Physical Inactivity is a Risk Factor for Lower Extremity Arterial Disease and Coronary Heart Disease

  • Dennis G. Caralis
  • Stamatis Dimitropoulos
Part of the Clinical Hypertension and Vascular Diseases book series (CHVD)


Coronary arterial disease, carotid artery disease, and Lower Extremity Arterial Disease (LEAD) have many causes. Risk factors associated with these disease entities, which can be modified are: cigaret smoking, arterial hypertension, diabetes mellitus, various dislipidemias, i.e., hypertriglyceridemia in particular for LEAD, high low-density lipopro-tein (LDL) cholesterol particularly for coronary artery disease, high lipoprotein(a) [Lp(a)], low high-density lipoprotein (HDL) cholesterol, obesity, homocysteinemia, elevated high sensitivity C-reactive protein (CRP), and physical inactivity (1, 2, 3). Significant progress has been made to lower the trend for cigaret smoking in the United States and other industrialized countries through educational programs for the public, reviews by the press, legislative action at all three levels of government (local, state, and federal), as well as landmark decisions by the judiciary. The pioneering work of the American Heart Association in initiating smoking cessation programs was closely followed by the American Lung Association, the American Cancer Society, the World Health Organization (4), and more recently by the European Union.


Physical Activity Coronary Heart Disease Physical Fitness Physical Inactivity Multiple Risk Factor Intervention Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Diabetes Prevention Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl JMed 2002; 346:393–403.CrossRefGoogle Scholar
  2. 2.
    Kokkinos P, Narayan P, Papademetriou V. Exercise as Hypertension Therapy. Card Clinics 2001; 19:507–516.CrossRefGoogle Scholar
  3. 3.
    Kokkinos P, Fernhall B. Physical activity and high density lipoprotein cholesterol levels: What is the relationship? Sports Medicine 1999; 28:307–314.PubMedCrossRefGoogle Scholar
  4. 4.
    Bijnen FC, Caspersen CJ, Mosterd WL. Physical inactivity as a risk factor for coronary heart disease: a WHO and International Society and Federation of Cardiology position statement. Bulletin of the World Health Org 1994; 72:1–4.Google Scholar
  5. 5.
    U.S. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives-full report and commentary. DHHS publication no. (PHS) 91-50212. Washington, DC: U.S. Department of Health and Human Services, 1991.Google Scholar
  6. 6.
    American College of Sports Medicine. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc 1998; 30:975–991.CrossRefGoogle Scholar
  7. 7.
    Eaton CB. Relation of physical activity and cardiovascular fitness to coronary heart disease, Part II: Cardiovascular fitness and the safety and efficacy of physical activity prescription. J Am Board Fam Practice 1992; 5:157–165.Google Scholar
  8. 8.
    Kannel WB, Belanger A, D’Agostino R, Israel I. Physical activity and physical demand on the job and risk of cardiovascular disease and death: the Framingham Study. Am Heart J 1986; 112:820–825.PubMedCrossRefGoogle Scholar
  9. 9.
    Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R, Rodahl K. Physical Fitness as a Predictor of Mortality among Healthy, Middle-Aged Norwegian Men. N Eng J Med 1993; 328:533–537.CrossRefGoogle Scholar
  10. 10.
    Ekroth R, Dahllof AG, Gundevall B, Holm J, Schersten T. Physical training of patients with intermittent claudication: Indications, methods, and results. Surgery 1978; 84:640–643.PubMedGoogle Scholar
  11. 11.
    Alpert JS, Larsen A, Lassen NA. Exercise and intermittent claudication: Blood flow in the calf muscle during walking studied by the Xenon-133 method. Circulation 1969; S9:353–359.Google Scholar
  12. 12.
    Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain: A meta-analysis. JAMA 1995; 274:975–980.PubMedCrossRefGoogle Scholar
  13. 13.
    Soofi M, Satter AM, Maisch B, Schaefer JR. Molecular mechanisms involved in atherosclerosis. Herz 2002; 27:637–648.CrossRefGoogle Scholar
  14. 14.
    Hiatt WR, Regensteiner JG, HArgarten ME, Wolfel EE, Brass EP. Benefit of exercise conditioning for patients with peripheral arterial disease. Circulation 1990; 81:602–609.PubMedGoogle Scholar
  15. 15.
