This article is more than 5 years old. Information may no longer be current.
Increased levels of any physical activity reduce mortality, CVD risk
Higher levels of recreational and nonrecreational physical activity reduced the risk for CVD events and mortality in participants from low-, middle- and high-income countries, according to new data from the PURE study published in The Lancet.
“For low- and middle-income countries where having heart disease can cause a severe financial burden, physical activity represents a low-cost approach that can be done throughout the world with potential large impact,” Salim Yusuf, MD, DPhil, MRCP, professor in the department of medicine, joint member of the department of health research methods, evidence and impact and director of the Population Health Research Institute at McMaster University in Ontario, Canada, and principal investigator of the PURE study, said in a press release.
PURE study data
Scott A. Lear, PhD, professor at Simon Fraser University Faculty of Health Sciences in British Columbia, Canada, and Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention Research, and colleagues reviewed data from 130,843 participants aged 35 to 70 years (mean age, 50 years; 42% men) from in the PURE study who were free from CVD.
Standardized procedures and measures were used to record data, including medical history, sociodemographic factors, risk factors and lifestyle behaviors. The International Physical Activity Questionnaire was used to assess physical activity.
Low physical activity was defined as less than 150 minutes of moderate-intensity physical activity, moderate physical activity was between 150 and 750 minutes per week and high physical activity was identified as more than 750 minutes per week.
Participants were also categorized by country income level: high, upper middle, lower middle and low.
The primary clinical outcomes were a composite or individual incidence of mortality and major CVD, which included CVD mortality and stroke, MI or HF. Patients were followed up for a mean of 6.9 years.
The risk for all-cause mortality was reduced with moderate (HR = 0.8; 95% CI, 0.74-0.87) and high physical activity (HR = 0.65; 95% CI, 0.6-0.71) compared with low physical activity. Moderate physical activity was also related to a risk reduction for major CVD vs. low physical activity (HR = 0.86; 95% CI, 0.78-0.93).
Reduced risk for CVD, mortality
A significantly lower risk for mortality and major CVD was seen in participants from upper middle- and low-income countries who had higher physical activity. The risk for mortality decreased in upper middle-, lower middle- and low-income countries with higher physical activity. Upper middle- and low-income countries had a decrease in major CVD risk in participants with higher physical activity.
At 5 years, the adjusted population attributable fraction for participants who did not meet physical activity guidelines was 4.6% for major CVD and 8% for mortality, and the adjusted population attributable fraction for participants who did not achieve high physical activity was 9.5% for major CVD and 13% for mortality.
Higher rates of both recreational and nonrecreational physical activity reduced risk that was equivalent to 150 minutes per week of moderate-intensity physical activity (P = .01) and 1,250 minutes per week (P < .0001), respectively.
“The affordability of other CVD interventions such as consuming fruits and vegetables and generic CVD drugs is beyond the reach of many people in low-income and middle-income countries; however, physical, activity represents a low-cost approach to CVD prevention,” Lear and colleagues wrote.
“Creating a physical, social and political environment where physical activity in daily living is desirable, accessible and safe should be a developmental imperative; a planning, economic, social and equity imperative; and a public health imperative,” Shifalika Goenka, MBBS, PhD, of the Public Health Foundation of India and Center for Chronic Disease Control in New Delhi, and I-Min Lee, professor in the department of epidemiology at Harvard T. H. Chan School of Public Health, wrote in a related editorial. “Parallel to pedestrian pavements, we need additional active transport roads for the many different modes of active transport along with cycling.” – by Darlene Dobkowski
Disclosures: The PURE study was funded by AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, King Pharma, Novartis, Sanofi Aventis and Servier. Lear, Yusuf, Goenka and Lee report no relevant financial disclosures.
Perspective
Back to Top
The study relies on survey data, but impactful survey data. This article tackles the big question whether recreational activity is a high-income luxury and whether low-income communities have the capacity to do enough exercise to decrease CVD outcomes.
This study gives a nice viewpoint and showed that despite dietary intake and other socioeconomic and environmental factors that you might see in those low-income countries and populations, if people in those countries were meeting those exercise or activity goals, then they still experienced CV benefit. Even smaller amounts of activity, such as walking 30 minutes a day, had impact in terms of reduction of CV outcomes.
The study highlights that exercise can be recreational and nonrecreational. Nonrecreational activities such as using the body as means of transportation, occupation and for domestic work are all effective means of decreasing CV outcomes.
The study also shows that surprisingly, many low-income countries are meeting physical activity goals — more than I expected. In terms of clinical practice, especially those of us who live and work with low-income communities, it reminds us to incorporate more educational counseling. We have to remind patients about how they can incorporate activity into their day, especially if they work longer hours or are unable to have time for recreation. There are ways to get exercise in our day-to-day such as walking to work, taking stairs and cycling around town to visit friends that can be emphasized to our patients. We need to remind our patients that even small changes do make a difference. That’s important as our role as physicians and counselors.
We did a study (Devries S, et al. Am J Med. 2017;doi:10.1016/j.amjmed.2017.04.043) that showed that physicians only counsel their patients for less than 3 minutes of their visit on nutrition. Same is true for all lifestyle counseling. Studies such as this one remind us to take the time to empower our patients to keep activity up within a model that works in their environment. Studies also show that the physician’s role as counselor is highly valued and patients respond to their physicians.
I’d like to see intervention studies. It would be interesting to see more global government and regional policy that would focus on educating people about lifestyle initiatives.
What I’d really like to see is a diet and lifestyle intervention study looking at multiple different income levels.
This study can serve as a call to action to say that we need to focus on initiatives to get people more active, especially in lower-income areas, where we could make a significant impact.