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The benefits of physical activity in middle-aged individuals for cardiovascular disease outcomes
Abstract
Regular physical activity (PA) has a positive role in preventing cardiovascular disease (CVD). Due to a trend toward a more sedentary lifestyle, the middle-aged population (35–65 years) is at greater risk of developing CVD. It is well established that PA improves cardiorespiratory fitness and reduces the risk of cardiovascular mortality and cardiovascular events, including stroke, coronary heart disease, heart failure, hypercholesterolemia, atherosclerosis, diabetes, and blood pressure. PA can potentially decrease oxidative stress and systemic inflammation, which are the two main underlying mechanisms leading to CVD. By reducing CRP, TNF-α, INF-γ, NF-κB and increasing IL-10, IL-4, and IL-8, PA can prevent the initiation and progression of CVD in middle-aged adults, highlighting the importance of being physically active for this age group. The general recommendation for PA to prevent CVD is at least 150 min/week at a moderate level of intensity; the type of PA should be adapted to the fitness level and medical condition of the individual. However, standardized guidelines for middle-aged individuals with cardiovascular events still need to be established.
... Besides obesity prevention, aerobic physical activity improves endothelial function and prevents arterial stiffness [132]. LTPA is also negatively associated with oxidative stress and inflammatory markers which are important underlying factors in the process of atherosclerosis [133,134]. Also, blood coagulation is diminished with regular physical activity, likely due to lower levels of coagulation factors such as blood fibrinogen and tissue plasminogen activator [135]. Parts of these benefits are exerted independently of the effect of physical activity on weight control. ...
... Measurement units of MET-hours/week, kcal/week, and hours/ week are in fact indicative of either combined intensity and duration (MET-hours/week and kcal/week) or duration only (hours/week). According to the available evidence, it seems that the duration of physical activity has a quite important impact on the reduction of CVD risk [151] but the intensity of exercise should be adapted to the cardiorespiratory capacity and medical conditions of the individual [134]. A meta-analysis of 5 cohort studies that measured the intensity of physical activity by an accelerometer in older adults found that HR for CVD risk was lower in moderate-to-vigorous physical activity than light-intensity physical activity although HR for CVD death was almost equal in light-and moderate-to-vigorous intensity physical activity [152], suggesting that moderate-to-vigorous intensity physical activity may be more beneficial for CVD incidence than light-intensity activity. ...
Background and objective
Physical activity has benefits for the cardiovascular system, however, what levels and types of activity provide optimal cardiovascular health is unclear. We aimed to determine the level of physical activity that has the most benefits against cardiovascular diseases (CVD).
Methods
PubMed, Scopus, and Web of Science were searched for prospective cohort studies on leisure-time (LTPA) or occupational physical activity (OPA) as the exposure and major types of CVD (total CVD, coronary heart disease [CHD], stroke, and atrial fibrillation [AF]) incidence as the outcome. Risk of bias of studies was evaluated using the ROBINS-I tool. Summary hazard ratios (HR) were calculated using random-effects pairwise model.
Results
A total of 103 studies were included in the analysis. The highest versus the lowest LTPA was associated with a lower risk of overall CVD (HR = 0.81; 95% CI: 0.77–0.86), CHD (HR = 0.83; 0.79–0.88), and stroke (HR = 0.83; 0.79–0.88), but not AF (HR = 0.98; 0.92–1.05). Linear dose-response analyses showed a 10%, 12%, 9%, and 8% risk reduction in CVD, CHD, stroke, and AF incidence, respectively, for every 20 MET-hours/week increase in LTPA. In nonlinear dose-response analyses, there were inverse associations up to 20 MET-hours/week with 19% and 20% reduction in CVD and CHD risk, and up to 25 MET-hours/week with 22% reduction in stroke, with no further risk reduction at higher LTPA levels. For AF, there was a U-shaped nonlinear association with the maximum 8% risk reduction at 10 MET-hours/week of LTPA. Higher levels of OPA were not associated with risk of CVD, CHD, stroke, or AF.
Conclusions
Overall, results showed an inverse dose-response relationship between LTPA and risk of CVD, CHD, stroke, and AF. Running was the most beneficial LTPA but the risk was similar among various LTPA intensities. OPA showed no benefits in total or any type of CVD.
... Physical activity plays a role in preventing cardiovascular disease, a decrease in physical activity at the age of 35-65 years is a big risk of contracting cardiovascular disease. (Shakoor et al., 2023). WHO recommends doing at least 150 minutes of physical activity per week for ages 8-64 years. ...
... WHO recommends doing at least 150 minutes of physical activity per week for ages 8-64 years. Moderate physical activity has been shown to improve body fitness, especially the cardiorespiratory system (Rehman & Ahmad, 2020;Shakoor et al., 2023) Table 3 explains that during the PPKM period, 39 participants consumed high-calorie foods, while 28 participants often consumed junk food. A total of 12 participants were active smokers while 23 participants were passive smokers, both of whom have the same increased risk of cardiovascular disease (Khorammdad et al., 2019). ...
The implementation of Community Restrictions (PPKM) is an effort by the Indonesian government to prevent the chain of transmission of Covid-19 that occurred in 2021. PPKM makes changes in lifestyle and physical activity. The benefit of physical activity for health is to prevent an increase in risk factors for chronic diseases such as cardiovascular disease. This study used risk factors for cardiovascular disease age, sex, lifestyle, diet, BMI, current blood glucose, total blood cholesterol, and blood pressure. Knowing the impact of decreased physical activity against increased risk factors for cardiovascular disease which can be controlled and which cannot be controlled at the productive age of 40-50 years. This study used the observation method on 50 participants from RW 01 Kampung Melayu, East Jakarta who were randomly selected. The study participants measured blood glucose levels, total cholesterol, blood pressure, BMI, and physical activity measurements during the PPKM period. Testing the correlation of the impact of physical activity with increased risk factors was conducted using the Wilcoxon signed rank test. Decreased physical activity occurred predominantly in all categories of participants caused by changes in lifestyle, sleep patterns, diet, and uncontrolled workload, causing increases in blood glucose levels, total cholesterol, BMI, and blood pressure. Statistical tests prove that there is a significant correlation between decreased physical activity and increased risk factors for cardiovascular disease. This study proves that there is an increase in cardiovascular disease risk factors associated with decreased physical activity and lifestyle changes in residents of RW 01 Kampung Melayu, East Jakarta.
... The pathology of CVDs is complex, and oxidative stress, hyper-inflammation, endothelial dysfunction, and hyperlipidemia have been reported as common phenotypes in the pathogenesis of CVDs and have become the main targets of therapeutic intervention [15,16]. Conventional therapy commonly used to treat CVDs can be costly and may produce adverse side effects, unwanted drug-drug interactions and life-threatening toxicities [17], and thus, alternative approaches have been considered, including physical activity, as well as the use medicinal natural product supplementation, for CVD treatment [18][19][20]. ...
... Nutrients 2023, 15,2562 therapeutic intervention [15,16]. Conventional therapy commonly used to treat CV be costly and may produce adverse side effects, unwanted drug-drug interactio life-threatening toxicities [17], and thus, alternative approaches have been conside cluding physical activity, as well as the use medicinal natural product supplemen for CVD treatment [18][19][20]. ...
