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Physical Activity in the Prevention of Cardiovascular Disease

An Epidemiological Perspective

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Abstract

This review of the epidemiological evidence regarding physical activity and cardiovascular disease (CVD) provides substantial evidence from many different populations that leisure time physical activity is associated with reduced risk of coronary heart disease (CHD) and cardiovascular mortality in both men and women and in middle-aged and older individuals. Physical activity appears to be a critical factor in both primary and secondary prevention of CHD. The studies indicate a dose-response relationship between overall physical activity and CVD, which is linear at least up to a certain level of activity. Prospective studies suggest that physical activity is also associated with reduced risk of stroke. The mechanisms underlying the protective effect of physical activity on CVD are still unclear. In recent years, the view that physical activity has to be vigorous to achieve a reduction in risk of CHD has been questioned. Overall, the evidence points to the benefit of continued regular moderate physical activity which does not need to be strenuous or prolonged and includes daily leisure activities such as walking or gardening which are readily attainable by large sections of the population. Taking up regular light or moderate physical activity in middle or older age confers significant benefit for CVD and all-cause mortality.

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References

  1. Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 1990; 132: 612–28

    PubMed  CAS  Google Scholar 

  2. Whaley MH, Blair SN. Epidemiology of physical activity, physical fitness and coronary heart disease. J Cardiovasc Risk 1995; 289–95

  3. Andersen LB. Physical activity and physical fitness as protection against premature disease or death. Scand J Med Sci Sports 1995; 5: 318–28

    Article  PubMed  CAS  Google Scholar 

  4. Francis K. Physical activity in the prevention of cardiovascular disease. Phys Ther 1996; 76: 456–68

    PubMed  CAS  Google Scholar 

  5. Lee IM, Paffenbarger RS, Hennekens CH. Physical activity, physical fitness and longevity. Aging (Milano) 1997 Feb–Apr; 9 (1–2): 2–11

    CAS  Google Scholar 

  6. Wannamethee SG, Shaper AG. Physical activity and the prevention of stroke. J Cardiovasc Risk 1999; 6 (4): 213–6

    PubMed  CAS  Google Scholar 

  7. Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta (GA): National Center for Chronic Diseases Prevention and Health Promotion, 1996

    Google Scholar 

  8. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. Physical activity and cardiovascular health. JAMA 1996; 276: 241–6

    Article  Google Scholar 

  9. Leon AS, Jacobs Jr DR, DeBacker G, et al. Relationship of physical characteristics and life habits to treadmill exercise capacity. Am J Epidemiol 1981; 113: 653–60

    PubMed  CAS  Google Scholar 

  10. Sherman SE, D’Agostino RB, Cobb JL, et al. Physical activity and mortality in women in the Framingham Heart Study. Am Heart J 1994; 128: 879–84

    Article  PubMed  CAS  Google Scholar 

  11. Sesso HD, Paffenbarger RS, Ha T, et al. Physical activity and cardiovascular disease risk in middle-aged and older women. Am J Epidemiol 1999; 150: 408–16

    Article  PubMed  CAS  Google Scholar 

  12. Lapidus L, Bengtsson C. Socioeconomic factors and physical activity in relation to cardiovascular disease and death: a 12 year follow-up of participants in a population study of women in Gothenburg, Sweden. Br Heart J 1986; 55: 295–301

    Article  PubMed  CAS  Google Scholar 

  13. Mensink GBM, Deketh M, Mul MDM, et al. Physical activity and its association with cardiovascular risk factors and mortality. Epidemiology 1996; 7 (4): 391–7

    Article  PubMed  CAS  Google Scholar 

  14. Lissner L, Bengtsson C, Bjorkelund C, et al. Physical activity levels and changes in relation to longevity: a prospective study of Swedish women. Am J Epidemiol 1996; 143: 54–62

    Article  PubMed  CAS  Google Scholar 

  15. Kushi LH, Fee RM, Folsom AR, et al. Physical activity and mortality in postmenopausal women. JAMA 1997; 277: 1287–92

    Article  PubMed  CAS  Google Scholar 

  16. Manson JE, Hu FB, Rich-Edwards JW, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med 1999; 341: 650–8

    Article  PubMed  CAS  Google Scholar 

  17. Morris JN, Clayton DG, Everitt MG, et al. Exercise in leisure time: coronary attack and death rates. Br Heart J 1990; 63: 325–34

