The Cooper Institute

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


2019 Research Review by The Cooper Institute 

Posted in

Tuesday, Jan 21, 2020

A look back at research published by The Cooper Institute

Last year was an incredible time for research at The Cooper Institute. Our team worked hard in 2019 to discover more about the many benefits of exercise and how it can improve our health and protect us from chronic disease. 

Most of our research stems from the Cooper Center Longitudinal Study (CCLS), the largest and longest-running study of its kind in the world on health with measured fitness. This incredible database is the crown jewel of our research with over 112,000 participants spanning the last 50 years and providing over 3,000 variables to study. The CCLS continues to grow as patients examined by Cooper Clinic physicians are continually added to the database. 

The results of our 2019 research, published in some of the top medical journals in the country, will make an impact on healthcare #WELLintothefuture. Let’s take a look back at the research and what it means. 

JAMA Cardiology: Heart of An Athlete

Atherosclerosis: Midlife Fitness

Journal of Investigative Medicine: African-Americans & Vitamin D 

JAMA Cardiology: Cardiovascular Risk in Hispanics

Journal of Women's Health: Fit vs. Fat

Journal of the American Geriatrics Association: Heart Health & Brain Health

JAMA Cardiology: Association of all-Cause and Cardiovascular Mortality with High Levels of Physical Activity and Concurrent Coronary Artery Calcification

While there is overwhelming scientific evidence that regular physical activity decreases the risk of developing and dying from a number of adverse health conditions, there is some concern about people who exercise at very high levels throughout their lifetimes. Endurance athletes who work out vigorously on most days over a period of many years sometimes develop coronary artery calcification (CAC), which indicates a buildup of plaque in their coronary arteries. CAC is a known risk factor for heart attack, so the important question is this: Is it safe for athletes with CAC to continue working out at high levels, or should they scale back their activity? 

To help answer this question, nearly 22,000 generally healthy middle-aged men were examined at the Cooper Clinic and underwent CAC scanning. They were then divided into three categories based on their physical activity levels, two categories based on their CAC score, and followed for an average of 10 years. 
The results, published in JAMA Cardiology, revealed two important findings. 

  1. Men with the highest physical activity levels were 11% more likely to have a significant amount of CAC than men who were less active. 
  2. The most highly active men with significant CAC were NOT at higher risk for all-cause and cardiovascular disease mortality when compared to less active men with significant CAC. 

The researchers concluded that these high volume athletes can safely continue with their exercise programs.

Atherosclerosis: The Association of Midlife Cardiorespiratory Fitness with Later Life Carotid Atherosclerosis

The carotid arteries help to supply oxygen and nutrients to the brain. Carotid artery disease, which is characterized by blockages in the carotid arteries, significantly increases the risk for stroke. Over 700,000 strokes occur in the U.S. each year and stroke is the number one cause of long-term disability. 

To learn more about the relationship between midlife fitness level and the development of carotid artery disease later in life, researchers from The Cooper Institute studied over 1000 middle-aged patients (men and women) at the Cooper Clinic who had no history of cardiovascular disease. Doctors used a maximal treadmill exercise test to measure cardiorespiratory fitness (CRF). Researchers categorized the patients by low, moderate, or high CRF based on their age, sex, and treadmill performance. These patients returned to the Cooper Clinic an average of 18 years later for an ultrasound to test for carotid artery disease. 

After taking into account factors such as body mass index, age, hypertension, diabetes, and blood cholesterol levels, the researchers learned that those with high baseline CRF were 50% less likely to have carotid artery disease later in life when compared to those with low baseline CRF. Additionally, the risk of having carotid artery disease later in life was decreased by 11% for every 2-minute increment in baseline treadmill test performance. 

These findings, published in Atherosclerosis, reinforce the American Heart Association recommendation that CRF should be measured or estimated as a clinical vital sign, similar to the standard checks for weight, temperature and blood pressure. The researchers also emphasized that middle-aged adults should follow the 2018 Physical Activity Guidelines for Americans in order to decrease the risk of carotid artery disease later in life.  

Journal of Investigative Medicine: Cardiorespiratory Fitness, Different Measures of Adiposity, and Serum Vitamin D Levels in African-American Adults

Earlier studies by The Cooper Institute show a strong relationship between fitness, body weight status, and vitamin D levels in Caucasian adults. To help generalize these findings to other groups, the research team examined these relationships in a group of 468 generally healthy African-American adults from the Cooper Center Longitudinal Study (CCLS). Patients underwent a maximal treadmill exercise test to measure fitness levels. Body mass index (BMI), waist circumference, and body fat percentage measured their body weight status and a blood sample determined vitamin D levels.  

The results, published in the Journal of Investigative Medicine, found that African-American men and women with moderate or high fitness levels were 45% less likely to have vitamin D deficiency than those with low fitness levels. Additionally, obese African-American men and women were 70% more likely to have vitamin D deficiency than those who were normal weight.    

