Physical Activity and Cardiovascular Disease

ABSTRACT

This review, based on prospective epidemiological studies, indicates the existence of a dose-response relationship between physical activity and coronary heart disease (CHD), which is linear at least up to a certain level of activity. Leisure time physical activity is associated with about a 30-50% reduction in risk of CHD. The benefit of leisure-time physical activity is seen in both men and women, in middle-aged and older subjects and in men with established CHD. Several mechanisms, which could contribute to the protective effect of physical activity on CHD have been identified. Prospective studies suggest that physical activity is also associated with reduced risk of stroke. Overall, the evidence points to the benefit of continued regular moderate physical activity which does not need to be vigorous or sporting, and includes activities such as walking or gardening, readily attainable by large sections of the population. Current evidence supports the recommended guidelines of 30 minutes of moderate physical activity on most days of the week in both primary and secondary prevention of CHD.

KEYWORDS

Cardiovascular disease - physical activity - coronary heart disease - prevention

REFERENCES

• 1 Berlin J A, Colditz G A. A meta-analysis of physical activity in the prevention of coronary heart disease.  Am J Epidemiol . 1990;  132 612-628
• 2 Whaley M H, Blair S N. Epidemiology of physical activity, physical fitness and coronary heart disease.  J Cardiovasc Risk . 1995;  289-295
• 3 Andersen L B. Physical activity and physical fitness as protection against premature disease or death.  Scand J Med Sci Sports . 1995;  5 318-328
• 4 Wannamethee S G, Shaper A G. Physical activity in the prevention of cardiovascular disease: an epidemiological perspective.  Sports Med . 2001;  31 101-114
• 5 Kohl H W. Physical activity and cardiovascular disease: evidence for a dose response.  Med Sci Sports and Exercise . 2001;  33(Suppl) S472-S483
• 6 Williams P T. Physical fitness and activity as separate heart disease risk factors: a meta-analysis.  Med Sci Sports Exerc . 2001;  33 754-761
• 7 Pate R R, Pratt M, Blair S N. Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.  JAMA . 1995;  273 402-440
• 8 Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta: National Center for Chronic Disease Prevention and Health Promotion, 1996.
• 9 Kushi L H, Fee R M, Folsom A R. Physical activity and mortality in postmenopausal women.  JAMA . 1997;  277 1287-1292
• 10 Folsom A R, Arnett D K, Hutchinson R G. Physical activity and incidence of coronary heart disease in middle-aged women and men.  Med Sci Sports Exerc . 1997;  29 901-909
• 11 Manson J E, Hu F B, Rich-Edwards J W. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women.  NEJM . 1999;  341 650-665
• 12 Sesso H D, Paffenbarger R S, Ha T. Physical activity and cardiovascular disease risk in middle-aged and older women.  Am J Epidemiol . 1999;  150 408-416
• 13 Lee I-Min, Rexrode K M, Cook N R. Physical activity and coronary heart disease in women: is ``no pain, no gain'' passé?.  JAMA . 2001;  285 1447-1454
• 14 Morris J N, Clayton D G, Everitt M G. Exercise in leisure time: coronary attack and death rates.  Br Heart J . 1990;  63 325-334
• 15 Lakka T A, Venalainen J M, Rauramaa R. Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction in men.  NEJM . 1994;  330 1549-1554
• 16 Mensink G BM, Deketh M, Mul M DM. Physical activity and its association with cardiovascular risk factors and mortality.  Epidemiology . 1996;  391-397
• 17 Shaper A G, Wannamethee G, Weatherall R. Physical activity and ischaemic heart disease in middle-aged British men.  Br Heart J . 1991;  66 384-394
• 18 Leon A S, Connett J, for the MRFIT Research Group. Physical activity and 10.5 year mortality in the multiple risk factors intervention trial (MRFIT).  Int J Epidemiol . 1991;  20 690-697
• 19 Hein H O, Suadicani P, Gyntelberg F. Physical fitness or physical activity as a predictor of ischaemic heart disease?.  <~>A 17 year follow-up in the Copenhagen Male Study. J Int Med . 1992;  232 471-479
• 20 Haapenen N, Miilunpalo S, Vuori I. Characteristics of leisure time physical activity associated with decreased risk of premature all-cause and cardiovascular disease mortality in middle-aged men.  Am J Epidemiol . 1996;  143 870-880
