2003

DOI: 10.1161/01.cir.0000075572.40158.77

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Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease

Paul D. Thompson¹,

David M. Buchner²,

Ileana L. Piña³

et al.

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Cited by 1,698 publications

(456 citation statements)

References 70 publications

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“…Further, ACHD patients frequently self‐restrict exercise because of perceived risks of underlying CHD or because of limited capacity for exercise 23, 24. Aside from predisposing to obesity and hyperlipidemia, the lack of aerobic exercise is associated with an increased risk of hospitalization and death in ACHD patients 14, 23, 25. Enhanced physical activity and aerobic exercise play an important role in decreasing cardiovascular risk 25.…”

Section: Discussionmentioning

confidence: 99%

“…Aside from predisposing to obesity and hyperlipidemia, the lack of aerobic exercise is associated with an increased risk of hospitalization and death in ACHD patients 14, 23, 25. Enhanced physical activity and aerobic exercise play an important role in decreasing cardiovascular risk 25. However, questions remain regarding this effect in CHD patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Metabolic Syndrome in Adults With Congenital Heart Disease

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²

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³

et al. 2016

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BackgroundMetabolic syndrome increases risk for atherosclerotic coronary artery disease, and its prevalence increases with increasing age and body mass index. Adults with congenital heart disease (ACHD) are now living longer and accruing coronary artery disease risk factors. However, the prevalence of metabolic syndrome in ACHD patients is unknown.Methods and ResultsWe conducted a retrospective cohort study of ACHD patients at our center to quantify the prevalence of metabolic syndrome in an ACHD population. Using case‐control matching, we constructed a comparable control group from a population‐based sample of 150 104 adults. International Diabetes Federation criteria were used to define metabolic syndrome. We used logistic regression to compare the risk of metabolic syndrome across the resulting cohorts, which were composed of 448 ACHD patients and 448 controls matched by age and sex. Mean age of both groups was 32.4±11.3 years, and 51.3% were female. Obesity was present in 16.1% of the ACHD patients and 16.7% of the controls. Metabolic syndrome was more common in ACHD patients than in controls (15.0% versus 7.4%; odds ratio 1.82, 95% CI 1.25–2.65).ConclusionsOur data suggest that metabolic syndrome is more common among adults with congenital heart disease than in the general population. Thus, patients with congenital heart disease should be screened for metabolic syndrome and risk factors mitigated where possible to prevent atherosclerotic coronary artery disease. Preventive cardiology should be included during routine ACHD care.

“…Further, ACHD patients frequently self‐restrict exercise because of perceived risks of underlying CHD or because of limited capacity for exercise 23, 24. Aside from predisposing to obesity and hyperlipidemia, the lack of aerobic exercise is associated with an increased risk of hospitalization and death in ACHD patients 14, 23, 25. Enhanced physical activity and aerobic exercise play an important role in decreasing cardiovascular risk 25.…”

Section: Discussionmentioning

confidence: 99%

“…Aside from predisposing to obesity and hyperlipidemia, the lack of aerobic exercise is associated with an increased risk of hospitalization and death in ACHD patients 14, 23, 25. Enhanced physical activity and aerobic exercise play an important role in decreasing cardiovascular risk 25. However, questions remain regarding this effect in CHD patients.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome in Adults With Congenital Heart Disease

¹

,

²

,

³

et al. 2016

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BackgroundMetabolic syndrome increases risk for atherosclerotic coronary artery disease, and its prevalence increases with increasing age and body mass index. Adults with congenital heart disease (ACHD) are now living longer and accruing coronary artery disease risk factors. However, the prevalence of metabolic syndrome in ACHD patients is unknown.Methods and ResultsWe conducted a retrospective cohort study of ACHD patients at our center to quantify the prevalence of metabolic syndrome in an ACHD population. Using case‐control matching, we constructed a comparable control group from a population‐based sample of 150 104 adults. International Diabetes Federation criteria were used to define metabolic syndrome. We used logistic regression to compare the risk of metabolic syndrome across the resulting cohorts, which were composed of 448 ACHD patients and 448 controls matched by age and sex. Mean age of both groups was 32.4±11.3 years, and 51.3% were female. Obesity was present in 16.1% of the ACHD patients and 16.7% of the controls. Metabolic syndrome was more common in ACHD patients than in controls (15.0% versus 7.4%; odds ratio 1.82, 95% CI 1.25–2.65).ConclusionsOur data suggest that metabolic syndrome is more common among adults with congenital heart disease than in the general population. Thus, patients with congenital heart disease should be screened for metabolic syndrome and risk factors mitigated where possible to prevent atherosclerotic coronary artery disease. Preventive cardiology should be included during routine ACHD care.

