Cardiovascular diseases are the first cause of death in Argentina and the world.
A handful of habits, including healthy eating, regular exercise, not smoking, resting well, and avoiding or moderating alcohol consumption, can help delay the onset of these pathologies and contribute to better control once they appear.
Exercise is one of the ones that has the most evidence about its benefits, but also the one that raises the most questions.
Which is better, aerobic or strength?
If I had a heart attack, is it risky to exercise?
Can I continue doing physical activity at any age?
Is more always better?
Can I make up for everything I don't do during the week at the weekend?
On the eve of
World Health Day
, which is commemorated on April 7, cardiologists from the Argentine Society of Cardiology (SAC) resolved the main doubts and urged the promotion of exercise and regular physical activity to contribute to the state of health in general.
preventive physical activity
"Cardiovascular diseases are the leading cause of death in the Western world. Myocardial infarction, sudden death, cardiac arrhythmias, and stroke are diseases that can be prevented with various strategies, whether pharmacological
or
non-pharmacological," said Mario. Fitz Maurice, former Director of the Arrhythmia Council and Director of Press and Communication of the SAC.
Argentina is no exception, since in the country heart diseases are the ones that generate the most deaths.
What did introduce an exception was the pandemic.
This was evidenced by the latest Vital Statistics Yearbook: during 2021 they were displaced as the main cause of death by COVID-19 (except in those over 75).
Heart diseases are grouped in the registry prepared by the Ministry of Health within the classification of diseases of the circulatory system, to which approximately one in
four
of all registered deaths were associated.
Heart failure and ischemic heart disease are the ones that produced the most deaths in 2021: 27,973 and 24,787, respectively.
While cerebrovascular diseases were associated with 18,612 deaths and hypertensive diseases with almost 8,500 deaths.
And to type 2 diabetes, another of the major cardiovascular risk factors, almost 10,000.
"Drugs intended to control arterial hypertension, dyslipidemia (elevated blood cholesterol), diabetes and overweight, administered chronically, have been shown to improve
the long-term prognosis
of patients," continued Fitz Maurice, in the document released by the SAC.
"However -he added-, a premise of great importance and that we must always keep in mind is that, when we talk about cardiovascular prevention, there is no drug or therapeutic intervention that provides as many benefits to our heart, as does the regular practice of physical activity physical."
What are the benefits of physical exercise for the heart?
"Physical exercise has multiple
direct and indirect
beneficial effects that improve the state of the arteries and the heart," said cardiologist Gonzalo Pérez.
Among them, he mentioned that it reduces inflammation, improves cholesterol levels, thrombotic phenomena, decreases overweight and blood pressure;
improves blood glucose metabolism, prevents the occurrence of cardiac arrhythmias, the formation of coronary atherosclerosis and
reduces the probability of death
from cardiovascular causes.
Likewise, he stressed that the benefits are not limited to the prevention of cardiovascular disease, since it has proven protective effects against cancer, diabetes, high blood pressure and immunological diseases, among others.
Strength training is good for the heart.
Photo Shutterstock.
How much and what type of exercise to do at each age?
The World Health Organization (WHO) physical activity guidelines recommend at least
150 to 300 minutes
of moderate to vigorous aerobic activity per week for all adults, including people living with chronic conditions or disabilities, and an average of 60 minutes per day for children and adolescents.
Among other recommendations, the WHO establishes that, for all populations and age ranges, doing some physical activity is better than doing nothing.
Based on the WHO guidelines, the SAC highlighted that in the case of adults aged
18 to 64
, many of the benefits of physical activity are observed in weekly quantities of between 150 and 300 minutes at a moderate intensity ( walking, golf), and 75 to 150 minutes at vigorous intensity (swimming, biking, running).
In addition, it is recommended to perform strength training at least two days a week to complement aerobic exercise.
"
The combination of these two types of exercises
has been shown to prevent the appearance of cardiovascular diseases and to improve said condition in those who already suffer from it", they affirm from the Argentine Society of Cardiology.
"For older adults (
65 years and older
) evidence demonstrates a benefit of aerobic physical activity in reducing the risk of developing physical functional limitations. While the risk of fall-related injury can be reduced with multicomponent physical activity, which is one that combines balance training, strength, resistance, gait and physical function," they added.
