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Project1.pptx

Cardiovascular Benefits from exercise

PICO question

P: Older adult population (ages 65 and older)

I: Meeting CDC guidelines recommendations of 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week for adult ages 65 and older.

C: Comparison of cardiac bench markers( when minimum requirements of 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week are met vs not meeting this minimum for given age group.

O: Measuring cardiovascular health with particular metrics the AHA use with their score, specifically blood pressure, glucose levels, and if applicable body mass index as well with the given age group.

Question: In the older adult population ages 65 years and older, what is the effect of meeting the CDC guidelines of 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week on their blood pressure, glucose levels and body mass index?

The American Heart Association’s ideal cardiovascular health score is based on 7 cardiovascular health metrics to measure progress toward their Impact Goal of reducing cardiovascular disease by 20 % before 2020. The heart health metrics of tobacco use, body mass index, physical activity, diet, blood pressure, and glucose were measured. (Patterson, et al., 2016)

Problem statement

Heart disease is the number one cause of death in the United States. By 2030 more than 22.2 million people will die annually from CVDs. (Ruan, et al., 2018) Older adults (ages 65 and older) are one of the most vulnerable populations for this disease. Exercise is highly recommended to better an individual's cardiovascular health. What impact does exercise have on blood pressure, glucose levels and body mass index?

(Ruan, et al., 2018)

Hamilton, Alaina J. (HAJ) - The information within this paragraph is good and explains the emphasis of cardiac health. Every statistic needs to be cited.

Key stakeholders

Adult population at risk for heart disease

Healthcare workers

Health Insurance Industry

Pharmeceutical Industry

Economic Impact

First author’s last name and first initial, year published & article title	Purpose/ Problem Statement	Design & level of evidence	Target Population	Data Collection: Variables, tools, and measurements	Statistical tests	Results/Findings	Implications	Strengths	Limitations	What recommendations can be provided based on the evidence found in this article?
Musich, S. (2017) The frequency and health benefits of physical activity (PA) for older adults.	Purpose is observing prevalence of light-to-moderate physical activity levels in varying frequencies (low, intermediate high) amongst Americas Association of Retired People (AARP) Medicare Supplement insureds, To understand any associations that may exist between physical activity and the prevalence of chronic conditions.	Primary source. Level IV (Correlation Design): Evidence from a cross-sectional study. AARP Medicare Supplement insureds (3 selected states from the U.S.) randomly surveyed with general health needs survey Included variety of information, namely light to moderate PA levels along Corresponding information such as physical health risks, self-reported mental and physical health status and other information gathered as well	65 years of age or older; age requirement Participants with minimum of 3 months in AARP Medicare Supplement plan Participants within the 3 states of Missouri, New Jersey and Washington	Survey utilized developed by UnitedHealthcare, screens for healthcare status, PA levels, physical and mental health risks, along with health literacy. Varying examples for targeted PA levels given in survey to determine participants estimated PA levels. Survey is 21 questions long.	Characteristics associated with PA frequency levels were determined using multivariate logistic regression	Reported better self-health by participants in high and intermediate PA groups Participants less likely to be diagnosed with various common physical medical conditions Results show a decrease in various chronic conditions such as diabetes, renal disease, liver disease, and COPD Reportedly less likely to experience any mental medical conditions with intermediate and high PA levels	Following CDC guidelines regarding PA (150 minutes/week) there is lower chance for common chronic medical conditions. Participants reported lower ER visits, lower medical expenditure amongst those that followed the CDC guidelines of 150 minutes of exercise/week. Less likely to be diagnosed with depression. Linking abundant health benefits	Specific exclusion of participants with limitation-related physical activity to strengthen validity of data (excluded 1% of total survey responders. Sample population size was 17,676 a relatively large population size which can strengthen reliability of data. Reportedly unique administrative medical/prescription drug claims that augment/corroborate self-survey reports	Self-reported data leads to possibility of misclassification of a person’s perception of PA frequency levels.	Recommendation can be made for adults over the age of 65 should exercise for ≥150 minutes of moderate intensity or ≥75 minutes of vigorous intensity PA per week in In addition, muscle strengthening exercises at least twice a week are recommended for this age group to prevent discussed medical conditions.

