The clinical practice statement of the ASPC of physical activity, cardiorespiratory fitness, and cardiovascular health: an interpretation_Chinese Journal of Evidence-Based Medicine

Authors：

CHENG Jingwei ¹ , QIAO Junjun ² , YIN Zhen ³ , HU Junpeng ⁴ , SHAO Xiayan ⁵ , LIU Yangqing ⁶ ,  YANG Jun ¹

1. School of Physical Education, Henan University, Kaifeng 475000, P. R. China;
2. Graduate School, KyungHee University, Suwon 16227, South Korea;
3. School of Sports Science, Kyonggi University, Suwon 16227, South Korea;
4. Department of Endocrinology, Henan Province Hospital of TCM, the Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450003, P. R. China;
5. Department of Cardio-Pulmonary Function, Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou 451464, P. R. China;
6. Editorial Department, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou 450003, P. R. China;

Corresponding author：

YANG Jun, Email: junyang@henu.edu.cn

Keywords：

Cardiovascular disease; Physical activity; Cardiorespiratory fitness; Cardiovascular events; American Society for Preventive Cardiology; Interpretation

DOI：

10.7507/1672-2531.202309008

Video：

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Abstract Full text Figures/Tables Video References Cited by

Cardiovascular disease is the number one cause of death worldwide. A large body of epidemiologic evidence suggests that regular physical activity (PA) and high levels of cardiorespiratory fitness can prevent the progression of atherosclerotic cardiovascular disease and reduce the incidence of cardiovascular events. "Physical activity, cardiorespiratory fitness, and cardiovascular health: a clinical practice statement of the ASPC" released in December, 2022 by the American Society for Preventive Cardiology (ASPC) and provided the most up-to-date guidance on the associations and mechanisms between PA and cardiorespiratory fitness, the development of exercise prescriptions, and exercise-associated cardiovascular risk. In this article, the main content of this guideline was interpreted, aiming to develop a more scientific exercise prescription for patients with cardiovascular disease.

Citation： CHENG Jingwei, QIAO Junjun, YIN Zhen, HU Junpeng, SHAO Xiayan, LIU Yangqing, YANG Jun. The clinical practice statement of the ASPC of physical activity, cardiorespiratory fitness, and cardiovascular health: an interpretation. Chinese Journal of Evidence-Based Medicine, 2024, 24(2): 220-227. doi: 10.7507/1672-2531.202309008 Copy

