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  • Writer's pictureNick Allen

The case for physical fitness testing during the annual medical exam

One of my college professors used to remind our class often that what we choose to measure is important. It becomes what we prioritize and what we naturally attempt to optimize. This is undeniably true in healthcare. We’re finally starting to recognize how important it is to prevent disease before symptoms arise. This means relying on measurements that suggest we should initiate treatment even when patients are feeling well. I think this is great, and you’d be hard-pressed to find a primary care physician who doesn’t think it’s important to keep blood sugar or cholesterol numbers optimized. My concern doesn’t have to do with the tracking of these proven metrics, but rather our failure to track the most important metrics we have pertaining to health and longevity.

In virtually every study, VO2 max (a measure of cardiorespiratory fitness we discuss often) and grip strength are better correlated with longevity than any health metric. We love to cite this study from JAMA in 2018 showing that the risk of mortality associated with a low VO2 max dwarfs the risk of mortality associated with smoking, high blood pressure, end stage kidney disease, and more. If measures of strength and cardiorespiratory fitness are so critical to health, how are they ignored in healthcare entirely?

I think there are a few reasons for this. Clinicians and patients understand that exercise is important, and that generally more is better. Why waste our time with measurements to tell us that we should exercise more? Additionally, whereas we have pills to help when blood sugar or blood pressure are too high, there’s no medication that will improve strength or cardiorespiratory fitness. Doctors may feel like they don’t have much to offer when a patient’s grip strength or VO2 max is below average.

While these arguments are understandable, I think they’re missing a few key perspectives. Though it’s true that the majority of people would benefit from more exercise, there’s a distinct motivation that comes from actually having a metric to follow. Remember, what you choose to measure is important. On top of this, I think that having a doctor tell you that something is not up to par hits home in a unique way. This is especially true if that doctor can eloquently explain the massive health risks associated with low strength and poor cardiorespiratory fitness.

In terms of how to “treat” poor physical fitness, some doctors are beginning to write exercise “prescriptions” that are meant to be taken as seriously as prescriptions for medications. At the very least, primary care clinicians should know the basics. It’s reasonable to expect that all can identify the specific shortcomings (strength, aerobic capacity, anaerobic capacity) and direct the patient towards an appropriate exercise regimen. Those with an interest in this space can probably go into much more detail. As with any other medical concerns, they can always refer to a specialist if they determine that more in-depth guidance is necessary.

Though it’s not conventional medicine, no doctor should be able to ignore the metrics most strongly tied to overall health and longevity. Time and time again, studies have suggested that measures of strength and cardiorespiratory fitness are the best we have for predicting healthspan. Their inclusion as part of routine medical exams would almost certainly lead to better health outcomes and long-term cost savings. If it’s true that we prioritize what we measure, this one seems to be a no-brainer.


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