Physical activity in patients with stable coronary heart disease: an international perspective

Abstract

AimsDespite the known benefits of regular exercise, the reasons why many coronary heart disease (CHD) patients engage in little physical activity are not well understood. This study identifies factors associated with low activity levels in individuals with chronic CHD participating in the STABILITY study, a global clinical outcomes trial evaluating the lipoprotein phospholipaseA2 inhibitor darapladib.Methods and resultsPrior to randomization, 15 486 (97.8%) participants from 39 countries completed a lifestyle questionnaire. Total physical activity was estimated from individual subject self-reports of hours spend each week on mild, moderate, and vigorous exercise, corresponding approximately to 2, 4, and 8 METS, respectively. Multivariate logistic regression evaluated clinical and demographic variables for the lowest compared with higher overall exercise levels, and for individuals who decreased rather than maintained or increased activity since diagnosis of CHD. The least active 5280 subjects (34%) reported exercise of ≤24MET.h/week. A total of 7191 subjects (46%) reported less exercise compared with before diagnosis of CHD. The majority of participants were either ‘not limited’ or ‘limited a little’ walking 100 m (84%), climbing one flight of stairs (82%), or walking 1 km/½ mile (68%), and <10% were limited ‘a lot’ by dyspnoea or angina. Variables independently associated with both low physical activity and decreasing exercise after diagnosis of CHD included more co-morbid conditions, poorer general health, fewer years of education, race, and country (P < 0.001 for all).ConclusionIn this international study, low physical activity was only partly explained by cardiovascular symptoms. Potentially modifiable societal and health system factors are important determinants of physical inactivity in patients with chronic CHD.

In-patient step count predicts re-hospitalization after cardiac surgery

“…A higher level of leisure-time activity and walking have been shown to be associated with graded lower incidence of atrial fibrillation, with progressively lower risk occurring as leisure-time activity and both the distance walked and pace of walking increased [17]. It has also been reported that physical activity in patients with stable coronary heart diseases was most often limited by non-specific symptoms such as shortness of breath, fatigue, and weakness [18]. It is possible that symptoms such as weakness and reduced vitality in part are associated with lower levels of physical activity.…”

Self‐Reported Health and Outcomes in Patients With Stable Coronary Heart Disease

“…Depressive symptoms were assessed from the questions “How is your current mood?” (denoted as “depressed mood”) and “Have you lost interest in activities or hobbies that normally give you pleasure?” (denoted as “loss of interest”), with possible responses of never or rarely, sometimes, often , or always . Physical activity was assessed from the total hours of moderate‐intensity (4 metabolic equivalents) and vigorous‐intensity (8 metabolic equivalents) physical activity during an average week . A healthy diet was classified using a Mediterranean diet score based on responses to a simple food‐frequency questionnaire .…”

Physical activity in primary and secondary prevention of cardiovascular disease: Overview updated

“…Despite the well-known benefits of physical activity and exercise training, most of eligible cardiovascular patients do not benefit from cardiac rehabilitation programs[52], and these patients are more likely to taking less exercise[53]. Exercise levels may even decrease after the diagnosis of heart disease.…”

“…Exercise levels may even decrease after the diagnosis of heart disease. The least active subjects are more likely to be older, male, obese and present symptoms during common activities such as short distance walking[53]. …”