Exercise for primary and secondary prevention of cardiovascular disease

mixed and endurance Yachting Alpine skiing Fencing swimming Equestrian Judo/karate Tennis single Long distance skating Weight lifting Waterpolo Pentathlon Wrestling Soccer competitive B

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BS MAI QUANG VĨNH LONG

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Regular exercise that meets or exceeds physical activity guidelines reduces cardiovascular risk and mortality and plays an important role in primary and secondary prevention of cardiovascular disease

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TYPE OF EXERCISE

Aerobic physical activity Activity in which the body's large muscles move in a rhythmic manner for a sustained

period of time Aerobic activity, also called endurance or cardio activity, improves cardiorespirotory fitness Examples iam

nclude brisk walking, running, swimming, and bicycling Aerobic activity has three components:

® Intensity, or how hard a person works to do the activity The intensities most often studied are

moderate (equivalent in effort to brisk walking) and vigorous (equivalent in effort to running or jogging):

® Frequency

® Duration,

Muscle-strengthening activity (strength training, resistance training, or muscular strength and endurance

exercises) Physical activity, including exercise, that increases skeletal muscle strenath, power, endurance, and

mass Muscle-strengthening activity has three components:

® Intensity,

® Frequency

se Sets and repetitions, or how many times a person does the muscle-strengthening activity, like lifting

G weight or doing a push-up (comparable to duration for aerobic activity)

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TYPE OF EXERCISE

Balance Activities

These kinds of activities can improve the ability to resist forces within or outside of the body that cause falls

Fall prevention programs that include balance training and other exercises to improve activities of daily

living can also significantly reduce the risk of injury, such as bone fractures, if a fall does occur

Flexibility Activities

Flexibility is an important part of physical fitness Some types

of physical activity, such as ballet or salsa dancing, require more flexibility than others Flexibility activities enhance the abiity of a joint to move through the full range of motion

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Figure 2 Sporting discipline in relation to the predominant component © E S C

Power Mixed Endurance

Golf (buggy) Shot putting Soccer (adapted) Jogging

Golf (18 holes Walking) (recreational) Basketball (adapted) Long distance walking

European Society

of Cardiology

Table tennis (double) Discus (recreational) Handball (adapted) Swimming (recreational) Figure 2 Sporting Table tennis (single) Alpine skiing Volleyball Speed walking discipline in relation to

Shooting (recreational) Tennis ¬- (double) Mid/long distance pl the predominant 1

Curling Short distance running Ice-Hockey

Bowling Shot putting Hociuy Shedhecbg component (skill, power,

Cycling (road)

Baling aon Rugby “”._ mixed and endurance)

Yachting Alpine skiing Fencing

swimming Equestrian Judo/karate Tennis (single) Long distance skating

Weight lifting Waterpolo Pentathlon

Wrestling Soccer (competitive)

Boxing Basketball

Rowing Canoeing

(competitive) X-country skiing

Handball (competitive) Biathlon

Triathlon Low Medium m High

intensity intensity intensity

www.escardio.org/guidelines 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease

(European Heart Journal 2020 - doi/10.1093/eurheartj/ ehaa605)

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Primary Prevention

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RECOMMENDATIONS FOR ADULTS (18-64 YEARS)

Examples of Moderate- and Vigorous-intensity Aerobic Activities

2020 WHO Physical Activity

Duration (min/wk)

150-300 min moderate-intensity Walking (2.5 miles/h, moderate pace)

aerobic exercise per week Ballroom dancing (slow pace)

Gardening and yardwork Bicycling (light, <10 mph) Brisk walking (3.5 miles/h, fast pace) 75-150 min vigorous-intensity Jogging (4.0 miles/h)

aerobic exercise per week Swimming (leisure)

Hiking

Bicycling (moderate, 12-14 miles/h) Running (6 miles/h)

150-300 150-300 113-225 113-225 105-209

75-150 75-150 75-150 56-113 46-92

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General recommendations for exercise and sports in healthy @ ESC

European Society

At least 150 minutes per week of moderate intensity, or 75 minutes per week

of vigorous intensity aerobic exercise or an equivalent combination thereof is recommended in all healthy adults

A gradual increase in aerobic exercise to 300 minutes per week of moderate

intensity, or 150 minutes per week of vigorous intensity aerobic exercise, or

an equivalent combination is recommended for additional benefits in healthy adults

2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease

www.escardio.org/guidelines

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Physical Activity ! 5

Adults need a mix of physical

YOUR WAY activity to stay healthy

2™ edition

Moderate-intensity Muscle-strengthening aerobic activity* activity

Anything that gets your heart Do activities that make your muscles beating faster counts work harder than usucl

If that’s more than you can do right now, do what you can

Even 5 minutes of physical activity has real health benefits

Walk Run Dance Play What's your move?

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Recommendations for exercise in ageing individuals @ESC

In older adults at risk of falls, strength training exercises to improve balance

and coordination on at least 2 days a week are recommended

a

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e Frequency: Moderate exercise for 5 days per week or vigorous exercise for 3 days per week

¢ Intensity: 5-6 points (for the modified 10 point Borg scale) for moderate exercise

or 7-8 points for vigorous

Strength training (all major muscle groups)

e Frequency: at least twice a week

s® Number of exercises: 8-10

¢ Number of repetitions: 10-15

Exercises for flexibility and balance

e At least twice a week

SC Guidelines on sports cardiology and exercise in patients with cardiovascular disease

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SECONDARY PREVENTION

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Participation in sports activities should be considered in individuals with

heart failure who are at low risk, based on a complete assessment and

exclusion of all contra-indications, in stable condition for at least 4 weeks,

optimal treatment, and NYHA functional class | status

Non-competitive (low- to moderate-intensity recreational) skill, power, mixed or endurance sports may be considered in stable, asymptomatic and

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Recommendations for exercise and participation in sport in WESC

European Society

individuals with heart failure with preserved ejection fraction of Cardiology

Moderate endurance and dynamic resistance exercise, together with lifestyle intervention and optimal treatment of cardiovascular risk factors (i.e arterial hypertension and type 2 diabetes) are recommended

Competitive sports may be considered in selected stable patients without

abnormalities on maximal exercise testing

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Recommendations for exercise and participation in @ ESC

European Society

recreational/leisure sports in asymptomatic individuals with of Cardiology aortic stenosis (1)

Aortic Stenosis?

