Atherosclerosis and Osteoarthritis: Understanding the Impact of being Physical Active

Nearly everyone can experience health benefits from being physically active.  Simply, brisk walking can be “go to” for a safe and effective tool to improve or maintain current activity levels.

Physical activity continues to be encouraged because of the staggering impact it has on delaying death from all causes (i.e. heart disease).

The Physical Activity Guidelines for Americans report people who are physically active for approximately 150 minutes a week to have a 33 percent lower risk of all-cause mortality. More importantly, these 150 minutes can be spread throughout a 24 hour period. The benefits accumulate (CDC, 2021).

Thus, avoiding a sedentary lifestyle or even prolonged periods of sitting will maintain a healthy vascular system and keep the heart pumping the way you need it. There is evidence showing that as little as 10 minutes of sitting results in changes that impact microcirculation of blood (Vranish et al., 2018). This microcirculation area is the final destination of the cardiovascular system, and ultimately where oxygen is exchanged.

Breaking up the day into brief bouts of activity goes a long way. So those reminders on the fitness trackers, make sure to use them to your advantage. If you have some health goals you want to meet, use physical activity tracking as a supplement to your plan. Walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and cardiovascular disease morbidity and mortality in adults (Hall et al., 2020).

A study published by Wolf et. al. showed that even four-second bouts of intense activity between bouts of sitting can carry benefits that extend into the next day. In a model of 8 hours of inactivity, study participants cycled five times every hour over a 6 hour period. These exercise bouts from the previous day reduced levels of fat in the blood by 31% (Wolfe et al., 2020).

However, not everyone can just get up and move. Individuals that are diagnosed with osteoarthritis of the hip and knee represent one of the leading causes of global disability (Skou et al., 2018). Thus, a group like this will struggle to meet activity guidelines and is likely to share an increased burden of cardiovascular disease risk. The presence of osteoarthritis in a large prospective cohort (1,775) followed over a mean of 8 years showed an increased risk of cardiovascular disease by 27% (Veronese et al., 2018).  Determining ways to encourage physical activity even in disabling scenarios/conditions, continues to be a challenge. Magnetic resonance (MR) imaging, one of the most advanced imaging techniques used clinically, could be used to inform physicians how to best to approach this challenge. In a brief review by Liu et. al., MR images were used to visualize lower limbs to aid in the development of biomarker development and/or predict patients with risk to PAD. This could patients who are inactive because of the severity of osteoarthritis (Liu et al., 2019).

Hopefully, we evolve in our approach for activity recommendations and potentially pain management in groups that exhibit disabling conditions like osteoarthritis. I think this brings another point about the pathology of the two conditions and the relatedness. There has been evidence to support a vascular etiology and its ability to predict structural progression of osteoarthritis over 10 years (Jonsson et al., 2019; Wang et al., 2015). There is also data that relates use of statins to treat atherosclerosis and knee osteoarthritis progression (Clockaerts et al., 2012). Recently a nutritional link has been brought to light with Vitamin K and osteoarthritis. Vitamin K is commonly known for its role in blood coagulation (Loeser et al., 2021). Below is the figure Loeser et. al., uses to illustrate vitamin K role in osteoarthritis.

In the next figure below, Findlay 2007, shows how the subchondral vasculature is related to the initiation and/or progression of osteoarthritis. The left side shows healthy articular cartilage and the right side shows some cartilage erosion that may be related to changes due to an occlusion of blood supply.


CDC, 2021. Benefits of Physical Activity [WWW Document]. Cent. Dis. Control Prev. URL https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm (accessed 5.20.21).

