May 19, 2025 • 24 mins
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Cardiorespiratory fitness might be the strongest predictor of how long you'll live, with a massive study showing fitness level may have a more significant impact than traditional risk factors like smoking or diabetes.
• Study of 122,000 people undergoing treadmill testing followed for eight years
• People with elite fitness were 80% less likely to die than those with low fitness
• Being unfit appeared worse for mortality than smoking, diabetes, or heart disease
• Benefits were seen across all age groups and genders
• Even modest improvements in fitness can make a significant difference
• Benefits begin at 0.1-7.5 MET hours per week of activity
• Optimal benefits occur at 22.5-75 MET hours weekly
• Strength training benefits begin at once weekly and peak at 60 minutes per week
• VO2 max can be tracked with fitness watches to monitor cardiorespiratory fitness
Please send us an email at yourcheckuppod@gmail.com with questions or topics you'd like us to cover in future episodes.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ed Delesky, MD (00:07):
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
Nicole Aruffo, RN (00:23):
And.
Ed Delesky, MD (00:23):
I'm Nicole Aruffo.
I'm a nurse and we are soexcited you were able to join us
here again today, so you reallyenjoyed your lunch today.
You know you've gotten thisthing.
As the weather has gottenbetter, you've been able to come
back home, since I've been onvacation, and describe to me
what you ate from yourperspective.
Nicole Aruffo, RN (00:44):
Yeah, I came home for lunch today and to my
surprise there was a big juicypiece of sirloin waiting for me
when I got home.
Ed Delesky, MD (00:53):
It was delicious .
Definitely medium rare.
Was that almost rare, would yousay?
How would you say that specificpiece of meat came out when I
thinly sliced the meat?
Nicole Aruffo, RN (01:08):
I don't know, I didn't examine it that
closely.
Ed Delesky, MD (01:11):
Okay.
Nicole Aruffo, RN (01:12):
I guess more on the rare side.
Ed Delesky, MD (01:15):
Could it have been like medium rare, or do you
think that was rare?
Nicole Aruffo, RN (01:19):
No, maybe like closer to medium On the
medium rare spectrum.
Ed Delesky, MD (01:24):
Okay, I get that .
I thought it was delicious, itwas so good.
I loved it too.
That was adorable actually.
Like he was so calm when helike came over and I was like
asking for his paw and he wouldgive me the little.
He'd give me his paw and thelittle piece of meat.
That was so cute I.
And then I love like I mean weput it in the dishwasher anyway.
(01:44):
But when he like gets hislittle plate afterwards- to let
him lick the plate it's so cute.
I love that, oh, my goodness.
Well, um anything else, let'ssee the breakfast.
We've been having the sourdoughbread we converted actually we
converted breads still sourdoughbut we've been converting from
(02:05):
getting trader joe's sourdoughbread to a whole foods sourdough
bread and I think the wholefoods one is better well, yeah,
obviously I'm pretty sure theylike make it there that wasn't
supposed to be so obvious to me,or like make it more fresh well
(02:25):
, it's a little closer.
And then the, like the, theygive you half a loaf, which
actually works out better,because I'd rather go get more
than I would purchase the wholebig trader joe's loaf where,
like we've had a couple of them,go bad well, yeah, I mean,
trader joe's is good for, likesome things, but things that
need to be kept fresh, I I don'tthink it's the best.
Nicole Aruffo, RN (02:47):
I feel like it's the way they like ship it
or something, because like theirproduce you like have to eat
the day you buy it because itdoesn't last.
Ed Delesky, MD (02:55):
Where does it come from?
Nicole Aruffo, RN (02:56):
Oh.
Ed Delesky, MD (02:57):
I don't know, Like do they have like a big, do
they?
They don't make it in the back,but it comes from somewhere
where they make it yeah, thetj's factory well, they're great
for like a frozen snack likeI've been having cheese and a
dip yeah, they're.
Oh yeah, that was good.
Nicole Aruffo, RN (03:15):
We had the labna, labna, labna no idea, it
was delicious, but it wasdelicious.
Ed Delesky, MD (03:20):
It reminded me of soraya.
Um was great.
I got a little cracker on there.
Might have to.
When we're done with this,might have to go like take a
couple scoops and do that.
Nicole Aruffo, RN (03:29):
Well, you left like one bite.
Ed Delesky, MD (03:30):
so yeah, I wanted more for later.
Oh my God, I did.
Nicole Aruffo, RN (03:35):
I know.
Ed Delesky, MD (03:36):
Well, and then after this, you're getting some
crab cavatelli, or I guess thecavatelli part is the pasta.
This is going to be a corkscrewpasta.
Nicole Aruffo, RN (03:45):
Well, that's okay, it can still be crab
cavatelli.
Ed Delesky, MD (03:47):
It'll be crab cavatelli for all intents and
purposes, and the return of thePollock, which, if you've been a
longtime listener of the show,you will understand that.
Nicole Aruffo, RN (03:56):
Pollock has justice in our household.
Ed Delesky, MD (03:58):
It does.
We're not just eating imitationcrab, we're eating Pollock and
we're shedding light on your oldteacher, mr Pollock,
pediatrician oh, pediatrician,it might've been a fish, oh no,
we're recycling bits now.
Nicole Aruffo, RN (04:13):
Oh man, time to quit.
You took an FLS.
I did.
What does FLS stand for?
Fantastic lady shower,basically it's when I wash my
hair.
What do you do when you washyour hair?
What do you mean?
What do I do?
Well, tell, like, what's goingin there.
(04:33):
What's going in there?
