Effects of aerobic interval training and continuous training on cellular markers of endothelial integrity in coronary artery disease: a SAINTEX-CAD substudy

Abstract

In this large multicenter trial, we aimed to assess the effect of aerobic exercise training in stable coronary artery disease (CAD) patients on cellular markers of endothelial integrity and to examine their relation with improvement of endothelial function. Two-hundred CAD patients (left ventricular ejection fraction > 40%, 90% male, mean age 58.4 ± 9.1 yr) were randomized on a 1:1 base to a supervised 12-wk rehabilitation program of either aerobic interval training or aerobic continuous training on a bicycle. At baseline and after 12 wk, numbers of circulating CD34(+)/KDR(+)/CD45dim endothelial progenitor cells (EPCs), CD31(+)/CD3(+)/CXCR4(+) angiogenic T cells, and CD31(+)/CD42b(-) endothelial microparticles (EMPs) were analyzed by flow cytometry. Endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery. After 12 wk of aerobic interval training or aerobic continuous training, numbers of circulating EPCs, angiogenic T cells, and EMPs were comparable with baseline levels. Whereas improvement in peak oxygen consumption was correlated to improvement in FMD (Pearson r = 0.17, P = 0.035), a direct correlation of baseline or posttraining EPCs, angiogenic T cells, and EMP levels with FMD was absent. Baseline EMPs related inversely to the magnitude of the increases in peak oxygen consumption (Spearman rho = -0.245, P = 0.027) and FMD (Spearman rho = -0.374, P = 0.001) following exercise training. In conclusion, endothelial function improvement in response to exercise training in patients with CAD did not relate to altered levels of EPCs and angiogenic T cells and/or a diminished shedding of EMPs into the circulation. EMP flow cytometry may be predictive of the increase in aerobic capacity and endothelial function.

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

“…The most common biomarker of endothelial function investigated was NO bioavailability. Rakobowchuk et al 28 included measurement of EPCs, Guiraud et al 30 used EMPs as a biomarker and Van Craenenbroeck et al 36 included both EPC and EMP. Furthermore, Wahl et al 33 also included each of VEGF, hepatocyte growth factor and migration inhibitory factor as outcome measures for endothelial function and pro-angiogenic status, in addition to EMP.…”

“…28 Duration of training protocol varied between 4, 32 6 23,28 and 8 weeks 25 up to 12 21,26,31,34–36 and 24 weeks. 24 …”

“…21 The remaining longitudinal studies found no change in endothelial function after weeks in either mode of exercise. 32,35,36 …”

“…No change in endothelial function was reported in studies with short-interval HIT protocol 28,30 as well as with long duration of intervals. 22,32,35,36 The remaining studies that found HIT to be equal to MICE, or superior to controls, showed large variations in their exercise protocols regarding duration of intervals, type of recovery between intervals and duration of training intervention.…”

“…Of the nine studies, six concluded HIT to be equal to or better than MICE or control, 21,24–26,31,32,34 while three found MICE to be superior to HIT or no significant effect by either of the two training modalities regarding an effect on endothelial function. 32,35,36 …”