1.	GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol, 2021, 20(10): 795-820.
2.	Franklin BA, Eijsvogels TMH, Pandey A, et al. Physical activity, cardiorespiratory fitness, and cardiovascular health: a clinical practice statement of the ASPC Part Ⅰ: bioenergetics, contemporary physical activity recommendations, benefits, risks, extreme exercise regimens, potential maladaptations. Am J Prev Cardiol, 2022, 12: 100424.
3.	Franklin BA, Eijsvogels TMH, Pandey A, et al. Physical activity, cardiorespiratory fitness, and cardiovascular health: a clinical practice statement of the American Society for Preventive Cardiology Part Ⅱ: physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations. Am J Prev Cardiol, 2022, 12: 100425.
4.	Tian R, Colucci WS, Arany Z, et al. Unlocking the secrets of mitochondria in the cardiovascular system: path to a cure in heart failure-a report from the 2018 National Heart, Lung, and Blood Institute Workshop. Circulation, 2019, 140(14): 1205-1216.
5.	Conley KE. Mitochondria to motion: optimizing oxidative phosphorylation to improve exercise performance. J Exp Biol, 2016, 219(Pt 2): 243-249.
6.	Tofas T, Fatouros IG, Draganidis D, et al. Effects of cardiovascular, resistance and combined exercise training on cardiovascular, performance and blood redox parameters in coronary artery disease patients: an 8-month training-detraining randomized intervention. Antioxidants (Basel), 2021, 10(3): 409.
7.	Kaminsky LA, Arena R, Ellingsen Ø, et al. Cardiorespiratory fitness and cardiovascular disease - the past, present, and future. Prog Cardiovasc Dis, 2019, 62(2): 86-93.
8.	Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation, 2016, 134(24): e653-e699.
9.	Carbone S, Kim Y, Kachur S, et al. Peak oxygen consumption achieved at the end of cardiac rehabilitation predicts long-term survival in patients with coronary heart disease. Eur Heart J Qual Care Clin Outcomes, 2022, 8(3): 361-367.
10.	Iannetta D, Rouleau CR, Chirico D, et al. An evaluation of the role of the exercise training dose for changes in exercise capacity following a standard cardiac rehabilitation program. Int J Cardiol, 2023, 379: 104-110.
11.	Bernardo BC, Ooi JYY, Weeks KL, et al. Understanding key mechanisms of exercise-induced cardiac protection to mitigate disease: current knowledge and emerging concepts. Physiol Rev, 2018, 98(1): 419-475.
12.	WHO. Guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization, 2020.
13.	Strain T, Wijndaele K, Dempsey PC, et al. Wearable-device-measured physical activity and future health risk. Nat Med, 2020, 26(9): 1385-1391.
14.	Dunstan DW, Dogra S, Carter SE, et al. Sit less and move more for cardiovascular health: emerging insights and opportunities. Nat Rev Cardiol, 2021, 18(9): 637-648.
15.	Ekelund U, Tarp J, Fagerland MW, et al. Joint associations of accelero-meter measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals. Br J Sports Med, 2020, 54(24): 1499-1506.
16.	Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet, 2011, 378(9798): 1244-1253.
17.	Arem H, Moore SC, Patel A, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med, 2015, 175(6): 959-967.
18.	Li S, Lear SA, Rangarajan S, et al. Association of sitting time with mortality and cardiovascular events in high-income, middle-income, and low-income countries. JAMA Cardiol, 2022, 7(8): 796-807.
