PR O G RE S S I N C ARDI O V A S CU L A R D I S EA S E S 5 7 (2 0 1 5) 29 3–2 9 5
Available online at www.sciencedirect.com
ScienceDirect www.onlinepcd.com
Editorial
A Message From Modern-Day Healthcare to Physical Activity and Fitness: Welcome Home! The fact that higher levels of cardiorespiratory fitness (CRF) and physical activity (PA) are of tremendous benefit to your overall health, functional capabilities, quality of life and longevity is no secret. In fact, an awareness of the importance of CRF and PA dates back thousands of years. Susruta was a physician in India in approximately 600 B.C. His writings stressed the importance of preventative medicine, which included physical exercise. Susruta believed that moderate exercise on a regular basis, a premise that should sound familiar, protected the body from disease and “against physical decay”. He also was opposed to what we now call “high-intensity” exercise, believing it can lead to a host of diseases and other physical disorders,1 another premise that should sound familiar given recent publications.2,3 Hippocrates, a Greek physician (460–377 B.C.) wrote “in order to remain healthy, the entire day should be devoted exclusively to ways and means of increasing one's strength and staying healthy, and the best way to do so is through physical exercise”.4 In 1915, Dr. F.C. Smith of the US Surgeon General's Office stated “exercise is necessary for all except those actually and acutely physically ill, at all ages, for both sexes, daily, in amount just short of fatigue”.5 There are numerous other examples from key historical figures demonstrating a long-standing keen awareness that CRF and PA were important to one's health. These historical statements are now coupled to one of the most robust bodies of scientific evidence, clearly and unequivocally supporting the value of CRF and PA.6–12 Despite these statements, beliefs and practices by key historical figures through time, as well as original research and countless guidelines and policy statements, CRF and PA continue to decline globally, although we acutely recognize something needs to be done to reverse these trends.13–15 In fact, physical inactivity has recently been described as a global pandemic.16 One of the many contributors to the world's current and disconcerting CRF and PA status is the limited role CRF and PA assessment and promotion plays in the current healthcare model. Simply stated, as healthcare professionals, we have not stressed the importance of CRF and PA to our patients nearly as much as we should; that however, given a very recent event, may be on the verge of changing. The American Heart Association (AHA) runs a Global Congress concurrently with its November Scientific Sessions Meeting. In 2013, the AHA Global Congress was entitled “All
Hearts Need Exercise: A Global Call to Action by the American Heart Association”. A brief description of the Global Congress follows: “This exciting five-day series of seminars and how-to sessions will bring together leading experts on physical activity and fitness from around the world, in the areas of epidemiology, basic and clinical science, prevention science, rehabilitation, public health, and governmental policy. Participants and attendees will hear state-of-the-art information on the detrimental impact of physical inactivity and diminished fitness on a global scale. The importance of improving physical activity patterns and strategies to achieve this goal will be equally addressed.” In all, there were 24 sessions in the Global Congress (see Table 1 for Session Titles), with the keynote presentation provided by Dr. Kenneth Cooper from the Cooper Clinic, which was titled: “The Emergence of Physical Fitness as a Primary Health Indicator: An Historical Perspective from the Cooper Clinic”. In conjunction with the Global Congress, the AHA held the 1st of what we hope will become an annual “Sessions Walking Challenge” (Results from the walking challenge provided herein). Session attendees were able to track their daily steps and leader boards were displayed throughout the convention center. The AHA also promoted a “Wear Your Sneakers to Sessions” day and gave out sneaker pins. This Global Congress on CRF and PA, held at a major cardiology conference, was very well received and represents a major turning point. It sends a message that exercise and fitness matter, they are vital signs 17–19 and perhaps most importantly, “Exercise is Medicine”.20 The AHA is certainly thought of as a leading professional organization in terms of shaping modern-day healthcare. As such, we feel the fact that the AHA gave CRF and PA center stage at its annual conference is a “welcome home” message. Certainly no one can argue that CRF and PA, as primary health metrics and interventional approaches, should feel right at home in healthcare. Susruta, Hippocrates, Dr. F.C. Smith and many others who have advocated for the importance of CRF and PA throughout history would be very pleased with the message sent by the AHA. This edition of Progress in Cardiovascular Disease represents the proceedings from the AHA Global Physical Activity Congress. Many of the speakers at the congress are authors for the collection of review papers included in these
294
PR O GRE S S I N C ARDI O VAS CU L AR D I S EAS E S 5 7 ( 2 0 15 ) 29 3–2 95
Abbreviations and Acronyms
proceedings. Readers of the review papers AHA = American Heart provided herein will Association quickly have an appreCRF = Cardiorespiratory fitness ciation of the depth and breadth of the PA = Physical Activity Congress, international funding opportunities and the current body of CRF/PA research. The editors and authors of this edition of Progress in Cardiovascular Disease hope you find it to be an insightful and valuable body of work.
