Taking up and maintaining exercise both beneficial post cardiovascular event

By Dr. Timothy Swinn, edited by Dr. Ahmed El-Medany

A recent cohort study published in Heart using a Korean health database has concluded that both maintaining and taking up exercise after a cardiovascular event confers a mortality benefit. Although the benefits of exercise are well-established, this study by Kang et al¹ differs to previous studies due to the older median age (72), and analysis of the temporal change in exercise, rather than a snapshot pre or post event.

6,076 participants were included. Exercise habits pre and post diagnosis of cardiovascular event (stroke, myocardial infarction, or heart failure) were characterised from a self-reported questionnaire. Individuals were labelled as exercising if they reported undertaking 30 minutes of moderate/vigorous exercise 5 times per week or 30 minutes of vigorous exercise 3 times per week. They were then categorised as “persistent non-exercisers”, “exercise dropouts”, “new exercisers”, or “exercise maintainers” depending on whether they exercised before and/or after diagnosis (Figure 1).

Primary outcomes were all-cause mortality, cardiovascular death, and non-cardiovascular death. The results shown in Figure 1 demonstrate that “exercise maintainers” had a statistically significant lower hazard ratio (HR) in all outcomes compared to “persistent non-exercisers”. “New exercisers” also had a statistically significant lower all-cause and non-cardiovascular mortality HR. Age >75 years was associated with a statistically significant smaller magnitude of benefit.

The results demonstrate that taking up and maintaining exercise is beneficial post stroke, MI, or heart failure exacerbation and this should continue to be included in guidelines, even for older patients.

Figure 1: Cohort subgroups are demonstrated at the top of this figure, and primary outcomes below. Figure from Kang et al, 2022¹.

References

1. Kang DS, Sung JH, Kim D, Jin MN, Jang E, Yu HT, et al. Association between exercise habit changes and mortality following a cardiovascular event. Heart [Internet]. 2022 May 18 [cited 2022 Oct 13]; Available from: https://heart.bmj.com/content/early/2022/05/18/heartjnl-2022-320882