What is the clinical evidence from this study?

Study design: Cohort. Population: Healthy men without known or suspected heart disease (n=2136). Intervention: Physical fitness vs. Lower physical fitness. Primary outcome: Total incidence of coronary heart disease (CHD) events and 7-year incidence of death from CHD.

What question did this study set out to answer?

To evaluate the relationship between physical fitness and coronary risk factors, and incidence of coronary death over seven years.

April 22, 2026

Coronary risk factors and incidence of coronary death in relation to physical fitness. Seven-year follow-up study of middle-aged and elderly men

Key Result

High physical fitness was strongly and inversely associated with the 7-year risk of dying from coronary heart disease among middle-aged men free from known heart disease at baseline.

Key Points

To evaluate the relationship between physical fitness and coronary risk factors, and incidence of coronary death over seven years.
Two populations assessed: 122 elite skiers and 2014 healthy men aged 40-59 without heart disease at baseline.
Participants underwent a near-maximal bicycle exercise test to measure physical fitness.
Incidence of coronary heart disease (CHD) events and deaths were monitored over seven years across fitness quartiles.
Higher physical fitness was significantly associated with lower levels of coronary risk factors.
Death from myocardial infarction and sudden death showed an inverse relation to fitness levels.
The most fit individuals among the healthy men had similar outcomes to elite skiers regarding CHD events and mortality.

Study Design

Type

Cohort (n=2,136)

Structured PICO

Does higher physical fitness reduce the incidence of coronary heart disease events and death in middle-aged and elderly men?

Population

2,136 men without known or suspected heart disease at baseline, comprising 122 middle-aged and elderly cross-country skiers with very high physical performance and 2,014 apparently healthy men aged 40-59 years.

Intervention

High physical fitness (assessed by a near maximal bicycle exercise test).

Comparator

Lower levels/quartiles of physical fitness.

Outcome

Total incidence of coronary heart disease (CHD) events and 7-year incidence of death from CHD.hard clinical

Higher physical fitness is strongly associated with a more favorable coronary risk profile and a reduced risk of coronary heart disease death in middle-aged men.

Abstract

Physical fitness was assessed in relation to a near maximal bicycle exercise test in two populations; population 1: 122 middle aged and elderly cross-country skiers with a documented very high physical performance, and population 2: 2014 apparently healthy men 40-59 years of age. All were without known or suspected heart disease at the baseline study. A number of so-called coronary risk factors were studied simultaneously. The total incidence of coronary heart disease (CHD) events were noted as was the total 7 year incidence of death from CHD among men from population 2. By subdividing the latter in quartiles of physical fitness within each 5 year age group--and studying levels of coronary risk factors and CHD deaths within these 16 subgroups--the following findings were made: All coronary risk factors were favourably and strongly associated with high physical fitness and vice versa in a consistent way. Death from myocardial infarction and sudden, unexpected death followed the same pattern in an inverse way. The skiers as a group closely followed the most fit men from population 2 in all respects. Thus we have noted a strong, graded, positive association between physical fitness and a number of coronary risk factors, and an inverse relationship between high physical fitness and the risk of dying from CHD. These findings hold true for a period of 7 years among middle aged men free from known or suspected heart disease.