Blood vessels and heart disorders are usually referred to as cardiovascular diseases (CVDs) and they include cerebrovascular disease, rheumatic heart disease, congenital heart disease, peripheral artery disease, vein thrombosis, and coronary heart disease (Shat et al., 2018). According to the World Health Organization, 80% of CVDs deaths are as a result of either strokes or heart attacks (Shah et al., 2018). Individuals with high blood pressure, lipids, blood glucose and obese persons are at the risk of cardiovascular diseases. Such factors can be measured in the primary health cares (American Diabetes Association, 2016). Identification of persons with the highest risk of CVDs and making sure they receive suitable treatment can help reduce the number of premature deaths (Anderson et al, 2016). However, individuals should note that they have a major role of reducing the risk of being CVD victims by either dietary changes or exercise. The latter have been proven to have extensive benefits if correctly implemented. Among other factors, physical inactivity also increases the chance of cardiovascular diseases. Research shows that maintaining and continuously improving physical fitness reduce the chances of contracting cardiovascular diseases and also plays a role of reversing heart disease. It is therefore important for people to get exposed to the types of exercises that can minimize risks and their benefits. Exercises such as swimming, brisk walking, cycling and interval training are just a few exercises that improve the overall heart health. There are studies that have been conducted on the benefits of exercise on cardiovascular diseases, and an in depth analysis of these articles would help us get the actual meaning and effectiveness of exercise. This paper seeks to state the common cardiovascular diseases, their causes, and how they can be prevented. Several types of exercises will also be evaluated in terms of how they are implemented and their benefits. The research will finalize by providing statistical evidence of the benefits of exercise from several studies.
Coronary artery disease (CAD) is among the most prevalent of cardiovascular diseases. The main cause of CAD is plaque that builds up on the walls of the coronary artery. Usually plaque is made up of cholesterol deposits which could either fully or partially block the flow of blood in a process known as atherosclerosis (Bonnefont-Rousselot, 2016). The common symptom of CAD is Angina, a condition caused by insufficient flow of blood to the heart muscles causing discomfort and chest pains. Continuous weakening of the heart muscles could lead to irregular heartbeat or even heart attack over time. Coronary artery diseases risk factors are tobacco smoking, physical inactivity, unhealthy diet and obesity. Heart disease history in the family could also increase the risk of CADs. Some of the suggested measures of reducing the risks for CAD include surgical procedures, medications and lifestyle changes.
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Cerebrovascular disease, a disorder that affects blood vessels that supply the brain with blood, is the fifth most common death cause. Similar to the coronary artery disease, cerebrovascular disorder is as a result of plaque builds up in the walls of either the carotid or intracranial arteries. This disorder can develop from deep vein thrombosis or atherosclerosis. There are many types of cerebrovascular disease including aneurysms, ischemic attack, stroke, and vascular malformations (Bonnefont-Rousselot, 2016). The earliest symptoms of the disease include communication difficulties and general body weakness. In a case where cerebrovascular disease is associated with brain hemorrhage severe headache may also be experienced. The risk factors for cerebrovascular disease include obesity, smoking, poor diet, hypertension, high cholesterol levels and lack of physical exercise. Blood pressure control, healthy weight and regular exercise are a few ways of reducing the risks of this disease.
The third most common cardiovascular disease is Peripheral artery disease in which the arteries suppling blood to the limbs are narrowed by fat deposits (Bonnefont-Rousselot, 2016). Usually when an individual has this condition, the legs do not receive enough blood flow causing claudication (pain when walking). The symptoms of this disease include numbness, hair loss on the feet, painful cramping on the hip or thigh muscles or toe soreness. The risk factors for this disease are high blood pressure, obesity, smoking, increasing age, and diabetes. In serious cases, this disorder might cause limb ischemia, heart attack or stroke. Healthy lifestyle and exercise is the best way to reduce the risk of claudication. Any exercise that aids in reducing weight and cholesterol levels would effectively work in minimizing the peripheral artery disease cases.
Rheumatic heart disease is not as common as other cardiovascular diseases. The disease is a complication associated with rheumatic fever when the heart valves are completely damaged. It is an inflammatory disease that first attacks the strep throat and the connective tissues particularly the brain, joints, skin and heart (Bonnefont-Rousselot, 2016). Rheumatic disease, unlike coronary artery is not a lifestyle disease and can be easily treated by administering antibiotics. Exercises such as swimming, cycling and brisk walking can help reduce the risk of cardiovascular diseases.
