Prescribe exercise for ‘dramatic impact’ on mortality, heart disease risk

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Prescribe exercise for ‘dramatic impact’ on mortality, heart disease risk

Key takeaways:

• The benefits of exercise occur at levels well below federal recommendations.
• Physical activity impacts mortality risk across ages, races and genders.

ARLINGTON, Texas — Physical fitness is a vital sign for overall health, and prescribing even small amounts of exercise to increase cardiorespiratory fitness can reduce mortality and CVD risk, according to a speaker.

The 2018 federal physical activity guidelines suggest 150 to 300 minutes per week of moderate physical activity or 75 minutes per week of vigorous physical activity, Carl “Chip” Lavie Jr., MD, FACC, FACP, FCCP, professor of medicine, medical director of cardiac rehabilitation and preventive cardiology, director of the Exercise Testing Laboratory and staff cardiologist in the Echocardiographic Laboratory at the John Ochsner Heart and Vascular Institute, Ochsner Clinical School–The University of Queensland School of Medicine, said during a presentation at the American Society for Preventive Cardiology Congress on CVD Prevention.

The benefits of exercise occur at levels well below federal recommendations.
Image: Adobe Stock

However, evidence suggests that exercise benefits occur even at levels far below those federal recommendations. Maximal health benefits occur at about 40 to 60 minutes per week of physical activity for “almost everyone;” with activities like running, maximal benefits occur at very low levels, Lavie said.

Carl “Chip” Lavie Jr.

“Regardless of whether you have a low or higher level of fitness, [data show] changes in your fitness over time had a dramatic impact on all-cause mortality,” Lavie said. “If you are fit, increasing your fitness more can have benefits long term.”

Heart benefits with increased fitness

Exercise and improved cardiorespiratory fitness provide many physiological benefits, Lavie said, including improved heart rate variability, reduced BP and systemic inflammation, improved insulin sensitivity and endothelial function and decreased myocardial oxygen demand. Exercise is also associated with reduced risk for development of hypertension, metabolic syndrome, type 2 diabetes, dementia and Alzheimer’s disease. There are also mental health benefits that have a downstream effect on CV and overall health, Lavie said.

“Physical activity and fitness have a tremendous impact on psychosocial stress,” Lavie said. “We have shown that improving this in the cardiac rehab setting is associated with reductions in mortality.”

In a retrospective analysis published in May 2022 in European Heart Journal – Quality of Care & Clinical Outcomes, Lavie and colleagues found that, among 853 patients with CHD referred to cardiac rehab who completed a maximal cardiopulmonary exercise test, peak VO₂ at the end of cardiac rehab was an independent predictor of long-term survival.

“The most important thing that predicted survival in our coronary patients was getting a higher end of cardiac rehab peak VO₂,” Lavie said. “Exercise capacity at the end of rehab was the strongest predictor of subsequent survival.”

Exercise ‘dose,’ frequency matter

Small, incremental changes can lead to health benefits for patients, Lavie said. For the biggest “bang for the buck,” clinicians should work to move patients out of a “low fitness” category — when they are at highest risk for CV events — into a mid-level fitness regimen by encouraging about 150 minutes per week of moderate levels of regular exercise, Lavie said.

“An exercise prescription involves information on intensity, frequency, duration and mode of exercise,” Lavie said. “The main mode recommended is aerobic exercise: walking or jogging on the treadmill or outside, bicycle, aerobic dance and swimming. Certainly, resistance exercises is needed as well, at least once or twice per week.”

To improve fitness, patients should aim to achieve about 65% to 85% of their maximum heart rate for a duration of about 15 to 20 minutes at a frequency of four to five times per week, Lavie said. Clinicians should caution patients to monitor the intensity level of any exercise regimen.

“Patients should be able to talk while they are exercising,” Lavie said. “If they can chat the entire time, they are probably not exercising hard enough. If they can’t talk at all, they are probably exercising too hard.”

Lavie said the promotion of physical activity and exercise training is needed throughout the health care system, particularly during the COVID-19 era.

“Every clinician that sees a patient should be telling them something about physical activity and documenting that in the medical record,” Lavie said.

References:

• Carbone S, et al. Eur Heart J Qual Care Clin Outcomes. 2022;doi:10.1093/ehjqcco/qcab032.
• Wen CP, et al. Lancet. 2011;doi:10.1016/S0140-6736(11)60749-6.