The negative impact of low physical fitness on middle age men is nearly as severe as smoking – according to a study published in the European Journal of Preventive Cardiology.

The study, by researchers at University of Gothenburg, reveals that middle-aged men who do better in exercise tests end up living longer than their peers who struggle with physical activity.

A sample of more than 650 men born in 1913 undertook an exercise test in 1967 – when they were 54 years old – measuring their maximal oxygen uptake (VO2).

After the initial examination in 1967, the men were followed up until 2012, to the age of 100 years – with several physical examinations performed during the intervening years.

To analyse the association between predicted VO2 max and mortality the men were divided into three groups (tertiles) ranging from low to high: 2.00 l/min, 2.26 l/min, and 2.56 l/min.

The researchers found that each tertile increase in predicted VO2 max was associated with a 21 per cent lower risk of death over 45 years of follow up, and after adjusting for other risk factors – smoking, blood pressure and serum cholesterol.

The study’s conclusion was that low aerobic capacity was associated with increased mortality rates, independent of the three traditional risk factors.

"We found that low aerobic capacity was associated with increased rates of death," said lead author Dr Per Ladenvall from University of Gothenburg. "The association between exercise capacity and all-cause death was graded, with the strongest risk in the tertile with the lowest maximum aerobic capacity.

"The effect of aerobic capacity on risk of death was second only to smoking – so the benefits of being physically active over a lifetime are clear."

"We have come a long way in reducing smoking. The next major challenge is to keep us physically active and also to reduce physical inactivity, such as prolonged sitting."

To read the full study, click here.