Reduction in Cardiovascular Disease Risk Factors: 6-Month Results from ProjectActive

doi:10.1006/pmed.1997.0218

Preventive Medicine

Volume 26, Issue 6, November 1997, Pages 883-892

https://doi.org/10.1006/pmed.1997.0218 Get rights and content

Abstract

Background.ProjectActiveis a randomized clinical trial that compares a lifestyle physical activity intervention with a traditional structured exercise intervention. The purpose of this paper is to report 6-month results of these interventions on cardiovascular disease (CVD) risk factors among healthy, sedentary, middle-aged men and women, and to examine the psychological strategies used in each group (Lifestyle and Structured) to reach the level of physical activity recommended by the Centers for Disease Control and Prevention (CDC) and American College of Sports Medicine (ACSM) and to achieve changes in these CVD risk factors.

Methods.A total of 116 initially sedentary men (mean ± SD self-reported physical activity, 33.2 ± 1.4 kcal · kg⁻¹· day⁻¹) and 119 women (32.9 ± 1.0 kcal · kg⁻¹· day⁻¹), ages 35–60 years (46.0 ± 6.7 years) were randomly assigned to a 6-month lifestyle physical activity counseling intervention or a 6-month gymnasium-based structured program. At baseline and 6 months, changes in lipid and lipoprotein-cholesterol concentrations, blood pressure, and body composition and cognitive and behavioral measures of change were assessed. One-way analyses of variance with covariate adjustment were used to test for between-group differences in CVD risk factors. Associations between achieving the CDC/ACSM criterion and changes in cognitive and behavioral measures were assessed with multiple logistic regression models.

Results.After 6 months of intervention, 78% of Lifestyle participants and 85% of Structured participants were meeting or exceeding the CDC/ACSM recommendation of accumulating 30 min or more of moderate-intensity physical activity on most, preferably all, days of the week. This was verified by a significant increase in cardiorespiratory fitness in both groups. The adjusted mean increase in maximal METs (VO_2peak÷ 3.5 ml · kg⁻¹· min⁻¹) between treadmill tests was 0.4 kcal · kg⁻¹· hr⁻¹(P< 0.001) for Lifestyle and 1.1 kcal · kg⁻¹· hr⁻¹(P< 0.001) for Structured. There was a significant difference between intervention groups for this outcome. Both groups had significant reductions in total cholesterol, total cholesterol/HDL-C ratio, diastolic blood pressure, and percentage of body fat. There were no significant between-group differences in changes in these outcomes. Adjusted mean changes in total cholesterol, systolic blood pressure, and percentage of body fat in Lifestyle [in Structured] participants were −0.2 [−0.3] mmol · L⁻¹, −3.2[−1.8] mm Hg, and −1.4 [−1.7] %, respectively. There were significant associations between achieving the CDC/ACSM physical activity criterion and greater use of the cognitive and behavioral strategies of change. Both groups changed self-efficacy and many of the behavioral measures, but there were no significant differences between intervention groups.

Conclusions.These results demonstrate that lifestyle physical activity counseling is as effective as structured exercise programs in increasing physical activity and improving CVD risk factors after 6 months among initially sedentary men and women. Furthermore, specific cognitive and behavioral counseling strategies were increased significantly as a result of the intervention. These strategies are effective and could be used in a wide variety of settings.

References (44)

JE Manson et al.
Physical activity and incidence of non-insulin-dependent diabetes mellitus in women
Lancet
(1991)
RF DeBusk et al.
Training effects of long versus short bouts of exercise in healthy subjects
Am J Cardiol
(1990)
JM Hagberg et al.
Effect of exercise training in 60- to 69-year-old persons with essential hypertension
Am J Cardiol
(1989)
DN Logsdon et al.
The feasibility of behavioral risk reduction in primary medical care
Am J Prev Med
(1989)
KJ Calfas et al.
A controlled trial of physician counseling to promote the adoption of physical activity
Prev Med
(1996)
RS Paffenbarger et al.
Physical activity, all-cause mortality, and longevity of college alumni
N Engl J Med
(1986)
SN Blair et al.
Physical fitness and all-cause mortality: a prospective study of healthy men and women
JAMA
(1989)
1994, Physical activity, fitness, and health: international proceedings and consensus statement, Human Kinetics,...
I Lee
Physical activity, fitness, and cancer
Physical activity, fitness, and health
(1994)
SP Helmrich et al.
Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus
N Engl J Med
(1991)

RS Paffenbarger et al.

