Blair S N, Kampert J B, Kohl H W, Barlow C E, Macera C A, Paffenbarger R S, Gibbons L W
Cooper Institute for Aerobics Research, Dallas, Tex 75230, USA.
JAMA. 1996 Jul 17;276(3):205-10.
To quantify the relation of cardiorespiratory fitness to cardiovascular disease (CVD) mortality and to all-cause mortality within strata of other personal characteristics that predispose to early mortality. DESIGN--Observational cohort study. We calculated CVD and all-cause death rates for low (least fit 20%), moderate (next 40%), and high (most fit 40%) fitness categories by strata of smoking habit, cholesterol level, blood pressure, and health status.
Preventive medicine clinic.
Participants were 25341 men and 7080 women who completed preventive medical examinations, including a maximal exercise test.
Cardiovascular disease and all-cause mortality.
There were 601 deaths during 211996 man-years of follow-up, and 89 deaths during 52982 woman-years of follow-up. Independent predictors of mortality among men, with adjusted relative risks (RRs) and 95% confidence intervals (CIs), were low fitness (RR, 1.52;95% CI, 1.28-1.82), smoking (RR, 1.65; 95% CI, 1.39-1.97), abnormal electrocardiogram (RR, 1.64;95% CI, 1.34-2.01), chronic illness (RR, 1.63;95% CI, 1.37-1.95), increased cholesterol level (RR, 1.34; 95% CI, 1.13-1.59), and elevated systolic blood pressure (RR, 1.34; 95% CI, 1.13-1.59). The only statistically significant independent predictors of mortality in women were low fitness (RR, 2.10; 95% Cl, 1.36-3.21) and smoking (RR, 1.99; 95% Cl, 1.25-3.17). Inverse gradients were seen for mortality across fitness categories within strata of other mortality predictors for both sexes. Fit persons with any combination of smoking, elevated blood pressure, or elevated cholesterol level had lower adjusted death rates than low-fit persons with none of these characteristics.
Low fitness is an important precursor of mortality. The protective effect of fitness held for smokers and nonsmokers, those with and without elevated cholesterol levels or elevated blood pressure, and unhealthy and healthy persons. Moderate fitness seems to protect against the influence of these other predictors on mortality. Physicians should encourage sedentary patients to become physically active and thereby reduce the risk of premature mortality.
量化心血管适能与心血管疾病（CVD）死亡率以及在其他易导致过早死亡的个人特征分层中的全因死亡率之间的关系。
设计——观察性队列研究。我们按吸烟习惯、胆固醇水平、血压和健康状况分层，计算了低（最不适能的20%）、中（接下来的40%）、高（最适能的40%）适能类别的心血管疾病和全因死亡率。
预防医学诊所。
25341名男性和7080名女性参与者完成了包括最大运动测试在内的预防性医学检查。
心血管疾病和全因死亡率。
在211996人年的男性随访期间有601例死亡，在52982人年的女性随访期间有89例死亡。男性中死亡率的独立预测因素，经调整的相对风险（RRs）和95%置信区间（CIs）分别为：低适能（RR，1.52；95%CI，1.28 - 1.82）、吸烟（RR，1.65；95%CI，1.39 - 1.97）、心电图异常（RR，1.64；95%CI，1.34 - 2.01）、慢性病（RR，1.63；95%CI，1.37 - 1.95）、胆固醇水平升高（RR，1.34；95%CI，1.13 - 1.59）以及收缩压升高（RR，1.34；95%CI，1.13 - 1.59）。女性中唯一具有统计学意义的死亡率独立预测因素是低适能（RR，2.10；95%CI，1.36 - 3.21）和吸烟（RR，1.99；95%CI，1.25 - 3.17）。在其他死亡率预测因素分层中，男女在不同适能类别间的死亡率均呈现相反梯度。具有吸烟、血压升高或胆固醇水平升高任意组合的适能者，其调整后的死亡率低于无这些特征的低适能者。
低适能是死亡率的重要先兆。适能对吸烟者和非吸烟者、胆固醇水平或血压升高与否者以及不健康和健康者均有保护作用。中等适能似乎可抵御这些其他预测因素对死亡率的影响。医生应鼓励久坐不动的患者进行体育锻炼，从而降低过早死亡的风险。