“…Physical activity (PA) is effective for preventing a stroke and reducing mortality 1, 2. However, approximately half of East Asians and 24% of US citizens still self‐reported as being physically inactive, suggesting that PA may not sufficiently work as a preventive strategy for strokes 3, 4.…”

Section: Introductionmentioning

confidence: 99%

Physical Activity Frequency and the Risk of Stroke: A Nationwide Cohort Study in Korea

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³

et al. 2017

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BackgroundThe current guideline recommends moderate‐ to vigorous‐intensity physical activity (PA) at least 40 min/day for 3 to 4 days/week. Although recent evidence has demonstrated that low‐dose PA could reduce cardiovascular mortality, the relationship between low‐dose PA and the risk of stroke remains uncertain.Methods and ResultsUsing data from a nation‐wide sample cohort in Korea, we examined 336 326 individuals who received a general health examination between 2009 and 2010. Level of PA was assessed using a questionnaire for weekly PA frequencies regarding 3 intensity categories: light, moderate, and vigorous. Moderate‐ to vigorous‐intensity PA (MVPA) was classified into 4 frequency categories: none, 1 to 2, 3 to 4, or ≥5 times/week. Cox proportional hazard models were constructed to estimate the risk of stroke. During the average follow‐up of 3.6 years, 2213 stroke cases occurred. MVPA was none in 50%, 1 to 2 times/week in 20%, 3 to 4 times/week in 13%, and ≥5 times/week in 18% of the cohort. Individuals with MVPA 1 to 2 times/week had a 16% reduced risk of stroke (adjusted hazard ratio, 0.84; 95% confidence interval, 0.73–0.96) compared with those with no MVPA. The population attributable fraction of no MVPA was 12%, which was the second most important risk factor for a stroke after hypertension.ConclusionsEven 1 to 2 times a week of MVPA might be beneficial to prevent a first‐ever stroke in the general population, although a quantitative validation of the questionnaire is needed. From a public health perspective, we need to encourage inactive people to start exercising with more‐achievable goals.

“…Regular physical activity reduces the risk of cardiovascular events among patients with IHD 1, 3. For example, participation in exercise‐based cardiac rehabilitation has been demonstrated to reduce mortality by up to 30% 4, 5, 6, 7, 8, 9.…”

mentioning

confidence: 99%

Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

¹

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²

,

³

et al. 2018

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BackgroundRegular physical activity reduces the risk of cardiovascular events, but most ischemic heart disease (IHD) patients do not obtain enough.Methods and ResultsACTIVE REWARD (A Clinical Trial Investigating Effects of a Randomized Evaluation of Wearable Activity Trackers with Financial Rewards) was a 24‐week home‐based, remotely monitored, randomized trial with a 16‐week intervention (8‐week ramp‐up incentive phase and 8‐week maintenance incentive phase) and an 8‐week follow‐up. Patients used wearable devices to track step counts and establish a baseline. Patients in control received no other interventions. Patients in the incentive arm received personalized step goals and daily feedback for all 24 weeks. In the ramp‐up incentive phase, daily step goals increased weekly by 15% from baseline with a maximum of 10 000 steps and then remained fixed. Each week, $14 was allocated to a virtual account; $2 could be lost per day for not achieving step goals. The primary outcome was change in mean daily steps from baseline to the maintenance incentive phase. Ischemic heart disease patients had a mean (SD) age of 60 (11) years and 70% were male. Compared with control, patients in the incentive arm had a significantly greater increase in mean daily steps from baseline during ramp‐up (1388 versus 385; adjusted difference, 1061 [95% confidence interval, 386–1736]; P<0.01), maintenance (1501 versus 264; adjusted difference, 1368 [95% confidence interval, 571–2164]; P<0.001), and follow‐up (1066 versus 92; adjusted difference, 1154 [95% confidence interval, 282–2027]; P<0.01).ConclusionsLoss‐framed financial incentives with personalized goal setting significantly increased physical activity among ischemic heart disease patients using wearable devices during the 16‐week intervention, and effects were sustained during the 8‐week follow‐up.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02531022.

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