Cardiorespiratory fitness and survival following cancer diagnosis

Alexander Fardman, Gabriel D. Banschick, Razi Rabia, Ruth Percik, Dana Fourey, Shlomo Segev, Robert Klempfner, Ehud Grossman, Elad Maor*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Aims: Data on the association of cardiorespiratory fitness with survival of cancer patients are limited. This study aimed to evaluate the association between midlife cardiorespiratory fitness and survival after a subsequent cancer diagnosis. Methods: We evaluated 19,134 asymptomatic self-referred adults who were screened in preventive healthcare settings. All subjects were free of cardiovascular disease and cancer at baseline and completed a maximal exercise stress test. Fitness was categorised into age-specific and sex-specific quintiles according to the treadmill time and dichotomised to low (quintiles 1-2) and high fitness groups. Results: The mean age was 50 ± 8 years and 72% were men. During a median follow-up of 13 years (interquartile range 7-16) 517 (3%) died. Overall, 1455 (7.6%) subjects developed cancer with a median time to cancer diagnosis of 6.4 years (interquartile range 3-10). Death from the time of cancer diagnosis was significantly lower among the high fitness group (Plog rank = 0.03). Time-dependent analysis showed that subjects who developed cancer during follow-up were more likely to die (P < 0.001). The association of cancer with survival was fitness dependent such that in the lower fitness group cancer was associated with a higher risk of death, whereas among the high fitness group the risk of death was lower (hazard ratio 20 vs. 15; Pfor interaction = 0.047). The effect modification persisted after applying a 4-year blanking period between fitness assessment and cancer diagnosis (Pfor interaction = 0.003). Conclusion: Higher midlife cardiorespiratory fitness is associated with better survival among cancer patients. Our findings support fitness assessment in preventive healthcare settings.

Original languageEnglish
Pages (from-to)1242-1249
Number of pages8
JournalEuropean Journal of Preventive Cardiology
Issue number11
StatePublished - 1 Nov 2021


  • Cardiorespiratory fitness
  • all-cause mortality
  • cancer


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