Ed Delesky, MD (04:35):
yeah, shampoo and conditioner do you still use
any of that, like scalptreatment stuff, the like powder
stuff?
Nicole Aruffo, RN (04:43):
yeah, sometimes I do a scalp scrub.
I didn't this time.
Sometimes I'll do like, um,what's it called a clarifying
shampoo?
Sometimes I'll do a hair mask.
None of that today.
We just went straight shampooand conditioner well, not to be
dramatic.
Ed Delesky, MD (04:59):
Is that still considered a an fls?
It is, yeah.
How does one differentiatebetween an FLS and the and
otherwise, when you're justwashing your hair versus?
Nicole Aruffo, RN (05:14):
I don't wash my hair every day and it's a
process, and then I have to dryit and it's like long and thick
and curly.
It's a whole process.
Ed Delesky, MD (05:24):
It truly is.
Well, let's not belabor ourlisteners anymore with our daily
happenings.
Why don't we dive in here andget started?
What are we going to talk abouttoday, Nick?
Nicole Aruffo, RN (05:34):
Today we're talking about cardiorespiratory
fitness and long-term mortality.
Ed Delesky, MD (05:41):
Yeah, so we are going to dive into.
Actually, when I read thisstudy, I really did think it was
jaw dropping what they wereable to represent in a simple
study, and it really had one bigtakeaway your fitness level
might be one of the strongestpredictors of how long you live,
and we don't mean that you needto be an ultra marathoner.
(06:03):
We're literally talking abouthow your body handles exercise
and how that translates intosurvival.
So this episode is about amassive study that used
treadmill tests to measurefitness in over 122,000 people.
The study was calledAssociation of Cardiorespiratory
(06:26):
Fitness with Long-TermMortality Among Adults
Undergoing Exercise TreadmillTesting.
So they followed these folksfor a little over eight years
and they looked at who livedlonger and the results might
change how you think aboutexercise.
So why don't we break it down alittle bit?
Nicole Aruffo, RN (06:46):
All right, Eddie, tell us what
cardiorespiratory fitness is.
Ed Delesky, MD (06:50):
Yeah.
So I think it's important totalk about what they were
actually measuring in this studybefore we dive into any of the
particulars.
So cardiorespiratory fitness,or what they call in this study,
if you were to look it up, orCRF is what they abbreviate it
to.
They call in this study, if youwere to look it up.
Crf is what they abbreviate itto.
It's a fancy term thatbasically explains how well your
(07:16):
heart and lungs work togetherto power your muscles during
exercise.
And in this study they measuredMETs, or a metabolic equivalent
of a task.
We've talked about that in oneof our older exercise episodes
task.
We've talked about that in oneof our older exercise episodes.
But to review, one met is theenergy you use while sitting,
still doing absolutely nothingelse.
And as you move more the metsthat you use go up, and so the
higher the mets that you use ina treadmill, the better your
(07:39):
fitness.
So something like a brisk walkis like three Mets, whereas
running faster, like six milesan hour, is about like nine
point eight Mets, seven and ahalf miles an hour, eleven and a
half Mets.
A light lifting session ofstrength training is three Mets,
so on and so forth, and thisstuff is largely available
(08:02):
online.
Nicole Aruffo, RN (08:02):
OK, so let's go back to this study.
What were they looking at?
Ed Delesky, MD (08:06):
So, like we talked about, they measured
122,007 adults who had atreadmill stress test, and so
this is exactly the one whereyou walk or run on a treadmill
and they track your heart rate,and these were average, everyday
people who were they're notOlympic athletes.
These are everyday people whoare getting checked for heart
(08:27):
symptoms, and so that'ssomething that is to be
considered when they look at thepopulation of who they were
actually studying.
They followed these people foreight years and, on average,
looked at who lived longer, andthe simple question they had was
does your performance on thattreadmill predict how long
you'll live?
And they actually came up withsome really interesting answers.
Nicole Aruffo, RN (08:52):
Like what.
Ed Delesky, MD (08:53):
So I got really excited about this because when
they started comparing thegroups and basically what they
came down to is the more fit youwere, the longer you lived, and
I don't know if anyone needed astudy to be able to tell them
this.
This is kind of like maybe aself-evident truth, but this was
done in 2018.
And this got a lot of citations, a lot of action, a lot of
(09:14):
views, and that fact, the morefit you are, the longer you will
live, was true all the way upto the highest fitness levels.
So what they did is theydivided people into five groups
based on their fitness and whatthey found in these tests the
treadmill tests.
They labeled them low, belowaverage, above average, high and
(09:39):
elite, and the elite group hadthe best survival rates of
anyone.
And when they compared the two,they compared the elite group
to the low group incardiorespiratory fitness, and
they found that people with lowfitness were five times more
likely to die than the eliteperformers, and that is huge.
(10:03):
That is five times more likely,which is stark and kind of just
to put this into perspective.
What they also did was theycompared people's fitness levels
, so these branded fitnesslevels that they gave people,
low below average, above average, high elite, so on and so forth
(10:24):
.
They compared those factors,this fitness level, against
standard risk factors likesmoking, heart disease, standard
risk factors like smoking,heart disease, coronary artery
disease.
And they found that in thisstudy, in this population of
(10:44):
people, they had some evidencethat showed that being unfit had
a higher risk of mortality thanbeing a smoker.
And they took the same group ofpeople.
They looked at smoker,non-smoker in that group of
people and found that maybebeing unfit was worse.
They found that being unfit orhaving low fitness was a bigger
(11:05):
risk for dying than havingdiabetes, heart disease or even
smoking cigarettes.
And that really tells ussomething powerful Fitness
matters way more than we thought.
