Strength Training May Best Aerobics for Cardioprotection

Batya Swift Yasgur MA, LSW

November 23, 2018

LIMA, Peru — Static exercise, such as strength training, might be superior to dynamic exercise, such as walking or cycling, for conferring protection against cardiovascular disease (CVD), new research suggests.

Using data from the 2005/06 National Health and Nutrition Examination Survey (NHANES), Maia P. Smith, PhD, assistant professor, Department of Public Health and Preventive Medicine, St. George's University, Granada, West Indies, analyzed cardiovascular risk factors in more than 4000 American adults as a function of self-reported static and/or dynamic activity.

She found that 36% of adults 21 to 44 years of age and 25% of adults older than 45 years engaged in static activity, compared with 28% and 21%, respectively, of adults engaging in dynamic activity.

Although both activities were associated with 30% to 70% lower rates of CVD risk factors, the associations were strongest for youth and for static activity.

"In over 4000 American adults from a representative sample, I found that static activity — strength training — appeared more cardioprotective than dynamic activity — in this case, walking, and biking," Smith told theheart.org | Medscape Cardiology.

"The odds of having a given risk factor — hypertension, overweight/obesity, diabetes, or high cholesterol — were between one-third and two-thirds lower for those who engaged in static activity than for those who engaged in no activity, but although dynamic activity wasn't as good as static, it still had some benefits, especially for overweight," she said.

Their results were presented November 16 at the American College of Cardiology (ACC) Latin America Conference 2018. 

Difficult to Compare

"Cardioprotective benefits of physical activity are known, but research and recommendations often do not distinguish dynamic activity, such as walking/cycling, from static activity, such as strength training," Smith writes.

She notes that static activity appears especially beneficial, but the two activity types are difficult to compare because most studies consider only one activity type and have varying populations, confounders, and biases.

"Intervention studies have previously suggested that static activity is at least as beneficial as dynamic, if not more so, but they tended to be short in duration and involve high activity levels, thus their relevance to the average American was not clear," Smith told theheart.org | Medscape Cardiology.

"I wanted to see if typical levels of activity still have clinically relevant effects, and they did," she said.

To investigate the question, she looked at self-reported data on static and/or dynamic activity in 4086 nonpregnant American adults.

CVD risk factors (hypertension, overweight, diabetes, and dyslipidemia) were modeled as functions of these self-reported data and then corrected for age, ethnicity, sex, and smoking.

Participants were stratified into two age groups: 21 to 44 years, and 45 years and older.

Each activity type was classified either as "none" or "any".

Separate Exposures

Both younger and older adults engaged in static (36% and 25%, respectively) and dynamic (28% and 21%, respectively) activity.

Although both activity types were associated with lower CVD risk, with flat dose–response curves across activity levels greater than none, the associations were strongest for static activity and in younger adults.

In younger adults, static activity was associated with a significantly lower risk for overweight (odds ratio [OR]), 0.61; = .0001), as was dynamic activity (OR, 0.64; = .05), but there was no significant relation between either activity and hypertension or dyslipidemia (> .10 for all).

Static activity was also associated with less diabetes (OR, 0.33; = .005).

In older adults, static activity was significantly associated with a lower risk for overweight (OR, 0.61; = .006), as was dynamic activity (OR, 0.75; P = .03), but again, there was no relation between either activity and dyslipidemia (P > .10 for both).

Static activity was also significantly associated with less diabetes (OR, 0.65; = .003) and nonsignificantly associated with hypertension (OR, 0.79; = .09) in the older group.

"Static and dynamic activity have such different effects they can almost be treated as separate exposures, and static activity is often better than dynamic for both preventing and treating risks, including but not limited to heart disease," Smith commented.

She suggested several potential reasons for this differential effect of static and dynamic exercise.

"Static activity is often higher intensity than dynamic and high-intensity activity is much better for many outcomes."

Moreover, "everyone in the study got at least some dynamic activity from daily living, but many people get almost no static activity, since almost everyone walks around the house and to and from the car, but not everyone even lifts their own groceries," she observed.

For this reason, "the addition of a little more static activity had a lot more of a noticeable effect."

Consistent With New Guidelines

Commenting on the study for theheart.org | Medscape Cardiology, Richard C. Becker, MD, professor of medicine, University of Cincinnati College of Medicine, who was not involved with the research, called it "an important perspective, as it emphasizes the importance of physical activity both dynamic (or aerobic) and static (muscle strength), their relation to known CHD [coronary heart disease] risk factors, and maintaining heart health."

He noted that the Physical Activity Guidelines for Americans, recently released by the Office of Disease Prevention and Health Promotion, Department of Health and Human Services, and presented at the American Heart Association Scientific Sessions 2018, highlight moderate-intensity aerobic activity of at least 150 minutes per week and muscle-strengthening activity 2 days per week.

The new guidelines "target not only cardiovascular health but also brain health, reducing chronic conditions, community engagement, and reducing the cost of care from seven of the 10 most common preventable diseases," he said.

"The study findings are consistent with the guidelines in the context of encouraging both [static and dynamic exercise] and pose an interesting possibility that some forms of exercise may have targeted effects on specific risk factors for CVD," he said.

"Additional research will be required to fully address this question," he added.

Smith recommended that people "find an activity you like and make it a habit. If you have one already, add another." 

She noted that effects "were bigger, not smaller, for young adults, [but] heart disease may not even be on their minds yet." So, "if someone claims not to care about dying young of a heart attack, she might be motivated [to exercise] to manage her diabetes or lose a little weight." 

No source of study funding listed. Smith and Becker disclose no conflicts of interest.

American College of Cardiology (ACC) Latin America Conference 2018: Poster 42. Presented November 16, 2018.

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