The shift in modern dietary regimens to “Western style” and sedentary lifestyles are believed to be partly responsible for the increase in the global burden of cardiovascular diseases. Natural products have been used throughout human history as treatments for a plethora of pathological conditions. Taurine and, more recently, black pepper have gained attention for their beneficial health effects while remaining non-toxic even when ingested in excess. Taurine, black pepper, and the major terpene constituents found in black pepper (i.e., β-caryophyllene; α-pinene; β-pinene; α-humulene; limonene; and sabinene) that are present in PhytoCann BP® have been shown to have cardioprotective effects based on anti-inflammatory, antioxidative, anti-hypertensive and anti-atherosclerotic mechanisms. This comprehensive review of the literature focuses on determining whether the combination of taurine and black pepper extract is an effective natural treatment for reducing cardiovascular diseases risk factors (i.e., hypertension and hyperhomocysteinemia) and for driving anti-inflammatory, antioxidative and anti-atherosclerotic mechanisms to combat coronary artery disease, heart failure, myocardial infarction, and atherosclerotic disease.
... 2 Physical activity significantly lowers the risk of cardiovascular events such stroke, heart failure and coronary heart disease. [3][4][5][6][7] Heart Failure (HF), a significant public health concern, according to estimates, there will be more than eight million HF patients in the US by 2030 and the accompanying medical expenses will rise from $31 billion in 2012 to $70 billion in 2030. 8 Numerous researches has looked into the relationship between obesity and HF and they have linked negative metabolic changes and cardiac remodeling to the development of HF. 9 Milrinone [MRN] (Figure 1) is frequently used in the intensive care unit and cardiac unit, MRN is used to provide cardiac S770 Santhinathan, et al.: Bilosome Nanocarriers for Enhanced Oral Bioavailability and Cardiovascular Activity of Milrinone support for patients suffering from acute heart failure, to wear patients who have pre-existing left ventricular dysfunction from cardio pulmonary bypass, or as a temporizing agent for patients awaiting heart surgery or transplantation. ...
... In the study by Zhang et al., 54.8% of patients with heart failure experienced fear of movement [39], while in the study by Shen et al., 75.7% of patients experienced it [39]. This is an example of how important a healthy lifestyle is for preventing CAD [41]. ...
Background — Among noncommunicable diseases, myocardial infarction (MI) and stroke are the most common global cause of death and the most important cause of disability. However, they are also regarded as the most preventable chronic noncommunicable diseases in humans. The goal of our study was to investigate the predictors of behavioral risk factors associated with MI and stroke based on the protection motivation theory (PMT) in the middle-aged adults of southern Iran. Methods — We conducted a cross-sectional descriptive analytical study. The study population included 383 middle-aged individuals from southern Iran. Data collection instruments included demographic questions, PMT questionnaire, and questions on preventive behaviors for MI and stroke. Descriptive and inferential statistics were calculated after data collection. Results — The mean age of the study subjects was 41.26±8.32 years. The results of this study showed that the construct of self-efficacy has the highest predictive power of protection motivation. In our study, the most important predictors of preventive behaviors against the risk of MI and stroke were perceived severity, perceived vulnerability, self-efficacy, protection motivation, risk level, gender, and literacy level. Conclusions — Our results confirmed that PMT is a suitable theory for preventive behaviors for MI and stroke. In this context, it is suggested to initially provide positive coping messages, especially to the middle-aged population, to increase patients’ self-confidence regarding preventive behavior, especially diet and regular physical activity.
... Cardiovascular diseases (CVDs), clinically defined as any pathology effecting the heart and/or vasculature (e.g., atherosclerosis, coronary artery disease (CAD), cerebrovascular disease and peripheral artery disease) [1] are the leading cause of global mortality and morbidity, being responsible for 19.1 million deaths in 2022 [2]. Hypertension [3], obesity [4], cigarette smoking [5], hyperhomocysteinemia [6], a sedentary lifestyle [7], inflammation [8], type-2 diabetes and insulin resistance [9] are some of the risk factors associated with CVDs. ...
Background: Obesity is a risk factor for developing cardiovascular diseases (CVDs) by impairing normal vascular function. Natural products are gaining momentum in the clinical setting due to their high efficacy and low toxicity. Caralluma fimbriata extract (CFE) has been shown to control appetite and promote weight loss; however, its effect on vascular function remains poorly understood. This study aimed to determine the effect that CFE had on weight loss and vascular function in mice fed a high-fat diet (HFD) to induce obesity, comparing this effect to that of lorcaserin (LOR) (an anti-obesity pharmaceutical) treatment. Methods: C57BL/6J male mice (n = 80) were fed a 16-week HFD to induce obesity prior to being treated with CFE and LOR as standalone treatments or in conjunction. Body composition data, such as weight gain and fat mass content were measured, isometric tension analyses were performed on isolated abdominal aortic rings to determine relaxation responses to acetylcholine, and immunohistochemistry studies were utilized to determine the expression profiles on endothelial nitric oxide synthase (eNOS) and cell stress markers (nitrotyrosine (NT) and 78 kDa glucose-regulated protein (GRP78)) in the endothelial, medial and adventitial layers of aortic rings. Results: The results demonstrated that CFE and CFE + LOR treatments significantly reduced weight gain (17%; 24%) and fat mass deposition (14%; 16%). A HFD markedly reduced acetylcholine-mediated relaxation (p < 0.05, p < 0.0001) and eNOS expression (p < 0.0001, p < 0.01) and significantly increased NT (p < 0.05, p < 0.0001) and GRP78 (p < 0.05, p < 0.01, p < 0.001). Obese mice treated with CFE exhibited significantly improved ACh-induced relaxation responses, increased eNOS (p < 0.05, p < 0.01) and reduced NT (p < 0.01) and GRP78 (p < 0.05, p < 0.01) expression. Conclusions: Thus, CFE alone or in combination with LOR could serve as an alternative strategy for preventing obesity-related cardiovascular diseases.
... Sin embargo, se ha evidenciado que la autoeficacia motriz es fundamental para el desarrollo de la motivación y de esta manera mantener estilos de vida activos (Morales-Sánchez, Hernández-Martos, Reigal Garrido & Hernández-Mendo, 2024). Siguiendo esta lógica, es importante mantener la relación entre estas variables, debido a que, permite al estudiantado mantener estilos de vida saludables y la adquisición de los beneficios que proporciona mantenerse físicamente activo (Navas, Soriano, Holgado & López, 2009;Maltagliati, Sarrazin, Fessler, Lebreton & Cheval, 2024;Shakoor, Platat, Ali, Ismail, Al Dhaheri, Bosevski,... & Stojanovska, 2023). En cuanto a la fiabilidad, ambos instrumentos presentaron índices factoriales muy altos, tanto en la prueba de α de Cronbach como también en la ω de McDonald. ...
