Physical Activity Stands Out in Iranian Study Linking Healthy Lifestyles to Lower Heart Disease Odds

At two hospitals in Kermanshah, Iran, Imam Reza and Imam Ali, two trained interviewers walked the inpatient wards between February 28 and June 9, 2023, asking patients about how they lived. They explained the aims of the research, obtained consent, and worked through a 46-question lifestyle questionnaire. The result, published in BMC Public Health, is a comparison of 495 adults with and without cardiovascular disease.

The design was a case-control study. The case group was 99 recently diagnosed patients admitted to inpatient heart and cardiac care departments. Each had a physician-confirmed diagnosis and used at least one cardiac medication. For every case, researchers chose four controls, 396 in all, from other departments such as gastroenterology and urology, none with a diagnosed cardiovascular condition. Participants were recruited by convenience sampling, meaning eligible, available, and willing patients. They were 18 to 65 years old, could communicate in Farsi or Kurdish, and had no sensory or cognitive impairment. People with serious illness such as kidney failure or metastatic cancer, or with unstable circulation, were excluded.

The questionnaire, previously validated, covered five areas: prevention, physical activity and recreation, healthy eating, stress management, and interpersonal and social relationships. Answers were scored on a five-point scale, and totals sorted lifestyle into unfavorable, moderate, or favorable.

The gap between the groups was clear. Patients with cardiovascular disease averaged 146.66, which fell in the moderate category. Controls averaged 169.4, in the favorable category. Each additional point on the scale was associated with 4% lower odds of cardiovascular disease in the unadjusted analysis and 6% lower after adjusting for education, age, marital status, job, income, computer knowledge, and source of health information. The adjusted odds ratio was 0.94, with a 95% confidence interval of 0.93 to 0.96. An odds ratio compares odds across values of a predictor; it does not establish that risk was reduced.

All five domains showed a significant link after adjustment. Physical activity and recreation had the strongest association per questionnaire point: each point went with 38% lower odds. Stress management was tied to 22% lower odds and healthy eating to 18%. Preventive measures and social and interpersonal relationships were each tied to 12%.

The groups also differed in income, job status, and computer knowledge, and more than half of the patients reported insufficient income. The authors suggested that income, education, and employment may shape the chance to build healthy habits, though the data did not directly test that. They recommended that prevention programs prioritize nutrition, stress management, social connection, and community support for physical activity, especially for people with lower incomes.

The limitations are substantial. Lifestyle was self-reported, which can introduce bias. The hospital-based convenience sample limits how far the findings travel. Lifestyle was recorded after diagnosis, so illness itself may have changed behavior. Comorbid conditions were not fully assessed, residual confounding from smoking, diabetes, and obesity remains possible, and the type of cardiovascular condition was not recorded, so no analysis by condition was possible.

The authors call for longitudinal and intervention studies that account for other illnesses and follow how lifestyle shapes heart health over the years. Only that kind of work can say whether changing habits prevents disease.