To compare the contributions of fitness level and physical activity patterns to all-cause mortality.

Of 6213 men referred for exercise testing between 1987 and 2000, 842 underwent an assessment of adulthood activity patterns. The predictive power of exercise capacity and activity patterns, along with clinical and exercise test data, were assessed for all-cause mortality during a mean (±SD) follow-up of 5.5 ± 2 years.

Expressing the data by age-adjusted quartiles, exercise capacity was a stronger predictor of mortality than was activity pattern (hazard ratio [HR] = 0.56; 95% confidence interval [CI]: 0.38 to 0.83; P < 0.001). In a multivariate analysis that considered clinical characteristics, risk factors, exercise test data, and activity patterns, exercise capacity (HR per quartile = 0.62; CI: 0.47 to 0.82; P < 0.001) and energy expenditure from adulthood recreational activity (HR per quartile = 0.72; 95% CI: 0.58 to 0.89; P = 0.002) were the only significant predictors of mortality; these two variables were stronger predictors than established risk factors such as smoking, hypertension, obesity, and diabetes. Age-adjusted mortality decreased per quartile increase in exercise capacity (HR for very low capacity = 1.0; HR for low = 0.59; HR for moderate = 0.46; HR for high = 0.28; P < 0.001) and physical activity (HR for very low activity = 1.0; HR for low = 0.63; HR for moderate = 0.42; HR for high = 0.38; P < 0.001). A 1000-kcal/wk increase in activity was approximately similar to a 1 metabolic equivalent increase in fitness; both conferred a mortality benefit of 20%.

Exercise capacity determined from exercise testing and energy expenditure from weekly activity outperform other clinical and exercise test variables in predicting all-cause mortality.