Dose-response associations of cardiorespiratory fitness with all-cause mortality and incidence and mortality of cancer and cardiovascular and respiratory diseases: the UK Biobank cohort study

Abstract

Objective: To investigate the association of cardiorespiratory fitness with all-cause mortality, and cardiovascular, respiratory, COPD and cancer mortality and incidence. Design: Prospective population based study. Setting: UK Biobank. Participants: Of the 502,628 (5.5% response rate) participants recruited by UK Biobank, we included 73,259 (14.6%) participants with available data in this analysis. Of these, 1,374 participants died and 4,210 developed circulatory diseases, 1,293 respiratory diseases and 4,281 cancer, over a median of 5.0 years [IQR 4.3–5.7] follow-up. Main outcome measures - All-cause mortality and circulatory disease, respiratory disease, chronic obstructive e pulmonary disease (COPD) and cancer (any-type, colorectal, lung, breast and prostate) mortality/incidence. Fitness was estimated with a submaximal cycle ergometer test. Results: The hazard ratio for all-cause mortality for each MET higher fitness was 0.96 ([95% CI 0.93–0.98]). Similar results were observed for incident circulatory (HR 0.96 [0.95–0.97]), respiratory disease (HR 0.96 [0.94–0.98]), COPD (HR 0.90 [0.86–0.95]), and colorectal cancer (HR 0.96 [0.92–1.00]). Nonlinear analysis revealed that a high level of fitness (>10 METs) was associated with a greater incidence of atrial fibrillation (HR 1.24 [1.07–1.44]) and prostate cancer (HR 1.16 [1.02–1.32]) compared with average fitness. All results were adjusted for sociodemographic, lifestyle, and dietary factors, body composition, and morbidity at baseline and excluded events in the first 2 years of follow up. Conclusions: Higher cardiorespiratory fitness was associated with lower risk of premature mortality and incidence of cardiovascular, respiratory disease and colorectal cancer