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OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
Prof. Emeline M. Van Craenenbroeck
Physical inactivity is a strong independent predictor of cardiovascular disease, whether assessed with objective exercise tests or through validated questionnaires. As such, staying physically fit throughout life may well be one of the easiest, cheapest and most effective ways to avoid the coronary care unit. Whereas the majority of evidence has been gathered in middle-aged men, the effects of regular physical are less well studied in elderly persons (>65 yrs) and in women. The new study of Barengo et al., aimed to fill this knowledge gap (1). According to their study, being physically active during leisure time can help elderly persons - both men and women - to achieve lower risk of total and cardiovascular mortality.
The researchers conducted a prospective analysis on 2456 Finnish healthy men and women who were 65 to 74 years old at baseline in 1997. They assessed leisure-time physical activity (LTPA) at baseline through self-administered questionnaires filled out by the participants and used Cox proportional-hazards analysis to study associations between CHD risk and frequency, type, and volume of physical activity. Subjects were stratified according to dose of LTPA into three groups: high (participation in recreational sports or intense training or sports competitions for ≥3 h/wk), moderate (walking, cycling, other light exercise (fishing, gardening, hunting) ≥4 h/wk, or low (reading, watching television, working in the housed without much physical activity). During a median follow-up period of 11.8 years, the researchers observed 591 deaths, 197 CVD deaths and 416 ﬁrst incident CVD events. They found that total mortality, CVD mortality and an incident CVD event was significantly lower for those with moderate or high LTPA levels than for those with low LTPA levels. The protective effect of LTPA seemed to be dose dependent in this patient-population.
This study assessed physical activity by a 7-day physical activity recall (7day PAR). The mean physical activity estimate from this questionnaire shows a close relationship to caloric intake (2). However, there are inherent pro’s and contra’s on self-reports for physical activity. Strengths include the ability to measure large cohorts and the low administrative cost. Weaknesses are the tendency to over-report activity levels and difficulties to compare activity levels across studies. As such, the dose-dependent effect that is suggested in this study should be interpreted with caution. Although very relevant to measure, recent advances in technology should assist to quantitatively study a dose-effect relation (eg via pedometers, accelerometers, and heart rate monitors).
The physical activity questionnaire that is used in this study mainly assessed leisure or recreational activities, without taking occupational activities into account. Whereas professional activities are limited in a population that is >65yrs, the International Physical Activity Questionnaire (IPAQ) could have been considered, as it assesses activities in both leisure time and occupational time. Form the Interheart study, we know that LTPA and mild-to moderate occupational PA, but not heavy physical labour, are associated with a reduced risk of myocardial infarction (3). LTPA is generally more prevalent among men than women. Lower average income, time-consuming housekeeping duties, and cultural restrictions could preclude women from participating in leisure time physical activity. This could be an argument to include occupational physical activity in the assessment, in order not to underestimate the physical activity in women.
In conclusion, this study is timely and relevant. Physicians should emphasize that daily exercise, even at a moderate intensity, is sufficient to reduce the risk of CVD mortality, even in the elderly. Every little bit counts, regardless of the intensity, it is just important to be active. Elderly persons are more prone to adopting a sedentary lifestyle, but according to this study, light exercise like walking already can give these patients a mortality benefit.
Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology
1. Leisure-Time Physical Activity Reduces Total and Cardiovascular Mortality and Cardiovascular Disease Incidence in Older Adults.,Barengo NC, Antikainen R, Borodulin K, Harald K, Jousilahti P, J Am Geriatr Soc. 2016 Dec 26.2. Validation and comparison of eight physical activity questionnaires. ,Albanes D, Conway JM, Taylor PR, Moe PW, Judd J.,Epidemiology. 1990 Jan;1(1):65–71.3. Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study.,Held C, Iqbal R, Lear SA, Rosengren A, Islam S, Mathew J, et al, European Heart Journal. Oxford University Press; 2012 Feb;33(4):452–66.
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