Heart disease risk and exercise
Keeping active, as we have seen above is a great way to live better and longer. But, what is the exact link between exercising and cardiovascular disease (CVD) risk? Does exercising more reduce the risk of having a heart failure? Let's see what science has to say about it:
The American Heart Association (2015) ( 1 ) is quite clear about the benefits of phyisical activity:
"Doubling or quadrupling the minimum federally recommended levels of physical activity lowered the risk of developing heart failure by 20 percent and 35 percent, respectively"
They also report that more you exercise, the lower is the risk of heart failure.
This conclusion is based on data from studies in the US and Europe involving more than 370,000 subjects over a 15-year follow-up.
However another study (Batacan, 2015) ( 2 ) which looked into the effects of light intensity physical activity on cardiovascular disease reviewed the data published between 1970 and 2015 and found that light intensity physical activity "did not improve CVD risk factors... in healthy individuals", however it did improve blood pressure in "physically inactive populations with a medical condition" (i.e. subjects with high blood pressure).
The authors believe that this strange outcome (one would expect a lower CVD risk in people who exercised) is due to the low quality studies (which didn't monitor other effects such as food intake) and low doses of light exercise used in them.
Don't overdo it
Sedentarism can hurt your heart and so can training too much. James O'Keefe and his team (2012) ( 3 ) report that people should exercise within the limits laid down by the Physical Activity Guidelines (See guidelines below) because high-intensity endurance training can increase the risk of "adverse cardiovascular events" (and musculoskeletal injuries too!).
Thhose who train and compete in extreme endurance events (ironman, triathlon, marathons, ultramarathons, very long distance bike races) suffer small damage which goes unnoticed but which after years of repetitive injury can eventually damage parts of the heart and be the cause of arrhythmias and calcification and wall-stiffening to arteries among other conditions.
They report that "Veteran endurance athletes in sports such as marathon or ultramarathon running or professional cycling have been noted to have a 5-fold increase in the prevalence of atrial fibrillation.".
Take home point
Exercising will help your heart, especially if you are in a CVD risk group. But don't overtrain.
Some unexpected health benefits of physical activity
Apart from contributing to shedding fat and maintaining a healthy weight and ward off heart disease, exercise also helps your health in other ways preventing dementia, depression and extending your lifespan, here's what science has to say about it:
Exercising can help improve memory and avoid dementia
Alzheimer's disease appears in a part of the brain known as the "hippocampus" (more on it below) which has an important role in memory processing and learning. That is why the onset of the disease causes severe memory loss. The hippocampus shrinks as you age, but a controlled trial with 120 older adults (Erickson, 2011) ( 4 ) found that very fit adults had larger hippocampal volume and that "exercise training increased hippocampal volume by 2%, effectively reversing age-related loss in volume by 1 to 2 years".
Take home point
Aerobic exercise can reverse hippocampal volume loss and improve memory in old age.
Exercise is a good treatment for depression
James Blumenthal and his team (2012) ( 5 ) report that even moderate levels of "exercise [are] an effective treatment for depression, improving depressive symptoms to a comparable extent as pharmacotherapy and psychotherapy".
Active people are less likely to become depressed. Aerobic and Resistance Training are equally effective, and "any exercise is better than no exercise.".
Take home point
Exercise is as efective as meds or psychotherapy against depression.
Longer telomeres equal longer lifespan
You may live longer if you exercise
James H. O'Keefe et al., (2012) (3) mentiones that "People who exercise regularly have ... a mean life expectancy that is 7 years longer than that of their physically inactive contemporaries", but what is the exact mechanism?
Apparently telomeres are involved in this life-extending benefit of exercise:
Telomeres are chunks of nucleoproteins that act as caps at the tips of each strand of DNA insde our chromosomes. They protect them (keeping them from sticking to each other). They are like the plastic tips at the ends of your shoelaces.
Larry Tucker (2017) ( 6 ) studied 5,823 adults from the National Health and Nutrition Examination Survey (NHANES 1999-2002) comparing their telomere lengths to that of a standard reference DNA. As their level of physical activity was known, it was easy to check if there was any link between telomere length and exercise.
They found that as you age, telomeres become shorter by 15.6 base pairs each year that passes and this causes cell deterioration and aging.