Swimming is often viewed as a leisure activity but most individuals are not aware that it helps prevent heart diseases. Swimming is a physical activity that can decrease the risks of high blood pressure, coronary artery disease and stroke. Health statistics show that swimming reduces stroke incidences by 31% (Chris, 2011). Swimming for 30 minutes three times a week significantly lowers blood pressure levels. Swimming also boosts the metabolism thus reducing the levels of cholesterol (Chris, 2011). Swimming being an aerobic exercise strengthens the muscles heart by making it larger and hence more efficient in blood pumping which results to increased blood flow in the body. Research also shows that aerobic exercises such as swimming keeps the cells lined on the arteries in good shape and flexible. Other benefits of swimming include diabetes prevention, stress reduction, and reduced risks of arthritis. Swimming might not be the best exercise but it helps a significant number of persons.
Running and brisk walking is by far the most effective exercises in reducing heart disease risks. New research shows that brisk walking might be more beneficial as compared to running and that might be an encouragement to a larger proportion of the population. Only 50% of the total American population is able to meet the recommended 2.5 hours per week, of moderate exercise ( Glatter, 2019) . A study published in the American Heart Association journal showed that people who took brisk walking as an exercise were able to significantly reduce their elevated cholesterol, blood sugar and high blood pressure just like the runners and to a higher degree. The study involved 33,000 runners and 15,000 walkers who were participating in the National Runner’s Health Study and National Walkers’ Health study respectively for a period of six years ( Glatter, 2019) . The entire sample was made up of participants between the age of 18 and 80 years with the majority being in their mid-40 and 50’s ( Glatter, 2019) . Data was collected using questionnaires to record answers to specific questions regarding medical history, high blood pressure, diabetes and cholesterol levels.
While running requires a lot of energy compared to brisk walking, both exercises significantly reduced blood sugar levels, blood pressure and high levels of cholesterol. The researchers also noted that participants who were able to run or walk more had a greater benefit of lowering the risks of heart diseases ( Glatter, 2019) . As much as the intensity of these two exercise differs, the muscles involved are the same and this explains the similarity of the observed outcome. The study further suggests that the exercise type adopted is not as important as the number of hours individuals walk or run ( Glatter, 2019) . Exact statistics gives us the actual similarities and differences in these two types of exercises.
Statistics specifics showed that running reduced the cholesterol levels by 4.3% compared to the 7% cholesterol reduction due to brisk walking ( Glatter, 2019) . The blood sugars levels reduced by 12.1% through running and by 12.3% by walking ( Glatter, 2019) . Runners reduced their risk of getting high blood pressure by 4.2% while walking reduced the blood pressure risk by 7.2% ( Glatter, 2019) . While runners reduced their risk of getting coronary artery disease by 4.3%, walkers reduced such risk by 9.3% ( Glatter, 2019) . Overall, the outcome of the study shows that brisk walkers actually benefit more than the runners. These results might be more appealing to a large number of people since compared to running, walking is quite reasonable. Walking is also more suitable and can be maintained even as age increases. In essence, running burns more calories within a short period compared to walking but the long run outcome is the complete opposite. In 2012, Centers for Disease Control reported that a larger proportion of the Americans had adopted walking and that they were more likely to achieve the recommended level of exercise and physical activity.
Cycling is also among the proven workout that reduces the risks of heart diseases. Recent research from Purdue University shows that cycling reduces the risk of heart diseases by approximately 50% if an individual cycles for twenty miles every week ( Mackenzie, 2015) . This is a significant proportion as research show that more than 250,000 cardiovascular disease cases could be prevented through exercise. Cycling utilizes the skeletal muscles rhythmically, with varied rest periods and active periods ( Mackenzie, 2015) . The rest period enhance recovery from the high intensity periods. The research also shows that cycling is an effective physical fitness exercise that allows oxygen uptake, varied breathing and equal distribution of body fats.
Resistance exercise training, according to Braith & Stewart plays a great role in prevention of cardiovascular diseases (2006). Resistance training prevents a decline in the mass of skeletal muscle and function that is often not sufficient with aging. Research shows that individuals who do not perform resistance training on regular basis lose an average of 0.46 Kgs of skeletal muscle every year ( Braith & Stewart, 2006) . Moreover, such individuals are likely to experience type 2 muscle fibers reduction by 50%; these fibers are responsible for the high strength levels by 80 years ( Braith & Stewart, 2006) . Long term performance of resistance training lowers response to acute stress and increases total energy used and physical activity. Additionally, resistance training relieves insomnia, depression and anxiety. Among chronic heart failure patients, resistance training accelerates Sarcopenia, a condition characterized by muscle wasting and abnormalities of the skeletal muscles.
