Exercise capacity and mortality – a follow-up study of 3033 subjects referred to clinical exercise testing

Abstract

Background: Exercise stress testing is used as a diagnostic and prognostic tool. We determined the prognostic significance of exercise test findings for cardiovascular (CVD) and all-cause mortality in men and women.

Material and methods: 3033 subjects underwent a symptom-limited bicycle exercise test. Exercise capacity was defined as the mean of last four minutes of exercise workload.

Results: During an average follow-up of 19 years, 186 (11.6%) CVD and 370 (20.6%) all-cause deaths in men and 57 (5.0%) CVD and 155 (12.5%) all-cause deaths in women occurred. Among exercise test variables (workload, ECG, BP, HR), exercise capacity was the strongest predictor of mortality. Low exercise capacity (1st quartile) was associated with a hazard ratio of 4.2 (95% CI: 1.7, 10.8) for CVD and 4.0 (95% CI: 2.5, 6.4) for all-cause mortality compared with high exercise capacity (4th quartile) among men and in women with a 5.4-fold (95% CI: 1.2, 24.0) risk for CVD and 2.3-fold (95% CI: 1.2, 4.3) risk for all-cause mortality, respectively. The relationship between other exercise test variables and mortality was much weaker.

Conclusions: Among exercise test variables exercise capacity was the strongest predictor of CVD and all-cause mortality in both genders, and especially CVD deaths in women.

Key Messages

• Exercise capacity was the most powerful predictor of CVD and all-cause mortality in both men and women.

• Low exercise capacity is a strong predictor of CVD death, especially among women.

Keywords:

• Exercise
• exercise test
• men
• mortality
• physical fitness
• prevention & control
• women

Disclosure statement

The financiers had no control on the conduct or the publication of the study. The authors declare that they have no conflicts of interest regarding this article.

Funding information

This study was funded by the Northern Ostrobothnia Hospital District and Oulu Deaconess Institute.