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Cardiorespiratory Fitness and Atherosclerosis: Recent Data and Future Directions

  • Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)
  • Published:
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Abstract

Historically, the relationship between exercise and the cardiovascular system was viewed as unidirectional, with a disease resulting in exercise limitation and hazard. This article reviews and explores the bidirectional nature, delineating the effects, generally positive, on the cardiovascular system and atherosclerosis. Exercise augments eNOS, affects redox potential, and favorably affects mediators of atherosclerosis including lipids, glucose homeostasis, and inflammation. There are direct effects on the vasculature as well as indirect benefits related to exercise-induced changes in body composition and skeletal muscle. Application of aerobic exercise to specific populations is described, with the hope that this knowledge will move the science forward and improve individual patient outcome.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Shephard RJ, Balady GJ. Exercise as cardiovascular therapy. Circulation. 1999;99(7):963–72.

    Article  CAS  PubMed  Google Scholar 

  2. Manou-Stathopoulou V, Goodwin CD, Patterson T, Redwood SR, Marber MS, Williams RP. The effects of cold and exercise on the cardiovascular system. Heart. 2015;101(10):808–20.

    Article  PubMed  Google Scholar 

  3. Hess OM, Bortone A, Eid K, et al. Coronary vasomotor tone during static and dynamic exercise. Eur Heart J. 1989;10(Suppl F):105–10.

    Article  PubMed  Google Scholar 

  4. van de Hoef TP, Meuwissen M, Piek JJ. Fractional flow reserve and beyond. Heart. 2013;99(22):1699–705.

    Article  PubMed  Google Scholar 

  5. Gielen S, Schuler G, Hambrecht R. Exercise training in coronary artery disease and coronary vasomotion. Circulation. 2001;103(1):E1–6.

    Article  CAS  PubMed  Google Scholar 

  6. Levy WC, Cerqueira MD, Harp GD, et al. Effect of endurance exercise training on heart rate variability at rest in healthy young and older men. Am J Cardiol. 1998;82(10):1236–41.

    Article  CAS  PubMed  Google Scholar 

  7. Sironi AM, Gastaldelli A, Mari A, et al. Visceral fat in hypertension: influence on insulin resistance and beta-cell function. Hypertension. 2004;44(2):127–33.

    Article  CAS  PubMed  Google Scholar 

  8. Golbidi S, Laher I. Exercise and the cardiovascular system. Cardiol Res Pract. 2012;2012:210852.

    PubMed  PubMed Central  Google Scholar 

  9. Lavie CJ, Arena R, Swift DL, et al. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ Res. 2015;117(2):207–19. Recent comprehensive review of clinical and epidemiologic evidence supporting the role of aerobic exercise in primary and secondary cardiovascular disease prevention.

    Article  CAS  PubMed  Google Scholar 

  10. Egan B, Zierath JR. Exercise metabolism and the molecular regulation of skeletal muscle adaptation. Cell Metab. 2013;17(2):162–84.

    Article  CAS  PubMed  Google Scholar 

  11. DeFronzo RA, Jacot E, Jequier E, Maeder E, Wahren J, Felber JP. The effect of insulin on the disposal of intravenous glucose. Results from indirect calorimetry and hepatic and femoral venous catheterization. Diabetes. 1981;30(12):1000–7.

    Article  CAS  PubMed  Google Scholar 

  12. Vinetti G, Mozzini C, Desenzani P, et al. Supervised exercise training reduces oxidative stress and cardiometabolic risk in adults with type 2 diabetes: a randomized controlled trial. Sci Rep. 2015;5:9238.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. Arterioscler Thromb Vasc Biol. 2003;23(2):168–75.

    Article  CAS  PubMed  Google Scholar 

  14. Di Francescomarino S, Sciartilli A, Di Valerio V, Di Baldassarre A, Gallina S. The effect of physical exercise on endothelial function. Sports Med. 2009;39(10):797–812. Distillation of data focused on the evidence of exercise mediated improvement in eNOS and endothelial function.

    Article  PubMed  Google Scholar 

  15. Franzoni F, Galetta F, Morizzo C, et al. Effects of age and physical fitness on microcirculatory function. Clin Sci (Lond). 2004;106(3):329–35.

