Exercise Training Benefits Marker of Cardiovascular Risk

The World Heart Federation has published a report that the leading cause of increasing prevalence of cardiovascular disease among Indians is due to:

• Physical inactivity - 79% men and 83% women
• High fat diet - 51% men and 48% women
• High Blood Pressure - 33% men and 30% women
• Diabetes - 34% men and 37% women

The alarmingly high percentage of physically inactive people and the increasing numbers of cardiovascular patients necessitate active measures to create necessary awareness. Though misconceptions exist that people with heart disease should not be physically active, research on patients with coronary artery disease who are non-diabetic has shown that there is no reduction in exercise capacity. An exercise intensity of as low as 8-10 minutes has shown improvement in cardiac health among teens.

A recent study by Dr Rune Byrkjeland and colleagues analyzed the effect of exercise training on carotid intima-media thickness (cIMT) development. This study, published in the Journal Cardiovascular Diabetology and titled “Effects of exercise training on carotid intima-media thickness in patients with type 2 diabetes and coronary artery disease. Influence of carotid plaques” monitored the effect of exercise training on the development of cIMT in patients with both:

a. Cardiovascular disease

b. Type 2 diabetes

Carotid Intima Media Thickness (cIMT):

Carotid Intima Media Thickness is a marker for atherosclerosis and other cardiovascular risk. Research studies by Professor Iana shimova on Carotid Intima Media Thickness (cIMT) and published in the journal of The European Society of Cardiology indicate that cIMT measurements should be carried out for patients at moderate risk for cardiovascular disease.
Table: Patients Requiring cIMT

S. No	Risk	cIMT measurement
1.	Moderate risk of cardiovascular disease- 1-5% of patients. Advertisement a. Large proportion of asymptomatic middle aged adults b. 10 year risk of cardiovascular disease that could prove fatal	cIMT measurement Carotid artery ultrasound Atherosclerotic plaques
2.	Hypertensive patients with moderate risk	cIMT measurement Target organ damage Carotid artery scanning for: Asymptomatic atherosclerosis Vascular hypertrophy
3.	Intermediate risk: 6-20% of patients. Advertisement Workout for People With Heart Conditions - Expert Speaks People with heart conditions can exercise to improve their general fitness. Dr. Selvapandian suggests what exercises can be taken up and what should be strictly avoided in a gym. a. 10 years risk of death due to cardiovascular disease or myocardial infarction b. First degree relative with cardiovascular disease	Carotid ultrasound scanning
4.	First atherosclerotic cardiovascular event	cIMT is not recommended

The importance of cIMT in cardiovascular disease prevention has prompted numerous research to understand the mechanisms of disease progression. The new age - research by Dr Rune Byrkjeland and colleagues is a significant study that analyzed the effect of exercise training on cIMT progression.

The study participants underwent 150 minutes of exercise per week, which extended to 12 months of aerobic(2/3rd) as well as strength training(1/3rd) which included:

a. Group based with special instructors

b. Home based with individual training

cIMT measurements: cIMT measurements were carried out using high resolution ultrasonography.

Results of the Study:

• No significant change in cIMT progression among patients with carotid plaques
• A significant difference in cIMT between exercise group and control among patients with no carotid plaques.

Significance of the Study

• Patients with carotid plaques- Patients with advancedstages of cardiovascular disease with carotid plaques did not show changes in cIMT progression. This does not mean that exercise training is not beneficial for such patients, only that the marker for the disease continues to increase. Exercise could affect other parameters that could contribute to disease progression.
• Patients without carotid plaques- Patients who are at a moderate risk for cardiovascular disease and who do not have cardiac plaques show significant control over cIMT progression after exercise training. This is an indication that early inclusion of regular exercise will control disease progression.

The health benefits of regular exercise are essential for everyone, including cardiac patients with diabetes. Though the benefits may not be as pronounced as when the disease is at its early stages, the advantages of being physically active continue to be promising. There are tailor made work out schedules for cardiac patients that improve health and fitness without undue stress.

References:

1. Rune Byrkjeland, Knut-Haakon Stensæth, Sigmund Anderssen, Ida U. Njerve,Harald Arnesen, Ingebjørg Seljeflot and Svein Solheim, “ Effects of exercise training on carotid intima-media thickness in patients with type 2 diabetes and coronary artery disease. Influence of carotid plaques” ; Cardiovascular Diabetology 2016, 15:13

2. http://www.world-heart-federation.org/press/releases/detail/article/reasons-for-indias-growing-cardiovascular-disease-epidemic-pinpointed-in-largest-ever-risk-factor/

3. http://content.onlinejacc.org/article.aspx?articleid=1358371

4. https://www.escardio.org/Guidelines-&-Education/Journals-and-publications/ESC-journals-family/E-journal-of-Cardiology-Practice/Volume-13/Intima-media-thickness-Appropriate-evaluation-and-proper-measurement-described

Source-Medindia