19.	Barnard RJ, Gardner GW, Diaco NV, et al. Cardiovascular responses to sudden strenuous exercise-heart rate, blood pressure, and ECG. J Appl Physiol, 1973, 34(6): 833-837.
20.	Dimsdale JE, Hartley LH, Guiney T, et al. Postexercise peril. Plasma catecholamines and exercise. JAMA, 1984, 251(5): 630-632.
21.	Karvonen MJ, Kentala E, Mustala O. The effects of training on heart rate: a longitudinal study. Ann Med Exp Biol Fenn, 1957, 35(3): 307-315.
22.	Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol, 2001, 37(1): 153-156.
23.	Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 1982, 14(5): 377-381.
24.	Swain DP, Franklin BA. Is there a threshold intensity for aerobic training in cardiac patients. Med Sci Sports Exerc, 2002, 34(7): 1071-1075.
25.	Davis JA, Convertino VA. A comparison of heart rate methods for predicting endurance training intensity. Med Sci Sports, 1975, 7(4): 295-298.
26.	Swain DP, Leutholtz BC, King ME, et al. Relationship between % heart rate reserve and % VO₂ reserve in treadmill exercise. Med Sci Sports Exerc, 1998, 30(2): 318-321.
27.	Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc, 2007, 39(8): 1423-1434.
28.	Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc, 2011, 43(8): 1575-1581.
29.	Franklin BA, Brinks J, Berra K, et al. Using metabolic equivalents in clinical practice. Am J Cardiol, 2018, 121(3): 382-387.
30.	Pollock ML, Gettman LR, Milesis CA, et al. Effects of frequency and duration of training on attrition and incidence of injury. Med Sci Sports, 1977, 9(1): 31-36.
31.	Rognmo Ø, Moholdt T, Bakken H, et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation, 2012, 126(12): 1436-1440.
32.	Eijsvogels TMH, Maessen MFH, Bakker EA, et al. Association of cardiac rehabilitation with all-cause mortality among patients with cardiovascular disease in the Netherlands. JAMA Netw Open, 2020, 3(7): e2011686.
33.	Laaksonen DE, Lindström J, Lakka TA, et al. Physical activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study. Diabetes, 2005, 54(1): 158-165.
34.	Chow LS, Odegaard AO, Bosch TA, et al. Twenty year fitness trends in young adults and incidence of prediabetes and diabetes: the CARDIA study. Diabetologia, 2016, 59(8): 1659-1665.
35.	Carnethon MR, Sternfeld B, Schreiner PJ, et al. Association of 20-year changes in cardiorespiratory fitness with incident type 2 diabetes: the coronary artery risk development in young adults (CARDIA) fitness study. Diabetes Care, 2009, 32(7): 1284-1288.
36.	Hu G, Jousilahti P, Barengo NC, et al. Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes. Diabetes Care, 2005, 28(4): 799-805.
37.	Sadarangani KP, Hamer M, Mindell JS, et al. Physical activity and risk of all-cause and cardiovascular disease mortality in diabetic adults from Great Britain: pooled analysis of 10 population-based cohorts. Diabetes Care, 2014, 37(4): 1016-1023.
38.	程经纬, 乔军军, 尹振, 等. 《2022 ISPAD临床实践共识指南: 儿童和青少年糖尿病患儿运动》解读. 中国全科医学, 2023, 26(30): 3719-3724, 3752.
39.	Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA, 2010, 304(20): 2253-2262.
40.	Pandey A, Garg S, Khunger M, et al. Dose-response relationship between physical activity and risk of heart failure: a meta-analysis. Circulation, 2015, 132(19): 1786-1794.