    Franklin BA, Gordon S, Timmis GC. Amount of exercise necessary for the patient with coronary artery disease. Am J Cardiol 1992; 69:1426–1431.PubMedCrossRefGoogle Scholar
  16. 16.
    Oberman A. Exercise and the primary prevention of cardiovascular disease. Am J Card 1985; 55:10D–20DPubMedCrossRefGoogle Scholar
  17. 17.
    Leon AS. Physical activity levels and coronary heart disease. Analysis of epidemio-logic and supporting studies. Med Clinics of N Am 1985; 69:3–20.Google Scholar
  18. 18.
    Blair SN, Kohl HW III, Barlow CE, Paffenbarger RS, Jr, Gibbons LW, Macera CA. Change in physical fitness and all-cause mortality: a prospective study. JAMA 1995; 273:1093–1098.PubMedCrossRefGoogle Scholar
  19. 19.
    Morris JN, Clayton DJ, Everitt MG, Semmence AM, Burgess EH. Exercise in leisure-time: coronary attack and death rates. Br Heart J 1990; 63:325–334.PubMedCrossRefGoogle Scholar
  20. 20.
    Powell KE, Thompson PA, Caspersen CJ, Kendrick JS. Physical activity and coronary heart disease. Annu Rev Public Health 1987; 8:253–287.PubMedCrossRefGoogle Scholar
  21. 21.
    Berlin JA, Colditz A. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 1990; 132:612–627.PubMedGoogle Scholar
  22. 22.
    Paffenbarger RS Jr, Hyde RT, Wing AL, Lee IM, Jung DL, Kampert JB. The association of changes in PA level and other lifestyle characteristics with mortality among men. N Engl J Med 1993; 328:538–545.PubMedCrossRefGoogle Scholar
  23. 23.
    Blackburn H, Taylor HL, Keyes A. Coronary heart disease in seven countries. Circulation 1970; 41:154–195.Google Scholar
  24. 24.
    Keys A. Seven countries: a multivariate analysis of death and coronary heart disease. A Commonwealth Fund Book. Cambridge Mass.: Harvard University Press, 1980.Google Scholar
  25. 25.
    Punsar S, Karvonen MJ. Physical activity and coronary heart disease in populations from east to west Finland. Adv Cardiol 1976; 18:196–207.PubMedGoogle Scholar
  26. 26.
    Kessaniemi YA, Danforth EJ, Jensen MD, et al. Dose-response issues concerning physical activity and health: an evidence-based symposium. Med Sci Sports Exercise 2001; 33:S351–S358.CrossRefGoogle Scholar
  27. 27.
    Blair SN, Kohl HW, Gordon NF, Paffenbarger RS Jr. How much physical activity is good for health? Ann Review of Pub Health 1992; 13:99–126.Google Scholar
  28. 28.
    American College of Sports Medicine. Guidelines for exercise testing and prescription. 4th ed. Philadelphia: Lea & Fibiger, 1991, pp. 93–119.Google Scholar
  29. 29.
    Morris JN, Heady J, Raffle P. Physique of London busmen. Lancet 1956; ii:569–570.CrossRefGoogle Scholar
  30. 30.
    Morris JN. Physical inactivity and coronary heart disease. Ada Cardiol 1974; suppl 20:95–103.Google Scholar
  31. 31.
    Fox SM, Skinner JS. Physical activity and cardiovascular health. Am J Cardiol 1964; 14:731–746.PubMedCrossRefGoogle Scholar
  32. 32.
    Rose G. Physical activity and coronary heart disease. Proc. R. Soc. Med. 1969; 62:1183–1188.PubMedGoogle Scholar
  33. 33.
    Chave SP, Morris JN, Moss S, Semmence AM. Vigorous exercise in leisure time and the death rate: a study of male civil servants. J Epidemiology Comm Health 1978;32:239–243.CrossRefGoogle Scholar
  34. 34.
    Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality, and longevity of college alumni. N Eng J Med 1986; 314:605–613.CrossRefGoogle Scholar
  35. 35.
    Marti B, Pekkanen J, Nissinen A, Ketola A, Kivela SL, Punsar S, Karvonen MJ. Association of physical activity with coronary risk factors and physical ability: twenty-year follow-up of a cohort of Finnish men. Age and Ageing 1989; 18:103–109.PubMedCrossRefGoogle Scholar
  36. 36.
