Exercise and physical activity are of vast global importance to prevent and control the increasing problem of heart disease and stroke, according to a review paper published today in the Journal of the American College of Cardiology. This paper is part of an eight-part health promotion series where each paper will focus on a different risk factor for cardiovascular disease.

Physical inactivity is considered one of the leading modifiable risk factors for heart disease, along with smoking status and high low-density lipoprotein (LDL) cholesterol levels. A 2012 study found physical inactivity accounted for 9 percent of premature deaths worldwide and was shown to be the reason behind 6 percent of coronary heart disease, 7 percent of Type 2 diabetes and 10 percent of both breast and colon cancer diagnoses.

In this systematic review, the authors compiled the results of 25 published reviews that addressed both personal and environmental variables related to physical activity to determine how health care professionals can empower patients to adhere to a heart-healthy lifestyle.

"Proper physical activity should be a lifelong commitment," said Gerald Fletcher, MD, professor of medicine and cardiovascular disease at Mayo Clinic Florida and the review's lead author. "The benefits of being physically active exist regardless of sex, ethnicity or age. The most active individuals have an approximate 40 percent lower risk of developing heart disease than those who do not exercise at all."

To benefit overall heart health, current guidelines recommend at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week. Aerobic forms of exercise have been shown to lower systolic and diastolic blood pressure as much as 15 and 9 mmHg, respectively, among hypertensive patients, as well as reduce ischemic stroke risk and decrease LDL levels with the aid of a proper diet.

Sedentary behaviors (e.g. sitting in front of a computer or watching television) occupy almost eight hours of the average person's day, but replacing one hour of sitting time with an equal amount of activity has been shown to effectively lower all-cause mortality. The researchers recommend incorporating more daily lifestyle activities into the day, such as yard work, household chores, or walking/biking to and from work. The authors list stand-up desks, stand-up conference rooms with no chairs and using the stairs instead of an elevator as a few of the ways a work environment can promote physical activity for its employees.

According to the review, both in-patient and out-patient cardiac rehabilitation have also been shown to successfully reduce all-cause mortality and empower heart disease patients to combat modifiable cardiac risk factors. The success of these preventive programs heavily relies on the patient's commitment to changing sedentary behaviors and consistent follow-up from the patient's health care provider.

"Just like medication, the right form of physical activity has to be specialized for each patient. Physical activity is no different from smoking cessation or eating a heart-healthy diet," said Fletcher. "It is up to health care professionals to set an example for their patients in all aspects of life."