Heart patients may benefit more from exercise than healthy people

(Reuters Health) – Exercise can do more to lower the risk of premature death for patients with cardiovascular disease than for healthy people, a new study suggests.

Healthy people did have a lower chance of dying during the study when they were more physically active. But the beneficial effect of exercise was more pronounced for people with heart problems, researchers reported in the European Heart Journal and at the annual meeting of the European Society of Cardiology in Paris.

The study team scored participants’ exercise levels and intensity based on a measure known as metabolic equivalent of task (MET) minutes per week. For optimal health, adults should get at least 500 MET minutes per week. (Because MET minutes can be difficult to calculate, an easier recommendation to follow is to get at least 150 minutes a week of moderate to vigorous exercise.)

When people had heart disease, every additional 500 MET minutes per week of exercise was associated with a 14% lower risk of dying from all causes during the study. For healthy people, the same increase in activity was tied to only a 7% lower mortality risk.

Altogether, researchers followed 131,558 patients with cardiovascular disease and 310,240 healthy people starting when they were around 60 years old. By the time half of the people had been in the study for at least seven years, those with cardiovascular disease were more than twice as likely to die during the study from all causes than individuals without this condition.

“Physical inactivity causes various non-communicable diseases such as coronary heart disease, diabetes, and breast and colon cancers, which ultimately lead to premature mortality,” said Dr. Si-Hyuck Kang, a co-author of the study and a researcher at Seoul National University

“Physical activity fosters normal growth and metabolism,” Kang said by email. “In addition, physical activity can make people feel better, sleep better, and perform daily tasks more easily.”

While the physiologic benefits of exercise may be similar for people with and without heart disease, it’s possible that heart disease patients benefit more from exercise because they have so many more risk factors for a premature death that might be addressed by getting more activity, Kang said.

“Physical activity has shown to lower blood pressure and blood (sugar), and (cholesterol),” Kang added.

Among people with cardiovascular disease, most had ischemic heart disease, also called coronary heart disease, in which the arteries supplying the heart become narrowed. People with heart disease tended to be older and they were also more likely to have other health issues like diabetes, high blood pressure and elevated cholesterol.

The study wasn’t a controlled experiment designed to prove whether or how exercise might directly impact the risk of premature death. Researchers relied on questionnaires to assess exercise, which isn’t always reliable, and didn’t examine activity levels at work or other non-leisure pursuits.

Even so, the results underscore the importance of getting moving after a heart attack, said Örjan Ekblom of the Swedish School of Sports and Health Sciences in Stockholm.

“Everybody knows that increasing one’s amount of exercise or general physical activity is quite a challenge, but I would say that for individuals who have survived a heart attack or similar event, it is indeed important to really try,” Ekblom, who wasn’t involved in the study, said by email. “It will not happen overnight, over a few weeks or even months, but little by little, one travels far.”

And if heart patients go the extra mile and get more than the minimum recommended amount of exercise, they will see more benefits, said Claude Bouchard of the Pennington Biomedical Research Center in Baton Rouge, Louisiana.

“The plateau in the relation between physical activity level versus reduction in the risk of death is reached at a higher level of activity than in adults without cardiovascular disease,” Bouchard, who wasn’t involved in the study, said by email.

SOURCE: bit.ly/2N0t4bR European Heart Journal, online September 1, 2019.