The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access published online on February 4, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, doi:10.1093/gerona/gln039
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Fitness and Fatness as Mortality Predictors in Healthy Older Men: The Veterans Exercise Testing Study
1 Department of Human Performance and Sport Sciences, Winston-Salem State University, North Carolina
2 Cardiology Division, VA Palo Alto Health Care System/Stanford University, California
Address correspondence to Jesse Pittsley, PhD, Department of Human Performance and Sport Sciences, Winston-Salem State University, 02A Old Nursing Building, 601 S. Martin Luther King Jr Drive, Winston-Salem, NC 27110. Email: pittsleyj{at}wssu.edu
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Abstract |
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Background.: Low body mass index (BMI) and low cardiorespiratory fitness (CRF) are independently associated with increased mortality in the elderly. However, interactions among BMI, CRF, and mortality in older persons have not been adequately explored.
Methods.: Hazard ratios (HRs) were calculated for predetermined strata of BMI and CRF. Independent and joint associations of CRF, BMI, and all-cause mortality were assessed by Cox proportional hazards analyses in a prospective cohort of 981 healthy men aged at least 65 years (mean age [±SD], 71 [±5] years; range, 65–88 years) referred for exercise testing during 1987–2003.
Results.: During a mean follow-up of 6.9 ± 4.4 years, a total of 208 patients died. Multivariate relative risks (95% confidence interval [CI]) of mortality across BMI groups of <20.0, 20.0–25.0, 25.0–29.9, 30.0–34.9, and 
35.0 were 2.51 (1.26–4.98), 1.0 (reference), 0.66 (0.48–0.90), 0.50 (0.31–0.78), and 0.44 (0.20–0.97), respectively, and across CRF groups of <5.0, 5.0–8.0, and >8.0 metabolic equivalents were 1.0 (reference), 0.56 (0.40–0.78), and 0.39 (0.26–0.58), respectively. In a separate analysis of within-strata CRF according to BMI grouping, the lowest mortality risk was observed in obese men with high fitness (HR [95% CI] 0.26 [0.10–0.69]; p = .007).
Conclusions.: In this cohort of elderly male veterans, we observed independent and joint inverse relations of BMI and CRF to mortality. This warrants further investigation of fitness, fatness, and mortality interactions in older persons.
Keywords Cardiorespiratory fitness; Body mass index; Mortality; Obesity paradox
Received: January 17, 2008; Accepted: August 17, 2008