Clockaerts, S., Osch, G.J.V.M.V., Bastiaansen-Jenniskens, Y.M., Verhaar, J. a. N., Glabbeek, F.V., Meurs, J.B.V., Kerkhof, H.J.M., Hofman, A., Stricker, B.H.C., Bierma-Zeinstra, S.M., 2012. Statin use is associated with reduced incidence and progression of knee osteoarthritis in the Rotterdam study. Ann. Rheum. Dis. 71, 642–647. https://doi.org/10.1136/annrheumdis-2011-200092

Hall, K.S., Hyde, E.T., Bassett, D.R., Carlson, S.A., Carnethon, M.R., Ekelund, U., Evenson, K.R., Galuska, D.A., Kraus, W.E., Lee, I.-M., Matthews, C.E., Omura, J.D., Paluch, A.E., Thomas, W.I., Fulton, J.E., 2020. Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. Int. J. Behav. Nutr. Phys. Act. 17, 78. https://doi.org/10.1186/s12966-020-00978-9

Jonsson, H., Fisher, D.E., Eiriksdottir, G., Aspelund, T., Klein, R., Gudnason, V., Cotch, M.F., 2019. Hand and knee osteoarthritis are associated with reduced diameters in retinal vessels: the AGES-Reykjavik study. Rheumatol. Int. 39, 669–677. https://doi.org/10.1007/s00296-019-04243-6

Liu, W., Balu, N., Canton, G., Hippe, D.S., Watase, H., Waterton, J.C., Hatsukami, T., Yuan, C., 2019. Understanding Atherosclerosis Through an Osteoarthritis Data Set. Arterioscler. Thromb. Vasc. Biol. 39, 1018–1025. https://doi.org/10.1161/ATVBAHA.119.312513

Loeser, R.F., Berenbaum, F., Kloppenburg, M., 2021. Vitamin K and osteoarthritis: is there a link? Ann. Rheum. Dis. 80, 547–549. https://doi.org/10.1136/annrheumdis-2020-219765

Skou, S.T., Pedersen, B.K., Abbott, J.H., Patterson, B., Barton, C., 2018. Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis. J. Orthop. Sports Phys. Ther. 48, 439–447. https://doi.org/10.2519/jospt.2018.7877

Veronese, N., Stubbs, B., Solmi, M., Smith, T.O., Reginster, J.-Y., Maggi, S., 2018. Osteoarthristis Increases the Risk of Cardiovascular Disease: Data from the Osteoarthritis Initiative. J. Nutr. Health Aging 22, 371–376. https://doi.org/10.1007/s12603-017-0941-0

Vranish, J.R., Young, B.E., Stephens, B.Y., Kaur, J., Padilla, J., Fadel, P.J., 2018. Brief periods of inactivity reduce leg microvascular, but not macrovascular, function in healthy young men. Exp. Physiol. 103, 1425–1434. https://doi.org/10.1113/EP086918

Wang, Y., Dawson, C., Hanna, F., Fairley, J., Cicuttini, F.M., 2015. Association between popliteal artery wall thickness and knee cartilage volume loss in community-based middle-aged women without clinical knee disease. Maturitas 82, 222–227. https://doi.org/10.1016/j.maturitas.2015.07.010

Wolfe, A.S., Burton, H.M., Vardarli, E., Coyle, E.F., 2020. Hourly 4-s Sprints Prevent Impairment of Postprandial Fat Metabolism from Inactivity. Med. Sci. Sports Exerc. 52, 2262–2269. https://doi.org/10.1249/MSS.0000000000002367


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Nursing And Allied Professional Sessions At The American Heart Association

During the American Heart Association Scientific Sessions, there were great sessions. It was really a struggle to make an overview of all the nurses and allied professional sessions in a short blog; they were just all very interesting and informative. But I summarized the topics that were for me the most interesting during the Sessions.
Adherence to medication use
Dr. Todd Ruppar (@ToddRuppar) presented the importance of the use of behavior prompt for cardiac patients to remember medication intake. Dr. Ellis presented one of the new examples of these behavioral prompt: the printable pillboxes with the possibility to connect to a mobile app (InterACT Pillbox).

Slide showing example of printable pill box with app capabilities

Dr. Rhonda Copper-deHoff suggested that pharmacogenetic testing could be a piece of the adherence puzzle in cardiac patients and Dr. Anton Vehovec (@antonvehovec) points out that medication adherence mediate the relationship between memory and emergency room visits and hospitalization. He stated that we should test interventions that aim to improve memory and look at the effect this has on medication adherence.


2. Technology use
Dr. Maria Liljeroos’ (@MartorMaria) research showed that telemonitoring is feasible to implement, but that we have to remember that it is still a challenge to include older cardiac patients.