El objetivo del estudio fue analizar las orientaciones motivacionales asociadas al autoconcepto físico y los perfiles motivacionales en estudiantes de educación media de una institución educacional de la zona norte de Chile. Cuyo tamaño muestral alcanza a 1075 estudiantes de educación secundaria, de los cuales 585 fueron hombres y 490 mujeres. El enfoque metodológico es cuantitativo, transversal, prospectivo, cuyo nivel de profundización es inferencial y de muestreo aleatorio estratificado. Se utilizó una estrategia asociativa de tipo comparativa transversal con un diseño de grupos naturales. Se aplicó el Cuestionario de Orientación al Ego y a la Tarea (TEOSQ) y el Cuestionario de Perfil Autopercepción Física (PSPP). Se observa que la combinación Baja Tarea-Bajo Ego presenta los máximos valores y Alta Tarea-Bajo Ego agrupa los valores más bajos. El perfil predominante en el sexo masculino es el que representa a sujetos muy competitivos, preferentemente motivados desde una perspectiva externa, y en el sexo femenino el que se caracteriza por una baja orientación motivacional general. En relación con el autoconcepto, los hombres obtienen puntuaciones más altas que las mujeres en todas las dimensiones. Los resultados muestran la existencia de diferencias significativas en las cinco dimensiones del autoconcepto físico en función del tipo de perfil motivacional, siendo predominante la orientación motivacional general que obtiene las puntuaciones más altas en Condición física, Apariencia, Competencia percibida y Fuerza. Respecto a los hallazgos se discuten la relación práctica entre el autoconcepto y el perfil motivacional. Palabras claves: Autoconcepto físico, ego, tarea, perfil motivacional, educación física. Abstract. The objective of the study was to analyze the motivational orientations associated with physical self-concept and motivational profiles in high school students from an educational institution in the northern part of Chile. The sample size reaches 1075 students for secundary education, of which 585 were men and 490 women. The methodological approach is quantitative, transversal, prospective. The level of depth is inferential and stratified random sampling. A cross-sectional comparative associative strategy was used with a natural group design. The Ego and Task Orientation Questionnaire (TEOSQ) and the Physical Self-Perception Profile Questionnaire (PSPP) were applied. It is observed that the combination between "Low Task" and "Low Ego" presents the maximum values, while "High Task" with "Low Ego" groups the lowest values. The predominant profile in the male sex is that which represents very competitive subjects, preferably motivated from an external perspective, and in the female sex the profile of low general motivational orientation predominates. In relation to self-concept, men obtain higher scores than women in all dimensions. The results show the existence of significant differences in the five dimensions of physical self-concept depending on the type of motivational profile, with the general motivational orientation predominating, obtaining the highest scores in physical condition, appearance, perceived competence and strength. Regarding the findings, the practical relationship between self-concept and motivational profile is discussed. Keywords: Physical self-concept, ego, task, motivational profile, physical education.
... Hsmm-Lwc group was lower (i.e., 42,1 years) in comparison with the other groups, however, independent of age, literature has shown that when adults and older adults are physically active, the SMM is minimally declined in older adults active, being more important than the chronological age, the PA promotion across the lifetime for sarcopenia prevention, (27) and thus as a pivotal result it is possible the reduction in diabetes (28) and HTN risk. (29) The fitness and fatness phenotypes have been previously explored using CRF (by VO 2 max) with WC. For example, Eisenman et al. (30) reported that children/adolescents despite reporting a lower adiposity, when these also reported lower CRF levels were at greater cardiovascular risk. ...
Introduction: Diabetes and arterial hypertension are increasing in adults, where calf circumference and waist circumference are two clinical epidemiological markers poorly studied for predicting cardiometabolic risk. Objective: To characterize four phenotypical models in the Chilean adult population based on muscleness and fatness using both calf circumference and waist circumference outcomes. Methodology: An epidemiological observational cross-sectional representative study based on the Chilean National Health Survey 2016-17, where four phenotypes groups were analyzed; Low skeletal muscle mass and high-waist circumference (Lsmm-Hwc, n=140), low skeletal muscle mass and low waist circumference (Lsmm-Lwc, n=242), high skeletal muscle mass and high waist circumference (Hsmm-Hwc, n=1076), and high skeletal muscle mass and low waist circumference (Hsmm-Lwc, n=1358). These groups described information about diabetes, hypertension prevalence, including other risk factors. Results: The reference group Hsmm-Lwc group showed lower fasting plasma glucose (FPG) vs. Hsmm-Hwc (90.4 [95%CI] [89.0; 91.8] vs. 111.7 [109.1; 114.3]), and vs. Lsmm-Hwc (90.4 [89.0; 91.8] vs. 118.3 [107.2; 129.4] mg/dL, both P<0.0001). Lower levels (i.e., appropriate) of FPG (R2 4.8%), glycated hemoglobin (R2 2.6%), systolic BP (R2 19.0%), and diastolic BP (R2 2.5%) were significantly associated (all, P<0.0001) with the Reference group Hsmm-Lwc. Conclusion: A high muscleness and low fatness phenotype is present in those who are younger adults, is associated with better glucose/blood pressure control, and reports low cardiovascular risk factors for diabetes and hypertension in Chilean adults.
... A recent study found that the middle-aged population (35-65 years) faces a higher risk of developing cardiovascular disease due to a predominantly sedentary lifestyle. 48 In general, regular physical activity plays a positive role as a modifiable factor in preventing CVD. A previous study has shown the benefits of physical activity in middle-aged women, with moderate physical activity being associated with a lower risk of coronary heart disease, venous thromboembolic events, and cerebrovascular disease than inactivity. ...
Purpose
Handgrip strength is an indicator of overall muscle strength and has been associated with an increased risk of cardiovascular disease. Evidence suggests that menopause is a risk factor for cardiovascular disease in women, and muscle strength decreases progressively after menopause. Despite the prognostic importance of the decline in muscle strength and increased cardiovascular disease risk among postmenopausal women, evidence of their association is limited. This study aimed to investigate the relationship between handgrip strength and cardiovascular disease risk among postmenopausal, middle-aged Korean women.
Patients and Methods
Using pooled cohort equations, we calculated the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) among postmenopausal women (N = 2019) aged 50–64 years without cardiovascular disease history from the 2014–2019 Korea National Health and Nutrition Examination Survey. Relative grip strength was defined as measured grip strength divided by body mass index. Logistic regression analysis of a complex sampling design was performed to evaluate the association between relative grip strength and a predicted 10-year ASCVD risk ≥7.5%.
Results
The average handgrip strength was 24.8 kg, and 5.2% of women were considered for sarcopenia (<18 kg). The quartile-stratified relative grip strength was negatively associated with 10-year ASCVD risk (p < 0.001). In the multiple logistic regression analysis, the adjusted odds ratio for the highest relative grip strength quartile was 0.53 (95% confidence interval [CI]: 0.36–0.78), and that of the group who breastfed for more than 12 months was 1.75 (95% CI: 1.36–2.25) for 10-year ASCVD risk.
Conclusion
Increased handgrip strength may be associated with lower cardiovascular disease risk among middle-aged postmenopausal women in Korea. Our findings provide critical evidence regarding the importance of increasing handgrip strength among postmenopausal, middle-aged women to reduce cardiovascular disease risk. Handgrip strength measurement might be a valuable screening tool for cardiovascular disease prevention.
... Furthermore, exercise and statin combination therapy markedly improved the LDL-C compared with exercise and placebo (À57.2 vs À1.27 mg/dL). The risk of SAMS in response to short-term exercise is small compared with the many cardiovascular benefits of statin therapy 2,3,38 and PA 39 and calls into question the exaggerated claims about SAMS risks. ...
Objective
To provide a synthesis of randomized controlled trials (RCTs) investigating statin-associated muscle symptoms (SAMS) in adults who underwent exercise training intervention.
Patients and Methods
We systematically searched 5 electronic databases for placebo-controlled RCTs through January 31, 2023. We included short-term and long-term exercise interventions that compared the efficacy and safety of exercise+statin vs exercise+placebo in healthy adults and reported SAMS preintervention and postintervention. Publication bias and methodological study quality assessments were performed.
Results
Five of 454 potentially qualifying RCTs met the inclusion criteria, all short-term exercise RCTs. Participants were predominantly physically inactive young to middle-aged (M=37.2 y) men (57%), 252 (49%) who were on statin therapy, and 271 (53%) on placebo. Of the 3 RCTs providing qualitative SAMS results, 19 (9%) out of 220 participants reported SAMS on exercise+statin and 10 (4%) out of 234 reported SAMS on exercise+placebo. There was no difference between exercise+statin vs exercise+placebo for maximal oxygen consumption (d=−0.18; 95% CI, −0.37 to 0.00; P=.06) or creatine kinase after short-term exercise (d=0.59; 95% CI, −0.06 to 1.25; P=.08). Participants in the exercise+statin group reduced low-density lipoprotein cholesterol vs exercise+placebo (d=−1.84; 95% CI, −2.28 to −1.39; P<.001). Most of the RCTs exhibited low levels of risk of bias (k=4, 80%) and achieved moderate methodological study quality (75.0%±5.2%).
