NEW YORK (Reuters Health) - The fittest may indeed survive the longest, according to new research suggesting that physical fitness is more important in death risk than even high blood pressure, high cholesterol or smoking.

The study of more than 6,200 US men who underwent treadmill testing for cardiovascular disease found that the risk of death over the next 6 years declined as exercise capacity rose. This was true of both men with cardiovascular disease and those whose exercise tests were normal.

In fact, researchers report in the March 14th issue of The New England Journal of Medicine, exercise capacity was the best predictor of death risk among men with cardiovascular disease. And among all participants, those in the group with the lowest exercise capacity were about four times more likely to die during the study period compared with the fittest group.

Overall, fitness mattered more in death risk than such classic cardiovascular risk factors as high blood pressure, smoking and body mass index, according to Dr. Jonathan Myers and his colleagues at Stanford University and the Veterans Affairs Palo Alto Health Care System in California.

For instance, a man who had high blood pressure but was among the fittest was about half as likely to die as a man with high blood pressure and low fitness levels, the report indicates.

Findings like this, the researchers write, "confirm the protective role" of exercise, even in individuals with other health risk factors.

They also "provide more evidence regarding the relation between fitness and survival," according to an accompanying editorial.

In addition, Dr. Gary J. Balady of Boston Medical Center in Massachusetts notes that "encouraging data" on people with and without cardiovascular disease show that the less-fit can improve their survival by becoming more physically active.

And although the current study included only men, Balady adds, "there is no reason to believe that its conclusions cannot be applied to women."

Current US guidelines for exercise recommend that all healthy adults take up some moderate physical activity for at least 30 minutes a day on most, and preferably all, days of the week. People with cardiovascular disease should consult their doctors about an appropriate exercise plan.

SOURCE: The New England Journal of Medicine 2002;346:793-801, 852-853.

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