Heart disease patients should aim to be active, not thin

Increased physical activity, rather than weight loss, gives people with coronary heart disease a longer life, according to a new study carried out by the Norwegian University of Science and Technology.

The researchers found that heart disease patients can gain weight without jeopardising their health, but inactivity increases health risks.

They studied 3307 people (1038 women and 2969 men) with coronary heart disease. The patients were examined in 1985, 1996 and 2007, and followed up to the end of 2014. The data from HUNT was compared with data from the Norwegian Cause of Death Registry.

During the 30-year period, 1493 of the participants died and 55 per cent of the deaths were due to cardiovascular disease.

The researchers found that weight loss seems to be associated with increased mortality for the participants in the study who were normal weight at baseline.

The study revealed that people who are physically active live longer than those who are not. Sustained physical activity over time was associated with substantially lower mortality risk.

Participants in the study were divided into three categories: inactive; slightly physically active, but below recommended activity level; and physically active at or above recommended activity level.

The recommended activity level is at least 150 minutes per week of moderate physical activity or 60 minutes per week of vigorous physical activity. The risk of premature death was higher for the group of patients who were completely inactive than for either of the other groups. The prognosis for people who exercise a little bit, even if it is below the recommended level, is better than not exercising at all.

The study’s lead author, Trine Moholdt, said: ’The clinical guidelines for heart disease patients currently include having normal weight and being physically active. I would put more emphasis on the exercise aspect. When it comes to physical activity, you have to do what gets you in better shape. That means training with high intensity. Do something that makes you breathe hard, so that it’s hard to talk, but not so hard that you can’t do it for four to five minutes.’

This doesn’t mean that losing weight is necessarily wrong.v Moholdt and her colleagues note in their article that ‘in our view, desired or intentional weight reduction may be useful for overweight or obese individuals, although little data supports this view in studies of coronary heart disease patients.’

  • Clive

    You should have excluded atrial fibrillation from ‘heart disease’ because for atrial fibrillation (AF), weight loss really matters. I hope I am a living example. Between August 2016 and now I lost over 30% of my body weight. I had paroxysmal AF or a couple of years until April 2017 when it became persistent. In October 2017 I had a Direct Current Cardioversion (DCC) which cardioverted me. The hospital elected not to perform an ablation partly because of the success of weight loss in making AF patients asymptomatic.

    I take my blood pressure every day and it has dropped a lot during the weight loss period, from around systolic 145 on 2 x 2.5 Bisoprolol a day to around 125 on 1 x 2.5 Bisoprolol. I have been vegan for almost 30 years and teetotal for longer so it’s hard to see how the structure of the heart could have changed much. The consultant at the hospital (QAH, Portsmouth) said my heart looked wonderful from an echo cardiogram even while I was in persistent AF.

    There was a major study reported recently that confirms this weight loss connection with AF:
    …After an average of four years, 45 percent of patients who lost 10 percent or more of their body weight and 22 percent of patients who lost 3 to 9 percent of their weight achieved freedom from atrial fibrillation symptoms without the use of any atrial fibrillation surgery or medication. Only 13 percent of patients who lost less than 3 percent of their body weight were free of symptoms without these treatments. Even with the use of surgery or medication, those who lost more weight were substantially more likely to achieve freedom from atrial fibrillation symptoms.

    Sustained weight management and a linear weight loss trajectory were also associated with greater freedom from atrial fibrillation. Patients who lost and then regained weight, causing a fluctuation of more than 5 percent between annual visits, were twice as likely to have recurrent rhythm problems than those who did not experience such fluctuations….