Survival of the Fittest: Impact of Cardiorespiratory Fitness on Outcomes in Men and Women with Cardiovascular Disease |
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| Affiliation: | 1. Centers for Preventive and Behavioral Medicine, The Miriam Hospital, 1 Hoppin St, Providence, RI 02903, United States;2. Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI 02903, United States;3. The Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St, Providence, RI 02903, United States;4. Providence Veterans Affairs Medical Center, Providence, RI 02908, United States;5. Department of Behavioral and Social Sciences and Epidemiology, Brown School of Public Health, Providence, RI 02903, United States;6. Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, United States;7. Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States;8. Minneapolis Medical Research Foundation, Minneapolis, MN 55404, United States;9. The Miriam Hospital''s Center for Cardiac Fitness, 208 Collyer St, Providence RI 02904, United States;10. Department of Medicine, Alpert Medical School, Brown University, Providence, RI 02903, United States;1. Ball State University, Muncie, IN, United States of America;2. Indiana University School of Medicine, Muncie, IN, United States of America;1. The Cooper Institute, Dallas, TX;2. Stanford University, Palo Alto, CA;3. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and University of Texas Southwestern Medical Center, Dallas, TX;4. Cooper Clinic, Dallas, TX |
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| Abstract: | Cardiovascular disease (CVD) in general and myocardial infarction in particular are the leading causes of mortality in men and women globally. Sex differences in CVD recovery exist, with higher rates of mortality, recurrent myocardial infarction, and poor functional outcomes seen in women compared to men with CVD. Physical inactivity has been identified as a crucial modifiable risk factor linked with poor survival and recovery in patients with CVD. Cardiac rehabilitation programs that aim to improve physical inactivity and cardiorespiratory fitness (CRF), a measure of physical fitness in patients with CVD, have gained popularity. The goals of this commentary were to summarize the existing literature on the impact of CRF on survival in patients with CVD, to document the impact of sex on CVD outcomes, and to highlight any gaps in current knowledge. Even minor improvements in CRF have been linked with improved survival, although contemporary data from randomized controlled trials have shown mixed results. Gender differences in cardiac rehabilitation have been well documented, with lower referral, enrollment, and completion rates noted in women compared to men with CVD. However, data on sex differences in CRF with cardiac rehabilitation are scant, mostly indicating lower peak CRF observed in female compared to male patients on completion. It is unclear whether similar thresholds of peak CRF are needed in male and female patients to improve survival after onset of CVD, and whether exercise prescriptions need to be adapted to include additional forms of exercise. CRF is also influenced by age, with a decline in peak exercise capacity with advancing age observed in both sexes, but steeper declines noted in men than women. From this perspective, we review the data intersecting age, sex, and exercise on survival in patients with CVD, as well as the biological mechanisms at play, and we identify areas for future research (Clin Ther. 2020; 42:XXX–XXX) © 2020 Elsevier Inc. |
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| Keywords: | sex gender physical activity cardiovascular disease fitness survival |
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