The article i found, “ideal cardiovascular health, mortality, and vascular events in elderly subject” was created to evaluate whether or not higher CVH status is associated with lower mortality and vascular events in an aging population. This quantitative french, multisite, observational prospective study was done on 9,294 men and women over 65, being examined initially and followed up for vascular health and occurrences. The results were clear that association between cardiovascular health and outcomes as linear and even intermediate CVH was associated with favorable outcomes. This implies that moderate physical activity, smoking cessation and a heart healthy diet contribute to the reduction of CV incident in adult populations and the study identified that risk reduction in mortality and events was consistent across age groups. Related to our PICO question, by implementing exercise regimens, larger populations can reduce their risk for future cardiovascular concerns as well as prevent occurrences for those already at risk.

Aerobic, Resistance, and Combined Training

First author’s last name and first initial, year published & article title	Purpose/ Problem Statement	Design & level of evidence	Target Population	Data Collection: Variables, tools, and measurements	Statistical tests	Results/Findings	Implications	Strengths	Limitations	What recommendations can be provided based on the evidence found in this article?
Schroeder, E., 2019, Comparative effectiveness of aerobic, resistance, and combined training on cardiovascular disease risk factors: A randomized controlled trial	The cardiovascular benefits from exercise are well known. However, the benefits of aerobic, anaerobic, and combination training hasn’t been studied extensively. What impact does this have on BP, CRF, muscular strength, body composition, blood glucose and lipids?	Randomized controlled trial. Level II	69 adults aged 45 to 74. Elevated blood pressure (120-149/80-99), overweight or obese (25-40 body mass index), and sedentary lifestyle (less than 150 minutes of exercise per week).	Independent variables: 1) no-training control, 2) aerobic training, 3) resistance training, 4) combination training Dependent variables: 1) blood pressure, 2) heart rate, 3) body composition, 4) lipid profile, 5) glucose Tools – sphygmomanometer XCEL automated oscillometric device, multi-frequency bioelectrical impedance analysis, modified Balke and Ware protocol, blood drawn Measurements – brachial BP cuff on left brachial artery, seated. 3x measured, 2-minute rest btw measurements. BMI using height and weight	Least-squares adjusted means with standard error. Statistical analyses using SAS software. 2-sided p-values.	66 (96% of individuals) completed the 8-week intervention. Combination group had -4 mmHg peripheral and central diastolic blood pressure. This was a positive sign due to high initial diastolic blood pressure. No improvement on systolic BP. Aerobic and combination groups -2 bpm resting heart rate. Aerobic had greatest reduction in weight (-1 kg) over 8 weeks. Combination group increased lean body mass 0.8 kg and lost 0.9 kg in 8 weeks. Cardiorespiratory fitness increased in aerobic and combination group by 7.7 ml/kg/min and 4.9 ml/kg/min.	Primary finding of this study was that only combined training provided significant changes in blood pressure, with only changes in diastolic pressure. Results suggest individuals receive greater and more complete CVD health benefits from both aerobic and resistance exercise. Aerobic training led to significant increased in cardiorespiratory fitness, resistance training led to significant increases in muscular strength. Combined group experienced benefits in both.	Randomization to ensure comparative baseline of participant, who were at a high risk for developing CVD. All exercise groups had equal training time, with objective verification for amount and intensity. Exercise programs well tolerated by participant. Pedometer to monitor that participant were exercising outside of study.	Cardio-respiratory fitness was estimated using a submaximal treadmill test rather than of maximal effort. Values may overestimate at baseline. Control group still had lifestyle education and dietary information. Control group motivated to make lifestyle changes (can effect changes observed). Study only measured effects of 8 weeks of exercise.	For individuals at high risk for developing cardiovascular disease with elevated BP, a combination of 150 min/week aerobic and resistance exercise training resulted in improved diastolic BP, increased lean body mass, and increased strength and cardiorespiratory fitness. Data suggests its better than just aerobic or resistance training alone.