Nicole Aruffo, RN (11:18):
Does this apply to everyone?
Ed Delesky, MD (11:20):
Yeah.
So I mean, you might bethinking like, yeah, I'm
listening to this and I'manywhere from like my twenties
to my seventies, like, does thiseven apply to me?
And it really does.
They showed the benefits acrossall age groups.
In fact, they thought thatolder age groups might have more
benefits for improvingcardiovascular fitness, and the
(11:42):
same went for men and women,though there were slightly more
men in the study than women.
And, no matter who you are, itshowed that better fitness meant
better chances of living longer.
There were some limits to otherstudies, which is why this one
was kind of more interestingthan others.
So earlier studies usedself-reported exercise, which is
(12:04):
really hard because peopleoften under or overestimate the
amount of exercise that theyactually do.
So that can be unreliable,which makes studying the science
even more difficult.
Furthermore, this study wasretrospective, which means
studying the science even moredifficult.
Furthermore, this study wasretrospective, which means that
it looked back at data that wasalready had, and so it shows
associations, but not directcause and effect.
(12:26):
So that's something that wehave to keep in mind is that
they were able to look at theseand say like, wow, these elite
performance athletes had so muchbetter mortality.
But it can't be attributed tocause and effect and, truthfully
, what they didn't measure wereunmeasured factors like income
or social determinants of health, to see if any of that played a
(12:49):
role.
Further, fitness was onlymeasured once.
It wasn't measured over time,and so there wasn't a lot to say
whether changes over time wouldaffect outcomes.
And truly, all these people whowere in this study were
referred by someone fortreadmill stress testing for
some reason, and so it's notexactly a random slice of the
(13:10):
general population of peoplelike you or I haven't had a
treadmill stress test.
I think what would really needto happen is we get a population
of average people and put themon treadmills and reproduce this
, and maybe that study has beendone.
But in that way, these uh limitthe findings that we have from
here.
Things that we're discussingare a little limited.
Nicole Aruffo, RN (13:31):
So what can all of us do with this new
information?
Ed Delesky, MD (13:35):
I mean, I think, when you think about it, bring
it back to your everyday life.
We're talking about these eliteathletes, elite cardio
respiratory fitness people and,yeah, they're the ones who get
the highlight of the study, buteveryone who had more than low
fitness had some benefit.
And so you don't need to runmarathons, but you really do
(13:57):
need to move.
So try to walk more.
Take the stairs, go get yourheart rate up with whatever
activity you enjoy Maybe it'sdancing, maybe you're biking,
swimming.
The goal is to build a heart andlungs that can handle a little
challenge, and if you aresomeone who's starting from a
place of very low fitness, thegood news is that even a small
(14:20):
improvement can really make abig difference in your life.
So the next time you'rethinking about skipping a walk
or putting off a workout,remember this study specifically
.
And moving your body isn't justabout looking better or losing
weight.
In fact, in this study, it'sabout living longer.
So today we talked thatcardiorespiratory fitness is one
(14:42):
of the strongest predictors ofsurvival that we have, and so
let's treat it like that.
Any thoughts or feelings about?
Nicole Aruffo, RN (14:51):
um no, I think it's pretty cool though.
Ed Delesky, MD (14:54):
I wish they had a study where they looked at the
general population.
I mean, I think it's prettycool, though I wish they had a
study where they looked at thegeneral population.
I mean, I think of the personthat I end up referring to like
a treadmill stress test.
It's like someone who usuallyhas shortness of breath or chest
pain or some weird thing, andso it would be really cool if
they took the average person,and maybe we have to go digging
and find that.
I loved when they compared thecommon comorbidities that people
(15:18):
have, like diabetes, coronaryartery disease.
Nicole Aruffo, RN (15:21):
Yeah, that's crazy, especially because we've
talked about how much thosethings can affect your mortality
and now it's like, oh, it'sactually worse to be.
I mean, it's still important,but it's worse to be Less fit.
Ed Delesky, MD (15:37):
Like this study at least makes I mean it's still
important, but it's worse to beless fit.
Like this study at least makesyou think that like it's
something at least important tothink about.
Like I mean, who isn't going topreach about exercise?
But oftentimes I hear I seeonline, like when we're so
active online, that people arelike, oh no, doctors talk about
like exercise and diet being soimportant.
Well, here's our stance thatlike it is, and here's the study
(16:00):
that shows that at least here'sa little backing that it truly
is one thing that we like.
That I was going to include inthis episode, but like we, you
know there's going to be a wholeexplanation of it is the vo2
max, which yeah, you love a vo2.
Nicole Aruffo, RN (16:14):
I do um in short, for, like anyone
listening, the vo2 max, which Ilove a.
Ed Delesky, MD (16:16):
VO2.
I do Um in short, for, likeanyone listening, the VO2 max
represents the maximum amount ofoxygen your body can use during
intense exercise, and so it canbe a key indicator of cardio
respiratory fitness, and itreflects the same thing the
efficiency of your heart, lungsand muscles.
Usually, if you're going to getlike the best measurement, you
(16:36):
have to do it in the lab, getspecialized equipment and like
do a graded exercise regimen.
But I mean, like we have applewatches and the apple watch
gives us a pretty decent ideaand for anyone listening out
there who has one, you can goget like looking at your health
app.
But you can also like do testsonline, like you can like vo2
test and like you can try to doa certain amount of exercise in
(16:59):
certain time and you can find it.
But that's the like.
Basically, the point is that youcan get that number easily if
you have like a fitness watch,fitness app and you can see
where you are, like I don't likewhere I am cardio respiratory
fitness wise and like I think itchanged, like my classification
changed this birthday.