    Article  PubMed  CAS  Google Scholar 

  18. Shaper AG, Wannamethee G. Physical activity and ischaemic heart disease in middle-aged British men. Br Heart J 1991; 66: 384–94

    Article  PubMed  CAS  Google Scholar 

  19. Leon AS, Connett J, MRFIT Research Group. Physical activity and 10.5 year mortality in the Multiple Risk Factors Intervention trial (MRFIT). Int J Epidemiol 1991; 20: 690–7

    Article  PubMed  CAS  Google Scholar 

  20. Hein HO, Suadicani P, Gyntelberg F. Physical fitness or physical activity as a predictor of ischaemic heart disease? A 17 year follow-up in the Copenhagen Male Study. J Int Med 1992; 232: 471–9

    Article  CAS  Google Scholar 

  21. Lakka TA, Venalainen JM, Rauramaa R, et al. Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction in men. N Engl J Med 1994; 330:1549–54

    Article  PubMed  CAS  Google Scholar 

  22. Haapenen N, Miilunpalo S, Vuori I, et al. Characteristics of leisure time physical activity associated with decreased risk of premature all-cause and cardiovascular disease mortality in middle-aged men. Am J Epidemiol 1996; 143: 870–80

    Article  Google Scholar 

  23. Kaplan GA, Strawbridge WJ, Cohen RD, et al. Natural history of leisure time physical activity and its correlates: associations with mortality from all causes and cardiovascular disease over 28 years. Am J Epidemiol 1996; 144: 793–7

    Article  PubMed  CAS  Google Scholar 

  24. LaCroix AZ, Leveille SG, Hecht JA, et al. Does walking decrease the risk of cardiovascular disease hospitalisations and death in older adults. J Am Geriatr Soc 1996; 44: 113–20

    PubMed  CAS  Google Scholar 

  25. Hakim AA, Petrovitch H, Burchfiel CM, et al. Effects of walking on mortality among non-smoking retired men. N Engl J Med 1998; 338: 94–9

    Article  PubMed  CAS  Google Scholar 

  26. Wannamethee SG, Shaper AG, Walker M. Changes in physical activity, mortality and incidence of coronary heart disease in older men. Lancet 1998; 351: 1603–8

    Article  PubMed  CAS  Google Scholar 

  27. Hakim AA, Curb D, Petrovich H, et al. Effects of walking on coronary heart disease in elderly men: the Honolulu Heart Program. Circulation 1999; 100: 9–13

    Article  PubMed  CAS  Google Scholar 

  28. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402–7

    Article  PubMed  CAS  Google Scholar 

  29. Wannamethee G, Shaper AG. Physical activity and stroke in British middle-aged men. BMJ 1992; 304: 597–601

    Article  PubMed  CAS  Google Scholar 

  30. Shaper AG, Wannamethee G, Walker M. Physical activity, hypertension and risk of heart attack in men without evidence of ischaemic heart disease. J Hum Hypertens 1994; 8: 3–10

    PubMed  CAS  Google Scholar 

  31. Paffenbarger Jr RS, Hyde RT, Wing AL, et al. Physical activity, all cause mortality and longevity of college alumni. N Engl J Med 1986; 314: 605–13

    Article  PubMed  Google Scholar 

  32. Arraiz GA, Wigle DT, Mao Y. Risk assessment of physical fitness in the Canada Health Survey mortality study. J Clin Epidemiol 1992; 45: 419–28

    Article  PubMed  CAS  Google Scholar 

  33. Rakowski W, Mor V. The association of physical activity with mortality among older adults in the Longitudinal Study of Aging (1984–1988). J Gerontol 1992; 47: M122–9

    Article  Google Scholar 

  34. Oldridge NB, Guyatt GH, Fischer ME, et al. Cardiac rehabilitation after myocardial infarction: combined experience of randomised clinical trials. JAMA 1988; 260: 945–50

    Article  PubMed  CAS  Google Scholar 

  35. O’Connor GT, Buring JE, Yusuf S, et al. An overview of randomised trials of rehabilitation with exercise after myocardial infarction. Circulation 1989; 80: 23444

