High leisure-time physical activity reduces major adverse limb events by 25% (HR 0.75) and major adverse cardiovascular events by 27% (HR 0.73), while occupational activity shows no benefit.
Does leisure-time physical activity reduce the risk of major adverse limb events in patients with established cardiovascular disease?
In patients with established cardiovascular disease, higher leisure-time physical activity reduces the risk of major adverse limb events and MACE, whereas occupational physical activity does not confer the same benefits.
Absolute Event Rate: 0% vs 0%
Abstract Background Leisure-time physical activity (LTPA) decreases the risk of major adverse cardiovascular events (MACE) via anti-inflammatory effects and the modification of classical risk factors such as hypertension, hypercholesterolemia and obesity, and by improving the cardiorespiratory system. However, accumulating evidence suggests that occupational physical activity (OPA) may not result in the same beneficial effects. Physical activity studies rarely report major adverse limb events (MALE) as their primary outcome, despite the substantial morbidity and related costs. Currently no evidence is available on the effect of different activity levels and MALE in patients with established cardiovascular disease (CVD). Purpose This study aimed to investigate the effects of LTPA and OPA on the risk of MALE in comparison with MACE in patients with established CVD. Methods Patients with established CVD from the prospective UCC-SMART cohort were included. History of CVD comprised of symptomatic peripheral artery disease, coronary artery disease , cerebrovascular disease and/or abdominal aortic aneurysm. After inclusion in the UCC-SMART cohort, patients completed a standardised screening protocol consisting of questionnaires, physical examination and laboratory measurements. LTPA and OPA were self-reported in the questionnaire. The MALE endpoint consisted of peripheral revascularisation and major vascular amputation of the lower limb. Cox proportional hazards models were used to quantify the effect of LTPA and OPA on the incidence of MALE and MACE, adjusted for confounders. Interaction between LTPA and OPA on the risk of MALE was tested by including an interaction term in the model. Results In 7060 patients (median follow-up 9.3 years), a total of 451 (6.4%) MALE and 1260 (18%) MACE occurred. The highest quarter of LTPA had a lower risk of MALE (HR 0.75, 95% CI 0.58 to 0.96) and MACE (HR 0.73, 95% CI 0.62 to 0.85), compared with the lowest quarter (Figure 1). For both outcomes the continuous LTPA association was non-linear, and had an optimum of LTPA after which no additional benefits of LTPA were observed (Figure 2). OPA (heavy manual vs sedentary) did not have a significant association with MALE (HR 0.81, 95% CI 0.53 to 1.22) and MACE (HR 1.15, 95% CI 0.93 to 1.42) (Figure 1). There was no significant interaction between LTPA and OPA on the risk of MALE (p for interaction: 0.21), indicating that the effect of LTPA on MALE did not differ across the categories of OPA. Conclusions In patients with established CVD, higher levels of LTPA decrease the risk of MALE and MACE to a similar extent. In contrast, higher levels of OPA do not confer the same benefits for these outcomes as LTPA does. In clinical practice, physicians should be aware of the fact that physical activity during occupation is not interchangeable for activity during leisure-time.
Reitsma et al. (Sat,) reported a other. High leisure-time physical activity reduces major adverse limb events by 25% (HR 0.75) and major adverse cardiovascular events by 27% (HR 0.73), while occupational activity shows no benefit.