Conclusion
Self-reported SAMs tended to be 5% greater after short-term exercise in statin users compared with placebo, although this difference did not achieve statistical significance. There remains an important need for placebo-controlled RCTs investigating the prevalence of statin-induced SAMS during exercise training.
... 37 Araştırmalara göre aerobik egzersizler kardiyovasküler sistemdeki değişiklikleri olumlu etkilemektedir. Yaşlanmaya bağlı meydana gelen pek çok kardiyovasküler bozulma düzenli yapılan dayanıklılık egzersizleri ve aerobik egzersiz programı ile engellenebilir veya ilerlemesi yavaşlatılabilmektedir. 38,39 Orta yaşlı ve yaşlı bireylerle yapılan bir çalışmada, 6 haftalık süre sonunda aerobik egzersizin NO düzenleyici hormonlarda düzelmeye yardımcı olduğu ve bu gelişmenin de yaşlanmaya bağlı merkezi arteriyel sertliğin iyileştirilmesine katkıda bulunabileceği öne sürülmüştür. 35,36 Düzenli egzersiz kas-iskelet sistemi üzerindeki olumlu etkilerinin yanında hipertansiyon, kardiyovasküler hastalıklar ve diyabet gibi hastalıkların oluşmasını önemli ölçüde engelleyebilmektedir. Yapılan çalışmalara göre düzenli egzersizin kardiyovasküler hastalıklara bağlı ölümlerde %40-45, tüm nedenlere bağlı ölümlerde %50 oranında azalmada etkili olduğu öne sürülmektedir. ...
... This gives a warning signal to take care of your health and promote a healthy lifestyle, such as regular exercise, a healthy diet, and adhering to the instructions of the healthcare professional for controlling any pre-existing complications, if any. Furthermore, it is highly evident that hypertension, dyslipidemia, diabetes mellitus, and other metabolic disorders are the major modifiable risk factors that contributed to the development of heart valve disease and other cardiovascular diseases (CVD) [24,25]. In line with these findings. ...
Despite the effectiveness of warfarin in extended anticoagulation, its narrow therapeutic index requires frequent dose adjustments and careful patient monitoring. Thus, we aimed to evaluate the outcomes of clinical pharmacists’ intervention in warfarin therapy management in terms of International Normalized Ratio (INR) control, reduction of bleeding, and hospitalization in a tertiary care hospital. An observational retrospective cohort study was conducted on 96 patients taking warfarin therapy in a clinical pharmacist-led anticoagulation clinic. We observed that 39.6% of patients required dose adjustments at their first and second visits. However, dose adjustments during the third, fourth, and fifth weeks were required at 31.1%, 20.8%, and 4.2%, respectively, to achieve INR levels. We also observed that 36.46% of the patients attained the target INR at baseline, which was increased over the first week to the fifth week to 57.29%, 61.46%, 61.46%, 68.75%, and 85.42%, respectively. No one reported the ADR between the third and fifth weeks. Based on our findings, the study strongly suggests that pharmacists’ interventions can improve the health-related quality of life of patients undergoing warfarin therapy. Thus, competent pharmacy personnel must be a priority in both usual patient care and critical care among primary care networks.
... This gives a warning signal to take care of your health and promote a healthy lifestyle, such as regular exercise, a healthy diet, and adhering to the instructions of the healthcare professional for controlling any pre-existing complications, if any. Furthermore, it is highly evident that hypertension, dyslipidemia, diabetes mellitus, and other metabolic disorders are the major modifiable risk factors that contributed to the development of heart valve disease and other cardiovascular diseases (CVD) [24,25]. In line with these findings. ...
... The present study aims to fill this research gap by simultaneously considering the relationship of physical activity, screen time, and academic burden on health, and further examining different influences of the above three on health among Chinese adolescents. Physical activity is one important health behavior and is defined as any bodily movement that is coordinated by skeletal muscle, resulting in increased energy expenditure above that of basal metabolism [8,9]. There is a large amount of research focusing on the linkage between physical activity and health. ...
This paper aims to analyze the effects of physical activity, screen time, and academic burden on adolescent health in China and compare their effects by using the nationally representative sample data from the CEPS (China Educational Panel Survey) cross-section data. This paper first uses regression analysis to examine the relationship between physical activity, screen time, academic burden and health among Chinese adolescents. Then, this paper uses the clustering analysis the influence of physical activity, screen time, and academic burden on the health of Chinese adolescents. The empirical results show that: (1) along with exercise, helping with the housework also has a clear health-promoting effect on adolescents; (2) the time spent surfing the Internet or playing video games, and heavy studying or homework off campus have a negative effect on adolescents’ self-rated health and mental health; (3) physical activity has the greatest impact on self-rated health, while screen time has the greatest impact on mental health, and academic burden is not the most important factor affecting adolescent health in China.
The purpose of the research is to study the relationship among physical activity, infrastructure parameters of the area of residence, and modifiable cardiovascular risk factors in the population of the Kemerovo Region. Design and methods . The study started at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo) in 2015 and continues to this day. It includes 1,598 residents aged 35–70 as part of the epidemiological work “Study of the influence of social factors on chronic non-communicable diseases.” The researchers measure the participants’ physical activity using the Russian-language version of the international IPAQ questionnaire and assess the subjective attitude of citizens to the infrastructure parameters using the NEWS questionnaire. The study establishes associations between the participants’ physical activity, mediated by their subjective attitude towards the infrastructure parameters, and modifiable cardiovascular risk factors such as hypertension, obesity, abdominal obesity, and lipid and carbohydrate metabolism disorders. Results . The present study demonstrates a direct impact of the infrastructure parameters from the NEWS scales on the reduction in the participants’ physical activity: B (accessibility of infrastructure facilities) [OR = 1,51]; D (pedestrian accessibility) [OR = 1,52]; E (environment in the vicinity) [OR = 1,55]; H (satisfaction with living conditions) [OR = 1,37]. In the group of individuals with low physical activity, characteristics of the area of residence combined into scales B [OR = 1,44], D [OR = 1,43], and F [OR = 1,30] were associated with hypertension; B [OR = 1,42] and [OR = 1,53], C [OR = 1,39] and [OR = 1,37], D [OR = 1,43] and [OR = 1,32] respectively — with obesity and its abdominal type; B [OR = 1,65] and D [OR = 1,41] — with dyslipidemia. Conclusions . The formed sample of the Kemerovo Region associates an increase in cardiovascular risk factors with the low physical activity of the population and its subjective attitude to the social characteristics (infrastructure parameters) of the area of residence.
Background
It has been shown that diabetes is associated with insufficient physical activity among middle-aged and older adults, but the association between different physical activity levels (PAL) and diabetes incidence needs to be further explored.
Objective
This study aims to explore the correlation and dose–response relationship between different PAL and the diabetes incidence in middle-aged and older adults.
Methods
Utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this cross-sectional analysis included 17,226 middle-aged and older adults aged 45 and above. Binary logistic regression models and restricted cubic spline (RCS) were used to explore the correlation and dose–response relationship between different PAL and the incidence of diabetes in the total middle-aged and older adults population as well as in subgroups. Sensitivity analyses were also performed to verify the robustness of the findings.