Diabetes is among the risk factors of cardiovascular diseases. If the glucose levels can be reduced by resistance training then there would be a significant decrease in the cardiovascular diseases cases and in particular coronary artery disease ( Braith & Stewart, 2006) . Muscle contraction enhances uptake of glucose in the skeletal muscles forming a basis of resistance training recommendation to individuals with abnormal glucose absorption. Resistance training has however not shown any significant effect on weight reduction; it is more focused on muscle gain. There is evidence that resistance training increases stiffness of the central arteries during high-volume or high-intensity routines ( Braith & Stewart, 2006) . Performing resistance training alone appears to contribute significantly in reducing some aspects of cardiovascular diseases but in essence this study do not give an estimation of the risk reduction magnitude. It might be difficult to challenge individuals without cardiac disease to incorporate resistance training in other aerobic exercises. However, for individuals with certain cardiovascular disorders, resistance training plays a significant role of reducing the magnitude of the condition.
Peripheral Artery disease is often associated with limited movement. The main objective of treating this disease is to increase exercise performance by improving their quality of life and functionality ( Olin et al., 2016) . Any treatments that improve exercise performance, patient-related quality of life and an average of 6 minutes walking distance could serve as basis claudication therapy (Olin et al., 2016). Physical exercise has been proven to treat symptomatic peripheral artery disease with an established benefit after a 12 week programs ( Olin et al., 2016) . Training exercise modifies certain pathophysiological mechanisms in peripheral artery disease that include: gait biomechanics, endothelial function, and skeletal muscle metabolism ( Olin et al., 2016) . Supervised exercise is recommended as class 1a while unsupervised exercise is recommended as class 11b ( Olin et al., 2016) . Despite clear evidence of health benefits, exercise programs have not been upheld by payers, providers and payers due to reasons such as uncertainty of long term adherence and benefits. Exercise programs are therefore very limited and not recompensed. However, people who have taken part in the programs report significant reduction of peripheral artery diseases and increased mobility. Exercise therefore proves to have a significant effect on reducing the risks associated with peripheral artery diseases.
A study by Anderson et al. that aimed at reviewing the effectiveness of exercise based cardiac rehabilitation confirmed that exercise reduces the risk of cardiovascular diseases (2016). In this study, controlled trials were used for comparison with the exercise-based cardiac rehabilitation treatments with six months follow-ups. Exercise-based cardiac rehabilitation referred to supervised and unsupervised community-based, inpatient, homebased and outpatient intervention which incorporated exercise training. The participants of this study had myocardial infarction, undergone revascularization and were selected irrespective of their age or sex. Exercised based cardiac rehabilitation programs were delivered in supervised center either in combination with home based exercise or exclusively (Anderson et al., 2016). The primary mode of exercise was aerobic but there were variation in terms of frequency, intensity and average duration. Twenty-four trials were exercise based only, 38 trials were comprehensive and only one trial was both comprehensive and exercise-based (Anderson et al., 2016). The overall bias was low across all domains therefore yielding consistent and reliable results.
The results indicated that there was no substantial disparity in clinical and exercise-based cardiac rehabilitation. Forty-seven studies reported 100% mortality as there was no significant all cases mortality reduction with exercise-based cardiac rehabilitation (Anderson et al., 2016). Significant reduction of cardiovascular mortality was also reported among the no-exercise subjects. Thirty-six studies showed a statistically insignificant reduction of both fatal and nonfatal risk of myocardial infarction among exercise based cardiac rehabilitation cases. The researchers found no substantial difference of the treatment effects across morbidity and mortality results. The study however showed a significant overall mortality reduction from 10.4% to 7.6%, 30.7% to 26.1% hospitalizations among exercise based trials compared to the controls (Anderson et al., 2016). This study gives the implication that however much exercise might not reduce mortality rates in all cases, there is sufficient evidence that exercise reduces mortality due to cardiovascular diseases such as coronary artery disease.
