Physical Activity for the Prevention of Cardiovascular Diseases

Open access

Abstract

Over the last decade, the quantity and quality of scientific literature examining the relationship between physical activity (PA) and cardiovascular diseases (CVD) have significantly increased. Data from the literature now unequivocally show that physical inactivity is one of the major risk factors for CVD. It is believed that obesity, the prevalence of which has tripled over the last three decades, and physical inactivity among children are the main factors that will increase the prevalence of CVD in this century. The cardiovascular benefits of exercise are multifactorial and include important systemic effects on skeletal muscle, the peripheral vasculature, metabolism, and neurohumoral systems, as well as beneficial alterations within the myocardium itself. Thus, exercise does much more than change traditional risk factors, such as blood pressure, blood lipids, glucose tolerance and insulin resistance, metabolic syndrome, and overweight and obesity. Evidence from epidemiologic studies suggests that the preventive effects of PA may be achieved by 150 minutes of moderate PA a week, while increases in the intensity and volume of exercise lead to further health benefits. This dose–response gradient is curvilinear, with the largest gains from the first hour of weekly exercise. However, although much progress has been made in this field, existing studies performed on human subjects do not clearly show what type, intensity, and duration of exercise is most beneficial to cardiovascular fitness and metabolic optimization. Animal-based exercise studies may provide more information and help to elucidate the abilities of different training regimens to reduce the risk of CVD.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Hardman AE Stensel DJ. Physical activity and health: the evidence explained. 2nd ed. London: Routledge Taylor and Francis Group 2009.

  • 2. Erikssen G. Physical fitness and changes in mortality: the survival of the fittest. Sports Med 2001; 31: 571–6.

  • 3. Nunan D Mahtani KR Roberts N Heneghan C. Physical activity for the prevention and treatment of major chronic disease: an overview of systematic reviews. Syst Rev 2013; 2: 56.

  • 4. Lee I-M Shiroma EJ Lobelo F Puska P Blair SN Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012; 380: 219–29.

  • 5. Sattelmair J Pertman J Ding EL Kohl HW 3rd Haskell W Lee IM. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation 2011; 124(7): 789-95.

  • 6. Smith SC Jr. Reducing the global burden of ischemic heart disease and stroke: A challenge for the cardiovascular community and the United Nations. Circulation 2011; 124: 278-9.

  • 7. Levi F Chatenoud L Bertuccio P Lucchini F Negri E La Vecchia C. Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update. Eur J Cardiovasc Prev Rehabil 2009; 16: 333–50.

  • 8. European Heart Network. European Cardiovascular Disease Statistics. 2008 edition.

  • 9. Ignarro LJ Balestrieri ML Napoli C. Nutrition physical activity and cardiovascular disease: An update. Cardiovasc Res 2007; 73: 326–40.

  • 10. Morris JN Heady JA Raffle PA et al. Coronary heart-disease and physical activity of work. Lancet 1953; 265: 1111-20.

  • 11. Morris JN Heady JA. Mortality in relation to the physical activity of work: a preliminary note on experience in middle age. Br J Ind Med 1953; 10: 245-54.

  • 12. Blair SN Kohl HW Paffenbarger RS Clark DG Cooper KH Gibbons LW. Physical fitness and all-cause mortality: a prospective study of healthy men and women. J Am Med Assoc 1989; 262: 2395–401.

  • 13. Blair SN Kampert JB Kohl HW. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. J Am Med Assoc 1996; 276: 205–10.

  • 14. Paffenbarger RS Hyde RT Wing AL and Hsieh CC. Physical activity all-cause mortality and longevity of college alumni. N Engl J Med 1986; 314: 605–13.

  • 15. Paffenbarger RS Hyde RT Wing AL Lee IM Jung DL and Kampert JB. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993; 328: 538–45.

  • 16. Oguma Y Sesso HD Paffenbarger RS Jr et al. Physical activity and all cause mortality in women: a review of the evidence. Br J Sports Med 2002; 36: 162-72.

  • 17. Tanasescu M Leitzmann MF Rimm EB Willett WC Stampfer MJ Hu FB. Exercise type and intensity in relation to coronary heart disease in men. J Am Med Assoc 2002; 288: 1994–2000.

  • 18. Myers J Prakash M Froelicher V Do D Partington S Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002; 346: 793–801.

  • 19. Lee IM Hsieh CC Paffenbarger RS Jr. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA 1995; 273: 1179-84.

  • 20. Morris JN Clayton DG Everitt MG Semmence AM Burgess EH. Exercise in leisure time: coronary attack and death rates. Br Heart J 1990; 63: 325–34.

