Does Physical Activity Improve Survival in CHD?

Sustained physical activity may be associated with “substantial risk reduction” in patients with coronary heart disease (CHD), according to study published March 5 in the Journal of the American College of Cardiology.

Using data from the Nord-Trøndelag Health Study, Trine Moholdt, PhD, et al., examined associations between long-term changes in physical activity and body mass index (BMI) with all-cause and cardiovascular disease mortality in 3,307 CHD patients. A total of 1,493 deaths occurred during the 30-year follow-up – 55 percent from cardiovascular disease – and only patients with data on physical activity, BMI, diabetes mellitus, self-reported health, blood pressure, smoking and alcohol consumption were included in the study.

Results showed that compared to those with a stable BMI, weight loss was associated with increased all-cause mortality risk (adjusted hazard ratio [HR]: 1.30; 95 percent confidence interval [CI]: 1.12 – 1.50), and weight gain was not "significantly associated" with increased all-cause mortality (adjusted HR: 0.97; 95 percent CI: 0.87 – 1.09). In stratified analyses, weight loss was associated with increased risk in those who were normal weight at baseline (adjusted HR: 1.38; 95 percent CI: 1.11 – 1.72), whereas weight gain was associated with decreased risk (HR: 0.75; 95 percent CI: 0.56 – 0.99). In overweight and obese subjects, neither weight loss or weight gain was associated with mortality risk.

In comparison, there was a lower risk shown for all-cause mortality in participants who maintained both low physical activity (adjusted HR: 0.81; 95 percent CI: 0.67 to 0.97) and high physical activity (adjusted HR: 0.64; 95 percent CI: 0.50 to 0.83), compared with participants who were inactive over time. However, greater risk reductions were associated with high physical activity compared to low physical activity. Similar associations were observed for both cardiovascular disease mortality and all-cause mortality.

The authors explain that their study had several limitations, including not being able to "distinguish between intentional and unintentional weight loss." They conclude that moving forward, increased attention should be placed on strategies to increase physical activity in secondary prevention of CHD. They add, "Physical inactivity and low aerobic capacity has largely been overlooked as a risk factor in primary and secondary prevention of cardiovascular disease, and is currently the only major risk factor not routinely assessed in clinical practice."

In an accompanying editorial comment, Claude Bouchard, PhD, notes that while there are other considerations that need to be taken into account when interpreting this study, "the findings add to the body of data suggesting that promoting regular physical activity in CHD patients is likely to save lives."

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Exercise, Smoking

Keywords: Body Mass Index, Risk Factors, Weight Gain, Weight Loss, Blood Pressure, Secondary Prevention, Follow-Up Studies, Exercise, Coronary Disease, Motor Activity, Smoking, Risk Reduction Behavior, Alcohol Drinking, Diabetes Mellitus

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