But those who engaged in routine physical activity helped conserve longer telomere length. Adults with high physical activity levels had telomers that were longer than those of less active ones. They were:
- 140 base pairs longer than sedentary adults
- 137 base pairs longer than low activity adults
- 111 base pairs longer than moerate activity adults
This translates into a "biologic aging advantage of 9 years (140 base pairs ÷ 15.6) over Sedentary adults", 8.8 years vs. Low activity adults and 7.1 years over Moderately active adults.
Why does this happen? Maybe the antioxidant properties of a healthier lifestyle (less fat means less oxidative stress for the body) helps conserve telomere length.
Take home point
"Adults who participate in high levels of Physical Activity tend to have longer telomeres".
This means reduced cellular aging compared to less active adults.
Longer telomeres in active adults accounted for 9 years of reduced cellular aging.
Exercise inhibits inflammation
Stoyan Dimitrova, Elaine Hultenga and Suzi Honga, (2017), ( 7 ) investigated how regular exercise exerts anti-inflammatory effects by studying how 20-minute periods of moderate exercise induced the release of catecholamine, which in turn has an anti-inflammatory effect. They suggest that this type of exercise "may protect against chronic conditions with low-grade inflammation".
Catecholamines are also neurotransmitters that affect immune response, so exercise may also impact positively on immunity.
Exercise reduces Mortality Risk
A study ( 8 ) involving 334,161 European men and women followed up for at least 12.4 years revealed that "The higher risk of death resulting from excess adiposity may be attenuated by physical activity".
The all-cause mortality in moderately inactive individuals was 16 to 30% lower than that of "inactive individuals". So even small increases in levels of physical activity can go a long way in reducing mortality.
The activity effect on mortality was twice that of avoiding obesity, while being physically inactive had the same risk as having a high waist circumference.
Learn why Waist Size Matters when it comes to your health.
Exercise helps beat abdominal fat and metabolic syndrome
Metabolic syndrome affects 1 out of every 5 adults around the world. It is defined as a combination of at least three of the following risk factors: abdominal obesity (high visceral fat), high blood pressure, high levels of triglycerides in your blood, low levels of "good" cholesterol (high-density lipoprotein or HDL) and insulin resistance.
Apparently Abdominal fat is the main culprit, as it causes the other factors involved in metabolic syndrome.
Paley and Johnson (2018) ( 9 ) report that "there is moderate evidence supporting the use of programmes of exercise to reverse metabolic syndrome", and cite a study that aerobic and resistance training, and high resistance-moderate endurance training helped reduce visceral fat and that the loss of this type of fatty tissue was more important than weight loss.
Take home point
Increasing daily physical activity levels and doing high-intensity interval training and resistance training will reduce abdominal fat and ward off metabolic syndrome.
Yes, Aerobic exercise leads to weight loss
Study after study show that exercise helps overweight and obese subjects lose weight. These trials include different types of physical activity, but all show that being active helps lose fat and weight. Below we summarize some of these studies:
- Exercise that burned 400 calories per session, 5 days a week for 10 month led to a 4.3% loss of body mass (8.6 lbs), those who burned 600 calories per session lost 5.7% of their body weight (11.5 lbs), the sedentary control group gained 1.1 lbs weight (0.5%) ( 10 )
- Resistance training (RT) led to loss of body mass, fat mass, reduced total cholesterol, triglycerides and "Bad" LDL cholesterol. It also reduced insulin levels more than endurane training. (8)
- Sedentary obese overweight, non-diabetic adults lost more weight and fat mass with aerobic training than with resistance training (though RT led to an increase in muscle mass). ( 11 )
- Obese and overweight women: diet alone led to more weight loss than exercise alone, but when combined diet plus exercise, they led to greater fat loss and change in body weight and composition. ( 12 )
The amount and intensity of physical activity is the key
Damon Swift and his team (2014) ( 13 ) reported that following aerobi exercise training programs in line with the public health guidelines (See guidelines below) led to modest weight loss (4.4 lbs or 2 kg) which may be below the expectations of many of those who engage in physical activity to lose weight.
However Swift points out that "numerous health benefits occur from Physical Activity programs in the absence of weight loss", so even if you don't lose weight, that doesn't mean that you aren't benefiting from your exercise.
