Physical activity, exercise and adverse cardiovascular outcomes in individuals with pre-existing cardiovascular disease: a narrative review

ABSTRACT

Introduction

The evidence supporting the cardiovascular health benefits of physical activity and/or exercise training is well-established. While the role of physical activity in primary prevention is unequivocal, its significance in secondary prevention (among those with preexisting cardiovascular disease) is less definitive. Though guidelines universally recommend physical activity as part of the secondary preventive strategy, the empirical evidence underpinning these recommendations is not as robust as that for primary prevention.

Areas covered

This review distills the body of available observational and interventional evidence on the relationship between physical activity, exercise, and adverse cardiovascular outcomes among those with preexisting cardiovascular disease. The postulated biologic mechanisms underlying the relationships, areas of prevailing uncertainty, and potential public health implications are also discussed.

Expert opinion

A physical activity level of 500 MET-min/week (equivalent to 150 min of moderate-intensity physical activity or 75 min of vigorous-intensity physical activity or an equivalent combination) may be a minimum requirement for patients with preexisting CVD. However, to reap the maximum benefits of physical activity and also minimize adverse effects, physical activity and/or exercise regimens should be tailored to unique factors such as individual’s baseline physical activity habits, cardiovascular health status and the specific nature of their cardiovascular disease.

KEYWORDS:

• Physical activity
• exercise
• cardiovascular disease
• mortality
• cohort study
• randomized controlled trial

Article highlights

• Consistent evidence shows that individuals with preexisting CVD who engage in regular physical activity experience a notable reduction in the risk of adverse cardiovascular outcomes, with significant variations in physical activity responses among specific cardiovascular conditions.

• Individuals with preexisting CVD seem to derive even greater benefits from physical activity than their counterparts without CVD, when engaging at the same levels of physical activity.

• The dose-response relationships between the intensity, frequency, duration and volume of physical activity and adverse cardiovascular outcomes in individuals with preexisting CVD are complex; however, though a general trend suggests that more physical activity leads to better outcomes, some evidence suggests an increased risk of adverse cardiovascular events at extremely high levels of physical activity.

• A striking finding is that sedentary individuals stand to gain the most from becoming physically active.

• A physical activity level of 500 MET-min/week (equivalent to 150 min of moderate-intensity physical activity or 75 min of vigorous-intensity physical activity or an equivalent combination) may be a minimum requirement for patients with preexisting CVD.

• There were consistent reductions in adverse cardiovascular outcomes following exercise-based CR or structured exercise training in individuals with preexisting CVD.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This research is funded by the National Institute for Health and Care Research (NIHR) Leicester NIHR Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.