The Role of Sleep and Physical Activity on the Risk for Cardiovascular Disease

Sleep and physical activity are important health behaviors promoting cardiovascular health. Large bodies of literature have documented the direct effects of sleep and physical activity on risk factors for cardiovascular disease (CVD). This review aimed to highlight the interactive effect of sleep and physical activity on CVD risk. The extant literature suggests that sleep and physical activity are lifestyle behaviors that interact and act synergistically to influence CVD risk. Adopting healthy lifestyles encompassing both adequate sleep and regular physical activity is optimal to maintain cardiovascular health.     

Physical activity and coronary heart disease: prevention and effect on risk factors

The general public recommendation to accumulate 30 minutes of daily physical activity on most, preferably all, days of the week was recently modified by the National Academy of Science Institute of Medicine to at least 60 minutes of cumulative daily physical activity to maintain cardiovascular health at a maximal level. Data suggest that regular physical activity, even as little as 30 minutes daily, can positively impact cardiovascular health by improving many of the major risk factors associated with coronary heart disease, including hypertension, dyslipidemia, obesity, insulin resistance, and endothelial function. With the recent and rapid rise in the rate of obesity in the United States, a doubling of the dose of physical activity daily may help offset the trend of increased caloric intake that has contributed to this epidemic. We briefly review the evidence regarding the amount and intensity of physical activity necessary to alter these cardiovascular risk factors with the goal of reducing coronary events.     

Too little exercise and too much sitting: Inactivity physiology and the need for new recommendations on sedentary behavior

Moderate-to vigorous-intensity physical activity has an established preventive role in cardiovascular disease, type 2 diabetes, obesity, and some cancers. However, recent epidemiologic evidence suggests that sitting time has deleterious cardiovascular and metabolic effects that are independent of whether adults meet physical activity guidelines. Evidence from “inactivity physiology” laboratory studies has identified unique mechanisms that are distinct from the biologic bases of exercising. Opportunities for sedentary behaviors are ubiquitous and are likely to increase with further innovations in technologies. We present a compelling selection of emerging evidence on the deleterious effects of sedentary behavior, as it is underpinned by the unique physiology of inactivity. It is time to consider excessive sitting a serious health hazard, with the potential for ultimately giving consideration to the inclusion of too much sitting (or too few breaks from sitting) in physical activity and health guidelines.     

Physical activity and the prevention of cardiovascular disease

This article summarizes recent evidence on the role of physical activity in the prevention of overt and subclinical vascular disease. Epidemiologic data suggest that as little as 30 minutes per day of moderate-intensity physical activity, including brisk walking, reduces the incidence of clinical cardiovascular events in men and women. Regular exercise may also retard the progression of asymptomatic coronary and peripheral arteriosclerosis. Cardioprotective mechanisms of physical activity include reducing adiposity, blood pressure, diabetes incidence, dyslipidemia, and inflammation, and enhancing insulin sensitivity, glycemic control, fibrinolysis, and endothelial function. In a sedentary society such as the United States, public health initiatives that promote moderate increases in activity represent the optimal balance between efficacy and feasibility to achieve desired improvements in cardiovascular health.     

"You aren't going to get better by just sitting around": physical activity perceptions,motivations, and barriers in adults 75 years of age or older

Despite accumulating evidence of cardiovascular benefits associated with physical activity in older people, sedentary behavior increases with age. Few physical activity research studies focus on underactive adults 75 years and older. In-depth qualitative interviews using open-ended questions explored perceptions, motivations, and barriers to physical activity in 33 previously sedentary or underactive adults age ≥75. Data were analyzed using the NUD*IST (Non-numerical, Unstructured Data Indexing, Searching, and Theorizing) qualitative analysis program. Participants saw sedentary behavior as harmful, considered themselves relatively active, were unsure of amounts of physical activity to do, and welcomed more physical activity information from their doctors. Motivations included health, independence, family, and appearances. Barriers were poor health, lack of time, aging, and adverse environments. Results suggest that people continue to be interested in physical activity as they age, but some misperceptions about physical activity exist. Even with health problems and age, physical activity counseling by doctors is valued and considered helpful by this age group.     