  • 21. Physical Activity Guidelines Advisory Committee. Physical activity guidelines advisory committee report 2008. Washington DC: US Department of Health and Human Services 2008.

  • 22. Wendel-Vos GCW Schuit AJ Feskens EJM et al. Physical activity and stroke. A meta-analysis of observational data. Int J Epidemiol 2004; 33: 787-98.

  • 23. Chiuve SC Rexrode KM Spiegelman D Logroscino G Manson JE Rimm EB. Primary prevention of stroke by healthy lifestyle. Circulation 2008; 118: 947-54.

  • 24. Lee CD Folsom AR Blair SN. Physical activity and stroke risk. A meta-analysis. Stroke 2003; 34: 2475-82.

  • 25. Nocon M Hiemann T Muller-Riemenschneider F Thalau F Roll S Willich SN. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and metaanalysis. Eur J Cardiovasc Prev Rehabilit 2008; 15: 239-46.

  • 26. European Heart Network. Diet Physical activity and cardiovascular disease prevention in Europe. Brussels 2011.

  • 27. Oguma S Shinoda-Tagawa T. Physical activity decreases cardiovascular disease risk in women: review and meta-analysis. Am J Prev Med 2004; 26: 407-18.

  • 28. Moore SC Patel AV Matthews CE et al. Leisure time physical activity of moderate to vigorous intensity and mortality: a large pooled cohort analysis. PLoS Med 2012; 9: e1001335.

  • 29. Mann N Rosenzweig A. Can exercise teach us how to treat heart disease? Circulation 2012; 126: 2625–35.

  • 30. Gielen S Schuler G Adams V. Cardiovascular effects of exercise training: molecular mechanisms. Circulation 2010; 122(12): 1221-38.

  • 31. Joyner MJ Green DJ. Exercise protects the cardiovascular system: effects beyond traditional risk factors. J Physiol 2009; 587(Pt 23): 5551-8.

  • 32. Mora S Cook N Buring JE Ridker PM Lee IM. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation 2007; 116: 2110–8.

  • 33. Katzmarzyk PT Janssen I. The economic costs associated with physical inactivity and obesity in Canada: An update. Can J App Physiol 2004; 29: 90-115.

  • 34. Zoeller RF. Physical activity and fitness in the prevention of coronary heart disease and associated risk factors. Am J Lifestyle Med 2007; 1(1): 29-33.

  • 35. Fagard RH Cornelissen VA. Effect of exercise on blood pressure control in hypertensive patients. Eur J Cardiovasc Prev Rehabil 2007; 14: 12-7.

  • 36. Braith RW Stewart KJ. Resistance exercise training. Its role in the prevention of cardiovascular disease. Circulation 2006; 113: 2642-50.

  • 37. Cornelissen VA Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc 2013; 2(1): e004473.

  • 38. Cornelissen VA Fagard RH. Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials. J Hypertens 2005; 23: 251–9.

  • 39. Pescatello LS Franklin BA Fagard R Farquhar WB Kelley GA Ray CA. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc 2004; 36(3): 533-53.

  • 40. Pronk NP. Short term effects of exercise on plasma lipids and lipoproteins in humans. Sports Med 1993; 16: 431-48.

  • 41. Tambalis K Panagiotakos DB Kavouras SA Sidosis LS. Responses of blood lipids to aerobic resistance and combined aerobic with resistance exercise training: a systematic review of current evidence. Angiology 2009; 60: 614-32.

  • 42. Jeon CY Lokken RP Hu FB van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Diabetes Care 2007; 30: 744-52.

  • 43. Hu FB Sigal RJ Rich-Edwards JW et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. JAMA 1999; 282: 1433-9.

  • 44. Weinstein AR Sesso HD Lee IM et al. Relationship of physical activity vs body mass index with type 2 diabetes in women. JAMA 2004; 292: 1188-94.

  • 45. Sui X Hooker SP Lee IM et al. A prospective study of cardiorespiratory fitness and risk of type 2 diabetes in women. Diabetes Care 2008; 31: 550-5.

  • 46. Honkola A1 Forsén T Eriksson J. Resistance training improves the metabolic profile in individuals with type 2 diabetes. Acta Diabetol 1997; 34(4): 245-8.

  • 47. Sigal RJ Kenny GP Wasserman DH Castaneda-Sceppa C. Physical activity/exercise and type 2 diabetes. Diabetes Care 2004; 27: 2518–39.

