Page 126 - Petelin, Ana, Nejc Šarabon, Boštjan Žvanut, eds. 2017. Zdravje delovno aktivne populacije ▪︎ Health of the Working-Age Population. Proceedings. Koper: Založba Univerze na Primorskem/University of Primorska Press
P. 126
avje delovno aktivne populacije | health of the working-age population 124 Regular physical activity and aerobic exercise training are related to a re-
duced risk of fatal and non-fatal coronary events in healthy individuals,
subjects with coronary risk factors, and cardiac patients over a wide age
range. A sedentary lifestyle is one of the major risk factors for CVD (Karmali et
al., 2013). Physical activity and aerobic exercise training are therefore suggested
by guidelines as a very important non-pharmacological tool for primary and
secondary cardiovascular prevention (Piepoli et al., 2016, Löllgen et al., 2009).
In the EU, 50 % of the citizens are involved in regular aerobic leisure-time,
and/or occupational physical activity and the observed increasing prevalence
of obesity is associated with a sedentary lifestyle; moreover, probably less than
one-third of patients eligible for cardiac rehabilitation are offered this service.
Biological rationale
Regular aerobic physical activity results in improved exercise performance,
which depends on an increased ability to use oxygen to derive energy for work.
Primary adaptations occur in the working muscles with increase of mitochon-
dria and improved biochemical substances and enzymes thus improving local
muscle endurance properties with increased oxygen extraction in the working
muscle. This will be the basis for regular physical activity.
Moreover, myocardial perfusion can be improved by aerobic exercise,
with an increase in the interior diameter of major coronary arteries, an aug-
mentation of microcirculation, and an improvement of endothelial function.
Additional reported effects of aerobic exercise are antithrombotic effects that
can reduce the risk of coronary occlusion after disruption of a vulnerable
plaque, such as increased plasma volume, reduced blood viscosity, decreased
platelet aggregation, and enhanced thrombolytic ability and a reduction of ar-
rhythmic risk by a favourable modulation of autonomic balance (Pescatello
2014, Piepoli et al., 2016, Rowe et al., 2014).
The preventive effects of regular activity also take place in older adults in
a similar way as described above with a dependency on activity amount and
intensity (Löllgen et al., 2009). Physical activity has positive effects on many
of the established risk factors for CVD therefore reflecting a pleiotropic effect.
Physical activity prevents or delayes the development of hypertension in nor-
motensive subjects and reduces blood pressure in hypertensive patients (James
et al., 2014). HDL cholesterol levels are increased, control of body weight is im-
proved, and the risk of developing non-insulin-dependent diabetes mellitus is
lowered by activity.
Healthy subjects
In healthy subjects, growing levels of both physical activity and cardiorespi-
ratory fitness are associated with a significant reduction (20 - 30 %) in risk of
all-cause and cardiovascular mortality, in anon-linear dose–response fashion
(Löllgen et al., 2009, Shiroma et al., 2014) The evidence suggests that risk of dy-
duced risk of fatal and non-fatal coronary events in healthy individuals,
subjects with coronary risk factors, and cardiac patients over a wide age
range. A sedentary lifestyle is one of the major risk factors for CVD (Karmali et
al., 2013). Physical activity and aerobic exercise training are therefore suggested
by guidelines as a very important non-pharmacological tool for primary and
secondary cardiovascular prevention (Piepoli et al., 2016, Löllgen et al., 2009).
In the EU, 50 % of the citizens are involved in regular aerobic leisure-time,
and/or occupational physical activity and the observed increasing prevalence
of obesity is associated with a sedentary lifestyle; moreover, probably less than
one-third of patients eligible for cardiac rehabilitation are offered this service.
Biological rationale
Regular aerobic physical activity results in improved exercise performance,
which depends on an increased ability to use oxygen to derive energy for work.
Primary adaptations occur in the working muscles with increase of mitochon-
dria and improved biochemical substances and enzymes thus improving local
muscle endurance properties with increased oxygen extraction in the working
muscle. This will be the basis for regular physical activity.
Moreover, myocardial perfusion can be improved by aerobic exercise,
with an increase in the interior diameter of major coronary arteries, an aug-
mentation of microcirculation, and an improvement of endothelial function.
Additional reported effects of aerobic exercise are antithrombotic effects that
can reduce the risk of coronary occlusion after disruption of a vulnerable
plaque, such as increased plasma volume, reduced blood viscosity, decreased
platelet aggregation, and enhanced thrombolytic ability and a reduction of ar-
rhythmic risk by a favourable modulation of autonomic balance (Pescatello
2014, Piepoli et al., 2016, Rowe et al., 2014).
The preventive effects of regular activity also take place in older adults in
a similar way as described above with a dependency on activity amount and
intensity (Löllgen et al., 2009). Physical activity has positive effects on many
of the established risk factors for CVD therefore reflecting a pleiotropic effect.
Physical activity prevents or delayes the development of hypertension in nor-
motensive subjects and reduces blood pressure in hypertensive patients (James
et al., 2014). HDL cholesterol levels are increased, control of body weight is im-
proved, and the risk of developing non-insulin-dependent diabetes mellitus is
lowered by activity.
Healthy subjects
In healthy subjects, growing levels of both physical activity and cardiorespi-
ratory fitness are associated with a significant reduction (20 - 30 %) in risk of
all-cause and cardiovascular mortality, in anon-linear dose–response fashion
(Löllgen et al., 2009, Shiroma et al., 2014) The evidence suggests that risk of dy-