Dr. Megan Reading gave a talk on technology use in patients with atrial fibrillation. In her research, they found that being asymptomatic was the main reason for not using technology. Also traveling and simply forgetting to use the technology were important reasons for not using it.

Dr. Mary Dolansky found in her research that the current evaluation of technology used to measure self-care behaviors, such as activity monitors, is insufficient. Future research should be focused on evaluating technologies for measuring and use in self-care in cardiac patients.

examples of self care measures slide

3. Palliative care/end of life in cardiac patients
A quote of Isaac Asimov, which Dr. Lisa Kitko used in her presentation, presents the importance of palliative care in cardiac patients:

Life is pleasant death is peaceful it's the transition that troublesome - Isaac Asimov

She further stated that we should remember that 67% of all patients with an LVAD have 5 or more comorbidities.

Dr. Lorraine Evangelista brings up in her presentation the importance of optimal palliative care in the beginning of the heart failure trajectory. She also presented a poster of Lisa Hjelmfors on the importance of communication about the heart failure prognosis in the US and Europe. And although most nurses think they have knowledge on prognosis and the communication with the patients, around 70% would like further education about this topic.

Dr. Dougherty gave a talk about technology advances create complex decision making for patients, family and providers. Health care professionals need to have conversations and discussions about device management at end of life.

Dr. Loreena Hill (@HillLoreena) and Dr. Donna Fitzsimons (@FitzsimonsDonna) stated that there is a paradigm shift regarding when deactivation should be discussed and who is responsible in long overdue if end of life care for patients with an ICD is to improve.

Study Characteristics

4. The importance of involving caregivers
Dr. Anna Strömberg (@Anna_Submitting) talked about the importance of involving caregivers and the support and education these caregivers want. Caregivers would like easy access to health care and support groups with caregivers alone. This could help them to handle their life situation.

J.N. Dionne-Odem (@jn_dionneodom) pointed out that caregivers are vital in care for patients with heart failure, but that we have to realize that only 1 in 3 are comfortable giving heart failure care.

A poster presented by Dr. Hiroko Ishida shows the importance of health literacy in caregivers. They found that health literacy of patients with heart failure and their caregivers was independently associated with caregivers burden.

5. Diet, fluid restriction and appetite
Dr Anna Strömberg (@Anna_Submitting) stated the importance of the need for more research in nutrition and fluid restriction and Dr. Lennie presented that we are all on a diet, but that just finding the best food for you, as a person is a challenge. Dr. Martha Biddle advised that cardiac patient should have a healthy, varied diet. She even presented a recipe for a cardiovascular health:

recipe for cardiovascular health slide

Dr. Lora Burke suggests that mobile apps could be a tool for nutrition research to increase adherence. Mobile apps could give feedback to the patients, which could improve dietary choice/eating behavior by make patients more aware of their choices. Dr. Misook Chung presented a poster concluding that diet quality was similar in patients with heart failure regardless their adherence to sodium restriction diet. Christina Andrea’s (@C_Andreae) poster demonstrated that patients who are more physically active have better appetites compared to those who are less physically active. This research underscore that in future studies, a need is for attention on physical activity and appetite.

physical activity and appetite in patients poster

6. Physical activities
Dr. Tiny Jaarsma (@DrJaarsma) presented a new way for patients in cardiac care to be active at home: Exergaming. Exergaming is being physical active with a gaming computer. In her research, (@HFWii) they found that installing such a computer at home with patients with heart failure increased their exercise capacity.

Another promising and alternative way to exercise in community-dwelling older adults, presented by Dr. Marjorie Funk, was Qigong. Qigong is a form of exercise composed of movements that are repeated a number of times, often stretching the body, increasing fluid movement (blood, synovial, and lymph) and building awareness of how the body moves through space. This research showed that Qigong was feasible for older adults and that they accepted this form of exercise. This research group next step is to test this on cardiac patients.

A intervention presented was the Heart Up!, (a text message intervention) showed promising in improving in physical activity and decreasing hopelessness in patients with ischemic heart disease.

Leonie Klompstra Headshot

Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.