physical activity and cardiovascular disease pdf

Physical activity and cardiovascular disease pdf

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Physical Activity, Coronary Heart Disease, and Inflammatory Response

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Physical Activity

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Physical Activity, Coronary Heart Disease, and Inflammatory Response

We sought to determine whether the association between physical activity and year cardiovascular disease CVD risk varies among normal weight, overweight, and obese adults in a nationally-representative sample of the United States. A subset of 22, participants aged 30—64 years was included with no CVD history. The average age of the population was Individuals who were overweight and obese had a higher year CVD risk compared to those with normal weight 9.

The association of physical activity and high year CVD risk differed by weight status. When compared the joint effects of physical activity level and weight status, physical activity was associated with a larger magnitude of reduced odds of year CVD risk than weight status.

Participation in any level of physical activity is associated with a lower year CVD risk for overweight and obese adults. Future studies are needed to identify effective modes and doses of exercise that offer optimal CVD benefits for populations with different weight statuses.

S adults. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This work was supported by Susan G. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. In —, S adults were obese and Obesity is soon replacing smoking as the leading cause of preventable premature death in the U. S [ 2 ], as it is a major risk factor for cardiovascular disease CVD , type 2 diabetes, hypertension, and cancer [ 3 — 5 ].

Excessive adiposity accumulates and alters cardiac structure and function in addition to metabolic dysfunction, even in the absence of comorbidities [ 6 ]. Thus, overweight and obesity may affect the heart through the effect on known risk factors such as dyslipidemia, hypertension, glucose intolerance, and inflammatory markers, as well as other unrecognized mechanisms [ 5 ]. A sedentary lifestyle is a major modifiable risk factor for CVD [ 3 , 7 — 10 ].

Many organizations, including the American Heart Association and the American College of Sports Medicine, have recommended increasing physical activity or aerobic exercise training to increase levels of cardiorespiratory fitness in the general population [ 3 , 7 , 11 ].

The updated Physical Activity Guidelines for Americans emphasize that moving more and sitting less will benefit nearly everyone [ 7 ]. Especially for sedentary individuals, even increasing a small amount of physical activity can provide CVD benefits, lower the risk of coronary heart disease, and reduce all-cause and CVD-specific mortality [ 9 , 10 , 12 ].

Higher levels of physical activity can attenuate elevated cardiovascular morbidity and mortality in obese adults with and without underlying CVD [ 9 , 10 , 13 ]. Intensive Lifestyle Interventions that combine increased physical activity and calorie-restricted diet have been proposed in overweight and obese populations and demonstrate favorable effects on cardiovascular risk factors, such as decreased insulin resistance, blood pressure, and inflammatory markers, and improved lipid profiles [ 14 ].

Although epidemiological studies report conflicting results of weight loss and risk reduction of CVD morbidity and mortality among obese adults [ 14 — 16 ], individuals with favorable behavioral responses might be more likely to benefit from ILIs and have a lower long-term CVD risk [ 17 ].

Being at-risk of CVD, individuals with overweight and obesity can increase physical activity to avoid a sedentary lifestyle, with a goal of obtaining a healthy weight and reducing CVD risk.

However, obesity is associated with variations of physiological functions and metabolic characteristics, which may influence the response to physical activity [ 18 — 21 ]. It is unknown whether overweight and obese adults receive the same health benefits from physical activity compared to adults with normal weight.

It is possible that individuals who are obese may respond differently to the same level of physical activity compared to individuals with normal weight, due to differences in body composition and energy expenditure [ 18 , 19 , 21 ]. Thus, we aimed to determine 1 the year CVD risk across U. S adults with normal weight, overweight, and obesity; and 2 whether the association of physical activity and CVD risk varies across weight statuses in a nationally-representative sample.

NHANES is a cross-sectional survey that uses a stratified, multistage probability sampling approach designed to represent the non-institutionalized U. S population, with oversampling of minority groups. All participants provided written informed consent [ 22 ]. The current study included adults aged 30—64 years old without a history of CVD, with completed data on height, weight, and CVD risk factors. The presence of CVD was self-reported if a doctor had ever told participants that they had any of the following: myocardial infarction, congestive heart failure, stroke, and coronary disease.

BMI was calculated by study technicians using standard measures of height meters and weight kg. Daily activities and leisure time activities were measured based on the Global Physical Activity Questionnaire [ 23 ].

Physical activity was quantified using the self-reported frequency of vigorous and moderate recreation activities at least 10 minutes continuously in a typical week. HDL-C, TC, and systolic blood pressure were measured by study technicians during the physical examination.

Diabetes was determined based on self-reported medical conditions or medication use for diabetes. Smoking status was defined as a current smoker or not current smoker including both former and never smokers. The year CVD risk was then determined using the total score. Demographic characteristics including age, sex, race, marital status, education, and income to poverty ratio were self-reported using a standardized questionnaire. A dietary interview was conducted to measure detailed dietary intake information for each participant.

