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Health

Risks of Sedentary Behavior

Risks of Sedentary Behavior vs Cardiovascular Risks Associated with Exercise

Risks of Sedentary Behavior

In most instances, remaining inactive will harm the patient.  According to the American Heart Association, sedentary behavior is identified as a distinct cardiovascular risk factor, with prevalence twice that of smoking, hypertension, and dyslipidemia . While there are relatively rare serious risks to beginning an exercise program, there are universal risks from inactivity. Some of the risks associated with a sedentary lifestyle include:

  • Reduced functional capacity
  • Osteoporosis
  • Obesity
  • Anxiety and depression
  • Hypertension
  • Cardiovascular disease
  • Thromboembolic stroke
  • Type 2 diabetes mellitus

Cardiovascular Risks Associated with Exercise

The most serious risks include myocardial infarctions and sudden cardiac death. Atherosclerotic coronary artery disease is the overwhelming cause of exercise-related deaths in adults. The relative risk of both exercise-related myocardial infarction and sudden death is most likely in individuals who are the least physically active and who engage in unaccustomed vigorous physical activity. Therefore, sedentary adults should avoid unaccustomed vigorous activity—they should begin with low- or moderate-intensity exercise and gradually increase their activity levels over time. Instead, they should begin with low- or moderate-intensity exercise and gradually increase their activity levels over time.

Solution

By following the recommendation of the Surgeon Generals’ Report on Physical Activity and Health (1996): “previously inactive men over age 40 and women over age 50, and people at high risk for cardiovascular disease (CVD) should first consult a physician before embarking on a program of vigorous physical activity to which they are unaccustomed” . Please note the emphasis on the vigorous intensity. Initiating moderate-intensity physical activity does not require this screening.

Major Signs and Symptoms of Cardiovascular, Pulmonary or Metabolic Disease (HIGH RISK):

  • Chest discomfort with exertion
  • Dizziness, fainting or blackouts
  • Heart rhythm disturbance
  • Taking heart medications
  • Bilateral ankle edema
  • Unreasonable breathlessness (at rest, with mild exercise, or when recumbent)
  • Burning or cramping sensation in lower legs when walking short distances
  • Pain or discomfort in the chest, neck, jaw, arms, or elsewhere that may be due to ischemia

Cardiovascular, Pulmonary or Metabolic Risk Factors:

  • Male > 45 years old
  • Female > 55 years old, or has had hysterectomy, or is postmenopausal
  • Smoker (or quit within past 6 months)
  • BP > 140/90 mm Hg
  • On BP medication
  • Blood cholesterol >200 mg/dL
  • Close blood relative who had a heart attack/surgery at age <55 (male) or <65 (female)
  • 20 pounds overweight (BMI > 30)
  • Pre-diabetes (see below for definition*) sedentary lifestyle (not exercising ≥ 30 min, 3×/week for past 3 months)
  • Negative risk factor: high-serum HDL cholesterol ≥ 60 mg/dL (1.6 mmol/L)

Example: 

If an individual is a non-smoking male aged 50 with a blood pressure of 130/85 mm Hg and maintains a regular exercise routine, they would have less than two risk factors (age and gender) and therefore be categorized as LOW RISK. However, if the same individual were a smoker with high blood pressure, their risk factor count would be two, categorizing them as MODERATE RISK. Regular monitoring and consultation with healthcare providers are essential for managing and modifyin these risk factors.

 Note:

The patient’s risk level may change over time. For example, if your patient’s signs and symptoms improve (e.g., resolution of ischemic chest pain or shortness of breath with exertion), the patient may be advanced from HIGH RISK to MODERATE RISK. Similarly, if your patient’s disease is stable (e.g., stable CVD, well-controlled metabolic or pulmonary disease such as asthma, and other stable chronic diseases or conditions) she will remain at HIGH RISK; however, the intensity of her exercise may be increased at the discretion of her physician or after consultation with a cardiologist or other specialist.

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  • Pre-diabetes: Impaired Fasting Glucose (IFG) = fasting plasma glucose ≥ 100 mg/dL but < 126 mg/dL or Impaired Glucose Tolerance (IGT) = 2-hour values in oral glucose tolerance test (OGTT) ≥ 140 mg/dL but < 200 mg/dL confirmed by measurements on ≥ 2 separate occasions 
  • (<2 risk factors = LOW RISK; ≥2 = MODERATE RISK)

Reference:

  1. American College of Sports Medicine. ACSM’S Exercise Is Medicine™: A Clinician’s Guide to Exercise Prescription. Edited by Steven Jonas, MD, MPH, MS, FNYAS. Stony Brook University: School of Medicine, Stony Brook, NY.
  2. American College of Sports Medicine. ACSM’S Guidelines for Exercise Testing and Prescription. Ninth Edition. Stony Brook University: School of Medicine, Stony Brook, NY.