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Original article
Cardiorespiratory fitness and death from cancer: a 42-year follow-up from the Copenhagen Male Study
  1. Magnus Thorsten Jensen1,
  2. Andreas Holtermann2,
  3. Hans Bay2,3,
  4. Finn Gyntelberg2,3
  1. 1 Department of Internal Medicine, Holbaek Hospital, Holbæk, Denmark
  2. 2 National Research Centre for the Working Environment, Copenhagen, Denmark
  3. 3 Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, The Copenhagen Male Study, Bispebjerg University Hospital, Copenhagen, Denmark
  1. Correspondence to Dr Magnus Thorsten Jensen, Department of Internal Medicine, Holbaek Hospital, Smedelundsgade 60, Holbaek 4300, Denmark; magnustjensen{at}gmail.com

Abstract

Objectives Poor cardiorespiratory fitness (CRF) is associated with death from cancer. If follow-up time is short, this association may be confounded by subclinical disease already present at the time of CRF assessment. This study investigates the association between CRF and death from cancer and any cause with 42 years and 44 years of follow-up, respectively.

Setting, participants and main outcome measures Middle-aged, employed and cancer-free Danish men from the prospective Copenhagen Male Study, enrolled in 1970–1971, were included. CRF (maximal oxygen consumption (VO2max)) was estimated using a bicycle ergometer test and analysed in multivariable Cox models including conventional risk factors, social class and self-reported physical activity. Death from cancer and all-cause mortality was assessed using Danish national registers. Follow-up was 100% complete.

Results In total, 5131 men were included, mean (SD) age 48.8 (5.4) years. During 44 years of follow-up, 4486 subjects died (87.4%), 1527 (29.8%) from cancer. In multivariable models, CRF was highly significantly inversely associated with death from cancer and all-cause mortality ((HR (95% CI)) 0.83 (0.77 to 0.90) and 0.89 (0.85 to 0.93) per 10 mL/kg/min increase in estimated VO2max, respectively). A similar association was seen across specific cancer groups, except death from prostate cancer (1.00 (0.82 to 1.2); p=0.97; n=231). The associations between CRF and outcomes remained essentially unchanged after excluding subjects dying within 10 years (n=377) and 20 years (n=1276) of inclusion.

Conclusions CRF is highly significantly inversely associated with death from cancer and all-cause mortality. The associations are robust for exclusion of subjects dying within 20 years of study inclusion, thereby suggesting a minimal influence of reverse causation.

  • Cancer
  • VO2max
  • Fitness
  • Longevity
  • Physical fitness

http://dx.doi.org/10.1136/bjsports-2016-096860

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    Footnotes

    • Contributors MTJ contributed substantially to the conception and design of the work, analysis and interpretation of data, as well as drafting the work, approved the final version of the manuscript to be published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AH contributed substantially to the analysis and interpretation of data, as well as revising it critically for important intellectual content, approved the final version of the manuscript to be published, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. HB and AH contributed substantially to the analysis and interpretation of data, as well as revising it critically for important intellectual content, approved the final version of the manuscript to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. FG contributed substantially to the acquisition, analysis or interpretation of data, as well as revising it critically for important intellectual content, approved the final version of the manuscript to be published, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. MTJ affirms that the manuscript is an honest, accurate and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as planned have been explained.

    • Funding The Copenhagen Male Study was supported by grants from King Christian X Foundation, The Danish Medical Research Council, The Danish Heart Foundation and Else and Mogens Wedell-Wedellsborg Foundation.

    • Disclaimer The funders of the Copenhagen Male Study had no role in the present study.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Full data set is available from the corresponding author. Patient consent was not obtained but the presented data are anonymised and risk of identification is low.