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Cited by 2,132Physical Activity and HealthCardiovascular and exercise physiologyCardiovascular Effects of Exercise

Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity)

Thompson, Paul D., Buchner, David, Piña, Ileana L., Balady, Gary J., Williams, Mark A., Marcus, Bess H., Berra, Kathy, Blair, Steven N. +8 more·2003·Circulation
DOI 10.1161/01.cir.0000075572.40158.77
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Abstract

R egular physical activity using large muscle groups, such as walking, running, or swimming, produces cardiovascular adaptations that increase exercise capacity, endurance, and skeletal muscle strength.Habitual physical activity also prevents the development of coronary artery disease (CAD) and reduces symptoms in patients with established cardiovascular disease.There is also evidence that exercise reduces the risk of other chronic diseases, including type 2 diabetes, 1 osteoporosis, 2 obesity, 3 depression, 4 and cancer of the breast 5 and colon.6 This American Heart Association (AHA) Scientific Statement for health professionals summarizes the evidence for the benefits of physical activity in the prevention and treatment of cardiovascular disease, provides suggestions to healthcare professionals for implementing physical activity programs for their patients, and identifies areas for future investigation.This statement focuses on aerobic physical activity and does not directly evaluate resistance exercises, such as weight lifting, because most of the research linking physical activity and cardiovascular disease has evaluated aerobic activity.Whenever possible, the writing group has cited summary articles or meta-analyses to support conclusions and recommendations.This evidence supports the recommendation from the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) that individuals should engage in 30 minutes or more of moderate…

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Crossref · 10.1161/01.cir.0000075572.40158.77

Cites

84 of 84 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

21 of 137 cited sources checked · 12 supported · 0 flagged · accuracy not yet measured

  • Interpretationcitation

    In contrast to prior analyses, recent results suggest that the exercise component is a critical aspect of the rehabilitation process.

    “In contrast to the prior analyses, however, these recent results suggest that the exercise component is a critical aspect of the rehabilitation process.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source
  • Findingcitation

    The most recent and comprehensive meta-analysis identified 51 randomized controlled trials of exercise-based cardiac rehabilitation.

    “The most recent and comprehensive meta-analysis identified 51 randomized controlled trials of exercise-based cardiac rehabilitation.25”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

      The Effects of interventions section reports 36 exercise-based cardiac rehabilitation trials found and 32 included. Subdividing some included trials produced 51 separate studies, not 51 randomized controlled trials. The Discussion describes this review as including more trials and patients than earlier meta-analyses. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    These findings suggest that exercise training altered the coronary vasomotor response to exercise.

    “These findings suggest that exercise training altered the coronary vasomotor response to exercise.32”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [32] 32. Sim DN, Neill WA. Investigation of the physiological basis for increased exercise threshold for angina pectoris after physical conditioning. J Clin Invest. 1974;54:763-770. source

      In the Results/Discussion (page not supplied), the paper considers an exercise-specific coronary vasomotor response as one possible explanation for the higher angina threshold after conditioning. It also offers an alternative involving myocardial oxygen consumption and says it lacked the measurements during exercise needed to distinguish the two. The findings therefore do not specifically establish an altered vasomotor response. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Findingcitation

    The incidence of injury can be as high as 55% in 8 weeks among women undergoing US Army basic training.

    “The incidence of injury can be as high as 55% in 8 weeks among women undergoing US Army basic training.52”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [52] 52. Jones BH, Knapik JJ. Physical training and exercise-related injuries: sur- veillance, research and injury prevention in military populations. Sports Med. 1999;27:111-125. source
  • Premisecitation

    Vigorous physical activity acutely increases the risk of myocardial infarction among individuals with diagnosed and occult heart disease.

    “Vigorous physical activity acutely increases the risk of sudden cardiac death 56,57 and myocardial infarction 58,59 among individuals with both diagnosed and occult heart disease.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [58] 58. Mittleman MA, Maclure M, Tofler GH, et al. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med. 1993;329:1677-1683. source
    • cites [59] 59. Giri S, Thompson PD, Kiernan FJ, et al. Clinical and angiographic charac- teristics of exertion-related acute myocardial infarction. JAMA. 1999;282: 1731-1736. source
  • May combine two claims. 42
  • Classified as probably not a substantial claim. 7

  • May combine two claims.

