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![Page 1: How Much Exercise Is Necessary to Prevent CV Disease? Thomas G. Allison, PhD, MPH Mayo Clinic, Rochester, MN, USA.](https://reader036.fdocuments.us/reader036/viewer/2022081503/56649db15503460f94a9ff84/html5/thumbnails/1.jpg)
How Much Exercise Is Necessary to Prevent CV Disease?
Thomas G. Allison, PhD, MPH
Mayo Clinic, Rochester, MN, USA
![Page 2: How Much Exercise Is Necessary to Prevent CV Disease? Thomas G. Allison, PhD, MPH Mayo Clinic, Rochester, MN, USA.](https://reader036.fdocuments.us/reader036/viewer/2022081503/56649db15503460f94a9ff84/html5/thumbnails/2.jpg)
ExercisePrevention
of CHD
Amount of exercise?
Exercise intensity?
Type of exercise?
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![Page 4: How Much Exercise Is Necessary to Prevent CV Disease? Thomas G. Allison, PhD, MPH Mayo Clinic, Rochester, MN, USA.](https://reader036.fdocuments.us/reader036/viewer/2022081503/56649db15503460f94a9ff84/html5/thumbnails/4.jpg)
![Page 5: How Much Exercise Is Necessary to Prevent CV Disease? Thomas G. Allison, PhD, MPH Mayo Clinic, Rochester, MN, USA.](https://reader036.fdocuments.us/reader036/viewer/2022081503/56649db15503460f94a9ff84/html5/thumbnails/5.jpg)
The relationship between exercise or physical fitness and CHD is curvilinear
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An
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None 360 720 1080 1440 1800 2160 2520
kcal of Exercise per Week
– CHD risk = f(1/x)
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Age 70-84 Age 60-69 Age 50-59 Age 35-49
Relationship of Leisure-Time Physical Activity to All-Cause Mortality in Male Harvard Alumni
< 500 kcal/week
500-1999 kcal/week
2000+ kcal/week
Benefits of Exercise Increase with Age (and Risk)
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CHD Risk Factor Trends in US
Risk factors declining since 1980
• Smoking• LDL cholesterol
Risk factors increasing since 1980
• Obesity• Diabetes/IFG• Low HDL cholesterol• High triglycerides• Sedentary lifestyleNot strongly associated with
exercise/physical activity
Strongly associated with exercise/physical activity
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Physical Activity and All-cause Mortality In Iowa Women
• Prospective cohort study of 40,417 women
• Aged 55-69 years at baseline
• Followed 7 years
• Physical activity assessed by mailed questionnaire
Kushi et al, JAMA 1997;277:1287-1292
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All-cause Mortality In Iowa Women Related to Moderate and Vigorous Activity
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CHD and Exercise in Women
• Women’s Health Initiative Observational Study
• 73,743 women reporting amount and intensity of exercise, including walking, and amount of time sitting– age 50-79 years– no baseline CHD or cancer– followed from 1994-1998 through August 27, 2000
Manson et al, NEJM 2002;347:716-725
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Age-Adjusted Rate of CV Events According to Quintiles of Total Physical Activity
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MET-hours/week
Tot
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V E
vent
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e pe
r 10
,000
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Yea
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(1000 kcal/week 16.7 MET-hours/week)
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CHD and Exercise in Men
• Health Professionals Follow-up Study
• 44,452 male health professionals
• Baseline age 40-72 years
• Excluding baseline CHD and cancer
• Biennial questionnaire reporting amount and type of physical activity
• Followed 1986 to January 31, 1998
Tanasescu et al, JAMA 2002;288:1994-2000
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Rate of New CHD According to Quintiles of Total Physical Activity
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-Yea
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(2000 kcal/week 33.3 MET-hours/week)
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Types of Exercise
• Significant reductions in risk seen with – total physical activity– running– jogging– walking– rowing– weight training > 30 minutes per week
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CHD and Exercise Intensity
• New analysis of Harvard Alumni Study
• 7337 men reporting amount and absolute and relative exercise intensity– average age 66 years– no baseline CHD or cancer– followed from 1988 to 1995– CHD = angina pectoris, MI, PTCA, CABG,
CHD deathLee et al, Circ 2003;107:1110-1116
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Exercise Classification
• Amount of exercise:[< 1000] vs [1000-2499] vs [ 2500 kcal/week]
• Absolute intensity of exercise:[< 3] vs [3-6] vs [> 6 METs]
• Relative intensity of exercise (based on 10-point Borg Scale):[Weak or less (0-2)] vs [Moderate (3)] vs
[Somewhat Strong (4)] vs [Strong or greater (5+)]
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0 Nothing at all0.5 Very, very weak1 Very weak2 Weak3 Moderate4 Somewhat strong5 Strong67 Very strong8910 Very, very strong• Maximal
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Results
00.10.20.30.40.50.60.70.80.9
1
Rel
ativ
e R
isk
of
CH
D
Amount Absolute Intensity Relative Intensity
Exercise Classification
Age-adjusted relative risk of CHD (n = 551) by ascending categories of exercise amount, absolute intensity, and relative intensity
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How Does CV Fitness Contribute to Risk Stratification?
FAC Group (% predicted)
FRS Group
>110%90-109%
70-89% 50-69% <50%
< 5% 0.7 1.2 1.7 5.0 14.1
5 - 9.9% 1.7 2.4 3.6 9.6 22.1
10 – 14.9% 2.3 4.0 7.2 11.5 22.3
15 – 19.9% 5.6 6.7 10.6 13.9 32.5
≥ 20% 5.4 10.8 15.5 20.0 27.2
Al Badarin FJ, Kopecky SL, Allison TG. JACC 2009 Mar; 53(10 Suppl 1):A258. (Abstract)
8-Year All-Cause Mortality
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Recommendations
• Start with a level of exercise appropriate to the baseline fitness and activity level of the patient
• Progressively advance the exercise prescription until risk factors are optimally controlled … or limits of tolerance are reached
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Recommendations
Amount of exercise
• To “get on the flat tail” of the CHD:exercise curve, it appears that one or more of the following are needed:– “vigorous” exercise at least 2-4 times per week– at least 2000 kcal/week in leisure-time physical activity– exercise capacity of 10 METs for men or 9 METs for
women
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Recommendations
Exercise intensity
• Relative exercise intensity of 4 (“somewhat strong”) on the 10-point Borg scale– probably 12-14 on the older 6-20 Borg scale
Type of exercise
• Running, jogging, walking, rowing, weight training have all been validated
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Greetings from Rochester, MN
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Back to Rochester, MN