Table 1 – AHA 2013 Global Congress: All Hearts Need Exercise: A Global Call to Action by the American Heart Association. Session Titles • ASPEN TIMEOUT: How Can Sports Best Produce a Physically Active Lifestyle? • Assessing Physical Activity, Cardiorespiratory Fitness or Both as “Vital Signs” in the Primary Care Setting • Creative Approaches to Improving Physical Activity: The Power of Technology and Play for All Ages • Critical Review of Tools to Use for Assessing Physical Activity • Current State of Physical Activity Patterns and Burden of Disease: A Global Perspective • Determinants of Patterns of Physical Activity Behaviors Across the Life Course and Diverse Populations • Developing a Career in Physical Activity Research: Is Funding Available? • From Bench to Bedside: Novel Insights into the Role of Exercise in the Treatment of Heart Disease • How Should We Conduct Cardiovascular Disease Trials? • Improving Patient Adherence to Treatment Recommendations • Physical Activity and Bench-to-Bedside Research: Cellular Discoveries and Implications for Clinical Practice • Physical Activity in Special Populations: Where Are We and Where Are We Going? • Potential Cardiotoxicity of Extreme Endurance Exercise • Promoting Physical Activity Through Worksite Wellness Programs • Reaching the AHA 2020 Goals: Strategies for Success • Screening Considerations for Athletes: Balancing the Risks with Cost of Assessment • Solving the Obesity/Type 2 Diabetes Epidemic: The Role of Physical Activity/Exercise • State of Exercise Science for Cardiovascular Health Promotion: Methods, Measures and Interventions • Stemming the Tide: The Role of Physical Activity in Reversing the Obesity and Diabetes Epidemic • The Cardiovascular Health and Prevention Agenda: 2013-2030 • The Emergence of Physical Fitness and Activity as a Primary Health Indicator: A Historical Perspective from the Cooper Clinic • The Future of Physical Education Programs in the School Systems: A Global Perspective • The Physician's Role in Assessing and Promoting Physical Activity in the Clinical Setting • Web-Based Physical Activity Tools from Professional Organizations: AHA Start Walking Now and ACSM Exercise Is Medicine
REFERENCES
1. Tipton CM. Susruta of India, an unrecognized contributor to the history of exercise physiology. J Appl Physiol. 2008;104(6): 1553-1556. 2. Bhatti SK, O'Keefe JH, Lavie CJ. Of mice and men: atrial fibrillation in veteran endurance runners. J Am Coll Cardiol. 2007;63(1):89. 3. O'Keefe JH, Patil HR, Lavie CJ, Magalski A, Vogel RA, McCullough PA. Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin Proc. 2012;87(6):587-595. 4. Agarwal SK. Cardiovascular benefits of exercise. Int J Gen Med. 2012;5:541-545. 5. Paffenbarger RS, Blair SN, Lee IM. A history of physical activity, cardiovascular health and longevity: the scientific contributions of Jeremy N Morris, DSc, DPH, FRCP. Int J Epidemiol. 2001;30(5):1184-1192. 6. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation. 2007;116(3):329-343. 7. Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128(8):873-934. 8. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1081-1093. 9. Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van HL, Lichtenstein AH, et al. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation. 2010;122(4):406-441. 10. Pearson TA, Palaniappan LP, Artinian NT, Carnethon MR, Criqui MH, Daniels SR, et al. American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation. 2013;127(16):1730-1753. 11. Lauer M, Froelicher ES, Williams M, Kligfield P. Exercise testing in asymptomatic adults: a statement for professionals from the American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation. 2005;112(5):771-776. 12. Kaminsky LA, Arena R, Beckie TM, Brubaker PH, Church TS, Forman DE, et al. The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association. Circulation. 2013;127(5):652-662. 13. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219-229. 14. Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, Kahlmeier S. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294-305. 15. Blanchard C, Shilton T, Bull F. Global Advocacy for Physical Activity (GAPA): global leadership towards a raised profile. Glob Health Promot. 2013;20(4 Suppl):113-121. 16. Kohl III HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294-305.
