Definition [1]
Cardiovascular diseases are a group of disorders of the heart and blood vessels and include:
- Coronary heart disease: disease of the blood vessels supplying the heart muscle
- Cerebrovascular disease: disease of the blood vessels supplying the brain
- Peripheral arterial disease: disease of blood vessels supplying the arms and legs
- Rheumatic heart disease: damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria
- Congenital heart disease: malformations of heart structure existing at birth
- Deep vein thrombosis and pulmonary embolism: blood clots in the leg veins, which can dislodge and move to the heart and lungs
Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason is a build-up of fatty deposits on the inner walls of the blood vessels. Strokes can be caused by bleeding from a blood vessel in the brain or by blood clots.
Physical Activity Effects on Cardiovascular Diseases
The benefits of exercise with 1000kcal per week in secondary prevention decreases the all cause mortality around 20-30% [2] Physical activity improves systolic blood pressure, angina symptoms and exercises tolerance in patients without re-vascularisation [3]. For patients with re-vascularisation physical activity improves quality of lives and exercise tolerance, as well as 29% of cardiac events and around 20% lower re-admission rates[4].
A large and rigorous systematic review and meta-analysis[5], published in June 2018, found that “Resistance Training leads to improvement in cardiac autonomic control of diseased individuals”; interestingly, this review also demonstrated that in people with no cardiac disease Resistance Training has “no or minimal effects on cardiac autonomic control of healthy individuals”.
However, it is important to note that only current physical activity is protective – sports participation in youth does not provide protection in later life unless activity is maintained[6].
PA effect on Hypertension/Blood Pressure
Studies show that there is an inverse relationship between physical activity and the incidence of hypertension, with inactive individuals having a 30-50% greater risk of high blood pressure/hypertension than fit and active individuals[7].
The frequency of exercise has a significant effect: the acute effect of PA causes a reduction in blood pressure lasting 4 to 10 hours; therefore, daily activity may achieve clinically significant improvement[8],
Aerobic fitness training has the greatest benefit, but dynamic resistance and isometric resistance at moderate intensity training has a smaller benefit[8][9][10].
Exercise in Coronary Artery Disease
The evidence for benefit of exercise in Coronary Artery Disease (CAD) is compelling and it has been conclusively established that exercise is indicated in the primary and secondary prevention of CAD. Studies demonstrate that the benefits of exercise are greater than the results of PCI (Percutaneous Coronary Intervention) techniques.
In one study of 101 men with stable CAD[11], over a two year period, regular exercise intervention outperformed PCI on all measures:
- “Event free survival” rates after 24 months were 78% in the exercise group versus 62% in the PCI cohort (P = 0.039).
- At two years, maximal oxygen consumption (VO2max) had increased by 10% in the exercise group versus 7% in the PCI group.
- Inflammatory markers improved in the exercise cohort: high-sensitive C-reactive protein levels and interleukin-6 levels were significantly reduced after two years of exercise by 41 and 18%, respectively, whereas no relevant changes were observed in the PCI group.
PA in secondary prevention of MI
Guidelines on secondary prevention for patients following a myocardial infarct recommend[12]:
- Following MI, patients should be physically active for 20-30 minutes a day to the point of slight breathlessness.
- People who are not active to this level should increase their activity gradually aiming to increase their exercise capacity. They should start at a level that is comfortable, and increase the duration and intensity of activity as they gain fitness.
Exercise in Chronic Heart Failure
The benefits of physical exercise in patients with Chronic Heart Failure (CHF) have been identified in many studies and in a large meta-analysis published in 2006, the authors came to the following conclusions:
- exercise training in stable patients with mild to moderate CHF results in statistically significant improvements in maximum heart rate, maximum cardiac output, peak VO2, anaerobic threshold, 6 minute walk test and HRQL (quality of life questionnaire).
Symptoms of Cardiovascular Events [13]
The classic symptoms of a cardiovascular event include;
- Chest discomfort (pressure, squeezing, fullness, pain)
- Discomfort in one or both arms, back, jaw or stomach
- Shortness of breath
- Cold sweat
- Nausea
- Lightheadedness
Women may not experience the classic symptoms above. Instead, they are more likely to experience the following;
- Unusual fatigue
- Sleep disturbances
- Weakness
- Shortness of breath
- Nausea/vomiting
- Back or jaw pain. [14]
The American Heart Association designed a Prodromal Symptoms
A 10mmHg decrease in systolic blood pressure was associated with a higher risk for fatal and non-fatal cardiovascular events.[15] Increased long-term variability in systolic blood pressure was associated with a higher risk for cardiovascular events, mortality and disease.[16] The American College of Sports Medicine (ACSM) published guidelines which were based on their traditional exercise guidelines but adapted for the physiological differences in patients with CAD compared to healthy individuals. Patients with CAD should perform everyday physical activity as well as supervised exercise lessons.
Cardiovascular exercise in supervised programs should be of moderate intensity. Intensity can be determined using various methods;
Patients should exercise at a sub-symptom threshold to avoid provoking myocardial ischaemia, significant arrhythmias or symptoms of exercise intolerance. Patients at higher risk should exercise at lower levels of intensity.
Absolute contraindications to exercise;[18] Antihypertensive medication can influence exercise and should be considered by the therapist when prescribing exercise. [19] Risk of Exercise for patients with coronary heart disease: acute myocardial infarction, cardiac arrest and sudden death. Incidence in supervised cardiac rehabilitation programs are:
Over 80% of persons who reported cardiac arrest symptoms while exercising have been successfully resuscitated with prompt defibrillation [20].
Exercise response to cardiac medications
Exercise Prescription[17]
Mode
Frequency
Duration
Intensity
Progression
Monitoring
Contraindications for Exercises
Special Considerations
Risk of Exercises
Exercises and Medications
Resources
References
Does resistance training modulate cardiac autonomic control? A systematic review and meta-analysis.
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Clin Auton Res. 2018 Aug 23. doi: 10.1007/s10286-018-0558-3. [Epub ahead of print]
Position stand. (1993) Physical activity, physical fitness and hypertension. Medicine and Science in Sport and Exercise. 25:i-x
