Exercise Prescription and Primary Prevention of Cardiovascular Disease

Abstract

Case presentation: Mr R. is a 48-year-old man with hypertension and dyslipidemia. He is 5′8″ tall and weighs 177 lb, with a body mass index of 26.9 kg/m2. He swam competitively in college but has performed little physical activity since. He holds an office job and has no symptoms of angina, dyspnea, or palpitations. His brother recently had a myocardial infarction at 50 years of age. Mr. R. asks your advice about an exercise program that will reduce his risk of future myocardial infarction. Coronary heart disease (CHD) remains a major cause of morbidity and mortality, and effective strategies for primary prevention of CHD are critical. Physical inactivity is one of several modifiable risk factors that contribute to CHD risk.1 This article presents a practical approach to prescribing exercise for primary prevention of CHD. Observational studies have reported decreased numbers of CHD events in subjects who perform regular aerobic activity.2,3 There is a dose-response relationship between CHD and aerobic physical activity, and even 1 hour of walking per week is associated with lower risk.4 Strength training may impart additional benefit.5 Exercise training positively impacts several cardiac risk factors (Table 1).6–11 View this table: Table 1. Effect of Exercise Training on Cardiac Risk Factors The American Heart Association and others have issued recommendations for aerobic exercise and resistance training for healthy adults 18 to 65 years of age.12,13 The most common noncardiac risk of exercise training is musculoskeletal injury, a risk that can be mitigated by a gradual increase in the intensity of exercise. Of greater concern is the risk of exercise-induced cardiac events. Compared with sedentary activity, vigorous exercise may increase the risk of sudden cardiac death as much as 16.9-fold during and immediately after activity.14 Similarly, the relative risk of myocardial infarction …