Effect of Physical Activity Level on Biomarkers of Inflammation and Insulin Resistance Over 5 Years in Outpatients With Coronary Heart Disease (from the Heart and Soul Study)

Abstract

Higher levels of physical activity are associated with lower rates of coronary heart disease (CHD). Prior studies suggest this is partly due to lower levels of inflammation and insulin resistance. We sought to determine whether physical activity level was associated with inflammation or insulin resistance during a 5-year period in outpatients with known CHD. We evaluated 656 participants from the Heart and Soul Study, a prospective cohort study of outpatients with documented CHD. Self-reported physical activity frequency was assessed at baseline and after 5 years of follow-up. Participants were classified as low versus high activity at each visit, yielding 4 physical activity groups: stable low activity, decreasing activity (high at baseline to low at Year 5), increasing activity (low at baseline to high at Year 5), and stable high activity. We compared Year 5 markers of inflammation (C-reactive protein [CRP], interleukin-6, and fibrinogen) and insulin resistance (insulin, glucose, and A1c) across the 4 activity groups. After 5-years of follow-up, higher activity was associated with lower mean levels of all biomarkers. In the fully adjusted regression models CRP, interleukin-6, and glucose remained independently associated with physical activity frequency (log CRP p-trend across activity groups = 0.03; log interleukin-6 p-trend = 0.01; log glucose p-trend = 0.003). Individuals with Stable High Activity typically had the lowest levels of biomarkers. In conclusion, in this novel population of outpatients with known CHD followed for 5 years, higher physical activity frequency was independently associated with lower levels of CRP, interleukin-6, and glucose.

Association between a Healthy Lifestyle Score and inflammatory markers among Puerto Rican adults

“…Consistent with previous literature, we observed that those with lower income and educational attainment had lower adherence to the HLS [10, 11]. Although having higher socioeconomic and educational status can help support a healthy lifestyle environment, in our analysis the HLS remained significantly associated with inflammatory markers even after adjusting for such factors.…”

“…The evidence for physical activity and inflammation is inconsistent; while some studies have reported an association with CRP and IL-6 independent of BMI [10, 11, 29], others found no association or the association was null when adjusted for adiposity markers [24, 26, 30]. Furthermore, we found that IL-6 was associated individually with physical activity and sedentary behavior, and with social support, but that these associations were attenuated when adjusted for the other components of the HLS, suggesting that they were not independent of the other lifestyles behaviors.…”

“…For instance, higher concentrations of inflammatory markers such as interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and C-reactive protein (CRP) have been shown to be associated with higher cardiovascular risk [3, 4]. In addition, lifestyle behaviors may underlie the inflammatory processes, as posited by several studies reporting an inverse association between inflammatory markers and adherence to overall dietary patterns [5–9] or physical activity [10–12]. Other lifestyle behaviors, such as smoking [13] or sleep [14], have also been linked to inflammatory response.…”

Direction of Association Between Depressive Symptoms and Lifestyle Behaviors in Patients with Coronary Heart Disease: the Heart and Soul Study

“…Point values ranged from 0 to 5, with higher scores indicating greater physical activity. This one-item measure of physical activity was predictive of subsequent inflammation, insulin resistance, cardiovascular events, and mortality in this cohort (4,25). Self-reported physical activity has been shown to be a valid and reliable assessment of physical activity (26–28).…”

“…There is compelling evidence supporting the role of inflammatory responses in the pathophysiology of depression (57). Physical inactivity, inadequate sleep, and other unhealthy behaviors can lead to elevated inflammation (25) and thus contribute to the development and exacerbation of depressive symptoms. On the other hand, specific symptoms of depression—including loss of interest, hopelessness, fatigue, and trouble remembering—may reduce one’s motivation or ability to maintain physical activity and medication regimens.…”