(17:20):
Go around that.
It's something I'm reallytrying to get up, but like yours
is pristine and beautiful andI'm jealous.
Oh my gosh, there are.
So there are age-relateddeclines with the vo2 and so,
like, like I said, like I, mymost recent birthday, like
changed the stratification, so,like the they went down the
categories and you know, that iswhat it is.
(17:43):
I had um chris one of mychris's um texted me and was
like why did I get this giantjump in my vo2?
And I was like, did any of yourequipment change?
And he was like yeah, I got anew watch.
I'm like that's why, like Idon't think you magically got
four points on your vo2 maxovernight which would have been
really cool.
(18:03):
but it's true, I do love a vo2because I don't think many
people are going to be doinglike mets, right, like I don't
even think a lot of.
How do you even like calculatea mat?
Yeah, some treadmills do it,some bikes do it.
They have them out there.
Nicole Aruffo, RN (18:20):
But like how do you know how many mats are
like enough mats?
Ed Delesky, MD (18:26):
Oh wait, now you sound dumb.
No, this is, this is anexcellent question.
Nicole Aruffo, RN (18:29):
So how many mats a day should you be Doing
yeah?
Ed Delesky, MD (18:36):
Yeah, this is an amazing question.
So the conversation starts withaerobic exercise, like regular
aerobic activity, like walking,running, cycling, swimming all
of that can improve your VO2.
And the all cause mortality.
This is from a separate studythat looked at VO2 and all cause
mortality and that all startsanywhere from like 0.1 to 7.5
(19:01):
met hours per week.
So met hours per week is kindof a loaded thing and then I
guess we'll kind of break thatdown.
But the benefit peaks at 22.5to 75 met hours per week.
So if we were to kind of breakdown some of these activities,
(19:22):
here are some mets of commonthings.
So let's say walking, walkingat a moderate pace which is
three miles an hour is 3.3 mets.
So let's say you wanted to dothe bare minimum but you wanted
to be healthy, we said that thebenefit starts at 0.1.
Let's say you wanted to like dothe bare minimum but you wanted
to be healthy, we said that,like, the benefit starts at 0.1,
(19:44):
.
But if you want to get to thethreshold of like 7.5 Mets and
they say a Met hour per week,how long do you have to walk at
three miles per hour to get 3.3Mets an hour?
Well, that's why they add a timefeature in it, cause, like, the
Met is just the measurement ofthe activity.
Oh, and so in that thing theysay a Met hour per week.
Nicole Aruffo, RN (20:07):
So that's for an hour, all of these.
Ed Delesky, MD (20:10):
So that, like, if you wanted to do a good
example here would be like onehour of running five miles per
hour would get you eight methours, and if you can do that
per week that mortality benefitstarts.
Nicole Aruffo, RN (20:27):
Oh gotcha.
Ed Delesky, MD (20:29):
And so, like one of these studies suggested that
if you can get somewherebetween 22.5 to 75 met hours per
week, then you would be likemax maximizing the benefit of
your metabolic equivalent.
And so let's say, like youwanted to go for six miles an
(20:52):
hour, for 2.29 hours in a week,to get that 22.5 met hours per
week, so on and so forth.
So there's a little bit of mathto it and like, if you wanted
(21:14):
to, let's say cycling, and youwanted to do moderate cycling,
which is like 10 to 12 miles anhour, you have six mets.
You calculate how much time youneed to get up to whatever
threshold you want to get to.
It seems like 22.5 is like thelowest of the most successful
range.
Then that's where you go forthat seems doable yeah, and this
(21:37):
like this.
I mean I think people will alsohit this if they get to like the
30 minutes five times a week ofa moderate intensity
cardiovascular exercise and twodays of strength training.
And just to say it out loudthat the all-cause mortality
risk reduction for strengthtraining begins at one time per
week and peaks at about 60minutes per week for how much
(21:59):
you're lifting, just to givepeople a better idea.
Yeah, I'm like over here now.
Nicole Aruffo, RN (22:03):
I'm like calculating how many met hours
how many met hours do you havethis week?
Ed Delesky, MD (22:10):
that's a great question.
I don't even like and then likewhat does it take to get up to
75 met hours per week?
Kind of a decent amount ifwe're gonna.
I mean, what burlake?
Running somewhere probably, Imean that's seven over seven and
a half hours of jogging at sixmiles an hour yeah so that's
(22:30):
like a little over an hour a dayof jogging at six miles an hour
if you're gonna do that thatway yeah that feels like a lot
yeah, but you know, somewherearound, like what peak said,
22.5, even like 30, is veryattainable, I think sure, yeah,
yeah, I guess I wonder, evenwithin that range 22.5 to 75
(22:51):
does that improve within itself?
not exactly sure, yeah, but yeah, these are all really cool
things that I wanted to sharetoday, because I sometimes
exercise doesn't get enough loveand it can be helpful to hear
some data to really give peoplea push in the right direction,
that it is totally worth it andsomething you absolutely need to
(23:12):
consider, and I hope you don'tlook at your Apple watch and
you're so shocked about yourcardio respiratory fitness and
that you feel like you're goingto pass away because it's low.
It's all something that you canwork on and move forward and
get healthier.
So hopefully today you wereable to learn something for
yourself, a loved one or aneighbor, and we hope you come
(23:35):
back next week for anotherepisode of your Checkup.
Please send us an email atyourcheckuppod at gmailcom, send
us some fan mail and send usquestions on there as well, if
you need.
But most importantly, stayhealthy, my friends.
Until next time.
I'm Ed Dolesky.
