Changes in physical XXXX and changes in mortality.

@entity1 @entity410 @entity204
BACKGROUND: Point estimates of physical @entity410 give important information on the risk of @entity204 in healthy @entity1 , but there is little information available on effects of sequential changes in physical @entity410 on mortality. We studied this latter aspect in healthy middle-aged @entity1 over a total follow-up period of 22 years. METHODS: 2014 healthy @entity1 aged 40-60 years had a bicycle exercise test and clinical examination, and completed a questionnaire in 1972-75 (survey 1). This was repeated for 1756 (91%) of 1932 @entity1 still alive by Dec 31, 1982 (survey 2). The exercise scores were adjusted for age. The change in exercise scores between surveys was divided into quartiles (Q1=least fit, Q4=fittest). An adjusted Cox's proportional hazards model was used to study the association between changes in physical @entity410 and mortality, with the Q1 @entity1 used as controls. FINDINGS: By Dec 31, 1994, 238 (17%) of the 1428 @entity1 had died, 120 from cardiovascular causes. There were 37 deaths in the Q4 group (19 cardiovascular); their relative risks of @entity204 were 0.45 (95% CI 0.29-0.69) for any cause and 0.47 (0.26-0.86) for cardiovascular causes. There was a graded, inverse relation between changes in physical @entity410 and mortality irrespective of physical @entity410 status at survey 1. INTERPRETATION: Change in physical @entity410 in healthy middle-aged @entity1 is a strong predictor of mortality. Even small improvements in physical @entity410 are associated with a significantly lowered risk of @entity204 . If confirmed, these findings should be used to influence public health policy.