    Google Scholar 

  36. Deedwania PC, Amsterdam EA, Randall H, California Cardiology Working Group on Post-myocardial Infarction Management, et al. Evidence-based, cost effective risk stratification and management after myocardial infarction. Arch Intern Med 1997; 157: 273–80

    Article  PubMed  CAS  Google Scholar 

  37. Kallio V, Hamalainen H, Hakkila J, et al. Reduction in sudden deaths by a multifactorial intervention programme after acute myocardial infarction. Lancet 1979; II: 1081–94

    Google Scholar 

  38. Vermeulen A, Lie KI, Durrer D. Effects of cardiac rehabilitation after myocardial infarction: changes in coronary risk factors and long term prognosis. Am Heart J 1983; 105: 798–801

    Article  PubMed  CAS  Google Scholar 

  39. Stern MJ, Cleary P. The National Exercise and Heart Disease Project: psychosocial changes observed during a low-level exercise program. Arch Intern Med 1982; 142: 1093–97

    Article  PubMed  CAS  Google Scholar 

  40. Kitajima K, Sasaki J, Kono S, et al. Prognostic significance of daily physical activity after first acute myocardial infarction. Am Heart J 1990; 119 (5): 1193–4

    Article  PubMed  CAS  Google Scholar 

  41. Paffenbarger Jr RS. Physical activity as a defense against coronary heart disease. In: Connor WE, Bristow JD, editors. Coronary heart disease: prevention, complications and treatment. Philadelphia (PA): JB Lippencott Co., 1985: 135–56

    Google Scholar 

  42. Wannamethee SG, Shaper AG, Walker M. Physical activity and mortality in older men with diagnosed coronary heart disease. Circulation 2000; 102: 1358–63

    Article  PubMed  CAS  Google Scholar 

  43. Hardman A. Physical activity and cardiovascular risk. J Cardiovasc Risk 1995; 2 (4): 285–8

    Article  PubMed  CAS  Google Scholar 

  44. Fontbonne A, Charles MA, Thibult N, et al. Hyperinsulinaemia as a predictor of coronary heart disease mortality in a healthy population: the Paris Prospective Study, 15 year follow-up. Diabetologia 1991; 34: 356–61

    Article  PubMed  CAS  Google Scholar 

  45. Perry IJ, Wannamethee SG, Whincup PH, et al. Serum insulin and incident coronary heart disease in middle-aged British men. Am J Epidemiol 1996; 144: 224–34

    Article  PubMed  CAS  Google Scholar 

  46. Pyorala M, Miettinen H, Laakso M, et al. Hyperinsulinaemia predicts coronary heart disease risk in healthy middle-aged men: the 22 year follow-up results of the Helsinki Policemen Study. Circulation 1998; 98: 398–404

    Article  PubMed  CAS  Google Scholar 

  47. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595–607

    Article  PubMed  CAS  Google Scholar 

  48. Koivisto VA, Yki-Jarvinen H, DeFronzo RA. Physical training and insulin sensitivity. Diabetes Metab Rev 1988; 1: 445–81

    Article  Google Scholar 

  49. Henriksson J. Influence of exercise on insulin sensitivity. J Cardiovasc Risk 1995; 303–9

  50. Zimmet PZ, Collins VR, Dowse GK, et al. The relation of physical activity to cardiovascular disease risk factors in Mauritians. Am J Epidemiol 1991; 134: 862–75

    PubMed  CAS  Google Scholar 

  51. Wannamethee SG, Shaper AG, Alberti KGGM. Physical activity, metabolic factors and the incidence of coronary heart disease and type-2 diabetes. Arch Intern Med 2000; 160: 2108–16

    Article  PubMed  CAS  Google Scholar 

  52. Kujala UM, Kaprio J, Sarna S, et al. Relationship of leisure-time physical activity and mortality. JAMA 1998; 279: 440–4

    Article  PubMed  CAS  Google Scholar 

  53. Paffenbarger RS, Wing AL, Hyde RT. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol 1978; 108: 161–75

    PubMed  Google Scholar 

  54. Rauramma R, Salonen JT, Seppanen K, et al. Inhibition of platelet aggregation by moderate-intensity physical exercise: a randomised clinical trial in overweight men. Circulation 1986; 74:939–44