Regarding the type of exercise to perform, the SAC's response is that
any is beneficial for health
: the problem is physical inactivity.
However, within the general recommendations, they agreed that one should try to combine
two types of physical exercise
: aerobic (walking, bicycling, running or swimming) and muscular strength, the latter with strong evidence in favor of reduction of cardiovascular events.
The regular practice of physical activity is one of the most effective strategies for cardiovascular prevention.
Photo Shutterstock.
If I had a heart attack or live with cardiovascular disease, can I still exercise?
"In those cases in which the person has had a cardiovascular problem, surely your GP will prescribe the appropriate medication and will not forget to recommend exercising, which provides as many or more benefits than any medication. It will remain under the responsibility
of
the patient, then, compliance with both indications: medication plus physical exercise", stressed Fitz Maurice.
From the SAC they affirm that the benefits of physical activity have been demonstrated not only in people without previous diseases (primary prevention), but also in those who have suffered at some time cardiovascular disease, such as heart attack, coronary angioplasty, heart failure, accident cerebrovascular disease, or cardiac arrhythmias, among others (secondary prevention).
And the results published in a recent article in the
American Journal of Preventive Cardiology
stand out , which reviewed general and specific aspects regarding the benefits of physical exercise and addressed some questions about the possible harm it could cause.
The expert consensus concluded, based on a review of the evidence, that people who have had or have some type of heart disease, contrary to what the majority generally believes, not only can, but "should" perform physical
activity
to improve the parameters of your heart and quality of life.
It is in this group of people where physical exercise has shown the greatest benefit.
However, they emphasize that all patients should consult with a specialist doctor before starting any training plan to carry out a
cardiovascular evaluation
.
Studies to prescribe exercise accurately
"Most of these controls will be able to determine what type of exercise and how much can be done; therefore, although the evaluations tend to reduce the probability of any cardiological event as much as possible, it cannot reach 100%," said Jorge
Franchella
. , sports doctor and cardiologist, director of the Council of Exercise Cardiology of the SAC.
"That is why all those people who want to perform programmed exercises must first have an evaluation of fitness for effort," he said.
As shown by various studies, "the number of minutes walked on the treadmill achieved in a stress test (METs) is a
valuable predictor of the level of risk
and allows for more precise prescription."
Franchella added that another study, also recently published in the Journal of the American College of Cardiology, showed that the likelihood of cardiovascular disease and the risk of cardiovascular mortality across the entire age spectrum (including those over 70 and 80), "decreases with age
.
" physical exercise and helps control risk factors in both the healthy and sick population".
In the same study, no increased risk was observed with extreme physical fitness.
he added he.
"
Being out of shape carries a higher risk
than any of the cardiac risk factors examined."
You have to be careful with very intense physical activity.
Photo Shutterstock.
Warning for weekend athletes
However, the consensus of experts also warns that very intense physical activity, and mainly in
people without prior training
(weekend physical activity), increases the risk of triggering a myocardial infarction or sudden death, mainly in those with coronary atherosclerotic disease.
The mechanism may be due to the rupture of atherosclerotic plaques associated with intense physical activity, they explained from the SAC, and highlighted that it is an
extremely low
risk , and it is lower in those people with regular training.
"That is why it is strictly recommended to go to exercise in places where there are
automatic external defibrillators
(AEDs) and people trained to do CPR and handle this type of equipment," Pérez said.
And he added that "the greater the amount of physical activity, the greater the benefit for our heart and arteries, however, it has been observed that as the duration
and intensity
increase , the benefit begins to be less."
"Those people with a high level of training (duration and/or intensity) present signs in the heart that we call
'maladaptive'
, such as calcifications, muscle enlargement or fibrosis, but these signs have not translated into an increased risk of cardiovascular disease. ", he clarified.
For her part, Franchella stressed that Dr. Paul Thompson's
slogan
"More is not better" is still valid, "since exercises and sports carried out at high intensity for months or years have shown that they have a negative impact on the cardiovascular structure."
"In summary, the regular practice of physical activity is one of the
most effective strategies and with the greatest evidence
in the prevention of cardiovascular diseases; no therapeutic intervention offers so many benefits. However, it is important that, prior to starting a plan of physical exercise, a cardiovascular evaluation is carried out by a specialist doctor", concluded Pérez.
***
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