Exercise as it relates to Disease/Is low intensity exercise the key to a good health related quality of life for cardiovascular disease sufferers?

This is an analysis on the journal article "Home-Based Exercise in Older Adults Recently Discharged From the Hospital for Cardiovascular Disease in China: Randomized Clinical Trial" by Xueyu et al. in 2015.



Background information
CVD is a collective term for any heart disease, stroke or blood vessel disease.

CVD accounts for 31% of all deaths worldwide, totalling 17.5 million deaths. It is important to research the physiological processes that lead to CVD in order to understand how to treat and prevent underlying comorbidities.

Where is the research from?
The research was conducted on a Chinese elderly population. All participants had recently been discharged after CVD treatment and were of a military background. The study was conducted in Beijing, China and subjects were all treated at the General Hospital of Chinese People’s Liberation Army.

Researchers
The Authors all have at minimum a master’s degree in their respective fields, with 2 of the 5 authors having PhD’s. All researchers worked at a hospital.

Sponsorship
There are no organizational or sponsorship links that may effect the research.

What kind of research was this?
The study was a randomized clinical trial (RCT).

RCT’s are good in that there is a control group and at least one intervention group, this gives great comparative results. These results are valid, but when compared to meta-analysis’ it is not as comprehensive and reliable.

What did the research involve?
The control group were treated as per a standard cardiovascular (CV) discharge treatment. This included education about health and physical activity (PA) and being told to undergo moderate PA regularly. The frequency of the PA was not specified. The intervention group were prescribed a 12-week exercise rehabilitation program to be completed at home, which was regularly followed up by an Advanced Practice Nurse with special rehabilitation training. The intervention prescribed were 14-type joint exercises and walking. The 14-type joint exercises is a filtered version of the standard Chinese physical fitness method. These exercises were done once per day, five days per week. A borg rating of between 9 and 11 was the required intensity. The walking stage consisted of a 5-minute slow walking warm-up followed by 20–30 minutes of brisk walking and then another period of 5 minutes of slow walking. Health related quality of life (HRQOL) was measured by the Medical Outcomes Study SF-36 questionnaire and the Senior fitness test (SFT). The Left Ventricle Ejection Fraction (LVEF) was measured by echocardiogram. The physician had no knowledge of which patients were in which group.

The method of testing used was well thought out in most aspects because both intervention and control groups and pre and post testing were implemented. The SF-36 questionnaire was a questionable method as it was self reported data. Self reported data is often either over or underestimated and does not always give valid results. Using an ex-military population is questionable in that they would have completed a higher level of PA throughout life compared to a general population.

Basic Results
The intervention group was shown to have greater improvements in HRQOL than the control group when SF-36 results were compared. The results from SFT showed that the intervention group had greater improvements across all physical tests. LVEF had the same mean improvement for both the intervention group and the control group, this indicated a non significant positive correlation.

The researchers interpreted that there was a p-value of below 0.05 for improvement in physical function, role-physical, bodily pain and vitality. They described significant improvement in chair stands, arm curls, TUG, and the 6-minute walk distance.

There was minimal over-emphasis on the positives that they found, this is evident in the way they acknowledge the difference in LVEF between pre and post intervention. More emphasis was put on the positives found from the intervention in the results and discussion.

Conclusions from this research
The evidence of PA’s benefits on CVD rehabilitation and general quality of life is made clear in this study. LVEF was shown to not be improved at a greater rate in the intervention group, but this could be due to the intervention being only 12 weeks. Therefore, a more chronic, longitudinal study would be beneficial with a general population.

Other research
Khoja et al. found that increased PA levels had a positive correlation with improving underlying risk factors for CVD. These improvements included: decreased LDL levels, increased HDL levels, decreased total triglycerides and improved blood pressure. A sedentary state was shown to have the opposite effect on these measurements.

In a statement by the Council on Clinical Cardiology and Council on Nutrition, PA and Metabolism in the USA, it is stated that PA improves CV function, endurance and muscular strength as well as reducing symptoms of CVD and preventing coronary artery disease.

Practical advice
This research provides further evidence about PA’s ability to improve human function. The research delivers a valuable comparison between low intensity PA and a sedentary lifestyle. It is invaluable to know that it CV function can be improved through an affordable mechanism as it is prevalent in all income classes worldwide.

If readers are concerned about their own health in relation to any of this information they should consult a doctor or allied health professional before commencing any sort of intervention.