Being out of shape is a bigger risk for early death than either high blood pressure or high cholesterol, finds a large new study. In fact, the only thing worse for longevity was smoking, the study found.

The study, which spanned 45 years, was published Tuesday in the European Journal of Preventive Cardiology.

In 1967, at 54 years of age, the 792 men did an exercise test. Of those, 656 men also did a maximum exercise test in which they pushed themselves to the limit. The remaining men were excluded from the maximum exercise test because they had a health condition that could make it unsafe.

The studies determined the men’s VO2 max, or maximal oxygen uptake, as a way to measure their aerobic capacity. The higher the VO2 max, the more physically fit the men were.

The men underwent several physical examinations every 10 years until 2012, when they would have reached 100 years old. Data on their cause of death was obtained from the National Cause of Death Registry.

“The benefits of being physically active over a lifetime are clear,” said lead author Dr Per Ladenvall, a researcher in the Department of Molecular and Clinical Medicine, at the University of Gothenburg in Sweden.

“Low physical capacity is a greater risk for death than high blood pressure or high cholesterol.”

Original Report

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