  • 48. Kodama S Tanaka S Heianza Y et al. Association between physical activity and risk of all-cause mortality and cardiovascular disease in patients with diabetes: a meta-analysis. Diabetes Care 2013; 36: 471-9.

  • 49. Sluik D Buijsse B Muckelbauer R et al. Physical activity and mortality in individuals with diabetes mellitus: a prospective study and meta-analysis. Arch Intern Med 2012; 172: 1285-95.

  • 50. Boule NG Kenny GP Haddad E Wells GA Sigal RJ. Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus. Diabetologia 2003; 46(8): 1071-81.

  • 51. Manley S. Haemoglobin A1c: a marker for complications of type 2 diabetes: the experience from the UK Prospective Diabetes Study (UKPDS). Clin Chem Lab Med 2003; 41: 1182–90.

  • 52. Khaw KT Wareham N Luben R Bingham S Oakes S Welch A et al. Glycated haemoglobin diabetes and mortality in men in Norfolk cohort of European prospective investigation of cancer and nutrition (EPIC-Norfolk). BMJ 2001; 322: 1–6.

  • 53. Schmitz KH Jacobs DR Jr Leon AS Schreiner PJ Sternfeld B. Physical activity and body weight: associations over ten years in the CARDIA study. Coronary artery risk development in young adults. Int J Obes Relat Metab Disord 2000; 24: 1475-87.

  • 54. Di Pietro L1 Dziura J Blair SN. Estimated change in physical activity level (PAL) and prediction of 5-year weight change in men: the Aerobics Center Longitudinal Study. Int J Obes Relat Metab Disord 2004; 28(12): 1541-7.

  • 55. Haapanen N Miilunpalo S Pasanen M Oja P Vuori I. Association between leisure time physical activity and 10-year body mass change among working-aged men and women. Int J Obes Relat Metab Disord 1997; 21: 288-96.

  • 56. Donnelly JE Blair SN Jakicic JM Manore MM Rankin JW Smith BK. American College of Sports Medicine position stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 2009; 41(2): 459-71.

  • 57. Fogelholm M. Physical activity fitness and fatness: relations to mortality morbidity and disease risk factors. A systematic review. Obes Rev 2010; 11(3): 202-21.

  • 58. Williamson DF Madans J Anda RF Kleinman JC Kahn HS Byers T. Recreational physical activity and ten-year weight change in a US national cohort. Int J Obes Relat Metab Disord 1993; 17: 279-86.

  • 59. Lee IM Djousse L Sesso HD Wang L Buring JE. Physical activity and weight gain prevention. JAMA 2010; 303: 1173-9.

  • 60. Mekary RA Feskanich D Malspeis S Hu FB Willett WC Field AE. Physical activity patterns and prevention of weight gain in premenopausal women. Int J Obes (Lond) 2009; 33: 1039-47.

  • 61. Vaughan L Zurlo F Ravussin E. Aging and energy expenditure. Am J Clin Nutr 1991; 53: 821–5.

  • 62. Williams MJ Hunter GR Kekes-Szabo T Snyder S Treuth MS. Regional fat distribution in women and risk of cardiovascular disease. Am J Clin Nutr 1997; 65: 855–60.

  • 63. Hunter GR Kekes-Szabo T Snyder SW Nicholson C Nyikos I Berland L. Fat distribution physical activity and cardiovascular risk factors. Med Sci Sports Exerc 1997; 29: 362–9.

  • 64. Ouchi N Parker JL Lugus JJ Walsk K. Adipokines in inflammation and metabolic disease. Nature Rev Immunol 2011; 11: 85–97.

  • 65. Wilund KR. Is the anti-inflammatory effect of regular exercise responsible for reduced cardiovascular disease? Clin Sci 2007; 112: 543-55.

  • 66. Mathur N Pedersen BK. Exercise as a mean to control low-grade systemic inflammation. Mediators Inflamm 2008; 2008: 109502.

  • 67. Petersen AM Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol 2005; 98: 1154–62.

  • 68. Park YM Myers M Vieira-Potter VJ. Adipose tissue inflammation and metabolic dysfunction: role of exercise. Mo Med 2014; 111(1): 65-72.

  • 69. Bruunsgaard H. Physical activity and modulation of systemic low-level inflammation. J Leukocyte Biol 2005; 78: 819–35.

  • 70. Gleeson M Bishop NC Stensel DJ Lindley MR Mastana SS Nimmo MA. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol 2011; 11(9): 607-15.

  • 71. Plaisance EP Grandjean PW. Physical activity and highsensitivity C-reactive protein. Sports Med 2006; 36(5): 443–58.

