Physical activity and coronary heart disease
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7448.1089 (Published 06 May 2004) Cite this as: BMJ 2004;328:1089
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Dear sir:
Notably, a large body of research data as also emphasized in this
impressive editorial by Batty and Lee (2004) suggests robustly the
PREVENTIVE effect of physical excercise in leisure time on the development
of coronary artery disease (CAD). Possibly, other diseases such as
diabetes mellitus, stroke, cancers, and osteoporosis are also similarly
affected by physical exercise, which is reported to have an inverse
relationship with these diseases including CAD coupled with high morbidity
and mortality and global huge burden on the care givers plus
unsurmountable financial difficulties.
The two editorialists identified and highlighted certain pathways
underlying the physical activity and cardioprotection, which include
improvement in blood pressure, lipid profile, insulin sensitivity, body
weight, endothelial function, coronary blood flow and beneficial changes
in haemostatic and infammatory responses. There may exist other mechanisms
underlying this inverse relationship. There is a converging evidence that
multiple stressors arising from
numerous sources associated with revealed neuroimmunological and
endocrinological changes are one of the etiological denominators of
depression, which is reported to have high comorbidity with coronary
artery disease with poor outcome and enhanced mortality. Physical activity
is documented to have not only protective effect on depression but also on
the overall quality of life and general well being. Moreover, physical
activity also effects considerable improvement in the general mood of the
individual.
Unfortunately, a big chunk of world population is antagonistic to
regular physical exercise and hence with progressive age they tend to
develop aforesaid chronic but mostly fatal diseases. Sadly, many years of
relevant campaigns have not been very successful in changing such negative
attitudes of people against physical excercise. They have their choices-
good or bad-but in the shadow of solid findings of 50 years of research on
physical activity and its protective effect on cardiorespiratory fitness,
the two editorialists have brilliantly delivered this important message to
the audiences of the world.
Reference:
G David Batty and I-Min Lee. Physical activity and coronary heart
.disease. BMJ 2004; 328: 1089-1090.
Competing interests:
Physical Exercise Supporter.
Competing interests:
Physical Exercise Supporter.
Competing interests: No competing interests
Dear sir:
Notably, a large body of research data as also emphasized in this
impressive editorial by Batty and Lee (2004) suggests robustly the
protective effect of physical excercise in leisure time on the development
of coronary artery disease (CAD). Possibly, other diseases such as
diabetes mellitus, stroke, cancers, and osteoporosis are also positively
affected by physical exercise, which is reported to have an inverse
relationship with these diseases including CAD coupled with high morbidity
and mortality and global huge burden on the care givers plus
unsurmountable financial difficulties.
The two editorialists identified and highlighted certain pathways
underlying the physical activity and cardioprotection, which include
improvement in blood pressure, lipid profile, insulin sensitivity, body
weight, endothelial function, coronary blood flow and beneficial changes
in haemostatic and infammatory responses. There may exist other mechanisms
underlying this inverse relationship.
There is a converging evidence that multiple stressors arising from
numerous sources associated with revealed neuroimmunological and
endocrinological changes are one of the etiological denominators of
depression, which is reported to have high comorbidity with coronary
artery disease with poor outcome and enhanced mortality. Physical activity
is documented to have not only protective effect on depression but also on
the overall quality of life and general well being. Moreover, physical
activity also effects considerable improvement in the general mood of the
individual.
Unfortunately, a big chunk of world population is antagonistic to
regular physical exercises and hence with progressive age they tend to
develop aforesaid chronic but mostly fatal diseases. Sadly, many years of
relevant campaigns have not been very successful in changing such negative
attitudes of people against physical excercise. They have their choices-
good or bad-but in the shadow of solid findings of 50 years of research on
physical activity and its protective effect on cardiorespiratory fitness,
the two editorialists have brilliantly delivered this important message to
the audiences of the world.
Reference:
G David Batty and I-Min Lee. Physical activity and coronary heart
disease. BMJ 2004; 328: 1089-1090.
Competing interests:
Physical Exercise Supporter.
Competing interests: No competing interests
Controlled trials and coronary heart disease
The randomised, controlled intervention trial is generally regarded
as the best evidence, the “gold standard” for determining the effects of a
therapeutic intervention. Such trials have been used to evaluate lifestyle
factors, including exercise. In the Finnish businessmen’s study (1, 2) 612
men took part in a 5 year program to increase their physical activity,
improve their diet and quit smoking. Where necessary they were also given
conventional treatment to reduce their blood pressure and plasma
cholesterol. The results were disastrous. Ten years after the trial the
total mortality rate was 45% higher in the intervention group than in the
control group, largely due to a doubling of the coronary heart disease
death rate. Your authors make no mention of this or similar trials.
Instead they rely on work described by Bradford Hill (3) in his textbook
of medical statistics as “second-best” and “inferior” because of the
absence of an adequate control group. Unfortunately this is not an
uncommon occurrence. The controlled trial may be rightly and universally
praised yet all too often when such a trial fails to produce an expected
and desired result it is ignored and indeed suppressed.
The BMJ should discourage the authors of such work, not publish them.
1 Miettinen, T.A., J.K. Huttunen, V. Naukkarinen, T. Strandberg, S.
Mattila, T. Kumlin and S. Sarna (1985), 'Multifactorial primary prevention
of cardiovascular diseases in middle-aged men: risk-factor changes,
incidence and mortality', Journal of the American Medical Association,
254, pages 2097-2102.
2 Strandberg, T.E., Salomaa, V.V., Naukkarinen, V.A., Vanhanen, H.T.,
Sarna, S.J. and Miettinen, T.A.(1991), ‘Long-term mortality after 5-year
multifactorial primary prevention of cardiovascular diseases in middle-
aged men’, , Journal of the American Medical Association, 266, pages 1225-
1229
3 Hill,A.B. (1971), "Principles of Medical Statistics", 9th edition,
The Lancet
Competing interests:
None declared
Competing interests: No competing interests