The impact of COVID-19 on cardiovascular health behaviors in student veterans

Background and aimsPandemics have previously resulted in increased cardiovascular morbidity and mortality. It is unclear if the effects of the COVID-19 pandemic will be amplified in individuals at high risk for cardiovascular disease, such as military populations, resulting in augmented cardiovascular events in Veterans. The purpose of this study was to determine if traditional behavioral risk factors for cardiovascular disease are amplified due to the COVID-19 pandemic and if risk factors are more prevalent in Veterans compared to non-Veterans.Methods and resultsThirty-two student Veterans and 46 non-Veteran students between the ages of 18 and 35 completed a Qualtrics self-report questionnaire assessing health behaviors, physical activity, and mental health both before and during COVID-19. Veterans displayed worse pre-COVID cardiovascular health behaviors such as poor sleep habits, greater use of tobacco, alcohol, and energy drinks, and lower values of social engagement compared to non-Veterans. Many health behaviors remained unchanged in student Veterans during the pandemic. The non-Veteran group exhibited augmentation of cardiovascular health behaviors during COVID-19, shown through the worsening sleep habits, increased anxiety, and reduced physical activity.ConclusionStudent Veterans demonstrate heightened risk for cardiovascular disease based on the pre-COVID elevation of behavioral risk factors. These behavioral factors continued to remain elevated during the COVID-19 pandemic. Non-Veteran students displayed amplification of behavioral risk factors for cardiovascular disease due to the COVID-19 pandemic. These results highlight the need for resources and interventions for our student veterans and suggest long-term cardiovascular consequences for all students who suffered through the COVID-19 pandemic.     

Exercise and heart disease in women: why, how, and how much?

Despite a traditional view that cardiovascular disease primarily affects men, a growing body of information now recognizes that it is a disease that equally affects women and is the leading cause of morbidity and mortality in women in the United States. Both physical activity and physical fitness have been shown to have an inverse association with coronary heart disease and cardiovascular risk factors. Furthermore, physical inactivity is now recognized by the American Heart Association as an independent risk factor for coronary heart disease. However, national surveillance programs have reported that 1/4 of adults are currently sedentary, and 1/3 of women do not engage in any leisure-time physical activity. Regular exercise may significantly impact coronary heart disease in women, as some coronary risk factors have a stronger predictive value for coronary heart disease in women as compared with men. Recent studies have shown that women who exercise regularly are less likely to develop diabetes mellitus; exercise may reduce blood pressure and produce improvements in lipid profiles. Conflicting data exist regarding the dose and intensity of exercise necessary to achieve significant health benefits; however, many reports demonstrate a reduced risk of mortality from cardiovascular diseases and from all causes with only moderate intensity physical activity. The Centers for Disease Control, American Heart Association, and American College of Sports Medicine recommend a regular pattern of physical activity of moderate intensity, which can be accumulated throughout the day and should be performed at least 3 to 5 days per week. In addition, the benefit of weight-bearing exercise should be underscored in women, because it plays an important role in the prevention and treatment of osteoporosis. Continued efforts are necessary to encourage the many American women who are currently inactive to make even modest increases in levels of physical activity to achieve substantial cardiovascular, as well as other, health benefits.     

Physical activity in primary and secondary prevention of cardiovascular disease: Overview updated

Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.     

The emergence of sedentary behaviour physiology and its effects on the cardiometabolic profile in young and older adults

It has recently emerged that sedentary behaviour is independent of a lack of physical activity as individuals can be sufficiently active, based on the recommended physical activity guidelines, but also spend the majority of their waking hours engaging in sedentary behaviour. Individuals who follow this pattern of physical activity and sedentary behaviour are known as ‘active couch potatoes’. Sedentary behaviour has been found to have detrimental effects on cardiometabolic markers associated with cardiovascular disease. Since the positive effects of moderate-to-vigorous intensity physical activity do not necessarily negate the deleterious effects of sedentary behaviour on cardiometabolic markers, it is postulated that engaging in light physical activity is an intervention that will successfully reduce levels of sedentary behaviour and may hence improve health markers of quality of life. We propose that such lifestyle changes may be particularly relevant to older populations as these engage in sedentary behaviour for the majority of their waking hours, thereby adding to the negative aging effect on cardiometabolic markers.     

