If your annual physical includes a mandatory test of how many pushups you can do, rest assured that your doctor and trainer haven’t switched places. A recent study published in JAMA Network Open reported that middle-age men who performed 40 consecutive pushups had a significantly lower risk of cardiovascular disease than those who did 10 or less.“Our findings provide evidence that pushup capacity could be an easy, no-cost method to help assess cardiovascular disease risk in almost any setting,” said lead author Justin Yang of Harvard Medical School’s Cambridge Health Alliance.Yang claims this simple test is a better predictor of heart health than a more expensive and difficult to deliver evaluation performed on a treadmill. The pushup test is also a less subjective measure of physical fitness than relying on a patient’s report of his or her own fitness habits, which are often overstated.Yang and his research team reviewed the medical and fitness testing records of 1,562 firefighters 21-66 years of age (average age of 39) from 10 Indiana fire departments over a 10-year period and discovered a link between how they scored on their pushup test and the risk ofOK having coronary artery disease, heart failure or sudden cardiac death.“Participants able to complete more than 40 pushups had a 96-per-cent reduction in incident cardiovascular disease events compared with those completing fewer than 10 pushups,” said the researchers.If 40 pushups is way out of your league, take heart that anyone able to perform 11 or more repetitions benefitted from a significantly reduced risk of heart disease as compared to those who couldn’t make it into the double digits. And while the researchers warned that the results may not extend to women and younger or older men, it’s likely that anyone fit enough to do more than 10 pushups will reap some of the heart health benefits associated with being physically fit.The results shouldn’t be all that surprising given that the pushup test is a measure of muscular strength, which has long been associated with a lower risk of cardiovascular disease. But before you go ahead and see how many pushups you can do, keep in mind that maintaining proper technique is part of the test. The protocol followed by the firefighters included a metronome set at 80 beats per minute, with staff counting the number of pushups performed until the firefighters hit 80, missed three or more beats of the metronome or gave up due to exhaustion.Speed of execution is important, as pumping out a series of pushups in record time is easier than following a “one-second down and one second up” sequence. On the other hand, pushups done slowly make the exercise more difficult.There was little detail offered as to the type of pushup performed by the firefighters but it’s safe to assume that it was the traditional form of the exercise, which is described below.Modifications to the exercise, like executing it from the knees, doesn’t guarantee the same results as those reported by Yang and his research team. That doesn’t mean that pushups from the knees are a waste of time. If the top end of your pushup count is under 10, moving from the toes to the knees for the next 10 is the first step toward building more strength and endurance.But before you replace your regular exercise routine with one designed solely to improve the number of pushups you can do in two minutes, keep in mind that it’s not the exercise alone that has a positive effect on heart health. The value of the pushup test is that it’s an objective marker of overall strength and fitness, which are important factors in keeping chronic disease at bay. In other words anyone with the strength to perform 40 pushups is likely physically active.For all of you who want to see just how many pushups you can accomplish, refer to the directions below. Technique counts, so if you can no longer maintain the right cadence or form, consider your test over. With your baseline established, your next goal is to add a couple of more reps every week until you can drop and do 40 with ease.How to do a pushupStart Position: Place your hands on the floor just wider than shoulder distance apart, arms straight. Extend your legs out behind the hips, toes down, heels up and your head, shoulders, hips and ankles in a straight line.Action: Lower your chest toward the floor, keeping the arms at a 45-degree angle from the torso, until the shoulders are lined up with the elbows. Push back up to the starting position.Tips: Take 1-2 seconds to lower the chest and 1-2 seconds to push back up to the starting position, exhaling while descending and inhaling when pushing back up.