PR O G RE S S I N C ARDI O V A S CU L A R D I S EA S E S 5 7 (2 0 1 5) 29 3–2 9 5
17. Arena R, Myers J, Guazzi M. The future of aerobic exercise testing in clinical practice: is it the ultimate vital sign? Future Cardiol. 2010;6(3):325-342. 18. Sallis R. Developing healthcare systems to support exercise: exercise as the fifth vital sign. Br J Sports Med. 2011;45(6):473-474. 19. Coleman KJ, Ngor E, Reynolds K, Quinn VP, Koebnick C, Young DR, et al. Initial validation of an exercise “vital sign” in electronic medical records. Med Sci Sports Exerc. 2012;44(11): 2071-2076. 20. Sallis RE. Exercise is medicine and physicians need to prescribe it! Br J Sports Med. 2009;43(1):3-4.
Ross Arena Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL Corresponding author at: Department of Physical Therapy College of
295
Applied Health Sciences University of New Illinois Chicago 1919 W. Taylor Street (MC 898) Chicago, IL 60612 Office: (312) 355-3338 E-mail address: [email protected] Robert A. Harrington Department of Medicine, Stanford University, Stanford, CA Jean-Pierre Després Centre de recherche du Centre Hospitalier de l’Université de Montréal Montréal, QC, Canada Department of Social and Preventive Medicine, Université de Montréal Montréal, QC, Canada 0033-0620 © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pcad.2014.11.001
Available online at www.sciencedirect.com
ScienceDirect www.onlinepcd.com
Editorial
A Message From Modern-Day Healthcare to Physical Activity and Fitness: Welcome Home! The fact that higher levels of cardiorespiratory fitness (CRF) and physical activity (PA) are of tremendous benefit to your overall health, functional capabilities, quality of life and longevity is no secret. In fact, an awareness of the importance of CRF and PA dates back thousands of years. Susruta was a physician in India in approximately 600 B.C. His writings stressed the importance of preventative medicine, which included physical exercise. Susruta believed that moderate exercise on a regular basis, a premise that should sound familiar, protected the body from disease and “against physical decay”. He also was opposed to what we now call “high-intensity” exercise, believing it can lead to a host of diseases and other physical disorders,1 another premise that should sound familiar given recent publications.2,3 Hippocrates, a Greek physician (460–377 B.C.) wrote “in order to remain healthy, the entire day should be devoted exclusively to ways and means of increasing one's strength and staying healthy, and the best way to do so is through physical exercise”.4 In 1915, Dr. F.C. Smith of the US Surgeon General's Office stated “exercise is necessary for all except those actually and acutely physically ill, at all ages, for both sexes, daily, in amount just short of fatigue”.5 There are numerous other examples from key historical figures demonstrating a long-standing keen awareness that CRF and PA were important to one's health. These historical statements are now coupled to one of the most robust bodies of scientific evidence, clearly and unequivocally supporting the value of CRF and PA.6–12 Despite these statements, beliefs and practices by key historical figures through time, as well as original research and countless guidelines and policy statements, CRF and PA continue to decline globally, although we acutely recognize something needs to be done to reverse these trends.13–15 In fact, physical inactivity has recently been described as a global pandemic.16 One of the many contributors to the world's current and disconcerting CRF and PA status is the limited role CRF and PA assessment and promotion plays in the current healthcare model. Simply stated, as healthcare professionals, we have not stressed the importance of CRF and PA to our patients nearly as much as we should; that however, given a very recent event, may be on the verge of changing. The American Heart Association (AHA) runs a Global Congress concurrently with its November Scientific Sessions Meeting. In 2013, the AHA Global Congress was entitled “All
