Exercise at the Extremes

Abstract

Habitual physical activity and regular exercise training improve cardiovascular health and longevity. A physically active lifestyle is, therefore, a key aspect of primary and secondary prevention strategies. An appropriate volume and intensity are essential to maximally benefit from exercise interventions. This document summarizes available evidence on the relationship between the exercise volume and risk reductions in cardiovascular morbidity and mortality. Furthermore, the risks and benefits of moderate- versus high-intensity exercise interventions are compared. Findings are presented for the general population and cardiac patients eligible for cardiac rehabilitation. Finally, the controversy of excessive volumes of exercise in the athletic population is discussed.

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

“…In patients with heart failure, serious adverse events were numerically higher with HIT than with MCT. This finding and the association of myocardial infarction, need for coronary intervention, and mortality in patients with CAD with exercise session duration or intensity, even though these findings are controversial, should receive attention in future trials 17, 18, 77, 119…”

“…The authors concluded that running for even 5 to 10 min/d or 50 min/wk at a low speed of <6 miles/h (<10 km/h) markedly reduces the risk of death 13. However, in subgroups with the highest running intensity, the impact of running on mortality leveled off, whereas other trials even showed a loss of mortality reduction in healthy subjects and patients with CAD with high exercise intensities 10, 16, 17, 18. O′Keefe et al reviewed the pathophysiologic mechanisms of potential adverse cardiovascular effects from long‐term excessive endurance exercise, such as ultramarathons, ironman distance triathlons, or long‐distance bicycle races, which might diminish exercise‐related mortality benefits 19.…”

Walking and Calcified Atherosclerotic Plaque in the Coronary Arteries

“…Prior studies have described the association between physical activity and CVD outcomes as curvilinear. 20,21 Although less reduction in CVD events was observed at high levels of moderate to vigorous activity, the protective effect for CVD mortality was still present as compared to those who were sedentary. 21 Another plausible explanation for why we might find a J-shaped association lies in the method of measurement of the outcome (CAC).…”

“…20,21 Although less reduction in CVD events was observed at high levels of moderate to vigorous activity, the protective effect for CVD mortality was still present as compared to those who were sedentary. 21 Another plausible explanation for why we might find a J-shaped association lies in the method of measurement of the outcome (CAC). Although the Agatston method is the standard for scoring coronary calcification, some have suggested that other methods of determining coronary calcification should be considered.…”

Exercise dose in clinical practice: Right is better than more

“…Nevertheless, there is debate on the dose-response relationship of exercise and CVD outcomes [4,5] and whether high volumes of exercise may accelerate coronary atherosclerosis [6,7]. Nonetheless, CV prevention is in the first instance preferable by lifestyle changes, and many studies have shown an inverse association between physical activity level and the incidence of CVDs suggesting low aerobic fitness as a strong predictor for future CVD and all-cause mortality in both healthy and CVD patients [8,9].…”