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Physical activity and fitness vs adiposity and weight loss for the prevention of cardiovascular ...
https://www.nature.com/articles/s41366-022-01209-wPublished: 20 August 2022
Physical activity and fitness vs adiposity and weight loss for the prevention of cardiovascular disease and cancer mortality
Carl J. Lavie, Robert Ross & Ian J. Neeland
International Journal of Obesity (2022)
Considerable and unequivocal evidence demonstrates the importance of obesity as a risk factor for numerous chronic diseases, especially cardiovascular disease (CVD), disabilities, and reduced quality and duration of life [1, 2]. Despite this recognition, the rate of obesity continues to rise in the United States and worldwide. The importance of physical activity (PA), exercise, and cardiorespiratory fitness (CRF) has also been recognized, yet physical inactivity and sedentary behavior remain highly prevalent worldwide [1,2,3]. The relative importance of obesity, PA, and CRF, both individually and jointly, and changes in these parameters, continues to be debated.
In the current issue of the International Journal of Obesity, Ahmadi and colleagues [4] assessed longitudinal data from Taiwan’s MJ cohort on 116, 228 adults with repeated measures of PA, body mass index (BMI), waist circumference (WC), and body fat percentage (BF %) 4.6 years apart with assessment of mortality from CVD and cancer over 12 years. Increasing PA over time was associated with lower all-cause mortality (ACM) and CVD-mortality, by 15 and 28%, respectively. On the other hand, reducing adiposity attenuated but did not offset mortality risk for ACM, CVD-mortality, and cancer-mortality, whereas only maintaining a healthy adiposity over time offset mortality risk. Lower mortality risk was associated with increases in PA across adiposity change groups. Decreased adiposity somewhat attenuated the negative association of decreased PA. The authors concluded that the beneficial association of joint changes in PA and adiposity was primarily driven by PA.
A primary finding of the Ahmadi et al. paper is that PA drives the interaction between PA, WC and ACM/CVD-mortality, although the authors may have somewhat understated the relative contribution of PA. Of interest from a public health perspective is the observation that increasing PA essentially eliminates most of the risk for ACM and CVD-mortality associated with a stable or increased WC. This is a finding that is entirely consistent with numerous observations demonstrating that exercise is associated with benefits across a wide range of health outcomes in association with no or minimal weight loss – certainly weight loss below the suggested threshold of 5%, which has recently been reviewed [1]. However, considerable evidence suggests that a monolithic focus on weight loss as the only determinant of success for strategies that aim to reduce obesity is not justified and, more importantly, eliminates opportunities to focus on other potentially important lifestyle behaviors that are associated with substantial health benefits. The finding that obesity and related health risks can be considerably reduced by adoption of a physically active lifestyle and a healthy diet, even in the presence of minimal weight loss, is encouraging and provides the practitioner and the adult with overweight/obesity additional options for successful treatment [1]. Therefore, if a patient increases PA and achieves moderate weight loss, this may be ideal. However, much can be achieved with increases in PA and CRF without much weight loss, which is generally associated with improvements in cardiometabolic risk, which is a powerful message for patients [1].
Additionally, substantial evidence suggests that focusing on improving CRF, which is largely driven by PA and exercise, and reducing visceral/ectopic adiposity, may be more important, as these are the key drivers of cardiometabolic diseases and adverse outcomes in patients with overweight and obesity [5]. Indeed, reductions in visceral fat do not always equate to substantial weight loss; but, are associated with lower CVD risk.
[...]
Physical activity and fitness vs adiposity and weight loss for the prevention of cardiovascular disease and cancer mortality
Carl J. Lavie, Robert Ross & Ian J. Neeland
International Journal of Obesity (2022)
Considerable and unequivocal evidence demonstrates the importance of obesity as a risk factor for numerous chronic diseases, especially cardiovascular disease (CVD), disabilities, and reduced quality and duration of life [1, 2]. Despite this recognition, the rate of obesity continues to rise in the United States and worldwide. The importance of physical activity (PA), exercise, and cardiorespiratory fitness (CRF) has also been recognized, yet physical inactivity and sedentary behavior remain highly prevalent worldwide [1,2,3]. The relative importance of obesity, PA, and CRF, both individually and jointly, and changes in these parameters, continues to be debated.
In the current issue of the International Journal of Obesity, Ahmadi and colleagues [4] assessed longitudinal data from Taiwan’s MJ cohort on 116, 228 adults with repeated measures of PA, body mass index (BMI), waist circumference (WC), and body fat percentage (BF %) 4.6 years apart with assessment of mortality from CVD and cancer over 12 years. Increasing PA over time was associated with lower all-cause mortality (ACM) and CVD-mortality, by 15 and 28%, respectively. On the other hand, reducing adiposity attenuated but did not offset mortality risk for ACM, CVD-mortality, and cancer-mortality, whereas only maintaining a healthy adiposity over time offset mortality risk. Lower mortality risk was associated with increases in PA across adiposity change groups. Decreased adiposity somewhat attenuated the negative association of decreased PA. The authors concluded that the beneficial association of joint changes in PA and adiposity was primarily driven by PA.
A primary finding of the Ahmadi et al. paper is that PA drives the interaction between PA, WC and ACM/CVD-mortality, although the authors may have somewhat understated the relative contribution of PA. Of interest from a public health perspective is the observation that increasing PA essentially eliminates most of the risk for ACM and CVD-mortality associated with a stable or increased WC. This is a finding that is entirely consistent with numerous observations demonstrating that exercise is associated with benefits across a wide range of health outcomes in association with no or minimal weight loss – certainly weight loss below the suggested threshold of 5%, which has recently been reviewed [1]. However, considerable evidence suggests that a monolithic focus on weight loss as the only determinant of success for strategies that aim to reduce obesity is not justified and, more importantly, eliminates opportunities to focus on other potentially important lifestyle behaviors that are associated with substantial health benefits. The finding that obesity and related health risks can be considerably reduced by adoption of a physically active lifestyle and a healthy diet, even in the presence of minimal weight loss, is encouraging and provides the practitioner and the adult with overweight/obesity additional options for successful treatment [1]. Therefore, if a patient increases PA and achieves moderate weight loss, this may be ideal. However, much can be achieved with increases in PA and CRF without much weight loss, which is generally associated with improvements in cardiometabolic risk, which is a powerful message for patients [1].
Additionally, substantial evidence suggests that focusing on improving CRF, which is largely driven by PA and exercise, and reducing visceral/ectopic adiposity, may be more important, as these are the key drivers of cardiometabolic diseases and adverse outcomes in patients with overweight and obesity [5]. Indeed, reductions in visceral fat do not always equate to substantial weight loss; but, are associated with lower CVD risk.
[...]
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