Thin vs Fat: Heart Disease Risk May Be Equal! (New Study)


Being Thin Might Not Be An Advantage


Being thin won’t necessarily protect you from heart disease. 

A new study from the University of Florida as found that low levels of physical activity can put healthy weight adults at the same risk for cardiovascular disease as adults who are overweight.

“Our study demonstrates that a sedentary lifestyle counters the benefit of being at a normal weight when it comes to heart disease risk,” said lead investigator Arch G. Mainous III, Ph.D., chair of the department of health services research, management and policy in the UF College of Public Health and Health Professions, part of UF Health.

“Achieving a body mass index, or BMI, in the normal range shouldn’t give people a false sense of confidence they’re in good health. If you’re not exercising, you’re not doing enough.”

The study, which appears online ahead of print in the American Journal of Cardiology, found that 30 percent of U.S. adults at a normal weight are at increased risk of heart attack or stroke.


30% of normal weight U.S. adults are at increased risk of heart attack or stroke.


These adults had higher levels of belly fat, shortness of breath upon exertion, unhealthy waist circumference or less than recommended levels of physical activity, the UF researchers say.

“We have traditionally thought that people with a normal BMI are healthy and at low risk for heart disease, but increasingly we are finding that how much you weigh is not necessarily a measure of good health,” said Mainous, the Florida Blue endowed chair of health administration. “Sedentary lifestyle markers may play a better role in predicting cardiovascular disease risk.”



“How much you weigh is not necessarily a measure of good health.”

– Arch G. Mainous III, Ph.D., Lead Investigator


For the study, the investigators analyzed data from the National Health and Nutrition Examination Survey, a nationally representative study that collects data from a combination of interviews, physical examinations and laboratory tests.

The study focused on participants ages 40 to 79 who did not have a previous diagnosis of coronary heart disease, stroke or heart attack.

Researchers examined participants’ sagittal abdominal diameter, which is a measure of fat in the gut region, and waist circumference as well as self-reports on the amount of moderate to vigorous physical activity, the amount of time spent sitting and whether they experienced shortness of breath either when hurrying or walking up a slight hill.

In addition, researchers calculated the American College of Cardiology and the American Heart Association, or ASCVD risk score, of participants.

The ASCVD risk score uses weighted variables, including age, sex, race/ethnicity, smoking status, diabetes status, cholesterol, blood pressure and blood pressure medication status, to calculate individuals’ risk of having a heart attack or stroke within the next 10 years (a score of 7.5 percent or higher is considered high risk).

The investigators found the rate of high ASCVD risk score among people who are overweight was similar to the rate among people who had a normal BMI, but had indicators of a sedentary lifestyle.


The ASCVD risk score was the same among the overweight and the sedentary normal weight people.



Boosting Activity Levels

For those looking to increase their activity level, Mainous suggests reviewing the Centers for Disease Control and Prevention’s physical activity guidelines, which recommend at least 150 minutes of moderate intensity exercise a week for adults.

Exercise should include a combination of aerobic activity and strength training.


Physical Activity Guidelines

The U.S. Government’s Office of Disease Prevention & Health Promotion offers Physical Activity Guidelines for Americans.

The second edition of the Physical Activity Guidelines for Americans provides evidence-based recommendations for adults and youth ages 3 through 17 to safely get the physical activity they need to stay healthy.

There are new key guidelines for children ages 3 through 5 and updated guidelines for youth ages 6 through 17, adults, older adults, women during pregnancy and the postpartum period, adults with chronic health conditions, and adults with disabilities.


Preschool-Aged Children



The new key guidelines for children ages 3 through 5 state that preschool-aged children should be active throughout the day to enhance growth and development.

Adults caring for children this age should encourage active play (light, moderate, or vigorous intensity) and aim for at least 3 hours per day.


Youth Aged 6 Through 17



The recommended amount of physical activity for youth ages 6 through 17 is the same.

Each day, youth ages 6 through 17 need at least 60 minutes of moderate-to-vigorous activity to attain the most health benefits from physical activity.

Most activity can be aerobic, like walking, running, or anything that makes their hearts beat faster.

They also need activities that make their muscles and bones strong, like climbing on playground equipment, playing basketball, and jumping rope.





The recommended amount of physical activity for adults is the same.

To attain the most health benefits from physical activity, adults need at least 150 to 300 minutes of moderate-intensity aerobic activity, like brisk walking or fast dancing, each week.



Adults also need muscle-strengthening activity, like lifting weights or doing push-ups, at least 2 days each week.


Key Exercise Guidelines

We now know about more health benefits from physical activity — and how Americans can more easily achieve them.

The second edition of the Physical Activity Guidelines for Americans is based on the latest scientific evidence that shows that physical activity has many health benefits independent of other healthy behaviors, like good nutrition.


Move More and Sit Less



The first key guideline for adults is to move more and sit less. This recommendation is based on new evidence that shows a strong relationship between increased sedentary behavior and increased risk of heart disease, high blood pressure, and all-cause mortality.