  • 72. Fallon KE Fallon SK Boston T. The acute phase response and exercise: court and field sports. Br J Sports Med 2001; 35(3): 170-3.

  • 73. Kasapis C Thompson PD. The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review. J Am Coll Cardiol 2005; 45: 1563–9.

  • 74. Kohut ML McCann DA Russell DW et al. Aerobic exercise but not flexibility/resistance exercise reduces serum IL-18 CRP and IL-6 independent of β-blockers BMI and psychosocial factors in older adults. Brain Behav Immunol 2006; 20: 201–9.

  • 75. Glass CK Witztum JL. Atherosclerosis. The road ahead. Cell 2001; 104: 503–16.

  • 76. Meilhac O Ramachandran S Chiang K Santanam N Parthasarathy S. Role of arterial wall antioxidant defense in beneficial effects of exercise on atherosclerosis in mice. Arterioscler Thromb Vasc Biol 2001; 21: 1681–8.

  • 77. Vollaard NB Shearman JP Cooper CE. Exercise-induced oxidative stress: myths realities and physiological relevance. Sports Med 2005; 35: 1045–62.

  • 78. Galassetti PR Nemet D Pescatello A Rose-Gottron C Larson J Cooper DM. Exercise caloric restriction and systemic oxidative stress. J Invest Med 2006; 54: 67–75.

  • 79. Richter B Niessner A Penka M et al. Endurance training reduces circulating asymmetric dimethylarginine and myeloperoxidase levels in persons at risk of coronary events. Thromb Haemostasis 2005; 94: 1306–11.

  • 80. Brennan ML Penn MS Van Lente F et al. Prognostic value of myeloperoxidase in patients with chest pain. N Engl J Med 2003; 349: 1595–1604.

  • 81. Patrono C FitzGerald GA. Isoprostanes: potential markers of oxidant stress in atherothrombotic disease. Arterioscler Thromb Vasc Biol 1997; 17: 2309–15.

  • 82. Golbidi S Laher I. Exercise and the aging endothelium. J Diabetes Res 2013; 2013: 789607.

  • 83. Tanaka H DeSouza CA Seals DR. Absence of age-related increase in central arterial stiffness in physically active women. Arterioscler Thromb Vasc Biol 1998; 18: 127–32.

  • 84. Edwards DG Schofield RS Magyari PM Nichols WW Braith RW. Effect of exercise training on central aortic pressure wave reflection in coronary artery disease. Am J Hypertens 2004; 17: 540–3.

  • 85. Taddei S Galetta F Virdis A et al. Physical activity prevents age-related impairment in nitric oxide availability in elderly athletes. Circulation 2000; 101(25): 2896–901.

  • 86. Green DJ O’Driscoll G Joyner MJ Cable NT. Exercisea nd cardiovascular risk reduction: Time to update rationale for exercise. J Appl Physiol 2008; 105: 766-8.

  • 87. Bertovic DA Waddell TK Gatzka CD Cameron JD Dart AM Kingwell BA. Muscular strength training is associated with low arterial compliance and high pulse pressure. Hypertension 1999; 33: 1385–91.

  • 88. Hayashi K Sugawara J Komine H Maeda S Yokoi T. Effects of aerobic exercise training on stiffness of central and peripheral arteries in middle-aged sedentary men. Jpn J Physiol 2005; 55: 235–9.

  • 89. Rakobowchuk M McGowan CL de Groot PC Bruinsma D Hartman JW Phillips SM et al. Effect of whole body resistance training on arterial compliance in young men. Exp Physiol 2005; 90: 645–51.

  • 90. Prasad DS Das BC. Physical inactivity: a cardiovascular risk factor Indian J Med Sci 2009; 63(1): 33-42.

  • 91. Thompson WR Gordon NF Pescatello LS et al. ACSM’s guidelines for exercise testing and prescription. 8th ed. Philadelphia PA: Lippincott Williams & Wilkins 2009.

  • 92. World Health Organisation: Global recommendations on physical activity for health. Geneva; 2010:60.

  • 93. Wisløff U Ellingsen Ø Kemi OJ. High-intensity interval training to maximize cardiac benefits of exercise training. Exerc Sport Sci Rev 2009; 37(3): 139-46.

  • 94. Wisloff U Nilsen TI Droyvold WB Morkved S Slordahl SA Vatten LJ. A single weekly bout of exercise may reduce cardiovascular mortality: how little pain for cardiac gain? The HUNT study Norway. Eur J Cardiovasc Prev Rehabil 2006;13: 798Y804.