Results
In the entire study population, compared with the lowest PAL, participants in the third and fourth quartiles PAL saw diabetes incidence significantly reduced by 16% (p = 0.005) and 33% (p < 0.001), respectively (pfor trend < 0.001). In subgroup analyses, the fourth quartile PAL significantly reduced the diabetes incidence among females, individuals aged 60–69, and rural residents by 25% (p = 0.011), 38% (p < 0.001) and 28% (p < 0.001), respectively. For males, middle-aged (45–59 years), and urban residents, the third quartile PAL reduced diabetes incidence by 22% (p = 0.004), 24% (p = 0.012), 21% (p = 0.013), respectively. When the fourth quartile PAL was reached, the diabetes incidence was significantly reduced in these populations by 41% (p < 0.001), 39% (p < 0.001), and 41% (p < 0.001), respectively. There was a negative dose–response relationship between physical activity and diabetes incidence in specific Chinese middle-aged and older adults population. In addition, sensitivity analyses indicated the robustness of the findings.
Conclusion
Higher PAL was associated with lower diabetes incidence in specific Chinese middle-aged and older adults population. It is feasible to use physical activity to predict diabetes incidence in this demographic, and high PAL may be an effective means of preventing and controlling diabetes.
Dear Editors,
Technological advancements have revolutionized the way we live, work and communicate. However, this progress comes at a cost to our physical well-being. The rise of the digital age has brought about a sedentary society, characterized by increased levels of inactivity and reduced physical activity. This problem is related to one of the correspondence articles at JPH entitled ‘Gender inequity in physical activity and governmental health expenditure: evidence from big data’ ¹ that explains the stark inequity in physical activity can indicate the poor performance of a government in tacking the population health issue.
One of the primary contributors to this sedentary lifestyle is the pervasive use of screens and digital devices. From smartphones and tablets to computers and televisions, our daily lives are intertwined with technology. We spend hours seated, engrossed in virtual worlds and digital content, often at the expense of physical movement. The consequences of this sedentary behavior are far-reaching and impact our physical health. Lack of physical activity is a significant risk factor for chronic conditions such as obesity and diabetes 2–5, cardiovascular disease 6–8 and certain types of cancer 9–11. The more time we spend sitting and the less we engage in physical activities, the higher our chances of developing these health issues.
Atherothrombosis, a multifactorial and multistep artery disorder, represents one of the main causes of morbidity and mortality worldwide. The development and progression of atherothrombosis is closely associated with age, gender and a complex relationship between unhealthy lifestyle habits and several genetic risk factors. The imbalance between oxidative stress and antioxidant defenses is the main biological event leading to the development of a pro-oxidant phenotype, triggering cellular and molecular mechanisms associated with the atherothrombotic process. The pathogenesis of atherosclerosis and its late thrombotic complications involve multiple cellular events such as inflammation, endothelial dysfunction, proliferation of vascular smooth muscle cells (SMCs), extracellular matrix (ECM) alterations, and platelet activation, contributing to chronic pathological remodeling of the vascular wall, atheromatous plague formation, vascular stenosis, and eventually, thrombus growth and propagation. Emerging studies suggest that clotting activation and endothelial cell (EC) dysfunction play key roles in the pathogenesis of atherothrombosis. Furthermore, a growing body of evidence indicates that defective autophagy is closely linked to the overproduction of reactive oxygen species (ROS) which, in turn, are involved in the development and progression of atherosclerotic disease. This topic represents a large field of study aimed at identifying new potential therapeutic targets. In this review, we focus on the major role played by the autophagic pathway induced by oxidative stress in the modulation of EC dysfunction as a background to understand its potential role in the development of atherothrombosis.
Although physical activity is an established protective factor for cardiovascular diseases such as ischemic heart disease and stroke, less is known with regard to the association between specific domains of physical activity and heart failure, as well as the association between cardiorespiratory fitness and heart failure. We conducted a systematic review and meta-analysis of prospective observational studies to clarify the relations of total physical activity, domains of physical activity and cardi-orespiratory fitness to risk of heart failure. PubMed and Embase databases were searched up to January 14th, 2020. Summary relative risks (RRs) were calculated using random effects models. Twenty-nine prospective studies (36 publications) were included in the review. The summary RRs for high versus low levels were 0.77 (95% CI 0.70-0.85, I 2 = 49%, n = 7) for total physical activity, 0.74 (95% CI 0.68-0.81, I 2 = 88.1%, n = 16) for leisure-time activity, 0.66 (95% CI 0.59-0.74, I 2 = 0%, n = 2) for vigorous activity, 0.81 (95% CI 0.69-0.94, I 2 = 86%, n = 3) for walking and bicycling combined, 0.90 (95% CI 0.86-0.95, I 2 = 0%, n = 3) for occupational activity, and 0.31 (95% CI 0.19-0.49, I 2 = 96%, n = 6) for cardiorespiratory fitness. In dose-response analyses, the summary RRs were 0.89 (95% CI 0.83-0.95, I 2 = 67%, n = 4) per 20 MET-hours per day of total activity and 0.71 (95% CI 0.65-0.78, I 2 = 85%, n = 11) per 20 MET-hours per week of leisure-time activity. Nonlinear associations were observed in both analyses with a flattening of the dose-response curve at 15-20 MET-hours/week for leisure-time activity. These findings suggest that high levels of total physical activity, leisure-time activity, vigorous activity , occupational activity, walking and bicycling combined and cardiorespiratory fitness are associated with reduced risk of developing heart failure.
The complex physiological signal transduction networks that respond to the dual challenges of inflammatory and oxidative stress are major factors that promote the development of cardiovascular pathologies. These signaling networks contribute to the development of age-related diseases, suggesting crosstalk between the development of aging and cardiovascular disease. Inhibition and/or attenuation of these signaling networks also delays the onset of disease. Therefore, a concept of targeting the signaling networks that are involved in inflammation and oxidative stress may represent a novel treatment paradigm for many types of heart disease. In this review, we discuss the molecular mechanisms associated with the physiological responses to inflammation and oxidative stress especially in heart failure with preserved ejection fraction and emphasize the nature of the crosstalk of these signaling processes as well as possible therapeutic implications for cardiovascular medicine.
Aerobic exercise is a core component of cardiac rehabilitation (CR). Leading organizations recommend that the exercise prescriptions should be based on a symptom limited baseline graded exercise test (GXT). However, recent evidence suggests that only ~30% of CR clinics perform baseline GXTs. Consequently, exercise prescriptions including exercise progression in CR are not following standard exercise prescription guidelines. Therefore, the purpose of this review is to provide clinicians with evidence-based techniques for prescribing exercise in the absence of a baseline GXT. Intensity indicators (e.g., heart rate, perceived exertion) are reviewed, along with special exercise considerations for various disease states (e.g., heart failure, peripheral artery disease, and coronary artery disease). Baseline exercise testing remains the gold standard approach for prescribing exercise among heart disease patients, however, clinicians must be prepared to safely develop and monitor patients when a baseline GXT is not performed.
Objective:
To investigate the influence of prestroke physical activity (PA) on acute stroke severity.
Methods:
Data from patients with first stroke were retrieved from registries with a cross-sectional design. The variables were PA, age, sex, smoking, diabetes, hypertension and statin treatment, stroke severity, myocardial infarction, new stroke during hospital stay, and duration of inpatient care at stroke unit. PA was assessed with Saltin-Grimby's 4-level Physical Activity Level Scale, and stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Logistic regression was used to predict stroke severity, and negative binomial regression was used to compare the level of PA and stroke severity.