For instance, to prevent weight gain, one should do 150-250 minutes per week of moderate to vigorous physical activity burning around 1,200 to 2,000 calories weekly.
Those who gain most from exercise regardless of weight loss are the overweight and obese individuals at risk for Cardiovascular diseases
Exercise will keep you from regaining lost weight
Finally, adhering to an exercise training program over the long-term plays a major role in keeping the lost pounds off, and not regaining them.
A study involving a group that dieted in combination with aerobic exercise training lost the same weight as another group that dieted and did the minimum physical activity suggested by the guidelines (+17 lbs after 16 weeks - 8 kg) but, one year later, those who were most active lost an extra 4.2 lbs (1.9kg) while the other group regained 10.8 lbs. (4.9 kg).
Take home point
You should aim at going above the minimum guideline levels of physical activity.
Substantial weight loss from physical activity will only happen if the exercise level is intense.
Your body will try to compensate for the energy burned during exercise
The effect of additional exercise was also reported in a recent study by Kyle Flack and his team (2018) ( 14 ) that looked into the effect of "extra" exercise and weight loss. To do so they organized two groups of sedentary overweight to obese men and women; they were to exercise 5 days per week. One group was to burn 300 calories per exercise session, and the other one 600 calories per session.
After 12 weeks they were tested, the 3,000 calories per week group lost weight and body fat while the 1,500 calories per week group did not lose weight or fat.
The study found that somehow the bodies of the participants tried to "compensate" for the extra energy expenditure either by eating more or moving less throughout the day. But the "compensatory effect" was almost the same in both groups (around 1,000 calories) which more or less compensated the energy expended by the least active group, so they didn't lose weight.
The 3,000 calories per week group on the other hand only compensated 1,000 calories so their weekly deficit was 2,000 calories and that is what led to their weight loss (they burned fat to cover this deficit).
The authors concluded that compensation is not proportionate to energy expenditure meaning that you need to exercise more vigorously to shed pounds.
Take home point
When it comes to exercise, try to go the extra mile and you will lose more weight and fat.
Physical Activity Guidelines
The Physical Activity Guidelines for Americans ( 15 ) defined by the U.S. Department of Health and Human Services lays down the recommended amount and type of physical activity needed to maintain health:
Adults 18 to 64 years old
- Any physical activity (PA) is better than none. Avoid inactivity. Any amount of PA will provide health benefits.
- For "substantial" health benefits: Do at least 150 minutes per week (2 hours and 30 minutes) of moderate-intensity activity or 75 minutes (1 hour and 15 minutes) of vigorouos-intensity aerobic physical activity each week. Or a combination of both.
- Aerobic activity should last at least 10 minutes and be spread out throughout the week.
- For even more health benefits increase the moderate-intensity aerobic activity to 5 hours ⁄ week or the vigorous-intensity to 150 minutes ⁄ week.
- You should also include muscle-strengthening activities involving all major muscle groups on 2 or more days a week.
Older Adults: 65 years and older
- Try to follow the adult guidelines above, if you can't then try to keep as physically active as possible.
- Exercise to maintain and improve balance -to avoid the risk of falling.
- Your level of physical activity (PA) should be in line with your level of fitness.
- Those suffering from chronic health conditions should understand whether and how their conditions affect their ability to do regular PA safely.
- Moderate-intensity physical activity: is aerobic activity that increases your heart rate and breathing somewhat. So it is a 5 or 6 on a 0 to 10 scale.
Examples: Brisk walking, swimming, cycling on a level terrain or dancing. You can maintain a conversation during moderate PA.
- Vigorous-intensity physical activity: is aerobic activity that greatly increases your heart rate and breathing. It is a 7 or 8 on a 0 to 10 scale.
Exampes: singles tennis, cycling uphill, jogging, swimming continuous laps. You will find it hard to keep up a conversation.
- Muscle-strengthening activity: PA that builds muscle power, mass and endurance. It includes strength training, resistance training, muscular strength and endurance exercises.
Scientifically proven benefits of exercise
We have seen that there is strong evidence backing exercise as a way towards a healthier life. Not only will you lose weight and keep it off, it also has many beneficial "side-effects" such as extending lifespan, improving memory as you age, warding off depression, reducing risk of metabolic syndrome and heart disease.
