The impact of low physical capacity on risk of death is second only to smoking, a 45 year study in middle-aged men has found. "The risk associated with low aerobic capacity was evident throughout more than four decades and suggests that being physically active can have a big impact over a lifetime," said lead author Per Ladenvall from Sahlgrenska Academy at the University of Gothenburg, Sweden. "The effect of aerobic capacity on risk of death was second only to smoking," Ladenvall noted. The study included 792 men from a representative sample of 50-year-old men in Gothenburg recruited in 1963. In 1967, at 54 years of age, the men did an exercise test. Of those, 656 men also did a maximum exercise test in which they pushed themselves to the limit. The remaining men were excluded from the maximum exercise test because they had a health condition that could make it unsafe. Maximal oxygen uptake, called VO2 max, was measured in a sub-population of the 656 men using ergospirometry. After the initial examination in 1967, the men were followed up until 2012, at the age of 100 years. Several physical examinations were performed, about one every 10 years. Data on all-cause death was obtained from the National Cause of Death Registry. "We found that low aerobic capacity was associated with increased rates of death," Ladenvall said. The findings, published in the European Journal of Preventive Cardiology, showed that low physical capacity is a greater risk for death than high blood pressure or high cholesterol. "We have come a long way in reducing smoking. The next major challenge is to keep us physically active and also to reduce physical inactivity, such as prolonged sitting," Ladenvall noted.