The association of changes in physical-activity level and other lifestyle characteristics with mortality among men

N Engl J Med

(1993)

SN Blair

1993 C. H. McCloy research lecture: physical activity, physical fitness, and health

Research Quarterly for Exercise and Sport

(1993)

SN Blair et al.

Changes in physical fitness and all-cause mortality: a prospective study of healthy and unhealthy men

JAMA

(1995)

PD Wood et al.

Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise

N Engl J Med

(1988)

JJ Duncan et al.

The effects of aerobic exercise on plasma catecholamines and blood pressure in patients with mild essential hypertension

JAMA

(1985)

SN Blair et al.

Physical fitness and functional health status

Med Sci Sports Exerc

(1994)

AC King et al.

Group vs. home-based exercise training in healthy older men and women: a community-based clinical trial

JAMA

(1991)

National Center for Health Statistics, 1994, Healthy people 2000 review, 1993, Public Health Service, Hyattsville,...

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic...

A Bandura

Social foundations of thought and action: a social cognitive theory

(1986)

JO Prochaska et al.

The stages and processes of self-change in smoking: towards an integrative model of change

J Consult Clin Psychol

(1983)

Cited by (213)

Effects of exercise training on metabolic syndrome risk factors in post-menopausal women – A systematic review and meta-analysis of randomised controlled trials
2023, Clinical Nutrition
Alterations in the hormonal profiles as women transition to the menopause predisposes individuals to the metabolic syndrome (MetS). In post-menopausal women, this can be exacerbated by sedentary behaviour and physical inactivity. Physical activity can convey many health benefits including improvement in MetS risk factors. However, it remains to be elucidated how differing exercise intensities and its mode of delivery can ameliorate MetS risk factors and resultant progression amongst post-menopausal women. The purpose of this systematic review and meta-analysis was to investigate the effects and efficacy of exercise training on MetS risk factors in post-menopausal women.
Database searches using PubMed, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials were conducted from inception to December 2021 for randomised controlled studies (RCTs) investigating exercise training (>8 weeks) in at least one of the MetS risk factors in post-menopausal women. Utilising the random-effects model, appropriate standardised mean differences (SMD) or mean differences (MD) with 95% confidence interval (CI) for each MetS risk factor were used to calculate the overall effect size between the exercise and control groups. Sub-group analyses were performed for exercise intensity, modality, and duration for each risk factor. Meta-regression was performed for categorical (health status) and continuous (body mass index) covariates.
39 RCTs (40 studies) involving 2132 participants were identified as eligible. Overall, the meta-analysis shows that exercise training significantly improved all MetS risk factors: waist circumference (WC) [MD: −2.61 cm; 95% CI: −3.39 to −1.86 cm; p < 0.001; 21 studies]; triglycerides (TG) [SMD: −0.40 mmol/L; 95% CI: −0.71 to −0.09 mmol/L; p = 0.01; 25 studies]; high-density lipoprotein (HDL) [SMD: 0.84 mmol/L (95% CI: 0.41–1.27 mmol/L; p < 0.001; 26 studies]; fasting glucose (BG) [SMD: −0.38 mmol/L (95% CI: −0.60 to −0.16 mmol/L; p < 0.001; 20 studies]; systolic blood pressure (SBP) [MD: −5.95 mmHg (95% CI: −7.98 to −3.92 mmHg; p < 0.001; 23 studies]; and diastolic blood pressure (DBP) [MD: −4.14 mmHg (95% CI: −6.19 to −2.08 mmHg; p < 0.001; 23 studies]. Furthermore, sub-group analyses identified that moderate intensity and combined exercise training significantly improved MetS risk factors (p < 0.05) except for HDL, with combined exercise being the most effective. Long duration (≥12 weeks) training also significantly improved MetS risk factors except for TG. Meta-regression revealed no moderating effects on any MetS risk variables.
This study reinforces the importance of regular physical activity as a non-pharmacological tool in the reduction of MetS risk in post-menopausal women, with significant metabolic improvements seen in interventions spanning 8–10 weeks. Moderate intensity and combined training significantly benefitted abdominal obesity, dyslipidaemia, dysglycaemia and hypertension in post-menopausal women. Improvements in at least one MetS risk were also seen with other exercise modalities and intensities.
Role of exercise in the prevention and treatment of metabolic syndrome
2023, Metabolic Syndrome: From Mechanisms to Interventions
