Purpose: The prevalences of diabetes, hypertension, and high cholesterol all decrease with increased levels of physical activity and cardiorespiratory fitness. Whether these reductions extend beyond contemporary guideline activity levels and whether fitness affects medication use independent of activity, remains unclear.
Methods: Cross-sectional analyses of 62,291 male and 45,041 female runners, of whom 496 used antidiabetic, 3738 used antihypertension, and 2360 used low-density lipoprotein cholesterol (LDL-C)-lowering medications. Cardiorespiratory fitness was reported as speed (m·s−1) during a 10-km foot race.
Results: Medication use was significantly inversely associated with activity and fitness (P < 0.001, except LDL-C-lowering versus women's fitness). Compared with ≤ 16 km·wk−1 (guideline levels), the odds in men and women who ran > 64 km·wk−1 were, respectively, 69% and 55% lower for antidiabetic, 48% and 52% lower for antihypertension, and 64% and 51% lower for LDL-C-lowering medication use. Compared with the least-fit men (< 3.25 m·s−1) and women (< 2.8 m·s−1), the odds for those who were most fit (men > 4.75 m·s−1; women > 4.0 m·s−1) were 58% and 65% lower for antidiabetic, and 76% and 55% lower for antihypertensive medication use. Odds for LDL-C-lowering medication use were 87% lower in the fittest versus the least-fit men. Adjustment for activity only moderately diminished the inverse relationships of fitness with medication use.
Conclusion: Among individuals who exceed current guideline levels, antidiabetic, antihypertension, and LDL-C-lowering medications are inversely related to vigorous physical activity and cardiorespiratory fitness. Lower odds of medication use with higher fitness occur independently of physical activity.