Smoking Or Being Out Of Shape: Which Is Worse?

Can you settle an argument? A friend insists that research shows that being out of shape is even worse for long-term health than smoking. I can’t believe that. Is it true?

– October 7, 2016

No, it isn’t true. However, newly published research from Sweden suggests that being out of shape is almost as bad for men’s health as smoking, and worse than the risks posed by high blood pressure or high cholesterol. The study, from the University of Gothenburg, was unique in that it followed 792 healthy Swedish men from 1963 when they all turned 50, and continued to monitor them for the rest of their lives. At the start of the study, the researchers checked the men’s blood pressure, cholesterol levels, weight, and asked them whether or not they smoked or exercised. Four years later, some of the men underwent exercise stress tests to determine their maximum aerobic capacity, known as VO2 max. Using this measurement was deemed a more accurate way to assess fitness than relying on self-reports of activity. The investigators used the VO2 max findings to develop a formula enabling them to estimate the aerobic capacity of the rest of the men in the study. Based on the results, they divided the men into three groups, those with low, medium and high VO2 max. Over time, the researchers found that low aerobic capacity was linked to increased risk of premature death. Only smoking proved a greater risk.

While our VO2 max is partly inborn, it mostly depends on our weight and how active we are. If your V02 max is low, you can help raise it with regular aerobic exercise. Over the 45-year length of the study, the researchers found that the men in the “medium” group had a 21 percent lower risk of death than those in the “low” VO2 max group and the men in the “high” group had a 21 percent lower risk of death than those in the “medium” group.

Overall, the study found that being out of shape was worse for health than high blood pressure or high cholesterol. In fact, the researchers reported that the most physically fit men in the study who had high blood pressure or high cholesterol tended to live longer than men whose physical fitness was poor but whose blood pressure and cholesterol levels were fine.

The Swedish findings apply only to men, and the investigation is named the “Study of Men Born in 1913.” While the results showed an association between low aerobic capacity and premature death, they did not prove cause and effect. Still, we have plenty of evidence to show that aerobic exercise such as walking, jogging, swimming, and biking benefits cardiovascular health, weight management and emotional well being. As the results of the Swedish study suggest, it also may be key to a longer life.

Andrew Weil, M.D.


Per Ladenvall et al, “Low aerobic capacity in middle-aged men associated with increased mortality rates during 45 years of follow-up.” European Journal of Preventive Cardiology, July 26, 2016, doi: 10.1177/2047487316655466

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