Association between muscular strength and mortality in men: prospective cohort study

doi:10.1136/bmj.a439

Published 1 July 2008, doi:10.1136/bmj.a439
Cite this as: BMJ 2008;337:a439

Research

Association between muscular strength and mortality in men: prospective cohort study

Jonatan R Ruiz, research associate¹^,2, Xuemei Sui, research associate³, Felipe Lobelo, research associate³, James R Morrow, Jr, professor⁴, Allen W Jackson, professor⁴, Michael Sjöström, associate professor¹, Steven N Blair, professor³^,4

¹ Department of Biosciences and Nutrition at NOVUM, Unit for Preventive Nutrition, Karolinska Institutet, Huddinge, Sweden, ² Department of Physiology, School of Medicine, University of Granada, Spain, ³ Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, ⁴ Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, USA

Correspondence to: J R Ruiz ruizj{at}ugr.es

Objective To examine prospectively the association between muscularstrength and mortality from all causes, cardiovascular disease,and cancer in men.

Design Prospective cohort study.

Setting Aerobics centre longitudinal study.

Participants 8762 men aged 20-80.

Main outcome measures All cause mortality up to 31 December2003; muscular strength, quantified by combining one repetitionmaximal measures for leg and bench presses and further categorisedas age specific thirds of the combined strength variable; andcardiorespiratory fitness assessed by a maximal exercise teston a treadmill.

Results During an average follow-up of 18.9 years, 503 deathsoccurred (145 cardiovascular disease, 199 cancer). Age adjusteddeath rates per 10 000 person years across incremental thirdsof muscular strength were 38.9, 25.9, and 26.6 for all causes;12.1, 7.6, and 6.6 for cardiovascular disease; and 6.1, 4.9,and 4.2 for cancer (all P<0.01 for linear trend). After adjustingfor age, physical activity, smoking, alcohol intake, body massindex, baseline medical conditions, and family history of cardiovasculardisease, hazard ratios across incremental thirds of muscularstrength for all cause mortality were 1.0 (referent), 0.72 (95%confidence interval 0.58 to 0.90), and 0.77 (0.62 to 0.96);for death from cardiovascular disease were 1.0 (referent), 0.74(0.50 to 1.10), and 0.71 (0.47 to 1.07); and for death fromcancer were 1.0 (referent), 0.72 (0.51 to 1.00), and 0.68 (0.48to 0.97). The pattern of the association between muscular strengthand death from all causes and cancer persisted after furtheradjustment for cardiorespiratory fitness; however, the associationbetween muscular strength and death from cardiovascular diseasewas attenuated after further adjustment for cardiorespiratoryfitness.

Conclusion Muscular strength is inversely and independentlyassociated with death from all causes and cancer in men, evenafter adjusting for cardiorespiratory fitness and other potentialconfounders.

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