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Patients with heart disease who sit a lot have worse health even if they include exercise in their lives. That is the conclusion of new findings that looked at the activity levels and corresponding health indicators of patients with coronary artery disease.
“Limiting the amount of time we spend sitting may be as important as the amount we exercise,” said lead author Stephanie Prince, PhD, post-doctorate fellow in the Division of Prevention and Rehabilitation at the University of Ottawa Heart Institute. “Sitting, watching TV, working at a computer and driving in a car are all sedentary behaviours and we need to take breaks from them.”
Previous research has shown that being sedentary increases the risk of cardiovascular disease, but until now, its effect on patients with established heart disease was unknown.
The current study, published in November in the European Journal of Cardiovascular Prevention, investigated levels of sedentary behaviour and the effect on health in 278 patients with coronary artery disease. The patients had been through a cardiac rehabilitation programme which taught them how to improve their levels of exercise in the long term.
Patients wore an activity monitor during their waking hours for nine days. The monitors allowed the researchers to measure how long patients spent being sedentary, or doing light, moderate or vigorous levels of physical activity.
The researchers also assessed various markers of health including BMI and cardiorespiratory fitness to determine whether the amount of time a person spent being sedentary (mainly sitting) was related to these markers.
The patients spent an average of eight hours each day being sedentary. “This was surprising given that they had taken classes on how to exercise more,” said Dr. Prince. “We assumed they would be less sedentary but they spent the majority of their day sitting.”
Men spent more time sitting than women—an average of one additional hour each day. This difference was primarily because women tended to do more light-intensity movement—things like light housework, walking to the end of the drive, or running errands.
Dr. Prince said: “Women with coronary artery disease spend less time sitting for long periods, but we need to do more research to understand why. There is some research which suggests that at around the age of 60 men become more sedentary than women and may watch more TV.”
The patients who sat more had a higher BMI and had lower cardiorespiratory fitness. This was assessed using their aerobic capacity. This is the maximum rate at which the heart, lungs and muscles use oxygen during an exercise test.
“These relationships remained even when we controlled for an individual’s age, gender or physical activity levels,” said Dr. Prince. “In other words, people who sat for longer periods were heavier and less fit regardless of how much they exercised.”
Dr. Prince emphasized that sitting less was not a replacement for exercise. “It’s important to limit prolonged bouts of sitting and in addition to be physically active,” she said. “Sedentary time may be another area of focus for cardiac rehabilitation programmes along with exercise.”
How low should treatment targets for blood pressure be? Major medical groups, including the American Heart Association (AHA), recommend maintaining systolic blood pressure below 140 mm Hg. But results from the large randomized Systolic Blood Pressure Intervention Trial (SPRINT) show that, for some patients at risk of cardiovascular disease, bringing systolic blood pressure below 120 mm Hg saves lives with manageable side effects.
Released simultaneously at the AHA 2015 Scientific Sessions and in the New England Journal of Medicine, SPRINT included over 9,000 volunteers, half of whom were assigned to standard therapy (to bring systolic pressure below 140 mm Hg) and half to intensive therapy (below 120 mm Hg). Medication regimens were individualized and relied on standard, widely available drugs: mostly diuretics, ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers, with other drugs used as needed to meet the blood pressure targets.
All participants were at least 50 years old and had high blood pressure and at least one other risk factor for heart disease. The trial included older patients (75 years or older), people with chronic kidney disease, and people with a history of cardiovascular disease. The participants were also diverse: about 36 per cent were women, 30 per cent African American, and 11 per cent Hispanic. People with diabetes, prior stroke or advanced kidney disease were excluded.
SPRINT was scheduled to run for five years but was stopped after less than three and a half because of the strong benefits seen in the intensive therapy group: those participants had a 43 per cent decrease in risk of death from cardiovascular disease and a 27 per cent decrease in overall mortality compared with the standard treatment group. This was true across all subgroups, including older participants.
The benefits seen in the intensive therapy group did come with an increase in side effects: more patients showed an increased indication of kidney damage and an increased risk of low blood pressure episodes and fainting, though not of falls leading to injury. Overall, 4.7 per cent of patients in the intensive therapy group and 2.5 per cent in the standard therapy group experienced a serious adverse event. “Our impression overall is that the beneficial effects [in the intensive therapy group] seem to be much, much more important,” said Paul Whelton, MD, chairman of the SPRINT steering committee. Additional data on kidney function and cognitive performance will be published in 2016.
A concurrent paper, published in the Journal of the American College of Cardiology, estimated that 16.8 per cent of U.S. adults would meet the SPRINT eligibility criteria.
More news from AHA 2015, including updates on cardiac resuscitation, salt intake and the clinical use of genetic risk scores, is available at now at The Beat.