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Is exercise the best medicine?

ESC Congress News 2019 - Paris, France

We put this question to Professor Sanjay Sharma (St. George’s, University of London, London, UK) and asked him to pick out abstracts at ESC Congress 2019 that further inform about the positive effects of exercise.

Risk Factors, Prevention, Rehabilitation, Sports Cardiology
Physical Inactivity and Exercise


Prof. Sanjay Sharma“The benefits of physical activity on the cardiovascular system are unrivalled. We already know that individuals who exercise regularly live at least 3 years longer than sedentary counterparts and are around 50% less likely to have an adverse cardiac event later in life, and this is due to a myriad of favourable effects, including improvements in blood pressure, the lipid profile and insulin sensitivity. Exercise is also beneficial for vascular ageing. Tomorrow, we will hear about a Swiss study that examined large artery stiffness and retinal microvascular diameter in older adults who were healthy and active (n=38), healthy and sedentary (n=36) or sedentary with ≥2 cardiovascular risk factors (n=84) (Abstract 4095). Active participants were less likely to have large arterial stiffness and more likely to have favourable retinal vessel diameters than sedentary people. Furthermore, when sedentary individuals with ≥2 risk factors underwent 12 weeks of high-intensity training, improvements in retinal microvasculature were observed. Large artery changes were not significantly different but may have been seen with time—at EuroCMR 2019, a study demonstrated reduced aortic stiffness and a ~4-year reduction in vascular ageing in novice athletes who trained for and completed their first marathon.1

exercise-best-medicine.jpgPeople who don’t regularly exercise generally have higher resting heart rates (RHR) and we know that elevated RHR is a risk factor for heart failure. Tomorrow, a large study in 1,008,485 Swedish young men will be presented, which demonstrates a positive association between RHR and the development of dilated cardiomyopathy over 34 years’ follow up (adjusted hazard ratio 1.58; 95% confidence interval 1.37–1.83) (Abstract P3821). This study provides more evidence that a slower RHR is beneficial—that’s another improvement that regular exercise can bring.

ESC Guidelines recommend a minimum of 30 minutes of moderate intensity exercise five times a week but state that additional benefits can be gained from twice this amount.2 In fact, the most benefit can be gained from physical activity around five times higher than currently recommended levels, but it’s important to emphasise that any exercise is better than none and that simple ‘free’ exercise, such as regular brisk walks in the park can contribute towards improved cardiovascular health.

But is exercise beneficial for people who already have established atherosclerotic cardiovascular disease (CVD)? Yes, is the answer, according to today’s presentation of a South Korean study of 441,798 individuals with and without CVD (Abstract 1272). Of note, after around 6 years’ follow up, individuals with CVD appeared to benefit from physical activity to a greater extent: every 500 metabolic equivalents (METs)-min/week increase in physical activity resulted in a 14% reduction in mortality in those with CVD and a 7% reduction in those without.

Apart from cardiovascular benefits, exercise is known to reduce the risk of developing certain malignancies. Yesterday, a study from Israel revealed that physical fitness may also improve survival in cancer patients (Abstract P626). The cumulative probability of death in patients who developed cancer was significantly lower in fitter than less fit patients.

Exercise is undeniably the most effective, accessible and cheapest therapy available and has very few side effects.

But are there situations where exercise is detrimental? We occasionally hear of sudden cardiac deaths in young athletes, often due to undetected inherited conditions, including hypertrophic cardiomyopathy. Until recently, patients diagnosed with these conditions were generally advised not to participate in sports. However, due to evolving knowledge, a recent position statement from the European Association of Preventive Cardiology (EAPC) takes a less restrictive approach for asymptomatic or mildly symptomatic patients with cardiomyopathies.3 A poster on Tuesday reviews the data from 27 papers and also supports ‘taking off the shackles’ and moving away from prohibition to a safe and sensible level of exercise in patients with hypertrophic cardiomyopathy (Abstract P5548).”

Prof. Sharma concludes, “It’s clear that the benefits of exercise are obtained regardless of age, sex, race and the presence of most comorbidities—it’s never too late to start.”

 

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References

  1. https://esc365.escardio.org/Congress/EuroCMR-2019/Young-Investigator-Award-session/191529-training-for-a-first-time-marathon-reverses-vascular-ageing
  2. Piepoli M, et al. Eur Heart J 2016;37:2315–2381.
  3. Pelliccia A, et al. Eur Heart J 2019;40:19–33.

Notes to editor

About the European Society of Cardiology

The European Society of Cardiology brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2019

ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2019 takes place 31 August to 4 September at the Paris Expo Porte de Versailles, Paris - France. Explore the scientific programme