# Exercise as it relates to Disease/The relation of cardiovascular health to fitness and physical activity in children and adults

This article is a critical analyses of the paper "Relation of Cardiovascular Fitness and Physical Activity to Cardiovascular Disease Risk Factors in Children and Adults" (James S. Fallis, 1998)

## What is the background to this research?

* CVD: Cardiovascular disease is a condition that involves the narrowing or blocking of blood vessels that could possibly lead to chest pain, heart attack or even a stroke. CVD is the leading cause of death and disease in Australia, with approximately 43,477 in 2017. CVD is one of Australia's largest health problems despite the recent improvements over the past few decades, it is one of the largest burdens on the economy that Australia faces. Research into physical activity reduces the risk of cardiovascular disease morbidity and mortality and increases longevity. There has been research that CVD can be avoided or delayed by the changes of diet and lifestyle. Heart attacks, stoke and other cardiovascular related diseases kill or seriously affect a large majority of the Australian population.

## Where is the research from?

* This research article was published in the American Journal of Epidemiology, one of a peer-reviewed journals for opinions and methodological development in the field of epidemiological research.
* James F. Sallis is a distinguished professor, family, medicine and public health at the University of California, San Diego and Director of Active Living Research. Dr. Sallis is an author of over 500 scientific publications, co-author of several books, on the editorial boards of several journals and one of the worlds most cited authors in the social sciences. His current focus with the implantation of his research to inform policy and environmental changes that will increase physical activity and reduce childhood obesity.

## What kind of research was this?

* This study was conducted in the form of a Case-Control Study, in which the participants were interviewed to rule out people with pre-existing cardiovascular disease or a very high risk of having cardiovascular related diseases or symptoms. High risk people were people referred to as having a systolic blood pressure above 95mmHg.
* A Case-control study is where the study begins with no intervention in mind and the participants are only required to be tested once and not multiple times. The people are chosen with the case in mind and maybe interviewed, or chosen purely through checking their medical records . After the results are taken, they compare the outcome with the odds of having a disease. Throughout the research it is important to keep in mind that they are not measuring people with cardiovascular disease, and to consider the people that would have cardiovascular disease and the effect of cardiovascular fitness and physical activity.

## What did the research involve?

* The study involved 88 male adults, 180 female adults, 148 male children and 142 female children. These were families and children from the fifth and sixth grade and was free from the risk of Cardiovascular disease or at high risk. The high-risk participants were defined as having a diastolic blood pressure greater than 95mmHg. Each of the families consisted of 1 adult and 1 child who contributed to different house hold activities.
* The testing of the participants was conducted over a week long period. A physical activity recall was used over several days. There was 43 adults and children that were reinterviewed from the overall 558 participants on the same day but by different interviewers. To test the participants cardiovascular fitness, the participants were required to cycle on a cycle ergometer at a VO2 submaximal workload. The test involved a modified Astrand Rhyming protocol of gradually increasing workloads throughout the test. The test was terminated when the adults reached 70% of their predicted maximal heart rate whereas the test was terminated when the children reached 85 % of their predicated maximal heart rate. The participants maximal heart rate was determined before commencing physical activity. Throughout the duration of the study the participants energy expenditure was estimated through the different tests and their physical activity recall. Throughout the study the participants blood lipids were collected after a 12 hours fasting to determine their triglycerides, total cholesterol, HDL cholesterol levels and low density lipoprotein cholesterol was calculated by an equation. Heart rate was assessed by palpation for one minute. Finally, body mass was assessed with weight without shoes on scales and height using a height stadiometer. Data was analysed and the Pearson correlation and partial correlation procedures were used to a assess the data.

