The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Being Physically Fit can Help Decrease Risk of Premature Death in Men with Emotional Distress

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Wednesday, May 22, 2019

We all feel a little stressed and anxious sometimes. An estimated 20 million Americans have symptoms of major depressive disorder, which is why mental health is one of the hottest topics in healthcare. The economic cost and magnitude of human suffering are enormous and a concern for all.

Many studies conducted worldwide have consistently shown that depressive disorders are associated with shorter life expectancy and increased rates of all-cause and cardiovascular disease mortality among those afflicted. Additionally, low levels of physical activity and low cardiorespiratory fitness (CRF) are strongly related to mortality risk.

The good news is that physical activity can help extend and improve your quality of life by improving symptoms of depression and anxiety.

A study of Cooper Clinic patients examined the complex relationships between CRF, emotions and mortality to see if fitness can help decrease the risk of premature death among those with depressive disorders.  

In the study, over 5200 middle-aged men (average age 47) completed a medical questionnaire and indicated that they had experienced depression, anxiety, thoughts of suicide, or had received psychological or psychiatric counseling. For those who reported some type of emotional distress, 46% reported depression, 58% reported anxiety, 51% reported psychological counseling, and 8% reported having suicidal thoughts.

The group then underwent a comprehensive physical examination at the Cooper Clinic, which included a maximal treadmill exercise test to measure cardiorespiratory fitness. Based on their age and treadmill performance, men were placed into low, moderate or high fitness categories. Interestingly, the percentage of men who reported more than one type of emotional distress was greater in those with low fitness when compared with those with moderate to high fitness.

During an average follow-up period of nine years, 128 deaths occurred. Compared to men with low CRF, men with moderate and high CRF were 46% and 53% less likely to die, respectively. As a result, the authors concluded that higher levels of CRF are associated with a significantly reduced risk of all-cause mortality in men with emotional distress.

Improving CRF in men with emotional distress will not only reduce symptoms of distress, but will also likely reduce all-cause mortality risk.


These findings add to an overwhelming body of evidence that physical activity and exercise training are useful in reducing many serious health risks.

While the study only examined men due to an inadequate sample size among women, physical fitness is important for everyone. All men and women are urged to meet the current public health guidelines for physical activity* in order to decrease morbidity and mortality risk, regardless of whether or not major depressive disorders are present.  

*All adults should accumulate a minimum of 150 minutes each week of moderate-intensity aerobic exercise training, or a minimum of 75 minutes each week of vigorous-intensity aerobic exercise training, along with at least two days each week of resistance training.  


Sui, X., Ott, J., Becofsky, K., Lavie, C., Ernstsen, L., Zhang, J., Blair, S. (2017). Cardiorespiratory Fitness and All-Cause Mortality in Men with Emotional Distress. Mayo Clin Proc, 92(6):918-924.