A study in more than 30,000 heart patients shows that becoming active later in life can be nearly as beneficial to survival as continued activity.
A study of more than 30,000 patients with cardiovascular disease shows that becoming active later in life can be nearly as beneficial to survival as continued activity. These encouraging findings highlight how patients with coronary heart disease may benefit by preserving or adopting a physically active lifestyle.
Regular physical activity is advised for patients with heart disease, but recommendations are largely based on studies that used either a single assessment or an average of activity levels assessed over time. However, patients may modify the amount of exercise they do, and it remains unclear whether these changes are related to survival.
This study investigated activity levels over time and their relationship to the risk of death in patients with heart disease.
The researchers examined the risks of all-cause death and death from cardiovascular disease according to the four groups. Compared to patients who were inactive over time, the risk of all-cause death was 50% lower in those who were active over time, 45% lower in those who were inactive but became active, and 20% lower in those who had been active but became inactive.
Similar results were observed for death due to cardiovascular disease. Compared to those who remained inactive, the risk for cardiovascular mortality was 51% lower among those who remained active and 27% lower for those whose activity increased. Cardiovascular mortality was not statistically different for those whose activity decreased over time, compared to those who remained inactive.
These results show that continuing an active lifestyle over the years is associated with the greatest longevity. However, patients with heart disease can overcome prior years of inactivity and obtain survival benefits by taking up exercise later in life. On the other hand, the benefits of activity can be weakened or even lost if activity is not maintained. The findings illustrate the benefits to heart patients of being physically active, regardless of their previous habits.
Moderate-vigorous physical activity is the most efficient at improving fitness
In the largest study performed to date to understand the relationship between habitual physical activity and physical fitness, researchers from Boston University School of Medicine (BUSM) have found that higher amount of time spent performing exercise (moderate-vigorous physical activity) and low-moderate level activity (steps) and less time spent sedentary, translated to greater physical fitness.
"By establishing the relationship between different forms of habitual physical activity and detailed fitness measures, we hope that our study will provide important information that can ultimately be used to improve physical fitness and overall health across the life course," explained corresponding author Matthew Nayor, MD, MPH, assistant professor of medicine at BUSM.
He and his team studied approximately 2,000 participants from the community-based Framingham Heart Study who underwent comprehensive cardiopulmonary exercise tests (CPET) for the "gold standard" measurement of physical fitness. Physical fitness measurements were associated with physical activity data obtained through accelerometers (device that measures frequency and intensity of human movement) that were worn for one week around the time of CPET and approximately eight years earlier.
They found dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.
According to the researchers, while the study was focused on the relationship of physical activity and fitness specifically (rather than any health-related outcomes), fitness has a powerful influence on health and is associated with lower risk of cardiovascular disease, diabetes, cancer and premature death. "Therefore, improved understanding of methods to improve fitness would be expected to have broad implications for improved health," said Nayor, a cardiologist at Boston Medical Center.
Matthew Nayor, Ariel Chernofsky, Nicole L Spartano, Melissa Tanguay, Jasmine B Blodgett, Venkatesh L Murthy, Rajeev Malhotra, Nicholas E Houstis, Raghava S Velagaleti, Joanne M Murabito, Martin G Larson, Ramachandran S Vasan, Ravi V Shah, Gregory D Lewis. Physical activity and fitness in the community: the Framingham Heart Study. European Heart Journal, 2021; DOI: 10.1093/eurheartj/ehab580