Managing CMR

Managing Cardiometabolic Risk in Abdominally Obese Patients

Physical Activity and Exercise

Key Points

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  • Physical inactivity is the most common cardiometabolic risk factor and the easiest one to eliminate.
  • Up to 60 minutes of moderate-intensity endurance exercise on most days of the week can significantly reduce abdominal fat, intra-abdominal (visceral) fat in particular (~30%).
  • Both an acute bout of exercise and chronic endurance exercise can significantly improve insulin sensitivity. The effect is equal to or greater than that achieved with pharmacotherapy (~20% improvement with acute and 30-85% improvement with chronic exercise).
  • Regular endurance exercise can lead to modest but significant improvements in HDL cholesterol (~5%) and triglyceride (~15%) levels. It has less of an effect on LDL cholesterol levels. The lack of change in LDL cholesterol may be misleading, as physical activity can produce a beneficial increase in LDL particle size from small to large.
  • While regular, moderate-intensity endurance exercise can reduce the risk of cardiovascular events by improving an individual’s hemostatic and fibrinolytic profile, intense acute exercise may trigger myocardial infarction, especially in at-risk individuals, by inducing a hypercoaguable state.
  • Endurance exercise has consistently been shown to modestly reduce both systolic and diastolic blood pressure by ~4 mmHg in lean, overweight, hypertensive, and normotensive patients.
  • Although acute exercise can cause elevated systemic inflammation, regular endurance exercise of fairly vigorous intensity appears to reduce levels of inflammatory markers by ~30%.
  • Although the metabolic improvements achieved through regular endurance exercise are generally greater when body weight is reduced, increasing physical activity can dramatically improve intra-abdominal fat, insulin resistance, lipid levels, and blood pressure, even when body weight does not change.