{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T03:32:43Z","timestamp":1769916763138,"version":"3.49.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,12,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Data are sparse on the prospective associations between physical activity and incidence of lower extremity peripheral artery disease (PAD).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Linking participant data from the CCLS (Cooper Center Longitudinal Study) to Medicare claims files, we studied 19\u00a0023 participants with objectively measured midlife cardiorespiratory fitness through maximal effort on the Balke protocol who survived to receive Medicare coverage between 1999 and 2009. The study aimed to determine the association between midlife cardiorespiratory fitness and incident PAD with proportional hazards intensity models, adjusted for age, sex, body mass index, and other covariates, to PAD failure time data. During 121\u00a0288 person\u2010years of Medicare follow\u2010up, we observed 805 PAD\u2010related hospitalizations\/procedures among 19\u00a0023 participants (21% women, median age 50\u00a0years). Lower midlife fitness was associated with a higher rate of incident PAD in patients aged 65 years and older (low fit [quintile 1]: 11.4, moderate fit [quintile 2 to 3]: 7.8, and high fit [quintile 4 to 5]: 5.7 per 1000\u00a0person years). After multivariable adjustment for common predictors of incident PAD such as age, body mass index, hypertension, and diabetes, these findings persisted. Lower risk for PAD per greater metabolic equivalent task of fitness was observed (hazard ratio [HR], 0.93 [95% CI, 0.90\u20130.97];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Among a subset of patients with an additional fitness assessment, each 1 metabolic equivalent task increase from baseline fitness was associated with decreased risk of incident PAD (HR, 0.90 [95% CI, 0.82\u20130.99];\n              <jats:italic>P<\/jats:italic>\n              =0.03).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Cardiorespiratory fitness in healthy, middle\u2010aged adults is associated with lower risk of incident PAD in later life, independent of other predictors of incident PAD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.020841","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T12:33:46Z","timestamp":1638448426000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6890-8670","authenticated-orcid":false,"given":"Neil","family":"Keshvani","sequence":"first","affiliation":[{"name":"Division of Cardiology University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Willis","sequence":"additional","affiliation":[{"name":"Cooper Institute Dallas TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Leonard","sequence":"additional","affiliation":[{"name":"Cooper Institute Dallas TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ang","family":"Gao","sequence":"additional","affiliation":[{"name":"Cooper Institute Dallas TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"DeFina","sequence":"additional","affiliation":[{"name":"Cooper Institute Dallas TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3724-7619","authenticated-orcid":false,"given":"Mary M.","family":"McDermott","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jarett D.","family":"Berry","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4321-4538","authenticated-orcid":false,"given":"Dharam J.","family":"Kumbhani","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61249-0"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2006.12.010"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.11.1317"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X11436195"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.05.063"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.119.312142"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2014.12.009"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.07.051"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.174526"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2008.962"},{"key":"e_1_3_2_12_2","first-page":"CD005263","article-title":"Supervised exercise therapy versus home\u2010based exercise therapy versus walking advice for intermittent claudication","volume":"4","author":"Hageman D","year":"2018","unstructured":"Hageman D, Fokkenrood HJ, Gommans LN, van den Houten MM, Teijink JA. 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