Exercise as a Medicine for Cardiovasular Protection Thomas G. Allison, PhD, MPH, FACC Mayo Clinic, Rochester, MN ©2012 MFMER | slide-1 VNHA – Da Nang October, 2014 No Disclosures Question 1: Does Exercise Prevent CVD over a Lifetime in Healthy People? → This is principally an epidemiologic question Large, long-term randomized trials are not feasible [...]... nonfatal stroke, or hospitalization for angina • Maximum follow-up 13.5 years • Trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years LOOK AHEAD Research Group N Engl J Med 2013;369:145-54 ©2012 MFMER | slide-28 Exercise Training in CHF: Mortality and Morbidity Effects • HF ACTION: • RCT: usual care vs structured exercise training; 50 sites in US and Canada... slide-31 Recommendations • Assess the potential impact of increased physical activity for the individual patient • Start with a level of exercise appropriate to the baseline fitness and activity level of the patient • Progressively advance the exercise prescription until risk factors are optimally controlled … or limits of tolerance are reached Recommendations Amount of exercise • “Vigorous” exercise (like... Management on Symptom Burden and Severity in Patients with Atrial Fibrillation • 150 patients with history of atrial fibrillation but currently in sinus rhythm • Randomized to aggressive lifestyle management versus usual care + fish oil 3g/day • Lifestyle management program • Phase 1: low calorie diet + light exercise program for 8 weeks • Phase 2: low glycemic diet + vigorous exercise program • Patients... in LOOK AHEAD and HF-ACTION ©2012 MFMER | slide-16 Conclusions • Exercise appears to be potentially good medicine for CV prevention • Strong epidemiological evidence for primary prevention of CAD and diabetes • Beneficial effects on risk factors • Clinical trials for secondary prevention are limited in number, size, and methodology • Inadequate stimulus and poor compliance with exercise programs likely... Exercise Training in CHF: Mortality and Morbidity Effects O’Connor CM et al JAMA 2009;301:1439-1450 HF-ACTION Results • Suboptimal adherence to exercise training • 40% of exercisers reported 6.9 > 3.4 > 140 = LDL-C FBG SBP < 2.6 < 5.6 < 120 Physician Ideal levels Living Under the Umbrella of Good Cardiovascular Health Patient Contact: allison.thomas@mayo.edu tgallison@yahoo.com 19 • Comments? • Questions? • Contact: allison.thomas@mayo.edu... obese patients with type 2 diabetes • Intervention group • Intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity • Control group • Diabetes support and education LOOK AHEAD Research Group N Engl J Med 2013;369:145-54 ©2012 MFMER | slide-27 LOOK AHEAD TRIAL • Primary outcome composite of death from CV causes, nonfatal myocardial infarction,... weight training have all been validated • Other forms or aerobic exercise likely beneficial • “Reasonable” to do resistance training 2-3 times per week Implications of Recent Trials • High intensity interval training more effective than continuous low-moderate intensity training • Supervised training superior to home programs • Both HF-ACTION and LOOK AHEAD had more frequent supervised sessions initially,... month training program versus usual care C T C T T C Schuler G et al Circulation 1992:86:1-11 ©2012 MFMER | slide-22 Meta-Analysis: Exercise for 2° CHD Prevention • 8440 CHD patients randomized to exercise- based rehab programs • 27% reduction in all-cause mortality • 31% reduction in CHD mortality • No evidence of reduction in non-fatal CHD Jolliffe et al, The Cochrane Library 2003:Issue 4 Effect of Aggressive... jogging) for 30 minutes at least 2-4 times per week • At least 2000 kcal/week in leisure-time physical activity (like brisk walking) • Achieve an exercise capacity of 10 METs for men or 9 METs for women Recommendations Exercise intensity • Relative exercise intensity of 4 (“somewhat strong”) on the 10-point Borg scale • 12-14 on the older 6-20 Borg scale Type of exercise • Running, jogging, walking,