Prescribing exercise for ‘dramatic impact’ on mortality and risk of heart disease

Key points to remember:

• The benefits of exercise occur at levels well below federal recommendations.
• Physical activity has an impact on mortality risk by age, race and sex.

ARLINGTON, Texas – Physical fitness is a vital sign of 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, FCCPProfessor of Medicine, Medical Director of Cardiac Rehabilitation and Preventive Cardiology, Director of the Stress Testing Laboratory and Staff Cardiologist in the Echocardiography 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 Cardiovascular Disease Prevention.

However, evidence suggests that exercise benefits occur even at levels well below these federal recommendations. Maximum health benefits occur at around 40-60 minutes of physical activity per week for “almost everyone”; with activities like running, peak benefits occur at very low levels, Lavie said.

Carl “Chip” Lavie Jr.

“Whether you have a weak or superior physical condition, [data show] changes in your physical condition over time have had a dramatic impact on all-cause mortality,” Lavie said. “If you’re fit, increasing your fitness further can have long-term benefits.”

Benefits for the heart with better fitness

Exercise and improved cardiorespiratory fitness provide numerous physiological benefits, Lavie said, including improved heart rate variability, reduced blood pressure and systemic inflammation, improved insulin sensitivity and endothelial function, and decreased myocardial oxygen demand. Exercise is also associated with a reduced risk of developing 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 huge impact on psychosocial stress,” Lavie said. “We have shown that improving this in the setting of cardiac rehabilitation is associated with reductions in mortality.”

In a retrospective analysis published in May 2022 in European journal of the heart – Quality of Care & Clinical results, Lavie and colleagues found that among 853 coronary artery disease patients referred to cardiac rehabilitation who performed a maximal cardiopulmonary exercise test, peak VO₂ at the end of cardiac rehabilitation was an independent predictor of long-term survival.

“The most important thing that predicted the survival of our coronary patients was getting an upper end of the VO cardiac rehab peak.₂“, Lavie said. “Exercise capacity at the end of rehabilitation was the best predictor of subsequent survival.”

The “dose” of exercise, the frequency matters

Small, incremental changes can lead to health benefits for patients, Lavie said. For the greatest “value for money,” clinicians should strive to move patients out of a “low fitness” category — when they’re most at risk for CV events — toward 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 about exercise intensity, frequency, duration, and mode,” Lavie said. “The main mode recommended is aerobic exercise: walking or jogging on a treadmill or outdoors, cycling, aerobic dancing and swimming. Certainly, resistance exercises are also necessary, at least once or twice a week.

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

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

Lavie said promoting physical activity and physical fitness is needed across the health system, especially in the era of COVID-19.

“Every clinician who sees a patient should tell them something about physical activity and document it in the medical record,” Lavie said.

The references:

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American Society of Preventive Cardiology