Performance on exercise test predicts risk of death from cardiovascular disease and cancer

The study included 12,615 participants with known or suspected coronary artery disease. Participants underwent treadmill exercise echocardiography, in which they were asked to walk or run, gradually increasing the intensity, and continue until exhaustion. The test also generates images of the heart to check its function.

During a median 4.7-year follow-up, there were 1,253 cardiovascular deaths, 670 cancer deaths, and 650 deaths from other causes. After adjusting for age, sex, and other factors that could potentially influence the relationship, each MET (metabolic equivalent)* achieved was independently associated with 9%, 9%, and 4% lower risks of cardiovascular death, cancer death, and other causes of death during follow-up.

The death rate from cardiovascular disease was nearly three times higher in participants with poor compared to good functional capacity (3.2% versus 1.2%, p<0.001). Non-cardiovascular and non-cancer deaths were also nearly three-fold higher in those with poor compared to good functional capacity (1.7% versus 0.6%, p<0.001). Cancer deaths were almost double in participants with poor compared to good functional capacity (1.5% versus 0.8%, p<0.001).

As expected, the imaging part of the examination was predictive of cardiovascular death, but not of deaths caused by cancer or other conditions.

Study author Dr Jesús Peteiro, a cardiologist at University Hospital A Coruña, A Coruña, Spain, said: "Our results provide further evidence of the benefits of exercise and being fit on health and longevity. In addition to keeping body weight down, physical activity has positive effects on blood pressure and lipids, reduces inflammation, and improves the body's immune response to tumours."

Dr Peteiro said people do not need to undergo exercise echocardiography to check their fitness level. "There are much cheaper ways to estimate if you could achieve ten METs on the treadmill test," he said. "If you can walk very fast up three floors of stairs without stopping, or fast up four floors without stopping, you have good functional capacity. If not, it's a good indication that you need more exercise."

ESC guidelines recommend at least 150 minutes a week of moderate aerobic physical activity or 75 minutes a week of vigorous aerobic physical activity, or a combination of the two intensities.2