Hearts Need Exercise: A Global Call to Action by the American Heart Association”. A brief description of the Global Congress follows: “This exciting five-day series of seminars and how-to sessions will bring together leading experts on physical activity and fitness from around the world, in the areas of epidemiology, basic and clinical science, prevention science, rehabilitation, public health, and governmental policy. Participants and attendees will hear state-of-the-art information on the detrimental impact of physical inactivity and diminished fitness on a global scale. The importance of improving physical activity patterns and strategies to achieve this goal will be equally addressed.” In all, there were 24 sessions in the Global Congress (see Table 1 for Session Titles), with the keynote presentation provided by Dr. Kenneth Cooper from the Cooper Clinic, which was titled: “The Emergence of Physical Fitness as a Primary Health Indicator: An Historical Perspective from the Cooper Clinic”. In conjunction with the Global Congress, the AHA held the 1st of what we hope will become an annual “Sessions Walking Challenge” (Results from the walking challenge provided herein). Session attendees were able to track their daily steps and leader boards were displayed throughout the convention center. The AHA also promoted a “Wear Your Sneakers to Sessions” day and gave out sneaker pins. This Global Congress on CRF and PA, held at a major cardiology conference, was very well received and represents a major turning point. It sends a message that exercise and fitness matter, they are vital signs 17–19 and perhaps most importantly, “Exercise is Medicine”.20 The AHA is certainly thought of as a leading professional organization in terms of shaping modern-day healthcare. As such, we feel the fact that the AHA gave CRF and PA center stage at its annual conference is a “welcome home” message. Certainly no one can argue that CRF and PA, as primary health metrics and interventional approaches, should feel right at home in healthcare. Susruta, Hippocrates, Dr. F.C. Smith and many others who have advocated for the importance of CRF and PA throughout history would be very pleased with the message sent by the AHA. This edition of Progress in Cardiovascular Disease represents the proceedings from the AHA Global Physical Activity Congress. Many of the speakers at the congress are authors for the collection of review papers included in these
294
PR O GRE S S I N C ARDI O VAS CU L AR D I S EAS E S 5 7 ( 2 0 15 ) 29 3–2 95
Abbreviations and Acronyms
proceedings. Readers of the review papers AHA = American Heart provided herein will Association quickly have an appreCRF = Cardiorespiratory fitness ciation of the depth and breadth of the PA = Physical Activity Congress, international funding opportunities and the current body of CRF/PA research. The editors and authors of this edition of Progress in Cardiovascular Disease hope you find it to be an insightful and valuable body of work.
Table 1 – AHA 2013 Global Congress: All Hearts Need Exercise: A Global Call to Action by the American Heart Association. Session Titles • ASPEN TIMEOUT: How Can Sports Best Produce a Physically Active Lifestyle? • Assessing Physical Activity, Cardiorespiratory Fitness or Both as “Vital Signs” in the Primary Care Setting • Creative Approaches to Improving Physical Activity: The Power of Technology and Play for All Ages • Critical Review of Tools to Use for Assessing Physical Activity • Current State of Physical Activity Patterns and Burden of Disease: A Global Perspective • Determinants of Patterns of Physical Activity Behaviors Across the Life Course and Diverse Populations • Developing a Career in Physical Activity Research: Is Funding Available? • From Bench to Bedside: Novel Insights into the Role of Exercise in the Treatment of Heart Disease • How Should We Conduct Cardiovascular Disease Trials? • Improving Patient Adherence to Treatment Recommendations • Physical Activity and Bench-to-Bedside Research: Cellular Discoveries and Implications for Clinical Practice • Physical Activity in Special Populations: Where Are We and Where Are We Going? • Potential Cardiotoxicity of Extreme Endurance Exercise • Promoting Physical Activity Through Worksite Wellness Programs • Reaching the AHA 2020 Goals: Strategies for Success • Screening Considerations for Athletes: Balancing the Risks with Cost of Assessment • Solving the