Posts tagged heart disease
Can push ups help determine future heart disease events?
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Heart disease remains the number one killer of both women and men in our country. Although the causes of heart disease are multifactorial in nature a significant percentage of known risk factors are modifiable. Abstaining from smoking, weight loss, nutrition, and exercise remain some of the most powerful ways to reduce your individual risk for heart disease including heart attack and stroke. Unfortunately, only a small percentage of Americans reach minimum national standards for weekly exercise. As our country becomes more sedentary and obese heart disease will continue to be a major health problem. Consistent with any disease, emphasis is often placed on prevention of heart disease as a more effective and less costly option for tackling heart disease. A recent study identified a functional test that can be used to help identify those at risk of future heart disease.

Researchers in the Journal of the American Medical Association reported on a retrospective analysis of heart disease events and push up ability (Yang et al. JAMA Network Open. 2019). Authors reviewed the cardiac history, anthrometric measurements, and functional testing of over 1100 participants. During the 10 year follow up 37 cardiovascular disease outcomes were reported. Authors reported a lower push up capacity was associated with an increased risk of cardiovascular disease events. Participants who could perform > 40 push ups were at a significantly lower risk of cardiovascular risk compared to those who were unable to perform 10 reps. Further studies are needed to confirm these findings and determine if this relationship is present in other patient populations.

If I Am Active At Work Do I Still Need to Exercise?
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Studies reported the United States lost 1/3 of all manufacturing positions between 1999 and 2010. Many of these individuals have not returned to their prior manufacturing jobs and may have started more sedentary occupations. While prior U.S. generations relied upon their work to provide daily activity, more recent generations must actively pursue aerobic and strength training exercise to receive the incredible health benefits associated with consistent exercise. Individuals who continue to work in active jobs such as construction, shipping, or manufacturing often believe their jobs provide all the activity they need, but new research questions the ability for these occupational activity to meet each individual’s exercise requirements.

A review article in the British Journal of Sports Medicine discussed the available research on occupational activity and health benefits, as well as, made arguments as to why workers with more active occupations should exercise (Holtermann et al. 2018). Previous research in this area has shown occupational activity does not improve an individual’s health. Further, many studies have shown these individuals have poor health and an increased risk of cardiovascular disease and early death.

Individuals in jobs with higher occupational activity often perform repetitive, low load movements with periods of heavy lifting and/or abnormal postures. This is in contrast to the shorter duration, higher intensity body movements associated with physical activity and exercise. Specifically, authors report aerobic capacity utlization of 30-35% and 60-80% between occupational activity and exercise, respectively, These lower aerobic intensities do not meet the minimal aerobic levels required for cardiovascular health benefits.

Aerobically trained individuals demonstrate decreased resting heart rate and blood pressure measurements compared to their sedentary peers. Conversely, research shows individuals involved in occupational active jobs demonstrate increased inflammation, heart rate, and blood pressure in the 24 hours following their shifts. If sustained, elevations in heart rate and blood pressure have been shown to be independent risk factors for the development of cardiovascular disease. These increases may be explained in part due to the lack of adequate recovery following occupational activities. Resistance training participants take 1-2 days off between sessions while this category of workers often perform job duties longer hours over consecutive days within the work week. Based on these aforementioned factors, workers in these jobs are encouraged to meet the same weekly exercise goals as the general population.

How Does Exercise Compare With Medications In The Treatment Of High Blood Pressure?
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The ability of aerobic exercise to reduce systolic (top number) blood pressure has long been established. Reductions in blood pressure have been shown to reduce an individual’s risk for chronic diseases including heart disease and ischemic events such as stroke and heart attack. Reducing an adult’s high blood pressure is an aim of many primary care physicians. Commonly utilized medication classes including beta blockers, calcium channel blockers, diuretics, and ace inhibitors are commonly prescribed to effectively reduce high blood pressure. Exercise, although shown to be an effective treatment for 26 chronic diseases, remains underutilized by both patients and physicians prompting many medical groups to adopt “exercise is medicine” platforms to raise awareness. A recent review of the evidence compared the effectiveness of medications and exercise on blood pressure.