A depression score was calculated using the nine-item Patient Health Questionnaire PHQ-9 to determine the frequency of depressive symptoms over the past two weeks [ 27 ]. All analyses incorporated the NHANES sample weights and accounted for the complex sample survey design using standard methods [ 28 ].

Unconditional logistic regression quantified the association of physical activity and high CVD-risk and stratified by weight status. Models were estimated as unadjusted model 1 , adjusted for demographic characteristics including race, marital status, education level, and income-to-poverty ratio model 2 , and fully adjusted for demographic, dietary intake, and depressive symptoms score model 3.

The interaction between physical activity level and weight status was included in each model and tested using the adjusted Wald test. We examined the association of physical activity level and year CVD risk within each weight status and also compared the joint effect of each combination of physical activity level and weight status among sedentary obese adults on year CVD risk.

All statistical analyses were completed using Stata MP Version We identified 24, adults aged 30 to 64 years with no CVD history.

Sufficient information was available on 22, participants to define the CVD risk according to the Framingham Risk Score. In our study population, after applied sample weights, the average age was The majority were non-Hispanic whites The characteristics of participants who were obese were in the same direction with those who were overweight, but they were more likely to be Non-Hispanic Black In our study population, Specifically, 8.

In the unadjusted model model 1 , compared to sedentary adults, adults who were inactive or active had lower odds of high year CVD risk, regardless of weight status. The magnitudes of the associations were greater among those who were active compared to those who were inactive.

Additional analyses that compared the joint effects of physical activity level and weight status on year CVD risk showed that compared to sedentary obese U.

Similarly, within overweight and normal weight categories, physically active and inactive adults had lower odds of high year CVD risk compared to sedentary adults. Whereas compared to sedentary obese U. However, the odds ratio for high year CVD risk were similar between overweight and obese adults within each physical activity level.

Moreover, we further examined the interaction between physical activity and weight status on CVD-risk, which confirmed our hypothesis that cardiovascular benefits from physical activity vary among adults with normal weight, overweight, and obesity.

Additionally, when we compared the joint effects of physical activity level and weight status, we found that physical activity was associated with a larger magnitude of reduced odds of year CVD risk than weight status.

This is consistent with recent evidence that physical activity plays a more important role than weight status or weight loss in CVD-specific and all-cause mortality [ 32 , 33 ].

Therefore, increasing physical activity level, especially promoting to meet the physical activity guidelines, could provide cardiovascular benefits for adults regardless of weight status [ 9 , 10 ]. Intensive lifestyle interventions ILI combining a calorie-restricted diet and increased physical activity has been recommended for individuals with obesity [ 14 , 34 , 35 ]. ILI with physical activity components provides various metabolic benefits, such as decreased insulin resistance, blood pressure, and improved lipid profiles, in addition to improvement in fat mass and waist circumference [ 34 — 37 ].

A similar result was observed in the Aerobics Center Longitudinal Study that within similar cardiorespiratory fitness level individuals, those with higher physical activity had a more favorable aerobic function and health profile [ 39 ].

Together with our findings, promoting physical activity regardless of body fatness can decrease CVD risk. Biological mechanisms linking increased physical activity and lower risk of CVD are attributed to alterations in the myocardium, skeletal muscle, and vascular system [ 9 , 40 ]. Physical activity is associated with increased shear stress, which leads to increased vascular nitric oxide concentration and up-regulated endothelial nitric oxide synthase activity [ 41 , 42 ]. Physical activity increases the mean size of high-density lipoprotein HDL and low-density lipoprotein, resulting in improved endothelial function [ 43 ].

The increased shear stress can improve collateral formation angiogenesis [ 44 , 45 ]. With these cardiovascular benefits and observed associations, physical activity may be treated as an independent factor for CVD risk that is not included in the Framingham Risk Score. In this population-based sample of U.

This is consistent with prior reports of objectively-measured physical activity that the majority of overweight and obese adults do not regularly participate in the recommended levels of physical activity [ 49 , 50 ]. Moreover, our findings suggest that increasing physical activity level may contribute greater risk reduction of year CVD risk compared to weight status. Together with the fact that most U.

S adults are classified as having a poor diet according to the Life Simple 7 dietary composite score, a substantial CVD burden could be potentially prevented by engaging in healthy behaviors. Healthcare providers play an essential role in promoting behavior change: overweight and obese adults who received advice from healthcare providers were four times more likely to attempt a healthy lifestyle compared to those who did not receive advice [ 51 ].

The observed evidence of lower CVD risk among those engaged in any physical activity among individuals who were overweight and obese suggests the possibility of engaging in a healthy lifestyle to alter the negative effects of excessive body weight on health outcomes.

