Physical Activity and Cardiovascular Disease

Definition (cited from WHO) [1]
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Cardiovascular diseases are a group of disorders of the heart and blood vessels and include:

  • coronary heart disease: disease of the blood vessels supplying the heart muscle;
  • cerebrovascular disease: disease of the blood vessels supplying the brain;
  • peripheral arterial disease: disease of blood vessels supplying the arms and legs;
  • rheumatic heart disease: damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria;
  • congenital heart disease: malformations of heart structure existing at birth;
  • deep vein thrombosis and pulmonary embolism: blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason is a build-up of fatty deposits on the inner walls of the blood vessels. Strokes can be caused by bleeding from a blood vessel in the brain or by blood clots.

Physical Activity Effects on Cardiovascular Diseases
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The benefits of exercise with 1000kcal per week in secondary prevention decreases the all cause mortality around 20-30% [2] Physical activity improves systolic blood pressure, angina symptoms and exercise tolerance in patients without revascularization [3]. For patients with revascularization physical activity improves quality of lives and exercise tolerance, as well as 29% of cardiac events and around 20% lower re-admission rates[4].

However, it is important to note that only current physical activity is protective – sports participation in youth does not provide protection in later life unless activity is maintained[5].

https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_488240.pdf

Exercise in Coronary Artery Disease[edit | edit source]

The evidence for benefit of exercise in Coronary Artery Disease [CAD] is compelling,and it is conclusively established that exercise in indicated in the primary and secondary prevention of CAD.

Studies demonstrate that the benefits of exercise are greater than the results of PCI [Percutaneous coronary intervention] techniques!

In one study of 101 men with stable CAD[6], over a 2 year period, regular exercise intervention outperformed PCI on all measures: 

  • "Event free survival" rates after 24 months were 78% in the exercise group versus 62% in the PCI  cohort (P = 0.039).
  • At 2 years maximal oxygen consumption (Vo2 max) increased by 10% in the Exercise group versus 7% in the PCI group.
  • Inflammatory markers improved in the Exercise cohort: high-sensitive C-reactive protein levels and interleukin-6 levels were significantly reduced after 2 years of Exercise by 41 and 18%, respectively, whereas no relevant changes were observed in the PCI group.

Exercise in Chronic Heart Failure[edit | edit source]

The benefits of physical exercise in patients with Chronic Heart Failure have been identified in many studies, and a large meta-analysis published in 2006 comes to the following conclusions:

  • exercise training in stable patients with mild to moderate CHF, results in statistically significant improvements in maximum heart rate, maximum cardiac output, peak VO2, anaerobic threshold, 6 minute walk test and HRQL (quality of life questionnaire).

Symptoms of Cardiovascular Events (cited from[7])[edit | edit source]

Chest discomfort (pressure, squeezing, fullness, pain) Discomfort in one or both arms, back, jaw or stomach Shortness of breath Cold sweat, nausea, lightheadness

Womens Signs[8]:[edit | edit source]

Women are more likely to experience unusual fatigue, sleep disturbances, weakness, shortness of breath, nausea/vomiting and back or jaw pain

Resource: [edit | edit source]

The American Heart Association designed a `Healthy Heart Quiz` are you able to recognize a Heart Attack?

Prodromal Symptoms:[edit | edit source]

A 10 mmgHg decrease of systolic blood pressure was associated with a higher risk for fatal and non-fatal cardiovascular events[9]

Increased longterm variability in systolic blood pressure was associated with a higher risk for cardiovascular events, mortality and disease[10]

Exercise Prescription (cited from[11])[edit | edit source]

Patients with coronary heart disease should perform everyday physical activity as well as supervised exercise lessions. The ACSM prescription based on traditional prescriptions, but they are adapted to the special issue of affected person due to physiological differences to healthy persons.

Mode: Large muscle groups, continuous exercises (e.g. walking, swimming, group aerobics) fosters cardiovascular endurance. Upper extremities exercises like arm ergometers may useful for people with musculoskeletal problems in their lower extremities. Resistance Exercises should be provided in a circuit training approach. 10-12 exercises using 10-12 repetitions of resistances that can be performed comfortably. Cross-training is possible, too.

Frequency: Three nonconsecutive days per week, as a minimum. With increased frequency of exercise, the risk of musculoskeletal injuries increases.

Duration: 10 min. warm-up and cool-down phases, including stretching and flexibility exercises. 20-40 min. cardiovascular exercise continuously or interval training. Interval training may be useful for persons with peripheral vascular disease and intermittent claudication.

Intensity: Exercise in supervised programs in moderate intensity 40-85% VO2 max. or 40-85% maximal heart rate reserve (max. heart rate- resting heart rate) X 40-85% + resting heart rate. Or 55-90% of maximal heart rate. Ratings of perceived exertion (RPE) is appropriate to monitor exercise intensity. The intensity should be moderate.

Progression: Initial slow, progression through longer exercise duration and intensity.

Monitoring: Patient observation and measuring heart rate and rhythm. Blood pressure measuring when clinically indicated, that depends on the patients risks for exercise complications. Patients who exercise without supervision should perform lower exercise intensities.

