High physical activity volume, sustained weight loss lowers risk for cardiovascular events

Key takeaways:

• High physical activity levels and maintained weight loss reduced the risk for cardiovascular events by 61%.
• Experts said this combination may be more beneficial in those with overweight or obesity and diabetes.

Maintaining high levels of physical activity and weight loss were associated with reduced risks for several cardiovascular events, a study published in JAMA Network Open showed.

“Additional research is crucial to deepen our knowledge of the outcomes of lifestyle-induced weight loss,” Zihao Huang, Msc, from the First Affiliated Hospital in China, and colleagues wrote. “Recent studies have indicated that increased physical activity volume could enhance the metabolic benefits of weight loss, but it is unclear whether the association between weight loss and the risk of cardiovascular events differs by physical activity volumes.”

A recent analysis of data from the Look AHEAD study — a randomized clinical trial that examined the cardiovascular effects of an intensive lifestyle intervention in patients with overweight or obesity and type 2 diabetes — showed that high levels of physical activity lowered the risk for chronic kidney disease progression.

In the current post hoc analysis, the researchers examined a cohort of Look AHEAD participants (n = 1,229) who had been in a substudy of accelerometry-measured physical activity.

The primary outcome was one of several cardiovascular events, which included:

• death from cardiovascular causes;
• nonfatal myocardial infarction;
• nonfatal stroke; or
• hospitalization for angina.

Among the cohort, 27% achieved and maintained weight loss during the first 4 years of the study, whereas 32% of those participants also maintained a high level of physical activity.

During a median 9.5 years of follow-up, 16.1% of participants experienced a primary outcome.
Huang and colleagues found that maintaining high physical activity volumes and weight loss was associated with a 61% lower risk for a primary outcome (HR = 0.39; 95% CI, 0.19-0.81) vs. low physical activity volume and no weight loss.

The cardiovascular benefits from high physical activity volumes were also greater for those who achieved weight loss of 7% or more.

The researchers added that there was no difference in the risk for primary outcomes among those with either weight loss only or high physical activity volumes only.

They noted that both high physical activity and weight loss are important but that the combination “may be more beneficial” in the study’s population.

“It may be more helpful when clinicians give prescriptions and lifestyle suggestions considering the association between cardiovascular benefits, physical activity, and weight loss with the individual’s characteristics,” they wrote.

Huang and colleagues also noted that future studies should “consider lifestyle interventions based on basic characteristics or combining weight loss and increased physical activity to elucidate the causal relationships between exercise, weight loss and cardiovascular events.”