    Findingcitation

    Total mortality was reduced 27% (P<0.05) with the exercise-only intervention and 13% (P=NS) with comprehensive rehabilitation.

    “Total mortality was reduced 27% (PϽ0.05) with the exercise-only intervention and 13% (PϭNS) with comprehensive rehabilitation (Table).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

  • May combine two claims.

    Interpretationcitation

    This review adds approximately 4000 patients to prior meta-analyses and confirms that exercise-based cardiac rehabilitation reduces cardiac mortality but does not reduce the risk of recurrent myocardial infarction.

    “This review 25 adds Ϸ4000 patients to the prior, widely cited meta-analyses of cardiac rehabilitation 23,24 and confirms that exercise-based cardiac rehabilitation reduces cardiac mortality but does not reduce the risk of recurrent myocardial infarction.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source
    • cites [23] 23. O'Connor GT, Buring JE, Yusuf S, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation. 1989; 80:234 -244. source
    • cites [24] 24. Oldridge NB, Guyatt GH, Fischer ME, et al. Cardiac rehabilitation after myocardial infarction: combined experience of randomized clinical trials. JAMA. 1988;260:945-950. source

  • May combine two claims.

    Findingcitation

    All studies in that meta-analysis were published before January 1, 1999, and included 8440 patients who were primarily middle-aged, low-risk men.

    “All studies were published before January 1, 1999, and included 8440 patients who were primarily middle-aged, low-risk men.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

      The Discussion reports 8,440 patients, and “Characteristics of trial participants” describes a predominantly male, middle-aged population whose studies commonly excluded people with comorbidity or heart failure. The Search methods say databases were searched through December 31, 1998, but that does not establish that every included study was published before January 1, 1999; the included-study tables list “Bell 99.” Page numbers were not available for these passages. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Rates of sudden cardiac death were not reduced, although only 4 exercise-only and 14 comprehensive rehabilitation trials analyzed this outcome.

    “Additionally, rates of sudden cardiac death were not reduced, although only 4 exercise-only and 14 comprehensive rehabilitation trials analyzed this outcome.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

      The Effects of interventions section reports no significant effect on sudden cardiac deaths and says that only 4 exercise-only trials and 14 comprehensive rehabilitation trials reported this outcome. The trial counts match, but 'rates were not reduced' states a stronger conclusion than the paper's finding of no statistically significant effect. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Cardiac mortality was reduced 31% (P<0.05) and 26% (P<0.05) for the exercise-only and comprehensive programs, respectively.

    “Cardiac mortality was reduced 31% (PϽ0.05) and 26% (PϽ0.05) for the exercise-only and comprehensive programs, respectively.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

  • May combine two claims.

    Findingcitation

    At least 8 studies have examined the adjunctive effect of exercise on smoking cessation, but most trials were small and the results not subjected to meta-analysis.

    “At least 8 studies have examined the adjunctive effect of exercise on smoking cessation, but most trials were small and the results not subjected to meta-analysis.21”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [21] 21. Ussher MH, West R, Taylor AH, et al. Exercise interventions for smoking cessation. Cochrane Database Syst Rev. 2000;(3):CD002295. source

  • May combine two claims.

    Findingcitation

    Only 5 exercise-only trials and 10 comprehensive trials examined the rate of coronary artery bypass grafting.

    “Similarly, only 5 exercise-only trials and 10 comprehensive trials examined the rate of coronary artery bypass grafting.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

  • May combine two claims.

    Findingcitation

    Neither the exercise-only program nor the comprehensive intervention significantly reduced the rate of nonfatal myocardial infarction.

    “Neither the exercise-only program nor the comprehensive intervention significantly reduced the rate of nonfatal myocardial infarction.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

  • May combine two claims.

    Findingcitation

    Exercise training in heart failure patients improves cardiac output at maximal workloads, mitochondrial size and density, skeletal muscle oxidative enzymes, reduces endothelial dysfunction, and decreases circulating catecholamines.