Metabolic syndrome (MetS) has been on the rise worldwide, contributing to an increase in cardiovascular morbidity and mortality. The components of the MetS such as diabetes, hypertension, dyslipidemia, and obesity are rightly known as “lifestyle” diseases. It is well known that in addition to excess calorie consumption and certain types of diet, a sedentary lifestyle is a significant risk factor for the development of obesity and cardiovascular disease. Physical activity including exercise as well as leisure time physical activity have an important role in both prevention and management of MetS. Regular physical activity benefits individual components of MetS such as waist circumference, adiposity, hyperglycemia, and hypertension. Also, daily exercise has been known to improve cardiorespiratory fitness and reduce cardiovascular risk. Unlike the loss of lean body mass with calorie restriction alone, weight loss as a result of regular exercise combined with a low calorie diet tends to preserve lean body mass while reducing adiposity. Increasing evidence has come to light about the importance of exercise intensity rather than its duration for its beneficial effect on cardiovascular health. This has led to the evolution of various forms of exercise and exercise routines such as the high intensity interval training which may provide greater cardiovascular benefit with shorter duration of exercise. However, such high intensity exercise is contraindicated in certain disease states. International recommendations for exercise for the prevention and treatment of MetS stress the importance of individualizing exercise programs based on the cardiovascular fitness and other existing health conditions of the person. Although low-to-moderate intensity exercise does not require pre-exercise evaluation, high intensity exercise, especially in previously sedentary individuals, warrants medical clearance. In general, beginning with simple low-intensity exercises with a gradual increase in intensity would be prudent to avoid injuries and complications.
Advances in understanding mechanisms and therapeutic targets to treat comorbid depression and cardiovascular disease
2020, Neuroscience and Biobehavioral Reviews
Chronic or repeated social stress exposure often precipitates the onset of depression and cardiovascular disease (CVD). Despite a clear clinical association between CVD and depression, the pathophysiology underlying these comorbid conditions is unclear. Chronic exposure to social stress can lead to immune system dysregulation, mitochondrial dysfunction, and vagal withdrawal. Further, regular physical exercise is well-known to exert cardioprotective effects, and accumulating evidence demonstrates the antidepressant effect of exercise. This review explores the contribution of inflammation, mitochondrial dysfunction, and vagal withdrawal to stress-induced depression and CVD. Evidence for therapeutic benefits of exercise, anti-inflammatory therapies, and vagus nerve stimulation are also reviewed. Benefits of targeted therapeutics of mitochondrial agents, anti-inflammatory therapies, and vagus nerve stimulation are discussed. Importantly, the ability of exercise to impact each of these factors is also reviewed. The current findings described here implicate a new direction for research, targeting the shared mechanisms underlying comorbid depression-CVD. This will guide the development of novel therapeutic strategies for the prevention and treatment of these stress-related pathologies, particularly within treatment-resistant populations.
Influence of a physical exercise program on VO<inf>2</inf>max in adults with cardiovascular risk factors
2018, Clinica e Investigacion en Arteriosclerosis
El objetivo de la presente investigación fue valorar la influencia de un programa de ejercicio físico terapéutico en el VO₂máx en sujetos sedentarios que presentan factores de riesgo cardiovascular.
La muestra estuvo formada por 214 pacientes (80 varones y 134 mujeres) con una media de edad de 52 años, derivados de 2 centros de atención primaria del sureste español. Se llevó a cabo un programa de 10 semanas (3 sesiones × 1 h/sem) que combinaba fuerza muscular con resistencia cardiorrespiratoria. El nivel de VO₂máx se analizó mediante el test de campo Rockport Walk Test (RWT), comparando las 2 mediciones efectuadas al inicio y final del programa.
Los resultados indican que se producen mejoras significativas sobre el VO₂máx en ambos sexos (p < 0,05). El aumento más pronunciado en el VO₂máx se produce en varones en la franja de edad analizada superior (56-73 años).
La prescripción y derivación a programas de ejercicio físico desde los centros de atención primaria se debe de valorar como recurso para la mejora del fitness cardiorrespiratorio en la población estudiada.
The aim of the study was to assess the influence of a physical exercise program on VO₂max in sedentary subjects with cardiovascular risk factors.
The sample was composed of 214 patients (80 males, 134 females) with an average age of 52 years, who were referred to a physical exercise program from 2 primary care centres of Spanish southeast. It was implemented a 10 week program (3 training × 1 h/week) combining strength with cardiorespiratory fitness. TheVO₂max was analyzed through the Rockport Walk Test (RWT) comparing the pre and post program measurements.
The results show significant improvements on VO₂max for both genders (p < 0,05). The most pronounced increase in VO₂max was among males in the highest age band (56-73 years).
Prescribing and referral exercise programs from primary care centers must be considered as a resource for improving cardiorespiratory fitness in the population studied.
Health-related fitness in medical students: a curricular intervention in Bogota, Colombia
2024, BMC Public Health
Relation Between Endothelial Dysfunction and Exercise Training-Mediated Adaptation in Cardiovascular Risk Factors, Cardiorespiratory Fitness, and Vascular Health in Humans: A seconadary analysis
2024, Journal of Science in Sport and Exercise

