Prevent cardiovascular disease, start with exercise

  Physical activity is the basic skill that human beings rely on for survival since evolution. However, in modern society, with the rapid development of science and technology, and the emergence of transportation tools such as cars and elevators, humans can easily obtain food and water without walking, and physical activity is no longer a necessary skill to sustain life. If work is sedentary, it seems that there is no need for any physical activity. But is this really the case? In fact, this change in lifestyle is exactly the beginning of human digging.
  At present, obesity and related chronic diseases, especially cardiovascular diseases, are increasing year by year due to reduced physical activity and energy imbalance. Studies have shown that regular physical exercise is an effective way to prolong life and reduce the incidence of cardiovascular diseases. For patients with cardiovascular disease, regardless of primary prevention or secondary prevention, moderate exercise is recommended. So, how to grasp this “right amount”? It is recommended that different groups of people choose different exercise programs.
Exercise can “repel” multiple cardiovascular disease risk factors

  There are many risk factors for cardiovascular disease, and exercise can achieve different cardiovascular disease outcomes by intervening in different risk factors. In clinical practice, individualized exercise prescriptions need to be formulated according to the situation of different populations. The effects of exercise on different risk factors are briefly summarized as follows:
  In general, the effect of regular exercise on blood lipids is biased toward beneficial. For high-density lipoprotein (HDL), multiple studies have consistently confirmed its effectiveness; but for low-density lipoprotein (LDL) and triglycerides, there are still conflicting results.
  There have been a lot of studies on blood pressure to explore the relationship between exercise and blood pressure. Large observational studies suggest that the greater the amount of activity, the lower the incidence of hypertension. A small controlled experiment conducted a study on elderly hypertensive patients, suggesting that low-intensity exercise has a better effect on lowering blood pressure than high-intensity exercise. But several other studies have shown that compared with low-intensity continuous exercise, high-intensity intermittent exercise has a more significant blood pressure reduction effect. In short, the effect of exercise on blood pressure is positive, but there is no definite dose-effect relationship study, nor is it clear the minimum exercise threshold that can improve blood pressure.
  Epidemiological data of insulin and glucose metabolism show that exercise can improve metabolism, increase insulin sensitivity and non-insulin-mediated glucose metabolism of skeletal muscle. Although studies have suggested that high exercise volume can improve insulin sensitivity, existing guidelines still recommend moderate-intensity exercise programs.
  Weight loss is the most direct result of exercise. Exercise can change the body’s energy balance, but the factor that affects energy balance is calorie intake. The minimum amount of exercise required for weight control or weight loss is far greater than the amount of exercise required to reduce the risk of cardiovascular disease. It is necessary to emphasize the goal of reducing fat by strengthening exercise and controlling caloric intake.
  A large number of studies on physical fitness have shown that physical fitness (Editor’s note: refers to the body’s ability to have sufficient energy to engage in daily work and study without being tired, while having spare energy to enjoy leisure activities, and the ability to adapt to emergencies). There is a negative correlation between mortality and cardiovascular event mortality. A study that followed up with elderly male veterans for 20 years suggested that for every additional MET (metabolic equivalent, which is the ratio of the metabolic rate during exercise to the metabolic rate at rest) exercise value, the risk of death decreased by 12%. Regardless of age and gender, any increase in the amount of exercise (such as frequency, intensity, and duration) promotes an increase in physical fitness. There are many factors that affect physical fitness. In addition to exercise, it also includes age, gender, weight, and heredity. It is worth mentioning that the impact of exercise on physical fitness is greater than other traditional cardiovascular disease risk factors. This partly explains why the cardiovascular protective effects of exercise far exceed the sum of its expected effects on traditional cardiovascular risk factor interventions.
Exercise recommendation cannot be absolute

  Exercise is an important part of daily activities and is relatively easy to quantify, so it has always been a focus of research on total activity. But now everyone is starting to pay more and more attention to the relationship between total activity and health, thus putting forward the concept of non-exercise activity. The clinically recommended exercise goal value is 10,000 steps per day, which was proposed by Japan in the 1960s. Although there are some reports in the literature that the amount of activity in this range is beneficial to health, there is still no clear scientific basis to support this formulation. Therefore, the relationship between this non-exercise activity and health needs further research. But clinically, the use of fitness monitors is encouraged, because patients tend to increase their activity level.
  The guidelines recommend large-scale flow adjustment data show that: moderate-intensity exercise for less than 0.5 hours per week has a high risk of death, and 1.5 hours of moderate-intensity exercise per week can reduce the risk of death by 20%; if it is to be reduced by another 20% (total 40%) ), you need to add 5.5 hours/week of moderate-intensity exercise (7 hours/week in total). The study also found that if the amount of exercise increased again, the risk of death would continue to decrease, and no extreme amount was found. However, none of these studies provide values ​​for the minimum and optimal amount of exercise.
  The amount of activity that is lower than recommended by the guideline is mostly required to maintain health, but it is not that lower than this dosage is useless. It is currently believed that even a small amount of exercise is good for health. Therefore, for those patients who are completely inactive, it is clinically recommended that even the smallest amount of activity can improve their health.
  Higher than recommended by the guidelines At present, more and more people around the world are starting to do a lot of sports, such as want to participate in sports competitions or want to control their weight. For a large number of sports, previous epidemiological data are from athletes, who have continued to perform high-intensity sports for the first half of their lives. The result of the observation is that these athletes obviously rarely go to the hospital, and few people suffer from asthma, cardiovascular disease and anti-inflammatory drugs, and they live longer than the non-athlete control group. Despite these convincing preliminary results, recent studies have concluded that high-level vigorous exercise does more harm than good. Some studies believe that the end of the dose-response curve of exercise volume and mortality may be J-shaped or U-shaped, indicating that a lot of vigorous exercise has reduced the benefits of exercise. This study shows that light and moderate exercise have a continuous positive effect on health, and continuous increase in exercise volume cannot lead to better outcomes, but it is also harmless. Therefore, the amount of exercise should be fully considered when performing secondary prevention and developing a cardiac rehabilitation plan for patients with cardiovascular disease.
  In short, exercise is like drugs used in clinical practice. It is best to be quantified, including intensity, duration and frequency. The existing sports-related guideline data are mostly based on the existing epidemiological basis. In the clinical practice of cardiovascular disease, the amount and type of exercise should be individualized according to different individuals and different goals. Therefore, patients with cardiovascular disease must find a professional doctor for evaluation before exercising.