The role of physical activity in established atherosclerotic cardiovascular disease.

Gonzalez Jaramillo, Nathalia (2022). The role of physical activity in established atherosclerotic cardiovascular disease. (Unpublished). (Dissertation, University of Bern, the Faculty of Medicine and the Faculty of Human Sciences)

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Background: Cardiovascular disease (CVD) remains the leading cause of morbidity
and mortality worldwide. CVD incidence and prognosis are largely a consequence of
genetics, environmental exposures, and lifestyle-related factors such as physical
activity (PA), sleep, diet, smoking, and alcohol consumption. Physical inactivity is an
important contributor to premature mortality, morbidity, and disability-adjusted life
years for adults in most of the world. On the other hand, PA is a major modifiable
protective factor against CVD and death among the general population and
specifically, in patients with coronary artery disease (CAD). American and European
guidelines thus recommend that adults engage in regular lifestyle PA, according to
their abilities, and avoid inactivity, yet more than a quarter of the world´s adult
population is insufficiently active. PA behaviours may vary during the life course.
Therefore, it is crucial to identify patients with low levels of PA, increase their PA, and
facilitate a tailored cardiac care approach.

Aims: The overall aim of this thesis was to enhance the understanding of the role of
PA in established atherosclerotic CVD. In four subsequent parts, the following
knowledge is provided: 1) Clinical outcomes and cardiac rehabilitation (CR) uptake
among underrepresented groups after percutaneous coronary intervention (PCI). 2)
Associations of physical activity trajectories with all-cause and CVD-specific mortality
in patients with CAD. 3) Protocol to establish the associations of objectively measured
PA with major adverse cardiac and cerebrovascular events (MACCE) and mortality at
one-year follow-up. 4)Prevalence estimates of adherence to PA recommendations
among patients after PCI across the 2010 and 2020 WHO guidelines, as well as 7,500
and 10,000 steps.

Methods: In Article 1 we included 15211 consecutive patients from the CARDIOBASE
Bern PCI registry (2009-2018). we used multi-state models to compare transition
probabilities of events among migrants, women, and older adults. we used logistic
regression to assess the associations of CR uptake with underrepresented groups. In
addition, we performed Cox regression analyses to evaluate the associations of CR
uptake with all-cause, CVD-specific mortality, and the incidence of major
cardiovascular events (MACE) after PCI. To assess the associations of physical
activity trajectories with all-cause and CVD-specific mortality in patients with CAD in
Article 2, we conducted a systematic review and meta-analysis of nine prospective
cohorts including 33,576 participants. In Article 3, we designed a study protocol. The
PIPAP study is a prospective observational single-center study that monitors patients’
PA and assesses the potential of acceleration and steps parameters for risk
quantification, and analyze the associations of objectively measured PA trajectories
after PCI with all-cause and CVD mortality at one-year follow-up. For Article 4, we
used accelerometer data from 282 consecutive patients after PCI for chronic or acute
coronary syndromes who are participating in the PIPAP study.

Results: These studies’ results are presented in four articles. Article 1 shows that
among underrepresented groups undergoing PCI, age, but not migration status nor
sex contributed to disparities in mortality. Migrant status did not result in lower
attendance of CR. Considering the protective associations of CR on CVD mortality
independent of age, sex, and migration status, the lower uptake in women and older
adults should be a call to action. Article 2 illustrates how patients with CAD may benefit
by preserving or adopting an active lifestyle. However, patients with CAD can
overcome prior years of inactivity by taking up exercise later in life. The benefits of
past activity can be weakened or even lost if PA is not maintained. Article 3 describes
the PIPAP study protocol. Article 4 shows that patients from the PIPAP study, the
recommendations from 2020 WHO PA guidelines for MVPA were fulfilled easily by
activities of daily living, without any planned or structured exercise. Additionally, this
study found a fourfold discrepancy in the frequency of participants fulfilling 2010 and
2020 WHO guidelines for PA among patients following hospital discharge after PCI.

Conclusion: In this thesis, we contribute knowledge about the role of PA in patients
with established CAD. First, we contributed to the limited data on the access to CR
among underrepresented populations, based on a large population of more than
15,000 patients from Switzerland. Second, we provided for the first time in the
literature summarized and synthesized data on PA trajectories from nine prospective
cohorts including 33,576 participants. Third, we provided a study design to analyze
patterns of short term and long-term objectively measured PA trajectories in patients
after PCI. From that study, in the fourth article we showed a large discrepancy in the
prevalence of PA between clinical guidelines recommendations with public health
implications that need to be evaluated by future studies. Overall, physical activity
should be considered a foundational therapy for patients with CAD.

Item Type:	Thesis (Dissertation)
Division/Institute:	04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM) 04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
Graduate School:	Graduate School for Health Sciences (GHS)
UniBE Contributor:	Gonzalez Jaramillo, Nathalia, Franco Duran, Oscar Horacio, Wilhelm, Matthias, Bano, Arjola
Subjects:	600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services
Language:	English
Submitter:	Doris Kopp Heim
Date Deposited:	17 Mar 2023 16:29
Last Modified:	17 Mar 2023 23:27
Additional Information:	PhD in Health Sciences (Epidemiology)
URI:	https://boris.unibe.ch/id/eprint/180293