Exercise as the cornerstone of cardiovascular prevention

Lack of physical activity in the general population is a public health problem and is recognized as an independent risk factor for the development of coronary disease. The relative risk of inactivity is similar to that of hypertension, hypercholesterolemia and smoking. Consequently, a sedentary lifestyle is associated with a concurrent increase in cardiovascular disease. Engaging regularly in mild-to-moderate physical exercise results in a range of physiological adaptations that are beneficial for health. Various studies have demonstrated that there is an inverse relationship between regular exercise and the risk of coronary heart disease, cardiac events and death. Exercise improves the lipid profile and glycemic control, reduces or prevents hypertension, obesity and stress, and promotes fitness and longevity. However, most evidence for the benefits of exercise comes from observational studies and, although maximum oxygen uptake and the duration of exercise on an exercise stress test are powerful predictors of mortality, there is no agreement on the quantity or intensity of the physical activity needed for primary or secondary prevention. On the other hand, although there is a temporarily increased risk of acute myocardial infarction during exhaustive exercise, the balance of risks and benefits is strongly in favor of the benefits because there is a minimum threshold for the weekly energy expenditure required to reduce cardiovascular risk.