Physical Fitness in Late Adolescence Linked to Future Cardiovascular Outcomes

Summary and Comment |
November 17, 2015

Physical Fitness in Late Adolescence Linked to Future Cardiovascular Outcomes

  1. Karol E. Watson, MD, PhD, FACC

Exercise capacity and muscle strength at age 18 predict mid-life cardiovascular events in a 26-year follow-up study.

  1. Karol E. Watson, MD, PhD, FACC

Exercise capacity and muscle strength in adulthood predict later cardiovascular outcomes; however, whether exercise capacity and muscle strength in late adolescence are predictive of cardiovascular risk in mid-life is unknown. To assess effects on vascular diseases and arrhythmias, investigators performed a prospective follow-up study of 1.1 million men examined at mandatory military conscription in Sweden between 1972 and 1995 (median baseline age, 18; median follow-up, 26 years). An ergometer bicycle test and handgrip strength were used to estimate maximum exercise capacity and muscle strength, respectively.

During follow-up, 26,088 vascular disease events and 17,312 arrhythmia events occurred. Exercise capacity was inversely associated with risk for vascular disease overall and all of its subgroups (ischemic heart disease, heart failure, stroke, and cardiovascular death), with the association driven mostly by lower risk for heart failure and cardiovascular death. Exercise capacity had a U-shaped association with risk for arrhythmia overall and specifically with bradyarrhythmia risk and was directly associated with risk for atrial fibrillation. Greater muscle strength was associated with lower arrhythmia risk. The combination of high exercise capacity and high muscle strength was associated with significant reductions in vascular events (hazard ratio, 0.67) and arrhythmia (HR, 0.92) compared with the combination of low exercise capacity and low muscle strength.

Comment

Increasing evidence suggests that the path to your cardiovascular destiny is laid down at a young age. For example, dietary patterns in adolescence can affect future cardiovascular events. In this study, exercise capacity and muscle strength in late adolescence were associated with future cardiovascular events. Rates of serious cardiovascular events and cardiovascular deaths were lower with greater exercise capacity and muscle strength. Although arrhythmia (primarily atrial fibrillation and bradyarrhythmia) was linked to higher exercise capacity, the authors note that the health benefits were “not outweighed by higher risk of arrhythmia.”

Strengths of this study are its very large sample size, long follow-up, and detailed data. A limitation is that the cohort evaluated was restricted to male military registrants. The authors note that “equivalent data for women are needed.”

Editor Disclosures at Time of Publication

  • Disclosures for Karol E. Watson, MD, PhD, FACC at time of publication Consultant / Advisory board: AstraZeneca; Daiichi Sankyo; GlaxoSmithKline; Merck; Pfizer; Quest Editorial boards: Reviews in Cardiovascular Medicine; Circulation Quality Outcomes; Circulation

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