## What were the basic results?

* The aim of the study was to determine if regular physical activity will reduce the risk of cardiovascular disease morbidity and mortality and increase the longevity.
* The results have shown that for male adults, energy expenditure did not correlate with any risk factors. Whereas for the female adults, the energy expenditure was significantly correlated with body mass index.
* The result in the children was similar to what was found in the adults. For both male and female children fitness was significantly correlated with all risk factors, refer to table 1.
Energy expenditure was correlated with none of the risk factors which included blood pressure, high density lipoproteins and body mass index in male children and only HDL/LDL in female children.
Relations between cardiovascular fitness, physical activity and cardiovascular disease (Table 1)
| | Males | Males | Males | Females | Females | Females |
| Variable | Predicted VO$_2$ max | Energy Expenditure | Activity Rating | Predicted VO$_2$ Max | Energy Expenditure | Activity rating |
| Systolic blood pressure | -0.35 | 0.02 | 0.06 | -0.28 | -0.03 | 0.00 |
| Diastolic blood pressure | -0.42 | 0.02 | 0.07 | -0.36 | 0.02 | -0.10 |
| HDL cholesterol | 0.25 | 0.08 | 0.06 | 0.24 | 0.09 | 0.09 |
| HDL/LDL | 0.18 | 0.03 | 0.06 | 0.29 | 0.15 | 0.13 |
| Body Mass Index | -0.69 | 0.04 | -0.25 | -0.53 | -0.16 | -0.13 |
| Heart Rate | -0.45 | -0.09 | -0.27 | -0.30 | -0.05 | -0.16 |
| Energy Expenditure | | | 0.01 | | | 0.03 |
* The numbers displayed in the table are a Pearson correlation that was calculated and adjusted for.

## What conclusions can we take from this research?

* Previous research in cardiovascular fitness, physical activity and selected coronary heart disease risk factors in adults has shown that there is a relationship between cardiovascular disease and cardiovascular fitness but not a relationship to physical activity. In this study there was a relationship between cardiovascular fitness and cardiovascular disease risk factors. It has been shown that the risk factors and variables have been displayed with previous studies in ‘Association between coronary heart disease risk factors and physical fitness in healthy adult women’ and ‘ relationship of physical characteristics an life habits to treadmill exercise capacity'.
* Throughout the research it has found a relationship between that the higher the cardiovascular fitness the lower the risk of developing cardiovascular like symptoms for example heart attack, chest pain or stroke.

## Practical advice

* As supported by other research, resistance-based training may reduce cardiovascular disease. Prescribed and supervised resistance training enhances muscular strength and endurance, functional capacity and independence and quality of life while reducing disability in people with cardiovascular disease.
* What is resistance training?
* With cardiovascular disease prevalence becoming high it is recommended that you seek medical advice from a general practitioner before starting cardiovascular related resistance training. It is recommended that once a general practitioner has recommended resistance training the patient should seek advice from an exercise physiologist. It is also recommended that throughout the training prescribed that it is supervised from a medical professional. Due to the increasing prevalence of cardiovascular disease and cardiovascular condition such as stoke and heart disease there has been a lot of research money and time poured into the research that has been recently achieved into cardiovascular medical devices, cardiovascular neuroscience and cardiovascular-protective signaling and drug discovery through the heart research institute.

## Further information/resources

* Heart Foundation can provide some information about what is cardiovascular disease and how this can be prevented and managed.
* Heart Research Australia can help by identifying risk factors that are increasing the risk of a cardiovascular disease.
* Department of Health shows different ways that someone can become more physically active and different types of management and treatment methods.
* Australian Cardiovascular Disease Risk Calculator indicated who is at risk of a cardiovascular disease and when they should be assessed.
* Physical Activity with Cardiovascular Disease identifies why it is important to be physically active, different types of exercise, who should participant in the physical activity and what types of assistance are available for people.

## References

* 1 2 3 4 5 6 7 8 SALLIS JF, PATTERSON TL, BUONO MJ, NADER PR. Relation of cardiovascular fitness and physical activity to cardiovascular disease risk factors in children and adults. American Journal of Epidemiology. 1988 May 1;127(5):933-41.
* ↑ Department of Health | Cardiovascular disease [Internet]. www1.health.gov.au. 2019 [cited 25 August 2019].
* 1 2 Foundation T. Heart disease in Australia. The Heart Foundation. 2019.
* ↑ Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%(vol 326, gp 1419, 2003). British Medical Journal. 2003 Sep 13;327(7415):586-.
* ↑ James F. Sallis | Active Living Research [Internet]. Activelivingresearch.org. Available from: https://activelivingresearch.org/about/programstaff/sallis
* ↑ Gibbons LW, Blair SN, Cooper KH, Smith M. Association between coronary heart disease risk factors and physical fitness in healthy adult women. Circulation. 1983;67(5):977-83.
* ↑ Leon AS, JACOBS Jr DR, DEBACKER G, TAYLOR HL. Relationship of physical characteristics and life habits to treadmill exercise capacity. American Journal of Epidemiology. 1981;113(6):653-60.
* ↑ Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116(5):572-84.
* ↑ Cardiovascular and Heart Disease [Internet]. Heart Research Institute. Available from: https://www.hri.org.au/