The multifactorial impact of exercise
in cardiovascular diseases
Daniel Umpierre, ScD
Federal University of Pelotas
Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS
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Disclosures
• Shareholding: Evidência Saúde (continuing professional education);
• Consultancy: ABRASCO/PAHO; Ministério da Saúde (Brasil).
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Me
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Goals
• Physical (in)activity as major problem
• Exercise in the era of statins
• Treating early: exercise in hypertension
• Treating lately: exercise in coronary disease and chronic heart
failure
• Summary
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Physical activity and CVD
Morris et al. Lancet, 1953
"Coronary heart-disease and
physical activity of work".
‘Jerry Morris’
1910 - 2009
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Prevention as a primary strategy
Ekelund et al. Lancet 2016, 388(10051):1302-10
Sitting time
Physical activity (PA)
IPD meta-analysis | N = 1 005 791
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Prevention as a primary strategy
Ekelund et al. Lancet 2016, 388(10051):1302-10
Sitting time
Physical activity (PA)
Too much sitting
No sweat at all
Too much sitting
Physically active
IPD meta-analysis | N = 1 005 791
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Mora et al. Circulation 2007, 116: 2110
0.7%
0.3%
Homocysteine
59%
All pooled factors 35.5%
32.6%
Inflammatory/
Hemostatic 20.9%
27.1%
Blood pressure /
Hypertension 14.9%
19.1%
Traditional lipids
13.4%
15.5%
Novel lipids
11.1%
10.1%
BMI
6.8%
HbA1c / Diabetes 8.9%
5.0%
0 10 20 30 40 50 60 70
CVD
CAD
27 055 women
1500 kcal/wk
vs.
<200 kcal/wk
Multiple factors for CVD risk reduction
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No content
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JAMA, 2014; 311:463-64
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Changes in HDL-cholesterol
(mg/dl)
-2
0
1
4
7
P = 0.015
Kraus WE et al. N Engl J Med 2002, 347:1483-92
Controls
Mod. Volume – Mod. Intensity
Mod. Volume – High Intensity
High Volume – High Intensity
Lipid levels may be a tricky route
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Sex:
males
Cornelissen, Smart. J Am Heart Assoc 2013, e004473.
Exercise training and blood pressure
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Hypertension
Sex:
males
Cornelissen, Smart. J Am Heart Assoc 2013, e004473.
Exercise training and blood pressure
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Hypertension
Sex:
males
Cornelissen, Smart. J Am Heart Assoc 2013, e004473.
Programs with
lengths
between 12-24
weeks
Exercise training and blood pressure
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Sessions
from 30 to
45 min
Hypertension
Sex:
males
Cornelissen, Smart. J Am Heart Assoc 2013, e004473.
Programs with
lengths
between 12-24
weeks
Exercise training and blood pressure
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Weekly volume
from 150 to
210 min
Sessions
from 30 to
45 min
Hypertension
Sex:
males
Cornelissen, Smart. J Am Heart Assoc 2013, e004473.
Programs with
lengths
between 12-24
weeks
Exercise training and blood pressure
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Santos et al. J Hypertens. 2016, 34(7):1317-24.
Effect from a single exercise session
• Assessing subsets of hypertensive patients and exercise prescriptions
Univariate
Age
VE
/VCO2
Training volume
% men
Ejection fraction
% β-blockers
Target intensity
VO2
peak
FC max
1st VT
Exercise training characteristics in heart failure
Belli et al. Tese de doutorado. UFRGS, 2016.
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Univariate
Age
VE
/VCO2
Training volume
% men
Ejection fraction
% β-blockers
Target intensity
VO2
peak
FC max
1st VT
Exercise training characteristics in heart failure
Belli et al. Tese de doutorado. UFRGS, 2016.
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Univariate
Age
VE
/VCO2
Training volume
% men
Ejection fraction
% β-blockers
Target intensity
VO2
peak
FC max
1st VT
Exercise training characteristics in heart failure
Belli et al. Tese de doutorado. UFRGS, 2016.
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Univariate Age
VE
/VCO2
Training volume
% men
Ejection fraction
% β-blockers
Target intensity
VO2
peak
FC max
1st VT
Exercise training characteristics in heart failure
Belli et al. Tese de doutorado. UFRGS, 2016.
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Ejection
fraction*
Age*
% men
%
β-
blockers
Exercise
volume*
Target
intensity*
VO2
peak
R = 0.70
P = 0.005
R = 0.35
P = 0.04
*Multivariable model: p = 0.033
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Take-home messages
• Prevention matters. Interventions are necessary to increase
physical activity levels in general population;
• Formal exercise is well integrated with pharmacological therapy and
there is some tension in terms of benefits/interests;
• High odds for benefits when delivering exercise stimuli for
hypertensives;
• Exercise is an important player for CHF, but tailoring the
prescription may strengthen benefits.
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www.ufrgs.br/lafiex
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The multifactorial impact of exercise
in cardiovascular diseases
Daniel Umpierre
[email protected]
Material: www.evidenciasaude.com.br/cardio2016