Key Research Findings

Exercising for ≥150 minutes of moderate intensity or ≥75 minutes of vigorous intensity physical activity per week leads to a decrease in various chronic conditions such as diabetes, renal disease, liver disease, and COPD for adults over the age of 65 (Musich et al., 2017)

Increased Cardiovascular Health shows risk reduction in mortality and vascular events, consistent across age groups, emphasizing the benefit of primordial prevention even in the elderly (Gaye, 2017)

Across a meta-analysis, it was determined that regular exercise is beneficial to managing and reducing the risk of hypertension (Kazeminia et. al. 2020)

Summary of results

There is evidence moderate physical activity, smoking cessation, and optimal diet are beneficial for optimal cardiovascular function (Gaye, 2017)

Prolonged life is directly linked to the health of the cardiovascular system being increased by reduction of even 1 unhealthy metric (cigarette smoking, hypertension, obesity, high cholesterol) (Gaye, 2017)

Providing these older adults with a combined aerobic and resistance exercise training regimen will yield the most well-rounded cardiovascular benefits (Schroeder, 2019)

Recommendations

Exercising for ≥150 minutes of moderate intensity or ≥75 minutes of vigorous intensity physical activity per week (Musich et al., 2017)

By implementing exercise regimens and heart healthy dietary options, larger populations of people can reduce their risk for cardiovascular accidents (Gaye, 2017)

There should be national emphasis of heart healthy initiatives, including price reductions on healthy foods. (Gaye, 2017)

Based on the research, we would suggest specific to our population that older adults participate in 30 minutes of moderate activity at least three times per week in order to maintain cardiac health (Kazemina, 2020)

References

CDC. (2021). Heart disease. https://www.cdc.gov/nchs/fastats/heart-disease.htm

Füzéki, E., & Banzer, W. (2018). Physical activity recommendations for health and beyond in currently inactive populations. International Journal of Environmental Research and Public Health, 15(5), 1042. https://doi.org/10.3390/ijerph15051042

Gaye, B., Canonico, M., Perier, M.-C., Samieri, C., Berr, C., Dartigues, J-F., Tzourio, C., Elbaz, A., & Empana, J-P. (2017). Ideal Cardiovascular Health, Mortality, and Vascular Events in Elderly Subjects. Journal of the American College of Cardiology, 69(25), 3015-3026. h"p://doi.org/ 10.1016/j.jacc.2017.05.011

Kazeminia, M., Daneshkhah, A., Jalali, R., Vaisi-Raygani, A., Salari, N., & Mohammadi, M. (2020, September 15). The Effect of Exercise on the Older Adult's Blood Pressure Suffering Hypertension: Systematic Review and Meta-Analysis on Clinical Trial Studies. International Journal of Hypertension. https://www.hindawi.com/journals/ijhy/2020/2786120/.

Krumholz, H. M., Normand, S. T., & Wang, Y. (2019) Twenty-year trends in outcomes for older adults with acute myocardial infarction in the United States. JAMA Netw Open, 2(3):e191938.https://doi:10.1001/jamanetworkopen.2019.1938

Musich, S., Wang, S. S., Hawkins, K., & Greame, C. (2017). The Frequency and Health Benefits of Physical Activity for Older Adults. Population Health Management, 20(3), 199–207. https://doi.org/10.1089/pop.2016.0071

References

Patterson, F., Zhang, G., Davey, A., Tan, Y., & Ma, G. X. (2016). American Heart Association’s ideal cardiovascular health metrics in under-represented Asian Americans. Journal of Community Health, 41(6), 1282–1289. https://doi.org/10.1007/s10900-016-0217-3

Ruan, Y., Guo, Y., Zheng, Y., Huang, Z., Sun, S., Kowal, P., Shi, Y., & Wu, F. (2018). Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: results from SAGE Wave 1. BMC public health, 18(1), 778. https://doi.org/10.1186/s12889-018-5653-9

Ruegsegger, G. N., & Booth, F. W. (2018). Health benefits of exercise. Cold Spring Harbor Perspectives in Medicine, 8(7), a029694. https://doi.org/10.1101/cshperspect.a029694

Schroeder, E. C., Franke, W. D., Sharp, R. L., & Lee, D. (2019). Compared effectiveness of aerobic, resistance, and combined training on cardiovascular disease risk factors: A randomized controlled trial. Plos One. https://doi.org/10.1371/journal.pone.0210292