Participation in all recreational sports, if desired, is

Participation in all recreational sports involving low to

moderate intensity, if desired, should be considered in individuals with LVEF 250%, good functional capacity and normal exercise test

@For mixed valvular disease, the recommendation for the predominant lesion (stenotic or regurgitant) should be followed

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Recommendations for exercise and participation in

recreational/leisure sports in asymptomatic individuals with

aortic stenosis (2)

Aortic Stenosis?

Recommendations Severe Participation in all recreational sports/exercise involving low

intensity, if desired, may be considered in individuals with

LVEF 250% and normal BP response during exercise

Participation in competitive or recreational sports/exercise of moderate and high intensity is not recommended

*For mixed valvular disease, the recommendation for the predominant lesion (stenotic or regurgitant) should be followed

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Recommendations for participation in recreational/leisure-time ESC

European Society

sports in asymptomatic individuals with mitral regurgitation (1) of Cardiology

Mitral Regurgitation?”

Mild Participation in all sports, if desired, is recommended n4 Cc

Moderate Participation in all recreational sports, if desired, should be

considered in individuals fulfilling the following:

eLVEDD <60 mm or <35.3 mm/m2 in men and <40 mm/m?2in women

eLVEF >60%

seResting sPAP <50 mmHg

eNormail exercise test

*For mixed valvular disease, the recommendation for the predominant valve lesion should be followed

'No collision or body contact sports if anticoagulated for atrial fibrillation

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Recommendations for participation in competitive sports in ESC

European Society

asymptomatic individuals with mitral regurgitation (1) of Cardiology

Mitral Regurgitation?»

Mild Participation in all competitive sports, if desired, is recommended a) Cc Moderate Participation in all competitive sports, if desired, should be

considered in individuals fulfilling the following

¢ LVEDD <60 mm or <35.3 mm/m?in men

and <40 mm/m?in women

¢ LVEF >60%

¢ Resting sPAP <SO mmHg

¢ Normal exercise test

Severe Participation in competitive sports is not recommended in

individuals with a LVEF <60%

(European Heart Journal 2020- doi/10.1093/eurheartj/ ehaa605)

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Recommendations for participation in recreational/leisure sports YESC

and normal exercise test

Moderate Participation in all recreational sports involving low and

(MVA1.0-1.5cm?) moderate intensity, if desired, may be considered in

individuals with resting sPAP <40 mmHg and a normal exercise test

IIb

Severe Participation in leisure sports of moderate or high intensity is

(MVA <1 cm?) not recommended

®No collision or body contact sports if anticoagulated for atrial fibrillation

es 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease

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Recommendations for participation in competitive sports in ESC

European Society

Mitral Stenosis?”

Mild Participation in all competitive sports, if desired, is

(MVA 1.5-2.0cm?) recommended in individuals with a resting sPAP <40 mmHg

and a normal exercise test

Moderate Participation in all competitive sports involving low intensity (MVA 1.0-1.5 cm?) may be considered in individuals with a resting

sPAP <40 mmHg and normal exercise test

Severe

Participation in competitive sports is not recommended

(MVA <1 cm?)

>No collision or body contact sports if anticoagulated for atrial fibrillation de

~

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sa

⁄

Vigoroust recreational activities are reasonable

(COR 2a)

Competitive

sports} may be

considered (COR 2b)

Encouraging exercise for HCM patients

Recent evidence demonstrates benefits outweigh risks in many patients

with appropriate assessment

*Recreational exercise ts for leisure, without cormnpetition tVigorous = 6 METs intensity for at least an hour per week

{Competitive sports involve training to compete against others

Coylewright M, et al J Am Coll Cardiol 2024;10.1016/j jacc 2024.04.002

COR = class of recommendation; HOM = hypertrophic cardiomyopathy: METs = metabolic equivalents

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Special considerations for individuals with obesity, hypertension, @ ESC

European Society

dyslipidemia or diabetes (1) of Cardiology

> z ist cj >

females or > 94 cm for males) resistance training > 3 times per week, in 'addition to moderate or vigorous aerobic exercise (at least 30 minutes, 5—7 days per week) is recommended to reduce CVD risk

In individuals with well-controlled hypertension, resistance training 2 3 times per week in addition to moderate or vigorous aerobic exercise (at least 30 minutes, 5-7 days per week) is recommended to reduce blood pressure and CVD risk

Among individuals with diabetes mellitus, resistance training 23 times per week in addition to moderate or vigorous aerobic exercise (at least 30 minutes, 5—7 days per week) is recommended to improve insulin sensitivity and achieve a better CVD risk profile

2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease www escardio org/guidelines

(European Heart Journal 2020 - doi/10.1093/eurhe artj/ ehaa605)

Tiêu đề	Exercise For Primary And Secondary Prevention Of Cardiovascular Disease
Tác giả	Bs. Mai Quang Vĩnh Long
Thể loại	Essay

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Số trang	29
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