Survival of the Fittest: Impact of Cardiorespiratory Fitness on Outcomes in Men and Women with Cardiovascular Disease

Abstract

Cardiovascular disease (CVD) in general and myocardial infarction in particular are the leading causes of mortality in men and women globally. Sex differences in CVD recovery exist, with higher rates of mortality, recurrent myocardial infarction, and poor functional outcomes seen in women compared to men with CVD. Physical inactivity has been identified as a crucial modifiable risk factor linked with poor survival and recovery in patients with CVD. Cardiac rehabilitation programs that aim to improve physical inactivity and cardiorespiratory fitness (CRF), a measure of physical fitness in patients with CVD, have gained popularity. The goals of this commentary were to summarize the existing literature on the impact of CRF on survival in patients with CVD, to document the impact of sex on CVD outcomes, and to highlight any gaps in current knowledge. Even minor improvements in CRF have been linked with improved survival, although contemporary data from randomized controlled trials have shown mixed results. Gender differences in cardiac rehabilitation have been well documented, with lower referral, enrollment, and completion rates noted in women compared to men with CVD. However, data on sex differences in CRF with cardiac rehabilitation are scant, mostly indicating lower peak CRF observed in female compared to male patients on completion. It is unclear whether similar thresholds of peak CRF are needed in male and female patients to improve survival after onset of CVD, and whether exercise prescriptions need to be adapted to include additional forms of exercise. CRF is also influenced by age, with a decline in peak exercise capacity with advancing age observed in both sexes, but steeper declines noted in men than women. From this perspective, we review the data intersecting age, sex, and exercise on survival in patients with CVD, as well as the biological mechanisms at play, and we identify areas for future research (Clin Ther.

Hyperoxia improves exercise capacity in cardiopulmonary disease: a series of randomised controlled trials

“…The multiple benefits in terms of quality of life and survival by increased cardiorespiratory fitness in cardiopulmonary diseases are well known [ 9 , 10 ]. Even in patients with pulmonary vascular diseases (PVDs) characterised by pulmonary hypertension (PH) to whom physicians were reluctant to recommend training in fear of right-heart failure, supervised exercise training is nowadays widely practiced in specialised centres and recommended by the European Respiratory Society in addition to drug therapy [ 11 , 12 ].…”

Beneficial Effect on Exercise Tolerance of a Comprehensive Rehabilitation Program in Elderly Obese Patients Affected With Heart Disease

“…Moreover, we have to consider that both the number of elderly subjects and the prevalence of obesity are constantly increasing (2), which accounts for the considerable figures we have to deal with. Elderly patients are at a higher risk for complications and physical deconditioning: we know that physical activity is an important contributor to the prevention of disability and favors a healthy process of aging; moreover, exercise tolerance is also a very strong predictor of survival and is an easily available outcome of rehabilitation programs (3)(4)(5).…”

Comparison of the Ekblom-Bak Submaximal Test to a Maximal Test in a Cohort of Healthy Younger and Older Adults in the United States

“…In adulthood, poor CRF and sedentary lifestyle are associated with risk for cardiovascular disease (Kodama et al, 2009;Khan et al, 2015;Laukkanen et al, 2019), Type 2 diabetes (Lavie et al, 2014;Zaccardi et al, 2015), and Alzheimer disease (Kurl et al, 2018;Silva et al, 2019). Improvement of CRF, through engagement in regular physical activity, leads to a significant improvement in health outcomes including lowering risk of all-cause mortality (Harber et al, 2017), cardiovascular disease (Safdar and Mangi, 2020), and diabetes (Tuomilehto et al, 2001). There is now growing interest to consider the predictive value and effects of improved CRF on brain aging and dementia.…”

“…Improvement of CRF, through engagement in regular physical activity, leads to a significant improvement in health outcomes including lowering risk of all-cause mortality ( Harber et al, 2017 ), cardiovascular disease ( Safdar and Mangi, 2020 ), and diabetes ( Tuomilehto et al, 2001 ). There is now growing interest to consider the predictive value and effects of improved CRF on brain aging and dementia.…”