  • 95. Lee IM Sesso HD Paffenbarger RS Jr. Physical activity and coronary heart disease risk in men: does the duration of exercise episodes predict risk? Circulation 2000; 102: 981-6.

  • 96. Bassuk SS Manson JE. Physical activity and health in women a review of the epidemiologic evidence. Am J Lifestyle Med 2014 8(3): 144-58.

  • 97. Hamer M Chida Y. Active commuting and cardiovascular risk: a meta-analytic review. Prev Med 2008; 46: 9-13.

  • 98. Boone-Heinonen J Evenson KR Taber DR Gordon-Larsen P. Walking for prevention of cardiovascular disease in men and women: a systematic review of observational studies. Obesity Reviews 2008; 10: 204-17.

  • 99. Zheng H Orsini N Amin J Wolk A Nguyen VTT Ehrlich F. Quantifying the dose-response of walking in reducing coronary heart disease risk: meta-analysis. Eur J Epidemiol 2009; 24: 181-92.

  • 100. Hoevenaar-Blom MP Wendel-Vos GCV Spijkerman AMW Kromhout D Verschuren WMM. Cycling and sports but not walking are associated with 10-year cardiovascular disease incidence: the MORGEN study. Eur J Cardiovasc Prev Rehabil 2011; 18: 41-7.

  • 101. Matthews CE Jurj AL Shu XO et al. Influence of exercise walking cycling and overall nonexercise physical activity on mortality in Chinese women. Am J Epidemiol 2007; 165: 1343-50.

  • 102. Meyer P Kayser B Mach F. Stair use for cardiovascular disease prevention. Eur J Cardiovasc Prev Rehabil 2009; 16: S17-8.

  • 103. Kodama S Kazumi S Tanaka S et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 2009; 301: 2024-35.

  • 104. Williams MA Haskell WL Ades PA et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition Physical Activity and Metabolism. Circulation 2007; 116: 572-84.

  • 105. Tanasescu M Leitzmann MF Rimm EB Willett WC Stampfer MJ Hu FB. Exercise type and intensity in relation to coronary heart disease in men. JAMA 2002; 288: 1994-2000.

  • 106. Haskell WL Lee IM Pate RR et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39: 1423–34.

  • 107. Pollock ML Franklin BA Balady GJ et al. AHA Science Advisory: resistance exercise in individuals with and without cardiovascular disease: benefits rationale safety and prescription: an advisory from the Committee on Exercise Rehabilitation and Prevention Council on Clinical Cardiology American Heart Association; Position paper endorsed by the American College of Sports Medicine. Circulation 2000; 101: 828–33.

  • 108. Franklin BA. American College of Sports Medicine guidelines for exercise testing and prescription. 7th ed. Baltimore Md: Lippincott Williams & Wilkins; 2006.

  • 109. Chobanian AV Bakris GL Black HR et al. Seventh report of the Joint National Committee on Prevention Detection Evaluation and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206-52.

  • 110. Rogers MW Probst MM Gruber JJ Berger R Boone JB Jr. Differential effects of exercise training intensity on blood pressure and cardiovascular responses to stress in borderline hypertensive humans. J Hypertens 1996; 14: 1369-75.

  • 111. Kukkonen K Rauramaa R Voutilainen E Lansimies E. Physical training of middle aged men with borderline hypertension. Ann Clin Res 1982; 14(suppl 34): 139-45.

  • 112. Söderlund A Fischer A Johansson T. Physical activity diet and behaviour modification in the treatment of overweight and obese adults: a systematic review. Perspect Public Health 2009; 129: 1132-42.

  • 113. Brown T Avenell A Edmunds LD et al. Systematic review of long-term lifestyle interventions to prevent weight gain and morbidity in adults. Obes Rev 2009; 10: 627-38.

  • 114. Wu T Gao X Chen M van Dam RM. Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis. Obes Rev 2009; 10: 313-23.

  • 115. Mitchell H Whaley P. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. Philadelphia Pa: Lippincott Williams and Wilkins; 2006.

  • 116. Dahabreh IJ Paulus JK. Association of episodic physical and sexual activity with triggering of acute cardiac events: systematic review and meta-analysis. JAMA 2011; 305: 1225-33.

Search
Journal information
Impact Factor


CiteScore 2018: 0.13

SCImago Journal Rank (SJR) 2018: 0.118
Source Normalized Impact per Paper (SNIP) 2018: 0.079

Cited By
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 576 276 29
PDF Downloads 311 192 34