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The generally accepted inverse relation between cardiovascular fitness and adverse cardiovascular events and all-cause mortality has been challenged recently by reports that suggest a possible U-shaped dose-response association, in which extreme exercise and fitness is associated with excess mortality risk due to myocardial fibrosis, atrial fibrillation, and coronary artery calcification. This retrospective cohort study overcame the limitations of many studies in which self-reported exercise patterns were used.
Cleveland Clinic researchers identified 122,000 patients (mean age, 53) who were referred for symptom-limited exercise treadmill testing. According to peak achieved metabolic equivalents (METs; similar to maximal oxygen uptake), patie…