Nicole Aruffo, RN (23:51):
I'm Nicole Rufo.
Ed Delesky, MD (23:53):
Thank you Goodbye.
Nicole Aruffo, RN (23:54):
Bye.
Ed Delesky, MD (24:11):
This information may provide a brief overview of
diagnosis, treatment andmedications.
Thank you.
Attempt to substitute medicaladvice, you should contact a
healthcare provider forpersonalized guidance based on
your unique circumstances.
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
(24:33):
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
Nicole Aruffo, RN (00:23):
And.
Ed Delesky, MD (00:23):
I'm Nicole Aruffo.
I'm a nurse and we are soexcited you were able to join us
here again today, so you reallyenjoyed your lunch today.
You know you've gotten thisthing.
As the weather has gottenbetter, you've been able to come
back home, since I've been onvacation, and describe to me
what you ate from yourperspective.
Nicole Aruffo, RN (00:44):
Yeah, I came home for lunch today and to my
surprise there was a big juicypiece of sirloin waiting for me
when I got home.
Ed Delesky, MD (00:53):
It was delicious .
Definitely medium rare.
Was that almost rare, would yousay?
How would you say that specificpiece of meat came out when I
thinly sliced the meat?
Nicole Aruffo, RN (01:08):
I don't know, I didn't examine it that
closely.
Ed Delesky, MD (01:11):
Okay.
Nicole Aruffo, RN (01:12):
I guess more on the rare side.
Ed Delesky, MD (01:15):
Could it have been like medium rare, or do you
think that was rare?
Nicole Aruffo, RN (01:19):
No, maybe like closer to medium On the
medium rare spectrum.
Ed Delesky, MD (01:24):
Okay, I get that .
I thought it was delicious, itwas so good.
I loved it too.
That was adorable actually.
Like he was so calm when helike came over and I was like
asking for his paw and he wouldgive me the little.
He'd give me his paw and thelittle piece of meat.
That was so cute I.
And then I love like I mean weput it in the dishwasher anyway.
(01:44):
But when he like gets hislittle plate afterwards- to let
him lick the plate it's so cute.
I love that, oh, my goodness.
Well, um anything else, let'ssee the breakfast.
We've been having the sourdoughbread we converted actually we
converted breads still sourdoughbut we've been converting from
(02:05):
getting trader joe's sourdoughbread to a whole foods sourdough
bread and I think the wholefoods one is better well, yeah,
obviously I'm pretty sure theylike make it there that wasn't
supposed to be so obvious to me,or like make it more fresh well
(02:25):
, it's a little closer.
And then the, like the, theygive you half a loaf, which
actually works out better,because I'd rather go get more
than I would purchase the wholebig trader joe's loaf where,
like we've had a couple of them,go bad well, yeah, I mean,
trader joe's is good for, likesome things, but things that
need to be kept fresh, I I don'tthink it's the best.
Nicole Aruffo, RN (02:47):
I feel like it's the way they like ship it
or something, because like theirproduce you like have to eat
the day you buy it because itdoesn't last.
Ed Delesky, MD (02:55):
Where does it come from?
Nicole Aruffo, RN (02:56):
Oh.
Ed Delesky, MD (02:57):
I don't know, Like do they have like a big, do
they?
They don't make it in the back,but it comes from somewhere
where they make it yeah, thetj's factory well, they're great
for like a frozen snack likeI've been having cheese and a
dip yeah, they're.
Oh yeah, that was good.
Nicole Aruffo, RN (03:15):
We had the labna, labna, labna no idea, it
was delicious, but it wasdelicious.
Ed Delesky, MD (03:20):
It reminded me of soraya.
Um was great.
I got a little cracker on there.
Might have to.
When we're done with this,might have to go like take a
couple scoops and do that.
Nicole Aruffo, RN (03:29):
Well, you left like one bite.
Ed Delesky, MD (03:30):
so yeah, I wanted more for later.
Oh my God, I did.
Nicole Aruffo, RN (03:35):
I know.
Ed Delesky, MD (03:36):
Well, and then after this, you're getting some
crab cavatelli, or I guess thecavatelli part is the pasta.
This is going to be a corkscrewpasta.
Nicole Aruffo, RN (03:45):
Well, that's okay, it can still be crab
cavatelli.
Ed Delesky, MD (03:47):
It'll be crab cavatelli for all intents and
purposes, and the return of thePollock, which, if you've been a
longtime listener of the show,you will understand that.
Nicole Aruffo, RN (03:56):
Pollock has justice in our household.
Ed Delesky, MD (03:58):
It does.
We're not just eating imitationcrab, we're eating Pollock and
we're shedding light on your oldteacher, mr Pollock,
pediatrician oh, pediatrician,it might've been a fish, oh no,
we're recycling bits now.
Nicole Aruffo, RN (04:13):
Oh man, time to quit.
You took an FLS.
I did.
What does FLS stand for?
Fantastic lady shower,basically it's when I wash my
hair.
What do you do when you washyour hair?
What do you mean?
What do I do?
Well, tell, like, what's goingin there.
(04:33):
What's going in there?
Ed Delesky, MD (04:35):
yeah, shampoo and conditioner do you still use
any of that, like scalptreatment stuff, the like powder
stuff?
Nicole Aruffo, RN (04:43):
yeah, sometimes I do a scalp scrub.
I didn't this time.
Sometimes I'll do like, um,what's it called a clarifying
shampoo?
Sometimes I'll do a hair mask.
None of that today.
We just went straight shampooand conditioner well, not to be
dramatic.
Ed Delesky, MD (04:59):
Is that still considered a an fls?
