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

BMJ 2008; 337 doi: (Published 01 July 2008) Cite this as: BMJ 2008;337:a439
  1. Jonatan R Ruiz, research associate12,
  2. Xuemei Sui, research associate3,
  3. Felipe Lobelo, research associate3,
  4. James R Morrow Jr, professor4,
  5. Allen W Jackson, professor4,
  6. Michael Sjöström, associate professor1,
  7. Steven N Blair, professor34
  1. 1Department of Biosciences and Nutrition at NOVUM, Unit for Preventive Nutrition, Karolinska Institutet, Huddinge, Sweden
  2. 2Department of Physiology, School of Medicine, University of Granada, Spain
  3. 3Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
  4. 4Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, USA
  1. Correspondence to: J R Ruiz ruizj{at}
  • Accepted 16 June 2008


Objective To examine prospectively the association between muscular strength 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 December 2003; muscular strength, quantified by combining one repetition maximal measures for leg and bench presses and further categorised as age specific thirds of the combined strength variable; and cardiorespiratory fitness assessed by a maximal exercise test on a treadmill.

Results During an average follow-up of 18.9 years, 503 deaths occurred (145 cardiovascular disease, 199 cancer). Age adjusted death rates per 10 000 person years across incremental thirds of 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 adjusting for age, physical activity, smoking, alcohol intake, body mass index, baseline medical conditions, and family history of cardiovascular disease, hazard ratios across incremental thirds of muscular strength 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 from cancer were 1.0 (referent), 0.72 (0.51 to 1.00), and 0.68 (0.48 to 0.97). The pattern of the association between muscular strength and death from all causes and cancer persisted after further adjustment for cardiorespiratory fitness; however, the association between muscular strength and death from cardiovascular disease was attenuated after further adjustment for cardiorespiratory fitness.

Conclusion Muscular strength is inversely and independently associated with death from all causes and cancer in men, even after adjusting for cardiorespiratory fitness and other potential confounders.


  • We thank the doctors and technicians at the Cooper Clinic who collected the baseline data and staff at the Cooper Institute for data entry and data management.

  • Contributors: All authors were involved in the concept and design of the study, the analysis and interpretation of data, drafting the manuscript, and critical revision of the manuscript for important intellectual content. They are guarantors. XS and SNB acquired the data. JRR, XS, FL, JRM, AWJJr, and SNB did the statistical analysis.

  • Funding: The aerobics centre longitudinal study was supported by the National Institutes of Health (grants AG06945, HL62508); the Spanish Ministry of Education (AP2003-2128, EX-2007-1124); the Margit and Folke Pehrzon Foundation; the European Union, in the framework of the public health programme (ALPHA project, 2006120); the American Heart Association predoctoral fellowship; and the American College of Sports Medicine Paffenbarger-Blair fund for epidemiological research on physical activity.

  • Competing interests: None declared.

  • Ethical approval: This study was approved by the Cooper Institute institutional review board.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 16 June 2008
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