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To the Editor: The article by Dr Shishehbor and colleagues¹ demonstrated that impaired functional capacity and abnormal heart rate recovery following exercise testing accounted for a major proportion of the association between socioeconomic status (SES) and all-cause mortality. The SES gradient in certain health-related behaviors such as smoking and diet are well established, although less so for physical activity. Thus, these data highlight an important aspect of public health research that is often neglected.

Maintenance of higher physical function in early old age appears to be dependent on participation in a physically active lifestyle during midlife,² and it is increasingly common for trials to include exercise for prevention of chronic diseases.³ However, there is a critical problem related to the association between physical activity and SES. Some of the disparities in physical activity levels among SES groups may be due to fewer possibilities for safe outdoor exercise and less disposable . . . [Full Text of this Article]

Mark Hamer, PhD
m.hamer@ucl.ac.uk
Department of Epidemiology and Public Health
University College London
London, England

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