What is the best exercise for increasing cardiovascular endurance?

1.

Balady, Gary J., Ades, Philip A. (2022). In Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine (pp. 175). DOI: 10.1016/B978-0-323-72219-3.00015-3

Exercise training programs are designed to maintain or improve fitness and include the prescriptive components of intensity, duration, frequency, and modality. Details regarding the exercise prescription for patients with CVD are provided elsewhere.,,For patients with CVD, theintensityof dynamic aerobic exercise is usually determined from the results of a pretraining exercise test by using either of two methods: 40% to 80% of peak exercise capacity using theHR reservemethod ([peak HR − resting HR] × [percent intensity] + [resting HR]), and in patients who have performed a CPX, the HR at 40% to 80% of the measured peakV˙o2. A simpler approach is to have individuals exercise at 70% to 85% of their maximal measured HR. Intensity may be modified further by using the subjective perceived exertion scale at a rating of 11 to 16 on a scale of 6 to 20. In patients with an ischemic response during exercise, the intensity should be prescribed at a HR that is at least 10 beats below the symptomatic ischemic threshold (i.e., the HR at which ischemic ST depressions and typical angina begin to occur). The goaldurationof exercise at the prescribed intensity is generally 20 to 60 minutes per session at afrequencyof 3 to 5 days per week. Trainingmodalitiesshould ideally incorporate exercises that include rhythmic, large muscle group activities of both the upper and the lower extremities with varying types of exercise equipment such as treadmills, cycle ergometers and elliptical trainers. A symptom limited ECG stress test can also screen for the safety of resistance training in cardiac patients as the maximal HR × BP product attained at the stress test is rarely exceeded during clinical (non-body building) strength training (see “Classic References”). Emerging data on aerobic interval training (AIT) offer promise for patients with CVD. AIT involves alternating 3- to 4-minute periods of exercise at very high intensity (90% to 95% of peak HR) with exercise at moderate intensity (60% to 70% of peak HR).

AIT involves alternating 3- to 4-minute periods of exercise at very high intensity (90% to 95% of peak HR) with exercise at moderate intensity (60% to 70% of peak HR). When such training is performed for approximately 40 minutes, three times per week, studies demonstrate greater improvements in peakV˙o2, endothelial function, and metabolic parameters than with standard continuous, moderate-intensity exercise.The cardiovascular risks of AIT appear to be low in a supervised cardiac rehabilitation setting. Although more studies are needed, AIT can be considered in select patients as an alternative training modality for those with CVD enrolled in cardiac rehabilitation program.Disability AssessmentThe U.S. Social Security Administration defines disability as “the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”In several cardiovascular conditions, disability is not based solely on the diagnosis but also on the functional limitations imposed by the condition. Thus, exercise testing plays an integral role in the determination of disability for several cardiovascular conditions, including chronic heart failure, ischemic heart disease, congenital heart disease, PAD, and valvular heart disease. The Institute of Medicine (IOM) convened a panel of experts to provide recommendations for updating the Social Security listings for cardiovascular conditions. Although each of the previous conditions have specific criteria to define the condition, functional disability in almost all of them is defined by the inability to attain a directly measured peakV˙o2of 15 mL/kg/min using gas exchange (or 5 estimated METs) on a symptom-limited treadmill or stationary cycle test.Table 15.16outlines details regarding exercise test criteria for specific cardiovascular conditions as recommended by IOM.

2.

Forman, Daniel E., Fleg, Jerome L., Wenger, Nanette kass, Rich, Michael W. (2022). In Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine (pp. 1687). DOI: 10.1016/B978-0-323-72219-3.00090-6

The most important considerations when counseling regarding physical activity is to help shape a program that is pleasurable and achievable and that avoids injury or exacerbation of comorbid problems. Aerobics, strength, balance, and flexibility are all vital components. For adults willing to enter a formal exercise program, specific exercises can help improve tolerance of the physical demands of daily living and recreational activities. Generally, work intensities start lower than in younger patients, with smaller increments over time, especially in those with significant comorbidities that limit mobility (e.g., arthritis, pulmonary disease, and PAD). Increasing frequency and duration of exercise sessions should supersede increases in intensity to reduce the potential for overuse injuries. For adults who are disinclined to exercise in a program, increasing activity as part of daily living is also beneficial. Regular leisure activities such as walking, yoga, and gardening are all healthful. Accumulating evidence suggests that activity benefits may increase in proportion to intensity. Reports in patients with established heart disease, including one study of patients with a mean age of 75 years, suggest that high intensity aerobic interval training can elicit greater improvement in exercise capacity than continuous exercise at a lower intensity.Despite these encouraging data, such training is more complex than traditional training, necessitating more supervision for implementation and safety. Larger studies are needed to establish the efficacy and safety of high intensity interval training in older patients.

