# Exercise as it relates to Disease/Exercise Guidelines to Prevent Atherosclerosis
## Prevalence

Atherosclerotic cardiovascular disease is the leading causes of death and a major source of morbidity in Australia. Ischemic heart disease (angina, blocked arteries of the heart, heart attacks) and cerebrovascular disease (haemorrhages, strokes, infarctions, blocked arteries of the brain) are the top two causes of death in Australia resulting in 32, 764 deaths in 2011.

## What is Atherosclerosis?

Atherosclerosis is a chronic inflammatory condition that is initiated by damage to the endothelium inside blood vessels. This is due to a number of factors such as high blood pressure, smoking and elevated levels of cholesterol and triglycerides in the blood. This damage results in the accumulation of fats, cholesterol, cellular debris, platelets and calcium forming on the inside of the artery walls. Overtime hard structures, called plaque, form inside the artery wall making them stiffer. This gradual process slowly reduces the diameter of the artery causing less blood flow and a decreased oxygen supply around the body. Eventually pieces of plaque break off due to high blood pressure and turbulent blood flow and travel to smaller blood vessels causing a blockage. This blockage starves the tissues of blood and oxygen and is a common cause of a stroke and heart attack. Atherosclerosis also contributes to the development of a number of diseases in the circulatory system which include Ischemic heart disease,Peripheral Artery Disease,Heart failure,Hypertension

## Risk Factors

| Preventable Factors | Non-Preventable Factors |
| *Improper Diet (high in fats, sugars and salts) | *Genetic disposition |
| *Insufficient or no physical activity | *Gender |
| *Obesity | *Age |
| *Hypertension | *Environmental pollution |
| *Lipid metabolism disorders | |
| *Tobacco smoking | |

# Benefits of exercise as a form of prevention and treatment

The American Heart Association Counsels of Clinical Cardiology and Nutrition, Physical Activity and Metabolism emphasise that exercise for patients with, or at risk of atherosclerotic cardiovascular disease is a valuable therapeutic strategy.
TABLE 1. Comparison of the Effects of Aerobic Training and Resistance Training on Health and Fitness Variables.
| Health/Fitness Variable | Aerobic Exercise | Resistance Exercise |
| Insulin sensitivity | ↑↑ | ↑↑ |
| Total cholesterol | ↓ | ↓ |
| Plasma triglyceride | ↓ | ↓ |
| High-density lipoprotein | ↑↔ | ↑↔ |
| Low-denisty lipoprotein | ↓↔ | ↓↔ |
| Resting heart rate | ↓↓ | ↔ |
| Systolic blood pressure at rest | ↓↓ | ↓ |
| Diastolic blood pressure at rest | ↓↓ | ↓ |
↑ indicates increased; ↓ decreased; and ↔ small effect.

# Exercise Guidelines

The American College of Sports Medicine recommends men aged 45+, women aged 55+ and individuals with major risk factors for atherosclerosis and diabetes at any age should consult a health practitioner for a physical examination and a medical history before beginning a vigorous exercise program.
Recommended activity guidelines by the American College of Sports Medicine:
| Aerobic Training | Resistance Training |
| Minimum 3 sessions/week for 12 + weeks | 2-3 sessions/week |
| Intensity should be 70-85% maximal heart rate | 10-15 repetitions to a moderate level of fatigue |
| 30 minutes continuous exercise or 3 x 10 minute bouts | Single set program |
| Different types of aerobic exercise consist of brisk walking, jogging, swimming and cycling. | 8-10 different exercises that target the major muscle groups (arms, shoulders, chest, back, hips and legs) |

# Further Readings

* American Heart Association Interactive Cardiovascular Library – Atherosclerosis and Cholesterol and Coronary Artery Disease
* The Heart Foundation: Australian physical activity guidelines and policies
* American Heart Association Heart Attack Risk Calculator
* Reducing Risk in Heart Disease

# Reference List

* ↑ Tuzcu, E. M., Kapadia, S. R., Tutar, E., Ziada, K. M., Hobbs, R. E., McCarthy, P. M., ... & Nissen, S. E. (2001). High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults evidence from intravascular ultrasound. Circulation, 103(22), 2705-2710.
* ↑ Australian Bureau of Statistics. 2011. Causes of Death [Online]. Canberra. Available: http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/3303.0Main%20Features12011?opendocument&tabname=Summary&prodno=3303.0&issue=2011&num=&view= [Accessed 20 October 2013]
* 1 2 3 4 5 A.D.A.M. Medical Encyclopedia. 2012. Hardening of the arteries [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001224/ [Accessed 14 October 2013].
* 1 2 3 American Heart Association (2013, May 1). Atherosclerosis. Retrieved October 20, 2013, from http://www.heart.org/HEARTORG/Conditions/Cholesterol/WhyCholesterolMatters/Atherosclerosis_UCM_305564_Article.jsp
* 1 2 3 4 Y. Arteriosclerosis, Thrombosis & Vascular Biology, 2001 [Online]. Available: http://www.webmd.com/heart-disease/what-is-atherosclerosis?page=1 [Accessed 14 October 2013]
* 1 2 3 4 5 6 7 8 9 10 11 12 Michalak, E., Laurentowska, M., Pospieszna, B., Domaszewska, K., & Rutkowski. R. (2008). RECREATIONAL TRAINING VS. SELECTED ATHEROSCLEROSIS RISK FACTORS IN POSTMENOPAUSAL WOMEN. Polish Journal Of Sports Medicine/ Medycyna Sportowa, 24(2), 81-88.
* ↑ Thompson, P. D. (2003). Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Arteriosclerosis, thrombosis, and vascular biology, 23(8), 1319-1321.
* 1 2 Braith, R. W., & Stewart, K. J. (2006). Resistance exercise training its role in the prevention of cardiovascular disease. Circulation, 113(22), 2642-2650.
* ↑ Durstine, J. L., Grandejean, P. W., Davis, P. G., Ferguson, M. A., Alderson, N. L., & duBose, K. D. (2001). Blood lipid and lipoprotein adaptations to exercise: a quantitative analysis. /Lipides sanguins et adaptations des lipoproteins a 1’exercise: analyse quantitative. Sports Medicine, 31(15), 1033-1062
* ↑ Hurley, B. F. (1989). Effects of resistive training on lipoprotein-lipid profiles: a comparison to aerobic exercise training. Med Sci Sports Exerc, 21(6), 689-693.
* ↑ Kelley, G. A., & Kelley, K. S. (2006). Aerobic exercise and lipids and lipoproteins in men: a meta-analysis of randomized controlled trials. The journal of men's health & gender, 3(1), 61-70
* ↑ Thompson, P. D., Buchner, D., Piña, I. L., Balady, G. J., Williams, M. A., Marcus, B. H., ... & Wenger, N. K. (2003). 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,107(24), 3109-3116.
* ↑ Tolfrey, K., Jones, A. M., & Campbell, I. G. (2000). The effect of aerobic exercise training on the lipid-lipoprotein profile of children and adolescents. Sports Medicine, 29(2), 99-112.
* ↑ FRANKLIN, A. B., BALADY, J. G., BERRA, K., GORDON, F. N. & POLLOCK, L. M. 2012. Exercise for persons with cardiovascular disease [Online]. Available:http://www.acsm.org/docs/current-comments/exercise-for-persons-with-cardiovascular-disease.pdf [Accessed 13 October 2013].