High cholesterol & exercise: An Exercise is Medicine Fact Sheet
What is dyslipidaemia (high cholesterol)?
Dyslipidaemia is the term used when there are abnormal levels of lipids (blood fats) or lipoproteins – the carriers that move fat around the body. High blood cholesterol and triglyceride levels (hyperlipidemia) are the most common dyslipidaemias. Lipoproteins can be categorised as low-density lipoprotein cholesterol (LDL-c, referred to as the ‘bad’ cholesterol) or high-density lipoprotein cholesterol (HDL-c, the ‘good’ cholesterol).
Of course, LDL-c is present in unhealthy foods such as fast foods. These contain an abnormally large amount of fat. Luckily, HDL-c can be found in more healthy foods such as fish, lean meats and tree nuts such as walnuts.
A blood test called a ‘lipid profile’ is normally carried out and used to diagnose dyslipidemia.
The best thing to do is a fasting sample. It can be used to determine the levels of LDL-c in relation to HDL-c.
An abnormal lipid profile can be a significant risk factor for blood vessel damage. Most importantly, this can contribute to end-organ damage such as blood vessel (cardiovascular) disease, pancreatitis and hepatic stenosis (fatty liver)1.
How does exercise help?
Management of dyslipidaemia needs to target reducing the absolute risk of cardiovascular (CV) ‘events’. Such as myocardial infarction (heart attacks) that may occur over the next 5-10 years. Most importantly, lowering the LDL-c and triglycerides and increasing HDL-c can help to reduce this CV risk.
The majority of cholesterol is transported as LDL-c, so the recommended targets for maximal benefit are:
• Less than 2.5 millimoles per litre (mmol/L) for LDL-c in healthy people;
• Less than 1.8 mmol/L for LDL-c in people with existing heart disease;
• Greater than 1.0 mmol/L for HDL-c; and,
• Less than 2.0 mmol/L for triglycerides2
The prescription of statin therapies for dyslipidaemia has received a great deal of attention of the past 5-10 years. Management of cardiovascular risk should include a strong focus on lifestyle changes, including regular physical activity and exercise as well as improving the diet and reducing body fat. Luckily, exercise is a low-cost, readily available treatment modality with proven benefits for lipid and lipoprotein levels (3,4)
So what are the recommendations for high cholesterol & exercise?
It is important to improve lipid profiles and reduce cardiovascular risk, people with high cholesterol should aim for aerobic exercise for at least 30 minutes on most, if not all, days of the week. A useful strategy of doing so may doing shorter bouts of 10 minutes at a time and building up.
Examples of aerobic exercise are brisk walking, jogging, cycling, swimming dancing, ball games or other sporting activities.
Regular aerobic exercise can:
a) increase HDL-c by 3-10% (up to 0.16 mmol/L); and,
b) reduce triglycerides by about 11% (up to 0.34 mmol/L).
Vigorous exercise can improve HDL-c levels more so than low intensity exercise.
A good way to determine exercise intensity is to exercise at an intensity where you can maintain a conversation without getting too short of breath.
Resistance training (weights) can also help to reduce lipid and lipoprotein levels. Generally 2-3 sets of 8-10 different exercises at a moderate level of intensity (able to do 8-12 repetitions), twice a week can help to improve HDL-c levels6. It is advisable to start with a general aerobic warm up of 5-10 minutes prior to carrying out resistance training. Ensure that appropriate technique is used for each exercise to reduce the risk of injury.
A warning,self-administered vigorous aerobic or resistance training may not be suitable for all people with high cholesterol.
People with dyslipidaemia who would benefit from a structured program delivered by an accredited exercise physiologist (AEP) include:
• any person with known CV disease, metabolic syndrome or diabetes
• anyone with a family history of CV disease
• people with hypertension (high blood pressure)
• men aged over 45 years and women aged over 55 years
• people who have not been doing regular physical activity or exercise.
How can we help?
The myPhyioSA fitness and rehabilitation team accredited exercise physiologists (AEPs) can help you with your goals to reduce your cardiovascular risk, including aiming to lower your lipid and lipoprotein levels. This can be one-to-one through a range of referral pathways including Medicare and through your private health insurance.
Accredited exercise physiologists (AEPs) are skilled in determining exercise prescription specific to your needs.
You may be able to participate in a group class where you exercise alongside people with similar cardiac risk factors.
If you would like further information on high cholesterol & exercise, please do not hesitate to contact us at myPhysioSA.
By Stephen Bateman, Accredited Exercise Physiologist
References and further information:
1. Sullivan D.R., Watts G.F., Nicholls S.J., Barter P., Grenfell R., Chow C.K., Tonkin A. and Keech A. (2015). “Clinical guidelines on hyperlidipaemia: Recent developments, future challenges and the need for an Australian review”. Heart, Lung and Circulation 24: 495-502.
2. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand (2012). “Reducing the risk in heart disease: an expert guide to clinical practice for secondary prevention of coronary heart disease. Melbourne: National Heart Foundation of Australia.
3. Kelley G.A., Kelley, K.S. and Franklin B (2006). “Aerobic exercise and lipids and lipoproteins in patients with cardiovascular disease: a meta-analysis of randomized controlled trials”. Journal of Cardiopulmonary Rehabilitation. 26(3): 131-9.
4. Kelley G.A., Kelley K.S. and Tran Z.V (2005). “Aerobic exercise, lipids and lipoproteins in overweight and obese adults: a meta-analysis of randomized controlled trials. International Journal of Obesity. 29(8): 881-893.
5. Exercise is Medicine (2014). “Exercise is medicine Australia factsheet: Dyslipidaemia and exercise”. www.exerciseismedicine.org.au
6. Braith R.W. (2006). “Resistance exercise training: its role in the prevention of cardiovascular disease”. Circulation. 113(22): 2642-2650.