Results:
The study included 925 patients with a mean age of 73.1 years, and 45.2% were women. Patients who reported light or moderate PA levels were more likely to present a mild stroke (NIHSS score 0 to 5) compared with physically inactive patients in a model that also included younger age as a predictor (odds ratio = 2.02 for PA and odds ratio = 0.97 for age). The explanatory value was limited at 6.8%. Prestroke PA was associated with less severe stroke, and both light PA such as walking at least 4 h/wk and moderate PA 2-3 h/wk appear to be beneficial. Physical inactivity was associated with increased stroke severity.
Conclusions:
This study suggests that PA and younger age could result in a less severe stroke. Both light PA such as walking at least 4 h/wk and moderate PA 2-3 h/wk appear to be beneficial.
Cardiovascular disease (CVD) risk factors, incidence and death increases from around the time of menopause comparing to women in reproductive age. A healthy lifestyle can prevent CVD, but it is unclear which lifestyle factors may help maintain and improve cardiovascular health for women after menopausal transition. We conducted a systematic review and meta-analysis of prospective cohort studies to evaluate the association between modifiable lifestyle factors (specifically smoking, physical activity, alcohol intake, and obesity), with CVD and mortality in middle-aged and elderly women. Pubmed, Embase, among other databases and reference lists were searched until February 29th, 2016. Study specific relative risks (RR) were meta-analyzed using random effect models. We included 59 studies involving 5,358,902 women. Comparing current versus never smokers, pooled RR were 3.12 (95% CI 2.15–4.52) for CHD incidence, 2.09 (95% CI 1.51–2.89) for stroke incidence, 2.76 (95% CI 1.62–4.71) for CVD mortality and 2.22 (95% CI 1.92–2.57) for all-cause mortality. Physical activity was associated with a decreased risk of 0.74 (95% CI 0.67–0.80) for overall CVD, 0.71 (95% CI 0.67–0.75) for CHD, 0.77 (95% CI 0.70–0.85) for stroke, 0.70 (95% CI 0.58–0.84) for CVD mortality and 0.71 (95% CI 0.65–0.78) for all-cause mortality. Comparing moderate drinkers versus non-drinkers, the RR was 0.72 (95% CI 0.56–0.91) for CHD, 0.63 (95% CI 0.57–0.71) for CVD mortality and 0.80 (95% CI 0.76–0.84) for all-cause mortality. For women with BMI 30–35 kg/m2 the risk was 1.67 (95% CI 1.24–2.25) for CHD and 2.3 (95% CI 1.56–3.40) for CVD mortality, compared to normal weight. Each 5 kg/m2 increase in BMI was associated with 24% (95% CI 16–33%) higher risk for all-cause mortality. This meta-analysis suggests that physical activity and moderate alcohol intake were associated with a reduced risk for CVD and mortality. Smoking and higher BMI were associated with an increased risk of these endpoints. Adherence to a healthy lifestyle may substantially lower the burden of CVD and reduce the risk of mortality among middle-aged and elderly women. However, this review highlights important gaps, as lack of standardized methods in assessing lifestyle factors and lack of accurate information on menopause status, which should be addressed by future studies in order to understand the role of menopause on the association between lifestyle factors and cardiovascular events.
The role of CRP and fibinogen determination in patints with typ 2 diabetes and coronary artery disease in manner of their pognosis was discussed.
Inflammation is established as a factor for the development of type 2 diabetes. Not much is known about the potentially unique features of inflammatory process in diabetic vascular disease. We describe the role of inflammatory biomarkers, C-reactive protein, fibrinogen and the effects of pro-inflammatory cytokines and Th22 cells in initiation and progression of atherosclerosis in diabetic patients.
Acute exercise induces an increase in Reactive Oxygen Species (ROS) production dependent on exercise intensity with highest ROS amount generated by strenuous exercise. However, chronic repetition of exercise, that is, exercise training, may reduce exercise-induced oxidative stress. Aim of this study was to evaluate the effects of 6-weeks high-intensity discontinuous training (HIDT), characterized by repeated variations of intensity and changes of redox potential, on ROS production and antioxidant capacity in sixteen master swimmers. Time course changes of ROS generation were assessed by Electron Paramagnetic Resonance in capillary blood by a microinvasive approach. An incremental arm-ergometer exercise (IE) until exhaustion was carried out at both before (PRE) and after (POST) training (Trg) period. A significant (P < 0.01) increase of ROS production from REST to the END of IE in PRE Trg (2.82 ± 0.66 versus 3.28 ± 0.66 µmol·min(-1)) was observed. HIDT increased peak oxygen consumption (36.1 ± 4.3 versus 40.6 ± 5.7 mL·kg(-1)·min(-1) PRE and POST Trg, resp.) and the antioxidant capacity (+13%) while it significantly decreased the ROS production both at REST (-20%) and after IE (-25%). The observed link between ROS production, adaptive antioxidant defense mechanisms, and peak oxygen consumption provides new insight into the correlation between ROS response pathways and muscle metabolic function.
Cardiovascular disease (CVD) represents a leading cause of mortality and morbidity especially among the elder people, and therefore the need of effective preventive strategies is imperative. Despite limited data among the elderly people, the majority of published studies have demonstrated that physically active elderly people have lower rates of CVD. In this article, we provide an overview of the epidemiology studies that investigate this association and analyze the relevant underlying biological mechanisms. We also discuss the types and amounts of physical activity recommended for the primary prevention of CVD in older adults.
Traditionally, chronic heart failure (CHF) subjects are often recommended to rest and restrict physical activity; however, this advice may exacerbate the disease. Exercise training is associated with many central and peripheral adaptations that improve clinical outcomes. Exercise training can restore the abnormal autonomic function, attenuate the production of proinflammatory cytokines and the N-terminal precursor of brain natriuretic peptide (NT-pro-BNP), and improve the endothelial dysfunction and the oxidative capacity of peripheral muscle. The current evidence supports the concept that exercise training can effectively improve the exercise capacity and quality of life of subjects with CHF, to some extent, as well as reduce hospitalization and risk of mortality. Structured exercise training is proved to be safe for CHF subjects. Exercise training had no detrimental effects on the left ventricular remodeling. Ultimately, trained subjects showed a significant improvement in left ventricle function. An important limitation of current published studies is that only a few have included significant proportions of elderly subjects with CHF. The limited data available suggests that elderly subjects derive similar benefits from exercise training as younger subjects. In summary, exercise training is an inexpensive and effective intervention for subjects with CHF. This article reviews the current knowledge of the effects of exercise training on the exercise capacity, quality of life, and mortality and morbidity of subjects with CHF and elderly subjects. A major challenge for the future is the inclusion of representative proportions of elderly and frail subjects in heart failure training trials.
Although such data are available for young competitive athletes, the prevalence, characteristics, and outcome of sports-related sudden death have not been assessed previously in the general population.
A prospective and comprehensive national survey was performed throughout France from 2005 to 2010, involving subjects 10 to 75 years of age. Case detection for sports-related sudden death, including resuscitated cardiac arrest, was undertaken via national ambulance service reporting and Web-based screening of media releases. The overall burden of sports-related sudden death was 4.6 cases per million population per year, with 6% of cases occurring in young competitive athletes. Sensitivity analyses used to address suspected underreporting demonstrated an incidence ranging from 5 to 17 new cases per million population per year. More than 90% of cases occurred in the context of recreational sports. The age of subjects was relatively young (mean ± SD 46 ± 15 years), with a predominance of men (95%). Although most cases were witnessed (93%), bystander cardiopulmonary resuscitation was only commenced in 30.7% of cases. Bystander cardiopulmonary resuscitation (odds ratio 3.73, 95% confidence interval 2.19 to 6.39, P<0.0001) and initial use of cardiac defibrillation (odds ratio 3.71, 95% confidence interval 2.07 to 6.64, P<0.0001) were the strongest independent predictors for survival to hospital discharge (15.7%, 95% confidence interval 13.2% to 18.2%).
