Exercise-mediated adaptations in vascular function and structure: Beneficial effects in coronary artery disease

Abstract

Exercise exerts direct effects on the vasculature via the impact of hemodynamic forces on the endothelium, thereby leading to functional and structural adaptations that lower cardiovascular risk. The patterns of blood flow and endothelial shear stress during exercise lead to atheroprotective hemodynamic stimuli on the endothelium and contribute to adaptations in vascular function and structure. The structural adaptations observed in arterial lumen dimensions after prolonged exercise supplant the need for acute functional vasodilatation in case of an increase in endothelial shear stress due to repeated exercise bouts. In contrast, wall thickness is affected by rather systemic factors, such as transmural pressure modulated during exercise by generalized changes in blood pressure. Several mechanisms have been proposed to explain the exercise-induced benefits in patients with coronary artery disease (CAD). They include decreased progression of coronary plaques in CAD, recruitment of collaterals, enhanced blood rheological properties, improvement of vascular smooth muscle cell and endothelial function, and coronary blood flow. This review describes how exercise via alterations in hemodynamic factors influences vascular function and structure which contributes to cardiovascular risk reduction, and highlights which mechanisms are involved in the positive effects of exercise on CAD.

The effect of a game-based mobile app ‘MyHeartMate’ to promote lifestyle change in coronary disease patients: a randomized controlled trial

“… 7 , 8 Regardless, physical activity participation provides substantial benefits to patients with CHD including decreasing the progression of plaques and improving recruitment of collaterals, endothelial function and coronary blood flow. 34 Guidelines recommend at least 150 min/week of moderate exercise, so an improvement of 140 MET mins/wk in the MyHeartMate group is likely to have a clinical impact. 35 Future research is needed that can distinguish the most active and effective app components including gamification elements for specific behaviours in this population.…”

Exercise Training and Interventions for Coronary Artery Disease

“…Specifically, NO protects the vascular wall by inhibiting platelet aggregation, adhesion molecule expression and leukocyte penetration into the arterial intima and media layers, and lipid oxidation. These effects of NO may attenuate atherosclerosis by protecting the vessel from injury and from fatty lesion generation [ 2 , 18 , 42 ]. In this sense, investigations were carried out on whether exercise could increase NO concentrations in patients with CAD since they present a decrease in its concentration.…”

“…Furthermore, a very interesting benefit of CR in these patients is that the atherosclerotic lesion changes from a vulnerable atherosclerotic plaque to a more stable plaque, making it less prone to rupture and consequently could reduce cardiac mortality [ 45 ]. This stabilization of the atherosclerotic plaque in the groups that performed exercise occurs for various reasons, such as the conversion of the osteogenic phenotype of CSM to a contractile and healthy one, a higher content of collagen and elastin and a lower concentration of macrophages [ 2 , 10 , 42 ].…”

“…Despite the fact of the regression of the atherosclerotic plaque, the decrease in blood viscosity and the growth of collateral vessels have been proposed as improvements that CAD patients may obtain under exercise performance, although there is still no clear evidence to confirm these changes are so significant to produce a benefit [ 14 , 42 ]. After carrying out an analysis of the improvements obtained in general when performing different types of exercise in relation to the pathophysiological processes of CAD, we are going to carry out a brief specific analysis of the results achieved when performing endurance, strength or inspiratory muscle training.…”

Microbiome First Approaches to Rescue Public Health and Reduce Human Suffering

“…Dancing can improve motor impairments, non-motor skills, and quality of life in both Parkinson's disease patients [156] and those with Alzheimer's disease [157]. Exercise can reduce cardiovascular risk and improve quality of life in cardiovascular patients [158]. It can also improve the disease management of adolescent obesity [159].…”