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Chapter Summary

This chapter discusses the effects of sedentary lifestyle and physical activity (PA) on cardiovascular disease (CVD) and cardiovascular health. PA and cardiorespiratory fitness (CRF) are risk factors for CVD and have garnered attention as targets for primary and secondary prevention of CVD. Low PA and CRF are independently associated with atherosclerotic CVD as well as heart failure (HF). Sedentary lifestyle contributes to CVD risk through excess burden of CVD risk factors and development of intermediate at-risk phenotypes (see Fuster and Hurst’s Central Illustration). Among individuals with prevalent CVD, low PA and CRF levels portend higher risk of adverse outcomes. However, adoption of healthy exercise behavior and adherence to guideline-recommended levels of PA are low in the general population due to individual, interpersonal, and societal barriers. Identification of these barriers to PA may help inform strategies for PA promotion at an individual, community, and societal level. By increasing healthcare provider awareness of the salutary effects of PA, equipping providers with the training and resources needed to optimize PA adherence, and leveraging a multidisciplinary approach to PA promotion, society can move closer toward realizing the cardiovascular benefits of an active lifestyle.

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death in the United States, and accounts for ~32% of deaths globally.1 Since 1992, the age-standardized mortality rate for CVD has decreased in most countries.2 However, in 2017, CVD was responsible for 17.8 million deaths worldwide, reflecting a 21% increase in annual CVD deaths since 2007.1 In addition, the prevalence of CVD has been increasing globally. In 2017, the prevalence of CVD was 486 million cases, reflecting a 29% increase in CVD prevalence since 2007.1 These trends may in part reflect an increase in the prevalence of CVD risk factors such as hypertension (HTN), diabetes mellitus (DM), obesity, dyslipidemia, and physical inactivity (PI).1

A concerning trend among CVD risk factors is the recent increase in sedentary behavior (SB) and PI. In 2008, the US Department of Health and Human Services published federal guidelines for physical activity (PA),3 which was updated in 2018.4 The purpose of this guideline was to prescribe PA and specify the type, dose, and duration most likely to improve cardiovascular (CV) health based on available evidence. The guidelines recommend participation in at least 150 minutes a week of moderate-intensity or 75 minutes a week of vigorous-intensity aerobic PA. Despite these recommendations, data suggests that adherence to these PA levels in the United States and worldwide has not improved in the last decade; rather, time spent in SB has significantly increased.5 Furthermore, a significant proportion of individuals in the United States and worldwide lead a lifestyle marked by PI.6–9 This is particularly concerning in light of the favorable pleiotropic effects of PA. Exercise and PA have salutary effects on a ...

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