Newswise — People with high fitness levels in midlife have significantly lower annual health care costs after age 65 than people with low fitness in midlife, after adjusting for cardiovascular risk factors, according to a study published in the Journal of the American College of Cardiology (JACC). Vanderbilt cardiologist and first author Justin Bachmann, M.D., MPH, and researchers studied 19,571 healthy individuals who underwent cardiorespiratory fitness assessment at a mean age of 49 and received Medicare coverage about 22 years later, from 1999 to 2009, at an average age of 71. Cardiorespiratory fitness was estimated by maximal metabolic equivalents (METs) calculated from treadmill time. METs are used to estimate the oxygen cost of activity; for example, sitting equals one MET while running hard on a treadmill on incline equals 15 METS. The researchers followed healthy individuals in the Cooper Center Longitudinal Study and found that average annual health care costs, obtained from Medicare files, were significantly lower for participants 65 years or older with high midlife fitness than with low midlife fitness in both men ($7,569 vs. $12,811) and women ($6,065 vs. $10,029). The study also looked at hospitalization rates and found that the low fitness group was hospitalized at a much higher rate than the MET fit group. Mean annual inpatient rates and physician office visits were also significantly higher in the low fitness group. “No one had previously investigated whether fitness in midlife translates into decreased health care costs 20-30 years later while adjusting for the risk factors,” said Bachmann, instructor in Medicine. “For every metabolic equivalent you are able to achieve, your health care costs decrease by about 7 percent. A lot of exercise machines these days will measure METS, so this is information people can access.” These findings may have important implications for health policies directed at improving physical fitness, he added.