Exercise and coronary heart disease (CHD)

Exercise in patients without pre-existing coronary artery disease:

• a cohort study of participants in the Aerobics Center Longitudinal Study has revealed that men who maintained or improved adequate physical fitness had a reduced risk for all-cause and cardiovascular mortality in comparison with men who were persistently unfit. The criteria that the authors used to define 'fit' and 'unfit' are to be found in the study (1)
• the National Service Framework on Coronary Heart Disease recommends that adults should undertake 30 minutes of moderate intensity activity (such as brisk walking, cycling or heavy house work) on at least 5 days per week (2)
  
  
• NICE state that (3):
  
  
  • advise people at high risk of or with CVD to do the following every week:
    
    
    • at least 150 minutes of moderate intensity aerobic activity or
      
      
    • 75 minutes of vigorous intensity aerobic activity or
      
      
    • a mix of moderate and vigorous aerobic activity
      
      
  • advise people to do muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms) in line with national guidance for the general population
    
    
  • encourage people who are unable to perform moderate-intensity physical activity because of comorbidity, medical conditions or personal circumstances to exercise at their maximum safe capacity
    
    
  • advice about physical activity should take into account the person's needs, preferences and circumstances

Exercise based cardiac rehabilitation in patients with existing coronary heart disease:

• there is evidence that exercise based cardiac rehabilitation reduces all cause and cardiac mortality and improves a number of cardiac risk factors (3)
• increased physical activity and combined dietary changes reduce mortality in coronary heart disease (4)

Vigorous physical activity and incident cardiovascular disease (6)

• a study (n=71,893; UK Biobank) suggests reduced health risks possible through relatively modest amounts of vigorous physical activity (VPA) accrued in short bouts across the week (15-20min/wk linked to 16-40% lower mortality hazard ratio, with further decreases up to 50–57min/wk)

Reference:

• (1) Blair SN et al (1995), Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men, JAMA; 273: 1093-8.
• (2) Health Development Agency. Coronary heart disease. Guidance for implementing the preventive aspects of the National Service Framework. London 2000.
• (3) NICE (July 2014).Lipid modification - Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease
• (4) Taylor RS et al (2004). Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med;116:682-92
• (5) Iestra JA et al. Effect size estimates of lifestyle and dietary canges on all-cause mortality in coronary artery disease patients: a systematic review. Circulation 2005;112:924-34.
• (6) Ahmadi MN et al. Vigorous physical activity, incident heart disease, and cancer: how little is enough?, European Heart Journal, Volume 43, Issue 46, 7 December 2022, Pages 4801–4814, https://doi.org/10.1093/eurheartj/ehac572