Sports-related sudden death in the general population is considerably more common than previously suspected. Most cases are witnessed, yet bystander cardiopulmonary resuscitation was only initiated in one third of cases. Given the often predictable setting of sports-related sudden death and that prompt interventions were significantly associated with improved survival, these data have implications for health services planning.
Physical activity has been associated with a reduced risk of coronary heart disease, but the mechanism underlying this association is unclear. Because coronary heart disease is increasingly seen as an inflammatory process, it might be reasonable to hypothesize that physical activity reduces risk of coronary heart disease by reducing or preventing inflammation.
The study examined the relationship between physical activity and elevated inflammation as indicated by a high C-reactive protein level, white blood cell count, or fibrinogen level. Study subjects were 3638 apparently healthy US men and women 40 years and older who participated in the Third National Health and Nutrition Examination Survey.
More frequent physical activity was independently associated with a lower odds of having an elevated C-reactive protein level. Compared with those engaging in physical activity 0 to 3 times per month, the odds of having an elevated C-reactive protein level was reduced among those engaging in physical activity 4 to 21 times per month (odds ratio, 0.77; 95% confidence interval, 0.58-1.02) and 22 or more times per month (odds ratio, 0.63; 95% confidence interval, 0.43-0.93) (P for trend,.02). Similar associations were seen for white blood cell count and fibrinogen levels.
More frequent physical activity is independently associated with a lower odds of having elevated inflammation levels among apparently healthy US adults 40 years and older, independent of several confounding factors. The results suggest that the association between physical activity and reduced coronary heart disease risk may be mediated by anti-inflammatory effects of regular physical activity.
Objective
Few data are available on the associations between the level of pre-stroke physical activity and long-term outcomes in patients with stroke. This study is designed to assess the associations between pre-stroke physical activity and age of first-ever stroke occurrence and long-term outcomes.Methods
Six hundred twenty-four cases with first-ever stroke were recruited from the Mashhad Stroke Incidence Study a prospective population-based cohort in Iran. Data on Physical Activity Level (PAL) were collected retrospectively and were available in 395 cases. According to the PAL values, subjects were classified as inactive (PAL < 1.70) and active (PAL ≥ 1.70). Age at onset of stroke was compared between active and inactive groups. Using logistic model, we assessed association between pre-stroke physical activity and long-term (5-year) mortality, recurrence, disability, and functional dependency rates. We used multiple imputation to analyze missing data.ResultsInactive patients (PAL < 1.70) were more than 6 years younger at their age of first-ever-stroke occurrence (60.7 ± 15.5) than active patients (67.0 ± 13.2; p < 0.001). Patients with PAL< 1.7 also had a greater risk of mortality at 1 year [adjusted odds ratio (aOR) = 2.31; 95%CI: 1.14–4.67, p = 0.02] and 5 years after stroke (aOR = 1.81; 95%CI: 1.05–3.14, p = 0.03) than patients who were more physically active. Recurrence rate, disability, and functional dependency were not statistically different between two groups. Missing data analysis also showed a higher odds of death at one and 5 years for inactive patients.Conclusions
In our cohort, we observed a younger age of stroke and a higher odds of 1- and 5-year mortality among those with less physical activity. This is an important health promotion strategy to encourage people to remain physically active.
Purpose:
Whether physical activity (PA) might have certain benefits for cardiovascular disease (CVD) primordial prevention even in the absence of clinically significant weight loss is of public health interest. In this study, we examined the independent and combined associations of simultaneous changes in PA and body weight with the subsequent development of major CVD risk factors in adults.
Methods:
This prospective analysis included 116,134 healthy men and women, aged ≥18 years, with at least 3 medical examinations from the Taiwan MJ Cohort. Two-year changes in PA and body weight between the first and second examination were linked to subsequent development of hypertension, hypercholesterolemia, atherogenic dyslipidemia, metabolic syndrome, type 2 diabetes mellitus (T2DM), and chronic inflammation, which were assessed by physical examinations and laboratory tests.
Results:
During an average follow-up of 5.7 ± 4.1 years after the second examination, 10,840 individuals developed hypertension, 10,888 hypercholesterolemia, 6078 atherogenic dyslipidemia, 13,223 metabolic syndrome, 4816 T2DM, and 2027 inflammation. Weight gain was associated with a subsequent higher risk of all CVD risk factors, with HR (95%CI) ranging from 1.11 (1.00-1.23) for inflammation to 1.74 (1.67-1.82) for metabolic syndrome, compared with participants who lost weight. A stable weight was also associated with a higher risk of all CVD risk factors except with inflammation. In combined analyses, participants who simultaneously gained weight and decreased PA levels had the highest risk compared with those who lost weight and increased PA. Increasing or maintaining PA reduced the increased subsequent risk of some CVD risk factors among participants who maintained a stable weight or gained weight. Among participants who lost weight, decreased PA was not associated with an increased risk.
Conclusions:
Although weight loss is crucial for the prevention of CVD risk factors, increasing or maintaining PA is also important to prevent them among adults who gain or maintain their weight.
Background:
Cardiorespiratory fitness, measured as peak oxygen consumption, is a potent predictor of stroke risk. Muscle weakness is the most prominent impairment after stroke and is directly associated with reduced walking capacity. There is a lack of recommendations for optimal combined aerobic training and resistance training for those patients. The purpose of this study was to systematically review and quantify the effects of exercise training on cardiorespiratory fitness, muscle strength, and walking capacity after stroke.
Methods:
Five electronic databases were searched (until May 2019) for studies that met the following criteria: (1) adult humans with a history of stroke who ambulate independently; (2) structured exercise intervention based on combined aerobic training and resistance training; and (3) measured cardiorespiratory fitness, muscle strength, and/or walking capacity.
Results:
Eighteen studies (602 participants, average age 62 years) met the inclusion criteria. Exercise training significantly improved all 3 outcomes. In subgroup analyses for cardiorespiratory fitness, longer training duration was significantly associated with larger effect size. Likewise, for muscle strength, moderate weekly frequency and lower training volume were significantly associated with larger effect size. Furthermore, in walking capacity, moderate weekly frequency and longer training duration were significantly associated with larger effect size.
Conclusions:
These results suggest that an exercise program consisting of moderate-intensity, 3 days per week, for 20 weeks should be considered for greater effect on cardiorespiratory fitness, muscle strength, and walking capacity in stroke patients.
Background and Purpose—
Low cardiorespiratory fitness is associated with increased risk of cardiovascular disease. The present study aims to assess whether change of fitness over time has any impact on long-term risk of stroke and death.
Methods—
We recruited healthy men aged 40 to 59 years in 1972 to 1975, and followed them until 2007. Physical fitness was assessed with a bicycle ECG test at baseline and again at 7 years, by dividing the total exercise work by body weight. Participants were categorized as remained fit, became unfit, remained unfit, or became fit, depending on whether fitness remained or crossed the median values from baseline to the 7-year visit. Outcome data were collected up to 35 years, from study visits, hospital records, and the National Cause of Death Registry. Risks of stroke and death were estimated by Cox regression analyses and expressed as hazard ratios (HRs) with 95% CIs.