3.

Gonçalves C, Raimundo A, Abreu A, Bravo J. International Journal of Environmental Research and Public Health. 2021;18(7):3574. doi:10.3390/ijerph18073574. Copyright License: CC BY

Publish date: March 2, 2021.

Exercise-induced improvements in the VOpeak of cardiac rehabilitation participants are well documented. However, optimal exercise intensity remains doubtful. This study aimed to identify the optimal exercise intensity and program length to improve VOpeak in patients with cardiovascular diseases (CVDs) following cardiac rehabilitation. Randomized controlled trials (RCTs) included a control group and at least one exercise group. RCTs assessed cardiorespiratory fitness (CRF) changes resulting from exercise interventions and reported exercise intensity, risk ratio, and confidence intervals (CIs). The primary outcome was CRF (VOpeak or VO at anaerobic threshold). Two hundred and twenty-one studies were found from the initial search (CENTRAL, MEDLINE, CINAHL and SPORTDiscus). Following inclusion criteria, 16 RCTs were considered. Meta-regression analyses revealed that VOpeak significantly increased in all intensity categories. Moderate-intensity interventions were associated with a moderate increase in relative VOpeak (SMD = 0.71 mL-kg-min; 95% CI = [0.27-1.15]; = 0.001) with moderate heterogeneity (I = 45%). Moderate-to-vigorous-intensity and vigorous-intensity interventions were associated with a large increase in relative VOpeak (SMD = 1.84 mL-kg-min; 95% CI = [1.18-2.50], < 0.001 and SMD = 1.80 mL-kg-min; 95% CI = [0.82-2.78] = 0.001, respectively), and were also highly heterogeneous with I values of 91% and 95% ( < 0.001), respectively. Moderate-to-vigorous and vigorous-intensity interventions, conducted for 6-12 weeks, were more effective at improving CVD patients' CRF.

4.

Elsevier ClinicalKey Clinical Overview

Screening and Prevention Physical activity is the cornerstone of maintaining and improving cardiovascular health Adults should engage in at least 150 minutes per week of moderate-intensity physical activity or at least 75 minutes per week of vigorous-intensity aerobic physical activity to reduce atherosclerotic cardiovascular disease risk Moderate-intensity physical activities include: Brisk walking (2.4-4 mph) Biking (5-9 mph) Ballroom dancing Active yoga Recreational swimming Vigorous-intensity physical activities include: Jogging or running Biking (more than 10 mph) Singles tennis Swimming laps Short durations of exercise are as beneficial as longer ones, and total accumulated amount should be considered Engaging in some moderate- or vigorous-intensity physical activity even if less than the recommended amount can be beneficial A consistent, strong inverse dose–response relationship exists between amount of physical activity and incident atherosclerotic cardiovascular disease events and death Sedentary behavior in adults is detrimental to atherosclerotic cardiovascular disease risk and should be minimized Routinely assess physical activity and counsel patients at health care visits

5.

Mora, Samia, Libby, Peter, Ridker, Paul M (2022). In Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine (pp. 442). DOI: 10.1016/B978-0-323-72219-3.00025-6

The large body of epidemiologic evidence that has accumulated since the 1950s demonstrates that physical activity unequivocally is associated with health benefits including reduced rates of cardiovascular morbidity and mortality, all-cause and premature mortality, and multiple non-communicable diseases including hypertension, diabetes, depression, dementia, and at least 8 cancers including breast and colorectal cancer. Physical inactivity is a major risk factor for cardiovascular disease, peripheral arterial disease, and heart failure, and meeting guideline-recommended activity levels is one of the AHA LS7 components.Currently there is a global pandemic of physical inactivity. Worldwide, more than 1.4 billion adults have insufficient activity levels, with higher age-standardized prevalence of insufficient activity in women than men (31.7% vs. 23.4%) and high- versus low-income countries (36.8% vs. 16.2%).In the United States, the prevalence of self-reported physical inactivity in adults has decreased over the past decade from 40.2% to 25.9%, but ethnic/racial, socioeconomic, and gender disparities continue, with greater activity levels among educated non-Hispanic white men.At least 10% of deaths could be avoided if guideline-recommended activity levels were met. The US federal government issued its first-ever physical activity guidelines in 2008 and updated them in 2018, asking adults to do at least 150 to 300 minutes (2.5 to 5 hours) per week of moderate-intensity aerobic physical activity (e.g., brisk walking), or 75 to 150 minutes per week of vigorous aerobic activity (e.g., jogging), or a combination of activities of both intensities that expends an equivalent amount of energy, preferably spread throughout the week.,In addition, the guidelines recommended muscle-strengthening activities (e.g., push-ups) on 2 or more days per week, as these activities provide additional benefits.