Exercise to control cholesterol level
Heart disease is the main killer in Malaysia. Thirty-six per cent of deaths in Malaysia are due to heart disease. One of the risk factors for heart disease is high cholesterol. The number of Malaysians with high cholesterol is increasing.
Over four years (2011-2015), the prevalence of high cholesterol increased by 46 per cent. The prevalence increases with age, with a peak between 55 and 59 years of age (68.8 per cent).
Overall, 47.7 per cent of adult Malaysians have high cholesterol with a total cholesterol level of more than 5.2mmol/l. A study in Malaysia showed that among 13-yearold schoolchildren, 23 per cent have high cholesterol. This figure is alarming.
Dyslipidaemia has been well-established as a major risk factor for heart disease. It refers to the following lipid levels: Total cholesterol (TC) more than 5.2 mmol/L or high-density lipoprotein cholesterol (HDL-C) less than 1.0 mmol/L (males) or less than 1.2 mmol/L (females) or triglycerides (TG) more than 1.7 mmol/L.
The low density lipoprotein cholesterol (LDL-C) levels will depend on the patient’s cardiovascular risk. For the high risk group, the LDL-C level should be less than 1.8 mmol/l.
Exercise may help prevent high cholesterol because it has been shown to reduce 40 per cent of CVD risk, one of it through cholesterol reduction.
Exercise and maintaining fitness level are able to reduce 30 per cent risk of getting high cholesterol. For every 1-MET improvement in fitness, one lowers the risk of incidence of high cholesterol by 12 per cent. It has been established that exercise (along with good lifestyle habits) will prevent dyslipidemia.
HOW DOES EXERCISE CONTROL CHOLESTEROL LEVEL?
Exercise has effects on LDL-C, HDL-C and TG. To improve the lipid profile (LDL-C, HDL-C and TG), lifestyle changes including regular exercise and dietary changes should be undertaken. Many studies show that exercise leads to reduction of LDL-C for about 1-2 mmol/l.
Exercise will also increase HDL-C for 1.4mg/dl (0.036mmol/L). The changes of LDL-C and HDL-C are about 5-10 per cent by aerobic exercise. Exercise reduces TG by about 11 per cent (up to 0.34 mmol/L). The effect on HDL-C is more consistent, compared with LDL-C. Overall, the effect of exercise on lipid profile is modest.
For an obese or overweight person with high cholesterol, the aim should be weight reduction and improving Body Mass Index (BMI). An exercise programme that focuses on weight loss can affect total cholesterol, LDL-C, HDL-C and TG levels.
Exercise, lifestyle changes, good dietary habits, cessation of smoking and weight reduction are usually prescribed for all patients with high cholesterol. Lifestyle changes are considered as critical component in managing high cholesterol.
Most patients in low and moderate risk groups can manage their risk by lifestyle changes alone. But lifestyle changes alone may not be adequate to control the cholesterol level, especially in the high risk group. Medication is usually initiated together with lifestyle changes if the targeted LDL-C level is not achieved. Always discuss with your doctor the best treatment option.
WHAT TYPES OF EXERCISES ARE BEST TO PREVENT AND TREAT HIGH CHOLESTEROL?
Lifestyle changes, including exercise, are the basic treatment for all patients with high cholesterol, even for a patient who eventually needs lipid-lowering agent to treat the condition. Both aerobic and strength exercises have effect on lipid profile.
However, aerobic exercise has more effect on lipid profile and weight reduction. Most of the literature emphasises on volume of exercise, not the intensity of exercise. For overweight and obese individuals, reducing weight should be highly emphasised.
For a high cholesterol patient, the ACSM recommends following a guideline similar to an obese individual. This strategy is to increase energy expenditure. More energy expenditure is important to this patient to enhance fat utilisation. This is easily achieved with high volume of aerobic exercise. The intensity of exercise should be at moderate intensity level.