• 21 Kaplan G A, Strawbridge W J, Cohen R D. Natural history of leisure time physical activity and its correlates: associations with mortality from all causes and cardiovascular disease over 28 years.  Am J Epidemiol . 1996;  144 793-797
• 22 Rosengren A, Wilhelmsen L. Physical activity protects against coronary death and deaths from all causes in middle-aged men. Evidence from a 20-year follow-up of the primary prevention study in Goteborg.  Ann Epidem . 1997;  7 69-75
• 23 LaCroix A Z, Leveille S G, Hecht J A. Does walking decrease the risk of cardiovascular disease hospitalisations and death in older adults.  J Am Geriat Soc . 1996;  44 113-120
• 24 Wannamethee S G, Shaper A G, Walker M. Changes in physical activity, mortality and incidence of coronary heart disease in older men.  Lancet . 1998;  351 1603-1608
• 25 Bijnen F C, Caspersen C J, Feskens E J. Physical activity and 10 year mortality from cardiovascular disease and all causes. The Zutphen Elderly Study.  Arch Intern Med . 1998;  158 1499-1505
• 26 Hakim A A, Curb D, Petrovich H. Effects of walking on coronary heart disease in elderly men: The Honolulu Heart Program.  Circulation . 1999;  100 9-13
• 27 Sesso H D, Paffenbarger R S, Lee I-Min. Physical activity and coronary heart disease in men: the Harvard Alumni Health Study.  Circulation . 2000;  102 975-980
• 28 Shaper A G, Wannamethee G, Walker M. Physical activity, hypertension and risk of heart attack in men without evidence of ischaemic heart disease.  J Hum Hypertens . 1994;  8 3-10
• 29 Hagberg J M, Montain S J, Martin W H. Effect of exercise training in 60-69 year old persons with essential hypertension.  Am J Cardiol . 1989;  64 348-353
• 30 Matsusaki M, Ikeda M, Tashiro E. Influence of workload on the antihypertensive effect of exercise.  Clin Exp Pharmacol Physiol . 1992;  19 471-470
• 31 Paffenbarger Jr S R, Hyde R T, Wing A L. Physical activity, all cause mortality and longevity of college alumni.  N Engl J Med . 1986;  314 605-613
• 32 Arraiz G A, Wigle D T, Mao Y. Risk assessment of physical fitness in the Canada Health Survey mortality study.  J Clin Epidemiol . 1992;  45 419-428
• 33 Oldridge N B, Guyatt G H, Fischer M E. Cardiac rehabilitation after myocardial infarction: combined experience of randomised clinical trials.  JAMA . 1988;  260 945-950
• 34 O'Connor G T, Buring J E, Yusuf S. An overview of randomised trials of rehabilitation with exercise after myocardial infarction.  Circulation . 1989;  80 234-244
• 35 Deedwania P C, Amsterdam E A, Randall H. for the California Cardiology Working Group on Post-myocardial infarction Management et al. Evidence-based, cost effective risk stratification and management after myocardial infarction.  Arch Int Med . 1997;  157 273-280
• 36 Kitajima K, Sasaki J, Kono S. Prognostic significance of daily physical activity after first acute myocardial infarction.  Am Heart J . 1990;  119 1193-1194
• 37 Paffenbarger Jr R S. Physical activity as a defense against coronary heart disease, in Connor WE, Bristow JD (eds):Coronary Heart Disease: prevention, complications and treatment. Philadelphia, JB Lippencott Co, 1985, p135-156
• 38 Wannamethee S G, Shaper A G, Walker M. Physical activity and mortality in older men with diagnosed coronary heart disease.  Circulation . 2000;  102 1358-1363
• 39 Steffen-Batey L, Nichamen M Z, Goff D C. Change in level of physical activity and risk of all-cause mortality or reinfarction: The Corpus Christi Heart Project.  Circulation . 2000;  102 2204-2209
• 40 Hu F B, Stampfer M J, Solomen C. Physical activity and risk for cardiovascular events in diabetic women.  Ann Intern Med . 2001;  134 96-105
• 41 Paffenbarger Jr S R, Hyde R T, Wing A L. The association of changes in physical activity level and other lifestyle characteristics with mortality among men.  N Engl J Med . 1993;  328 538-545
• 42 Blair S N. Changes in physical fitness and all cause-mortality. A prospective study of healthy and unhealthy men.  JAMA . 1995;  73 1093-1098
• 43 Hein H O, Suadicani P, Sorensen H. Changes in physical activity level and risk of ischaemic heart disease.  Scand J Med Sci Sports . 1994;  4 57-64
• 44 Hardman A. Physical activity and cardiovascular risk.  J Cardiovasc Risk . 1995;  285-288
