conditions (CVD, HTN, DM, and hypercholesterolemia, present or not for each); Model 2 adjusted for covariates listed for model 1 plus fitness. All P for quadratic trend. P<0.004 P<0.005 Sui X et al, JAMA 2007 BMI:
Slide 20 : Adjusted HRs by Waist Circumference Groups for All-cause Mortality in Adults 60+, ACLS (N=2,603) Adjusted HR Model 1 adjusted for age, sex, exam year, smoking, abnormal exercise ECG responses, and baseline health conditions (CVD, HTN, DM, and hypercholesterolemia, present or not for each); Model 2 adjusted for covariates listed for model 1 plus fitness. P=0.05 P=0.95 Sui X et al, JAMA 2007 WC:
Slide 21 : Adjusted HRs by Percent Body Fat Groups for All-cause Mortality in Adults 60+, ACLS (N=2,603) Adjusted HR Model 1 adjusted for age, sex, exam year, smoking, abnormal exercise ECG responses, and baseline health conditions (CVD, HTN, DM, and hypercholesterolemia, present or not for each); Model 2 adjusted for covariates listed for model 1 plus fitness. P=0.78 P=0.07 Sui X et al, JAMA 2007 Percent Body Fat:
Slide 22 : Adjusted HRs by Fat-free Mass Groups for All-cause Mortality in Adults 60+, ACLS (N=2,603) Adjusted HR Model 1 adjusted for age, sex, exam year, smoking, abnormal exercise ECG responses, and baseline health conditions (CVD, HTN, DM, and hypercholesterolemia, present or not for each); Model 2 adjusted for covariates listed for model 1 plus fitness. All P for linear trend. P=0.36 P=0.91 Sui X et al, JAMA 2007 Fat-free Mass Quintiles:
Slide 23 : Joint Association of Fitness and Adiposity Measures with All-cause Mortality in Older Adults
Slide 24 : 18.5-24.9 25.0-29.9 30.0-34.9 =35.0 P<0.001 P<0.001 P=0.46 P=0.05 Body Mass Index 158 152 32 10 2 18 44 34 Interaction: P=0.82 Joint Association of Fitness and Body Mass Index with All-cause Mortality Rates P**=0.004 P*=0.26 *Death rates were adjusted for age, sex, and exam year **P for quadratic trend across BMI categories Sui X et al, JAMA 2007
Slide 25 : Normal Abdominal obesity P<0.001 P<0.001 Waist Circumference (cm) 274 70 45 61 Interaction: P=0.24 Joint Association of Fitness and Waist Circumference with All-cause Mortality Rates Sui X et al, JAMA 2007 *Death rates were adjusted for age, sex, and exam year
Slide 26 : Normal Obese P<0.001 P<0.001 Percent Body Fat 151 190 72 29 Interaction: P=0.84 Joint Association of Fitness and Percent Body Fat with All-cause Mortality Rates Sui X et al, JAMA 2007 *Death rates were adjusted for age, sex, and exam year
Slide 27 : Conclusions In this prospective study of adults 60 years or older, low fitness predicted higher risk of all-cause mortality after adjustment for potential confounding factors, including adiposity. Fit individuals had greater longevity than unfit individuals, regardless of their body composition or fat distribution. Sui X et al, JAMA 2007
Slide 28 : Implications A greater fitness level through regular physical activity may reduce the excess mortality in older persons, including those who are obese. Our study findings provide support for the current national and international physical activity promotion campaigns by public health organizations. Older adults should strive to obtain at least 30 minutes of walking on at least 5 days of the week, or other equivalent activity. Sui X et al, JAMA 2007

 


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