Physical activity shows strongest link to reduced heart disease

Physical activity and recreation emerged as the lifestyle domain with the most pronounced statistical link to lower cardiovascular disease (CVD) odds, according to a recent analysis of hospital patients in Iran. The study, published in BMC Public Health, examined five lifestyle areas among 495 participants to determine which habits distinguished those with diagnosed CVD from those without.

Study design and participant selection

Researchers conducted a case-control study at Imam Reza and Imam Ali hospitals in Kermanshah, Iran. The sample included 99 recently diagnosed CVD patients admitted to inpatient heart and cardiac care departments. These cases were matched with 396 controls selected from other departments, such as gastroenterology and urology, who had no diagnosed cardiovascular disease. To increase statistical power, four controls were chosen for every CVD case.

Eligible participants ranged from 18 to 65 years old, could communicate in Farsi or Kurdish, and had no sensory or cognitive impairment. Case participants required a physician-confirmed diagnosis and used at least one cardiac medication. Individuals with serious underlying illnesses like kidney failure, metastatic cancer, or unstable circulation were excluded. Recruitment occurred via convenience sampling between February 28 and June 9, 2023.

Lifestyle assessment methodology

The team utilized a previously validated healthy lifestyle questionnaire containing 46 questions across five domains: prevention, physical activity and recreation, healthy eating, stress management, and interpersonal and social relationships. Responses were scored on a five-point scale, classifying total scores as unfavorable, moderate, or favorable. Two trained interviewers collected data after explaining study aims and obtaining informed consent.

Statistical analysis employed Chi-square tests for categorical characteristics and one-way analysis of variance (ANOVA) for mean lifestyle scores. Logistic regression estimated odds ratios before and after adjusting for education, age, marital status, job, income, computer knowledge, and source of health information. Sample size calculations relied on lifestyle scores from an earlier study, targeting a 5% significance level and 80% statistical power.

Key findings on risk reduction

Patients with higher lifestyle scores exhibited lower odds of being in the CVD group, even after accounting for demographic differences. The average lifestyle score was 146.66 for CVD patients and 169.4 for controls, falling into moderate and favorable categories respectively. Each additional point on the scale correlated with 4% lower odds of CVDs in unadjusted analysis and 6% lower odds after adjustment. The adjusted odds ratio stood at 0.94 (95% confidence interval, 0.93 to 0.96).

All five lifestyle domains showed significant links to CVD odds. Physical activity and recreation demonstrated the strongest numerical association per questionnaire point, with a one-point increase linked to 38% lower odds of CVDs after adjustment. Stress management associated with 22% lower odds, while healthy eating linked to 18% lower odds. Preventive measures and social relationships each corresponded to 12% lower odds.

Socioeconomic factors and limitations

CVD patients differed from controls in income, job status, and computer knowledge, with more than half reporting insufficient income. Authors suggested that socioeconomic circumstances may influence opportunities for healthy habits, though the findings did not directly establish this causal pathway. The study recommended prioritizing nutrition, stress management, social connection, and community support for physical activity in prevention programs.

Limitations included the self-reported nature of the questionnaire, which could introduce bias, and the hospital-based convenience sample restricting generalizability. Lifestyle data was recorded post-diagnosis, meaning illness itself might have influenced behavior. Comorbid conditions were not fully assessed, leaving residual confounding from factors like smoking, diabetes, and obesity possible. Additionally, the specific type of cardiovascular condition was not detailed for each participant, preventing analyses by condition.

Implications for public health

The findings indicate that better lifestyle scores correlate with lower adjusted odds of CVDs, with physical activity showing the strongest per-point association. Authors concluded that improving nutrition, social relationships, stress management, and physical activity opportunities could support prevention efforts, particularly among individuals with lower incomes. However, these associations do not confirm whether lifestyle changes prevent CVDs. Future longitudinal and intervention studies are needed to account for other illnesses and clarify how lifestyle shapes heart health over time.