Author + information
- Abraham Samuel Babu, MPT∗ (, )
- Sundar Kumar Veluswamy, MPT,
- Peter H. Brubaker, PhD and
- Larry F. Hamm, PhD
- ↵∗Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal 576104, Karnataka, India
The role of regular exercise and/or adequate amounts of physical activity in the prevention and control of cardiovascular diseases and its risk factors has been firmly established by a variety of epidemiological and interventional studies (1). However, with respect to the primary prevention and management of atherosclerosis, there has been little attention to the effects of exercise on plaque size, stability, and regression. There are published data on the potential benefits of exercise on atherosclerotic plaque and its regression (2); however, despite such evidence, statins continue to monopolize atherosclerosis prevention programs.
Robinson and Gidding (3) recently published a review recommending that curing atherosclerosis should be the next goal of cardiovascular prevention. We agree with the authors that this is definitely an important goal, but is initiating statins at such early ages the best approach? The authors provide compelling evidence that suggest the benefits of early initiation of statins on various atherosclerotic progression pathways. Even though this suggests that there could be benefits in high-risk groups with statins, it is important to realize that there is still a strong need to promote active lifestyles among children. A recent report by Palmefors et al. (2) found significant evidence supporting the benefits of physical activity on tumor necrosis factor α levels, C-reactive protein levels, endothelial progenitor cells, and, with aerobic exercise, intercellular adhesion molecule 1 levels. However, these findings have not found their way into prevention guidelines.
In an accompanying report, Daniels (4) also suggested the need for lifestyle interventions to help control the atherosclerotic cascade. As currently understood, the risk of cardiovascular disease cannot be attributable to only dyslipidemia (especially elevated low-density lipoprotein levels, which is the target for statins) but also involves a host of other risk factors. Therefore, effective prevention strategies cannot target only one dimension (i.e., increased low-density lipoprotein levels) but should focus on other modifiable risk factors that, in our opinion, can be addressed best through lifestyle interventions. Regular exercise and physical activity produce numerous health benefits (e.g., antiatherosclerotic, antithrombotic, anti-ischemic, antiarrhythmic, and psychological effects), thereby acting as a “polypill”. In fact, these benefits supersede the effects obtained through pharmacotherapy and are also cost-effective and free from adverse events (5). In this regard, we would like to emphasize a few steps in working toward the prevention and/or management of atherosclerosis through exercise and physical activity.
1. Promoting high-energy expenditure through proper diet and structured exercise training and physical activity to promote plaque stability (1,500 kcal/week) and reversal (>2,000 kcal/week)
2. Promoting an active lifestyle at home
a. Moving away from video games and the Internet to playing outdoors in parks, walking, and using stairs
3. Promoting an active lifestyle at school
a. Improving participation in physical education and tailoring programs to suit the needs and interests of children for optimal health benefits
b. Emphasizing the need for excellence in sports in addition to academic excellence
4. Promoting healthy food habits at home, school, and public places
It is our opinion that encouraging such healthy behaviors early in life will facilitate improvements with regard to cardiovascular-related events and help curb the rise in the incidence of childhood obesity and type 2 diabetes mellitus. There is, however, a strong need for prospective trials spanning various age groups comparing aggressive exercise-based and lifestyle interventions on the progression of atherosclerosis and cardiovascular-related endpoints before there is a move to recommend early drug therapy for children.
- American College of Cardiology Foundation
- Robinson J.G.,
- Gidding S.S.
- Daniels S.R.
- Fiuza-Luces C.,
- Garatachea N.,
- Berger N.A.,
- Lucia A.