Comparison of Cardioprotective Benefits of Vigorous Versus Moderate Intensity Aerobic Exercise

doi:10.1016/j.amjcard.2005.07.130

The American Journal of Cardiology

Volume 97, Issue 1, 1 January 2006, Pages 141-147

https://doi.org/10.1016/j.amjcard.2005.07.130 Get rights and content

Aerobic fitness, not merely physical activity, is associated with a reduced risk of cardiovascular disease. Vigorous intensity exercise has been shown to increase aerobic fitness more effectively than moderate intensity exercise, suggesting that the former may confer greater cardioprotective benefits. An electronic search of published studies using PubMed was conducted for 2 types of investigations, epidemiologic studies that evaluated the benefits of physical activity of varying intensity levels and clinical trials that trained individuals at different intensities of exercise while controlling for the total energy expenditure. A secondary search was conducted using the references from these studies. The epidemiologic studies consistently found a greater reduction in risk of cardiovascular disease with vigorous (typically ≥6 METs) than with moderate intensity physical activity and reported more favorable risk profiles for individuals engaged in vigorous, as opposed to moderate, intensity physical activity. Clinical trials generally reported greater improvements after vigorous (typically ≥60% aerobic capacity) compared with moderate intensity exercise for diastolic blood pressure, glucose control, and aerobic capacity, but reported no intensity effect on improvements in systolic blood pressure, lipid profile, or body fat loss. In conclusion, if the total energy expenditure of exercise is held constant, exercise performed at a vigorous intensity appears to convey greater cardioprotective benefits than exercise of a moderate intensity.

Section snippets

Methods

Epidemiologic studies and clinical trials were examined. For the former, only those that controlled for EE, or that found a relation between 1 intensity level and the study end points (incidence of CHD or development of CHD risk factors) but not for other intensity levels, were included. For clinical trials, only those that controlled for EE were included. A meta-analysis of the data was not feasible, because the number of studies that examined any 1 end point (such as blood pressure or insulin

Epidemiologic studies

Table 1, Table 2 list the epidemiologic studies of exercise intensity and incidence of CHD, or risk factors for CHD, respectively. In such studies, the determination of exercise intensity was imprecise. Subjects reported their physical activity, and investigators designated activities as “moderate” or “vigorous,” or assigned an intensity on the basis of estimated multiples of metabolism at rest (METs; 1 MET = 3.5 ml · min⁻¹ · kg⁻¹). However, the actual intensity of a given activity can vary

Discussion

Although many studies have evaluated the cardioprotective benefits of exercise, relatively few have compared different intensities while controlling EE. Although additional studies are warranted, a consistent picture has emerged. Several epidemiologic studies found benefits for accumulated EE performed at a vigorous intensity but not at a moderate intensity.6, 7, 9, 10, 11, 14, 17 The epidemiologic studies that specifically controlled EE all found greater benefits at higher intensities.8, 10, 15