    Article  Google Scholar 

  16. Taddei S, Galetta F, Virdis A, et al. Physical activity prevents age-related impairment in nitric oxide availability in elderly athletes. Circulation. 2000;101(25):2896–901.

    Article  CAS  PubMed  Google Scholar 

  17. Barone Gibbs B, Dobrosielski DA, Bonekamp S, Stewart KJ, Clark JM. A randomized trial of exercise for blood pressure reduction in type 2 diabetes: effect on flow-mediated dilation and circulating biomarkers of endothelial function. Atherosclerosis. 2012;224(2):446–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Dawson EA, Whyte GP, Black MA, et al. Changes in vascular and cardiac function after prolonged strenuous exercise in humans. J Appl Physiol (1985). 2008;105(5):1562–8.

    Article  Google Scholar 

  19. Higashi Y, Yoshizumi M. Exercise and endothelial function: role of endothelium-derived nitric oxide and oxidative stress in healthy subjects and hypertensive patients. Pharmacol Ther. 2004;102(1):87–96.

    Article  CAS  PubMed  Google Scholar 

  20. Haram PM, Adams V, Kemi OJ, et al. Time-course of endothelial adaptation following acute and regular exercise. Eur J Cardiovasc Prev Rehabil. 2006;13(4):585–91.

    Article  PubMed  Google Scholar 

  21. Franke WD, Stephens GM, Schmid 3rd PG. Effects of intense exercise training on endothelium-dependent exercise-induced vasodilatation. Clin Physiol. 1998;18(6):521–8.

    Article  CAS  PubMed  Google Scholar 

  22. Soccio M, Toniato E, Evangelista V, Carluccio M, De Caterina R. Oxidative stress and cardiovascular risk: the role of vascular NAD(P)H oxidase and its genetic variants. Eur J Clin Investig. 2005;35(5):305–14.

    Article  CAS  Google Scholar 

  23. De Caterina R. Endothelial dysfunctions: common denominators in vascular disease. Curr Opin Lipidol. 2000;11(1):9–23.

    Article  PubMed  Google Scholar 

  24. Pitocco D, Tesauro M, Alessandro R, Ghirlanda G, Cardillo C. Oxidative stress in diabetes: implications for vascular and other complications. Int J Mol Sci. 2013;14(11):21525–50.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Verma S, Anderson TJ. Fundamentals of endothelial function for the clinical cardiologist. Circulation. 2002;105(5):546–9.

    Article  CAS  PubMed  Google Scholar 

  26. Green DJ, O′Driscoll G, Joyner MJ, Cable NT. Exercise and cardiovascular risk reduction: time to update the rationale for exercise? J Appl Physiol (1985). 2008;105(2):766–8.

    Article  Google Scholar 

  27. Wilson MG, Ellison GM, Cable NT. Basic science behind the cardiovascular benefits of exercise. Heart. 2015;101(10):758–65.

    Article  PubMed  Google Scholar 

  28. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2960–84.

    Article  PubMed  Google Scholar 

  29. Barengo NC, Hu G, Lakka TA, Pekkarinen H, Nissinen A, Tuomilehto J. Low physical activity as a predictor for total and cardiovascular disease mortality in middle-aged men and women in Finland. Eur Heart J. 2004;25(24):2204–11.

    Article  PubMed  Google Scholar 

  30. Marijon E, Tafflet M, Antero-Jacquemin J, et al. Mortality of French participants in the Tour de France (1947–2012). Eur Heart J. 2013;34(40):3145–50.

    Article  PubMed  Google Scholar 

  31. Kramsch DM, Aspen AJ, Abramowitz BM, Kreimendahl T, Hood Jr WB. Reduction of coronary atherosclerosis by moderate conditioning exercise in monkeys on an atherogenic diet. N Engl J Med. 1981;305(25):1483–9.

    Article  CAS  PubMed  Google Scholar 

  32. Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2010;304(20):2253–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Sigal RJ, Kenny GP, Boule NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 2007;147(6):357–69.

    Article  PubMed  Google Scholar 

  34. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care. 2010;33(12):2692–6.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kraus WE, Houmard JA, Duscha BD, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med. 2002;347(19):1483–92.

