Category Archives: #GetFit

#GetFit: Cardiorespiratory Fitness and Long-Term Survival in “Low-Risk” Adults

You are young and healthy, meaning that you must be “low-risk,” right? But what does this mean in terms of long-term survival?

In a 2012 study in the Journal of the American Heart Association, a group of authors, including our own Jarret Barry, sought to answer this question. They sought to establish whether cardiorespiratory fitness had important implications for long-term cardiovascular risk among individuals classified as low risk by the Framingham Risk Score (10-year coronary heart disease risk <10%).

The study population was composed of men and women, 30 to 50 years of age in our own city of Dallas, Texas. Eligible individuals were defined as being at low risk for coronary heart disease by Framingham Risk Score at the time of study entry and had no history of diabetes (n=11 190). Cardiorespiratory fitness was determined by maximum graded exercise treadmill tests. Over an average 27±2-year period, 15% of low-fit (quintile 1) compared to 6% of high-fit (quintile 5) individuals died (P<0.001).

The study noted that a 1–metabolic equivalent level increase in baseline fitness was associated with an 11% reduction in all-cause deaths and an 18% reduction in deaths due to cardiovascular disease (CVD) after adjustment for age, sex, body mass index, systolic blood pressure, total cholesterol, blood glucose levels, smoking, and early family history of coronary disease. There was an incremental decrease in CVD risk with increasing fitness quintile, such that the high fit had the lowest adjusted 30-year CVD mortality rate compared to the low fit.

Cardiorespiratory fitness is associated with a significant reduction in long-term CVD among individuals identified as low risk by Framingham Risk Score. These data suggest that preventive lifestyle interventions geared to optimize cardiorespiratory fitness, even among a “low-risk” subset, should be considered to improve CVD-free survival.

See you on the Katy Trail!

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#GetFit: Physical Fitness and Mortality

Low levels of physical capability in middle age may signal poorer chances of survival over the next 13 years, according to a cohort study of 1355 men and 1411 women in the United Kingdom.

Nurses assessed grip strength, chair rise speed, and standing balance time of participants at age 53 years.Participants with lower physical capability scores tended to have lower socioeconomic position; less healthy lifestyles; and higher prevalence of self reported cardiovascular disease,diabetes, and severe respiratory symptoms when compared with those with higher scores.

During the follow-up period, there were 177 deaths (88 from cancer, 47 from cardiovascular disease, and 42 from other causes). The fully adjusted hazard ratio of all-cause mortality for participants in the lowest vs highest quintiles of physical capability was 3.68. Those who could not complete any of the 3 tests had death rates more than 12 times higher than those who were able to complete the tests.

Subpar performance on the tests in middle age likely reflects subclinical disease and aging processes rather than manifest diseases, making this population an important one for interventions, said the investigators. What does all of this mean? Time to hit the gym!

#GetFit: Do Pedometers Work?

You have a fitbit, or an up, or moov, or misfit, or SOMETHING to help track your steps and encourage your to take the fabled 10,000 steps. Companies around the country are giving their employees FREE fitness trackers to promote wellness (and perhaps reduce health insurance claims in the long-term?). But the question remains, does this strategy actually work?! Does counting steps encourage fitness and improve health? Before we tackle the modern fitness trackers, with heart rate monitoring, smartphone apps, frequent notifications, etc., let’s start at the beginning, with the basic pedometer.

In 2007, before the smartphone era, a group out of Stanford asked if pedometers increase physical activity and improve health. In the systematic review of 26 studies with over 2700 participants with a median age of 49, they found that the use of a pedometer increased physical activity by a statistically significant 27%! In the randomized-controlled trials, particiapnts averaged about 2500 additional steps. In observational studies, they increased their steps about 2200 above baseline. Importantly, this increase in steps per day led to a significant decrease in both BMI and systolic blood pressure! The study suggested that simple pedometers have the potential to significantly improve health. To read the full study, click here to visit the Journal of the American Medical Association.

Get Fit Week! Ideal Cardiovascular Fitness

Get Fit Week

As our year comes to a close, we would like to present our last themed series of posts, a part of GET FIT WEEK. These posts will focus on the scientific evidence and guidelines for obtaining and mantaining physical fitness, with a focus on health benefits and tools for achieving these goals.

Ideal Cardiovascular Fitness

It makes sense to start with ideal cardiovascular fitness! The American Heart Association 2020 Strategic Goals include this idea. It is defined as optimal levels of three cardiovascular risk factors (blood pressure, fasting glucose, cholersterol) and 4 lifestyle behaviors (BMI, smoking, physical activity, and diet). In a cohort study of ~5800 young adults (age range of 29 to 39 years) from the United States, Finland, and Australia, investigators compared the presence of these 7 measures of ideal cardiovascular fitness with carotid intima-media thickness. The ideal numbers for each metric is as follows: BP 120/80, total cholesterol < 5.17 mmol/L, fasting glucose < 5.6 mmol/L, BMI < 25 kg/m2, and no history of smoking (or quit > 1 year ago). Ideal physical activity was defined as >150 min/week of moderate exertion or > 75 min/week of vigorous exertion. The concept of the ideal diet was most complicated, requiring 4 of the following 5 components: > 4.5 cups of fruits or vegetables per day, > two 3.5 oz servings of fish per week, > three 1 oz servings of whole grains per day, < 1500 mg sodium per day, and < 450 kcal from sugary drinks per week. One of the most notable aspects of this study was that only 1% of the participants had all 7 ideal CV health metrics! The findings of the study indicated that, with the presence of each additional “ideal” measure (i.e. well-controlled BP, recommended levels of physical activity, etc.), carotid intima-media thickness was significantly lower. Essentially, this suggests that physical fitness, as defined by the above measures of blood pressure, cholesterol, BMI, smoking, etc., not only makes you feel great, (and need less medications!), it appears to have a significant impact on the burden of atherosclerotic disease. The authors note that “this finding and the fact that complete ideal CV health was very rare among this large sample of young adults strengthen the need for early evaluation of CV risk factors and for development of effective intervention strategies for behavioral change.” The next question is, does this translate into a mortality benefit. To read the full study, click here.

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