Reports From The Field-Heart disease

Even short duration exercise can improve patient health

Findings may motivate the sedentary

Case managers working with heart patients can pass on the good news that patients don't have to invest hours at the gym to improve their health and lower their risk for serious heart disease. Researchers now have proof that several short sessions of exercise, lasting just 15 minutes each, may be as beneficial as one longer session, according to a recent article in Circulation.

Researchers in the Harvard Alumni Health Study followed 7,307 Harvard University alumni with a mean age of 66.1 years from 1988 through 1993. At baseline, men reported their walking, stair climbing, and participation in sports or recreational activities. For each of the recreational activities, they also reported the frequency and average duration of each episode. During follow-up, 482 men developed coronary heart disease (CHD).

In age-adjusted analysis, a longer duration of exercise episodes predicted lower CHD risk. However, after total energy expended on physical activity and potential confounders was accounted for, duration no longer had an independent effect on CHD risk. In other words, longer sessions of exercise did not have a different effect on risk compared with shorter ones, as long as the total energy expended was similar. In addition, men who engaged in sports or recreational activities showed similar effects on heart disease risk as those who only walked and climbed stairs, provided total energy output was similar. In contrast, researchers found higher levels of total energy expenditure significantly predicted decreased CHD risk in both age-adjusted and multivariate analyses.

Researchers concluded that physical activity is associated with decreased CHD risk. In addition, findings also lend some support to recent recommendations that allow for the accumulation of shorter sessions of physical activity, as opposed to requiring one longer session of exercise. That may provide some impetus for those who are sedentary to become more active, they note.

[See: Lee IM, Sesso HD, Paffenbarger RS. Heart disease risk in men: Does the duration of exercise episodes predict physical activity and coronary risk? Circulation 2000; 102:981-989.]

What type of stroke? Knowing helps predict recovery

Recent study looks at outcomes

Stroke recurrence and survival rates are well-documented, but it has been less clear what those rates are for patients suffering different types of strokes. A recent study in Stroke focused on outcome variations in patients who had strokes without bleeding in or around the brain. Researchers found the following:

• Patients whose embolism originated in the heart (cardioembolic) had the poorest survival.

• Patients whose strokes were caused by intracranial atherosclerosis with narrowing stenosis had higher recurrence rates.

• Patients with lacunae (small areas of cerebral infarction) had better post-stroke functional status than patients with other types of nonhemorrhagic (ischemic) stroke.

The findings are based on a study of functional outcomes of 454 residents of Rochester, MN, who had a first ischemic stroke between 1985 and 1989. Researchers compared how survival and recurrence rates varied among patients with common stroke subtypes. Of the 454 subjects, 80% were hospitalized, and 75% were evaluated by a neurologist.

Among the study subjects, 16% suffered atherosclerotic strokes, 29% suffered cardioembolic strokes, 16% suffered lacunar strokes, 36% suffered strokes of uncertain type, and 3% suffered strokes from unusual causes.

Lacunar patients fared best

Specific findings from the study include the following:

• Lacunar stroke patients had milder maximal neurological deficits at the time of stroke and better post-stroke functional scores compared with patients who had other types of strokes.

• Lacunar stroke patients also had the best functional outcomes, with more than 80% having minimal or no impairment one year after stroke.

• Cardioembolic stroke patients had poorer pre-stroke functional status, more severe neurological deficits at the time of stroke, and poorer functional outcomes compared with other subtypes.

• Cardioembolic stroke patients also were nearly four times as likely to die within 30 days after stroke than patients with atherosclerotic stroke and 2.5 times more likely to die in the next five years.

• Twenty-five patients in the study suffered recurrent strokes within 30 days, with 13 of the 25 suffering large-vessel atherosclerosis with narrowing of the artery as the first stroke subtype.

[See: Petty GW, Brown RD, Whisnant JP, et al. Ischemic stroke subtypes: A population-based study of functional outcome, survival, and recurrence. Stroke 2000; 31:1,062-1,068.]