February 2018 Issue

Focus on Fitness: Exercise and Heart Health — Rundown of the Latest Research
By Jennifer Van Pelt, MA
Today's Dietitian
Vol. 20, No. 2, P. 52

February is American Heart Month and, as such, a good time to focus on heart-healthy habits. Responsible for one in four deaths in the United States, CVD is the leading cause of death in both men and women. In 2017, several newly published studies added to the knowledge base on preventing heart disease and exercising with a heart condition. These new research findings suggest that more isn't necessarily better with regard to exercise, and that mind-body modalities (eg, tai chi, yoga, and meditation) offer new alternatives to traditional exercise.

Heart Disease Prevention
In September 2017, results of one of the largest international studies on the benefits of physical activity and heart health were published.1 Data from more than 130,000 participants aged 35 to 70 from urban and rural areas in 17 high- to low-income countries were assessed for physical activity levels, mortality, and major CVD and followed for an average of seven years; those with preexisting CVD were excluded. Higher levels of both recreational and nonrecreational physical activity—at least 150 minutes weekly—were associated with a significantly lower risk of mortality (28% reduction) and CVD (20% reduction) in all study participants, regardless of income and geographic area. These findings demonstrated that active jobs, housework, and active commuting (eg, walking to work) were just as beneficial as working out at gyms and doing fitness classes. The researchers also found that, though more physical activity correlated with additional health benefits, those benefits maxed out at just under the equivalent of two hours of brisk walking daily. In addition, study participants who reported the most physical activity weren't the avid gym-goers but those who had exercise "built into" daily life with walking to work or errands, active jobs, and housework.1

In October 2017, the American Heart Association (AHA) released a new scientific statement endorsing meditation as a potential adjunctive activity in reducing heart disease risk, emphasizing that a heart-healthy lifestyle and adherence to medical advice remain primary prevention strategies. Citing its comprehensive review of published studies on meditation and its effect on heart disease risk factors, the AHA concluded that meditation may help lower stress levels, anxiety, and depression, as well as help with smoking cessation, sleep quality, and general well-being. The AHA also noted that meditation may reduce high blood pressure and risk of heart attack, though evidence doesn't definitively confirm these benefits and therefore more study is needed. The AHA strongly advises that meditation isn't a substitute for traditional medical care. Because education on meditation is widely available and there's little if any risk associated with meditating, the AHA encourages interested individuals to add meditation to established medical and lifestyle interventions to further lower heart disease risk.2

In November 2017, results of the 25-year Coronary Artery Risk Development in Young Adults study were published. More than 3,100 participants were monitored for coronary artery calcification (CAC), a known predictor of future heart disease. Physical activity data were evaluated for three groups of subjects—those who exercised less than the recommended 150 minutes per week, those who met the recommended amount, and those who exercised excessively at 450 minutes per week. Researchers were shocked to find that the excessive exercisers—especially white men—had a 27% increased risk of developing CAC by middle age. This study suggests that more exercise isn't necessarily better, and research will further explore the biologic reasons for CAC risk with high levels of exercise.3

Exercises for Heart Conditions
Major guidelines recommend referral to cardiac rehabilitation following a cardiovascular event (eg, heart attack or cardiovascular surgery). However, the majority of patients don't begin or complete the recommended course of cardiac rehabilitation. In October 2017, the first study to evaluate whether tai chi could be a viable alternative to cardiac rehabilitation was published.4 Researchers observed patients with heart disease who declined cardiac rehabilitation but successfully completed three to six months of tai chi. Those completing six months of two to three one-hour sessions weekly safely improved physical conditioning, weight, and quality of life. Researchers propose tai chi as a potential alternative to cardiac rehabilitation due to its safety in high-risk patients, movements that are easily adaptable to different levels of physical functioning, ability to be practiced at home, and appeal compared with traditional rehab exercises that may be intimidating to many patients.4

A June 2017 study compared yoga with water exercise in patients with heart failure. Both forms of exercise equally improved overall clinical outcomes, quality of life, exercise capacity, and anxiety/depression. Researchers propose yoga as an alternative or complement to the more established water exercise for patients with heart failure.5 In a January 2017 study, researchers found that adding gentle yoga with deep breathing to standard treatment improved quality of life, as well as reduced blood pressure and heart rate in patients with atrial fibrillation.6

Practice Advice for Clients
Recent research findings can be translated into the following advice for clients:

• Spending money on gym memberships, fitness classes, and expensive exercise gear isn't necessary to reap the benefits of physical activity for heart health. Simply increasing daily time spent on walking or active house or yard chores can provide heart-healthy benefits, too.

• Moderate exercise is beneficial in preventing heart disease, and in living with or recovering from a heart condition. Very intense exercise may not add benefit and in some cases may increase heart disease risk.

• Mind-body exercise (eg, gentle yoga and tai chi) are safe and beneficial following a cardiovascular event and/or for those with certain heart conditions.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Lancaster, Pennsylvania, area.


1. Lear SA, Hu W, Rangarajan S, et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet. 2017;390(10113):2643-2654.

2. Levine GN, Lange RA, Bairey-Merz CN, et al. Meditation and cardiovascular risk reduction: a scientific statement from the American Heart Association. J Am Heart Assoc. 2017;6(10):e002218.

3. Laddu DR, Rana JS, Murillo R, et al. 25-year physical activity trajectories and development of subclinical coronary artery disease as measured by coronary artery calcium: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Mayo Clin Proc. 2017;92(11):1660-1670.

4. Salmoirago-Blotcher E, Wayne PM, Dunsiger S, et al. Tai chi is a promising exercise option for patients with coronary heart disease declining cardiac rehabilitation. J Am Heart Assoc. 2017;6(10):e006603.

5. Hägglund E, Hagerman I, Dencker K, Strömberg A. Effects of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure: a randomized controlled study. Eur J Cardiovasc Nurs. 2017;16(5):381-389.

6. Wahlstrom M, Rydell Karlsson M, Medin J, Frykman V. Effects of yoga in patients with paroxysmal atrial fibrillation — a randomized controlled study. Eur J Cardiovasc Nurs. 2017;16(1):57-63.