Cite this article:
A. Whittall. ©2018. The science of exercise. Patagonia Wellness, 11 Nov. 2018. http://www.patagoniawellness.com/fitness/exercise-science.html
Subject: Exercise not only helps you lose weight and fat (and not regain it), it also has many health benefits such as longer life expectancy, improvements in metabolic syndrome, heart disease, depression, memory in older people and antiinflammatory efects.
References and Further Reading
(1) American Heart Association News, (2015). Physical activity: More is better for heart failure prevention, October 5th, 2015
(2) Romeo B. Batacan Jr., et al., (2015). Effects of Light Intensity Activity on CVD Risk Factors: A Systematic Review of Intervention Studies, BioMed Research International Vol 2015, Article ID 596367, http://dx.doi.org/10.1155/2015/596367
(3) James H. O'Keefe et al., (2012). Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise, Mayo Clin Proc. 2012 Jun; 87(6): 587-595. doi: [10.1016/j.mayocp.2012.04.005]
(4) Kirk I. Erickson et al., (2011). Exercise training increases size of hippocampus and improves memory, PNAS February 15, 2011 108 (7) 3017-3022; https://doi.org/10.1073/pnas.1015950108
(5) James A. Blumenthal, Patrick J. Smith, and Benson M. Hoffman, (2012). Is Exercise a Viable Treatment for Depression?, ACSMs Health Fit J. 2012 July/August; 16(4): 14-21. doi: [10.1249/01.FIT.0000416000.09526.eb]
(6) Larry A.Tucker, (2017). Physical activity and telomere length in U.S. men and women: An NHANES investigation, Preventive Medicine. Vol 100, July 2017, 45-151, https://doi.org/10.1016/j.ypmed.2017.04.027
(7) Stoyan Dimitrova, Elaine Hultenga and Suzi Honga, (2017). Inflammation and exercise: Inhibition of monocytic intracellular TNF production by acute exercise via β2-adrenergic activation, Brain, Behavior, and Immunity Vol 61, March 2017, 60-68, https://doi.org/10.1016/j.bbi.2016.12.017Get rights and content
(8) Ulf Ekelund et al., (2015). Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC), The American Journal of Clinical Nutrition, Vol 101:3, 1 March 2015, 613-621, https://doi.org/10.3945/ajcn.114.100065
(9) Carole A. Paley and Mark I. Johnson, (2018). Abdominal obesity and metabolic syndrome: exercise as medicine?, BMC Sports Sci Med Rehabil. 2018; 10: 7, 2018 May 4. doi: [10.1186/s13102-018-0097-1]
(10) Joseph E. Donnelly et al., (2013). Aerobic exercise alone results in clinically significant weight loss for men and women: Midwest Exercise Trial-2, Obesity (Silver Spring). 2013 Mar; 21(3): E219-E228. doi: [10.1002/oby.20145]
(11) Leslie H. Willis et al., (2012). Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults, J Appl Physiol (1985). 2012 Dec 15; 113(12): 1831-1837. 2012 Sep 27. doi: [10.1152/japplphysiol.01370.2011]
(12) Cheng CC, Hsu CY, Liu JF., (2018). Effects of dietary and exercise intervention on weight loss and body composition in obese postmenopausal women: a systematic review and meta-analysis, Menopause. 2018 Jul;25(7):772-782. doi: 10.1097/GME.0000000000001085
(13) Damon L. Swift, et al., (2014). The Role of Exercise and Physical Activity in Weight Loss and Maintenance, Prog Cardiovasc Dis. 2014 Jan-Feb; 56(4): 441-447. 2013 Oct 11. doi: [10.1016/j.pcad.2013.09.012]
(14) Kyle D. Flack, Kelsey Ufholz, LuAnn Johnson, John S. Fitzgerald, and James N. Roemmich, (2018). Energy compensation in response to aerobic exercise training in overweight adults, Am J Physiol Regul Integr Comp Physiol. 2018 Oct 1;315(4):R619-R626. doi: 10.1152/ajpregu.00071.2018. Epub 2018 Jun 13.
(15) Dietary Guidelines 2015-2020 - Appendix 1. Physical Activity Guidelines for Americans. Accessed 01 Nov 2018.