# Exercise as it relates to Disease/Physical activity to reduce the risk of cardiovascular disease

This Wikibooks page is a critique of "Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: the “Pas-a-Pas” community intervention trial" by Arija et al. published in BioMed Central Public Health in 2017.

## What is the background to this research?

Cardiovascular disease is any disease that affects the heart or blood vessels. This includes coronary heart disease, cardiomyopathy and stroke. Exercise is critical to the prevention and treatment of cardiovascular disease.

### Prevalence

Cardiovascular disease has been the leading cause of deaths in Australia for many years with 43,963 deaths in 2016. In Spain where the intervention was conducted there is also a high prevalence of cardiovascular disease with 53,101 deaths, or 16.92% of all deaths in 2017.
On a worldwide scale 17.5 million people or 31% of all mortality died from cardiovascular disease in 2012. The World Health Organization estimated that 23.6 million people will be dying each year from cardiovascular disease by 2030.

### Risk Factors

Risk factors increasing the risk of cardiovascular disease include:
* Hypertension
* High cholesterol
* Smoking
* Obesity
* Sedentary lifestyle
* Diet
* Age

## Where is the research from?
### Location of the Study

The study was conducted at 4 primary care centres in Reus, Catalonia, Spain.

### Location of the Author

Victoria Arija is affiliated with Rovira i Virgili University in Tarragona, Spain. Victoria researches chronic diseases with association to 123 publications on ResearchGate and has been published 7 times in BMC Public Health.

### Publishing Journal

BMC Public Health is the largest open access, peer-reviewed journal with a focus on public health. BMC Public Health addresses the social, behavioural and environmental effects on health and disease, investigating how different interventions make for a healthier community.

## What kind of research was this?

Arjia V et al. conducted a randomised controlled community intervention. Randomised controlled interventions are thought to be the gold standard, reduce bias and be a thorough method of evaluating whether a cause-effect relationship exists between the intervention and the outcome.

## What did the research involve?

This research intervention involved collecting clinical history, baseline dietary intake and physical activity levels. The participant's cardiovascular risk factor was also measured using the Registre Gironí del Cor scale. This scale assessed blood pressure, smoking status, waist circumference, weight, BMI and cholesterol.
The intervention consisted of a control group of 104 people and intervention group of 260 people. The participants completed 120min/week walking (396METs/min/week) and a social gathering once a month.
This article did not address the risk of human error in initial measurements. Blood pressure was measured with a manual sphygmomanometer 3 times and an average recorded. There is the possibility the clinician could mishear the blood pressure reading or left inadequate time between the tests which would elevate the participant's blood pressure. The cardiovascular risk factor scale Registre Gironí del Cor asks whether a participant smokes with simply yes or no. This does not take into account the quantity of cigarettes the participant smokes per day. This would have a major effect on the narrowing of arteries and their lung function therefore affecting their cardiovascular disease risk and ability to participate in walking interventions. Studies that have found the Registre Gironí del Cor risk factor scale to underestimate the risk of cardiovascular disease.

## What were the basic results?

| Key Factor | Result of Intervention | P-Value |
| Physical Activity | +774.81 METs/min/week | 0.026 |
| Systolic Blood Pressure | -6.63mmHg | 0.029 |
| Total Cholesterol | -10.12mg/dL | 0.006 |
| LDL-Cholesterol | -9.05mg/dL | 0.009 |
A p-value <0.05 was considered to be of statistical significance.
* Two years after intervention, the incidence of adverse cardiovascular events remained 8% lower in the intervention group participants and their maintenance of regular physical exercise was 45.6% higher than the control group participants.

## What conclusions can we take from this research?

Results show that walking over extended periods of time reduces cardiovascular disease prevalence. This is through decreased systolic blood pressure, LDL-cholesterol and total cholesterol. These results aligns with current research findings.
The method could be adapted to reduce the risk for error. There should be more research in this area and awareness raised that cardiovascular disease is the biggest killer of Australians and that exercise can reduce the risk and severity of the disease.

## Practical advice

If you consider that you or a family member may have cardiovascular disease book an appointment with your local general practitioner. They will access your medical history and order testing if necessary.
To get an individualised exercise plan you should contact an Exercise Physiologist. They have the anatomical knowledge to write an exercise plan for cardiovascular disease.

## Further Readings

* Cardiovascular Disease Fact Sheet - Heart Foundation: https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/cardiovascular-disease-fact-sheet.
* Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity): http://scholar.google.com.au/scholar_url?url=http%3A%2F%2Fscholarcommons.sc.edu%2Fcgi%2Fviewcontent.cgi%3Farticle%3D1137%26context%3Dsph_physical_activity_public_health_facpub&hl=en&sa=T&oi=gga&ct=gga&cd=3&d=14765982305966312302&ei=2tiXW-QIh-LKBNWNuNgL&scisig=AAGBfm2WVidg3MMjpUEFu96ITxn3sOKw4w&nossl=1&ws=1536x770.

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Arjia V et al. Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: the “Pas-a-Pas” community intervention trial. BMC Public Health. 2017 Jun 15; 17:576.
* 1 2 3 Heart Foundation. Cardiovascular disease fact sheet. Australia: Heart Foundation; 2018.
* ↑ Heart Foundation. Cardiovascular disease, heart disease and heart attack. Australia: Heart Foundation; 2017.
* ↑ World Health Rankings. Spain: Coronary Heart Disease. World Health Foundation; 2017.
* ↑ World Health Organization. Cardiovascular disease. World Health Organization; 2017.
* ↑ World Health Organization. About cardiovascular diseases. World Health Organization; 2018.
* 1 2 3 4 5 6 7 World Heart Foundation. Risk factors. World Heart Foundation; 2017.
* 1 2 ResearchGate. Victoria Arija's research. ResearchGate; 2018.
* ↑ BMC Public Health. Articles. BMC Public Health; 2018.
* 1 2 BMC Public Health. About. BMC Public Health; 2018.
* ↑ Practical Radiation Oncology Physics. Randomized Controlled Trial. ScienceDirect; 2016.
* ↑ Eguchi K et al. What is the optimal interval between successive home blood pressure readings using an automated oscillometric device?. J Hypertens. 2009 Jun;27(6):1172-77.
* ↑ British Heart Foundation. Smoking. Britain: British Heart Foundation; 2018.
* ↑ Gómez-Vaquero C et al. SCORE and REGICOR function charts underestimate the cardiovascular risk in Spanish patients with rheumatoid arthritis. BMC Public Health. 2013 Aug 21;15.
* ↑ Gómez-Marcos MA et al. Therapeutic implications of selecting the SCORE (European) versus the D'AGOSTINO (American) risk charts for cardiovascular risk assessment in hypertensive patients. BMC Cardio Disorders. 2009 May 11;9:17.
* 1 2 Thompson PD et al. Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003;107(24):3109-16.
* ↑ Whelton SP et al. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. 2002.
* ↑ HealthDirect. Diagnosis of coronary heart disease. Australia: HealthDirect; 2018.