    Article  CAS  PubMed  Google Scholar 

  36. Swift DL, Lavie CJ, Johannsen NM, et al. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J. 2013;77(2):281–92.

    Article  PubMed  Google Scholar 

  37. Howard G, Wagenknecht LE, Burke GL, et al. Cigarette smoking and progression of atherosclerosis: the Atherosclerosis Risk in Communities (ARIC) Study. JAMA. 1998;279(2):119–24.

    Article  CAS  PubMed  Google Scholar 

  38. Celermajer DS, Sorensen KE, Georgakopoulos D, et al. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation. 1993;88(5 Pt 1):2149–55.

    Article  CAS  PubMed  Google Scholar 

  39. Marcus BH, Albrecht AE, King TK, et al. The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial. Arch Intern Med. 1999;159(11):1229–34.

    Article  CAS  PubMed  Google Scholar 

  40. Millar PJ, McGowan CL, Cornelissen VA, Araujo CG, Swaine IL. Evidence for the role of isometric exercise training in reducing blood pressure: potential mechanisms and future directions. Sports Med. 2014;44(3):345–56.

    Article  PubMed  Google Scholar 

  41. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1), e004473.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Carlson DJ, Dieberg G, Hess NC, Millar PJ, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis. Mayo Clin Proc. 2014;89(3):327–34.

    Article  PubMed  Google Scholar 

  43. Pedersen BK, Saltin B. Exercise as medicine—evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25 Suppl 3:1–72. Comprehensive review covering evidence of exercise benefits for many different chronic diseases. There is particularly strong evidence for benefit in individuals with cardiovascular disease.

    Article  PubMed  Google Scholar 

  44. Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003;107(24):3109–16.

    Article  PubMed  Google Scholar 

  45. O′Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301(14):1439–50.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Jones LW, Douglas PS, Khouri MG, et al. Safety and efficacy of aerobic training in patients with cancer who have heart failure: an analysis of the HF-ACTION randomized trial. J Clin Oncol. 2014;32(23):2496–502.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Mentz RJ, Schulte PJ, Fleg JL, et al. Clinical characteristics, response to exercise training, and outcomes in patients with heart failure and chronic obstructive pulmonary disease: findings from Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION). Am Heart J. 2013;165(2):193–9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Banks AZ, Mentz RJ, Stebbins A, Mikus CR, Schulte PJ, Fleg JL, Cooper LS, Leifer ES, Badenhop DT, Keteyian SJ et al. Response to Exercise Training and Outcomes in Patients With Heart Failure and Diabetes Mellitus: Insights From the HF-ACTION Trial. J Card Fail. 2015.

  49. Mentz RJ, Bittner V, Schulte PJ, et al. Race, exercise training, and outcomes in chronic heart failure: findings from Heart Failure - A Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION). Am Heart J. 2013;166(3):488–95.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Pina IL, Bittner V, Clare RM, et al. Effects of exercise training on outcomes in women with heart failure: analysis of HF-ACTION (Heart Failure-A Controlled Trial Investigating Outcomes of Exercise TraiNing) by sex. JACC Heart Fail. 2014;2(2):180–6.

    Article  PubMed  Google Scholar 

  51. Babu AS, Padmakumar R, Maiya AG, Mohapatra AK, Kamath RL. Effects of exercise training on exercise capacity in pulmonary arterial hypertension: a systematic review of clinical trials. Heart Lung Circ. 2015.

  52. Parmenter BJ, Raymond J, Dinnen P, Singh MA. A systematic review of randomized controlled trials: walking versus alternative exercise prescription as treatment for intermittent claudication. Atherosclerosis. 2011;218(1):1–12.

    Article  CAS  PubMed  Google Scholar 

  53. Studenski S, Perera S, Wallace D, et al. Physical performance measures in the clinical setting. J Am Geriatr Soc. 2003;51(3):314–22.

    Article  PubMed  Google Scholar 

  54. Parmenter BJ, Raymond J, Fiatarone Singh MA. The effect of exercise on fitness and performance-based tests of function in intermittent claudication: a systematic review. Sports Med. 2013;43(6):513–24.

    Article  PubMed  Google Scholar 

  55. Parmenter BJ, Dieberg G, Phipps G, Smart NA. Exercise training for health-related quality of life in peripheral artery disease: a systematic review and meta-analysis. Vasc Med. 2015;20(1):30–40.

