Cardiovascular Disease Risk and Exercise Inactivity in NZ
Avoiding the Risks of Acute Intervention
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide [1]. In New Zealand cardiovascular disease (CVD) and its subsequent components also drive health loss such that for example ischemic heart disease and stroke, are ranked first and fifth in importance [2]. CVD is also expensive there is the annual loss of income to NZ citizens from CVD, estimated at US$427 million or NZD$800 million (15.6% of all disease-related income loss; and far ahead of cancer-related income loss at US$122 million) [3].
The 1st and 4th most prevalent risk factors for CVD in NZ ranked by attributable health loss, is high BP and high body-mass index (BMI) [4]. These two variables are highly modifiable by exercise [5, 6]. But in patients that have high blood pressure (BP) and BMI, the requirement for exercise at an intensity that can significantly alter CVD biomarkers can be challenging [7]. (Although I must add cheekily we have some good options).
Importantly the obesity picture is complicated by the fact that BMI does not capture the large heterogeneity in cardiometabolic risk observed across individuals. This is partly due to BMI lacking the sensitivity needed to distinguish the proportions of fat and fat free mass that contribute to total body weight, and BMI provides no indication of fat mass distribution, where is the fat located, hip, butt or belly for example. As were it is located is critical for disease risk (visceral fa in particular as opposed to sub-cutaneous). Furthermore, BMI does not account for age, race, sex, or fitness level, which influence body composition [8]. Therefore, assessment of obesity and disease risk using BMI categories may misclassify individuals at risk for chronic disease. In essence an obesity epidemic (lifestyle factors) may well be driving health loss in New Zealand that is not reflected correctly in clinical data and its importance should be ranked higher [9].
Not So Surprising Findings
Among the many risk factors that predispose patients to CVD development and progression, particular attention is given to a sedentary lifestyle, characterized by consistently low levels of physical activity, because it is in theory easily to remedy. This risk factor is now recognized as a leading contributor to poor cardiovascular health. Conversely, regular exercise and physical activity are associated with widespread health benefits and a significantly lower CVD risk [10].
In a systematic review and meta-analysis of 33 cohort studies consisting of 883, 372 participants, Nocon et al. reported that physical activity was associated with 35% risk reduction for CVD mortality and 33% risk reduction for all-cause mortality [11].
Moderate to high intensity exercise carried out frequently has the most significant health benefit according to the American College of Sports Medicine [12] furthermore the recently updated World Health Organization 2020 Guidelines on physical activity and sedentary behaviour recommend performing at least 150 min of moderate-intensity physical activity per week, or 75 min of vigorous-intensity aerobic exercise, to achieve substantial health benefits [13, 14]. However, the lack of sufficient time is the most common barrier to adhering to regular exercise and has resulted in the widespread adoption of interval training [15].
Loss of Life Years
As early as 1996 in New Zealand when records started to be collected in cohesive form physical inactivity was the second leading risk factor for both genders and across ethnicity, accounting for approximately 7 percent and 6 percent of total DALYs respectively (DALY stands for Disability-Adjusted Life Year, a metric used to measure the burden of disease and injury in a population, combining years of life lost due to premature death and years lived with disability).
Australians are not much better as Ding et al. recently estimated that inactivity directly caused 6.4% of deaths and 38,900 DALYs in Australia [16]. Notably obesity and high blood pressure were also significant risk factors) [4], both of these factors are modifiable by exercise. In NZ and in people aged ≥ 60 years, the prevalence of physical inactivity has been reported as high as 50% in seniors +75 year old and 34% in those aged 65-74 years [17].
Summary Risk
So in essence regular exercise has a synergistic effect on health modifying the cardiometabolic profile of the body, helping people stay well mentally. In New Zealand the newly developed CVD risk prediction calculators Pylypchuk and colleagues (2018) has been validated to test CVD risks although it does not include physical activity, and/or use of alcohol; it does use important surrogates for higher CVD risk such as blood pressure and obesity, acknowledged as vital in prediction by both the American College of Cardiology/ American Heart Association and European Society of Cardiology/ European Society of Hypertension.
Identify lifestyle modification is in essence the cornerstone for prevention. Contact us to discuss in grater detail information in the article.
References
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Wilson, N., et al., Prioritization of intervention domains to prevent cardiovascular disease: a country-level case study using global burden of disease and local data. Population Health Metrics, 2023. 21(1): p. 1.
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Dipla, K., et al., Impaired Muscle Oxygenation and Elevated Exercise Blood Pressure in Hypertensive Patients. Hypertension, 2017. 70(2): p. 444-451.
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Heymsfield, S.B. and W.T. Cefalu, Does body mass index adequately convey a patient's mortality risk? Jama, 2013. 309(1): p. 87-8.
Nystoriak, M.A. and A. Bhatnagar, Cardiovascular Effects and Benefits of Exercise. Front Cardiovasc Med, 2018. 5: p. 135.
Nocon, M., et al., Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil, 2008. 15(3): p. 239-46.
Garber, C.E., et al., American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc, 2011. 43(7): p. 1334-59.
Bull, F.C., et al., World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British journal of sports medicine, 2020. 54(24): p. 1451-1462.
WHO, WHO Guidelines Approved by the Guidelines Review Committee, in WHO Guidelines on Physical Activity and Sedentary Behaviour. 2020, World Health Organization© World Health Organization 2020.: Geneva.
Pattyn, N., R. Beulque, and V. Cornelissen, Aerobic interval vs. continuous training in patients with coronary artery disease or heart failure: an updated systematic review and meta-analysis with a focus on secondary outcomes. Sports Medicine, 2018. 48: p. 1189-1205.
Ding, D., et al., The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet, 2016. 388(10051): p. 1311-24.
Tobias, M., The burden of disease and injury in New Zealand. 2001: Ministry of Health.
