Korean J Fam Pract. 2018; 8(5): 676-683  https://doi.org/10.21215/kjfp.2018.8.5.676
The Relationship Between Physical Activity and Risk of Cardiovascular Disease Among Hypertensive Persons: A Community-Based Prospective Study
Donghoo Kim1, Byungsung Kim1,*, Changwon Won1, Hyunrim Choi1, Sunyoung Kim2, Minhye Jang1, Wooyoung Shin3
1Department of Family Medicine, Kyung Hee University Hospital; 2Department of Medicine, Graduate School, Kyung Hee University, Seoul; 3Division of Biologics, Department of Biopharmaceuticals and Herbal Medicine Evaluation, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, Korea
Byungsung Kim
Tel: +82-2-958-8696, Fax: +82-2-958-8699
E-mail: bskim7@khmc.or.kr
ORCID: http://orcid.org/0000-0002-4984-6918
Received: July 20, 2017; Revised: September 20, 2017; Accepted: October 7, 2017; Published online: October 20, 2018.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Hypertension, a major risk factor for the development of cardiovascular disease, is a prevalent chronic disease in Korea. It has been shown previously that regular physical activity is effective in controlling blood pressure and preventing cardiovascular disease. We investigated the relationship between physical activity and cardiovascular disease in patients with hypertension.
Methods: This study used data collected in the Ansan and Anseong Cohort, performed by the Korean Center for Disease Control. The baseline survey was carried out between 2000–2001 and two prospective biennial surveys were conducted and analyzed.
Results: Of the 8,807 total subjects included in the analysis, 2,805 patients were hypertensive, and 705 patients were diagnosed with cardiovascular disease at 12-year follow up. The non-hypertensive subjects in the 7.5–15 metabolic equivalent hours per week (MET-hr/wk) group had the lowest cardiovascular disease risk (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.45–0.95). Of the hypertensive subjects, the risk of cardiovascular disease was lowest in the 15–30 MET-hr/wk group (HR, 0.6; 95% CI, 0.43–0.84). Multivariate analysis of hypertension showed a decrease in the risk of cardiovascular disease in the 15–30 MET-hr/wk group (HR, 0.69; 95% CI, 0.49–0.98). Additionally, the risk was significantly reduced in women compared to men at 15–30 MET-hr/wk (HR, 0.61; 95% CI, 0.39–0.97).
Conclusion: The risk of cardiovascular disease was significantly reduced in patients with hypertension and, specifically, females with hypertension who performed 15-30 MET-hr/wk of physical activity.
Keywords: Exercise; Metabolic Equivalent; Hypertension; Cardiovascular Diseases
References
  1. Korea Centers for Disease Control and Prevention. Korea National Health and Nutrition Examination Survey (KNHANES VI) 2015 [Internet]. Cheongju: KCDC [cited 2017 Jun 25].
    Available from: http://knhanes.cdc.go.kr
  2. Blood Pressure Lowering Treatment Trialists’ Collaboration, Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F, et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ 2008; 336: 1121-3.
    Pubmed KoreaMed CrossRef
  3. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension:the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281-357.
    Pubmed CrossRef
  4. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure:a meta-analysis of randomized, controlled trials. Ann Intern Med 2002; 136: 493-503.
    Pubmed CrossRef
  5. Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006; 24: 215-33.
    Pubmed CrossRef
  6. Cornelissen VA, Buys R, Smart NA. Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis. J Hypertens 2013; 31: 639-48.
    Pubmed CrossRef
  7. Shiroma EJ, Lee IM. Physical activity and cardiovascular health: lessons learned from epidemiological studies across age, gender, and race/ethnicity. Circulation 2010; 122: 743-52.
    Pubmed CrossRef
