Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III)

Abstract

The beneficial effect of exercise training and exercise-based cardiac rehabilitation on symptom-free exercise capacity,cardiovascular and skeletal muscle function, quality of life, general healthy lifestyle, and reduction of depressive symptoms and psychosocial stress is nowadays well recognized. However, it remains largely obscure, which characteristics of physical activity (PA) and exercise training--frequency, intensity, time (duration), type (mode), and volume (dose: intensity x duration) of exercise--are the most effective. The present paper, therefore, will deal with these exercise characteristics in the management of individuals with cardiovascular disease, i.e. coronary artery disease and chronic heart failure patients, but also in patients with congenital or valvular heart disease. Based on the current literature, and if sufficient evidence is available, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding frequency, intensity, time and type of PA, and safety aspects during exercise inpatients with cardiovascular disease. This paper is the third in a series of three papers, all devoted to the same theme: the importance of the exercise characteristics in the management of cardiovascular health. Part I is directed to the general population and Part II to individuals with cardiovascular risk factors. In general, PA recommendations and exercise training programmes for patients with coronary artery disease or chronic heart failure need to be tailored to the individual's exercise capacity and risk profile, with the aim to reach and maintain the individually highest fitness level possible and to perform endurance exercise training 30–60 min daily (3–5 days per week) in combination with resistance training 2–3 times a week. Because of the frequently reported dose–response relationship between training effect and exercise intensity, one should seek sufficiently high training intensities, although more scientific evidence on effect sizes and safety is warranted. At present, there is insufficient data to give more specific recommendations on type, dosage, and intensity of exercise in some other cardiovascular diseases, such as congenital heart disease, valve disease, cardiomyopathies, channelopathies, and patients with implanted devices.

Personalized weight loss strategies—the role of macronutrient distribution

“…70 In the same analysis, no synergistic effects on body weight were detected between low-calorie diets and exercise. 70 Although the benefits of regular physical activity include improved cardiovascular health and maintenance of skeletal muscle mass, [71][72][73] the specific role of exercise in weight loss and maintenance of healthy body weight, and the effects of dietary macronutrient distribution on this association, remain to be elucidated. 69 As weight loss is strongly advised in overweight or obese patients with type 2 diabetes mellitus, an intensive lifestyle intervention including restricted energy intake could potentially decrease the excess cardiovascular risk and mortality in this group.…”

Reporting and Replicating Trials of Exercise-Based Cardiac Rehabilitation

“…In a manner analogous to the prescription of medication, the frequency and length of sessions, intensity of exercise, and overall duration of the exercise program can be adjusted to provide varying exercise doses and each in turn may influence overall training benefit. 25 Some other types of nonpharmacological intervention may not require such a specific level of detail to completely report this item. Given the level of detail required to fully complete this item, it is therefore unsurprising that the exercise-based cardiac rehabilitation trials examined in this study displayed comparably worse reporting of the when and how much item compared with other nonpharmacological interventions.…”

Physical activity in women after an acute myocardial infarction

“…The selected alternatives were based on previous research. [14] Socio-demographics included age, marital status, education level and residence (rural or urban). Moreover, to test the user-friendliness and face validity regarding the questionnaire, a pilot study was conducted in 12 women (with no AMI diagnose) between the ages of 60 and 90 years.…”

“…[9,13] No generalizable recommendations can be made regarding the time for the resumption of daily activities, and decisions should be individualized, and based on left ventricular function, completeness of revascularization and rhythm control. [1] It has been well documented that the positive physiological and clinical effects of exercise can only be maintained if physical activity is performed throughout one's entire life, [14] and maintaining regular moderate physical activity is an important aim of secondary prevention. [3] Knowledge about women's leisure time physical activity after an AMI is limited.…”