    Article  PubMed  Google Scholar 

  56. Myers SA, Huben NB, Yentes JM, et al. Spatiotemporal changes posttreatment in peripheral arterial disease. Rehabil Res Pract. 2015;2015:124023.

    PubMed  PubMed Central  Google Scholar 

  57. Mora S, Cook N, Buring JE, Ridker PM, Lee IM. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation. 2007;116(19):2110–8. Review of biologic mechanisms underlying the epidemiologic evidence of exercise associated decrease in cardiovascular events such as myocardial infarction and death.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Green DJ, Maiorana A, O′Driscoll G, Taylor R. Effect of exercise training on endothelium-derived nitric oxide function in humans. J Physiol. 2004;561(Pt 1):1–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Shirwany NA, Zou MH. Arterial stiffness: a brief review. Acta Pharmacol Sin. 2010;31(10):1267–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Kitzman DW, Brubaker PH, Herrington DM, et al. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol. 2013;62(7):584–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Miura H, Takahashi Y, Maki Y, Sugino M. Effects of exercise training on arterial stiffness in older hypertensive females. Eur J Appl Physiol. 2015;115(9):1847–54.

    Article  PubMed  Google Scholar 

  62. Montero D, Roche E, Martinez-Rodriguez A. The impact of aerobic exercise training on arterial stiffness in pre- and hypertensive subjects: a systematic review and meta-analysis. Int J Cardiol. 2014;173(3):361–8.

    Article  PubMed  Google Scholar 

  63. Way KL, Keating SE, Baker MK, Chuter VH, Johnson NA. The effect of exercise on vascular function and stiffness in type 2 diabetes: a systematic review and meta-analysis. Curr Diabetes Rev. 2015.

  64. Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, et al. Effect of moderate aerobic exercise training on endothelial function and arterial stiffness in CKD stages 3–4: a randomized controlled trial. Am J Kidney Dis. 2015;66(2):285–96.

    Article  PubMed  Google Scholar 

  65. Greenwood SA, Koufaki P, Mercer TH, et al. Aerobic or resistance training and pulse wave velocity in kidney transplant recipients: a 12-week pilot randomized controlled trial (the Exercise in Renal Transplant [ExeRT] Trial). Am J Kidney Dis. 2015;66(4):689–98.

    Article  PubMed  Google Scholar 

  66. Sallam N, Laher I. Exercise Modulates Oxidative Stress and Inflammation in Aging and Cardiovascular Diseases. Oxidative Med Cell Longev. 2016;2016:7239639. Recent review of the mechanisms linking exercise, inflammation, and redox processes.

    Article  Google Scholar 

  67. Sallis R, Franklin B, Joy L, Ross R, Sabgir D, Stone J. Strategies for promoting physical activity in clinical practice. Prog Cardiovasc Dis. 2015;57(4):375–86.

    Article  PubMed  Google Scholar 

  68. Josephson RA, Mehanna E. Exercise Prescription: The Devil Is in the Details. http://www.acc.org. February 11, 2016. Accessed February 28th, 2016. http://www.acc.org/latest-in-cardiology/articles/2016/02/11/08/15/exercise-prescription.

  69. Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.

    Article  PubMed  Google Scholar 

  70. Abell B, Glasziou P, Hoffmann T. Reporting and replicating trials of exercise-based cardiac rehabilitation: do we know what the researchers actually did? Circ Cardiovasc Qual Outcomes. 2015;8(2):187–94.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported in part by the National Institutes of Health Grant HL113570 to A. Hamik.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Health System, Mailstop LKS 5038, 11100 Euclid Avenue, Cleveland, OH, 44106-5038, USA

    Emile Mehanna, Anne Hamik & Richard A Josephson

  2. Division of Cardiovascular Medicine, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, USA

    Anne Hamik

  3. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Emile Mehanna, Anne Hamik & Richard A Josephson

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  1. Emile Mehanna
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Correspondence to Richard A Josephson.

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This article is part of the Topical Collection on Coronary Heart Disease

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Mehanna, E., Hamik, A. & Josephson, R.A. Cardiorespiratory Fitness and Atherosclerosis: Recent Data and Future Directions. Curr Atheroscler Rep 18, 26 (2016). https://doi.org/10.1007/s11883-016-0580-7

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