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Review
. 2016 Jun 7;133(23):2297-313.
doi: 10.1161/CIRCULATIONAHA.116.018093.

Exercise Dose in Clinical Practice

Meagan M Wasfy  1 , Aaron L Baggish  2
Affiliations
Review

Exercise Dose in Clinical Practice

Meagan M Wasfy et al. Circulation. .

Abstract

There is wide variability in the physical activity patterns of the patients in contemporary clinical cardiovascular practice. This review is designed to address the impact of exercise dose on key cardiovascular risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and cardiovascular disease risk factors, including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical practice.

Keywords: exercise; hypertension; lipids; mortality.

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Conflict of interest statement

Conflict of Interest Disclosures: None

Figures

Figure 1
Figure 1
Exercise Dose and Mortality. In their broad-based literature review, the 2008 HHS Physical Activity guidelines identified 12 epidemiologic studies examining the exercise dose response and mortality which included at least 5 exercise levels., , , - The relative risk (RR) of mortality across exercise levels in each study is plotted above. Of these studies, 11 used an exercise dose unit that was convertible to hours of moderate to vigorous exercise. The median exercise amount (hours/week) at each exercise level is shown in the chart above. The median RR of mortality at each exercise level in these 11 studies (large black circles) demonstrates a curvilinear shape of the dose-response curve. Adapted from Physical Activity Guidelines Advisory Committee Report to the Secretary of Health and Human Services, 2008.
Figure 2
Figure 2
Integration of Exercise Dose in Clinical Practice. Algorithmic approach to the assessment and management of patients in clinical practice based on habitual physical activity and exercise dose exposure.
See this image and copyright information in PMC

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