It is, yeah.
How does one differentiatebetween an FLS and the and
otherwise, when you're justwashing your hair versus?
Nicole Aruffo, RN (05:14):
I don't wash my hair every day and it's a
process, and then I have to dryit and it's like long and thick
and curly.
It's a whole process.
Ed Delesky, MD (05:24):
It truly is.
Well, let's not belabor ourlisteners anymore with our daily
happenings.
Why don't we dive in here andget started?
What are we going to talk abouttoday, Nick?
Nicole Aruffo, RN (05:34):
Today we're talking about cardiorespiratory
fitness and long-term mortality.
Ed Delesky, MD (05:41):
Yeah, so we are going to dive into.
Actually, when I read thisstudy, I really did think it was
jaw dropping what they wereable to represent in a simple
study, and it really had one bigtakeaway your fitness level
might be one of the strongestpredictors of how long you live,
and we don't mean that you needto be an ultra marathoner.
(06:03):
We're literally talking abouthow your body handles exercise
and how that translates intosurvival.
So this episode is about amassive study that used
treadmill tests to measurefitness in over 122,000 people.
The study was calledAssociation of Cardiorespiratory
(06:26):
Fitness with Long-TermMortality Among Adults
Undergoing Exercise TreadmillTesting.
So they followed these folksfor a little over eight years
and they looked at who livedlonger and the results might
change how you think aboutexercise.
So why don't we break it down alittle bit?
Nicole Aruffo, RN (06:46):
All right, Eddie, tell us what
cardiorespiratory fitness is.
Ed Delesky, MD (06:50):
Yeah.
So I think it's important totalk about what they were
actually measuring in this studybefore we dive into any of the
particulars.
So cardiorespiratory fitness,or what they call in this study,
if you were to look it up, orCRF is what they abbreviate it
to.
They call in this study, if youwere to look it up.
Crf is what they abbreviate itto.
It's a fancy term thatbasically explains how well your
(07:16):
heart and lungs work togetherto power your muscles during
exercise.
And in this study they measuredMETs, or a metabolic equivalent
of a task.
We've talked about that in oneof our older exercise episodes
task.
We've talked about that in oneof our older exercise episodes.
But to review, one met is theenergy you use while sitting,
still doing absolutely nothingelse.
And as you move more the metsthat you use go up, and so the
higher the mets that you use ina treadmill, the better your
(07:39):
fitness.
So something like a brisk walkis like three Mets, whereas
running faster, like six milesan hour, is about like nine
point eight Mets, seven and ahalf miles an hour, eleven and a
half Mets.
A light lifting session ofstrength training is three Mets,
so on and so forth, and thisstuff is largely available
(08:02):
online.
Nicole Aruffo, RN (08:02):
OK, so let's go back to this study.
What were they looking at?
Ed Delesky, MD (08:06):
So, like we talked about, they measured
122,007 adults who had atreadmill stress test, and so
this is exactly the one whereyou walk or run on a treadmill
and they track your heart rate,and these were average, everyday
people who were they're notOlympic athletes.
These are everyday people whoare getting checked for heart
(08:27):
symptoms, and so that'ssomething that is to be
considered when they look at thepopulation of who they were
actually studying.
They followed these people foreight years and, on average,
looked at who lived longer, andthe simple question they had was
does your performance on thattreadmill predict how long
you'll live?
And they actually came up withsome really interesting answers.
Nicole Aruffo, RN (08:52):
Like what.
Ed Delesky, MD (08:53):
So I got really excited about this because when
they started comparing thegroups and basically what they
came down to is the more fit youwere, the longer you lived, and
I don't know if anyone needed astudy to be able to tell them
this.
This is kind of like maybe aself-evident truth, but this was
done in 2018.
And this got a lot of citations, a lot of action, a lot of
(09:14):
views, and that fact, the morefit you are, the longer you will
live, was true all the way upto the highest fitness levels.
So what they did is theydivided people into five groups
based on their fitness and whatthey found in these tests the
treadmill tests.
They labeled them low, belowaverage, above average, high and
(09:39):
elite, and the elite group hadthe best survival rates of
anyone.
And when they compared the two,they compared the elite group
to the low group incardiorespiratory fitness, and
they found that people with lowfitness were five times more
likely to die than the eliteperformers, and that is huge.
(10:03):
That is five times more likely,which is stark and kind of just
to put this into perspective.
What they also did was theycompared people's fitness levels
, so these branded fitnesslevels that they gave people,
low below average, above average, high elite, so on and so forth
(10:24):
.
They compared those factors,this fitness level, against
standard risk factors likesmoking, heart disease, standard
risk factors like smoking,heart disease, coronary artery
disease.
And they found that in thisstudy, in this population of
(10:44):
people, they had some evidencethat showed that being unfit had
a higher risk of mortality thanbeing a smoker.
And they took the same group ofpeople.
They looked at smoker,non-smoker in that group of
people and found that maybebeing unfit was worse.
They found that being unfit orhaving low fitness was a bigger
(11:05):
risk for dying than havingdiabetes, heart disease or even
smoking cigarettes.
And that really tells ussomething powerful Fitness
matters way more than we thought.
Nicole Aruffo, RN (11:18):
Does this apply to everyone?
Ed Delesky, MD (11:20):
Yeah.
So I mean, you might bethinking like, yeah, I'm
listening to this and I'manywhere from like my twenties
to my seventies, like, does thiseven apply to me?
And it really does.
They showed the benefits acrossall age groups.
In fact, they thought thatolder age groups might have more
benefits for improvingcardiovascular fitness, and the
(11:42):
same went for men and women,though there were slightly more
men in the study than women.