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Association of aerobic and muscle-strengthening physical activity with all-cause and cardiovascular disease mortality among adults with type 2 diabetes: A prospective cohort of US adults
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To investigate the relationship of moderate physical activity (MPA), vigorous physical activity (VPA), and muscle strengthening activity (MSA), independently and jointly, with all-cause, cardiovascular disease (CVD), and non-CVD mortality in individuals with type 2 diabetes (T2D).
This cohort study included 47,538 adults with T2D and 561,963 adults without T2D from the National Health Interview Survey 1997–2018 who provided data on self-reported physical activity (PA). Mortality data were obtained from the National Death Index through 2019. Cox regression was used to estimate hazard ratio (HR) and 95% confidence interval (CI).
In analyses mutually adjusted, versus no MPA adults with T2D, performing the recommendations of MPA (150–299 min/week) associated with lower all-cause mortality (HR, 0.72; 95% CI, 0.66–0.78), CVD mortality (HR, 0.68; 95% CI, 0.58–0.79), and non-CVD mortality (HR, 0.72; 95% CI, 0.65–0.79). Similar benefits were observed in those meeting recommendations for VPA and MSA. Higher levels of PA beyond current recommendations may provide a few additional benefits without adverse effects on mortality risk, regardless of diabetes onset age, duration of diabetes, and medication status. The joint analysis indicates that combining MSA with aerobic PA could further lower mortality risk, and lowest all-cause mortality was observed among individuals engaging in either 75–150 min/week of VPA and 1 time/week of MSA (HR, 0.30; 95% CI, 0.13–0.70) or 150–299 min/week of MPA and 1 time/week of MSA (HR, 0.33; 95% CI, 0.20–0.55).
Our study supports the current PA guidelines and suggests that there may be limited benefits gained from exercising beyond recommended levels in adults with T2D, combining recommended levels of aerobic and resistance exercises could yield the greatest benefits.
Aerobic interval training preconditioning protocols inhibit isoproterenol-induced pathological cardiac remodeling in rats: Implications on oxidative balance, autophagy, and apoptosis
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This study aimed to investigate the potential cardioprotective effects of moderate and high-intensity aerobic interval training (MIIT and HIIT) preconditioning. The focus was on histological changes, pro-oxidant-antioxidant balance, autophagy initiation, and apoptosis in myocardial tissue incited by isoproterenol-induced pathological cardiac remodeling (ISO-induced PCR). Male Wistar rats were randomly divided into control (n = 6), ISO (n = 8), MIIT (n = 4), HIIT (n = 4), MIIT + ISO (n = 8), and HIIT + ISO (n = 8) groups. The MIIT and HIIT protocols were administered for 10 weeks, followed by the induction of cardiac remodeling using subcutaneous injection of ISO (100 mg/kg for two consecutive days). Alterations in heart rate (HR), mean arterial pressure (MAP), rate pressure product (RPP), myocardial oxygen consumption (M $\dot{V}$ O₂), cardiac hypertrophy, histopathological changes, pro-oxidant-antioxidant balance, autophagy biomarkers (Beclin-1, Atg7, p62, LC3 I/II), and apoptotic cell distribution were measured. The findings revealed that the MIIT + ISO and HIIT + ISO groups demonstrated diminished myocardial damage, hemorrhage, immune cell infiltration, edema, necrosis, and apoptosis compared to ISO-induced rats. MIIT and HIIT preconditioning mitigated HR, enhanced MAP, and preserved M $\dot{V}$ O₂ and RPP. The pro-oxidant-antioxidant balance was sustained in both MIIT + ISO and HIIT + ISO groups, with MIIT primarily inhibiting pro-apoptotic autophagy progression through maintaining pro-oxidant-antioxidant balance, and HIIT promoting pro-survival autophagy. The results demonstrated the beneficial effects of both MIIT and HIIT as AITs preconditioning in ameliorating ISO-induced PCR by improving exercise capacity, hemodynamic parameters, and histopathological changes. Some of these protective effects can be attributed to the modulation of cardiac apoptosis, autophagy, and oxidative stress.
Brief bouts of device-measured intermittent lifestyle physical activity and its association with major adverse cardiovascular events and mortality in people who do not exercise: a prospective cohort study
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Guidelines emphasise the health benefits of bouts of physical activity of any duration. However, the associations of intermittent lifestyle physical activity accumulated through non-exercise with mortality and major adverse cardiovascular events (MACE) remain unclear. We aimed to examine the associations of bouts of moderate-to-vigorous intermittent lifestyle physical activity (MV-ILPA) and the proportion of vigorous activity contributing within these bouts with mortality and MACE.
In this prospective cohort study, we used data from the UK Biobank on adults who do not exercise (ie, those who did not report leisure-time exercise) who had wrist-worn accelerometry data available. Participants were followed up until Nov 30, 2022, with the outcome of interest of all-cause mortality obtained through linkage with NHS Digital of England and Wales, and the NHS Central Register and National Records of Scotland, and MACE obtained from inpatient hospitalisation data provided by the Hospital Episode Statistics for England, the Patient Episode Database for Wales, and the Scottish Morbidity Record for Scotland. MV-ILPA bouts were derived using a two-level Random Forest classifier and grouped as short (<1 min), medium (1 to <3 min; 3 to <5 min), and long (5 to <10 min). We further examined the dose–response relationship of the proportion of vigorous physical activity contributing to the MV-ILPA bout.
Between June 1, 2013, and Dec 23, 2015, 103 684 Biobank participants wore an accelerometer on their wrist. 25 241 adults (mean age 61·8 years [SD 7·6]), of whom 14 178 (56·2%) were women, were included in our analysis of all-cause mortality. During a mean follow-up duration of 7·9 years (SD 0·9), 824 MACE and 1111 deaths occurred. Compared with bouts of less than 1 min, mortality risk was lower for bouts of 1 min to less than 3 min (hazard ratio [HR] 0·66 [0·53–0·81]), 3 min to less than 5 min (HR 0·56 [0·46–0·69]), and 5 to less than 10 min (HR 0·48 [0·39–0·59]). Similarly, compared with bouts of less than 1 min, risk of MACE was lower for bouts of 1 min to less than 3 min (HR 0·71 [0·54–0·93]), 3 min to less than 5 min (0·62 [0·48–0·81]), and 5 min to less than 10 min (0·59 [0·46–0·76]). Short bouts (<1 min) were associated with lower MACE risk only when bouts were comprised of at least 15% vigorous activity.
Intermittent non-exercise physical activity was associated with lower mortality and MACE. Our results support the promotion of short intermittent bouts of non-exercise physical activity of moderate-to-vigorous intensity to improve longevity and cardiovascular health among adults who do not habitually exercise in their leisure time.
Australian National Health, Medical Research Council, and Wellcome Trust.
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To investigate the association between the combined effects of physical activity (PA) intensity and particulate matter ≤10 μm in diameter (PM₁₀) and mortality in older adults.
This nationwide cohort study included older adults without chronic heart or lung disease who engaged in regular PA. Physical activity was assessed by a standardized, self-reported questionnaire that asked the usual frequency of PA sessions with low (LPA), moderate (MPA), or vigorous intensity (VPA). Each participant’s annual average cumulative PM₁₀ was categorized as low to moderate and high PM₁₀ on the basis of a cutoff value of 90th percentile.
A total of 81,326 participants (median follow-up, 45 months) were included. For participants engaged in MPA or VPA sessions, every 10% increase in the proportion of VPA to total PA sessions resulted in a 4.9% (95% CI, 1.0% to 9.0%; P=.014) increased and 2.8% (95% CI, −5.0% to −0.5%; P=.018) decreased risk of mortality for those exposed to high and low to moderate PM₁₀, respectively (P_interaction, <.001). For participants engaged only in LPA or MPA sessions, every 10% increase in the proportion of MPA to total PA sessions resulted in a 4.8% (95% CI, −8.9% to −0.4%; P=.031) and 2.3% (95% CI, −4.2% to −0.3%; P=.023) decreased risk of mortality for those exposed to high and low to moderate PM₁₀, respectively (P_interaction, .096).
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The modern environment has led to an increased risk and incidence of sedentary lifestyles. When physical activity (PA) becomes insufficient, pathophysiological pathways are invoked and the future risk for chronic diseases and premature mortality increases. As a consequence, since the 1970s governmental agencies and medical societies have published guidelines to promote PA. The 2018 Guidelines for Physical Activity for Americans contain important updated guidelines, but many of these guidelines are not yet sufficiently known by the public or health providers. In addition, to make use of these guidelines, they need to be integrated with optimal behavioral interventions. Accordingly, this narrative review critically assesses five tenets that stem from the 2018 Guidelines and illustrates how these tenets can be integrated with tools and techniques for motivating individuals to initiate and maintain a more physically active lifestyle. The first tenet indicates that there is no lower threshold of PA that must be obtained before health benefits begin to accrue. Second, it is no longer required that PA be obtained in bouts of 10 min or more to “count”. Bouts of lesser duration also count. Pending further study, new accelerometry data suggest that vigorous intermittent PA of just 1–2 min may also benefit health, such as that acquired by stair climbing or carrying heavy groceries. This has led to a new concept of promoting “lifestyle physical activity”. Third, excessive sitting is health damaging if it is not accompanied by sufficient daily life PA or if it accrues over long uninterrupted bouts. Fourth, it is essential to incorporate resistance exercises for optimal health and to promote successful aging. Fifth, a wealth of new evidence indicates that PA strongly protects and promotes all aspects of brain health and may improve cognition even after a single bout of exercise.
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Methods—reviewComparison of Cardioprotective Benefits of Vigorous Versus Moderate Intensity Aerobic Exercise

