Introduction
A decrease in the quantity of physical activity, along with an increase in risk factors and comorbidities, may result in several CVDs, including heart failure, sudden cardiac death, coronary artery disease (CAD), ischemic and hemorrhagic stroke, and coronary artery disease.
What Are the Impacts of Physical Inactivity on Cardiovascular Health?
The impacts of physical inactivity on cardiovascular health include,
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High Blood Pressure: Physical activity (PA) can reduce blood pressure by 5 mmHg and 7 mmHg on the diastolic and systolic levels, respectively. PA relieves inflammation and the age-related stiffening of large elastic arteries, resulting in lower blood pressure. The requirement for medication may decrease with increased PA duration and intensity.
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Dyslipidemia: PA improves blood lipid levels. It activates several enzymes necessary for lipid metabolism in the skeletal muscles and enhances the metabolism of fat rather than glycogen. As a result, PA increases high-density lipoprotein cholesterol levels by five to ten percent while lowering low-density lipoprotein cholesterol levels by five percent and total cholesterol by 50 percent.
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Obesity: Physical activity decreases obesity and weight by boosting daily energy expenditure, lowering fat mass, maintaining a basal metabolic rate (BMR), and lean body mass. PA improves psychological health, making sticking to physical activity programs simpler. Aerobic exercise training has been shown to reduce visceral and hepatic fat in overweight or obese adults.
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Congenital Heart Disease: A customized exercise program with frequent reassessments should be designed for patients with congenital heart disease due to the wide range of variations in their hemodynamic status and prognosis. All coronary heart disease (CHD) patients are advised to engage in some type of PA. Moderate-intensity aerobic exercise for at least 30 minutes, four to five times a week, is safe and beneficial for CHD patients.
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Arrhythmogenic Conditions: Sports involvement in patients with arrhythmogenic disorders is managed based on three principles:
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Preventing life-threatening arrhythmias by doing exercise.
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Symptom management for sports participation.
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Assessing the evolution of the arrhythmogenic state as a result of athletic participation.
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Atrial Fibrillation (AF): This can be effectively prevented with PA. Sports involvement can be considered for people with well-tolerated AF and those without structural heart problems.
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Myocardial Disease: PA is not recommended for active myocarditis or pericarditis. People who wish to participate in regular sports but have cardiomyopathy or a history of resolved myocarditis or pericarditis should be evaluated thoroughly. An exercise test should be included in this evaluation in addition to magnetic resonance imaging (MRI) and echocardiography to determine the possibility of exercise-induced arrhythmias. Based on potential gene-specific interactions with sports, competitive sports involvement may be considered for persons with genotype positive but phenotypic negative or who exhibit a moderate cardiomyopathy phenotype but no symptoms or risk factors.
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Heart Failure: Cardiopulmonary exercise regimens can enhance exercise capacity and quality of life in individuals with heart failure (HF), and they may have a minor effect on all-cause mortality, all-cause hospitalization, HF-specific mortality, and HF-specific hospitalization. Patients with stable HF receiving optimal medical therapy are advised to engage in unrestricted exercise training. Customized sports guidance is necessary for high-risk heart patients.
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Coronary Artery Disease: Chronic CAD patients at low risk of exercise-related adverse effects can participate in competitive or recreational sports. Patients with chronic CAD at high-risk phenotypes for exercise-induced adverse effects include myocardial ischemia during exercise testing, a left ventricular ejection fraction of less than 50 percent, and significant coronary stenosis of more than 70 percent in a major epicardial artery. CAD patients should avoid competitive sports at high risk of exercise-induced adverse cardiac events, such as supraventricular tachycardia or acute coronary syndromes.
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Aortic Disease: PA is recommended for all patients with aortic disease, including dilated aortas. However, certain activities may produce greater aortic enlargement, raising the risk of acute aortic dissection due to increased blood pressure and wall stress. All sports are permitted and safe for people at low risk. However, more intense sports are contraindicated because the aneurysm-related risk for acute aortic events increases due to factors like larger diameter, hereditary pathology, rapid growth, or hypertension.
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Valvular Heart Disease: Exercise-induced big stroke volume, forceful contractions, and an enhanced chronotropic state (heart rate) may result in increased valve dysfunction and greater afterload due to blood pressure elevation. All forms of PA are still recommended for asymptomatic people with mild to moderate valvular heart disease. Exercise-induced cardiac events (ACEs) and the degree of valve dysfunction should be evaluated before beginning any exercise regimen because PA may result in greater left ventricular dimensions and an early need for surgery. After thorough evaluation and consultation, asymptomatic patients with moderate-to-severe aortic stenosis or severe aortic valve regurgitation may be evaluated for competitive sports participation.
What Are the Physical Activity Recommendations?
The World Health Organization (WHO) recommends all individuals engage in regular physical activity to get the health advantages of physical activity. PA is defined as any skeletal or muscular movement that uses energy expenditure. Adults should perform 75 to 150 minutes of vigorous-intensity aerobic PA per week or 150 to 300 minutes of moderate-intensity physical activity (PAA). It is suggested that moderately intense muscle-strengthening exercises be engaged twice weekly, targeting all main muscle groups, to get additional benefits.
Adults over 65 should engage in varied multicomponent physical activity three or more times a week, focusing on functional balance and moderate-to-intense strength training to improve functional ability and prevent falls. The most significant cardiovascular advantage of PA is cardiorespiratory fitness (CRF), evaluated as maximum oxygen consumption (VO2 max), which is a better predictor of prognosis than PA.
Conclusion
The trend toward sedentary lifestyles, combined with growing rates of smoking and obesity, highlights the need for a global effort to improve cardiovascular health. The goal of this program should be to encourage and direct the general public and patients with CVD to engage in PA. Almost all CVD patients can participate in some PA following appropriate risk categorization. Healthcare practitioners should explore the various challenges patients may experience and develop a personalized exercise regimen as an important treatment approach. The aim is to reach the maximum level of cardiovascular fitness in individuals.