    “In addition to improving exercise capacity, exercise training in HF patients has been shown to improve cardiac output at maximal workloads, 36 improve mitochondrial size and density, 37 increase skeletal muscle oxidative enzymes, reduce endothelial dysfunction, 38 and decrease circulating catecholamines.39”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [36] 36. Cheetham C, Green D, Collis J, et al. Effect of aerobic and resistance exercise on central hemodynamic responses in severe chronic heart failure. J Appl Physiol. 2002;93:175-180. source
    • cites [37] 37. Hambrecht R, Fiehn E, Yu J, et al. Effects of endurance training on mito- chondrial ultrastructure and fiber type distribution in skeletal muscle of patients with stable chronic heart failure. J Am Coll Cardiol. 1997;29: 1067-1073. source
    • cites [38] 38. Gielen S, Erbs S, Schuler G, et al. Exercise training and endothelial dys- function in coronary artery disease and chronic heart failure: from molecular biology to clinical benefits. Minerva Cardioangiol. 2002;50:95-106.

  • May combine two claims.

    Findingcitation

    In one study, the increase in rate-pressure product at the onset of angina occurred only during exercise, whereas the rate-pressure product at the onset of angina with ventricular pacing was unchanged.

    “In one study, the increase in RPP at the onset of angina occurred only during exercise, 32 whereas the RPP at the onset of angina with ventricular pacing was unchanged.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [32] 32. Sim DN, Neill WA. Investigation of the physiological basis for increased exercise threshold for angina pectoris after physical conditioning. J Clin Invest. 1974;54:763-770. source

      The Results report that RPP at the angina threshold rose after conditioning during exercise but was unchanged during pacing. The Methods identify that procedure as atrial pacing, not the ventricular pacing specified in the claim. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Older patients with CAD have exercise trainability comparable to that of younger patients participating in similar exercise rehabilitation, with elderly male and female patients showing comparable improvement.

    “Older patients with CAD have exercise trainability comparable to that of younger patients participating in similar exercise rehabilitation, with elderly male and female patients showing comparable improvement.[45][46][47]”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [45] 45. Lavie CJ, Milani RV, Littman AB. Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly. J Am Coll Cardiol. 1993;22:678 -683. source

      The Abstract’s Results and Conclusions report similar improvements in exercise capacity among older and younger patients in cardiac rehabilitation, supporting the age comparison. The available passages do not report a comparison of improvement between elderly male and female patients; a search for sex-specific results found none. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [46] 46. Williams MA, Maresh CM, Esterbrooks DJ, et al. Early exercise training in patients older than age 65 years compared with that in younger patients after acute myocardial infarction or coronary artery bypass grafting. Am J Cardiol. 1985;55:263-266. source
    • cites [47] 47. Ades PA, Waldmann ML, Gillespie C. A controlled trial of exercise training in older coronary patients. J Gerontol A Biol Sci Med Sci. 1995;50A: M7-M11. source

  • May combine two claims.

    Findingcitation

    Risk of injury increases with obesity, volume of exercise, and participation in vigorous exercise such as competitive sports, whereas higher fitness, supervision, stretching exercises, protective equipment such as bike helmets, and well-designed environments protect against injury.

    “Risk of injury increases with obesity, 51 volume of exercise, 50 and participation in vigorous exercise such as competitive sports, 54 whereas higher fitness, 50 supervision, stretching exercises, protective equipment such as bike helmets, and well-designed environments protect against injury.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [50] 50. Hootman JM, Macera CA, Ainsworth BE, et al. Epidemiology of musculo- skeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc. 2002;34:838 -844. source
    • cites [51] 51. Sutton AJ, Muir KR, Mockett S, et al. A case-control study to investigate the relation between low and moderate levels of physical activity and osteoar- thritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey. Ann Rheum Dis. 2001;60:756 -764. source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [54] 54. Nicholl JP, Coleman P, Williams BT. The epidemiology of sports and exercise related injury in the United Kingdom. Br J Sports Med. 1995;29: 232-238. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Eighty-one percent of the registrants reported increased physical activity.

    “Eighty-one percent of the registrants reported increased physical activity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] 3. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-341.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    Average systolic and diastolic blood pressures decreased 2.6 and 1.8 mm Hg in normotensive subjects and 7.4 and 5.8 mm Hg in hypertensive subjects, respectively.

    “Average systolic and diastolic blood pressures decreased 2.6 and 1.8 mm Hg in normotensive subjects and 7.4 and 5.8 mm Hg in hypertensive subjects, respectively, suggesting that exercise may serve as the only therapy required in some mildly hypertensive subjects.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] 19. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 suppl): S484 -S492. source

  • May combine two claims.