• 45 Dunn A L, Marcus B H, Kampert J B. Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomised trial.  JAMA . 1999; 
• 46 Andersen R E, Walden T A, Bartlett S J. Effects of lifestyle versus structured aerobic exercise in obese women: a randomised trial.  JAMA . 1999;  281 335-340
• 47 Thune I, Njolstad I, Lochen M L. Physical activity improves the metabolic risk profiles in men and women: the Tromso Study.  Arch Intern Med . 1998;  158 1633-1640
• 48 Fung T T, Hu F B, Yu J. Leisure-time physical activity, television watching, and plasma biomarkers of obesity and cardiovascular risk.  Am J Epidemiol . 2000;  152 1171-1178
• 49 Marugat J, Elosua R, Covas M I. Amount and intensity of physical activity, physical fitness and serum lipids in men. The MARATHON Investigators.  Am J Epidemiol . 1996;  143 562-569
• 50 Perry I J, Wannamethee S G, Whincup P H. Serum insulin and incident coronary heart disease in middle-aged British men.  Am J Epidemiol . 1996;  144 224-234
• 51 Pyorala M, Miettinen H, Laakso M. Hyperinsulinaemia predicts coronary heart disease risk in healthy middle-aged men: the 22 year follow-up results of the Helsinki Policemen Study.  Circulation . 1998;  98 398-404
• 52 Koivisto V A, Yki-Jarvinen H, DeFronzo R A. Physical training and insulin sensitivity.  Diabetes Metab Rev . 1988;  1 445-481
• 53 Henriksson J. Influence of exercise on insulin sensitivity.  J Cardiovasc Risk . 1995;  303-309
• 54 Zimmet P Z, Collins V R, Dowse G K. The relation of physical activity to cardiovascular disease risk factors in Mauritians.  Am J Epidemiol . 1991;  134 862-875
• 55 Wannamethee S G, Shaper A G, Alberti K G M G. Physical activity, metabolic factors and the incidence of coronary heart disease and Type-2 diabetes.  Arch Intern Med . 2000;  160 2108-2116
• 56 Paffenbarger R S, Wing A L, Hyde R T. Physical activity as an index of heart attack risk in college alumni.  Am J Epidemiol . 1978;  108 161-175
• 57 Paffenbarger R S, Hyde R T, Wing A L. Physical activity, all cause mortality and longevity of college alumni.  N Engl J Med . 1986;  314 605-613
• 58 Rauramma R, Salonen J T, Seppanen K. Inhibition of platelet aggregation by moderate-intensity physical exercise: a randomised clinical trial in overweight men.  Circulation . 1986;  74 939-944
• 59 Meade T. Exercise and haemostatic function.  J Cardiovasc Risk . 1995;  2 323-329
• 60 Wannamethee S G, Lowe G D, Whincup P H. Physical activity and haemostatic and inflammatory variables in elderly men (provisionally accepted).  Circulation.
• 61 Fernhall B, Szymanski L M, Gorman P A. Fibrinolytic activity is similar in physically active men with and without a history of myocardial infarction.  Arterioscler Thromb Vasc Biol . 1997;  17 1106-1113
• 62 Szymanski L M, Pate R R. Fibrinolytic responses to moderate intensity exercise. Comparisons of physically active and inactive men.  Arterioscler Thromb . 1994;  14 1746-1750
• 63 Eliasson M, Apslund K, Evrin P E. Regular leisure time physical activity predicts high activity of tissue plasminogen activator: the Northern Sweden Monica Study.  Int J Epidemiol . 1996;  25 1182-1187
• 64 Rauramaa R, Li G, Vaisanen S B. Dose-response and coagulation and hemostatic factors.  Med Sci Sports Exerc. 2001;  S516-S520
• 65 Sandvik L, Erikssen J, Thaulow E. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men.  N Engl J Med . 1993;  328 533-537
• 66 Blair S N, Kohl H W, Paffenbarger R S. Physical fitness and all cause mortality: a prospective study of healthy men and women.  JAMA . 1989;  262 2395-2401
• 67 Hu F B, Stampfer M J, Colditz G A. Physical activity and risk of stroke in women.  JAMA . 2000;  283 2961-2967
• 68 Physical activity and stroke mortality in women. Ten-year follow-up of the Nord-Trondelag health survey, 1984-1986. Stroke 2000 31: 14-18
• 69 Wannamethee G, Shaper A G. Physical activity and stroke in British middle-aged men.  BMJ . 1992;  304 597-601
• 70 Housley E, Leng G C, Donnan P T. Peripheral arterial disease in the general population: Edinburgh Artery Study.  J Epidemiol Comm Health . 1993;  47 475-480
• 71 Asgeirsdottir L P, Agnarsson U, Jonsson G S. Lower extremity blood flow in healthy men: effect of smoking, cholesterol, and physical activity-a Doppler study.  Angiology . 2001;  52 437-445