    The multiple risk factor intervention trial (MRFIT). A national study of primary prevention of coronary heart disease. JAMA 1976; 235:825–827.PubMedCrossRefGoogle Scholar
  37. 37.
    Salonen JT, Puska P, Tuomilehto J. Physical activity and risk of myocardial infarction, cerebral stroke and death. Am J Epidemiol 1982; 115:526–537.PubMedGoogle Scholar
  38. 38.
    Leon AS, Connett J, Jacobs DR, Rauramaa R. Leisure-time physical activity levels and risk of coronary heart disease and death. JAMA 1987;258:2388–2395.PubMedCrossRefGoogle Scholar
  39. 39.
    Rifkind BM. Plasma Lipid Distributions in selected North American populations: The Lipid Research Clinics Program Prevalence Study. Circulation 1979; 60:427–439.Google Scholar
  40. 40.
    Williams DO, Mowery RL, Waldman GT. Common methods, different populations. The Lipid Research Clinics Program Prevalence Study. Circulation 1980;62:18.Google Scholar
  41. 41.
    Leon AS, Jacobs DR Jr, DeBacker G, Taylor HL. Relationship of physical characteristics and life habits to treadmill exercise capacity. Am J Epidemiol 1981; 113:653–660.PubMedGoogle Scholar
  42. 42.
    Blair SN, Kohl HW, Barlow CE. Physical Activity, Physical Fitness, and All-Cause Mortality in Women: Do Women Need to be Active? J Am Coll Nutr 1993; 12:368–371.PubMedGoogle Scholar
  43. 43.
    Bruce RA, DeRouen TA, Hossack KF, Blake B, Hofer V. Value of maximal exercise tests in risk assessment of primary coronary heart disease events in healthy men. Aw J Cardiol 1980; 46:371–378.CrossRefGoogle Scholar
  44. 44.
    Blumenthal JA, Rejeski WJ, Walsh-Riddle M, Emery CF, Miller H, Roark S, Ribisl PM, Morris PB, Brubaker P, Williams RS. Comparison of high-and low-intensity exercise training early after acute myocardial infarction. Am J Cardiol 1988; 61:26–30.PubMedCrossRefGoogle Scholar
  45. 45.
    O’Connor GT, Buring JE, Yusuf S, Goldhaber SZ, Olmstead EM, Paffenbarger RS Jr, Hennekens CH. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989; 80:234–244.PubMedGoogle Scholar
  46. 46.
    Oldridge NB, Guyatt GH, Fischer ME, Rimm A A. Cardiac rehabilitation after myocardial infarction: combined experience of randomized clinical trials. JAMA 1991; 266:1535–1542.CrossRefGoogle Scholar
  47. 47.
    Hansen JE, Sue DY, Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis 1984; 129(suppl):549.Google Scholar
  48. 48.
    Bassett D, Howley E. Maximal oxygen uptake: “classical” versus “contemporary” viewpoints. Med Sci Sports Exerc 1997; 29:591.PubMedGoogle Scholar
  49. 49.
    Leon AS. Contribution of regular moderate-intensity physical activity. In: Leon AS, ed. Physical Activity and Cardiovascular Health: A National Consensus. Champaign, Ill: Human Kinetics; 1997:55–66.Google Scholar
  50. 50.
    Leon AS. Effects of exercise conditioning on physiologic precursors of coronary heart disease. J Cardiopulm Rehabil 1991; 11:46–57.Google Scholar
  51. 51.
    Leon AS, Richardson M. Exercise, health, and disease. In: Roberts SO, Robergs RA, Hanson P, eds. Clinical Exercise Testing and Prescription: Theory and Application. Boca Raton, Fla. CRC Press; 1997:281–302.Google Scholar
  52. 52.
    Tran ZV, Weltman A. Differential effects of exercise on serum lipid and lipoprotein levels seen with changes in body weight: a meta-analysis. JAMA 1985; 254:919–924.PubMedCrossRefGoogle Scholar
  53. 53.
    Stratton JR, Chandler WL, Schwartz RS, et al. Effects of physical conditioning on fibrinolytic variables and fibrinogen in young and old healthy adults. Circulation 1991; 83:1692–1697.PubMedGoogle Scholar
  54. 54.
    Kramsch DM, Aspen AJ, Abramowitz BM, et al. Reduction of coronary atherosclerosis by moderate conditioning exercise in monkeys on an atherogenic diet. N Engl J Med 1981; 305:1483–1489.PubMedCrossRefGoogle Scholar
  55. 55.