    Findingnone given

    Physical activity both prevents and helps treat many established atherosclerotic risk factors, including elevated blood pressure, insulin resistance and glucose intolerance, elevated triglyceride concentrations, low HDL-C concentrations, and obesity.

    “Physical activity both prevents and helps treat many established atherosclerotic risk factors, including elevated blood pressure, insulin resistance and glucose intolerance, elevated triglyceride concentrations, low high-density lipoprotein cholesterol (HDL-C) concentrations, and obesity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Exercise reduces the risk of type 2 diabetes, osteoporosis, obesity, depression, and breast and colon cancer.

    “There is also evidence that exercise reduces the risk of other chronic diseases, including type 2 diabetes, 1 osteoporosis, 2 obesity, 3 depression, 4 and cancer of the breast 5 and colon.6”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] 1. Knowler WC, Barrett-Connor E, Fowler SE, et al, for the Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. source
    • cites [2] 2. Vuori IM. Dose-response of physical activity and low back pain, osteoar- thritis, and osteoporosis. Med Sci Sports Exerc. 2001;33(6 suppl):S551-S586. source
    • cites [3] 3. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-341.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    The results are consistent with all published studies documenting lower CAD rates in more active subjects, although the relationship did not reach statistical significance in some individual reports.

    “The results are consistent with all published studies documenting lower CAD rates in the more active subjects, although the relationship did not reach statistical significance in some individual reports.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9] 9. Lee IM, Paffenbarger RS Jr, Hennekens CH. Physical activity, physical fitness and longevity. Aging (Milano). 1997;9:2-11. source
    • cites [10] 10. Blair SN, Jackson AS. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. 2001;33:762-764. source

  • May combine two claims.

    Findingcitation

    A meta-analysis of 52 exercise training trials of more than 12 weeks' duration including 4700 subjects demonstrated an average increase in HDL-C levels of 4.6% and reductions in triglyceride and LDL-C concentrations of 3.7% and 5.0%, respectively.

    “A meta-analysis of 52 exercise training trials of Ͼ12 weeks' duration including 4700 subjects demonstrated an average increase in HDL-C levels of 4.6% and reductions in triglyceride and LDL-C concentrations of 3.7% and 5.0%, respectively.15,16”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] 15. Leon AS, Sanchez OA. Response of blood lipids to exercise training alone or combined with dietary intervention. Med Sci Sports Exerc. 2001;33(6 suppl): S502-S515. source
    • cites [16] 16. Leon AS, Sanchez O. Meta-analysis of the effects of aerobic exercise training on blood lipids. Circulation. 2001;104(suppl II):II-414 -II-415. Abstract.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    Physical activity reduces insulin resistance and glucose intolerance, postprandial hyperglycemia, and possibly hepatic glucose output.

    “Physical activity also reduces insulin resistance and glucose intolerance, postprandial hyperglycemia, and possibly hepatic glucose output.20”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] 20. Thompson PD, Crouse SF, Goodpaster B, et al. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001;33(6 suppl):S438 -S445. source

  • May combine two claims.

    Findingcitation

    Exercise in combination with weight reduction can decrease LDL-C concentrations and limit the reduction in HDL-C that often occurs with a reduction in dietary saturated fat.

    “Exercise in combination with weight reduction can decrease low-density lipoprotein cholesterol (LDL-C) concentrations and limit the reduction in HDL-C that often occurs with a reduction in dietary saturated fat.14”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] 14. Stefanick ML, Mackey S, Sheehan M, et al. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. N Engl J Med. 1998;339:12-20. source

  • May combine two claims.

    Findingcitation

    In the HERITAGE study, HDL-C among the 376 women increased 1.4 mg/dL (3%), and triglycerides and LDL-C decreased 0.6 and 4.4 mg/dL or 0.6% and 4%, respectively.

    “HDL-C among the 376 women increased 1.4 mg/dL (3%), and triglycerides and LDL-C decreased 0.6 and 4.4 mg/dL or 0.6% and 4%, respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] 17. Leon AS, Rice T, Mandel S, et al. Blood lipid response to 20 weeks of supervised exercise in a large biracial population: the HERITAGE Family Study. Metabolism. 2000;49:513-520. source

  • May combine two claims.

