Published Online
on January 22, 2008

A more recent version of this article appeared on February 5, 2008

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Submitted on August 17, 2007
Accepted on November 8, 2007

Exercise Capacity and Mortality in Black and White Men

Peter Kokkinos PhD^*, Jonathan Myers PhD, John Peter Kokkinos , Andreas Pittaras MD, Puneet Narayan MD, Athanasios Manolis MD, Pamela Karasik MD, Michael Greenberg MD, Vasilios Papademetriou MD, and Steven Singh MD

From the Veterans Affairs Medical Center, Cardiology Department (P. Kokkinos, J.P.K., A.P., P.N., A.M., P. Karasik, M.G., V.P.), and Georgetown University School of Medicine (P. Kokkinos, S.S.), Washington, DC, and Veterans Affairs Palo Alto Health Care System, Cardiology Division, and Stanford University, Stanford, Calif (J.M.).

^* To whom correspondence should be addressed. E-mail: peter.kokkinos{at}med.va.gov.

Background—Exercise capacity is inversely related to mortality risk in healthy individuals and those with cardiovascular diseases. This evidence is based largely on white populations, with little information available for blacks.

Methods and Results—We assessed the association between exercise capacity and mortality in black (n=6749; age, 58±11 years) and white (n=8911; age, 60±11 years) male veterans with and without cardiovascular disease who successfully completed a treadmill exercise test at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, Calif. Fitness categories were based on peak metabolic equivalents (METs) achieved. Subjects were followed up for all-cause mortality for 7.5±5.3 years. Among clinical and exercise test variables, exercise capacity was the strongest predictor of risk for mortality. The adjusted risk was reduced by 13% for every 1-MET increase in exercise capacity (hazard ratio, 0.87; 95% confidence interval, 0.86 to 0.88; P<0.001). Compared with those who achieved <5 METs, the mortality risk was 50% lower for those with an exercise capacity of 7.1 to 10 METs (hazard ratio, 0.51; 95% confidence interval, 0.47 to 0.56; P<0.001) and 70% lower for those achieving >10 METs (hazard ratio, 0.31; 95% confidence interval, 0.26 to 0.36; P<0.001). The findings were similar for those with and without cardiovascular disease and for both races.

Conclusions—Exercise capacity is a strong predictor of all-cause mortality in blacks and whites. The relationship was inverse and graded, with a similar impact on mortality outcomes for both blacks and whites.

Key words: African Americans • epidemiology • exercise tolerance • mortality • exercise test

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