All physical activity, especially moderate-to-vigorous activity, can help offset these risks.


All Physical Activity Counts


Housework counts, too!


We now know that any amount of physical activity has some health benefits.

Americans can benefit from small amounts of moderate-to-vigorous physical activity throughout the day.


Outdoor chores are good for your health!


The first edition of the Physical Activity Guidelines for Americans stated that only 10-minute bouts of physical activity counted toward meeting the guidelines.

The second edition removes this requirement to encourage Americans to move more frequently throughout the day as they work toward meeting the guidelines.


Immediate Health Benefits



New evidence shows that physical activity has immediate health benefits. For example, physical activity can reduce anxiety and blood pressure and improve quality of sleep and insulin sensitivity.


Long-term Health Benefits

We now know that meeting the recommendations in the Physical Activity Guidelines for Americans consistently over time can lead to even more long-term health benefits.


Benefits for Youth



For youth, physical activity can help improve cognition, bone health, fitness, and heart health. It can also reduce the risk of depression.


Benefits for Adults




For adults, physical activity helps prevent 8 types of cancer (bladder, breast, colon, endometrium, esophagus, kidney, stomach, and lung); reduces the risk of dementia (including Alzheimer’s disease), all-cause mortality, heart disease, stroke, high blood pressure, type 2 diabetes, and depression; and improves bone health, physical function, and quality of life.


Benefits for Older Adults


For older adults, physical activity also lowers the risk of falls and injuries from falls.


Benefits for Pregnant Women


For pregnant women, physical activity reduces the risk of postpartum depression.


Benefits for Everyone



For all groups, physical activity reduces the risk of excessive weight gain and helps people maintain a healthy weight.

New evidence shows that physical activity can help manage more health conditions that Americans already have.



For example – 


Physical activity can decrease pain for those with osteoarthritis, reduce disease progression for hypertension and type 2 diabetes, reduce symptoms of anxiety and depression, and improve cognition for those with dementia, multiple sclerosis, ADHD, and Parkinson’s disease.


Exercise Tips for The Sedentary


Before beginning any fitness routine, it’s important to warm up, then do some light stretching. Save the bulk of the stretching for after the workout.

Once you’re warmed up, experts recommend three different types of exercise for overall physical fitness: cardiovascular activity, strength conditioning, and flexibility training.

These don’t all have to be done at once, but doing each on a regular basis will result in balanced fitness.


Cardiovascular Activity



Start by doing an aerobic activity, like walking or running, for a sustained 20-30 minutes, four to five times a week.

To ensure you’re working at an optimum level, try the “talk test”: Make sure you can carry on a basic level of conversation without being too winded. But if you can easily sing a song, you’re not working hard enough.


Strength Conditioning



Start by doing one set of exercises targeting each of the major muscle groups. Use a weight at which you can comfortably perform the exercise eight to 12 times in a set.

When you think you can handle more, gradually increase either the weight, the number of repetitions, or number of sets.

To maximize the benefits, do strength training at least twice a week. Never work the same body part two days in a row.


Flexibility Training



The American Council on Exercise recommends doing slow, sustained static stretches three to seven days per week. Each stretch should last 10-30 seconds.

To learn how to perform certain exercises, consider hiring a personal trainer for a session or two, or take advantage of free sessions offered when you join a gym.


Best Home Exercise Equipment


Exercise doesn’t have to be done at the gym. You can work out in the comfort of your own home.

And with calesthenic-type exercises such as squats, lunges, pushups, and sit-ups, you can use the resistance of your own weight to condition your body.

To boost your strength and aerobic capacity, you may also want to invest in some home exercise equipment.



Example: The XTERRA Folding Treadmill has excellent reviews.


Treadmills are the most popular piece of equipment is great for cardiovascular exercise.

Start out walking at a low intensity for 30 minutes and applying the talk test.

Depending on how you do, adjust the intensity, incline, and/or time accordingly.


Free Weights

These popular Unipack Dumbells have a comfortable neoprene coating.


Barbells and dumbbells make up this category of strength-training equipment. Dumbbells are recommended for beginners.

Purchase a dumbbell set, so you can adjust your workout as you gain strength.


Other Strength Training Equipment



This includes weight stacks (plates with cables and pulleys), flexible bands, and flexible rods.

Resistance bands are  a super choice for beginners, especially since they come with instructions.

Your muscles may adapt to the resistance and need more of a challenge as you gain strength, so purchase a set of bands with a variety of resistance strengths.


This LYOU Resistance Bands Set  includes 4 strengths.


These Instructional Resistance Bands Cards ensure an effective workout.


Exercise Ball


Although instructions and/or a companion video can accompany exercise balls, beginners may use exercise balls improperly.

Some people fall off or can’t keep the ball still. But with a little practice and patience, an exercise ball, it can provide a good, fun workout.


The URBNFit Exercise Ball is a popular choice.



