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/Physical Activity to Reduce the Risk of Cardiovascular Disease/

This Wikibooks page is a critique of "Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: the “Pas-a-Pas” community intervention trial" by Arija et al. published in BioMed Central Public Health in 2017.

What is the background to this research?
Cardiovascular disease is any disease that affects the heart or blood vessels. This includes coronary heart disease, cardiomyopathy and stroke.

Exercise is critical to the prevention and treatment of cardiovascular disease. These programs include aerobic exercise, resistance training, balance and flexibility exercises.

Prevalence
Cardiovascular disease is of high prevalence in Australia and around the world. Cardiovascular disease has been the leading cause of deaths in Australia for many years. In 2016 alone there were 43,963 deaths. This equates to one Australian life lost every 12 minutes from cardiovascular disease. In Spain where the intervention was conducted there is also a high prevalence of cardiovascular disease. In 2017 there were 53,101 deaths in spain from cardiovascular disease which made up 16.92% of all deaths in Spain. On a worldwide scale 17.5 million people, or 31% of all mortality, died from cardiovascular disease in 2012. The World Health Organization has estimated that 23.6 million people will be dying each year from cardiovascular disease by 2030.

Risk Factors
Risk factors increasing the risk of cardiovascular disease include:
 * Hypertension
 * High cholesterol
 * Smoking
 * Obesity
 * Sedentary lifestyle
 * Diet
 * Age

Location of the Study
The study was conducted at 4 primary care centres in Reus, Catalonia, Spain.

Location of the Author
Victoria Arija is affiliated with Rovira i Virgili University in Tarragona, Spain. She has been researching chronic diseases and other health conditions with association to 123 publications on ResearchGate and has been published 7 times in BMC Public Health.

Publishing Journal
BMC Public Health is the largest open access journal with a focus on public health. In particular BMC Public Health addresses the social, behavioural, environmental affects on health and disease and how different interventions and practices can make for a healthier community. Any article submitted to BMC Public Health is first peer-reviewed to assess quality, validity and originality of the study before it is published in the journal.

What kind of research was this?
The research in this article was a randomised controlled community intervention with a 3:1 ratio of intervention group participants and control group participants. Randomised controlled interventions are thought to be the gold standard and most thorough method of evaluating whether a cause-effect relationship exists between the intervention and the outcome. They reduce bias but are difficult to create and execute a high quality randomized control intervention. .

What did the research involve?
This research intervention involved collecting a clinical history and baseline dietary intake and physical activity levels. The participant's cardiovascular risk factor was also measured using the Registre Gironí del Cor scale. This scale assessed systolic and diastolic blood pressure, smoking status, waist circumference, weight, BMI, LDL- cholesterol, HDL-cholesterol and total cholesterol. Triglycerides, glucose and glycosylated hemoglobin are also factored into this scale. This data was collected pre and post intervention.

The intervention consisted of a control group of 104 people and an intervention group of 260 people. The participants completed 120min/week walking (396METs/min/week) and a social gathering once a month.

This article did not address the risk of human error in its initial measurements of blood pressure, waist circumference and risk factor questionnaire. In the measurement of blood pressure a manual sphygmomanometer was used and it was completed 3 times and an average taken. There is the chance that the clinician can mishear the blood pressure reading. The article did not specify if there was anytime separating the 3 blood pressure readings. If inadequate time was left between the readings this would have elevated the participant's blood pressure and so it would not have been a true reading. The possibility for human error also needs to be addressed in the measurement of waist circumference. This was done with a tape measure placed between the bottom of the ribs and the top of the hip bones. It is possible that the clinicians can interpret this point differently or that they mad an error when reading the tape measure. The other area of the method that could have been addressed is the cardiovascular risk factor scale Registre Gironí del Cor. The scale criteria asks whether a participant smokes with a simple yes or no answer. This does not take into account whether the participant smokes one cigarette every few days or 3 packs a day. This would have a major affect on the level of damage and narrowing of the arteries as result of smoking and therefore their risk of cardiovascular disease. The amount of cigarettes a participant smokes a day would also would have a major affect on lung function and therefore their ability to participate in the physical activity intervention. This is why the quantity of cigarettes per day should have included in their testing. In addition there are studies that have found the Registre Gironí del Cor risk factor scale to be unreliable in detecting the risk of cardiovascular disease, in particular underestimating the risk to participants.

What were the basic results?
A p-value <0.05 was considered to be of statistical significance.
 * In addition, 2 years after the intervention, the incidence of adverse cardiovascular events remained 8% lower in the intervention group participants and their maintenance of regular physical exercise was 45.6% higher than the control group participants.

What conclusions can we take from this research?
Results show that exercise over an extended period of time reduces cardiovascular disease prevalence. This is through decreased systolic blood pressure, LDL-cholesterol and total cholesterol. These results aligns with the current research findings.

The method could have been adapted to reduce the risk for error and better consider the risk factor of smoking. There should be more research in this area and awareness raised that cardiovascular disease is the biggest killer of Australians and that exercise can reduce the risk and severity of the disease.

Practical advice
If you think that you or a family member may have cardiovascular disease the first thing to do is book an appointment with your local general practitioner. They will look at your medical history and if necessary do some testing.

Exercise is an important part of the treatment plan for cardiovascular disease. To get an individualised exercise plan you should contact an Exercise Physiologist. They have the anatomical and medical knowledge to write an exercise plan that takes the cardiovascular disease into consideration.

Further Readings

 * Cardiovascular Disease Fact Sheet - Heart Foundation: https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/cardiovascular-disease-fact-sheet.


 * Cardiovascular Disease - Department of Health: http://www.health.gov.au/internet/main/publishing.nsf/Content/chronic-cardio


 * Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity): http://scholar.google.com.au/scholar_url?url=http%3A%2F%2Fscholarcommons.sc.edu%2Fcgi%2Fviewcontent.cgi%3Farticle%3D1137%26context%3Dsph_physical_activity_public_health_facpub&hl=en&sa=T&oi=gga&ct=gga&cd=3&d=14765982305966312302&ei=2tiXW-QIh-LKBNWNuNgL&scisig=AAGBfm2WVidg3MMjpUEFu96ITxn3sOKw4w&nossl=1&ws=1536x770 〈ref name = 'reference 17'>.