    Article  Google Scholar 

  55. Sandvik L, Erikssen J, Thaulow E, et al. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med 1993; 328: 533–7

    Article  PubMed  CAS  Google Scholar 

  56. Blair SN, Kohl HW, Paffenbarger RS, et al. Physical fitness and all cause mortality: a prospective study of healthy men and women. JAMA 1989; 262: 2395–401

    Article  PubMed  CAS  Google Scholar 

  57. Bennett N, Todd T, Flatley J, et al. Health Survey of England 1993. London: HM Stationary Office, 1993

    Google Scholar 

  58. Paffenbarger Jr RS, Hyde RT, Wing AL, et al. The association of changes in physical activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993; 328: 538–45

    Article  PubMed  Google Scholar 

  59. Hein HO, Suadicani P, Sorensen H, et al. Changes in physical activity level and risk of ischaemic heart disease. Scand J Med Sci Sports 1994; 4: 57–64

    Article  Google Scholar 

  60. Blair SN, Kohl HW, Barlow CE, et al. Changes in physical fitness and all cause-mortality: a prospective study of healthy and unhealthy men. JAMA 1995; 73: 1093–8

    Article  Google Scholar 

  61. Hermann B, Leyten ACH, Van Luijk JH, et al. An evaluation of risk factors for stroke in a Dutch community. Stroke 1982; 13: 334–9

    Article  Google Scholar 

  62. Shinton R, Sagar G. Lifelong exercise and stroke. BMJ 1993; 307: 231–4

    Article  PubMed  CAS  Google Scholar 

  63. Sacco RL, Gan R, Boden-Albala B, et al. Leisure-time physical activity and ischaemic stroke risk: the Northern Manhattan Stroke Study. Stroke 1998; 29: 380–7

    Article  PubMed  CAS  Google Scholar 

  64. Paffenbarger RS, Brand RJ, Shultz R, et al. Energy expenditure, cigarette smoking and blood pressure level as related to death from specific diseases. Am J Epidemiol 1978; 108: 12–8

    PubMed  Google Scholar 

  65. Lindenstrom E, Boysen G, Nyboe J. Lifestyle factors and risk of cerebrovascular disease in women: the Copenhagen City Heart Study. Stroke 1993; 24: 1468–72

    Article  PubMed  CAS  Google Scholar 

  66. Kiely DK, Wolf PA, Cupples LA, et al. Physical activity and stroke risk: the Framingham Study. Am J Epidemiol 1994; 140: 608–20

    PubMed  CAS  Google Scholar 

  67. Abbott RD, Rodriguez BL, Burchfiel CM, et al. Physical activity in older middle-aged men and reduced risk of stroke: the Honolulu Heart Program. Am J Epidemiol 1994; 139: 881–93

    PubMed  CAS  Google Scholar 

  68. Gillum RF, Mussolino ME, Ingram DD. Physical activity and stroke incidence in women and men. The NHANES I Epidemiologic Follow-up Study. Am J Epidemiol 1996; 143: 860–9

    Article  PubMed  CAS  Google Scholar 

  69. Lee I-M, Paffenbarger RS. Physical activity and stroke incidence: the Harvard Alumni Health Study. Stroke 1998; 29: 2049–54

    Article  PubMed  CAS  Google Scholar 

  70. Lee I-M, Hennekens CH, Berger K, et al. Exercise and risk of stroke in male physicians. Stroke 1999; 30: 1–6

    Article  PubMed  CAS  Google Scholar 

  71. Paffenbarger RS, Wing AL. Characteristics in youth predisposing to fatal stroke in later years. Lancet 1967; I: 753–4

    Article  Google Scholar 

  72. Slattery ML, Jacobs DR, Nichaman MZ. Leisure time physical activity and coronary heart disease death: the US Railroad Study. Circulation 1989; 79: 304–11

    Article  PubMed  CAS  Google Scholar 

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Correspondence to S. Goya Wannamethee.

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Wannamethee, S.G., Shaper, A.G. Physical Activity in the Prevention of Cardiovascular Disease. Sports Med 31, 101–114 (2001). https://doi.org/10.2165/00007256-200131020-00003

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