Physical activity,fitness and fatness: relations to mortality,morbidity and disease risk factors. A systematic review

The purpose of this systematic review was to study the relative health risks of poor cardio‐respiratory fitness (or physical inactivity) in normal‐weight people vs. obesity in individuals with good cardio‐respiratory fitness (or high physical activity). The core inclusion criteria were: publication year 1990 or later; adult participants; design prospective follow‐up, case–control or cross‐sectional; data on cardio‐respiratory fitness and/or physical activity; data on BMI (body mass index), waist circumference or body composition; outcome data on all‐cause mortality, cardiovascular disease mortality, cardiovascular disease incidence, type 2 diabetes or cardiovascular and type 2 diabetes risk factors. Thirty‐six publications filled the criteria for inclusion. The data indicate that the risk for all‐cause and cardiovascular mortality was lower in individuals with high BMI and good aerobic fitness, compared with individuals with normal BMI and poor fitness. In contrast, having high BMI even with high physical activity was a greater risk for the incidence of type 2 diabetes and the prevalence of cardiovascular and diabetes risk factors, compared with normal BMI with low physical activity. The conclusions of the present review may not be applicable to individuals with BMI > 35.     

Steps to Better Cardiovascular Health: How Many Steps Does It Take to Achieve Good Health and How Confident Are We in This Number?

Pedometers and other types of step-counting devices are growing in popularity with both researchers and practitioners. The focus of this article is on describing the most recent pedometer-related advances in terms of cardiovascular health. The emergent body of evidence suggests that pedometer-determined physical activity is related to a number of cardiovascular health outcomes and that intervention participants can realize modest changes in body mass index and blood pressure. Taking into consideration individual baseline values, tailored messages congruent with public health recommendations should promote incremental increases in steps/day on the order of an extra 3,000 to 4,000 (approximately 30 min) of at least moderate intensity and taken in at least 10-minute bouts. Additional health benefits accrue with greater increases. Of course, even more benefits are possible from engaging in vigorous physical activity, but this seems less appealing for most people. Pedometer-based guidelines are not intended to supplant existing public health recommendations, but rather supplement them.     

Putting the 2008 Physical Activity Guidelines Into Practice to Prevent Cardiovascular Disease

In 2008, the federal government of the United States issued its first-ever physical activity guidelines for Americans. These guidelines were based on a large body of scientific evidence, including evidence showing that physical activity can reduce the risk of developing cardiovascular disease. The guidelines encourage any amount of physical activity, and ideally encourage 150 min/wk of moderate-intensity aerobic activity or 75 min/wk of vigorous-intensity physical activity, or the equivalent in moderate plus vigorous activities. Physical activity can be accumulated in bouts of at least 10 min in duration to count toward the total. Amounts of physical activity exceeding the target are associated with additional risk reductions in cardiovascular disease. Although there are risks associated with physical activity, primarily musculoskeletal injuries, the benefits of physical activity clearly outweigh the risks. To minimize these risks, a “start low and go slow” approach is recommended. Physical activity is indeed a “best buy” for public health.     

Cardiorespiratory fitness relates more strongly than physical activity to cardiovascular disease risk factors in healthy children and adolescents: the European Youth Heart Study.