This highlights the gap between the urgent needs of providing healthy lifestyle advice and the current practice of healthcare providers towards overweight and obese individuals. Therefore, identifying effective strategies to deliver advice about positive health behaviors in the healthcare setting is crucial to address the needs of those populations.

Perhaps training for health professionals to improve essential knowledge and skills to provide lifestyle modification advice, as well as establishing and referring to accessible community-based programs to improve physical activity level and diet quality at the population level.

It is critical to acknowledge the strengths and weaknesses of this study to facilitate the interpretation of our findings. The main strength of this study is the large sample size that is representative of the general U. It also allowed us to have enough statistical power to examine the interaction effect and joint effect of physical activity level and weight status.

Additionally, the multivariable-adjusted regression models accounted for multiple variables that are known to influence the relationship between physical activity and CVD-risk, such as depression status. The limitations of this study include the cross-sectional study design, which limited our ability to infer the causality of the observed association between physical activity and CVD risk.

Because physical activity and diet quality were measured only once, it is unknown how increasing physical activity and improving diet quality would benefit cardiovascular health among overweight and obese adults. Understanding the underlying mechanism would require additional studies, perhaps through a prospective cohort study with longitudinal data to explore the temporality of the association, or a large-scale randomized lifestyle intervention trial to determine the effect of the lifestyle intervention.

Also, our data were limited to a self-reported questionnaire regarding health behaviors and medical history. This likely underestimated the prevalence of comorbidities and overestimated diet quality and physical activity level. Thus, caution is needed to interpret the results in terms of the CVD risk reduction within this group.

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The authors summarize the pathophysiological changes associated with obesity, which lead to the development of CVD, recommendations for interventions such as diet, increased physical activity, and weight loss according to current literature and guidelines, and the critical importance of cardiorespiratory fitness CRF. Clinical trials continue to demonstrate improved outcomes among overweight or obese individuals who achieve a healthy weight using various methods. Increasing CRF levels appears to demonstrate the largest health improvements, regardless of underlying comorbidities or achieving weight loss. CRF, which is perhaps the single most important predictor of overall health, seems more important than weight loss alone regarding improved CVD outcomes in the obese population. The importance of CRF is well established; future endeavors to establish specific CRF targets for various patient cohorts are needed. This is a preview of subscription content, access via your institution.

Metrics details. Physical activity is a major, modifiable, risk factor for cardiovascular disease CVD that contributes to the prevention and management of CVD. Multicentered, randomized, controlled community intervention involving patients in four primary care centers. Clinical history, physical activity, dietary intake, CVD risk factors smoking, systolic and diastolic blood pressure, weight, waist circumference, BMI, total cholesterol, LDL- and HDL-cholesterol, triglycerides, glycosylated hemoglobin and glucose and global CVD risk were assessed at baseline and at the end of the intervention and multivariate models were applied to the data. At the end of the intervention period, in the IG relative to the CG group, there was a significant increase in physical activity


PDF | According to the World Health Organization, cardiovascular diseases (CVD​) will account for around 30 % of deaths worldwide by


Physical Activity

This review is aimed at summarizing the new findings about the multiple benefits of exercise on cardiovascular disease CVD. We pay attention to the prevalence and risk factors of CVD and mechanisms and recommendations of physical activity. Physical activity can improve insulin sensitivity, alleviate plasma dyslipidemia, normalize elevated blood pressure, decrease blood viscosity, promote endothelial nitric oxide production, and improve leptin sensitivity to protect the heart and vessels. Besides, the protective role of exercise on the body involves not only animal models in the laboratory but also clinical studies which is demonstrated by WHO recommendations. The general exercise intensity for humans recommended by the American Heart Association to prevent CVD is moderate exercise of 30 minutes, 5 times a week.

Regular physical activity helps improve overall health and reduces the risk for heart disease, stroke, and premature death. To prevent cardiovascular disease, the U. Physical activity can also help people with cardiovascular disease manage their conditions; exercise training has been shown to have a positive effect on people with certain types of heart failure, and cardiac rehabilitation, which includes physical activity training, helps improve the health of people who have had a heart attack or bypass surgery.

We sought to determine whether the association between physical activity and year cardiovascular disease CVD risk varies among normal weight, overweight, and obese adults in a nationally-representative sample of the United States. A subset of 22, participants aged 30—64 years was included with no CVD history. The average age of the population was Individuals who were overweight and obese had a higher year CVD risk compared to those with normal weight 9.

Physical Activity

Page 5. Tobacco and Cardiovascular Disease. Physical Activity and Cardiovascular Disease.

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Arch Intern Med. Similar results were obtained for winter LTPA. Furthermore, levels of C-reactive protein, serum amyloid A, interleukin 6, and intercellular adhesion molecule 1 were inversely and independently associated with LTPA, but not with WRPS. It further demonstrates that LTPA is associated with beneficial effects on the inflammatory response.

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