The Role of Exercise in the Management of Cardiovascular Disease

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THE ROLE OF EXERCISE
IN THE MANAGEMENT OF CARDIOVASCULAR DISEASE

Cardiovascular disease (CVD) is the term used to describe the diseases affecting the heart, arteries and blood vessels. Coronary heart disease (CHD) is a leading public health problem in the UK with costs exceeding £30 billion per year. Mortality rates from the disease continue to fall, mainly due to a combination of public awareness of the risk factors and understanding of the need to lead a healthier life. However the death rate from CHD is still very high with more than 12500 deaths in under 65 age group in 2008 (British Heart Foundation). CHD, such as angina or heart attack is caused by a narrowing of the coronary arteries by fatty deposits, leading to atherosclerosis or hardening of the arteries. Atherosclerosis is the main cause of CVD but there is a strong link between developing CVD and physical inactivity, high blood pressure, unhealthy diet with consumption of saturated fats, stress and smoking (World Health Organisation). A literature review by Powel et al 1987 observed the inverse association between physical inactivity and CHD and in addition the risk is similar in magnitude to that of high blood pressure, high cholesterol levels and smoking. These observations suggested that CHD prevention programs should always include exercise and that this is as important as smoking cessation, blood pressure controls and cholesterol level decrease. A review of scientific evidence by Mozaffarian et al has indicated that trans-fatty- acids adversely affect cardiovascular health and reported an increased risk of heart attack or CHD of up to 32% for every 2% of trans-fatty-acids consumption replacing carbohydrate. Conclusions were reached that consumption of trans-fatty-acids from partially hydrogenated oils adversely affect cardiovascular health and significantly increase the risk of a cardiac event. Many studies have shown the link between high blood pressure and CVD e.g. a study by Ramachandra et al involving 6859 participants over 10 years who were initially free of hypertension and CVD. This study showed an increase in cardiac event rates in those with blood pressure higher than baseline figures. Cigarette smoking has been shown to predispose individuals to CVD and in particular angina, acute coronary syndromes, stroke and sudden death. (Diez Roux et al). Clinical imagery techniques have ascertained the relationship between smoking and atherosclerosis. Both active and passive smoking is associated with increase in the thickness of the carotid artery as assessed by ultrasound. (Howard et al) Emotional stress has been shown to have adverse effects on the heart causing left ventricle dysfunction, myocardial ischemia and cardiac rhythm disturbances. (Ziegelstein) Atherosclerosis as the main cause of the CHD.(Rosamond et al) Hypercholesterolaema, smoking and high blood pressure all increase the risk of developing atherosclerosis. All these risk factors can lead to inflammation of the artery walls that give rise to fatty deposits and cause hardening of the arteries. When physical trauma causes rupture then a heart attack or stroke will result. Exercise has been shown to reduce the risk of CHD as it reduces coagulation activity and at the same time increases fibrinolytic activity (el-Sayed). Fibrinolytic activity is elevated and sustained in individuals who exercise (Wallen) and as a result we can say that moderate exercise is beneficial to health. Severe exercise, on the other hand is associated with an increase in coagulation activity and platelet activation and therefore Wallen has warned of the danger of thrombosis for severe exercising. However Ferguson and Guest reported that the increase in coagulation seen in conditional athletes may be due to heamoconcentration associated with exercise. This area is not fully understood and more research is needed. Moderate exercise in particular was reported by Suzuki to improve blood...
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