Active, middle-aged men able to complete more than 40 pushups had a significantly lower risk of cardiovascular disease (CVD) outcomes — including diagnoses of coronary artery disease and major events such as heart failure — during 10 years of follow-up compared with those who were able to do fewer than 10 pushups during the baseline exam.

“Our findings provide evidence that pushup capacity could be an easy, no-cost method to help assess cardiovascular disease risk in almost any setting. Surprisingly, pushup capacity was more strongly associated with cardiovascular disease risk than the results of submaximal treadmill tests,” said first author Justin Yang, occupational medicine resident in the Department of Environmental Health at Harvard T.H. Chan School of Public Health.

This study was published today in JAMA Network Open.

Objective assessments of physical fitness are considered strong predictors of health status; however, most current tools, such as treadmill tests, are too expensive and time-consuming to use during routine exams. This is the first known study to report an association between pushup capacity and subsequent cardiovascular disease outcomes.

The researchers analyzed health data from 1,104 active male firefighters collected from 2000 to 2010. Their mean age was 39.6 and mean body mass index (BMI) was 28.7. Participants’ pushup capacity and submaximal treadmill exercise tolerance were measured at the start of the study, and each man subsequently completed annual physical examinations and health and medical questionnaires.

The Daily Gazette Sign up for daily emails to get the latest Harvard news.

During the 10-year study period, 37 CVD-related outcomes were reported. All but one occurred in men who completed 40 or fewer pushups during the baseline exam. The researchers calculated that men able to do more than 40 pushups had a 96 percent reduced risk of CVD events compared with those who were able to do fewer than 10 pushups. Push-up capacity was more strongly associated with lower incidence of cardiovascular disease events than was aerobic capacity as estimated by a submaximal treadmill exercise test.

Because the study population consisted of middle-aged, occupationally active men, the results may not be generalizable to women or to men of other ages or who are less active, note the authors.

“This study emphasizes the importance of physical fitness on health, and why clinicians should assess fitness during clinical encounters,” said senior author Stefanos Kales, professor in the Department of Environmental Health at Harvard Chan School and chief of occupational medicine at Cambridge Health Alliance.

Other Harvard Chan authors include Costas Christophi and Dorothee Baur.

The study was supported by the National Institute for Occupational Safety and Health (NIOSH), Harvard Education and Research Center for Occupational Safety and Health training grant T42 0H008416 (Yang); the FEMA Assistance to Firefighters grants EMW-2006-FP-01493 and EMW-2009-FP-00835, and grants from the Department of Homeland Security (Kales).