Section snippets

Methods

Epidemiologic studies

Discussion

Am J Cardiol

Arch Phys Med Rehabil

Am J Clin Nutr

Arch Phys Med Rehabil

Physical activity and public healtha recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine

JAMA

Physical Activity and HealthA Report of the Surgeon General

Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease

Circulation

VO2 reserve and the minimal intensity for improving cardiorespiratory fitness

Med Sci Sports Exerc

The interactions of intensity, frequency and duration of exercise training in altering cardiorespiratory fitness

Sports Med

Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction in men

N Engl J Med

Relative intensity of physical activity and risk of coronary heart disease

Circulation

A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women

N Engl J Med

Physical activity and coronary heart disease in menthe Harvard Alumni Health Study

Circulation

Exercise type and intensity in relation to coronary heart disease in men

JAMA

What level of physical activity protects against premature cardiovascular death? The Caerphilly study

Heart

Walking compared with vigorous physical activity and risk of type 2 diabetes in women

JAMA

Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men

Arch Int Med

Moderately intense physical activities and high levels of cardiorespiratory fitness reduce the risk of non-insulin-dependent diabetes mellitus in middle-aged men

Arch Int Med

Amount and intensity of physical activity, physical fitness, and serum lipids in men

Am J Epidemiol

Intensity, duration, and frequency of physical activity and coronary risk factors

Med Sci Sports Exerc

Intensity of physical activity related to incidence of hypertension and all-cause mortalityan epidemiologic view

Blood Press Monit

Exercise intensity and subclinical cardiovascular disease in the elderly

Am J Epidemiol

Relationships of heart disease risk factors to exercise quantity and intensity

Arch Intern Med

Methods—review
Comparison of Cardioprotective Benefits of Vigorous Versus Moderate Intensity Aerobic Exercise

VO₂ reserve and the minimal intensity for improving cardiorespiratory fitness