41.	Pandey A, Patel KV, Bahnson JL, et al. Association of intensive lifestyle intervention, fitness, and body mass index with risk of heart failure in overweight or obese adults with type 2 diabetes mellitus: an analysis from the look AHEAD trial. Circulation, 2020, 141(16): 1295-1306.
42.	O'Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA, 2009, 301(14): 1439-1450.
43.	Collins TC, Slovut DP, Newton R, et al. Ideal cardiovascular health and peripheral artery disease in African Americans: results from the Jackson heart study. Prev Med Rep, 2017, 7: 20-25.
44.	Duscha BD, Robbins JL, Jones WS, et al. Angiogenesis in skeletal muscle precede improvements in peak oxygen uptake in peripheral artery disease patients. Arterioscler Thromb Vasc Biol, 2011, 31(11): 2742-2748.
45.	McDermott MM. Exercise training for intermittent claudication. J Vasc Surg, 2017, 66(5): 1612-1620.
46.	Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol, 2017, 69(11): e71-e126.
47.	McDermott MM, Spring B, Tian L, et al. Effect of low-intensity vs high-intensity home-based walking exercise on walk distance in patients with peripheral artery disease: the LITE randomized clinical trial. JAMA, 2021, 325(13): 1266-1276.
48.	Treat-Jacobson D, McDermott MM, Bronas UG, et al. Optimal exercise programs for patients with peripheral artery disease: a scientific statement from the American Heart Association. Circulation, 2019, 139(4): e10-e33.
49.	Thompson PD, Franklin BA, Balady GJ, et al. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation, 2007, 115(17): 2358-2368.
50.	Franklin BA, Thompson PD, Al-Zaiti SS, et al. Exercise-related acute cardiovascular events and potential deleterious adaptations following long-term exercise training: placing the risks into perspective-an update: a scientific statement from the American Heart Association. Circulation, 2020, 141(13): e705-e736.
51.	Franklin BA. Preventing exercise-related cardiovascular events: is a medical examination more urgent for physical activity or inactivity. Circulation, 2014, 129(10): 1081-1084.
52.	Lown B, Verrier RL, Rabinowitz SH. Neural and psychologic mechanisms and the problem of sudden cardiac death. Am J Cardiol, 1977, 39(6): 890-902.
53.	Jonas DE, Reddy S, Middleton JC, et al. Screening for cardiovascular disease risk with resting or exercise electrocardiography: evidence report and systematic review for the US Preventive Services Task Force. JAMA, 2018, 319(22): 2315-2328.
54.	Chaddha A, Jackson EA, Richardson CR, et al. Technology to help promote physical activity. Am J Cardiol, 2017, 119(1): 149-152.
55.	Lieberman DA, Chamberlin B, Medina E, et al. The power of play: innovations in getting active summit 2011: a science panel proceedings report from the American Heart Association. Circulation, 2011, 123(21): 2507-2516.
56.	Lavie CJ, Franklin BA, Ferdinand KC. Improving behavioral counseling for primary cardiovascular disease prevention. JAMA Cardiol, 2022, 7(9): 886-888.
57.	Schroeder SA. Shattuck Lecture. We can do better--improving the health of the American people. N Engl J Med, 2007, 357(12): 1221-1228.
58.	Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet, 2012, 380(9838): 219-229.
59.	German CA, Baum SJ, Ferdinand KC, et al. Defining preventive cardiology: a clinical practice statement from the American Society for Preventive Cardiology. Am J Prev Cardiol, 2022, 12: 100432.

1. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol, 2021, 20(10): 795-820.
2. Franklin BA, Eijsvogels TMH, Pandey A, et al. Physical activity, cardiorespiratory fitness, and cardiovascular health: a clinical practice statement of the ASPC Part Ⅰ: bioenergetics, contemporary physical activity recommendations, benefits, risks, extreme exercise regimens, potential maladaptations. Am J Prev Cardiol, 2022, 12: 100424.
3. Franklin BA, Eijsvogels TMH, Pandey A, et al. Physical activity, cardiorespiratory fitness, and cardiovascular health: a clinical practice statement of the American Society for Preventive Cardiology Part Ⅱ: physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations. Am J Prev Cardiol, 2022, 12: 100425.
4. Tian R, Colucci WS, Arany Z, et al. Unlocking the secrets of mitochondria in the cardiovascular system: path to a cure in heart failure-a report from the 2018 National Heart, Lung, and Blood Institute Workshop. Circulation, 2019, 140(14): 1205-1216.
5. Conley KE. Mitochondria to motion: optimizing oxidative phosphorylation to improve exercise performance. J Exp Biol, 2016, 219(Pt 2): 243-249.
6. Tofas T, Fatouros IG, Draganidis D, et al. Effects of cardiovascular, resistance and combined exercise training on cardiovascular, performance and blood redox parameters in coronary artery disease patients: an 8-month training-detraining randomized intervention. Antioxidants (Basel), 2021, 10(3): 409.
7. Kaminsky LA, Arena R, Ellingsen Ø, et al. Cardiorespiratory fitness and cardiovascular disease - the past, present, and future. Prog Cardiovasc Dis, 2019, 62(2): 86-93.
8. Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation, 2016, 134(24): e653-e699.
9. Carbone S, Kim Y, Kachur S, et al. Peak oxygen consumption achieved at the end of cardiac rehabilitation predicts long-term survival in patients with coronary heart disease. Eur Heart J Qual Care Clin Outcomes, 2022, 8(3): 361-367.
10. Iannetta D, Rouleau CR, Chirico D, et al. An evaluation of the role of the exercise training dose for changes in exercise capacity following a standard cardiac rehabilitation program. Int J Cardiol, 2023, 379: 104-110.
11. Bernardo BC, Ooi JYY, Weeks KL, et al. Understanding key mechanisms of exercise-induced cardiac protection to mitigate disease: current knowledge and emerging concepts. Physiol Rev, 2018, 98(1): 419-475.
12. WHO. Guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization, 2020.
13. Strain T, Wijndaele K, Dempsey PC, et al. Wearable-device-measured physical activity and future health risk. Nat Med, 2020, 26(9): 1385-1391.
14. Dunstan DW, Dogra S, Carter SE, et al. Sit less and move more for cardiovascular health: emerging insights and opportunities. Nat Rev Cardiol, 2021, 18(9): 637-648.
15. Ekelund U, Tarp J, Fagerland MW, et al. Joint associations of accelero-meter measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals. Br J Sports Med, 2020, 54(24): 1499-1506.
16. Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet, 2011, 378(9798): 1244-1253.
17. Arem H, Moore SC, Patel A, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med, 2015, 175(6): 959-967.
18. Li S, Lear SA, Rangarajan S, et al. Association of sitting time with mortality and cardiovascular events in high-income, middle-income, and low-income countries. JAMA Cardiol, 2022, 7(8): 796-807.
19. Barnard RJ, Gardner GW, Diaco NV, et al. Cardiovascular responses to sudden strenuous exercise-heart rate, blood pressure, and ECG. J Appl Physiol, 1973, 34(6): 833-837.
20. Dimsdale JE, Hartley LH, Guiney T, et al. Postexercise peril. Plasma catecholamines and exercise. JAMA, 1984, 251(5): 630-632.
21. Karvonen MJ, Kentala E, Mustala O. The effects of training on heart rate: a longitudinal study. Ann Med Exp Biol Fenn, 1957, 35(3): 307-315.
22. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol, 2001, 37(1): 153-156.
23. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 1982, 14(5): 377-381.
24. Swain DP, Franklin BA. Is there a threshold intensity for aerobic training in cardiac patients. Med Sci Sports Exerc, 2002, 34(7): 1071-1075.
25. Davis JA, Convertino VA. A comparison of heart rate methods for predicting endurance training intensity. Med Sci Sports, 1975, 7(4): 295-298.
26. Swain DP, Leutholtz BC, King ME, et al. Relationship between % heart rate reserve and % VO₂ reserve in treadmill exercise. Med Sci Sports Exerc, 1998, 30(2): 318-321.
27. Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc, 2007, 39(8): 1423-1434.
28. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc, 2011, 43(8): 1575-1581.
29. Franklin BA, Brinks J, Berra K, et al. Using metabolic equivalents in clinical practice. Am J Cardiol, 2018, 121(3): 382-387.
30. Pollock ML, Gettman LR, Milesis CA, et al. Effects of frequency and duration of training on attrition and incidence of injury. Med Sci Sports, 1977, 9(1): 31-36.
31. Rognmo Ø, Moholdt T, Bakken H, et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation, 2012, 126(12): 1436-1440.
