Being Active Lowers Mortality, CVD Risk in Rich, Poor Countries

Marlene Busko

June 10, 2016

MEXICO CITY, MEXICO — In a study of thousands of adult participants in the Prospective Urban Rural Epidemiological (PURE) study, compared with individuals who did not meet the minimal guideline recommendations for physical activity, those who did so had a striking 28% to 50% lower risk of dying or having an MI in a 5-year follow-up[1].

Guidelines recommend doing 30 minutes of moderate physical activity 5 days a week or doing 20 minutes of vigorous physical activity 3 days a week, and in this study, physical activity included commuting, housework, recreation, or activity tied to occupation, lead author Dr Scott Lear (Simon Fraser University, Vancouver, BC) explained. He presented the study on June 6, 2016 at the World Heart Federation's World Congress of Cardiology & Cardiovascular Health 2016 (WCC 2016).

"We aimed to answer the question, 'Is physical activity as beneficial throughout the world as it is in high-income countries?' And the answer is 'yes,' " Lear told heartwire from Medscape.

Thus, encouraging people to keep active can help reduce the global burden of CVD, he said. The message is that clinicians need to "continue to encourage patients to exercise; prescribe exercise as a preventive treatment, just like you would give a medication," he added.

This study reinforces that "moderate physical activity sees the most gain in cardiovascular well-being, with high levels having an even greater impact," session moderator Dr Julie Redfern (University of Sydney and George Institute for Global Health, Australia) agreed in a comment to heartwire .

"It is essential that clinicians support and encourage patients to undertake regular physical activity and work through goal setting and practical barriers in terms of individual patient needs," she said.

Do Benefits From Exercise Differ Around the Globe?

Worldwide, one in three adults does not meet guideline recommendations for regular, at least moderate, physical activity, Lear reported. But research linking physical activity to better cardiovascular and survival outcomes comes from high-income countries.

To examine this in a range of countries including lower-income countries, Lear and colleagues analyzed data from 141,601 participants from 17 countries in the PURE study who reported their baseline level of physical activity in questionnaires and were then followed for 5 years.

Depending on whether the participants met guideline recommendations for physical activity, they were classed into three groups: inactive (they did not meet guideline recommendations), moderate (they did), or high (they exceeded this level of physical activity).

The researchers performed modeling analysis to predict how physical activity affected all-cause mortality, CVD mortality, non-CVD mortality, MI, stroke, heart failure, and severe CVD (a composite of fatal CVD, MI, stroke, heart failure), after adjusting for age, sex, education, country income level, urban/rural residency, family history of CVD, personal CVD history, and smoking status.

During a 5-year follow-up, compared with individuals who did not meet the guideline-recommended level for moderate physical activity, those who did had a strikingly reduced risk of dying from all causes (28%) and or CVD (36%). Those who were even more physically active had an even greater reduced risk of dying from all causes (40%) or from CVD (50%).

A similar pattern of benefits was seen for the other study outcomes. For example, compared with not meeting the recommended level of physical activity, being moderately or very active was linked with a 29% to 42% lower risk of MI, and a 20% to 40% lower risk of heart failure.

Risk of Outcomes With Moderate or High Physical Activity vs Low Physical Activitya

Outcome Moderate physical activity, HR (95% CI) High physical activityb , HR (95% CI)
Death 0.72 (0.66–0.78) 0.60 (0.55–0.65)
CVD Death 0.64 (0.55–0.75) 0.50 (0.43–0.58)
Non CVD death 0.76 (0.69–0.85) 0.65 (0.58–0.72)
MI 0.71 (0.63–0.81) 0.58 (0.51 – 0.66)
Stroke 0.83 (0.72 – 0.96) 0.75 (0.65–0.86)
Heart failure 0.80 (0.62–1.01) 0.60 (0.47–0.76)
Severe CVDc 0.77 (0.71–0.84) 0.65 (0.60–0.72)
a. 5-year risk, after adjustment for age, sex, education, country income level, urban rural residency, family history of CVD, personal CVD history, and smoking status
b. P<0.001 for trend, for comparing high physical activity to low physical activity, for all outcomes
c. Severe CVD=a composite of fatal CVD, myocardial infarction, stroke, heart failure

The effects of physical activity on death and CVD death were consistent across high-, upper-middle, lower-middle, and low-income levels.

Moreover, physical activity was beneficial even after adjustment for age, sex, smoking, diabetes, hypertension, and preexisting CVD. Thus, "meeting the minimal physical-activity guidelines has a substantial benefit" even in patients with other risk factors, Lear reported.

A half hour of moderately brisk walking almost every day is a low-cost way to meet the recommendations, which people from all income levels can do, and which can be a "low-cost approach to reduce the global burden of CVD," he summarized.

The authors have declared no relevant financial relationships.

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