    Findingcitation

    The lifestyle intervention was significantly more powerful than metformin (850 mg BID), which reduced the onset of type II diabetes by 31%.

    “The lifestyle intervention was also significantly more powerful than metformin (850 mg BID), which reduced the onset of type II diabetes by 31%.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] 1. Knowler WC, Barrett-Connor E, Fowler SE, et al, for the Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. source

  • May combine two claims.

    Findingcitation

    In the HERITAGE study, HDL-C increased 1.1 mg/dL (3%) among the 299 men studied, whereas triglycerides and LDL-C decreased 5.9 and 0.9 mg/dL or 2.7% and 0.8%, respectively.

    “HDL-C increased 1.1 mg/dL (3%) among the 299 men studied, whereas triglycerides and LDL-C decreased 5.9 and 0.9 mg/dL or 2.7% and 0.8%, respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] 17. Leon AS, Rice T, Mandel S, et al. Blood lipid response to 20 weeks of supervised exercise in a large biracial population: the HERITAGE Family Study. Metabolism. 2000;49:513-520. source

  • May combine two claims.

    Findingcitation

    During 33±7 months of follow-up, exercise-trained patients had fewer cardiac events (11.9% versus 32.2%) and hospital readmissions (18.6% versus 46%) than subjects assigned to usual care.

    “Furthermore, during 33Ϯ7 months of follow-up, the exercise-trained patients had fewer cardiac events (11.9% versus 32.2%) and hospital readmissions (18.6% versus 46%) than subjects assigned to usual care.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] 34. Belardinelli R, Paolini I, Cianci G, et al. Exercise training intervention after coronary angioplasty: the ETICA trial. J Am Coll Cardiol. 2001;37: 1891-1900. source

  • May combine two claims.

    Findingcitation

    Residual coronary stenosis and recurrent cardiac events were reduced by 30% and 29%, respectively, in the trained subjects.

    “Residual coronary stenosis and recurrent cardiac events were reduced by 30% and 29%, respectively, in the trained subjects.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] 34. Belardinelli R, Paolini I, Cianci G, et al. Exercise training intervention after coronary angioplasty: the ETICA trial. J Am Coll Cardiol. 2001;37: 1891-1900. source

  • May combine two claims.

    Findingnone given

    No large studies have directly addressed the utility of exercise in patients after coronary revascularization, although there are encouraging data.

    “No large studies have directly addressed the utility of exercise in this group, although there are encouraging data.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Vigorous exercise acutely reduces systolic blood pressure, and this effect may persist for up to 12 hours.

    “Vigorous exercise also acutely reduces systolic blood pressure, and this effect may persist for up to 12 hours.20”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] 20. Thompson PD, Crouse SF, Goodpaster B, et al. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001;33(6 suppl):S438 -S445. source

  • May combine two claims.

    Findingcitation

    In the ETICA trial, angiographic restenosis was not affected by exercise training, but trained patients demonstrated significant increases in peak VO2 (26%) and quality-of-life parameters (27%).

    “Angiographic restenosis was not affected by exercise training, but trained patients demonstrated significant increases in peak V ˙O2 (26%) and quality-of-life parameters (27%).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] 34. Belardinelli R, Paolini I, Cianci G, et al. Exercise training intervention after coronary angioplasty: the ETICA trial. J Am Coll Cardiol. 2001;37: 1891-1900. source

  • May combine two claims.

    Findingnone given

    Numerous trials have demonstrated that both exercise testing and training of patients with heart failure appear to be safe.

    “Numerous trials have demonstrated that both exercise testing and training of patients with HF appear to be safe.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In a cohort study of community adults aged 20 to 85 years with above-average activity levels, approximately 25% reported a musculoskeletal injury over 1 year, and one third of injured adults stopped exercising.

    “In a cohort study of community adults aged 20 to 85 years with above-average activity levels, Ϸ25% reported a musculoskeletal injury over 1 year, 50 and one third of injured adults stopped exercising.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] 50. Hootman JM, Macera CA, Ainsworth BE, et al. Epidemiology of musculo- skeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc. 2002;34:838 -844. source

  • May combine two claims.

    Findingcitation

    A direct comparison of invasive treatment and supervised exercise training found improvement at 1 year only in the invasively treated patients, so the issue remains controversial.