BACKGROUND: Physical activity and cardiorespiratory fitness are closely related to health variables in adults, especially those considered to be among risk factors for cardiovascular diseases. The possible tracking of cardiovascular disease risk factors from childhood to adulthood makes it important to increase our understanding of the complex relationships between physical activity, cardiorespiratory fitness and cardiovascular risk factors early in life. DESIGN: A cross-sectional, school-based study on healthy children and adolescents, aged 9-10 years (295 girls, 295 boys) and 15-16 years (302 girls, 233 boys) was performed during a school year in Sweden and Estonia, as part of the European Youth Heart Study. METHODS: Total physical activity, and minutes spent in inactivity and activity of moderate or higher intensity were measured by accelerometry. A maximal ergometer bike test was used for estimation of cardiorespiratory fitness. The risk factors included blood pressure and fasting blood levels of insulin, glucose, triglycerides, total cholesterol and high-density lipoprotein cholesterol. RESULTS: Canonical correlations between physical activity and cardiorespiratory fitness versus cardiovascular disease risk factors showed significant associations in both age and sex groups (rc=0.46-0.61, P<0.0001). The cardiorespiratory fitness was found to be the strongest contributor to these relationships. In girls high values of the physical activity variables were also associated with a favourable cardiovascular profile. CONCLUSIONS: Cardiorespiratory fitness relates more strongly to cardiovascular risk factors than components of objectively measured physical activity in children and adolescents. Physical activity becomes more important in the 15-year-old adolescents, indicating that these modifiable lifestyle factors increase in importance with age.     

Low level of physical fitness in Spanish adolescents. Relevance for future cardiovascular health (AVENA study)

INTRODUCTION AND OBJECTIVES: Several studies have demonstrated that physical fitness in childhood and adolescence is related to cardiovascular risk in adulthood. Current data on the physical fitness of Spanish adolescents are not available. Therefore, the aims of this study were: a) to assess the physical fitness of Spanish adolescents and establish reference values for use in health and educational settings as indicators of cardiovascular health, and b) to determine the percentage of Spanish adolescents below the minimum level of aerobic fitness needed to guarantee future cardiovascular health. SUBJECTS AND METHOD: The modified EUROFIT battery of tests was used to assess physical fitness in a representative sample of Spanish adolescents (n=2859; 1357 boys and 1502 girls) taking part in the AVENA (Alimentación y Valoración del Estado Nutricional de los Adolescentes) study. RESULTS: Standard parameters for the physical condition of Spanish adolescents are reported in this study. The 5th percentile for maximum aerobic capacity (Course Navette test) ranged from 2.0-3.3 palier in boys and from 1.4-1.9 palier in girls. The findings indicate that, on the basis of aerobic fitness, approximately 20% of Spanish adolescents have an increased risk of future cardiovascular disease. This subgroup also performed poorly in all other tests of physical fitness used. CONCLUSIONS: The results reported in this study enable the level of physical fitness in adolescents to be interpreted as an indicator of future cardiovascular health. They also indicate that the physical fitness of Spanish adolescents must be improved to help protect against cardiovascular disease in adulthood.     

The Limits of Cardiac Performance: Can Too Much Exercise Damage the Heart?

Routine moderate-intensity physical activity confers numerous cardiovascular benefits and reduces all-cause mortality. However, the health impact of exercise doses that exceed contemporary physical activity guidelines remains incompletely understood, and an emerging body of literature suggests that high levels of exercise may have the capacity to damage the cardiovascular system. This review focuses on the contemporary controversies regarding high-dose exercise and cardiovascular morbidity and mortality. We discuss the limitations of available studies, explore potential mechanisms that may mediate exercise-related cardiac injury, and highlight the gaps in knowledge for future research.     

Higher Physical Activity Is Associated With Lower Aortic Stiffness but Not With Central Blood Pressure: The ADDITION-Pro Study

