Your Checkup: What You Wish Your Doctor Explained

How Fitness Might Be the Best Medicine of All

• Ed Delesky, MD and Nicole Aruffo, RN • Season 2 • Episode 6

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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.


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Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski

Ed Delesky, MD:

Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine doctor in the Philadelphia area.

Nicole Aruffo, RN:

And.

Ed Delesky, MD:

I'm Nicole Aruffo. I'm a nurse and we are so excited you were able to join us here again today, so you really enjoyed your lunch today. You know you've gotten this thing. As the weather has gotten better, you've been able to come back home, since I've been on vacation, and describe to me what you ate from your perspective.

Nicole Aruffo, RN:

Yeah, I came home for lunch today and to my surprise there was a big juicy piece of sirloin waiting for me when I got home.

Ed Delesky, MD:

It was delicious. Definitely medium rare. Was that almost rare, would you say? How would you say that specific piece of meat came out when I thinly sliced the meat?

Nicole Aruffo, RN:

I don't know, I didn't examine it that closely.

Ed Delesky, MD:

Okay.

Nicole Aruffo, RN:

I guess more on the rare side.

Ed Delesky, MD:

Could it have been like medium rare, or do you think that was rare?

Nicole Aruffo, RN:

No, maybe like closer to medium On the medium rare spectrum.

Ed Delesky, MD:

Okay, I get that. I thought it was delicious, it was so good. I loved it too. That was adorable actually. Like he was so calm when he like came over and I was like asking for his paw and he would give me the little. He'd give me his paw and the little piece of meat. That was so cute I. And then I love like I mean we put it in the dishwasher anyway. But when he like gets his little plate afterwards- to let him lick the plate it's so cute.

Ed Delesky, MD:

I love that, oh, my goodness. Well, um anything else, let's see the breakfast. We've been having the sourdough bread we converted actually we converted breads still sourdough but we've been converting from getting trader joe's sourdough bread to a whole foods sourdough bread and I think the whole foods one is better well, yeah, obviously I'm pretty sure they like make it there that wasn't supposed to be so obvious to me, or like make it more fresh well, it's a little closer.

Ed Delesky, MD:

And then the, like the, they give you half a loaf, which actually works out better, because I'd rather go get more than I would purchase the whole big 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, like some things, but things that need to be kept fresh, I I don't think it's the best.

Nicole Aruffo, RN:

I feel like it's the way they like ship it or something, because like their produce you like have to eat the day you buy it because it doesn't last.

Ed Delesky, MD:

Where does it come from?

Nicole Aruffo, RN:

Oh.

Ed Delesky, MD:

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, the tj's factory well, they're great for like a frozen snack like I've been having cheese and a dip yeah, they're. Oh yeah, that was good.

Nicole Aruffo, RN:

We had the labna, labna, labna no idea, it was delicious, but it was delicious.

Ed Delesky, MD:

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:

Well, you left like one bite.

Ed Delesky, MD:

so yeah, I wanted more for later. Oh my God, I did.

Nicole Aruffo, RN:

I know.

Ed Delesky, MD:

Well, and then after this, you're getting some crab cavatelli, or I guess the cavatelli part is the pasta. This is going to be a corkscrew pasta.

Nicole Aruffo, RN:

Well, that's okay, it can still be crab cavatelli.

Ed Delesky, MD:

It'll be crab cavatelli for all intents and purposes, and the return of the Pollock, which, if you've been a longtime listener of the show, you will understand that.

Nicole Aruffo, RN:

Pollock has justice in our household.

Ed Delesky, MD:

It does. We're not just eating imitation crab, we're eating Pollock and we're shedding light on your old teacher, mr Pollock, pediatrician oh, pediatrician, it might've been a fish, oh no, we're recycling bits now.

Nicole Aruffo, RN:

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 wash your hair? What do you mean? What do I do? Well, tell, like, what's going in there. What's going in there?

Ed Delesky, MD:

yeah, shampoo and conditioner do you still use any of that, like scalp treatment stuff, the like powder stuff?

Nicole Aruffo, RN:

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 shampoo and conditioner well, not to be dramatic.

Ed Delesky, MD:

Is that still considered a an fls? It is, yeah. How does one differentiate between an FLS and the and otherwise, when you're just washing your hair versus?

Nicole Aruffo, RN:

I don't wash my hair every day and it's a process, and then I have to dry it and it's like long and thick and curly. It's a whole process.

Ed Delesky, MD:

It truly is. Well, let's not belabor our listeners anymore with our daily happenings. Why don't we dive in here and get started? What are we going to talk about today, Nick?

Nicole Aruffo, RN:

Today we're talking about cardiorespiratory fitness and long-term mortality.

