Nowadays, just about everyone who is health conscious knows that cardiovascular disease (CVD) is the leading cause of death in the U.S. for both men and women. Examples of CVD events are heart attack, stroke, sudden cardiac arrest, and heart failure. In 2016, the American Heart Association recommended that cardiorespiratory (aerobic) fitness be measured in patients and also be considered as a vital sign. Putting this recommendation into practice can be problematic, as treadmill exercise tests are expensive, time consuming, and require trained personnel to administer. This led a group of researchers from the Harvard School of Public Health and the Indiana University School of Public Health to test the hypothesis that a much faster, simpler and cost-free method of assessing physical fitness might be useful in helping to predict future CVD events. Specifically, the researchers sought to determine if results from a push-up test (a measure of muscular endurance) were related to risk of future CVD events.
In order to test this hypothesis, a group of 1104 Indiana firefighters (all men) with an average age of 40 years and an average body mass index of 28.7 kg/m2 underwent physical examinations between 2000 and 2010. As part of the exam, the subjects were asked to perform as many full-body push-ups as possible at a given cadence. The group was then split into 5 categories of push-ups performed in increments of 10:
Category 1: 0-10 push-ups
Category 2: 11-20 push-ups
Category 3: 21-30 push-ups
Category 4: 31-40 push-ups
Category 5: >40 push-ups
From this baseline data, the results showed that most coronary risk factors such as smoking, blood pressure, and blood cholesterol levels were more favorable across the increasing categories of push-ups. During a follow-up period averaging 10 years, there were a total of 37 CVD events among the firefighters. After taking into account the fact that age and BMI were more favorable across increasing push-up categories, the relationship between push-up category and future risk of CVD events is shown in the Figure below.
The authors acknowledged that some of the differences in the risk of having a CVD event during the follow-up could have been due to more favorable coronary risk factors such as not smoking and lower blood pressure in the higher performing groups compared to the lowest performing group. They also acknowledged that their results could not be generalized to women. Nor did the authors claim that push-up test performance is an independent risk factor for CVD events. Nevertheless, the study showed that even after taking age and body mass index differences into account, men who were able to perform more than 40 push-ups experienced a nearly 90% reduction in the risk of a CVD event. In conclusion, these results suggested that push-up performance is associated with future risk of CVD events. Additionally, a push-up test could be an easily implemented assessment and used as part of a comprehensive workplace wellness program.
Yang, J., Christophi, C., Farioli, A., Baur, D., Moffatt, S., Zollinger, T., Kales, S. (2019). Association between push-up capacity and future cardiovascular events among active adult men. JAMA Network Open. 2(2):e188341