32. Eijsvogels TMH, Maessen MFH, Bakker EA, et al. Association of cardiac rehabilitation with all-cause mortality among patients with cardiovascular disease in the Netherlands. JAMA Netw Open, 2020, 3(7): e2011686.
33. Laaksonen DE, Lindström J, Lakka TA, et al. Physical activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study. Diabetes, 2005, 54(1): 158-165.
34. Chow LS, Odegaard AO, Bosch TA, et al. Twenty year fitness trends in young adults and incidence of prediabetes and diabetes: the CARDIA study. Diabetologia, 2016, 59(8): 1659-1665.
35. Carnethon MR, Sternfeld B, Schreiner PJ, et al. Association of 20-year changes in cardiorespiratory fitness with incident type 2 diabetes: the coronary artery risk development in young adults (CARDIA) fitness study. Diabetes Care, 2009, 32(7): 1284-1288.
36. Hu G, Jousilahti P, Barengo NC, et al. Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes. Diabetes Care, 2005, 28(4): 799-805.
37. Sadarangani KP, Hamer M, Mindell JS, et al. Physical activity and risk of all-cause and cardiovascular disease mortality in diabetic adults from Great Britain: pooled analysis of 10 population-based cohorts. Diabetes Care, 2014, 37(4): 1016-1023.
38. 程经纬, 乔军军, 尹振, 等. 《2022 ISPAD临床实践共识指南: 儿童和青少年糖尿病患儿运动》解读. 中国全科医学, 2023, 26(30): 3719-3724, 3752.
39. Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA, 2010, 304(20): 2253-2262.
40. Pandey A, Garg S, Khunger M, et al. Dose-response relationship between physical activity and risk of heart failure: a meta-analysis. Circulation, 2015, 132(19): 1786-1794.
41. Pandey A, Patel KV, Bahnson JL, et al. Association of intensive lifestyle intervention, fitness, and body mass index with risk of heart failure in overweight or obese adults with type 2 diabetes mellitus: an analysis from the look AHEAD trial. Circulation, 2020, 141(16): 1295-1306.
42. O'Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA, 2009, 301(14): 1439-1450.
43. Collins TC, Slovut DP, Newton R, et al. Ideal cardiovascular health and peripheral artery disease in African Americans: results from the Jackson heart study. Prev Med Rep, 2017, 7: 20-25.
44. Duscha BD, Robbins JL, Jones WS, et al. Angiogenesis in skeletal muscle precede improvements in peak oxygen uptake in peripheral artery disease patients. Arterioscler Thromb Vasc Biol, 2011, 31(11): 2742-2748.
45. McDermott MM. Exercise training for intermittent claudication. J Vasc Surg, 2017, 66(5): 1612-1620.
46. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol, 2017, 69(11): e71-e126.
47. McDermott MM, Spring B, Tian L, et al. Effect of low-intensity vs high-intensity home-based walking exercise on walk distance in patients with peripheral artery disease: the LITE randomized clinical trial. JAMA, 2021, 325(13): 1266-1276.
48. Treat-Jacobson D, McDermott MM, Bronas UG, et al. Optimal exercise programs for patients with peripheral artery disease: a scientific statement from the American Heart Association. Circulation, 2019, 139(4): e10-e33.
49. Thompson PD, Franklin BA, Balady GJ, et al. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation, 2007, 115(17): 2358-2368.
50. Franklin BA, Thompson PD, Al-Zaiti SS, et al. Exercise-related acute cardiovascular events and potential deleterious adaptations following long-term exercise training: placing the risks into perspective-an update: a scientific statement from the American Heart Association. Circulation, 2020, 141(13): e705-e736.
51. Franklin BA. Preventing exercise-related cardiovascular events: is a medical examination more urgent for physical activity or inactivity. Circulation, 2014, 129(10): 1081-1084.
52. Lown B, Verrier RL, Rabinowitz SH. Neural and psychologic mechanisms and the problem of sudden cardiac death. Am J Cardiol, 1977, 39(6): 890-902.
53. Jonas DE, Reddy S, Middleton JC, et al. Screening for cardiovascular disease risk with resting or exercise electrocardiography: evidence report and systematic review for the US Preventive Services Task Force. JAMA, 2018, 319(22): 2315-2328.
54. Chaddha A, Jackson EA, Richardson CR, et al. Technology to help promote physical activity. Am J Cardiol, 2017, 119(1): 149-152.
55. Lieberman DA, Chamberlin B, Medina E, et al. The power of play: innovations in getting active summit 2011: a science panel proceedings report from the American Heart Association. Circulation, 2011, 123(21): 2507-2516.
56. Lavie CJ, Franklin BA, Ferdinand KC. Improving behavioral counseling for primary cardiovascular disease prevention. JAMA Cardiol, 2022, 7(9): 886-888.
57. Schroeder SA. Shattuck Lecture. We can do better--improving the health of the American people. N Engl J Med, 2007, 357(12): 1221-1228.
58. Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet, 2012, 380(9838): 219-229.
59. German CA, Baum SJ, Ferdinand KC, et al. Defining preventive cardiology: a clinical practice statement from the American Society for Preventive Cardiology. Am J Prev Cardiol, 2022, 12: 100432.

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