Exercise for people with high cardiovascular risk

Area of Science:

• Cardiology
• Preventive Medicine
• Exercise Science

Background:

• Multiple cardiovascular risk factors can interact multiplicatively, increasing cardiovascular disease risk.
• Exercise is known to manage individual risk factors, but its effect on overall cardiovascular risk is uncertain.

Purpose of the Study:

• To evaluate the impact of exercise training on cardiovascular mortality, events, and total risk in individuals with elevated cardiovascular risk but no existing cardiovascular disease.

Main Methods:

• A systematic search of multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, SCI-EXPANDED, CPCI-S) was performed.
• Included were randomized clinical trials of aerobic or resistance exercise in adults (≥18 years) with a 10-year Framingham risk score ≥10% or ≥2 risk factors, and no history of cardiovascular disease.
• Data collection involved two independent reviewers; meta-analysis was precluded by study heterogeneity and bias.

Main Results:

• Four studies with 823 participants (412 exercise, 411 control) were included, with follow-up ranging from 16 weeks to 6 months.
• Studies exhibited high risk of selection, detection, and attrition bias, preventing meta-analysis.
• No studies reported cardiovascular or all-cause mortality; evidence on total cardiovascular risk, lipids, blood pressure, BMI, exercise capacity, and quality of life was insufficient to determine exercise effectiveness.

Conclusions:

• Current evidence is limited by small sample sizes, short follow-up periods, and significant methodological bias.
• Conclusions regarding the efficacy or safety of exercise for individuals with increased cardiovascular risk cannot be drawn.
• Further randomized clinical trials with controlled exercise programs are needed to assess total cardiovascular risk.