And, no matter who you are, itshowed that better fitness meant
better chances of living longer.
There were some limits to otherstudies, which is why this one
was kind of more interestingthan others.
So earlier studies usedself-reported exercise, which is
(12:04):
really hard because peopleoften under or overestimate the
amount of exercise that theyactually do.
So that can be unreliable,which makes studying the science
even more difficult.
Furthermore, this study wasretrospective, which means
studying the science even moredifficult.
Furthermore, this study wasretrospective, which means that
it looked back at data that wasalready had, and so it shows
associations, but not directcause and effect.
(12:26):
So that's something that wehave to keep in mind is that
they were able to look at theseand say like, wow, these elite
performance athletes had so muchbetter mortality.
But it can't be attributed tocause and effect and, truthfully
, what they didn't measure wereunmeasured factors like income
or social determinants of health, to see if any of that played a
(12:49):
role.
Further, fitness was onlymeasured once.
It wasn't measured over time,and so there wasn't a lot to say
whether changes over time wouldaffect outcomes.
And truly, all these people whowere in this study were
referred by someone fortreadmill stress testing for
some reason, and so it's notexactly a random slice of the
(13:10):
general population of peoplelike you or I haven't had a
treadmill stress test.
I think what would really needto happen is we get a population
of average people and put themon treadmills and reproduce this
, and maybe that study has beendone.
But in that way, these uh limitthe findings that we have from
here.
Things that we're discussingare a little limited.
Nicole Aruffo, RN (13:31):
So what can all of us do with this new
information?
Ed Delesky, MD (13:35):
I mean, I think, when you think about it, bring
it back to your everyday life.
We're talking about these eliteathletes, elite cardio
respiratory fitness people and,yeah, they're the ones who get
the highlight of the study, buteveryone who had more than low
fitness had some benefit.
And so you don't need to runmarathons, but you really do
(13:57):
need to move.
So try to walk more.
Take the stairs, go get yourheart rate up with whatever
activity you enjoy Maybe it'sdancing, maybe you're biking,
swimming.
The goal is to build a heart andlungs that can handle a little
challenge, and if you aresomeone who's starting from a
place of very low fitness, thegood news is that even a small
(14:20):
improvement can really make abig difference in your life.
So the next time you'rethinking about skipping a walk
or putting off a workout,remember this study specifically
.
And moving your body isn't justabout looking better or losing
weight.
In fact, in this study, it'sabout living longer.
So today we talked thatcardiorespiratory fitness is one
(14:42):
of the strongest predictors ofsurvival that we have, and so
let's treat it like that.
Any thoughts or feelings about?
Nicole Aruffo, RN (14:51):
um no, I think it's pretty cool though.
Ed Delesky, MD (14:54):
I wish they had a study where they looked at the
general population.
I mean, I think it's prettycool, though I wish they had a
study where they looked at thegeneral population.
I mean, I think of the personthat I end up referring to like
a treadmill stress test.
It's like someone who usuallyhas shortness of breath or chest
pain or some weird thing, andso it would be really cool if
they took the average person,and maybe we have to go digging
and find that.
I loved when they compared thecommon comorbidities that people
(15:18):
have, like diabetes, coronaryartery disease.
Nicole Aruffo, RN (15:21):
Yeah, that's crazy, especially because we've
talked about how much thosethings can affect your mortality
and now it's like, oh, it'sactually worse to be.
I mean, it's still important,but it's worse to be Less fit.
Ed Delesky, MD (15:37):
Like this study at least makes I mean it's still
important, but it's worse to beless fit.
Like this study at least makesyou think that like it's
something at least important tothink about.
Like I mean, who isn't going topreach about exercise?
But oftentimes I hear I seeonline, like when we're so
active online, that people arelike, oh no, doctors talk about
like exercise and diet being soimportant.
Well, here's our stance thatlike it is, and here's the study
(16:00):
that shows that at least here'sa little backing that it truly
is one thing that we like.
That I was going to include inthis episode, but like we, you
know there's going to be a wholeexplanation of it is the vo2
max, which yeah, you love a vo2.
Nicole Aruffo, RN (16:14):
I do um in short, for, like anyone
listening, the vo2 max, which Ilove a.
Ed Delesky, MD (16:16):
VO2.
I do Um in short, for, likeanyone listening, the VO2 max
represents the maximum amount ofoxygen your body can use during
intense exercise, and so it canbe a key indicator of cardio
respiratory fitness, and itreflects the same thing the
efficiency of your heart, lungsand muscles.
Usually, if you're going to getlike the best measurement, you
(16:36):
have to do it in the lab, getspecialized equipment and like
do a graded exercise regimen.
But I mean, like we have applewatches and the apple watch
gives us a pretty decent ideaand for anyone listening out
there who has one, you can goget like looking at your health
app.
But you can also like do testsonline, like you can like vo2
test and like you can try to doa certain amount of exercise in
(16:59):
certain time and you can find it.
But that's the like.
Basically, the point is that youcan get that number easily if
you have like a fitness watch,fitness app and you can see
where you are, like I don't likewhere I am cardio respiratory
fitness wise and like I think itchanged, like my classification
changed this birthday.
(17:20):
Go around that.
It's something I'm reallytrying to get up, but like yours
is pristine and beautiful andI'm jealous.
Oh my gosh, there are.
So there are age-relateddeclines with the vo2 and so,
like, like I said, like I, mymost recent birthday, like
changed the stratification, so,like the they went down the
categories and you know, that iswhat it is.
(17:43):
I had um chris one of mychris's um texted me and was
like why did I get this giantjump in my vo2?