View all citing articles on Scopus

^☆: This study was funded in part by National Institutes of Health Grants HL-48597 and CA-01757 and by donations of exercise equipment from Nordic Track, Stairmaster, Cybex, and PreCor.

^☆☆: C, BouchardR, J, ShephardT, Stephens, editors

²: To whom reprint requests should be addressed. Fax: (972) 341-3225. E-mail: [email protected].

View full text

Regular ArticleReduction in Cardiovascular Disease Risk Factors: 6-Month Results from ProjectActive☆,☆☆

Abstract

Lancet

Am J Cardiol

Am J Cardiol

Am J Prev Med

Prev Med

Physical activity, all-cause mortality, and longevity of college alumni

N Engl J Med

Physical fitness and all-cause mortality: a prospective study of healthy men and women

JAMA

Physical activity, fitness, and cancer

Physical activity, fitness, and health

Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus

N Engl J Med

The association of changes in physical-activity level and other lifestyle characteristics with mortality among men

N Engl J Med

1993 C. H. McCloy research lecture: physical activity, physical fitness, and health

Research Quarterly for Exercise and Sport

Changes in physical fitness and all-cause mortality: a prospective study of healthy and unhealthy men

JAMA

Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise

N Engl J Med

The effects of aerobic exercise on plasma catecholamines and blood pressure in patients with mild essential hypertension

JAMA

Physical fitness and functional health status

Med Sci Sports Exerc

Group vs. home-based exercise training in healthy older men and women: a community-based clinical trial

JAMA

Social foundations of thought and action: a social cognitive theory

The stages and processes of self-change in smoking: towards an integrative model of change

J Consult Clin Psychol

Regular Article
Reduction in Cardiovascular Disease Risk Factors: 6-Month Results from ProjectActive☆,☆☆