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. 2020 Apr 14;41(15):1503-1510.
doi: 10.1093/eurheartj/ehz774.

Cardiorespiratory fitness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: a cohort study of 1 million men

Hanna Henriksson  1   2 , Pontus Henriksson  1   2   3 , Per Tynelius  4   5 , Mattias Ekstedt  2 , Daniel Berglind  4   5 , Idoia Labayen  6 , Jonatan R Ruiz  1   3 , Carl J Lavie  7 , Francisco B Ortega  1   3
Affiliations

Cardiorespiratory fitness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: a cohort study of 1 million men

Hanna Henriksson et al. Eur Heart J. .

Abstract

Aims: Cardiorespiratory fitness, muscular strength, and obesity in adulthood are risk factors for cardiovascular disease (CVD). However, little is known regarding the associations of these risk factors, already in adolescence, with later disability due to chronic CVD. Hence, we investigated associations of cardiorespiratory fitness, muscular strength, and body mass index (BMI) in adolescence with later chronic disability due to specific causes of CVD disability (i.e. cerebrovascular disease, ischaemic heart disease and heart failure).

Methods and results: This population-based cohort study included 1 078 685 male adolescents (16-19 years) from the Swedish military conscription register from 1972 to 1994. Cardiorespiratory fitness (bicycle ergometer test), muscular strength (knee extension strength), and BMI were measured during the conscription examination. Information about disability pension due to CVD was retrieved from the Social Insurance Agency during a mean follow-up of 28.4 years. Cardiorespiratory fitness was strongly and inversely associated with later risk of chronic CVD disability for all investigated causes. The association was particularly strong for ischaemic heart diseases (hazard ratio 0.11, 95% confidence interval 0.05-0.29 for highest vs. lowest fitness-quintiles). Furthermore, overweight/obesity were associated with CVD disability for all investigated causes. Conversely, associations of muscular strength with CVD disability were generally weak.

Conclusions: This study provides evidence for associations between low levels of cardiorespiratory fitness and obesity with later risk of chronic disability due to CVD. Preventive actions may begin at young ages and include promotion of cardiorespiratory fitness and healthy body weight.

Keywords: Cardiorespiratory fitness; Cardiovascular disease; Disability; Muscular strength; Obesity.

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Figures

Figure 1
Figure 1
Associations of cardiorespiratory fitness at conscription with later disability pension due to cardiovascular diseases (n = 1 078 685). Cox proportional hazards regression models were used to estimate hazard ratios with 95% confidence intervals. Basic adjustments in the analyses were age, centre, year of conscription, childhood socioeconomic position, and body mass index at conscription. Models were also further adjusted for muscular strength.
Figure 2
Figure 2
Associations of muscular strength at conscription with disability pension due to cardiovascular diseases (n = 1 078 685). Cox proportional hazards regression models were used to estimate hazard ratios with 95% confidence intervals. Basic adjustments in the analyses were age, centre, year of conscription, childhood socioeconomic position, and body mass index at conscription. Models were also further adjusted for cardiorespiratory fitness.
Figure 3
Figure 3
Associations of different body mass index categories at conscription with disability pension due to cardiovascular diseases (n = 1 078 685). Cox proportional hazards regression models were used to estimate hazard ratios with 95% confidence intervals. Basic adjustments in the analyses were age, centre, year of conscription, and childhood socioeconomic position. Models were also further adjusted for cardiorespiratory fitness and muscular strength.
Figure 4
Figure 4
Combined association of cardiorespiratory fitness and body mass index at conscription with disability pension due to cardiovascular diseases. NW, normal weight (n = 879 045); OB, obesity (n = 17 913). Adolescents with fitness in quintile 1 were considered as ‘Unfit’, while adolescents in quintiles 2–5 were considered ‘Fit’. Cox proportional hazards regression models were used to estimate hazard ratios with 95% confidence intervals. Models were adjusted for age, centre, year of conscription, childhood socioeconomic position, and muscular strength at conscription.
Take home figure
Take home figure
Association between risk factors at adolescence and disability pension due to cardiovascular disease in mid-life.
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