Effect of high-intensity training on endothelial function in patients with cardiovascular and cerebrovascular disease: A systematic review

Abstract

Objectives:Exercise improves endothelial dysfunction, the key manifestation of cardiovascular and cerebrovascular disease, and is recommended in both cardiovascular and cerebrovascular rehabilitation. Disagreement remains, however, on the role of intensity of exercise. The purpose of this review was to gather current knowledge on the effects of high-intensity training versus moderate-intensity continuous exercise on endothelial function in cardiovascular and cerebrovascular patients.Methods:A systematic review was performed in PubMed database, Embase and Cochrane libraries and on PEDro using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were restricted to cardiovascular and cerebrovascular patients, and healthy subjects as general reference. Interventions comprised of high-intensity training alone, high-intensity training compared to moderate-intensity continuous exercise, or no training, with endothelial function as outcome measure. Endothelial function was measured either physiologically by flow-mediated dilatation and/or by systemic biomarkers. Data were analyzed descriptively due to non-comparability for a meta-analysis to be performed.Results:A total of 20 studies were included in the review. Although there was great heterogenecity in design, population and exercise protocols, all studies found high-intensity training to be safe. High-intensity training was equal to moderate-intensity continuous exercise through improvement in endothelial function in 15 of the 20 selected studies, as measured by flow-mediated dilatation, nitric oxide bioavailability and circulating biomarkers. Only a few studies examined high-intensity training in cerebrovascular patients, none with endothelial function as outcome.Conclusion:High-intensity training is promising as a time-efficient exercise strategy in cardiovascular rehabilitation, but data on endothelial effects in cerebrovascular rehabilitation are warranted. Agreement on a more uniform exercise protocol is essential to further investigate the optimal exercise mode for cerebrovascular rehabilitation.

Does chronic high-intensity endurance training have an effect on cardiovascular markers of active populations and athletes? Systematic review and meta-analysis

“…The absolute magnitude of the increase in risk associated with vigorous exertion is extremely small, and the overall risk of sudden death was not increased in association with increasing frequency of vigorous exercise 58. Even sometimes, high-intensity endurance training is safe and highly relevant in patients with CVD59 if there is close monitoring during the training.…”

Cardiac Rehabilitation and Exercise Prescription in Symptomatic Patients with Non-Obstructive Coronary Artery Disease—a Systematic Review

“…As recommended by guidelines, authors chose mostly a moderate training intensity, although guidance parameters varied between the studies. A meta-analysis recently showed that high-intensity training improves endothelial function in patients with cardiovascular disease [ 24 ], hereby raising the question whether it might be a time-efficient alternative or addition in NOCAD patients. Furthermore, training strategies like skiing appear to have a beneficial effect on endothelial health, which might broaden the recommended exercise spectrum, at least in alpine regions [ 25 ].…”

Cucumis sativus Aqueous Fraction Inhibits Angiotensin II-Induced Inflammation and Oxidative Stress In Vitro

“…Inflammation and oxidative stress are strongly associated with the progression of endothelial dysfunction; in turn, the latter is the physiopathological substrate of several cardiovascular diseases with high impact on mortality indices such as myocardial infarction, cerebrovascular disease, and chronic renal failure [ 33 , 34 , 35 ]. Thus, treatments to control both conditions are emerging as key therapies against these high-impact diseases [ 1 ].…”