Exercise Videos and DVDs

Before working out with a home exercise video or DVD, watch through it at least once to observe the structure and proper form of the workout.

To further improve form, work out in front of a mirror, if possible, or having someone else watch you do the exercise.


Absolute Beginners Cardio & Strength Training Workout for Seniors leads you through a gentle, but effective routine.


Dance That Walk Total Body Circuit (DVD) features a full body workout, suitable for all shapes, sizes and fitness levels.


Overcoming Exercise Hurdles

Lots of things create obstacles to getting fit. What stands in the way?

Several factors create unidentified fitness obstacles that thwart our best efforts.



Psychological Concerns

Chronic depression, unsupportive family members and excess stress often defeat you before you start.

Recommendation: Visit a therapist, test out mood-enhancing drugs such as Prozac and visualize yourself enjoying exercise.


Appearance Obsession

Fear that everyone at the gym or the park looks better and displays more agility thwarts the best intentions.



Recommendation: Watch less television and fewer videos where all the stars look perfect. Most gyms cater to an array of people representing all ages, sizes and fitness levels.


Joint Problems

Just after you start a routine, your muscles ache, and your joints feel sore.



Recommendation: You may be working out too vigorously – start out slow and listen to your body.  You can also modify exercises as needed

It might also be beneficial to see a personal trainer who specializes in people rebounding from inactivity.

You may also want to see chiropractor or massage therapist to align your body, soothe aches and pains.



Walking round and round a track or outdoor trail can make you feel like a hamster in a cage.



Recommendation: Vary your routine. Try water aerobics, gym ball and weight classes, inline skating, rock climbing and kayaking. See what fits best with your personality and time schedule.


Food and Chemical Allergies

When you lack energy to sustain a simple walk around the block, you may need to see a nutritionist or physician.

Recommendation: Clean vents and buy an air filter to reduce sneezing and coughing, eat a healthier diet to sustain exercise such as vegetables, lean meat and fruit.


Time Constraints



Too often people get stuck in a rut caring for elder parents, children and a host of community concerns. Fitness comes last on the to-do list.

Recommendation: Get an exercise buddy or join a class so someone else will expect to see you regularly. Watch how much more energy you have for every other task when you take time to work out.


Poor Warm-ups and Exercise Routines

Some people try to jam an hour’s worth of exercise into 15 minutes, thinking faster and harder will get them to goal weight quicker. Instead, they can injure muscles.

Recommendation: Begin with a five- or 10-minute cardiovascular workout to increase the heart rate, stretch for 15 minutes then engage in a more active program.

Start on the low settings and work up. The tendency to improve too quickly can also lead to burnout.


Additional References
  1. Chronic Disease Overview. Centers for Disease Control and Prevention. June 28, 2017.
  2. Overview — Preventing Chronic Diseases: A Vital Investment. World Health Organization. 2015.
  3. Exercise and Chronic Disease: Get the Facts. Mayo Clinic. June 20, 2015.
  4. A New Way to Stretch. Arthritis Foundation.
  5. Daneman R, Prat A. The Blood-Brain Barrier. Cold Spring Harbor Perspectives in Biology. January 2015.
  6. Aktas O, et al. Neuronal Damage in Brain Inflammation. Archives of Neurology. February 2007.
  7. Adult Obesity Facts. Centers for Disease Control and Prevention. March 5, 2018.
  8. Childhood Obesity Facts. Centers for Disease Control and Prevention. April 10, 2017.
  9. Background on Obesity. The Surgeon General’s Vision for a Healthy and Fit Nation. Office of the Surgeon General. 2010.
  10. Schmidt S. Obesity and Exercise. American College of Sports Medicine. October 7, 2016.
  11. Fibromyalgia. Centers for Disease Control and Prevention. April 3, 2018.
  12. Bidonde J, Busch AJ, Schacter CL, et al. Aerobic Exercise Training for Adults with Fibromyalgia. Cochrane Database of Systemic Reviews. June 2017.
  13. Sawnyok J, Lynch ME. Qigong and Fibromyalgia Circa 2017. Medicines. June 2017.
  14. About Diabetes. Centers for Disease Control and Prevention. June 1, 2017.
  15. Thent ZC, Das S, Henry LJ. Role of Exercise in the Management of Diabetes Mellitus: The Global Scenario. PloS One. November 13, 2013.
  16. Colberg SR, Sigal R, Fernhall B, et al. Exercise and Type 2 Diabetes. American Diabetes Association Diabetes Care. December 2010.
  17. Heart Disease Facts. Centers for Disease Control and Prevention. November 28, 2017.
  18. Winzer EB, Woitek F, Linke A. Physical Activity in the Prevention and Treatment of Coronary Artery Disease. Journal of the American Heart Association. February 8, 2018.
  19. Robinson MM, Dasari S, Konopka AR, et al. Enhanced Protein Translation Underlies Improved Metabolic and Physical Adaptations to Different Exercise Training Modes in Young and Old Humans. Cell Metabolism. March 7, 2017.


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