Results—
Of 2014 participants, 1403 were assessed both at baseline and again at 7 years, and were followed for a mean of 23.6 years. Compared with the became unfit group, risk of stroke was 0.85 (0.54–1.36) for the remained unfit, 0.43 (0.28–0.67) for the remained fit, and 0.34 (0.17–0.67) for the became fit group. For all-cause death, risks were 0.99 (0.76–1.29), 0.57 (0.45–0.74), and 0.65 (0.46–0.90), respectively. Among those with high fitness at baseline, the became unfit group had a significantly higher risk of stroke (HR, 2.35; CI, 1.49–3.63) and death (HR, 1.74; CI, 1.35–2.23) than those who remained fit. Among those who had low fitness at baseline, the became fit group had a significantly lower risk of stroke (HR, 0.40; CI, 0.21–0.72) and death (HR, 0.66; CI, 0.50–0.85) than participants in the remained unfit group.
Conclusions—
Cardiorespiratory fitness at baseline and change in fitness was associated with large changes in long-term risk of stroke and death. These findings support the encouragement of regular exercise as a stroke prevention strategy.
Background/objectives
Walking pace is associated with risk of premature mortality. However, whether this relationship is independent of total volume of physical activity and highest physical activity intensity remains unclear. We examined the associations between walking pace and cause-specific mortality, investigating the potential modifying effect of factors such as total physical activity volume, highest physical activity intensity, age, sex and body mass index (BMI).
Methods
Prospective pooled analysis of 11 population-based baseline surveys in England and Scotland between 1994 and2008 that were linked with mortality records. Multivariate-adjusted Cox proportional hazards models examined associations between walking pace (slow, average, brisk/fast) and all-cause, cancer and cardiovascular disease (CVD) mortality.
Results
50 225 walkers were entered in the core analyses. Among participants who did not experience an event in the first 2 years of follow-up (n=49 731), walking at an average or brisk/fast pace was associated with a reduced risk of all-cause (20% (95% CI 12% to 28%) and 24% (95% CI 13% to 33%), respectively) and CVD mortality (24% (95% CI 9% to 36%) and 21% (95% CI 1% to 38%), respectively), compared with reporting walking at a slow pace. In stratified analyses, such associations were evident among those over 50 years, those not meeting the physical activity recommendations and those who did not undertake vigorous-intensity activity. There were no interactions by sex or BMI. No associations were seen between pace and cancer mortality.
Conclusion
Walking benefits health. Assuming causality, these analyses suggest that increasing walking pace could reduce risk for all-cause and CVD mortality. Walking pace could be emphasised in public health messages, especially in situations when increase in walking volume or frequency is less feasible.
Physical inactivity and sedentary lifestyles are believed to be independent risk factors for the occurrence of numerous diseases, including, obesity, Type 2 diabetes, metabolic syndrome, cardiovascular disease, cancer and mental health, all leading to substantial morbidity and/or premature death. It has been found that regular exercise, is associated with better quality of life and health outcomes, and reduces the risk of cardiovascular disease and cancer. Here, we review the effects regular exercise has on mental health and well-being, on the immune system and in cancer, cardiovascular disease, autoimmunity and metabolic syndrome. Is exercise the new immunotherapy to treat diseases?
Inflammatory processes are putative mechanisms underlying the cardioprotective effects of physical activity. An inverse association between physical activity and inflammation has been demonstrated, but no long-term prospective data are available. We therefore examined the association between physical activity and inflammatory markers over a 10-year follow-up period.
Participants were 4289 men and women (mean age, 49.2 years) from the Whitehall II cohort study. Self-reported physical activity and inflammatory markers (serum high-sensitivity C-reactive protein and interleukin-6) were measured at baseline (1991) and follow-up (2002). Forty-nine percent of the participants adhered to standard physical activity recommendations for cardiovascular health (2.5 h/wk moderate to vigorous physical activity) across all assessments. Physically active participants at baseline had lower C-reactive protein and interleukin-6 levels, and this difference remained stable over time. Compared with participants who rarely adhered to physical activity guidelines over the 10-year follow-up, the high-adherence group displayed lower log(e) C-reactive protein (β=-0.07; 95% confidence interval, -0.12 to -0.02) and log(e) interleukin-6 (β=-0.07; 95% confidence interval, -0.10 to -0.03) at follow-up after adjustment for a range of covariates. Compared with participants who remained stable, those who reported an increase in physical activity of at least 2.5 h/wk displayed lower log(e) C-reactive protein (β coefficient=-0.05; 95% confidence interval, -0.10 to -0.001) and log(e) interleukin-6 (β coefficient=-0.06; 95% confidence interval, -0.09 to -0.03) at follow-up.
Regular physical activity is associated with lower markers of inflammation over 10 years of follow-up and thus may be important in preventing the proinflammatory state seen with aging.
The purpose of this study was to determine the association between fitness and lifetime risk for cardiovascular disease (CVD).
Higher levels of traditional risk factors are associated with marked differences in lifetime risks for CVD. However, data are sparse regarding the association between fitness and the lifetime risk for CVD.
We followed up 11,049 men who underwent clinical examination at the Cooper Institute in Dallas, Texas, before 1990 until the occurrence of CVD death, non-CVD death, or attainment of age 90 years (281,469 person-years of follow-up, median follow-up 25.3 years, 1,106 CVD deaths). Fitness was measured by the Balke protocol and categorized according to treadmill time into low, moderate, and high fitness, with further stratification by CVD risk factor burden. Lifetime risk for CVD death determined by the National Death Index was estimated for fitness levels measured at ages 45, 55, and 65 years, with non-CVD death as the competing event.
Differences in fitness levels (low fitness vs. high fitness) were associated with marked differences in the lifetime risks for CVD death at each index age: age 45 years, 13.7% versus 3.4%; age 55 years, 34.2% versus 15.3%; and age 65 years, 35.6% versus 17.1%. These associations were strongest among persons with CVD risk factors.
A single measurement of low fitness in mid-life was associated with higher lifetime risk for CVD death, particularly among persons with a high burden of CVD risk factors.
Higher levels of physical activity are associated with fewer cardiovascular disease (CVD) events. Although the precise mechanisms underlying this inverse association are unclear, differences in several cardiovascular risk factors may mediate this effect.
In a prospective study of 27,055 apparently healthy women, we measured baseline levels of hemoglobin A1c, traditional lipids (total, low-density lipoprotein, and high-density lipoprotein cholesterol), novel lipids [lipoprotein(a) and apolipoprotein A1 and B-100], creatinine, homocysteine, and inflammatory/hemostatic biomarkers (high-sensitivity C-reactive protein, fibrinogen, soluble intracellular adhesion molecule-1) and used women's self-reported physical activity, weight, height, hypertension, and diabetes. Mean follow-up was 10.9+/-1.6 years, and 979 incident CVD events occurred. The risk of CVD decreased linearly with higher levels of activity (P for linear trend < 0.001). Using the reference group of < 200 kcal/wk of activity yielded age- and treatment-adjusted relative risk reductions associated with 200 to 599, 600 to 1499, and > or = 1500 kcal/wk of 27%, 32%, and 41%, respectively. Differences in known risk factors explained a large proportion (59.0%) of the observed inverse association. When sets of risk factors were examined, inflammatory/hemostatic biomarkers made the largest contribution to lower risk (32.6%), followed by blood pressure (27.1%). Novel lipids contributed less to CVD risk reduction compared with traditional lipids (15.5% and 19.1%, respectively). Smaller contributions were attributed to body mass index (10.1%) and hemoglobin A1c/diabetes (8.9%), whereas homocysteine and creatinine had negligible effects (< 1%).
The inverse association between physical activity and CVD risk is mediated in substantial part by known risk factors, particularly inflammatory/hemostatic factors and blood pressure.
C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women
- Ridker
The effect of continuous and interval aerobic trainings on body mass index and serum levels of ICAM-1 and VCAM-1 in men with heart failure
- Hosseni Abrishami
Exercise training improves functions of endothelial progenitor cells in patients with metabolic syndrome
- Tan