What level of physical activity is helpful?

Cardiovascular disease (CVD) is a broad term. As the National Institutes of Health (NIH) notes, CVD is any disease that impacts the heart or blood vessels, while heart disease includes disorders that specifically affect the heart.

Several disorders fall under the category of CVD, including:

The treatments for CVD can vary. Depending on the severity of the issue, people with CVD may need to take medications or undergo surgery.

Several risk factors increase a person’s risk of getting CVD. For example, the Centers for Disease Control and Prevention (CDC) note that having high blood pressure, high cholesterol, or diabetes increases a person’s risk for heart disease.

People can modify some risk factors to help prevent adverse health outcomes due to CVD.

Experts are still discovering how individuals can best prevent CVD and reduce their overall risk of death. Physical activity has been the subject of many studies, and experts are still learning who benefits from it the most.

The study in question was a cohort study that researchers conducted in the Netherlands. It included a total of 142,493 participants. The team wanted to find out if people’s cardiovascular health status impacted the overall benefit of physical activity.

In other words, is physical activity helpful for everyone at the same level or does it help those who already have CVD more?

Researchers also wanted to find out if the reason for the physical activity impacted the benefits. For example, are people who have to be physically active for a job reaping the same benefits as those who are physically active in their leisure time?

Because there are so many risk factors and CVD includes many disorders, researchers in this study had to define their terms carefully.

They looked at three broad groups of people and used the following definitions:

• Healthy individuals: These participants had all cardiovascular risk factors in a normal range and reported no known CVD.
• Individuals with at least one CVD risk factor: These participants had either self-reported high blood pressure, high cholesterol, and/or diabetes, plus medications to control the respective risk factors, or had confirmed high cholesterol or blood sugar levels, and no reported CVD.
• Individuals with CVD: These individuals had a history of heart failure, heart attack, or stroke and used medications for these conditions.

Each participant filled in a baseline questionnaire and undertook a physical exam. The questionnaire included information about lifestyle, health history, and diet. Researchers collected baseline data from each participant and followed up with them an average of 6.8 years later after collecting the baseline data.

The team further questioned participants about their level of physical activity. This information determined each participant’s amount of exercise that fit the study’s definition of moderate to vigorous.

They also divided types of physical activity into three categories:

1. Leisure physical activity was all the moderate-to-vigorous physical activity that participants did during their leisure time.
2. Nonleisure physical activity was all the moderate-to-vigorous physical activity that people did not do in their leisure time, such as during work or household chores.
3. Occupational physical activity was all the moderate-to-vigorous physical activity that participants did related to work. This was a subcategory of nonleisure physical activity.

The team looked at the relationship between moderate-to-vigorous physical activity, all causes of death, and major adverse cardiovascular events. They included heart attacks, strokes, chronic and acute heart failure, and any major heart or chest-related surgeries, such as heart transplants and heart bypass surgeries, in their analysis of major adverse cardiovascular events.

Researchers found that overall, moderate-to-vigorous physical activity had links to lower all-cause mortality and major adverse cardiovascular events. But they also found that it was most beneficial to the group of participants that already had CVD.

Study first author, Dr. Esmée Bakker, explained to Medical News Today that “for healthy individuals and those with cardiovascular risk factors, such as hypertension and diabetes, we found that increasing exercise volumes led to a gradual risk reduction up to a point at which a plateau occurs.”

Dr. Bakker went on to explain that this result was different for participants who already had CVD:

“Cardiovascular disease patients demonstrated a different pattern, however, with every increase in physical activity volume leading to a further risk reduction of mortality and cardiovascular events. This finding emphasizes that more exercise is better for [CVD] patients.”

Researchers also found that moderate-to-vigorous physical activity that participants did in their leisure time was associated with the highest level of health benefits. Nonleisure moderate-to-vigorous physical activity was associated with some health benefits, and occupational moderate-to-vigorous physical activity was associated with no benefits.

Overall, the researchers concluded that physical activity recommendations should consider cardiovascular health status and the physical activity’s — leisure versus nonleisure — nature.

However, the study did have some limitations. First of all, the research was observational, meaning it cannot prove that higher physical activity prevents mortality or adverse cardiovascular events. Secondly, some of the data were self-reported, which runs the risk of inaccurate data collection.

Dr. Edo Paz, cardiology specialist VP of Medical at K Health, noted the following study limitations to MNT:

“First off, activity level is self-reported, which can be inaccurate. Another key limitation of this study is that it is an observational study and thus limited by confounding. That means that exercise may be highly correlated with another factor (like weight, nutritional status, etc.), and it is actually that other factor that predicts cardiovascular events. Although the authors tried to account for these confounding factors, it is not possible to collect or control for them all.”

Finally, the authors did not examine the impact of light intensity physical activity — the study specifically examined moderate-to-vigorous physical activity.

The researchers note that other studies have looked at how doing some physical activity is better than doing none at all. They note that starting with lower levels of physical activity can help some people increase their regular physical activity level.

It is also important to remember that everyone is different, and physical activity levels will look different for different people.

Dr. Paz told MNT: “It seems clear that physical activity is an important part of a healthy lifestyle, which is why the American Heart Association (AHA) recommends getting 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity. However, this study indicates that these recommendations should always be personalized.”

Overall, the results indicate that physical activity recommendations should take into account a person’s cardiovascular health.

Dr. Bakker explained that the “[o]utcomes from this study are useful to further optimize physical activity recommendations by taking cardiovascular health status into account so that every individual, irrespective of cardiovascular health status, can optimally benefit from a physically active lifestyle.”

Further research would include looking at how to implement the best exercise plans for people with CVD.

Cardiology specialist Prof. Bernard Cheung — Sun Chieh Yeh Heart Foundation professor in Cardiovascular Therapeutics at the University of Hong Kong Faculty of Medicine — explained to MNT that “[c]aution should be exercised before getting cardiovascular disease patients to exercise to their limits […] more research is needed on what exercise programs are best for patients with different forms of cardiovascular disease (e.g., angina, heart failure).”

“The present study highlights the importance of evidence-based recommendations in this area,” he noted.