Association Between Push-up Exercise Capacity and Future Cardiovascular Events Among Active Adult Men

Justin Yang MD, MPH; Costas A. Christophi, PhD; Andrea Farioli, MD, PhD et al

JAMA Netw Open. 2019;2(2):e188341. doi:10.1001/jamanetworkopen.2018.8341

Study Purpose: The study authors examined baseline performance push-up capacity and its association with subsequent incident cardiovascular disease (CVD) events in a cohort of active men

Methods: Retrospective longitudinal cohort study conducted  in 1 outpatient clinic in Indiana of male firefighters from 10 fire departments aged ≥18 years. Participants were stratified into 5 groups based on number of push-ups completed in increments of 10 push-ups for each category and were followed up for 10 years. Exercise tolerance tests were performed on a treadmill using a modified Bruce protocol until participants reached at least 85% of their maximal predicted heart rates, requested early termination, or experienced a clinical indication for early termination. The main outcome that we examined in this study was incident CVD-related events among participants. Cardiovascular disease–related events were defined as incident diagnosis of coronary artery disease or other major CVD event (eg, heart failure, sudden cardiac death). Incidence rate ratios (IRRs) were computed, and logistic regression models were used to model the time to each outcome from baseline, adjusting for age and body mass index (BMI). Kaplan-Meier estimates for cumulative risk were computed for the push-up categories.

Results:   A total of 1562 participants underwent baseline examination, and the final cohort comprised of 1104 with available push-up data. Mean (SD) age of the cohort at baseline was 39.6 ± 9.2 years (age 21 to 66 years), and mean (SD) BMI was 28.7 ± 4.3. During the 10-year follow up, 37 CVD-related outcomes (8601 person-years) were reported in participants with available push-up data. Significant negative associations were found between increasing push-up capacity and CVD events. Participants able to complete more than 40 push-ups had a 96% reduction in incident CVD events compared with those completing fewer than 10 push-ups (IRR, 0.04; 95% CI, 0.01-0.36). In comparison, the study authors observed similar crude IRRs of CVD outcomes when stratifying the cohort by estimated V̇o2max baseline.

Study Authors Conclusions:  The findings suggest that higher baseline push-up capacity is associated with a lower incidence of CVD events. Although larger studies in more diverse cohorts are needed, push-up capacity may be a simple, no-cost measure to estimate functional status.

Dr Baliga’s Perspective: Push-ups require no special equipment, is no cost, can easily be performed in almost any setting within 2 minutes, and provides an objective estimate of functional status. However these results may not be generalizable to other occupational groups, or unemployed persons or white-collar workers, women, older or nonactive persons. I am not sure many doctors can do 40 push-ups in 2 minutes!