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Table 2 Content of PA interventions for the primary prevention of CVD

From: Systematic review of international clinical guidelines for the promotion of physical activity for the primary prevention of cardiovascular diseases

Focus of physical activity
intervention
Target population Recommendation Details of recommendation Guideline reference number (see Table 1 for details)
Global CVD prevention General adult population, regardless of CVD risk factors All adults should be advised to participate in:
At least 30 min of moderate intensity (aerobic) PA on at least 5 days of the week (minimum of 150 min/week), or preferably every day of the week
PA: Any bodily movement produced by skeletal muscles that requires energy expenditure
Cardiorespiratory fitness: ability of the body to use oxygen to do PA, improved by PA
Aerobic PA: movements of large muscle mass in a rhythmic manner for a sustained period
Moderate intensity: breathing faster than normal / 3.0–5.9 METS / Increase of breathing rate, heart rate, & warmth, possibly accompanied by sweating / Can be continued for many minutes without exhaustion feeling
Prescription of 4 dimensions: Frequency, duration, intensity & type – Taking into account contraindications (individual's condition)
Duration: No need for continuous PA to have benefit; longer sessions have no different effect on CHD risk compared with shorter sessions, as long as total energy expenditure is similar
CVD 1
CVD 2
CVD 3
CVD 4
CVD 5
CVD 6
CVD 7
LSt 2
LCh 2
LCh 3
LCh 4
BP 1
BP 3
DM 2
  OR
  At least 15 min of vigorous intensity (aerobic) PA on at least 5 days of the week (minimum of 75 min/week), or preferably every day of the week CVD 3
CVD 7
LSt 2
  OR
  An equivalent combination thereof, performed in sessions with a duration of at least 10 min/session CVD 3
CVD 4
CVD 7
OW 4
  PA may include occupational and/or leisure-time activity and should incorporate accumulated bouts of moderate-intensity activities Type of PA: Active living (non-recreational active travel, household work, gardening), occupational activity (at work), leisure time activity (non-occupational) & exercise (structured and done for specific reason, e.g. brisk walking, cycling, hiking, jogging, swimming) CVD 4
CVD 5
OW 4
OW 7
  All patients, irrespective of health, fitness or activity level, should be encouraged to increase activity levels gradually
Those who are moderately active and are able to increase their activity should be encouraged to do so. Activity can be increased through combination of changes to intensity, duration or frequency
For additional benefit in healthy adults, a gradual increase in aerobic PA to 300 min a week of moderate intensity, or 150 min a week of vigorous intensity aerobic PA, or an equivalent combination thereof is recommended
Inverse dose–response relationship between PA levels and CVD risk
Potential risk of adverse events associated with vigorous—& high-intensity exercise are extremely low (no significant difference when compared to moderate-intensity PA)
CVD 3
CVD 4
CVD 5
OW 7
LSt 2
LCh 2
DM 3
  Individuals should be advised to minimize the amount of time spent being sedentary (sitting) over extended periods; e.g. by reducing screen time and taking regular breaks from sitting both at home and at work Provide general advice to minimize periods of prolonged sitting:
- High levels of total sedentary behavior are associated with higher risk of CVD & mortality
- High levels of sedentary behavior may be associated with additional CVD risk at any level of PA
- Undertaking very high levels of PA (> 1 h/day moderate to vigorous PA) may eliminate the association between excess sitting & CVD risk
CVD 3
CVD 4
CVD 5
CVD 7
OW 7
Weight management Adult population with overweight/ obesity For adults who are overweight or obese, strongly recommend lifestyle change by participating for ≥ 6 months in comprehensive lifestyle interventions, including: reduced energy intake, increased PA and measures to support behavioral change (behavioral strategies) Comprehensive lifestyle interventions: multicomponent interventions, with combination of 3 components nutrition, PA & behavior change (BCT). Less amount of activity is needed for weight loss (because of energy deficit from diet + PA together), BCT assists pat in adhering to intervention
Prevent weight regain: Maintaining high levels of PA (approximately 60 min per day) combined with other behavioral strategies
CVD 7
LCh 4
OW 2
OW 3
OW 4
OW 7
BP 3
  For adults who are overweight or obese, prescribe approximately 300 min of moderate intensity activity, or 150 min of vigorous activity, or an equivalent combination of moderate intensity and vigorous activities each week combined with reduced dietary intake, to result in weight loss and gradually increase PA levels to prevent weight regain after initial weight loss CVD 3
OW 2
OW 4
Adult population with combined CVD risk factors Counsel overweight and obese adults with CVD risk factors (high BP, hyperlipidemia, hyperglycemia) that lifestyle changes that produce even modest, sustained weight loss of 3–5% produce clinically meaningful health benefits, and greater weight loss produces greater benefits Dose–response: between amount of weight loss & lowering of BP and improvements in lipid/glycaemia profiles OW 3
Blood glucose management Adult population with hyperglycemia or T2DM A structured program of lifestyle modification that includes moderate weight loss and regular PA should be implemented to reduce the risk of T2DM in individuals with impaired glucose tolerance (prediabetes, IGT) and impaired fasting glucose (IFG) and A1C 6.0–6.4% Target population for primary prevention: 1. High-risk individuals (e.g. obesity, IGT); 2. High-risk sub-groups (e.g. low SES); 3. General population CVD 7
DM 1
DM 2
DM 3
General adult population, adult population with hyperglycemia or T2DM Advise adults to engage in resistance (muscle-strengthening) training on at least two days a week, such as carrying heavy load, heavy gardening, weight training, push-ups or sit-ups (e.g. 9 exercises, 3 sets & 11 repetitions, intensity 70% of 1-max repetition) Resistance training: Muscle strengthening of all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms)
Limited evidence for resistance training, but no evidence to exclude it from exercise programs (may confer pat benefits as well)
Hypertensive individuals (SBP/DBP of 140–159/90–99 mm Hg): resistance or weight training exercise does not adversely influence the blood pressure
T2DM: Specifically for DM prevention, combination of both aerobic & resistance exercise is effective
CVD 3
CVD 4
CVD 5
LSt 2
LCh 1
BP 1
BP 3
DM 3