Physical activity is associated with reduced cardiovascular disease risk. However, improvements in conventional risk factors due to physical activity do not explain its full benefit. Therefore, we examined associations of objectively measured physical activity energy expenditure and intensity with central hemodynamics to provide new insight into the link between physical activity and cardiovascular disease.We analyzed data from 1816 Danes (median age: 66 years) without cardiovascular disease. Physical activity was estimated using combined accelerometry and heart rate monitoring. Aortic stiffness was assessed by applanation tonometry, as aortic pulse wave velocity, and central blood pressure was estimated from radial waveforms. Associations between physical activity energy expenditure and central hemodynamics were examined by linear regression. Furthermore, the consequence of substituting 1 hour sedentary behavior with 1 hour light or moderate-to-vigorous physical activity on central hemodynamics was examined.Median physical activity energy expenditure was 28.0 kJ/kg/d (IQR: 19.8; 38.7). A 10 kJ/kg/d higher energy expenditure was associated with 0.75% lower aortic pulse wave velocity (CI: −1.47; −0.03). Associations with central systolic blood pressure and central pulse pressure were not statistically significant. We observed no difference in central hemodynamics when substituting 1 hour sedentary behavior with 1 hour light or moderate-to-vigorous physical activity.In this relatively inactive population, higher physical activity energy expenditure was associated with lower aortic stiffness, while there was no statistically significant association between substitution of activity intensity and central hemodynamics. This suggests that lower aortic stiffness is one of a number of health benefits attributed to higher habitual physical activity.     

Do paediatric cardiologists discuss cardiovascular risk factors with patients and their families?

Atherosclerotic disease of the heart likely has its origins in childhood. The promotion of cardiovascular health in children, however, has been studied only for those practicing in general paediatrics. We hypothesised that paediatric cardiologists do not consistently discuss cardiovascular risk factors with patients and their families. We therefore, carried out a nationwide survey of paediatric cardiologists to determine how often they discussed atherosclerosis and 4 modifiable risk factors, specifically weight, smoking, diet and nutrition, and physical activity. Only two-fifths reported that they discussed atherosclerotic disease frequently to always. For patients with cardiovascular disease, weight was discussed frequently to always by 59%, smoking by 61%, diet and nutrition by 63%, and physical activity by 92%. In contrast, for patients without cardiovascular disease, weight was discussed frequently to always by 35%, smoking by 46%, diet and nutrition by 39%, and physical activity by 62%. These differences are statistically significant (p < 0.003 by chi2 analysis). Cardiovascular risk factors were discussed more consistently as children grew older (p < 0.0001). Respondents stated that, in their opinion, the promotion of cardiovascular health was a role more appropriate for providers of primary care than for paediatric cardiologists (p < 0.0001). Constraints of time, and the perceived role of the cardiologist, were the most common barriers to anticipatory guidance. We suggest that these findings indicate that paediatric cardiologists can assume a more prominent role in preventive cardiology and education, although their precise role or roles, and the optimal methods of anticipatory guidance, remain controversial.     

Reduced Physical Activity During COVID-19 Pandemic in Children With Congenital Heart Disease

Children with congenital heart disease (CHD) are at risk for both COVID-19 and secondary cardiovascular outcomes. Their increased cardiovascular risk may be mitigated through physical activity, but public health measures implemented for COVID-19 can make physical activity challenging. We objectively measured the impact of the COVID-19 pandemic on physical activity, continuously measured by Fitbit step counts, in children with CHD. Step counts were markedly lower in late March and early April 2020, compared with 2019 and early March 2020. It is vital to understand how precautions for COVID-19 will affect the health of children with CHD, especially if they persist long term.     

Physical activity and cardiovascular prevention: Is healthy urban living a possible reality or utopia?

Favoring correct lifestyles is the most important measure to contrast cardiovascular diseases and the epidemic of high cardiovascular risk conditions, such as obesity, diabetes, and hypertension. Lifestyle is a broad expression that includes diet, physical exercise, and psychological and socio-economic factors, each of which must be taken into due consideration because of their intertwining influences, which may be a barrier to healthy changes at both the individual and population levels. While physical activity has probably received less attention in the last decades, it is likely the most important among the modifiable risk factors for cardiovascular diseases. Improving the habitual physical activity level is an achievable goal, and even small improvements may have important favorable effects on health. Strategies at the population level have to be urgently taken, and involve not only public health, but also administrators and politicians, starting from a rethinking of our cities.