Physical Activity and Exercise in Cardiovascular Disease

Abstract

Cardiovascular diseases (CVD) are the leading cause of death in the world. Physical inactivity is one of the important risk factors for the development of CVD. It is thought that increasing physical inactivity and sedentary lifestyle in recent years will result in an increase in CVD and mortality due to CVD. Therefore the importance of physical activity (PA) programmeswhich are both preventive and treatment approaches in the disease process is increasing day by day. Regular exercise has been shown in many studies to improve endothelial function, increase aerobic capacity, improve autonomic function and blood pressure, reduce lipid accumulation and inflammation, improve vascular health, prevent sarcopenia, and increase muscle strength and endurance. However, discussions continue in the literature on which of the different PA programs such as aerobic exercise, resistance exercise, yoga, and pilates are more effective for people with CVD. For exercise programs in CVD, it is critical that health professionals choose a patient within the framework of guidelines, ensure the safety of patients during exercise, and making the patient feel safe. It should not be forgotten that the evidence-based benefits mentioned require a sustainable exercise habit and it is important to ensure exercise compliance of people with CVD. In this review, the effectiveness of PA and exercise programs in the CVD, studies on coronary heart disease, heart failure and peripheral artery disease, safety of exercise programs, patient selection, importance of PA and compliance with exercise programs were discussed. For this reason, it has been shown that PA and exercise program are effective in CVD and strategies to improve compliance with the programs should be used.

Keywords

• Cardiovascular disease
• physical activity
• exercise
• exercise contraindications
• self-efficiacy.

Kardiyovasküler Hastalıklarda Fiziksel Aktivite ve Egzersiz

Abstract

Kardiyovasküler hastalıklar (KVH) dünyada önde gelen ölüm nedenidir. Fiziksel hareketsizlik, KVH gelişimi için önemli risk faktörlerinden biridir. Son yıllarda artan fiziksel inaktivite ve sedanter yaşam tarzının KVH'da ve KVH'ye bağlı mortalitede artışa neden olacağı düşünülmektedir. Bu nedenle hastalık sürecinde hem koruyucu hem de tedavi yaklaşımı olan fiziksel aktivite (FA) programlarının önemi her geçen gün artmaktadır. Düzenli egzersizin endotel fonksiyonunu iyileştirdiği, aerobik kapasiteyi artırdığı, otonomik fonksiyonu ve kan basıncını iyileştirdiği, lipid birikimini ve inflamasyonu azalttığı, vasküler sağlığı iyileştirdiği, sarkopeniyi önlediği, kas kuvvetini ve dayanıklılığını artırdığı birçok çalışmada gösterilmiştir. Ancak literatürde aerobik egzersiz, dirençli egzersiz, yoga ve pilates gibi farklı FA programlarından hangisinin kardiyovasküler hastalığı olan kişiler için daha etkin olduğu konusunda tartışmalar devam etmektedir. KVH'da egzersiz programları için, sağlık profesyonellerinin mevcut kılavuzlar çerçevesinde hasta seçmeleri, egzersiz sırasında hastaların güvenliğini sağlamaları ve hastanın güvende hissetmesinin sağlanması kritik önem taşımaktadır. Bahsedilen kanıta dayalı faydaların sürdürülebilir bir egzersiz alışkanlığı gerektirdiği ve KVH'li kişilerin egzersiz uyumunun sağlanmasının önemli olduğu unutulmamalıdır. Bu derlemede, kardiyovasküler hastalıklarda FA ve egzersiz programlarının etkinliği, koroner kalp hastalığı, kalp yetmezliği ve periferik arter hastalığı ile ilgili çalışmalar, egzersiz programlarının güvenliği, hasta seçimi, FA'nın önemi ve egzersiz programlarına uyum tartışılmıştır. Sonuç olarak KVH’de FA ve egzersiz programının etkin olduğu ancak programlara uyumu geliştirecek stratejilerin kullanılması gerektiği gösterilmiştir.

