In the present study, the authors examined cardiovascular risk factors through another angle. They investigated the combined effects of low-risk factors such as a moderate to high level of cardiorespiratory fitness, not smoking and normal waist girth on coronary heart disease (CHD) and cardiovascular disease (CVD) and all-cause mortality in men from the Aerobics Center Longitudinal Study (ACLS). This prospective cohort study included 23 657 men, aged 30 to 79 years and used a standardized maximal exercise test to quantify cardiorespiratory fitness. Their major finding was that men who were physically fit, not smoking, and with a normal waist girth had a 59% lower risk of CHD events, a 77% lower risk of CVD mortality, and a 69% lower risk of all-cause mortality over 15 years, compared with men who had none of these “favourable” risk factors. Moreover, the study revealed a dose-response relationship between the number of low-risk factors and morbidity and mortality risks. Men with these 3 low-risk factors also had a 14.2-year longer life expectancy (all-cause mortality) compared to men with none of these low-risk factors. This article was accompanied by an editorial which highlighted the unique and valuable contribution of this study to demonstrate the health benefits of physical activity. They propose to examine the question from a behavioural perspective to test whether adding physical activity in the model would be equally protective since it is the behaviour on which one intervenes to improve fitness.
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