And I was like, did any of yourequipment change?
And he was like yeah, I got anew watch.
I'm like that's why, like Idon't think you magically got
four points on your vo2 maxovernight which would have been
really cool.
(18:03):
but it's true, I do love a vo2because I don't think many
people are going to be doinglike mets, right, like I don't
even think a lot of.
How do you even like calculatea mat?
Yeah, some treadmills do it,some bikes do it.
They have them out there.
Nicole Aruffo, RN (18:20):
But like how do you know how many mats are
like enough mats?
Ed Delesky, MD (18:26):
Oh wait, now you sound dumb.
No, this is, this is anexcellent question.
Nicole Aruffo, RN (18:29):
So how many mats a day should you be Doing
yeah?
Ed Delesky, MD (18:36):
Yeah, this is an amazing question.
So the conversation starts withaerobic exercise, like regular
aerobic activity, like walking,running, cycling, swimming all
of that can improve your VO2.
And the all cause mortality.
This is from a separate studythat looked at VO2 and all cause
mortality and that all startsanywhere from like 0.1 to 7.5
(19:01):
met hours per week.
So met hours per week is kindof a loaded thing and then I
guess we'll kind of break thatdown.
But the benefit peaks at 22.5to 75 met hours per week.
So if we were to kind of breakdown some of these activities,
(19:22):
here are some mets of commonthings.
So let's say walking, walkingat a moderate pace which is
three miles an hour is 3.3 mets.
So let's say you wanted to dothe bare minimum but you wanted
to be healthy, we said that thebenefit starts at 0.1.
Let's say you wanted to like dothe bare minimum but you wanted
to be healthy, we said that,like, the benefit starts at 0.1,
(19:44):
.
But if you want to get to thethreshold of like 7.5 Mets and
they say a Met hour per week,how long do you have to walk at
three miles per hour to get 3.3Mets an hour?
Well, that's why they add a timefeature in it, cause, like, the
Met is just the measurement ofthe activity.
Oh, and so in that thing theysay a Met hour per week.
Nicole Aruffo, RN (20:07):
So that's for an hour, all of these.
Ed Delesky, MD (20:10):
So that, like, if you wanted to do a good
example here would be like onehour of running five miles per
hour would get you eight methours, and if you can do that
per week that mortality benefitstarts.
Nicole Aruffo, RN (20:27):
Oh gotcha.
Ed Delesky, MD (20:29):
And so, like one of these studies suggested that
if you can get somewherebetween 22.5 to 75 met hours per
week, then you would be likemax maximizing the benefit of
your metabolic equivalent.
And so let's say, like youwanted to go for six miles an
(20:52):
hour, for 2.29 hours in a week,to get that 22.5 met hours per
week, so on and so forth.
So there's a little bit of mathto it and like, if you wanted
(21:14):
to, let's say cycling, and youwanted to do moderate cycling,
which is like 10 to 12 miles anhour, you have six mets.
You calculate how much time youneed to get up to whatever
threshold you want to get to.
It seems like 22.5 is like thelowest of the most successful
range.
Then that's where you go forthat seems doable yeah, and this
(21:37):
like this.
I mean I think people will alsohit this if they get to like the
30 minutes five times a week ofa moderate intensity
cardiovascular exercise and twodays of strength training.
And just to say it out loudthat the all-cause mortality
risk reduction for strengthtraining begins at one time per
week and peaks at about 60minutes per week for how much
(21:59):
you're lifting, just to givepeople a better idea.
Yeah, I'm like over here now.
Nicole Aruffo, RN (22:03):
I'm like calculating how many met hours
how many met hours do you havethis week?
Ed Delesky, MD (22:10):
that's a great question.
I don't even like and then likewhat does it take to get up to
75 met hours per week?
Kind of a decent amount ifwe're gonna.
I mean, what burlake?
Running somewhere probably, Imean that's seven over seven and
a half hours of jogging at sixmiles an hour yeah so that's
(22:30):
like a little over an hour a dayof jogging at six miles an hour
if you're gonna do that thatway yeah that feels like a lot
yeah, but you know, somewherearound, like what peak said,
22.5, even like 30, is veryattainable, I think sure, yeah,
yeah, I guess I wonder, evenwithin that range 22.5 to 75
(22:51):
does that improve within itself?
not exactly sure, yeah, but yeah, these are all really cool
things that I wanted to sharetoday, because I sometimes
exercise doesn't get enough loveand it can be helpful to hear
some data to really give peoplea push in the right direction,
that it is totally worth it andsomething you absolutely need to
(23:12):
consider, and I hope you don'tlook at your Apple watch and
you're so shocked about yourcardio respiratory fitness and
that you feel like you're goingto pass away because it's low.
It's all something that you canwork on and move forward and
get healthier.
So hopefully today you wereable to learn something for
yourself, a loved one or aneighbor, and we hope you come
(23:35):
back next week for anotherepisode of your Checkup.
Please send us an email atyourcheckuppod at gmailcom, send
us some fan mail and send usquestions on there as well, if
you need.
But most importantly, stayhealthy, my friends.
Until next time.
I'm Ed Dolesky.
Nicole Aruffo, RN (23:51):
I'm Nicole Rufo.
Ed Delesky, MD (23:53):
Thank you Goodbye.
Nicole Aruffo, RN (23:54):
Bye.
Ed Delesky, MD (24:11):
This information may provide a brief overview of
diagnosis, treatment andmedications.
Thank you.
Attempt to substitute medicaladvice, you should contact a
healthcare provider forpersonalized guidance based on
your unique circumstances.
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
(24:33):
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
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