Ed Delesky, MD:

Yeah, so we are going to dive into. Actually, when I read this study, I really did think it was jaw dropping what they were able to represent in a simple study, and it really had one big takeaway your fitness level might be one of the strongest predictors of how long you live, and we don't mean that you need to be an ultra marathoner. We're literally talking about how your body handles exercise and how that translates into survival. So this episode is about a massive study that used treadmill tests to measure fitness in over 122,000 people. The study was called Association of Cardiorespiratory Fitness with Long-Term Mortality Among Adults Undergoing Exercise Treadmill Testing. So they followed these folks for a little over eight years and they looked at who lived longer and the results might change how you think about exercise. So why don't we break it down a little bit?

Nicole Aruffo, RN:

All right, Eddie, tell us what cardiorespiratory fitness is.

Ed Delesky, MD:

Yeah. So I think it's important to talk about what they were actually measuring in this study before we dive into any of the particulars. So cardiorespiratory fitness, or what they call in this study, if you were to look it up, or CRF is what they abbreviate it to. They call in this study, if you were to look it up. Crf is what they abbreviate it to. It's a fancy term that basically explains how well your heart and lungs work together to power your muscles during exercise.

Ed Delesky, MD:

And in this study they measured METs, or a metabolic equivalent of a task. We've talked about that in one of our older exercise episodes task. We've talked about that in one of our older exercise episodes. But to review, one met is the energy you use while sitting, still doing absolutely nothing else. And as you move more the mets that you use go up, and so the higher the mets that you use in a treadmill, the better your fitness. So something like a brisk walk is like three Mets, whereas running faster, like six miles an hour, is about like nine point eight Mets, seven and a half miles an hour, eleven and a half Mets. A light lifting session of strength training is three Mets, so on and so forth, and this stuff is largely available online.

Nicole Aruffo, RN:

OK, so let's go back to this study. What were they looking at?

Ed Delesky, MD:

So, like we talked about, they measured 122,007 adults who had a treadmill stress test, and so this is exactly the one where you walk or run on a treadmill and they track your heart rate, and these were average, everyday people who were they're not Olympic athletes. These are everyday people who are getting checked for heart symptoms, and so that's something that is to be considered when they look at the population of who they were actually studying. They followed these people for eight years and, on average, looked at who lived longer, and the simple question they had was does your performance on that treadmill predict how long you'll live? And they actually came up with some really interesting answers.

Nicole Aruffo, RN:

Like what.

Ed Delesky, MD:

So I got really excited about this because when they started comparing the groups and basically what they came down to is the more fit you were, the longer you lived, and I don't know if anyone needed a study to be able to tell them this. This is kind of like maybe a self-evident truth, but this was done in 2018. And this got a lot of citations, a lot of action, a lot of views, and that fact, the more fit you are, the longer you will live, was true all the way up to the highest fitness levels. So what they did is they divided people into five groups based on their fitness and what they found in these tests the treadmill tests. They labeled them low, below average, above average, high and elite, and the elite group had the best survival rates of anyone. And when they compared the two, they compared the elite group to the low group in cardiorespiratory fitness, and they found that people with low fitness were five times more likely to die than the elite performers, and that is huge. That is five times more likely, which is stark and kind of just to put this into perspective.

Ed Delesky, MD:

What they also did was they compared people's fitness levels, so these branded fitness levels that they gave people, low below average, above average, high elite, so on and so forth. They compared those factors, this fitness level, against standard risk factors like smoking, heart disease, standard risk factors like smoking, heart disease, coronary artery disease. And they found that in this study, in this population of people, they had some evidence that showed that being unfit had a higher risk of mortality than being a smoker. And they took the same group of people. They looked at smoker, non-smoker in that group of people and found that maybe being unfit was worse. They found that being unfit or having low fitness was a bigger risk for dying than having diabetes, heart disease or even smoking cigarettes. And that really tells us something powerful Fitness matters way more than we thought.

Nicole Aruffo, RN:

Does this apply to everyone?

Ed Delesky, MD:

Yeah. So I mean, you might be thinking like, yeah, I'm listening to this and I'm anywhere from like my twenties to my seventies, like, does this even apply to me? And it really does. They showed the benefits across all age groups. In fact, they thought that older age groups might have more benefits for improving cardiovascular fitness, and the same went for men and women, though there were slightly more men in the study than women. And, no matter who you are, it showed that better fitness meant better chances of living longer.