Keywords

• Kardiyovasküler hastalık
• fiziksel aktivite
• egzersiz
• egzersiz kontraendikasyonu
• özyeterlilik

References

1. Centers for Disease Control and Prevention (CDC). Million hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors--United States, 2011. MMWR Morb Mortal Wkly Rep. 2011;60(36):1248-1251.
2. Kralj, V., Brkić Biloš, I. Morbidity and mortality from cardiovascular diseases. Cardiologia Croatica. 2013; 8(10-11): 373-378.
3. Perk J, Rosengren A, Dallongeville J. Prevention of cardiovascular disease: Risk factor detection and modification. In: Camm AJ, Lüscher TF, Serruys PW, editors. The ESC Textbook of Cardiovascular Medicine. 1st ed. Oxford: Blackwell; 2006. p. 243-70.
4. Perk J, De Backer G, Gohlke H, Graham I, Reiner Ž, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European heart journal. 2012 Jul 1;33(13):1635-701.
5. DiPietro L, Al-Ansari SS, Biddle S, Borodulin K, Bull FC, Buman MP, et al. Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group. Int J Behav Nutr Phys Act. 2020;17(1):143.
6. Fiuza-Luces C, Santos-Lozano A, Joyner M, Carrera-Bastos P, Picazo O, Zugaza JL, et al. Exercise benefits in cardiovascular disease: beyond attenuation of traditional risk factors. Nat Rev Cardiol. 2018;15(12):731-743.
7. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology and the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2003;107(24):3109-3116.
8. Adams V, Reich B, Uhlemann M, Niebauer J. Molecular effects of exercise training in patients with cardiovascular disease: focus on skeletal muscle, endothelium, and myocardium. Am J Physiol Heart Circ Physiol. 2017;313(1):H72-H88.

