Depressive symptoms, visual impairment, and its influence on physical disability and functional limitation.

To the Editor: Nylen and colleagues reported that physical fitness, as represented by exercise capacity, reduces the risk of mortality in people with diabetes mellitus regardless of age. I compliment the authors on their excellent study. I would also like to mention that data were reported from a study of 609 people with diabetes mellitus with a mean age of 70 with no history of coronary artery disease who were referred for an exercise treadmill sestamibi stress test because of chest pain or dyspnea. At 47-month follow-up, stepwise Cox regression analysis showed that a predicted exercise capacity of greater than 85% was a significant independent predictor of time to development of myocardial infarction, stroke, or death (hazard ratio50.52, 95% confidence interval50.34–0.78; P5.002). Older persons with diabetes mellitus with a predicted exercise capacity of greater than 85% had a 48% lower chance of myocardial infarction, stroke, or death than those with a predicted exercise capacity of 85% or less.