Ed Delesky, MD:

There were some limits to other studies, which is why this one was kind of more interesting than others. So earlier studies used self-reported exercise, which is really hard because people often under or overestimate the amount of exercise that they actually do. So that can be unreliable, which makes studying the science even more difficult. Furthermore, this study was retrospective, which means studying the science even more difficult. Furthermore, this study was retrospective, which means that it looked back at data that was already had, and so it shows associations, but not direct cause and effect. So that's something that we have to keep in mind is that they were able to look at these and say like, wow, these elite performance athletes had so much better mortality.

Ed Delesky, MD:

But it can't be attributed to cause and effect and, truthfully, what they didn't measure were unmeasured factors like income or social determinants of health, to see if any of that played a role. Further, fitness was only measured once. It wasn't measured over time, and so there wasn't a lot to say whether changes over time would affect outcomes. And truly, all these people who were in this study were referred by someone for treadmill stress testing for some reason, and so it's not exactly a random slice of the general population of people like you or I haven't had a treadmill stress test. I think what would really need to happen is we get a population of average people and put them on treadmills and reproduce this, and maybe that study has been done. But in that way, these uh limit the findings that we have from here. Things that we're discussing are a little limited.

Nicole Aruffo, RN:

So what can all of us do with this new information?

Ed Delesky, MD:

I mean, I think, when you think about it, bring it back to your everyday life. We're talking about these elite athletes, elite cardio respiratory fitness people and, yeah, they're the ones who get the highlight of the study, but everyone who had more than low fitness had some benefit. And so you don't need to run marathons, but you really do need to move. So try to walk more. Take the stairs, go get your heart rate up with whatever activity you enjoy Maybe it's dancing, maybe you're biking, swimming.

Ed Delesky, MD:

The goal is to build a heart and lungs that can handle a little challenge, and if you are someone who's starting from a place of very low fitness, the good news is that even a small improvement can really make a big difference in your life. So the next time you're thinking about skipping a walk or putting off a workout, remember this study specifically. And moving your body isn't just about looking better or losing weight. In fact, in this study, it's about living longer. So today we talked that cardiorespiratory fitness is one of the strongest predictors of survival that we have, and so let's treat it like that. Any thoughts or feelings about?

Nicole Aruffo, RN:

um no, I think it's pretty cool though.

Ed Delesky, MD:

I wish they had a study where they looked at the general population. I mean, I think it's pretty cool, though I wish they had a study where they looked at the general population. I mean, I think of the person that I end up referring to like a treadmill stress test. It's like someone who usually has shortness of breath or chest pain or some weird thing, and so 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 the common comorbidities that people have, like diabetes, coronary artery disease.

Nicole Aruffo, RN:

Yeah, that's crazy, especially because we've talked about how much those things can affect your mortality and now it's like, oh, it's actually worse to be. I mean, it's still important, but it's worse to be Less fit.

Ed Delesky, MD:

Like this study at least makes I mean it's still important, but it's worse to be less fit. Like this study at least makes you think that like it's something at least important to think about. Like I mean, who isn't going to preach about exercise? But oftentimes I hear I see online, like when we're so active online, that people are like, oh no, doctors talk about like exercise and diet being so important. Well, here's our stance that like it is, and here's the study that shows that at least here's a little backing that it truly is one thing that we like. That I was going to include in this episode, but like we, you know there's going to be a whole explanation of it is the vo2 max, which yeah, you love a vo2.

Nicole Aruffo, RN:

I do um in short, for, like anyone listening, the vo2 max, which I love a.

Ed Delesky, MD:

VO2. I do Um in short, for, like anyone listening, the VO2 max represents the maximum amount of oxygen your body can use during intense exercise, and so it can be a key indicator of cardio respiratory fitness, and it reflects the same thing the efficiency of your heart, lungs and muscles. Usually, if you're going to get like the best measurement, you have to do it in the lab, get specialized equipment and like do a graded exercise regimen. But I mean, like we have apple watches and the apple watch gives us a pretty decent idea and for anyone listening out there who has one, you can go get like looking at your health app. But you can also like do tests online, like you can like vo2 test and like you can try to do a certain amount of exercise in certain time and you can find it. But that's the like.

Ed Delesky, MD:

Basically, the point is that you can get that number easily if you have like a fitness watch, fitness app and you can see where you are, like I don't like where I am cardio respiratory fitness wise and like I think it changed, like my classification changed this birthday. Go around that. It's something I'm really trying to get up, but like yours is pristine and beautiful and I'm jealous. Oh my gosh, there are. So there are age-related declines with the vo2 and so, like, like I said, like I, my most recent birthday, like changed the stratification, so, like the they went down the categories and you know, that is what it is. I had um chris one of my chris's um texted me and was like why did I get this giant jump in my vo2? And I was like, did any of your equipment change? And he was like yeah, I got a new watch. I'm like that's why, like I don't think you magically got four points on your vo2 max overnight which would have been really cool.