9. Chew DP, Scott IA, Cullen L, French JK, Briffa TG, Tideman PA, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Med J Aust. 2016;205(3):128-133.
10. Briffa TG, Maiorana A, Sheerin NJ, Stubbs, AG, Oldenburg BF, Sammel NL, et al. Physical activity for people with cardiovascular disease: recommendations of the National Heart Foundation of Australia. Med J Aust. 2006;184(2):71-75.
11. Lusis AJ. Atherosclerosis. Nature. 2000;407(6801):233-241.
12. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685-1695.
13. Cooper R, Cutler J, Desvigne-Nickens P, Fortmann, SP, Friedman L, Havlik R, et al. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. Circulation. 2000;102(25):3137-3147.
14. McKirnan MD, Bloor CM. Clinical significance of coronary vascular adaptations to exercise training. Med Sci Sports Exerc. 1994;26(10):1262-1268.
15. Conraads VM, Pattyn N, De Maeyer C, Beckers PJ, Coeckelberghs E, Cornelissen VA, et al. Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study. Int J Cardiol. 2015;179:203-210.
16. Gomes-Neto M, Durães AR, Reis HFCD, Neves VR, Martinez BP, Carvalho VO. High-intensity interval training versus moderate-intensity continuous training on exercise capacity and quality of life in patients with coronary artery disease: A systematic review and meta-analysis. Eur J Prev Cardiol. 2017;24(16):1696-1707.
17. Caruso FR, Arena R, Phillips SA, Bonjorno, JC, Jr, Mendes RG, Arakelian VM, et al. Resistance exercise training improves heart rate variability and muscle performance: a randomized controlled trial in coronary artery disease patients. Eur J Phys Rehabil Med. 2015;51(3):281-289.
18. Yamamoto S, Hotta K, Ota E, Mori R, Matsunaga A. Effects of resistance training on muscle strength, exercise capacity, and mobility in middle-aged and elderly patients with coronary artery disease: A meta-analysis. J Cardiol. 2016;68(2):125-134.
19. Avila A, Claes J, Buys R, Azzawi M, Vanhees L, Cornelissen V. Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness?. Eur J Prev Cardiol. 2020;27(4):367-377.
20. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics--2015 update: a report from the American Heart Association [published correction appears in Circulation. 2015 Jun 16;131(24):e535] [published correction appears in Circulation. 2016 Feb 23;133(8):e417]. Circulation. 2015;131(4):e29-e322.
21. Alvarez P, Hannawi B, Guha A. Exercise And Heart Failure: Advancing Knowledge And Improving Care. Methodist Debakey Cardiovasc J. 2016;12(2):110-115.
22. Fleg JL, Piña IL, Balady GJ, Chaitman BR, Fletcher B, Lavie C, et al. Assessment of functional capacity in clinical and research applications: An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association. Circulation. 2000;102(13):1591-1597.
23. Golwala H, Pandey A, Ju C, Butler J, Yancy C, Bhatt DL, et al. Temporal Trends and Factors Associated With Cardiac Rehabilitation Referral Among Patients Hospitalized With Heart Failure: Findings From Get With The Guidelines-Heart Failure Registry. J Am Coll Cardiol. 2015;66(8):917-926.
24. Klompstra L, Jaarsma T, Strömberg A. Self-efficacy Mediates the Relationship Between Motivation and Physical Activity in Patients With Heart Failure. J Cardiovasc Nurs. 2018;33(3):211-216.
25. Pandey A, Parashar A, Kumbhani D, Agarwal S, Garg J, Kitzman D, et al. Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials. Circ Heart Fail. 2015;8(1):33-40.
26. Cornelis J, Beckers P, Taeymans J, Vrints C, Vissers D. Comparing exercise training modalities in heart failure: A systematic review and meta-analysis. Int J Cardiol. 2016;221:867-876.
27. Florea VG, Cohn JN. The autonomic nervous system and heart failure. Circ Res. 2014;114(11):1815-1826.
28. Pearson MJ, Smart NA. Exercise therapy and autonomic function in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev. 2018;23(1):91-108. doi:10.1007/s10741-017-9662-z
29. Klompstra L, Jaarsma T, Strömberg A, van der Wal MHL. Seasonal variation in physical activity in patients with heart failure. Heart Lung. 2019;48(5):381-385.
30. Campia U, Gerhard-Herman M, Piazza G, Goldhaber SZ. Peripheral Artery Disease: Past, Present, and Future. Am J Med. 2019;132(10):1133-1141.
31. Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc. 1985;33(1):13-18.
32. Lane R, Ellis B, Watson L, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2014;(7):CD000990.
33. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2017 Mar 21;135(12):e791-e792]. Circulation. 2017;135(12):e726-e779.
34. Fakhry F, van de Luijtgaarden KM, Bax L, den Hoed PT, Hunink MG, Rouwet EV, et al. Supervised walking therapy in patients with intermittent claudication. J Vasc Surg. 2012;56(4):1132-1142.
35. Vun SV, Miller MD, Delaney CL, Allan RB, Spark JI. The effect of supervised exercise therapy for intermittent claudication on lower limb lean mass. J Vasc Surg. 2016;64(6):1763-1769.
36. McDermott MM, Ades P, Guralnik JM, Dyer A, Ferrucci L, Liu K, et al. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial [published correction appears in JAMA. 2012 Apr 25;307(16):1694]. JAMA. 2009;301(2):165-174.
37. Machado I, Sousa N, Paredes H, Ferreira J, Abrantes C. Combined Aerobic and Resistance Exercise in Walking Performance of Patients With Intermittent Claudication: Systematic Review. Front Physiol. 2020;10:1538.
38. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease: a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines. Circulation. 2006;113(11):e463–e654.
39. Reis, A., Paulino, D., Abrantes, C., Machado, I. and Barroso, J. Usage of mobile devices to help people suffering from peripheral arterial disease upkeep a healthy life. J Phy Med Rehab. 2017; 1: p.103.
40. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2002;40(8):1531-1540.
41. Franklin BA, Bonzheim K, Gordon S, Timmis GC. Safety of medically supervised outpatient cardiac rehabilitation exercise therapy: a 16-year follow-up. Chest. 1998;114(3):902-906.
42. Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJ, et al. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 2019;1(1):CD003331.
43. Myers J, Arena R, Franklin B, Pina I, Kraus WE, McInnis K, et al. Recommendations for clinical exercise laboratories: a scientific statement from the american heart association. Circulation. 2009;119(24):3144-3161.
44. Ha FJ, Hare DL, Cameron JD, Toukhsati SR. Heart Failure and Exercise: A Narrative Review of the Role of Self-Efficacy. Heart Lung Circ. 2018;27(1):22-27.
45. Pihl E, Fridlund B, Mårtensson J. Patients' experiences of physical limitations in daily life activities when suffering from chronic heart failure; a phenomenographic analysis. Scand J Caring Sci. 2011;25(1):3-11.
46. Tierney S, Elwers H, Sange C, Mamas M, Rutter MK, Gibson M, et al. What influences physical activity in people with heart failure?: a qualitative study. Int J Nurs Stud. 2011;48(10):1234-1243.
47. Barbour KA, Miller NH. Adherence to exercise training in heart failure: a review. Heart Fail Rev. 2008;13(1):81-89.
48. Klompstra L, Jaarsma T, Strömberg A. Physical activity in patients with heart failure: barriers and motivations with special focus on sex differences. Patient Prefer Adherence. 2015;9:1603-1610.
49. Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010;12(1):e4.
50. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215.