The British Journal of Sports Medicine published a review of the medical literature including 391 randomized controlled trials (Naci et al. 2018). These trials included both exercise (10,491 participants) and blood pressure medications (29,281 participants, but unfortunately no trials compared the two interventions against one another. Interestingly, only 56 of the available trials (3508 participants) on the benefits of aerobic exercise on blood pressure were performed in patients with high blood pressure (systolic > 140 mmHg). When authors combined the data of all participants (high blood pressure or normals) they found blood pressure medication was more effective than exercise for lowering blood pressure. Conversely, and importantly, when authors pooled the data of only patients with high blood pressure they found exercise was equally effective to most blood pressure medications (beta blockers, ACE inhibitors, and diuretics). The authors of the review called on researchers to produce more head to head randomized trials between exercise and medications, as well as, stronger methodology to reduce the risk of bias and validity errors. Patients are advised to speak with their physician before making any changes to their medications or beginning an exercise program.

One Strength Session Per Week Reduces Cardiovascular Disease Risk
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Aerobic exercise has long been known to reduce an active individuals risk of chronic mental, emotional, and physical diseases. The majority of the publicity regarding the benefits of aerobic exercise has been related to the prevention of cardiovascular diseases and premature death due to these diagnoses. Government and professional medical organizations recommend 120-150 minutes of moderate exercise per week. These minutes should be at least 10 minutes in duration to receive the cardiovascular benefits of exercise. Interesting new research on strength training is being conducted on the benefits of this mode of exercise on the prevention of chronic disease and premature death.

Authors in the journal Medicine and Science in Sport and Exercise conducted an examination of the relationship of strength training, independent of aerobic exercise, and the development of cardiovascular disease (Liu et al. 2018). Authors included 12,591 participants who self reported their resistance training and disease status over a 16 year period. They reported a 40-70% disease risk reduction for all cardiovascular events with weekly resistance training frequencies of 1-3 sessions per week. No additional benefits were found with strength training frequencies of greater than 4 session per week. Interestingly, one session of up to 60 minutes of strength training was associated with decreased disease risk and early death independent of aerobic exercise participation. A patient’s body mass index (BMI) was found to significantly impact the impact of resistance training benefits.

This study supports the importance of strength training for cardiovascular health and wellness.

Lack Of Exercise Shown To Be Greatest Risk Factor For Premature Death
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Exercise remains one of the most powerful interventions to improve your mental, emotional, and physical health. Specifically, aerobic exercise, when performed consistent with medical experts prescriptions, has been shown to effectively treat 26 chronic conditions and diagnoses. Despite the clinically and cost effective benefits of aerobic exercise 80% of Americans to not reach the CDC’s recommendations of 2.5 hours of moderate exercise or 75 minutes of vigorous exercise. This sedentary behavior not only contributes to our countries 40% obesity rate, but also put these Americans at risk for serious health conditions and premature death. A new study shows this sedentary behavior may be more dangerous than high blood pressure or diabetes.

A new article published in the Journal of the American Medical Association followed 122,000 participants over an 8 year period (Mandsager et al. 2018). At the beginning of the study, participants were given a symptom limited treadmill test to determine their cardiovascular fitness. They were then placed into percentiles based on their performance and then followed to determine their how their aerobic performance impacted their development of chronic disease and premature death.

As expected, the authors found participants levels of cardiovascular fitness were inversely associated with life expectancy. Thus, fitter patients had the lowest risk of death without any upper limits to this benefit. Authors reported the most sedentary participants. were had a 500% higher risk of death compared to the most fit peers. Participants who exercise inconsistently, not meeting CDC guidelines, were still at close to 400% greater risk of early death compared to those who do exercise regularly. Amazingly, sedentary behavior was found to have a worse prognosis than high blood pressure, smoking, or being a diabetic (type II).

Running and Longevity
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We have written about running benefits on our mental, emotional, and physical health in previous blog posts.  Consistent physical activity through the life span has been shown to have significant beneficial effects on our health including decreased risk of disease and improved health and well being.  A new article highlights the impact running can have on our quantity and quality of our lifespan.  

Lee and colleagues analyzed the impact of lifestyle factors, including running, on disease risk and death (Prog Cardiovasc Dis. 2017).  The authors analyzed existing data from the Cooper Institute to look specifically at running and exercise.  The review supported prior research and indicated running reduced a patient's risk of early death by up to 40% even when controlling for other health and lifestyle factors like diet or smoking.  The authors reported each hour of running increased the lifespan up to 7 hours up to an upper limit of 3 years onto the lifespan.  Other forms of exercise such as walking improved health and longevity but to a lesser extent.  This study adds to the existing literature showing cardiovascular training is one of the best ways to improve health and reduce disease.