Taking steps toward a healthier heart
Regular exercise is important for everyone’s health, but new research shows that it is especially important for those with cardiovascular disease.
The study, which was done in South Korea, compared a group of 310,240 healthy people with a group of 131,558 people who had been diagnosed with pre-existing cardiovascular disease over a period of nearly six years. The median age of participants was 59.5 years of age.
The physical activity monitored was actual aerobic exercise and not daily activities, such as housework or gardening. Researchers then converted the data on exercise into metabolic equivalent task (MET) minutes per week. For every 500 MET minutes per week, healthy people saw a 7 percent reduction in premature death risk. Those with pre-existing cardiovascular disease saw a 14 percent reduction with the same MET score.
Cardiologist Eleanor Sullivan, MD, at Cape Cardiology in Brewster, said the study was unusual in its scope and its narrow subject, compared to most cardiology literature.
“There aren’t a lot of studies that show the relationship between exercise and mortality,” she said. “A lot of the cardiology literature does show a reduced death rate, but in the cardiology literature it’s usually a combination of what we call major adverse cardiac events, so that is usually heart attacks, heart failures, stroke and death. Here they really only used the ultimate endpoint – death.”
You can reach 500 MET minutes per week by brisk walking for 30 minutes, five times a week or by doing vigorous physical activity for 75 minutes once a week, according to the study co-author Dr. Si-Hyuck Kang.
When a person has already had a heart attack or is diagnosed with heart failure, it is especially important to begin exercising. That is one way to turn a frightening and life-changing event into a positive thing, Dr. Sullivan said.
“It’s a wonderful time to try to change people’s behavior,” she said. “I think that is one of the real benefits of cardiac rehab programs; Cape Cod Hospital and Falmouth both have robust rehab programs. It really is a time to get in there, spend more intensive time educating the patient and building a behavioral pattern because they have a scheduled time in their day they are supposed to be exercising.”
Even though the benefits were greater for those who already had cardiovascular disease, healthy people should aim for the same amount of exercise per week to prevent heart disease from occurring in the first place, Dr. Sullivan said.
“There are a number of reasons exercise is good for your heart,” she said. “We know that it has benefit on your risk factors. It can lower blood pressure. It can lower lipids. It can lower glucose. It can lower inflammation. Those are the standard ones, but we also know that it helps you sleep better. It helps you feel better. So, for some of those less traditional risk factors of heart disease you also see improvement there.”
The problem cardiologists face is getting people to change their behavior. In the Korean study, 50 percent of the people exercised very little and about 30 percent reported no physical activity. Study participants with pre-existing cardiovascular disease were the least likely to exercise.
Those numbers are similar to figures from the United States and Europe, Dr. Sullivan said. Part of it is lifestyle; many jobs keep people chained to desks. But it is also hard to get people to shake up their daily patterns.
“I think people who are the most successful at exercising do it at the same time every day,” she said. “Generally, the highest successes are usually those people who do it first thing in the morning before the rest of the day bogs them down.”
Dr. Sullivan regularly tells patients to exercise more, lose weight and eat more of a plant-based diet. Some patients take her advice seriously and see huge benefits. One of the things that she tries to do with her patients is to figure out how their day works and see where exercise can be fit into their schedule.
Also, some patients have other health considerations, like arthritis, to figure into the equation. Those patients need a modified exercise plan like riding a stationary bike or doing a water-based exercise program.
“It has to be very individualized,” she said. “It can’t be cookie cutter because that’s just not going to work for everyone.”