Fitness or Fatness? What to Focus on ?
-Dr Akshay Mehta

There is some good news for those huffing and puffing rolly pollies ! Fitness (aerobic or cardiovascular) appears to be more important thanweight loss when it comes to reducing overall death rates or deaths due to heart disease. Recent data from a large longitudinal study show that maintaining and improving physical-fitness levels (by increased physical activity) were associated with lower risks of all-cause andcardiovascular disease mortality, whereas changes in body-mass index(BMI) were not.

Data from the Aerobics Center Longitudinal Study, in 14 435 menwith an average follow-up of 11.4 years showed that men who maintainedtheir physical-fitness levels had a 30% and 27% lower risk of deathand cardiovascular death, respectively, when compared with men who lost fitness. Those who got into better shape from baseline had a 39% and 42% lower risk of death and cardiovascular mortality,respectively, when compared with those who lost fitness over the years. Cardiovascular fitness was measured by noting effort tolerance on an exercise treadmill as per a fixed protocol of speeds and inclinations. In contrast, changes in BMI status (calculated as a ratio of weight in Kg over height in meters squared) were not associated with mortality after accounting for other factors or 'confounders',including changes in fitness.

People think that weight gain is a bad thing, but in this studyfitness loss was associated with a higher risk of mortality regardless of weight change. The study thus concludes that if individuals can maintain or improve their fitness levels, they need to worry less about weight gain. Given the difficulty of reducing weight in some obese people,focusing on improving fitness instead, can have important clinical and public-health implications.