Cardioprotective Exercise and Pharmacologic Interventions as Complementary Antidotes to Cardiovascular Disease.

Exercise and pharmacologic therapies to prevent and treat cardiovascular disease have advanced largely through independent efforts. Understanding of first-line drug therapies, findings from preclinical animal studies, and the need for research initiatives related to complementary cardioprotective exercise-pharma interventions are reviewed from the premise that contemporary cardioprotective therapies must include adjunctive exercise and lifestyle interventions in addition to pharmacologic agents.

Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care.

The U.S. population is plagued by physical inactivity, lack of cardiorespiratory fitness, and sedentary lifestyles, all of which are strongly associated with the emerging epidemic of chronic disease. The time is right to incorporate physical activity assessment and promotion into health care in a manner that engages clinicians and patients. In April 2015, the American College of Sports Medicine and Kaiser Permanente convened a joint consensus meeting of subject matter experts from stakeholder organizations to discuss the development and implementation of a physical activity vital sign (PAVS) to be obtained and recorded at every medical visit for every patient. This statement represents a summary of the discussion, recommendations, and next steps developed during the consensus meeting. Foremost, it is a "call to action" for current and future clinicians and the health care community to implement a PAVS in daily practice with every patient.

Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

PURPOSE: This scientific statement provides an overview of the evidence on physical activity and exercise recommendations for stroke survivors. Evidence suggests that stroke survivors experience physical deconditioning and lead sedentary lifestyles. Therefore, this updated scientific statement serves as an overall guide for practitioners to gain a better understanding of the benefits of physical activity and recommendations for prescribing exercise for stroke survivors across all stages of recovery. METHODS: Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and indicate gaps in current knowledge. RESULTS: Physical inactivity after stroke is highly prevalent. The assessed body of evidence clearly supports the use of exercise training (both aerobic and strength training) for stroke survivors. Exercise training improves functional capacity, the ability to perform activities of daily living, and quality of life, and it reduces the risk for subsequent cardiovascular events. Physical activity goals and exercise prescription for stroke survivors need to be customized for the individual to maximize long-term adherence. CONCLUSIONS: The recommendation from this writing group is that physical activity and exercise prescription should be incorporated into the management of stroke survivors. The promotion of physical activity in stroke survivors should emphasize low- to moderate-intensity aerobic activity, muscle-strengthening activity, reduction of sedentary behavior, and risk management for secondary prevention of stroke.

The response to the COVID-19 pandemic: With hindsight what lessons can we learn?

The purpose of this paper is to put forward some evidence-based lessons that can be learned from how to respond to a Pandemic that relate to healthy living behaviours (HLB). A 4-step methodology was followed to conduct a narrative review of the literature and to present a professional practice vignette. The narrative review identified 8 lessons: 1) peer review; 2) historical perspectives; 3) investing in resilience and protection; 4) unintended consequences; 5) protecting physical activity; 6) school closures; 7) mental health; and 8) obesity. As in all probability there will be another Pandemic, it is important that the lessons learned over the last three years in relation to HLB are acted upon. Whilst there will not always be a consensus on what to emphasise, it is important that many evidence-based positions are presented. The authors of this paper recognise that this work is a starting point and that the lessons presented here will need to be revisited as new evidence becomes available.

Compounders of the COVID crisis: the "perfect storm".

Cultural and societal factors have placed some demographic, racial, and ethnic groups at increased risk of contracting and dying from coronavirus disease (COVID-19). This commentary addresses these population disparities and other potential modulators that negatively impact associated health outcomes in the US population, with specific reference to the need for greater self-responsibility.

High level physical activity in cardiac rehabilitation: Implications for exercise training and leisure-time pursuits.

IMPORTANCE: Regular moderate-to-vigorous physical activity and increased levels of cardiorespiratory fitness (CRF) are widely promoted as cardioprotective measures in secondary prevention interventions. OBSERVATIONS: A low level of CRF increases the risk of cardiovascular disease (CVD) to a greater extent than merely being physically inactive. An exercise capacity <5 metabolic equivalents (METs), generally corresponding to the bottom 20% of the fitness continuum, indicates a higher mortality group. Accordingly, a key objective in early cardiac rehabilitation (CR) is to increase the intensity of training to >3 METs, to empower patients to vacate this "high risk" group. Moreover, a "good" exercise capacity, expressed as peak METs, identifies individuals with a favorable long-term prognosis, regardless of the underlying extent of coronary disease. On the other hand, vigorous-to-high intensity physical activity, particularly when unaccustomed, and some competitive sports are associated with a greater incidence of acute cardiovascular events. Marathon and triathlon training/competition also have limited applicability and value in CR, are associated with acute cardiac events each year, and do not necessarily provide immunity to the development of or the progression of CVD. Furthermore, extreme endurance exercise regimens are associated with an increased incidence of atrial fibrillation and accelerated coronary artery calcification. CONCLUSIONS AND RELEVANCE: High-intensity training offers a time-saving alternative to moderate intensity continuous training, as well as other potential advantages. Additional long-term studies assessing safety, adherence, and morbidity and mortality are required before high-intensity CR training can be more widely recommended, especially in previously sedentary patients with known or suspected CVD exercising in non-medically supervised settings.

