Fitness, fatness and survival in elderly populations

This study examines the relative importance of fitness versus fatness in predicting mortality in elderly populations aged 70 years and over, and whether fitness may account for the ‘paradoxical’ relationship between better survival and increasing weight. Four thousand community-living Chinese men and women aged 65 years or over were recruited and stratified so that approximately 33% were in each of the age groups: 65–69, 70–74, and 75 or above. Medical history, height, weight, waist–hip ratio, body composition using DEXA, and walking speed were obtained. They were followed up for a mean of 7.0 years to ascertain death. Compared with the high fitness category, those in the moderate and low categories have a 43% and 68% increased risk of mortality at 7 years adjusting for multiple confounders. When mortality risk according to various fatness indicators was examined, only the lowest quartile of BMI, BFI, and FLMR conferred statistically significant increased risk. Fitness categories were significantly associated with all fatness indicators. The finding of fewer people in the high fitness category among the highest quartiles of other fatness indicators suggests that fitness is not the underlying mechanism for the obesity paradox. Within each quartile of fatness indicator, there was a significant trend towards reduced mortality with increasing fitness. In conclusion, the study confirms the beneficial effects of cardiorespiratory fitness on mortality but does not explain the ‘obesity paradox’. The findings underscore the importance of maintaining physical fitness through exercise and re-confirm the importance of weight maintenance in reducing mortality risk.