Physical activity in the prevention of atherosclerotic coronary heart disease

There are compelling epidemiologic and clinical data demonstrating that regular physical activity reduces the incidence of atherosclerotic vascular disease. The hypothesis that exercise decreases atherosclerotic coronary heart disease has never been directly tested in a randomized, controlled clinical trial. Nevertheless, there are sufficient data to recommend that adults should routinely engage in moderately vigorous physical activity. Exercise training also improves multiple atherosclerotic cardiovascular risk factors, including low levels of high-density lipoprotein cholesterol, blood triglycerides, blood pressure, glucose intolerance, insulin resistance, and obesity. Some of this effect attributed to exercise training is actually an acute effect of recent exercise and not a chronic metabolic adaptation. There are multiple randomized controlled clinical trials of exercise training in patients with established coronary artery disease enrolled in cardiac rehabilitation programs. These results demonstrate that exercise training reduces total cardiovascular mortality in patients with established coronary heart disease. The evidence cited above supports the recommendation that all stable adults should participate daily in a minimum of 30 minutes of moderately vigorous physical activity. Less activity than this is probably beneficial, whereas more activity is probably more beneficial.