Wednesday, March 20, 2019 Study: Light Physical Activity Could Help to Lower Risk of Coronary and Cardiovascular Problems No one doubts the positive health effects of regular moderate-to-vigorous physical activity (MVPA), but now researchers are finding that even light physical activity can reduce the risk of coronary heart disease and cardiovascular disease. The latest findings, focused on women age 65 and older, echo revised US Department of Health and Human Services (HHS) activity guidelines strongly supported by APTA. The recent study, published in JAMA Network Open, asked 5,861 women with an average age of 78.5 years to wear a hip accelerometer for a week to establish PA rates, and then tracked rates of later coronary heart disease (CHD) and cardiovascular disease (CVD) for nearly 5 years. Researchers were particularly interested in the effect of light physical activity (PA)—between 1.6 and 2.9 metabolic equivalent tasks (METs)—on the risk of experiencing CVD and CHD. Researchers divided the participants into 4 groups based on the average amount of time spent per day in light PA: 36-236 minutes, 235-285 minutes, 286-333 minutes, and 334-617 minutes. They also tracked rates of MVPA, as well as demographic, educational, and health information including the presence of chronic conditions, alcohol consumption, smoker or nonsmoker status, and use of antihypertensive and antilipidemic medications. The population studied was a mix of white (48%), black (33.5%), and Hispanic (17.6%) women. They found that during the study period, participants in the highest light PA quartile (about 5-10 hours of light PA per day) reduced their risk of both CVD and CHD by significant percentages compared with the lowest light PA quartile (about 30 minutes to 4 hours per day)—by 42% for CVD and 22% for CHD, adjusted for demographic and health variables. The reduction was dose-dependent, with every additional hour of light PA correlating to a 20% reduction in CHD risk and a 10% reduction in risk for CVD. When researchers factored in rates of MVPA (METs of 3 and above), they found risk reductions beginning with the second-lowest quartile (27 minutes or more per day). Compared with women in the lowest MVPA quartile, women in the highest MVPA quartile (a difference of 42 minutes per day) reduced risk of CHD by 46% and lowered CVD risk by 31%. Those results, so similar to the light PA risk reductions, told researchers that light PA could play a more important role in long-term health than previously thought. Authors acknowledge that women with the highest levels of light PA tended to have healthier levels of HDL-C, triglycerides, and glucose, as well as on-average lower BMI to begin with—factors possibly tied to genetics—but they still believe light PA itself has an important role to play. HHS agrees. Its latest revision to national physical activity guidelines emphasizes that "some physical activity is better than none," even while promoting the familiar goals of at least 150 minutes of moderate intensity PA or 75 minutes or more of vigorous PA per week for adults. What's different is that the new guidelines no longer include statements saying that PA must occur for at least 10 minutes to be effective, stressing instead the anything-is-better-than-nothing approach. "This study is encouraging, as well as another confirmation of what the new HHS guidelines tell us—that any amount of physical activity can positively affect health," said Hadiya Green Guerrero, PT, DPT, a senior staff specialist in the APTA practice department and a certified sports physical therapy specialist. "What's encouraging here is the emphasis on light physical activity, something that's attainable by adults who are older. It's important to have evidence that further supports the idea that PTs are doing well by their patients when they promote movement through usual and enjoyable physical activities like walking, gardening, dancing, stretching exercises, or playing with grandchildren." In an editorial that accompanies the JAMA Network Open article, author Gregory W. Heath, DHSc, MPH, characterizes the study as a "clarion call" for physicians, other health care providers, and health care systems to promote the HHS guidelines. "To temporize such action is to jeopardize the future health and well-being of older women," Health writes. Green Guerrero, who represents APTA on the board of directors for the National Coalition for Promoting Physical Activity, and who led APTA's recent collaborative efforts with the National Institutes of Health's "Go4Life" exercise campaign, says that APTA couldn't agree more. "APTA supports efforts that look to keep America healthy and level the health disparities playing field rather than continuing to spiral down the exponentially expensive sick care from which only a select few benefit," Green-Guerrero said. "As movement experts PTs intimately understand that blood flowing through arteries, to the brain, and to and from the heart are crucial to function and movement. It only makes sense that movement—any movement—will help things keep churning and, in the case of the evidence presented in this study, significantly reduce risk of preventable cardiovascular disease processes." [Editor's note: Visit APTA's prevention and wellness webpage for resources on how physical therapists and physical therapist assistants can help individuals become more physically active, and share the latest PA information from APTA's consumer-focused MoveForwardPT.com with your patients, clients, and others interested in the benefits of exercise and movement. Want to connect with others interested in physical therapy's role in improving health? Join APTA's Council on Prevention, Health Promotion, and Wellness. The association is also an organizational partner in the National Physical Activity Plan Alliance and has a seat on its board of directors.] Authors of the JAMA study say that while more clinical trials could help to better define the relationship between light PA and risk reduction, there's no reason to wait on promoting this type of PA. "The magnitude of these associations for light PA and their consistency across strata of CVD risk, physical functioning, and MVPA suggest that light PA could have much to offer older women in the prevention of CVD whether or not they can or choose to engage in MVPA," authors write. "Given the low risks of light PA and the abundance of light movements that are part of everyday life, even in the absence of trial data it may be prudent to encourage older women to increase light PA to improve their CVD health and reduce the occurrence of CVD events." Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.