Contraindications for Exercises[edit | edit source]

The exercise intensity should be below a level that provokes myocardial ischemia, significant arrhythmias or symptoms of exercise intolerance. Higher risk patients should exercise in lower levels. Absolute Contraindications of Exercise (cited from Motivate 2 Move[12])

  • Uncontrolled or poorly controlled asthma.
  • Cancer or blood disorders: when treatment or disease cause leucocytes below 0.5 x10/L, haemoglobin below 60g/L or platelets below 20 x 10/L
  • COPD: Patients are required to be stable before training and oxygen saturation levels should be above 88-90%.
  • Diabetes: If blood glucose is >13 mmol or <5.5 mmol/l then it should be corrected first. Patients with diabetic peripheral or autonomic neuropathy or foot ulcers should avoid weight bearing exercise. Any diabetic with acute illness or infection.
  • Heart disease: acute myocardial infarction or unstable angina until stable for at least 5 days, dyspnoea at rest, pericarditis, myocarditis, endocarditis, symptomatic aortic stenosis, cardiomyopathy, unstable or acute heart failure, uncontrolled tachycardia.
  • Hypertension: resting blood pressures of a systolic >180 or diastolic >100 or higher should receive medication before regular physical activity with particular restrictions on heavy weights strength conditioning, which can create particularly high pressures.
  • Osteoporosis: avoid activities with a high risk of falling • Fever: should be settled to avoid a risk of developing myocarditis
  • Unexplained dizzy spells
  • Acute pulmonary embolus or pulmonary infarction. Excessive or unexplained breathlessness on exertion
  • Any acute severe illness

Risk of Exercises[edit | edit source]

Risk of Exercise for patients with coronary heart disease: acute myocardial infarcation, cardiac arrest and sudden death.

Incidence in supervised cardiac rehabilitation programs are: 1 myocardial infarcation per 294,000 patient hours, 1 cardiac arrest per 112, 000 patient hours, 1 death per 784,000 patient hours. Over 80% of persons who reported cardiac arrest symptoms while exercising have been successfully resuscitated with prompt defibrillation [13].

Exercises and Medications[edit | edit source]

Exercise response to cardiac medications (Heart online)

Resources[edit | edit source]

CVD News and Research Updates (The Heart and Stroke Foundation South Africa)

Measuring Physical activity Intensity https://www.cdc.gov/physicalactivity/basics/measuring/ http://www.who.int/dietphysicalactivity/physical_activity_intensity/en/ Exercise Testing

The Motivate2Move website, created by Wales Deanery, has a useful section on activity and cardiorespiratory health.


References
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  1. WHO. Region Office for Europe. 2017. http://www.euro.who.int/en/health-topics/noncommunicable-diseases/cardiovascular-diseases/cardiovascular-diseases2/definition-of-cardiovascular-diseases [Accessed 2/25/2017].
  2. Lee I-M, Skerett PJ: Physical activity and all-cause mortality—What is the dose response relation? Med. Sci Sports exerc33(6Suppl):S459,2001.
  3. Hambrecht R. WoEffects of exercise on coronary endoothelial function in patients wwith coronary artery disease. Am J Cadriol 90:124, 2002.
  4. Belardinelli R, Paolini I, Cianci G, et al:Exercise training intervention after coronary angioplasty: The ETICA trial. J Am Coll Cardiol 37:1891, 2001.
  5. Sesso HD1, Paffenbarger RS Jr, Lee IM. Physical activity and coronary heart disease in men: The Harvard Alumni Health Study. Circulation. 2000 Aug 29;102(9):975-80.
  6. Claudia Walther, Sven Möbius-Winkler, Axel Linke, Mathias Bruegel, Joachim Thiery, Gerhard Schuler, Rainer Halbrecht. "Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease". European Journal of Preventitive Cardiology, Vol 15, Issue 1, 2008
  7. American Heart Association. Life is why. Warning signs of a Heart Attack.2017.https://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack_UCM_002039_Article.jsp [Accessed 2/26/2017].
  8. McSweeney,J.C., Cody, M., O`Sulivan, P., Elberson, K. Et al.Women’s Early Warning Symptoms of Acute Myocardial Infarction. Circulation. 2003;108:2619-2623. http://circ.ahajournals.org/content/108/21/2619 [Accessed 2/26/2017].
  9. Barlow, P.A., Otahal,P.O., Schultz, M.G. Et al.Low exercise blood pressure and risk of cardiovascular events and all-cause mortality: Systematic review and meta-analysis. 2014. Atheriosclerosis;237(1). 13-22. http://www.atherosclerosis-journal.com/article/S0021-9150(14)01356-2/abstract [Accessed 2/25/2017].
  10. Stevens, S.L., Wood, S., Koshiaris, C. Et al.. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ.2016;354:i4098 http://dx.doi.org/10.1136/bmj.i4098 http://www.bmj.com/content/bmj/354/bmj.i4098.full.pdf [Accessed 2/25/2017].
  11. American College of Sports medicine Position Stand. Exercise for patients with coronary artery disease. Me. Sci. Sports Exerc. 1994;26 (3): i-v.
  12. Revalidation Support Unit (RSU), PGMDE. Neuadd Merionnydd. Wales. Motivate 2 Move.https://gpcpd.walesdeanery.org/index.php/starting-to-exercise/contraindications [Accessed 2/25/2017].
  13. Thompson, P.D. Et al. Exercise and Acute Cardiovascular Events: Placing the Risks into Perspective.MEDICINE & SCIENCE IN SPORTS & EXERCISE. 2007; DOI: 10.1249/mss.0b013e3180574e0e Available under: http://www.acsm.org/public-information/position-stands [Accessed 2/25/2017].