Changing medical culture to promote physical activity in secondary prevention of coronary artery disease

Abstract

This editorial refers to ‘Physical activity in patients with stable coronary heart disease: an international perspective’[†][1], by R. Stewart et al. , on page 3286 Stewart and colleagues analyse reasons why many patients with coronary artery disease (CAD) do not engage in regular physical activity (PA) despite considerable evidence describing its benefit and guidelines promoting it.1 Their study population was a large ( n = 15 486) international (39 countries) cohort of patients with stable CHD participating in a large randomized clinical trial (STABILITY).2 PA was assessed by the International Physical Activity Questionnaire;3 subjects estimated the number of hours of ‘mild’, ‘moderate’, and ‘vigorous’ PA in which they engaged during a typical week. Total PA was reported in metabolic equivalent (MET)-hours/week. Subjects indicated whether moderately vigorous PA occurred at work or during leisure time and whether PA levels changed after their first ‘heart problem’. Further, subjects were asked to identify limitations to walking 100 m, climbing one flight of stairs, or walking 1 km. The investigators found that 46% of subjects reported decreased PA after their first heart problem. A lower level of PA was associated with older age, poorer health, more co-morbidities, depressed mood, greater exercise limitation, lack of cardiac rehabilitation (CR), non-white race, middle vs. higher income country, and less formal education. Self-reporting of PA is the usual methodology, though objective assessment by motion sensors can provide varying results; self-reporting generally overestimates PA.4 While the methodology of combining all PA into MET-hours per week is commonly used in epidemiological investigations, it makes it difficult to understand whether subjects are meeting current guidelines. Recommendations in the American Heart Association/American College of Cardiology (AHA/ACC) guidelines5 and European Society of Cadiology (ESC) Guidelines6 ( Figure 1 ) are phrased in terms of total recommended minutes of exercise on … [1]: #fn-2