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Exercising and Cardiovascular Risk

Is moderate exercising helping or hurting cardiovascular outcomes?

Exercises such as jogging, cycling, or swimming are becoming popular not only among youth, but in the elderly as well. It is meant to protect the bodies from early deterioration and lifestyle diseases. It is now a means to a healthy body in old age. Some benefits of working out for the elderly include modifications in their antioxidant defense system and in their muscle characteristics such as strength and endurance, making them less susceptible to acute injury and chronic inflammation. It is well known that moderate and consistent workouts promote good health. However, it is not clear whether vigorous physical activity can generate cardiovascular incidents. Physical activity interference slows the advancement of coronary artery disease. Cardiac rehabilitation trials also show a decline in cardiovascular events for patients with recent cardiovascular illness. A trial done by Lifestyle Interventions for Elders (LIFE) compared physical activity with health education. It showed that an organized physical activity program can avert mobility disability in older adults with functional limitations. A previous study done by Garcia-Valles et al. in mice showed that lifelong exercise failed to lengthen their lifespan, but it did show that regular exercise can improve age-related weakness and improves functional state.

In a retrospective study, patients who were admitted to the emergency department database were accessed. Patients who qualified were admitted to the emergency department either immediately after a workout or a day after a workout. Workouts such as high speed sports, boxing, and karate were excluded from the study. Data was categorized into gender, age, outcome (outpatient, inpatient, and death) type of sports, cardiovascular, neurological, musculoskeletal events, and soft tissues, and others such as hyperventilation and rhabdomyolysis. Of the 138 subjects, 115 were men and 23 women, cardiovascular events was 13.8%, neurological incidents 16.7%, musculoskeletal accidents 55.8%, soft tissue injuries 2.2% and others 11.6%. The participants were also divided into three age groups, with 45% from age 17 to 30, 46% between 31 and 65 years and 9% older than 66 years. The main causes for ED admissions were musculoskeletal accidents (n=77), followed by neurological events (n=23) and cardiovascular events (n=19). Soft tissue injuries (n=3) and others like infection, hyperventilation and rhabdomyolysis (n=16) were insignificant. Males were predominant in cardiovascular events, neurological events and musculoskeletal accidents. Most of the incidents of all types were due to workout (n=120; 87%) followed by treadmill (n=8; 5.8%), indoor cycling (n=7; 5.1%) and swimming (n=3; 2.2%). The main limitation of this study was the fact that it was done retrospectively. Also the study population was not balanced with respect to age and gender distribution.

In another study it was investigated whether cardiovascular morbidity and mortality would be reduced in long-term physical activity. In this investigation called the LIFE study, a randomized multicenter of 1,635 men and women ages 70-89 years we recruited. Another inclusion criteria of the participants was a sedentary lifestyle. Participants were randomized to a physical activity (PA) or a successful aging (SA). The PA intervention included walking, strength training, flexibility training, and balance training. The intervention group included attendance at two center-based visits per week and a home-based activity 3 to 4 times per week. Borg’s Scale of self-perceived exertion was used to measure intensity of activity. At baseline prevalent CVD was self-reported of MI, congestive heart failure, stroke or MI pattern on ECG. Silent MI was evaluated by ECG achieved at baseline, 18 months, and 36 months. Time from randomization to their first cardiovascular event, fatal or nonfatal was used to define incidence during trial.

There were 14.3% total incidents of CVD, 121 of 818 PA participants (14.8) and 113 of the 817 SA participants (13.8%) or 6.2 vs 5.6 events per person. An aerobically based moderately intensive physical activity program was not connected with decreased cardiovascular events. Cardiovascular outcome with less severe impairment had a higher rate of events in the physical activity group than when compared with the SA education group. Limitations to this study included a shorter follow-up period of only 2.6 years and also a smaller statistical power to detect small differences in rates.

In conclusion, though the LIFE study did not prove any relationship between increased physical activity and reduced CVD, there are guidelines for PA for elderly people who need to follow at least 150 minutes per week of moderate aerobic activity. This is considered safe and worthwhile for the avoidance of disability.

Practice Pearls:

  • Workouts and low speed sports seem to be defensive for human health, when done frequently and carefully.
  • Vigorous physical activity may aggravate the risks of cardiac death and myocardial infarction, mainly for untrained people and at some cardiovascular risk or people with occult heart disease.
  • Aerobically moderately intensive PA is not connected to a reduced cardiovascular events.

References:

Grad, Cosmin, and Dumitru Zdrenghea. “Heart Rate Recovery in Patients with Ischemic Heart Disease – Risk Factors.” Clujul Medical 87.4 (2014): 220–225. PMC. Web. 6 July 2016.

Imstepf, Valentina A. et al. “Time for a Break: Admissions to an Urban Emergency Department after Working Out-A Retrospective Study from Switzerland.” BioMed Research International 2015 (2015): 610137. PMC. Web. 6 July 2016.

Newman AB, Dodson JA, Church TS, et al. Cardiovascular Events in a Physical Activity Intervention Compared With a Successful Aging Intervention: The LIFE Study Randomized Trial. JAMA Cardiol. Published online June 29, 2016. doi:10.1001/jamacardio.2016.1324.