    “In contrast, a direct comparison of invasive treatment and supervised exercise training found improvement at 1 year only in the invasively treated patients, 44 so the issue remains controversial.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] 44. Gelin J, Jivegard L, Taft C, et al. Treatment efficacy of intermittent claudi- cation by surgical intervention, supervised physical exercise training compared to no treatment in unselected randomised patients: I. one year results of functional and physiological improvements. Eur J Vasc Endovasc Surg. 2001;22:107-113. source

  • May combine two claims.

    Findingcitation

    The greatest improvement with exercise training for claudication occurred with training to maximal tolerated pain, when training lasted at least 6 months, and when walking was the primary mode of exercise.

    “The greatest improvement with exercise training for claudication occurred with training to maximal tolerated pain, when training lasted at least 6 months, and when walking was the primary mode of exercise.42”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] 42. Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA. 1995;274:975-980. source

  • May combine two claims.

    Interpretationnone given

    In general, the effect of exercise on atherosclerotic risk factors is substantially less than that achieved by pharmacological therapies, although the exercise effect can be significantly magnified by other lifestyle changes such as changes in dietary composition and weight loss.

    “In general, the effect of exercise on atherosclerotic risk factors is substantially less than that achieved by pharmacological therapies, although the exercise effect can be significantly magnified by other lifestyle changes such as changes in dietary composition and weight loss.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    There was no relationship between weekly training frequency, time per session, or intensity of exercise training and the magnitude of blood pressure reduction, which suggests that the dose-response curve for exercise and blood pressure is flat.

    “There was no relationship between the weekly training frequency, time per session, or intensity of exercise training and the magnitude of the blood pressure reduction, which suggests that the dose-response curve for exercise and blood pressure is flat.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] 19. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 suppl): S484 -S492. source

  • May combine two claims.

    Interpretationnone given

    Habitual physical activity prevents the development of coronary artery disease and reduces symptoms in patients with established cardiovascular disease.

    “Habitual physical activity also prevents the development of coronary artery disease (CAD) and reduces symptoms in patients with established cardiovascular disease.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Greater increases in HDL-C may occur in individuals with baseline hypertriglyceridemia, but few studies have addressed the effect of exercise in subjects with lipid disorders.

    “Greater increases in HDL-C may occur in individuals with baseline hypertriglyceridemia, 18 but few studies have addressed the effect of exercise in subjects with lipid disorders.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] 18. Couillard C, Despres JP, Lamarche B, et al. Effects of endurance exercise training on plasma HDL cholesterol levels depend on levels of triglycerides: evidence from men of the Health, Risk Factors, Exercise Training and Genetics (HERITAGE) Family Study. Arterioscler Thromb Vasc Biol. 2001; 21:1226 -1232. source

  • May combine two claims.

    Interpretationreasoning

    The effect of exercise on atherosclerotic risk factors can be large in some individuals and obviate the need for other interventions.

    “The effect on atherosclerotic risk factors can be large in some individuals and obviate the need for other interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Some subsequent reports demonstrated an increase in the rate-pressure product at the onset of angina as well as a reduction in the ischemic response measured as angina, ST-segment depression, or nuclear and positron-emission tomography scanning perfusion defects at a given rate-pressure product, which suggests that exercise training improved myocardial oxygen delivery.

    “Some subsequent reports also demonstrated an increase in the RPP at the onset of angina as well as a reduction in the ischemic response measured as angina, ST-segment depression, 29 or nuclear and positron-emission tomography scanning perfusion defects 30,31 at a given RPP, which suggests that exercise training improved myocardial oxygen delivery.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [29] 29. Ehsani AA, Martin WH 3rd, Heath GW, et al. Cardiac effects of prolonged and intense exercise training in patients with coronary artery disease. Am J Cardiol. 1982;50:246 -254. source
    • cites [30] 30. Niebauer J, Hambrecht R, Velich T, et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation. 1997;96:2534 -2541. source
    • cites [31] 31. Gould KL, Ornish D, Kirkeeide R, et al. Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. Am J Cardiol. 1992;69:845-853. source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    These acute effects provide additional support for the CDC and ACSM recommendations that adults should participate in moderate-intensity physical activity on most, if not all, days of the week.

