UPDATE: Fitness Still Matters to Reduce all-Cause and Heart Disease Deaths, Despite Advances in Modern Medicine and Lifestyle Changes


DALLAS, TX (April 6, 2021) — Over the last 50 years, advances in modern medicine have helped us live longer by identifying and treating risk factors for heart disease, stroke and cancer. The groundbreaking 1989 study from the Cooper Center Longitudinal Study (CCLS) showed a strong and inverse relationship between fitness and mortality. But with these significant changes and improvements in cardiac and cancer treatment, does fitness still matter? A study from The Cooper Institute published in April 2020, in conjunction with researchers from Harvard and Stanford University, evaluates whether these changes in disease prevention, detection and treatment have any effect on the relationship between fitness and mortality.

Death rates from heart disease and stroke have dropped by 67% and 77%, respectively over the past 50 years, likely due to the use of statin medication to lower cholesterol, new high blood pressure and diabetes medications, decreased tobacco use, and more advanced cardiac catheterization and surgical techniques. While the original study prompted the American Heart Association to add physical inactivity as a modifiable risk factor for heart disease in 1992, the new study adds another 25 years of patient information to examine whether modern medicine negates the importance of fitness.

“Despite significant advances in medicine and a reduction in mortality rates over the past 30 years, fitness remains as important now as it did in the first study,” said Steve Farrell, PhD, Senior Investigator at The Cooper Institute and lead author. “Further, with the significant mental and physical challenges that have been brought on by the COVID-19 pandemic, meeting the current physical activity guidelines is more important than ever” Farrell said.

This study looked at nearly 48,000 men over a 50-year span who all completed baseline examinations and a maximal treadmill exercise test at the Cooper Clinic. The men were divided into two chronological groups based on changes in medical care, including the use of statins and advances in cardiovascular interventions such as thrombolytic drugs and stents, which became more common in the early 1990s.

Men from both groups were categorized as low fit, moderate fit or high fit based on their treadmill test results and age group. When compared against those with low fitness, men in both groups demonstrated that high and moderate fitness significantly decreases all-cause mortality risk:

  • High fitness reduced mortality by 47% in the group seen between 1970 and 1991.
  • High fitness reduced mortality by 48% in the group seen between 1992 and 2014.

Central Illustration

Fitness level (METs), is shown on the horizontal line of the graph. Risk of death from all causes is shown on the vertical line. Cohort 1 and Cohort 2 results are shown on the brown and dotted blue lines, respectively. At each point along the horizontal line, the risk of all-cause death is lower in Cohort 2 than Cohort 1. However, there is still a significant reduction in risk of all-cause death with increasing fitness among Cohort 2 men.

“The findings emphasize how important it is for us to be physically fit – even today, when medical diagnosis and treatment have advanced so much compared with a few decades ago,” said Dr. I-Min Lee, Professor of Medicine at Harvard Medical School and Professor of Epidemiology at Harvard T.H. Chan School of Public Health. “To improve our cardiorespiratory fitness, we should be physically active by following current guidelines.”

Men and women are urged to meet the 2018 Physical Activity Guidelines, which consist of accumulating a minimum of 150 minutes each week of moderate-intensity aerobic activity or a minimum of 75 minutes each week of vigorous-intensity aerobic activity, along with a minimum of two days each week of strength training. Along with regular physical activity, all individuals are urged to avoid tobacco in all forms, to consume a heart-healthy diet and achieve a reasonable body weight, and to have their blood pressure, as well as blood lipids and blood-glucose levels monitored by their physician. The importance of healthy lifestyle choices during the pandemic cannot be stressed enough for both physical and mental health. As is often stated by Kenneth H. Cooper MD, MPH “It is far easier and cheaper to maintain good health than it is to regain it once it is lost.”

The results of the 50-year combined study confirm and reinforce the importance of fitness even with today’s modern and aggressive screening and treatments for chronic disease. To summarize, major advances in screening, early detection, and treatment over the past three decades has resulted in substantially decreased mortality rates in the U.S. Despite these numerous advances, fitness remains strongly associated with mortality risk in men. In fact, the American Heart Association Scientific Statement recommends the inclusion of a baseline measured fitness assessment as a clinical vital sign.

The Cooper Institute was established as a nonprofit in 1970 by Kenneth H. Cooper, MD, MPH, to promoting life-long health and wellness worldwide through research, education and advocacy. By improving public health, The Cooper Institute helps people lead better, longer lives now and Well. Into the Future. To learn more, visit CooperInstitute.org.

Owned and operated by The Cooper Institute, the Cooper Center Longitudinal Study (CCLS) is the largest and longest-running study in the world with measured fitness. Developed in 1970, it contains over 300,000 patient records from the Cooper Clinic and is one of the world's most extensive studies relating fitness to overall wellbeing and the improvement of public health. To learn more, visit CooperInstitute.org/CCLS.

April 6, 2021