Coronary Heart Disease

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Based on their review of 43 studies that examined the relationship between physical inactivity and CHD incidence, Powell and colleagues (1987) concluded that the risk of incident CHD due to physical inactivity ranges from 1.5 to 2.4 (median = 1.9). These values are similar in magnitude to other CHD risk factors, such as hypertension, hypercholesterolemia, and smoking. These data are consistent with recent evidence from the Nurses Health Study, in which physical inactivity (<1 h of exercise per week) was found to be associated with increased risk (RR = 1.58; 95% CI, 1.39-1.80) of incident coronary heart disease in 88,393 women followed for 20 years (Li et al, 2006). Data from the Womens' Health Study also indicate that the health benefits of physical activity are not limited to vigorous activity, such that participating in light to moderate physical activity, such as walking for at least 1 h per week, is associated with lower CHD risk (RR = 0.49; 95% CI, 0.28-0.86) (Leeetal, 2001).

Participation in physical activities also affects prognosis in patients with CHD. For instance, in older men with established CHD followed for 5 years (N = 772, mean age = 63), light to moderate physical activity conferred a reduction in risk for all-cause and cardiovascular mortality over a sedentary lifestyle after covariate adjustment (light, RR = 0.42; 95% CI, 0.25-0.71; moderate, rr = 0.47; 95% CI, 0.24-0.92; Wannamethee et al, 2000). These results are consistent with the findings of Taylor et al (2004), who conducted a systematic quantitative review of exercise-based cardiac rehabilitation programs and found that, relative to usual care, cardiac rehabilitation was associated with reduced all-cause mortality (odds ratio [OR] = 0.80; 95% CI, 0.68-0.93) and fatal cardiac events (OR = 0.74; 95% CI: 0.610.96). Compared to usual care, cardiac rehabilitation was also associated with greater reductions in CHD-related risk factors, such as total cholesterol level, triglyceride level, and systolic blood pressure (Taylor et al, 2004).

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