Exercise as it relates to Disease/Effective treatment for atherosclerosis - Surgery vs Exercise

Background Prevalence Atherosclerosis is a type of cardiovascular disease and is the top 10 causes of death worldwide. An estimated 92% of Australian adults had at least one of the nine risk factors with atherosclerosis being the most common cause of heart disease.Bernenson, G. S., Srinivasan, S. R., Bao, W., Newman, W. P., Tracy, R. E. & Wattigney, W. A. (1998). 'Association between Multiple Cardiovascular Risk Factors and Atherosclerosis in Children and Young Adults.' New England Journal of Medicine, 338, 1650-1656. What is Atherosclerosis? Atherosclerosis is a condition where the arteries become narrow and hardened due to an accumulation of lipids called plaque inside the artery wall. This process reduces or completely blocks blood flow around the body, posing serious cardiovascular implications.A.D.A.M. Medical Encyclopedia. 2012. Hardening of the arteries [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001224/ [Accessed 22 October 2012]. Causes of Atherosclerosis Slow, complex disease that may start in childhood and develops faster with age Initiated by a damage occurring in the inner wall of an artery called the endothelium, overtime substances travelling in the blood such as cholesterol, fats and cellular waste products accumulate inside the damaged area of the artery wallA., Salahi, & E, Sezavar. (2012). 'The in vitro Effect of Oxidized LDL and PHA on Proliferation and Gene Expression of Regulatory T Cells in Patients with Atherosclerosis'. Iranian Journal of Allergy, Asthma & Immunology, 11, 217-223.T., Raposo, M., Kazachkova, &, M. L. & Lima, M. (2011). Cross-sectional study of risk factors for atherosclerosis in the Azorean population. Annals of Human Biology, 38, 354-359.Huang, C.-C., Liu, K., Pope, R. M., Du, P., M. L. & LLlyod-JonesS, D. M. (2011). 'Activated TLR signaling in atherosclerosis among women with lower Framingham risk score: the multi-ethnic study of atherosclerosis.' PLoS ONE, 6, e21067-e21067. Can affect the entire artery tree, but mainly affects the larger high-pressure arteries These comorbidities significantly increase the chances of atherosclerosis, and stem from risk factors such as Briffa, T. et al. (2006) 'National Heart Foundation of Australia physical activity reccomendations for people with cardiovascular disease.' Sydney. National Heart Foundation of Australia Preventable Factors Non-Preventable Factors * High Blood Pressure* High Cholesterol (poor diet)* Smoking* Obesity* Diabetes* Physical Inactivity * Family History* Ethnicity* Gender Effects of Atherosclerosis Coronary Artery Disease (plaque rupture and clotting causing heart muscle to die)Thompson, P. D., Buchner. & Wenger, N. K. (2003). ‘Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease’. Circulation, 107, 3109-3116. Cerebrovascular Disease (plaque rupture in the brain's arteries cause’s strokes, with the potential for permanent brain damage) Peripheral Artery Disease (narrowing in the arteries of the legs caused by plaque. This causes pain on walking and poor wound healing. Severe disease may lead to amputations) Current Rehabilitation Methods Appropriate pharmacological therapy Modification of lifestyle (e.g. smoking cessation, balanced diet, stress management) Appropriate exercise regime Surgery - There are 2 major surgeries to treat atherosclerosis Robert W. Hobson, II (2008)‘Management of atherosclerotic carotid artery disease: Clinical practice guidelines of the Society for Vascular Surgery’. Journal of Vascular Surgery Volume 48, Number 2. 48:480-6 1. Stent Placement and Angioplasty (PCIs) - Inserting a tiny wire mesh tube and inflating a tiny balloon where the artery is clogged to help widen the artery 2. Coronary Artery Bypass Graft Surgery (CABG) - Rerouting a healthier vessel onto a coronary artery bypassing the clogged artery Advantages and Disadvantages Of An Ongoing Intervention: Surgery vs. Exercise Surgery Advantages Disadvantages * PCIs has a low complication rate and recovery time is often less than one dayKadoglou, N. P. E., Iliadis, F. & Liapis, C. D.(2008). 