    “These acute effects provide additional support for the recommendations from the CDC and the ACSM that adults should participate in moderate-intensity physical activity on most, if not all, days of the week.7”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] 7. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402-407. source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The effects of medical treatment may be overestimated in medical intervention trials not involving exercise.

    “Similarly, the effects of medical treatment may be overestimated in medical intervention trials not involving exercise.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The reduction in death without a reduction in nonfatal reinfarction raises the possibility that exercise training enhanced electrical stability and reduced ventricular fibrillation or reduced myocardial damage directly or via factors such as ischemic preconditioning.

    “The reduction in death without a reduction in nonfatal reinfarction raises the possibility that exercise training enhanced electrical stability and reduced ventricular fibrillation 26 or reduced myocardial damage directly or via such factors as ischemic preconditioning.27”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [26] 26. Billman GE. Aerobic exercise conditioning: a nonpharmacological antiar- rhythmic intervention. J Appl Physiol. 2002;92:446 -454. source
    • cites [27] 27. Hamilton KL, Powers SK, Sugiura T, et al. Short-term exercise training can improve myocardial tolerance to I/R without elevation in heat shock proteins. Am J Physiol Heart Circ Physiol. 2001;281:H1346 -H1352. source

  • May combine two claims.

    Interpretationcitation

    Whether physiological adaptations from exercise training will ultimately reduce mortality and morbidity in heart failure is yet to be determined by a large prospective trial, although at least one small trial showed a reduction in hospitalizations and improved 1-year survival.

    “Whether these physiological adaptations will ultimately reduce mortality and morbidity is yet to be determined by a large prospective trial, although there is at least one small trial which showed a reduction in hospitalizations and improved 1-year survival.41”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] 41. Belardinelli R, Georgiou D, Cianci G, et al. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation. 1999; 99:1173-1182. source

  • May combine two claims.

    Premisecitation

    A preliminary report from a 3-million-member national fitness facility noted 61 male and 10 female deaths over 2 years and calculated an incidence rate of 1 death per 82 000 members per year or 2.6 million workouts.

    “A preliminary report from a 3-million-member national fitness facility noted 61 male and 10 female deaths over 2 years and calculated incidence rate of 1 death per 82 000 members per year or 2.6 million workouts.63”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] 63. Franklin BA, Conviser JM, Stewart B, et al. Sporadic exercise: a trigger for acute cardiovascular events? Circulation. 2000;102(suppl II):II-612. Abstract.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The original AHA Statement on Exercise in 1992 was among the first documents to conclude that physical inactivity is a major CAD risk factor.

    “Indeed, the original AHA Statement on Exercise in 1992 66 was among the first documents to conclude that physical inactivity is a major CAD risk factor.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] 66. Fletcher GF, Balady G, Blair SN, et al. Statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Asso- ciation. Circulation. 1996;94:857-862. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Regular physical activity reduces the risk of fall injuries in older adults.

    “In some situations, regular physical activity actually reduces injury risk, as indicated by a recent consensus statement that physical activity is recommended to reduce the risk of fall injuries in older adults.55”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] 55. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001;49:664 -672. source

  • May combine two claims.

    Premisecitation

    The 6 strategies deemed effective by the Task Force on Community Preventive Services are: (1) large-scale, intense, highly visible, community-wide campaigns; (2) point-of-decision prompts that encourage people to use the stairs instead of elevators or escalators; (3) physical education programs in schools; (4) social support programs such as buddy systems and walking groups; (5) individually-adapt

    “The 6 strategies deemed effective were: (1) large-scale, intense, highly visible, community-wide campaigns; (2) point-ofdecision prompts that encourage people to use the stairs instead of elevators or escalators; (3) physical education programs in schools; (4) social support programs (such as buddy systems and walking groups); (5) individually adapted behavior change programs; and (6) enhanced”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] 71. Increasing physical activity: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep. October 26, 2001;50(RR-18):1-14.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationcitation

    Physical activity and exercise training have important roles in preventing atherosclerotic CAD; managing selected CAD risk factors, including elevated triglyceride levels, low HDL-C, hypertension, glucose intolerance, obesity, and possibly cigarette use; and treating patients with CAD, HF, and claudication.

