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Original article
Midlife cardiorespiratory fitness and the long-term risk of chronic obstructive pulmonary disease
  1. Gorm Mørk Hansen1,
  2. Jacob Louis Marott2,
  3. Andreas Holtermann3,
  4. Finn Gyntelberg4,
  5. Peter Lange5,
  6. Magnus T Jensen6,7
  1. 1 Herlev-Gentofte University Hospital, Medical Department O, Respiratory Section; Herlev-Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
  2. 2 The Copenhagen Male Study Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital; The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
  3. 3 National Research Centre for the Working Environment; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Copenhagen, Denmark
  4. 4 The Copenhagen Male Study Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital; Bispebjerg Hospital, National Research Centre for the Working Environment, Copenhagen, Denmark
  5. 5 Herlev Hospital, Medical Department O, Respiratory Section; University of Copenhagen, Section of Epidemiology, Department of Public Health, Copenhagen, Denmark
  6. 6 The Copenhagen Male Study Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark, Copenhagen, Denmark
  7. 7 Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
  1. Correspondence to Dr Gorm Mørk Hansen, Herlev-Gentofte University Hospital, Medical Department O, Respiratory Section; Herlev-Gentofte University Hospital, Department of Cardiology, Copenhagen 2730, Denmark; gormmh{at}gmail.com

Abstract

Background Good midlife cardiorespiratory fitness (CRF) may reduce the risk of chronic obstructive pulmonary disease (COPD). Reverse causation may play a role if follow-up time is short. We examined the association between CRF and both incident COPD and COPD mortality in employed men with up to 46 years follow-up, which allowed us to account for reverse causality.

Methods Middle-aged men (n=4730) were recruited in 1970–1971. CRF was determined as VO2max by ergometer test. Categories of CRF (low, normal, high) were defined as ± 1 Z-score (± 1 SD) above or below the age-adjusted mean. Endpoints were identified through national registers and defined as incident COPD, and death from COPD. Multi-adjusted Cox models and restricted mean survival times (RMST) were performed.

Results Compared with low CRF, the estimated risk of incident COPD was 21% lower in participants with normal CRF (HR 0.79, 95% CI 0.63 to 0.99) and 31 % lower with high CRF (HR 0.69, 95% CI 0.52 to 0.91). Compared with low CRF, the risk of death from COPD was 35% lower in participants with normal CRF (HR 0.65, 95% CI 0.46 to 0.91) and 62% lower in participants with high CRF (HR 0.38, 95% CI 0.23 to 0.61). RMST showed a delay to incident COPD and death from COPD in the magnitude of 1.3–1.8 years in normal and high CRF vs low CRF. Test for reverse causation did not alter the results.

Conclusion In a population of healthy, middle-aged men, higher levels of CRF were associated with a lower long-term risk of incident COPD and death from COPD.

  • copd epidemiology
  • exercise
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Footnotes

  • Contributors Conceptualisation: MTJ, GMH, FG, AH. Formal analysis: MTJ, GMH, FG, AH, JLM, PL. Methodology: MTJ, GMH, JLM. Project administration: GMH. Writing – original draft: GMH, MTJ. Writing – review & editing: GMH, MTJ, FG, AH, JLM, PL.

  • Funding This study was supported by The Danish Heart Foundation, Else & Mogens Wedell-Wedellsborg Foundation, The Danish Medical Research Council, King Christian X Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

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