Exercise Intensity and Type Influence Cardiovascular Mortality

Goals

To estimate the relationship between the volume, type, and intensity of physical exercise with all-cause mortality and recurrent vascular events in patients with cardiovascular disease (CVD), and to quantify the extent to which traditional cardiovascular risk factors mediate these relationships.

Methods

In the prospective UCC-SMART cohort (N=8660), associations of clinical endpoints and physical exercise volume (metabolic equivalent of work hours per week, METh/week), type (endurance vs strength + endurance ) and intensity (moderate vs. vigorous) were estimated using multivariable-adjusted Cox models.

The ratio-mediated effect (PME) via body mass index, systolic blood pressure, low-density lipoprotein cholesterol, insulin sensitivity, and systemic inflammation was assessed using structural equation modeling.

Results

Sixty-one percent of patients (73% male, age 61 ± 10 years, >70% receiving lipid-lowering and blood pressure medications) reported no exercise. During a median follow-up of 9.5 years [IQR 5.1-14.0], 2256 deaths and 1828 recurrent vascular events occurred.

The association between exercise volume had an inverse J shape with a nadir of 29 (95% CI 24-29) METh/week, corresponding to an HR 0.56 (95% CI 0.48-0.64) for all-cause mortality and HR 0.63 (95% CI 0.55-0.73) for recurrent vascular events compared to no exercise.

Up to 38% (95% CI 24-61) of the association was mediated by the assessed risk factors of which insulin sensitivity (PME up to 12%, 95% CI 5-25) and systemic inflammation (PME up to 18%, 95%CI 9-37) were the most important.

Exercise Intensity and Type Influence Cardiovascul

Conclusion

Regular physical exercise is significantly related to reducing the risks of all-cause mortality and recurrent vascular events in patients with CVD. In this population with high rates of lipid-lowering and blood pressure medication use, the benefits of exercise were primarily mediated by systemic inflammation and insulin resistance.

Final message

People who have previously experienced cardiovascular events, such as a heart attack or stroke, have a lower risk of a recurrent event or mortality when they engage in regular physical exercise because exercise beneficially affects cardiovascular risk factors.
Time spent exercising is the most important determinant of exercise benefits; Similar cardiovascular benefits can be achieved with different types and intensities of exercise. It is important to choose an exercise modality that suits personal preferences and abilities, as any level of exercise is better than no exercise.
In the context of well-treated CVD patients, the benefits of exercise occur through beneficial modification of cardiovascular risk factors, particularly inflammation and insulin sensitivity.

Exercise Intensity and Type Influence Cardiovascular Mortality

Physical exercise’s volume, type, and intensity mediate the risk of all-cause mortality and cardiovascular events in patients with cardiovascular disease, according to a mediation analysis.