It is true that exercise reduces the chances of cardiovascular diseases but in many cases, individuals do not have a clear understanding of how exactly exercise works; the science behind exercise. Nada Sallam and Ismail Laher seek to answer this question in their article (2016). There is sufficient evidence that exercise decreases aging sequels and risks of cardiovascular diseases ( Sallam & Laher, 2016) . Regular physical exercise counteracts with the detrimental aging effects not only by exerting anti-inflammatory and antioxidant actions but also by contending obesity, sarcopenia and mitochondrial dysfunction. Exercise training has effects on the adipose tissue particularly the macrophages and visceral fat deposits. During training, the skeletal muscles generate heat shock proteins which exert anti-inflammatory action ( Sallam & Laher, 2016) . Exercise also alleviates aging of the mitochondria and stimulates mitochondrial biogenesis thus interrupting the oxidative damage ( Sallam & Laher, 2016) . Physical activity also enhances the oxidative capacity of the mitochondria.
Exercise training has anti-inflammatory effects on the adipose tissue. Acute sessions of exercise cause transitory mutilation to the skeletal muscles which triggers anti-inflammatory response which in return increases cytokines levels and acute phase blood reactants. Regular physical activity however, reduces systematic inflammatory markers like soluble TNF-α and CRP among young, middle aged adults and the elderly ( Sallam & Laher, 2016) . Moreover, high levels of anti-inflammatory cytokines including adiponectin and interleukin-10 are related to increased exercise among the elderly individuals ( Sallam & Laher, 2016) . Exercise can trigger anti-inflammatory response with or without loss of weight. However, considerable anti-inflammatory response arises among patients who have high levels of inflammatory biomarkers, and especially when accompanied by the loss of weight ( Sallam & Laher, 2016) . Notably, previous researches have not detected any significant effect of exercise on biomarker levels. The anti-inflammatory effects depend on the type, duration and intensity of exercise.
Physical exercises improve immunity and increases repair mechanisms of an individual. Regular exercise regulates the inborn response and reactivates the adaptive immunity with consequential inflammation suppression. Physical exercise moderates immunity by reducing CD14+CD16+ numbers, increasing T cells and shifting blood macrophages towards inflammatory phenotype, M2 ( Sallam & Laher, 2016) . Additionally, exercises stimulate the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system in order to increase the levels of serum glucocorticoid. The heat shock proteins regulate processing of the damaged proteins and folding hence exerting significant anti-inflammatory response. Exercise also regulates expression of HSP70, HSP60 and HSP72 in the heart, blood cells, arteries and the skeletal muscles ( Sallam & Laher, 2016) . This in return repairs the damaged muscles in human beings.
Exercise training has proven to have antioxidant benefits. The Generation of reactive oxygen species is rapidly increased when someone exercises. However, the disease incidences that are brought about by oxidative stress are significantly reduced by consistent physical activity. Exercise improves oxidative stress associated with age in the liver, plasma, arteries, heart and skeletal muscles. Among the ageing people, exercise suppressed myeloperoxidase plasma levels, a marker of oxidative stress and inflammation. Other effects of exercise training are PGC-1α signaling and increased metabolism ( Sallam & Laher, 2016) .
In conclusion, exercise has a great role on cardiovascular diseases. Cardiovascular diseases affect the heart and blood vessels therefore interfering with blood flow to the heart and other parts of the body. Some of the cardiovascular diseases include peripheral artery disease, coronary artery disease, rheumatic heart disease, cerebrovascular disease, vein thrombosis, and congenital heart disease. The risk factors for these diseases are related to physical inactivity and lifestyle. Exercise proves effective in reducing the risks of most cardiovascular diseases by reducing the inflammatory effects, increasing metabolism and improving immunity. Exercise also enhances repair of the damaged tissues among elderly patients. Some of the exercises include running, brisk walking, cycling, and swimming. Research shows that brisk walking is more effective in the long run compared to running. This should encourage more individuals to adopt walking as an exercise. Cycling and swimming are fun activities but with great benefits of improving heart health. The effect of exercise depends on the duration, intensity and type of exercise. People should consider spending more time in both resistance and aerobic exercises. Individuals are responsible of the cardiovascular diseases they get and they have an obligation of preventing or reducing the risks of these diseases through physical exercise. Exercise reduces mortality and morbidity caused by cardiovascular diseases. Reduced number of cardiovascular disease cases would save a huge sum of money that would have otherwise been used in treatment. Individuals have no reason, whatsoever of failing to incorporate physical exercise in their daily routine.
References
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