  8. Reddigan JI, Ardern CI, Riddell MC, Kuk JL. Relation of physical activity to cardiovascular disease mortality and the influence of cardiometabolic risk factors. Am J Cardiol 2011; 108: 1426-31.
    Pubmed CrossRef
  9. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116: 1081-93.
    Pubmed CrossRef
  10. Thune I, Furberg AS. Physical activity and cancer risk: dose-response and cancer, all sites and site-specific. Med Sci Sports Exerc 2001; 33(6 Suppl):S530-50.
    Pubmed CrossRef
  11. Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases:lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet 2014; 383: 1899-911.
    CrossRef
  12. Cho NH, Jang HC, Choi SH, Kim HR, Lee HK, Chan JC, et al. Abnormal liver function test predicts type 2 diabetes: a community-based prospective study. Diabetes Care 2007; 30: 2566-8.
    Pubmed CrossRef
  13. Choi SH, Kim TH, Lim S, Park KS, Jang HC, Cho NH. Hemoglobin A1c as a diagnostic tool for diabetes screening and new-onset diabetes prediction:a 6-year community-based prospective study. Diabetes Care 2011; 34: 9449.
    Pubmed KoreaMed CrossRef
  14. David MB, Jennifer B, David RB, Janet EF, Deborah AG; Commander Julie Gilchrist, et al.; U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans [Internet]. Washington, DC: U.S. Department of Health and Human Services [cited 2017 Jun 25].
    Available from: https://health.gov/paguidelines
  15. Arem H, Moore SC, Patel A, Hartge P, Berrington de Gonzalez A, Visvanathan K, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med 2015; 175:959-67.
    Pubmed KoreaMed CrossRef
  16. Williams PT. Physical fitness and activity as separate heart disease risk factors:a meta-analysis. Med Sci Sports Exerc 2001; 33: 754-61.
    Pubmed KoreaMed CrossRef
  17. Lee IM, Skerrett PJ. Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports Exerc 2001; 33(6 Suppl): S459-71.
    Pubmed CrossRef
  18. Manson JE, Greenland P, LaCroix AZ, Stefanick ML, Mouton CP, Oberman A, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med 2002; 347: 716-25.
    Pubmed CrossRef
  19. Hu FB, Stampfer MJ, Solomon C, Liu S, Colditz GA, Speizer FE, et al. Physical activity and risk for cardiovascular events in diabetic women. Ann Intern Med 2001; 134: 96-105.
    CrossRef
  20. MacAuley D, McCrum EE, Stott G, Evans AE, McRoberts B, Boreham CA, et al. Physical activity, physical fitness, blood pressure, and fibrinogen in the Northern Ireland health and activity survey. J Epidemiol Community Health 1996; 50: 258-63.
    Pubmed KoreaMed CrossRef
  21. Thompson PD, Tsongalis GJ, Seip RL, Bilbie C, Miles M, Zoeller R, et al. Apolipoprotein E genotype and changes in serum lipids and maximal oxygen uptake with exercise training. Metabolism 2004; 53: 193-202.
    Pubmed CrossRef
  22. Koenig W, Sund M, Döring A, Ernst E. Leisure-time physical activity but not work-related physical activity is associated with decreased plasma viscosity. Results from a large population sample. Circulation 1997; 95: 335-41.
    Pubmed CrossRef
  23. Burchfiel CM, Sharp DS, Curb JD, Rodriguez BL, Hwang LJ, Marcus EB, et al. Physical activity and incidence of diabetes: the Honolulu Heart Program. Am J Epidemiol 1995; 141: 360-8.
    Pubmed CrossRef
  24. Perry IJ, Wannamethee SG, Walker MK, Thomson AG, Whincup PH, Shaper AG. Prospective study of risk factors for development of non-insulin dependent diabetes in middle aged British men. BMJ 1995; 310: 560-4.
    Pubmed KoreaMed CrossRef
  25. Manson JE, Nathan DM, Krolewski AS, Stampfer MJ, Willett WC, Hennekens CH. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA 1992; 268: 63-7.
    Pubmed CrossRef
  26. Eriksson KF, Lindgärde F. Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmö feasibility study. Diabetologia 1991; 34: 891-8.
    Pubmed CrossRef
  27. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997; 20: 537-44.
    Pubmed CrossRef

This Article


Author ORCID Information

Services
Social Network Service

e-submission

Archives