Previous studies have shown that incorporating an exercise habit is inversely related to the risk of mortality. Current guidelines recommend regular exercise to reduce the risk of cardiovascular or all-cause death and morbidity. However, evidence supporting the benefits of exercise in older adults with cardiovascular disease (CVD) is scarce because studies on exercise and mortality have been conducted primarily in healthy, middle-aged people.
Although some studies attempted to demonstrate the impact of exercise habits on death in patients with CVD, the results were inconsistent. Furthermore, most studies were based on a single baseline exercise assessment with subsequent mortality follow-up. Several studies have shown that such assessment has limited predictive power over time and may not be able to accurately differentiate the effect of exercise per se from the influences of confounding factors such as genetic background, undetected comorbidities, and changes in the outcome variable. interest during follow-up.
Engeseth et al described that physical condition at the time of inclusion was a significant predictor of early cardiovascular death, but not of late cardiovascular death. To overcome these limitations, some studies have suggested using change in exercise habits as a variable to evaluate long-term results.
Taking into account the lack of information on the impact of exercise in older patients with CVD, this study aimed to analyze the association between the change in exercise habits after a new diagnosis of CVD and the risk of death from any cause, cardiovascular or non-cardiovascular.
Aim
To investigate the associations between changes in exercise habit after an incident cardiovascular event and mortality in older adults.
Methods
We analyzed the relationship between exercise habit change and deaths from all causes, cardiovascular and non-cardiovascular, in adults aged ≥60 years between 2003 and 2012 who underwent two consecutive health examinations within 2 years before and after exercise. diagnosis of cardiovascular disease (CVD).
They were classified into four groups according to changes in exercise habits: persistent non-exercisers , quitters , first-time exercisers , and maintainers . Differences in baseline characteristics were adjusted using inverse probability of treatment weighting.
Results
Of 6076 participants , the median age was 72 (IQR 69-76) years and men accounted for 50.6%.
Compared with persistent non-athletes (incidence rate [IR] 4.8 per 100 person-years), new athletes (IR 3.5, HR 0.73, 95% CI 0.58 to 0.91 ) and those maintaining exercise (IR 2.9, HR 0.53, 95% CI 0.38 to 0.73) were associated with a reduced risk of all-cause death .
The rate of non-cardiovascular death was significantly lower in new exercisers (IR 2.3, HR 0.73, 95% CI 0.56 to 0.95) and exercise maintainers (IR 2.3, HR 0. 61, 95% CI: 0.42 to 0.90) than in persistent non-athletes (IR 3.2).
Additionally, trends toward reduced cardiovascular death were observed in new athletes and exercise maintainers (p value for trend <0.001).
Graphic summary summarizing the main findings of this study. Risks of death from all causes, cardiovascular and noncardiovascular, are reduced with more virtuous exercise trajectories in older adults with newly diagnosed cardiovascular (CV) disease.
Conclusions
More virtuous exercise trajectories in older adults with CVD are associated with lower mortality rates. Our results support public health recommendations for older adults with CVD to engage in physical activity.
What is already known Current guidelines recommend regular exercise to reduce the risk of mortality and morbidity. Data on the prognostic effect of starting or maintaining exercise are primarily based on generally healthy populations. What does this study contribute? In patients with ischemic stroke, heart failure, or acute myocardial infarction, maintenance of regular exercise was associated with a reduction in all-cause, cardiovascular, and noncardiovascular deaths. The incorporation of exercise habits was related to a lower risk of death from any cause, cardiovascular and non-cardiovascular. Although patients aged ≥75 years had reduced benefits with respect to death prevention compared with those aged <75 years, the benefits remained statistically significant. Implications for practice Exercise recommendations are important and should be promoted among older adults with cardiovascular disease. |
Discussion
The main findings of this nationwide population-based cohort study that classified patients according to changes in exercise habits after a first incident of CVD are summarized in the figure.
First, maintenance of exercise was associated with a reduced risk of all-cause cardiovascular or noncardiovascular death.
Second, a trend of progressively lower mortality rates was observed with increasing exercise from those who persistently did not exercise to those who maintained exercise.
Finally, among patients younger than 75 years, those who were physically inactive tended to have a higher risk of cardiovascular death and those with a regular exercise habit tended to derive greater benefits from exercise than their counterparts among patients older than 75 years.
Change in exercise habit after CVD diagnosis and death
Physical inactivity is a well-known risk factor for all-cause cardiovascular deaths in adults. Contemporary physical activity guidelines recommend replacing physical inactivity with regular exercise and setting a target level of exercise to improve life expectancy. However, most of the previous studies cited in these guidelines were based on results in healthy adults or patients with hypertension, diabetes mellitus, or HIV infection.
Guidelines for the treatment of cardiovascular disease have also supported the benefits of exercise training, although uncertainty remains about its effects on mortality because the evidence was based primarily on small randomized trials or nonrandomized subgroup analyzes of studies of cardiovascular disease. prospective cohorts.
A recent cohort study found that a higher level of exercise not only tended to reduce the risk of death from all causes among patients with CVD , but also resulted in a greater survival benefit than in people without CVD . Our results were consistent with these findings and were robust even after adjusting for covariates in the Cox regression models and after analyzing the results in subgroups divided by age, sex, degree of comorbidities, and type of CVD.
Change in exercise habits and death in older adults
The WHO guideline describes the impact of regular moderate-intensity exercise on all-cause cardiovascular deaths in older adults. However, it simply extrapolates the conclusion of studies that showed benefits in middle-aged adults because no upper age limit criterion was established. Few studies to date have investigated a specific group of older people, and some studies have failed to prove that exercise improves prognosis.
Our current study showed that starting or maintaining regular exercise was associated with a lower risk of death from all causes, cardiovascular or non-cardiovascular.
Although the results among new athletes were not statistically significant for cardiovascular death, they were consistent with the trend observed in the main analysis regardless of various sensitivity and subgroup analyses. A recently published study examined physical activity trajectories in older adults with incident CVD and overall mortality. Some results in more virtuous trajectories of physical activity when considering cardiovascular outcomes and overall mortality are in the same direction as those found in the present paper.
In our study, although patients ≥75 years of age had reduced benefits with respect to death prevention compared with those younger than 75 years, the benefits were statistically significant. Barbiellini et al showed comparable results that the interaction with age supports a stronger effect of physical activity in early life rather than later in life. Therefore, our results suggest that the adoption and maintenance of regular exercise should not be ignored in older patients , even considering the reduced benefits obtained from exercise.
Final message Initiating or maintaining at least 5 days of moderate-intensity activity or 3 days of vigorous-intensity activity per week is associated with a reduced risk of all-cause cardiovascular and noncardiovascular deaths in older adults with newly diagnosed CVD. Exercise is important and should be recommended for older adults with CVD. |
