Relationship between objectively measured physical activity and subclinical cardiovascular disease: a systematic review

Abstract

IntroductionThe association of physical activity (PA) with subclinical cardiovascular disease (CVD) is unclear. Clarifying this relationship may inform cardiovascular prevention strategies.MethodsWe performed a systematic review (CRD42021226089) using Medline, Embase, CINAHL and Cochrane (1 January 2000 to 1 September 2023). Studies published with adult populations exploring the relationship between objectively measured PA and subclinical CVD were included. Subclinical CVD was assessed using: ankle-brachial index (ABI); arterial stiffness; carotid artery disease; coronary artery atherosclerosis; endothelial function; and measures of cardiac structure and function. The Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and Cochrane Risk of Bias tools were used for quality review.ResultsOf 68 included studies, most supported an inverse relationship between PA and subclinical CVD. Arterial stiffness was the most common outcome (n=40), and 33 studies suggested that less sedentary behaviour (SB), increased PA and/or higher intensity PA was associated with less arterial stiffness. Ten studies of carotid artery disease (totaln=18), six of endothelial function (n=10), two of coronary artery disease (n=3) and all of ABI (n=6) suggested that PA or less SB is associated with less subclinical disease. Five studies assessing cardiac structure/function (n=6) suggested alterations in structure/function with PA.ConclusionsPA reduces the risk of CVD events, and this systematic review demonstrates that some of the benefits may be mediated by an inverse association between PA and subclinical CVD. Interventions to increase PA are important for CVD prevention, so we provide a comprehensive overview of which surrogate outcome measures may be most useful to assess future CVD prevention interventions.PROSPERO registration numberCRD42021226089.

Objectively measured physical activity among people with and without HIV in Uganda: associations with cardiovascular risk and coronary artery disease

“…A large volume of population-level evidence supports the reduction in ASCVD events with increased physical activity 28 , 21 – 23 , and this benefit may be mediated by an inverse relationship between physical activity and sub-clinical cardiovascular disease 29 . Despite this, we did not find a significant association between the varied levels of physical activity and inactivity with elevated ASCVD risk after adjusting for age and sex.…”