Ed Delesky, MD:

but it's true, I do love a vo2 because I don't think many people are going to be doing like mets, right, like I don't even think a lot of. How do you even like calculate a mat? Yeah, some treadmills do it, some bikes do it. They have them out there.

Nicole Aruffo, RN:

But like how do you know how many mats are like enough mats?

Ed Delesky, MD:

Oh wait, now you sound dumb. No, this is, this is an excellent question.

Nicole Aruffo, RN:

So how many mats a day should you be Doing yeah?

Ed Delesky, MD:

Yeah, this is an amazing question. So the conversation starts with aerobic 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 study that looked at VO2 and all cause mortality and that all starts anywhere from like 0.1 to 7.5 met hours per week. So met hours per week is kind of a loaded thing and then I guess we'll kind of break that down. But the benefit peaks at 22.5 to 75 met hours per week.

Ed Delesky, MD:

So if we were to kind of break down some of these activities, here are some mets of common things. So let's say walking, walking at a moderate pace which is three miles an hour is 3.3 mets. So let's say you wanted to do the bare minimum but you wanted to be healthy, we said that the benefit starts at 0.1. Let's say you wanted to like do the bare minimum but you wanted to be healthy, we said that, like, the benefit starts at 0.1,. But if you want to get to the threshold 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 3.3 Mets an hour?

Ed Delesky, MD:

Well, that's why they add a time feature in it, cause, like, the Met is just the measurement of the activity. Oh, and so in that thing they say a Met hour per week.

Nicole Aruffo, RN:

So that's for an hour, all of these.

Ed Delesky, MD:

So that, like, if you wanted to do a good example here would be like one hour of running five miles per hour would get you eight met hours, and if you can do that per week that mortality benefit starts.

Nicole Aruffo, RN:

Oh gotcha.

Ed Delesky, MD:

And so, like one of these studies suggested that if you can get somewhere between 22.5 to 75 met hours per week, then you would be like max maximizing the benefit of your metabolic equivalent. And so let's say, like you wanted to go for six miles an 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 math to it and like, if you wanted to, let's say cycling, and you wanted to do moderate cycling, which is like 10 to 12 miles an hour, you have six mets. You calculate how much time you need to get up to whatever threshold you want to get to. It seems like 22.5 is like the lowest of the most successful range. Then that's where you go for that seems doable yeah, and this like this.

Ed Delesky, MD:

I mean I think people will also hit this if they get to like the 30 minutes five times a week of a moderate intensity cardiovascular exercise and two days of strength training. And just to say it out loud that the all-cause mortality risk reduction for strength training begins at one time per week and peaks at about 60 minutes per week for how much you're lifting, just to give people a better idea. Yeah, I'm like over here now.

Nicole Aruffo, RN:

I'm like calculating how many met hours how many met hours do you have this week?

Ed Delesky, MD:

that's a great question. I don't even like and then like what does it take to get up to 75 met hours per week? Kind of a decent amount if we're gonna. I mean, what burlake? Running somewhere probably, I mean that's seven over seven and a half hours of jogging at six miles an hour yeah so that's like a little over an hour a day of jogging at six miles an hour if you're gonna do that that way yeah that feels like a lot yeah, but you know, somewhere around, like what peak said, 22.5, even like 30, is very attainable, I think sure, yeah, yeah, I guess I wonder, even within that range 22.5 to 75 does that improve within itself?

Ed Delesky, MD:

not exactly sure, yeah, but yeah, these are all really cool things that I wanted to share today, because I sometimes exercise doesn't get enough love and it can be helpful to hear some data to really give people a push in the right direction, that it is totally worth it and something you absolutely need to consider, and I hope you don't look at your Apple watch and you're so shocked about your cardio respiratory fitness and that you feel like you're going to pass away because it's low. It's all something that you can work on and move forward and get healthier. So hopefully today you were able to learn something for yourself, a loved one or a neighbor, and we hope you come back next week for another episode of your Checkup. Please send us an email at yourcheckuppod at gmailcom, send us some fan mail and send us questions on there as well, if you need. But most importantly, stay healthy, my friends. Until next time. I'm Ed Dolesky.

Nicole Aruffo, RN:

I'm Nicole Rufo.

Ed Delesky, MD:

Thank you Goodbye.

Nicole Aruffo, RN:

Bye.

Ed Delesky, MD:

This information may provide a brief overview of diagnosis, treatment and medications. Thank you. Attempt to substitute medical advice, you should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for complete information tailored to you. In short, I'm not your doctor, I am not your nurse, and make sure you go get your own checkup with your own personal doctor.

People on this episode

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Nicole Aruffo, RN

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Dr. Edward Matthew Delesky, MD

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