Obesity/Type 2 Diabetes Epidemic: The Role of Physical Activity/Exercise • State of Exercise Science for Cardiovascular Health Promotion: Methods, Measures and Interventions • Stemming the Tide: The Role of Physical Activity in Reversing the Obesity and Diabetes Epidemic • The Cardiovascular Health and Prevention Agenda: 2013-2030 • The Emergence of Physical Fitness and Activity as a Primary Health Indicator: A Historical Perspective from the Cooper Clinic • The Future of Physical Education Programs in the School Systems: A Global Perspective • The Physician's Role in Assessing and Promoting Physical Activity in the Clinical Setting • Web-Based Physical Activity Tools from Professional Organizations: AHA Start Walking Now and ACSM Exercise Is Medicine
REFERENCES
1. Tipton CM. Susruta of India, an unrecognized contributor to the history of exercise physiology. J Appl Physiol. 2008;104(6): 1553-1556. 2. Bhatti SK, O'Keefe JH, Lavie CJ. Of mice and men: atrial fibrillation in veteran endurance runners. J Am Coll Cardiol. 2007;63(1):89. 3. O'Keefe JH, Patil HR, Lavie CJ, Magalski A, Vogel RA, McCullough PA. Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin Proc. 2012;87(6):587-595. 4. Agarwal SK. Cardiovascular benefits of exercise. Int J Gen Med. 2012;5:541-545. 5. Paffenbarger RS, Blair SN, Lee IM. A history of physical activity, cardiovascular health and longevity: the scientific contributions of Jeremy N Morris, DSc, DPH, FRCP. Int J Epidemiol. 2001;30(5):1184-1192. 6. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation. 2007;116(3):329-343. 7. Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128(8):873-934. 8. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1081-1093. 9. Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van HL, Lichtenstein AH, et al. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation. 2010;122(4):406-441. 10. Pearson TA, Palaniappan LP, Artinian NT, Carnethon MR, Criqui MH, Daniels SR, et al. American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation. 2013;127(16):1730-1753. 11. Lauer M, Froelicher ES, Williams M, Kligfield P. Exercise testing in asymptomatic adults: a statement for professionals from the American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation. 2005;112(5):771-776. 12. Kaminsky LA, Arena R, Beckie TM, Brubaker PH, Church TS, Forman DE, et al. The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association. Circulation. 2013;127(5):652-662. 13. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219-229. 14. Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, Kahlmeier S. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294-305. 15. Blanchard C, Shilton T, Bull F. Global Advocacy for Physical Activity (GAPA): global leadership towards a raised profile. Glob Health Promot. 2013;20(4 Suppl):113-121. 16. Kohl III HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294-305.
PR O G RE S S I N C ARDI O V A S CU L A R D I S EA S E S 5 7 (2 0 1 5) 29 3–2 9 5
17. Arena R, Myers J, Guazzi M. The future of aerobic exercise testing in clinical practice: is it the ultimate vital sign? Future Cardiol. 2010;6(3):325-342. 18. Sallis R. Developing healthcare systems to support exercise: exercise as the fifth vital sign. Br J Sports Med. 2011;45(6):473-474. 19. Coleman KJ, Ngor E, Reynolds K, Quinn VP, Koebnick C, Young DR, et al. Initial validation of an exercise “vital sign” in electronic medical records. Med Sci Sports Exerc. 2012;44(11): 2071-2076. 20. Sallis RE. Exercise is medicine and physicians need to prescribe it! Br J Sports Med. 2009;43(1):3-4.
Ross Arena Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL Corresponding author at: Department of Physical Therapy College of
295
Applied Health Sciences University of New Illinois Chicago 1919 W. Taylor Street (MC 898) Chicago, IL 60612 Office: (312) 355-3338 E-mail address: [email protected] Robert A. Harrington Department of Medicine, Stanford University, Stanford, CA Jean-Pierre Després Centre de recherche du Centre Hospitalier de l’Université de Montréal Montréal, QC, Canada Department of Social and Preventive Medicine, Université de Montréal Montréal, QC, Canada 0033-0620 © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pcad.2014.11.001
