TY - JOUR T1 - Submaximal fitness and mortality risk reduction in coronary heart disease: a retrospective cohort study of community-based exercise rehabilitation JF - BMJ Open JO - BMJ Open DO - 10.1136/bmjopen-2016-011125 VL - 6 IS - 6 SP - e011125 AU - Claire Taylor AU - Costas Tsakirides AU - James Moxon AU - James William Moxon AU - Michael Dudfield AU - Klaus K Witte AU - Lee Ingle AU - Sean Carroll Y1 - 2016/06/01 UR - http://bmjopen.bmj.com/content/6/6/e011125.abstract N2 - Objectives To examine the association between submaximal cardiorespiratory fitness (sCRF) and all-cause mortality in a cardiac rehabilitation (CR) cohort.Design Retrospective cohort study of participants entering CR between 26 May 1993 and 16 October 2006, followed up to 1 November 2013 (median 14 years, range 1.2–19.4 years).Setting A community-based CR exercise programme in Leeds, West Yorkshire, UK.Participants A cohort of 534 men (76%) and 136 women with a clinical diagnosis of coronary heart disease (CHD), aged 22–82 years, attending CR were evaluated for the association between baseline sCRF and all-cause mortality. 416 participants with an exercise test following CR (median 14 weeks) were examined for changes in sCRF and all-cause mortality.Main outcome measures All-cause mortality and change in sCRF expressed in estimated metabolic equivalents (METs).Results Baseline sCRF was a strong predictor of all-cause mortality; compared to the lowest sCRF group (<5 METs for women and <6 METs for men), mortality risk was 41% lower in those with moderate sCRF (HR 0.59; 95% CI 0.42 to 0.83) and 60% lower (HR 0.40; 95% CI 0.25 to 0.64) in those with higher sCRF levels (≥7 METs women and ≥8 METs for men). Although improvement in sCRF at 14 weeks was not associated with a significant mortality risk reduction (HR 0.91; 95% CI 0.79 to 1.06) for the whole cohort, in those with the lowest sCRF (and highest all-cause mortality) at baseline, each 1-MET improvement was associated with a 27% age-adjusted reduction in mortality risk (HR 0.73; 95% CI 0.57 to 0.94).Conclusions Higher baseline sCRF is associated with a reduced risk of all-cause mortality over 14 years in adults with CHD. Improving fitness through exercise-based CR is associated with significant risk reduction for the least fit. ER -