    Squires RW. Mechanisms by which exercise training may improve the clinical status of cardiac patients. In: Pollock ML, Schmidt DH, eds. Heart Disease and Rehabilitation, 3rd ed. Champaign, Ill: Human Kinetics; 1995:147–160.Google Scholar
  56. 56.
    Ehsani A, Martin W, Heath G, et al. Cardiac effects of prolonged and intense exercise training in patients with coronary artery disease. Am J Cardiol. 1982; 50:246–254.PubMedCrossRefGoogle Scholar
  57. 57.
    Niebauer J, Hambrecht R, Velich T, et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation 1997; 96:2534–2541.PubMedGoogle Scholar
  58. 58.
    Gould KL, Ornish D, Kirkeeide R, et al. Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. Am J Cardiol. 1992; 69:845–853.PubMedCrossRefGoogle Scholar
  59. 59.
    Goldsmith RL, Bigger JT Jr, Steinman RC, et al. Comparison of 24-hour parasym-pathetic activity in endurance-trained and untrained young men. JAm Coll Cardiol 1992; 20:552–558.CrossRefGoogle Scholar
  60. 60.
    Paffenbarger RS Jr, Wing AL, Hyde RT, et al. Physical activity and incidence of hypertension in college alumni. Am J Epidemiol 1983; 117:245–257.PubMedGoogle Scholar
  61. 61.
    Blair SN, Goodyear NN, Gibbons LW, et al. Physical fitness and incidence of hypertension in healthy normotensive men and women. JAMA 1984; 252:487–490.PubMedCrossRefGoogle Scholar
  62. 62.
    Hartley LH, Grimby G, Kilbom A, et al. Physical training in sedentary middle-aged and older men: cardiac output and gas exchange during submaximal and maximal exercise. Scand J Clin Lab Invest 1969; 24:335–344.PubMedGoogle Scholar
  63. 63.
    Gerstenblith G, Lakatta EG, Weisfeldt ML. Age changes in myocardial function and exercise response. Prog Cardiovasc Dis 1976; 19:1.PubMedCrossRefGoogle Scholar
  64. 64.
    Hartley LH, Mason JW, Hogan RP, et al. Multiple hormonal responses to prolonged exercise in relation to physical training. J Appl Physiol 1972; 33:607–610.PubMedGoogle Scholar
  65. 65.
    Weber KT, Janicki JS. Cardiopulmonary exercise testing for evaluation of chronic cardiac failure. Am J Cardiol 1985; 55:22A.PubMedCrossRefGoogle Scholar
  66. 66.
    Blomquist CG, Saltin B. Cardiovascular adaptations to physical training. Annu Rev Physiol 1983; 45:169.CrossRefGoogle Scholar
  67. 67.
    Oberman A, Fletcher GF, Lee J, et al. Efficacy of high-intensity exercise training on left ventricular function in normal subjects: a longitudinal study by radionuclide angiography. Am J Cardiol 1980; 45:244–252.CrossRefGoogle Scholar
  68. 68.
    Scheuer J. Physical training and intrinsic cardiac adaptations. Circulation 1973; 47:677–680.Google Scholar
  69. 69.
    Haskell WL. Sedentary lifestyle as a risk factor for coronary heart disease. In: Pearson TA, ed. Primer in Preventive Cardiology. Dallas, TX: American Heart Association, 1994: 173–187.Google Scholar
  70. 70.
    Orten JM, Neuhaus OW. Human Biochemistry. St. Louis: CV Mosby. 1982.Google Scholar
  71. 71.
    Phillips SM, Green HJ, Tarnopolsky MA, et al. Effects of training duration on substrate turnover and oxidation during exercise. J Appl Physiol 1996; 81:2182.PubMedGoogle Scholar
  72. 72.
    Pollack ML, Miller HS, Linnerud AC, Cooper KH. Frequency of training as a determinant for improvement in cardiovascular function and body composition of middle-aged men. Phys Med Rehab 1975; 58:141–145.Google Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Dennis G. Caralis
    • 1
  • Stamatis Dimitropoulos
    • 2
  1. 1.Division of Cardiology, Department of MedicineRush University Medical CenterChicago
  2. 2.Department of MedicineRush University Medical CenterChicago

Personalised recommendations