    “Physical activity and exercise training have important roles in: A. Preventing atherosclerotic CAD; B. Managing selected CAD risk factors, including elevated triglyceride levels, low HDL-C, hypertension, glucose intolerance, hypertension, obesity, and possibly cigarette use; C. Treating patients with CAD, HF, and claudication.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The general principle that the volume of physical activity should be increased gradually over time is critical for reducing injury risk.

    “The general principle that the volume of physical activity should be increased gradually over time is widely regarded as critical for reducing injury risk.7”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] 7. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402-407. source
48 of 48

  • The paper relies on this without support.

    Acute improvements in cardiovascular risk factors from exercise translate into reduced cardiovascular disease risk.

    “These acute effects provide additional support for the recommendations from the CDC and the ACSM that adults should participate in moderate-intensity physical activity on most, if not all, days of the week.7”

  • The paper relies on this without support.

    The epidemiological criteria used by the authors are sufficient to establish a causal relationship between physical activity and reduced CAD.

    “The data satisfy the criteria required to infer a causal relationship from epidemiological evidence.11,12”

  • The paper relies on this without support.

    Atherosclerotic vascular disease remains the major cause of death in many countries.

    “Because atherosclerotic vascular disease remains the major cause of death in many countries, it is important that healthcare providers support the implementation and maintenance of exercise programs for their patients across the lifespan.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The cited exercise statement has a conflicting year

    Minor

    The text dates the cited AHA exercise statement to 1992, but reference 66 lists its publication year as 1996.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 19

  1. 2001, Cancer Epidemiol Biomarkers Prev, 10, 805
  2. 10.1161/circ.104.14.1694 · DOI
  3. 1997, Aging (Milano), 9, 2
  4. 2001, Med Sci Sports Exerc, 33, 762
  5. 2001, Circulation, 104, II-414
  6. 10.1161/atvb.21.7.1226 · DOI
  7. 2000, Cochrane Database Syst Rev, CD002295.
  8. 10.1161/circ.80.2.2665973 · DOI
  9. 2001, Cochrane Database Syst Rev, CD001800.
  10. 10.1161/circ.53.3.813911 · DOI
  11. 10.1161/circ.96.8.2534 · DOI
  12. 2002, Minerva Cardioangiol, 50, 95
  13. 10.1161/circ.99.9.1173 · DOI
  14. 10.1161/circ.102.12.1358 · DOI
  15. 10.1161/circ.94.4.850 · DOI
  16. 2000, Circulation, 102, II
  17. 10.1161/circ.94.4.857 · DOI
  18. 10.1161/circ.101.7.828 · DOI
  19. 2001, MMWR Recomm Rep, 50, 1

Cited by

Sorted by citations

Related

Authors
Thompson, P. D., Buchner, D., Piña, I. L., Balady, G. J., Williams, M. A., Marcus, B. H., Berra, K., Blair, S. N., Costa, F., Franklin, B., Fletcher, G. F., Gordon, N. F., Pate, R. R., Rodriguez, B. L., Yancey, A. K., & Wenger, N. K.
Affiliations
American Heart Association (US)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2003-06-24
Volume
107
Issue
24
Pages
3109-3116
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.0000075572.40158.77
OpenAlex
W2117855475
Cited by
2,132
References
75
Citations by year
2026: 29 · 2025: 41 · 2024: 44 · 2023: 49 · 2022: 50 · 2021: 52 · 2020: 66 · 2019: 76 · 2018: 101 · 2017: 112 · 2016: 114 · 2015: 121 · 2014: 131 · 2013: 143 · 2012: 133
FWCI
52.84
Type
journal article
Language
en
Open access
closed
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
Keywords
physical activity, atherosclerotic cardiovascular disease, coronary artery disease, cardiovascular disease prevention, cardiovascular disease treatment, aerobic exercise, exercise capacity, cardiovascular adaptation, physical activity guidelines, chronic disease risk reduction
MeSH terms
Arteriosclerosis, Blood Pressure, Body Weight, Cardiovascular Diseases, Clinical Trials as Topic, Female, Humans, Insulin Resistance, Lipoproteins, HDL, Lipoproteins, LDL, Male, Motor Activity, Research, Risk Factors, Meta-Analysis as Topic, Weight Loss, Exercise, Smoking Cessation, Treatment Outcome, Exercise Tolerance, Risk Assessment, Risk Reduction Behavior

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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