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

Aparna Narendrula; Ellen Brinza; Christine Horvat Davey; Chris T Longenecker; Allison R Webel

doi:10.1136/bmjsem-2023-001596

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

BMJ Open Sport Exerc Med. 2024 Jan 29;10(1):e001596. doi: 10.1136/bmjsem-2023-001596. eCollection 2024.

Authors

Aparna Narendrula^#¹, Ellen Brinza^#², Christine Horvat Davey³, Chris T Longenecker⁴, Allison R Webel⁵

Affiliations

¹ Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA.
² Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
³ Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA.
⁴ Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA.
⁵ University of Washington School of Nursing, Seattle, Washington, USA.

^# Contributed equally.

Abstract

Introduction: The association of physical activity (PA) with subclinical cardiovascular disease (CVD) is unclear. Clarifying this relationship may inform cardiovascular prevention strategies.

Methods: We 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.

Results: Of 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 (total n=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.

Conclusions: PA 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 number: CRD42021226089.

Keywords: Accelerometer; Cardiology prevention; Physical activity; Review.