'Exercise and carotid atherosclerosis. European Journal of Vascular and Endovascular Surgery', 35, 264-272.* Increased survival rate with multiple or severely blocked coronary arteriesKadoglou, N. P. E., Iliadis, F. & Liapis, C. D.(2008). 'Exercise and carotid atherosclerosis. European Journal of Vascular and Endovascular Surgery', 35, 264-272.* Improves or completely relieves angina symptoms in most patients * Treatment with drugs can't control chronic chest pain* Recovery time can take weeks, even months for CABG surgery patients* Doesn't prevent other atherosclerotic plaques from causing problemsKadoglou, N. P. E., Iliadis, F. & Liapis, C. D.(2008). 'Exercise and carotid atherosclerosis. European Journal of Vascular and Endovascular Surgery', 35, 264-272.* Needs to take a daily regime of anti-atherosclerosis medication* Costly Exercise Advantages Disadvantages * Reduces atherosclerosis risk factors, including LDL cholesterol, high blood pressure and diabetes Kadoglou, N. P. E., Iliadis, F. & Liapis, C. D.(2008). 'Exercise and carotid atherosclerosis. European Journal of Vascular and Endovascular Surgery', 35, 264-272.* Increases HDL cholesterol levels Bernenson, G. S., Srinivasan, S. R., Bao, W., Newman, W. P., Tracy, R. E. & Wattigney, W. A. (1998). 'Association between Multiple Cardiovascular Risk Factors and Atherosclerosis in Children and Young Adults.' New England Journal of Medicine, 338, 1650-1656. Roitman, J. L. & Lafontaine, T. (2006). 'Special populations. Exercise, atherosclerosis, and the endothelium: where the action is (part II)'. Strength & Conditioning Journal (Allen Press), 28, 75-77.* Improved blood circulationRoitman, J. L. & Lafontaine, T. (2006). 'Special populations. Exercise, atherosclerosis, and the endothelium: where the action is (part II).' Strength & Conditioning Journal (Allen Press), 28, 75-77.* Stimulates production of new cells for arterial lining of vesselsBernenson, G. S., Srinivasan, S. R., Bao, W., Newman, W. P., Tracy, R. E. & Wattigney, W. A. (1998). 'Association between Multiple Cardiovascular Risk Factors and Atherosclerosis in Children and Young Adults.' New England Journal of Medicine, 338, 1650-1656. * Reduces plaque formation and inflammation in arteries* Decreases risk of plaque rupture* Cost-effecient * Musculoskeletal injuryBriffa, T. et al. (2006) National Heart Foundation of Australia physical activity reccomendations for people with cardiovascular disease. Sydney. National Heart Foundation of AustraliaGordon, N. et al. (2004) ‘Physical Activity and Exercise Recommendations for Stroke Survivors: An American Heart Association Scientific Statement’ Journal of the American Heart Association. Vol. 109. pp 2031 – 2040* Major or fatal cardiac event occurring in high risk atherosclerosis patients Patients with major contraindications should not engage in physical activity without medical review prior commencing physical activity Recommendations for Effective Exercise Rehabilitation Recommended Activity from the National Heart Foundation of Australia Briffa, T. et al. (2006) National Heart Foundation of Australia physical activity reccomendations for people with cardiovascular disease. Sydney. National Heart Foundation of Australia 30-45 min, preferably all days of the week of moderate-intensity physical activity using large muscle groups, such as walking, riding, or swimming Volume of physical activity should be increased gradually over time Improved Compliance Involvement and support from friends and family Gordon, N. et al. (2004) ‘Physical Activity and Exercise Recommendations for Stroke Survivors: An American Heart Association Scientific Statement’ Journal of the American Heart Association. Vol. 109. pp 2031 – 2040 Positive mindset and an interest in physical activity which will lead to increased motivation Physicians and patients must be equally committed to achieving set goals and should communicate instructions clearly and prescribe therapies that are effective, affordable, and have minimal or no adverse effects on patient quality of life Further reading Australian Physical Activity Recommendations Atherosclerosis References