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Between 1986 and 2010, more than 20,000 Veterans underwent cardiac stress tests—walking on a treadmill, with electrodes taped to their chest—at the VA medical centers in Washington, DC, and Palo Alto, Calif. Some were undergoing routine physicals. Others were being checked for exercise-induced ischemia—blockages in blood flow to the heart, made worse by physical exertion.
The results of the stress tests, along with other data in the Veterans' electronic health records, have been a gold mine for Peter Kokkinos, PhD, and other VA researchers interested in learning about the link between exercise capacity and longevity. They have authored a string of publications, dating back to the late 1980s, that have helped answer numerous questions. Among them: Does being fit extend life even for those with diabetes, hypertension, or obesity? Is low fitness truly a more critical risk factor than any other?
The answer to both questions is "yes," according to many studies, such as these two from Kokkinos and colleagues:
Another lesson from the study: When Veterans with diabetes were fit, they outlived others who were less fit, even when the fitter Veterans carried the burden of additional risk factors, such as hypertension, high cholesterol, and obesity.
Kokkinos' conclusion: "In diabetes, it doesn't matter what your BMI is. You must be fit. Fitness trumps the deleterious effects of any additional risk factors, including excess body weight."
He and his coauthors wrote that the public health message of the findings is that "low fitness should be considered by health professionals to be as important a risk factor as other traditional risk factors."