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How important is physical activity in CCS patients

Strong evidence supports an inverse dose-response relationship between physical activity levels and mortality1, but mostly demonstrated on healthy people. Does the benefits of physical activity are as important in patients with pre-existing cardiovascular diseases?

While individuals with cardiovascular disease (CVD) are at a higher risk for mortality and morbidity, they also tend to have sedentary lifestyles and are less physically active than are those without CVD.2

In addition, no previous studies have compared the beneficial effect of physical activity between healthy patients and CVD patients.

A 2019 study entitled Mortality reduction with physical activity in patients with and without cardiovascular disease3 analyzed a population-based cohort of 131 558 with and 310 240 subjects without cardiovascular disease (CVD), followed-up for a median of 5.9 years, to elucidate how the benefit of physical activity interacts with the presence of CVD. Main study outcome was all-cause mortality.

Confirming data of previous studies, there was an inverse relationship between the physical activity level and the mortality risk in both groups. The benefit in the CVD patients’ group was shown to be greater than that in the non-CVD group: every 500 MET-min/week increase in physical activity resulted in a 14% and 7% risk reduction in mortality in the CVD and non-CVD groups, respectively (interaction P < 0.001). In addition, while individuals without CVD benefited the most between 1 and 500 MET-min/week of physical activity, the benefit in those with CVD continued above 500 - 1000 MET-min/week. The adjusted mortality risk of individuals with CVD who performed a high level of physical activity (>_1000 MET-min/week) was shown to be comparable to or lower than that of their counterparts without CVD. In other words, CVD patients may benefit from physical activity to a greater extent than do healthy subjects without CVD.


Figure 1. Distribution and adjusted risk of mortality according to physical activity levels stratified by cardiovascular disease. Cox regression analysis with physical activity classified as a categorical variable: 0 (totally sedentary), <500, 500 to 999, 1000 to 1499, and >_1500 MET-min/week.

Patients with CVD should be encouraged to avoid a sedentary lifestyle and to maintain physically active behaviours for secondary prevention. An optimal medical treatment is also necessary, to optimize ATP production to increase cardiovascular function and improve exercise capacity in CCS patients. Trimetazidine have shown is various studies, thanks to its unique metabolic mechanism of action, its ability to increase ATP production of each ischemic cardiac cell by +33%, reflecting in improvement of exercise capacity by +4.09METs*4.

*METs: Metabolic Equivalent of Task

1. Moore SC, Patel AV, Matthews CE, Berrington de Gonzalez A, Park Y, Katki HA, Linet MS, Weiderpass E, Visvanathan K, Helzlsouer KJ, Thun M, Gapstur SM, Hartge P, Lee IM. Leisure time physical activity of moderate to vigorous intensity and mortality: a large pooled cohort analysis. PLoS Med 2012;9:e1001335.
2. Vasankari V, Husu P, Va¨ha¨-Ypya¨ H, Suni JH, Tokola K, Borodulin K, Wennman H, Halonen J, Hartikainen J, Sieva¨nen H, Vasankari T. Subjects with cardiovascular disease or high disease risk are more sedentary and less active than their healthy peers. BMJ Open Sport Exerc Med 2018;4:e000363.
3. Mortality reduction with physical activity in patients with and without cardiovascular disease, European Heart Journal (2019) 40, 3547–3555
4. Suljic. The role of metabolic therapy with trimetazidine in effort tolerance in patients with ischemic heart disease. Med Glas (Zenica) . 2018 Aug 1;15²:109-114.
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