Impact of Social Disparities on Cardiovascular Disease and COVID-19 Outcomes: BARRIERS TO CARE AND PREVENTIVE INTERVENTIONS.

The COVID-19 pandemic has exposed significant disparities within certain population subsets that manifest through greater disease burden and worse outcomes. In this commentary, we propose specific preventive interventions to address these disparities within the United States.

Aspirin for the primary prevention of cardiovascular events: considerations regarding the risk/benefit.

PRACTICE PEARL: This update of the 2002 US Preventive Services Task Force (USPSTF) recommendation on the benefits and harms of aspirin for the primary prevention of cardiovascular disease (including myocardial infarction and stroke) suggests that the benefits of aspirin are likely to outweigh the risks in middle-aged and older men and women at increased risk for cardiovascular events. ORIGINAL ARTICLE: U.S. Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: U.S. preventive services task force recommendation statement. Ann Intern Med. 2009;150(6):396-404.

Effects of single bout resistance exercise on glucose levels, insulin action, and cardiovascular risk in type 2 diabetes: A narrative review.

AIMS: Previous studies have reported beneficial effects of chronic resistance exercise in the prevention and treatment of type 2 diabetes. To clarify potential modulators of acute responses to resistance exercise, we reviewed the literature to determine the effects of a single bout of resistance exercise on cardiometabolic risk factors in type 2 diabetes. METHODS: Pubmed and Embase were searched for studies investigating the effects of single bouts of resistance exercise on glucose and insulin levels, and cardiovascular disease risk in people with diabetes. Fourteen reports were identified and reviewed to formulate evidence-based resistance exercise prescription recommendations. RESULTS: Glucose and insulin levels appear to decrease with resistance exercise with effects lasting up to 24 and 18 h, respectively. Bouts of resistance exercise may outperform aerobic exercise in reducing ambulatory blood pressure, with effects lasting up to 24 h. Moreover, resistance exercise after rather than before a meal may be more effective in reducing glucose, insulin, and triacylglycerol levels. However, reducing injectable insulin dosage prior to resistance exercise may blunt its favorable effects on glucose levels. CONCLUSIONS: This review suggests that a single bout of resistance exercise may be effective for acutely improving cardiometabolic markers in people with diabetes.

The Journal of Cardiopulmonary Rehabilitation and Prevention at 40 Years and Its Role in Promoting Lifestyle Medicine for Prevention of Cardiovascular Diseases: PART 1.

Risk to individuals for cardiovascular events are invariably tied to their exposure to major coronary risk factors. This risk can be substantially mitigated by lifestyle behaviors. This first part of this Commentary focuses on the important role both adopting healthful dietary patterns and regularly obtaining adequate physical activity have as preventative therapies for cardiovascular diseases.

Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.

SUMMARY: In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. PRIMARY RECOMMENDATION: To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]

Preparticipation Screening Prior to Physical Activity in Community Lifestyle Interventions.

Behavioral lifestyle interventions in the community setting are effective in reducing the risk and burden of chronic diseases. The promotion and implementation of physical activity plays a key role in these community-based lifestyle programs. New guidelines on preparticipation screening for cardiovascular disease prior to physical activity have been released which include substantive modifications. These updated recommendations represent a substantial paradigm shift toward a more liberal approach that results in fewer individuals needing to seek medical clearance before starting a physical activity program. This shift has significant implications for those promoting physical activity within the community setting. The objectives of this commentary are to review the updated recommendations within the context of community-based lifestyle intervention programs such as those currently being offered throughout the United States for the primary purpose of diabetes prevention and to discuss the implications for those providers developing and implementing such programs.

Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research.

In this review, our first purpose is to provide an overview of existing physical activity intervention research, focusing on subpopulations and intervention modalities. Our reviews within each area are not exhaustive or quantitative, as each area has been reviewed in more depth in numerous other reports. Instead, our goal is to provide a single document that provides a qualitative overview of intervention research that emphasizes selected topics of particular importance for improving the population-wide impact of interventions. Therefore, in synthesizing this vast literature, we begin with existing reviews of physical activity research in each area and incorporate in our discussions recent reports of well-designed individual physical activity intervention studies that expand the existing research base and/or target new areas of research. Our second purpose is to offer new ideas and recommendations to improve the state of the science within each area and, where possible, to propose ideas to help bridge the gaps between these existing categories of research.

Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.

SUMMARY: In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. PRIMARY RECOMMENDATION: To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)].

Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation.

This article updates the 1994 American Heart Association scientific statement on cardiac rehabilitation. It provides a review of recommended components for an effective cardiac rehabilitation/secondary prevention program, alternative ways to deliver these services, recommended future research directions, and the rationale for each component of the rehabilitation/secondary prevention program, with emphasis on the exercise training component.

Cardiac rehabilitation and risk reduction: time to "rebrand and reinvigorate".

Atherosclerotic cardiovascular disease (ASCVD) continues to increase annually in the United States along with its associated enormous costs. A multidisciplinary cardiac rehabilitation (CR) and risk reduction program is an essential component of ASCVD prevention and management. Despite the strong evidence for CR in the secondary prevention of ASCVD, it remains vastly underutilized due to significant barriers. The current model of CR delivery is unsustainable and needs significant improvement to provide cost-effective, patient-centered, comprehensive secondary ASCVD prevention.