The team suggested that all African-American adults have their blood vitamin D levels measured at their next checkup, meet the minimal physical activity, and strive to lose weight if overweight.  

JAMA Cardiology: Association of Educational Attainment and Cardiovascular Risk in Hispanic Individuals

Most patients in the Cooper Center Longitudinal Study (CCLS) are highly-educated Caucasians, so our findings are sometimes difficult to generalize to non-Caucasian populations. The CCLS now includes a large enough sample of highly-educated Hispanic men and women that researchers from The Cooper Institute and Stanford University could team up to study their cardiovascular risk and health outcomes compared to non-Hispanic whites. 

The study, published in JAMA Cardiology, looked at 1351 Hispanic and 43,736 non-Hispanic White (NHW) patients with similar education levels who underwent a comprehensive preventive medical examination at the Cooper Clinic. At baseline, Hispanic individuals were more likely to have higher BMIs, waist circumference, glucose levels, and triglyceride levels than NHW. Additionally, Hispanics were more likely to have metabolic syndrome and diabetes than NHW, and had slightly lower levels of cardiorespiratory fitness than NHW. However, because the Hispanic group was somewhat younger than the NHW group, the estimated 10-year risk of cardiovascular disease was similar in both groups.    

Coronary artery calcium (CAC) was measured in all patients over the age of 40. There was no significant difference between the two groups in the percentage of individuals who had CAC scores greater than zero, nor was there any significant difference in all-cause mortality risk. The researchers concluded that highly-educated Hispanics and non-Hispanic Whites have similar cardiovascular disease risk, CAC prevalence, and mortality risk. 

Journal of Women’s Health: Cardiorespiratory Fitness, Different Measures of Adiposity and Cardiovascular Disease Mortality in Women.

Evidence over the last few decades continues to show that low cardiorespiratory fitness is strongly associated with all-cause, cardiovascular disease (CVD) and cancer mortality. In fact, fitness may be an even stronger predictor of CVD mortality risk than any of the other major risk factors such as body weight status. The current “fit vs. fat” study examines whether fitness or body weight is a better predictor of CVD mortality for women.

The team looked at nearly 20,000 generally healthy middle-aged women who underwent a comprehensive physical exam at the Cooper Clinic. The exam included a maximal treadmill exercise test to measure their fitness level. Patients were then divided into categories of low, moderate or high fitness based on their age group. 

Researchers then classified women as normal weight or overweight based on body mass index, waist circumference, waist-to-height ratio, and percent body fat. The team then looked to see how many women died from CVD almost 20 years later to determine if fitness level or obesity was the more important factor.

The results, published in the Journal of Women’s Health, showed that:

  • Normal-weight women with high fitness had the lowest risk.
  • Normal-weight women with moderate fitness and overweight women with high to moderate fitness had moderate risk.
  • Normal-weight women with low fitness had higher risk.
  • Overweight women with low fitness had the highest risk. 

The conclusion by researchers is that having at least a moderate level of fitness offers some protection from CVD death for both normal weight and overweight women. This finding supports the 2016 recommendation by the American Heart Association that cardiorespiratory fitness be considered a vital sign.   

Journal of the American Geriatrics Association:  Metabolic Syndrome and Cognitive Impairment among High Socioeconomic Nondemented Older US Adults

Loss of memory, learning and decision-making are the calling cards of cognitive impairment (CI). The decline in cognitive function often begins many years before a clinical diagnosis of dementia is made. Some recent studies have found a connection between heart health and brain health, so researchers from The Cooper Institute and the University of Texas School of Public Health teamed up to conduct a study on the relationship between cognitive impairment and metabolic syndrome.  

Metabolic syndrome is a condition where 3 or more of 5 risk factors for cardiovascular disease are present. These include: 

  • fasting blood triglyceride level >150 mg/dl
  • HDL cholesterol <40 mg/dl in males or <50 mg/dl in females
  • resting blood pressure >130/85 mm Hg
  • waist circumference >40 inches in males or >35 inches in females
  • fasting blood glucose >100 mg/dl

The study, published in the Journal of the American Geriatrics Society, looked at 5200 highly-educated Cooper Clinic patients (average age 59) without dementia. Patients took the  Montreal Cognitive Assessment (MoCA) to measure cognition, a maximal treadmill exercise test to measure cardio fitness, and underwent testing for components of metabolic syndrome. Nearly 24% of the participants showed signs of cognitive impairment while about 20% had metabolic syndrome. For those with cognitive impairment, 27% had metabolic syndrome compared to 22% without metabolic syndrome. Because this difference was not significant, the researchers concluded that the presence of metabolic syndrome is not a good marker for identifying cognitive impairment.   

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