owledge Drop

Background + Aims

Study Design

Key Findings

owledge Drop

Running from Death: Can Fitness Outpace Alcohol’s Harm? (Nauman et al., 2025)

Strengths + Limitations

Application to coaching and reflection

In the media

Why did they do it?

• Public health guidance in the Nordic countries is increasingly shifting toward limiting or avoiding alcohol, as accumulating evidence indicates that even low levels of consumption increase the risk of cancer, cardiovascular disease, and premature mortality.

• Alcohol consumption is associated with increased cardiovascular risk, whereas regular physical activity (PA) and higher cardiorespiratory fitness (CRF) are well established to reduce all-cause mortality.

• Few studies have examined the joint effects of PA, CRF, and alcohol consumption on mortality, particularly using repeated assessments to capture changes over time.

• This study aimed to plug this gap by observing how longitudinal changes in alcohol intake and cardiorespiratory fitness are associated with all-cause mortality among Norwegian adults

WHat are peoples thoughts

• Initial reception 'keep fit, keep drinking'

• From "Curious Bartender" podcast

• Marathon Handbook article

• Physiologically Speaking article

• Dr Layne Norton interpretation

What they found

• The association between changes in alcohol intake and all cause mortality was modified by CRF

• Compared to reference group: individuals who abstained from alcohol and remained fit
• Individuals who remained unfit had an increased mortality risk regardless of alcohol intake, including those who abstained.
• Transitions in fitness mattered. Moving from fit to unfit increased mortality risk even with abstinence, and moving from unfit to fit while increasing alcohol intake still showed increased mortality
• BUT individuals who remained fit (at both timepoints) did not show an increased mortality risk even with increased alcohol intake, except those who moved from abstinence to drinking within recommendations.

• Similar patterns were found for individuals meeting PA recommendations, as no significant increase in mortality risk across alcohol change categories amongst these individuals. However, the association was weaker compared to CRF

AUTHOR'S CONCLUSIONS: "Temporal change in CRF appeared to be a stronger predictor of mortality than contemporary changes in alcohol intake"

Strengths

Limitations

• Large sample size

• Longitudinal design = could track temporal changes

• Measured changes in CRF, PA and alcohol consumption, and their joint association with all-cause mortality

• Self-reported alcohol intake - potential under-reporting (social desirability bias)

• Doesn't encapsulate binge drinking episodes

• Did not record data around diet or medication use - potential confounds

Sample Size: 24,853 adults

How did they do it?

• Using data from the Norwegian HUNT Study, with health data collected between HUNT 2 (1995-7) to HUNT3 (2006-8), this study followed people over time

• Alcohol intake was self-reported and categorised as:
• abstinent - no alcohol
• within recommendations -  140 g/week for men, ≤ 70 g/week for women
• above recommendations - > 140 g/week for men, > 70 g/week for women

• CRF (based on age and sex) was estimated using non exercise model.:
• Participants in lowest 20% CRF classified 'unfit',
• remaining 80% classified as 'fit'

• PA categoriesed as meeting recommendations or not (weekly 150 min of moderate intensity or 75 min of vigorous activity, or a combination of both)

• CRF and alcohol status recorded at both time points, which allowed changes over time to be analysed

• Examined joint associations between changes in alcohol intake, changes in fitness, and all cause mortality, adjusting for key lifestyle and health factors (e.g bmi, smoking status, diabetes, hypertension)

Food for thought

• Based on the study's findings, how could you respond to this patient?:

“I’m trying to improve my fitness, does cutting alcohol make a big difference?”

• How could representatitons of this study in the media impact patient behaviour?

• How should we contextualise findings like these with patients?

• Can you find any counter research?

Add your thoughts to slack!