Inactivity pandemic may"undo" advances made in primary and secondary prevention of CVD

In the review, Pedro L Valenzuela, University of Alcala, Madrid, Spain, and colleagues discuss some of the primary cardiovascular effects of physical activity/exercise, including a healthier metabolic milieu with attenuation of systemic chronic inflammation and adaptations at the heart tissue (myocardial regeneration and cardioprotective) and vascular (antiatherogenic effects) levels.

The authors have also summarized the current evidence for safe exercise and physical activity implementation in patients with cardiovascular disease.

Dr Valenzuela and the team have discussed myriad ways physical activity improves cardiovascular health for primary and secondary prevention. These include reduced inflammation, improved glucose control, and improved cellular integrity. In addition, there are improvements in endothelial function, endothelial cell integrity, and antiatherogenic and structural adaptations at the vascular level.

Also, there is preclinical evidence of myocardial regeneration, with data demonstrating that exercise following myocardial infarction can enhance perfusion, angiogenesis, and left ventricular function. The benefits go beyond moderating traditional risk factors; the reviewers say, "partly owing to the release of exercise-derived factors or exerkines. These are a broad array of signalling molecules that affect different organ systems, including the cardiovascular system. Additionally, exercise can also promote cardioprotective preconditioning and protect against malignant arrhythmias.

In their review, Valenzuela and colleagues say there is some debate around whether some people can exercise too much, specifically those who engage in strenuous aerobic sports like long-distance cycling events or marathon running.

Despite some concerns, no evidence links participation to a higher cardiovascular (CV) mortality risk. "There are consistent results for the opposite trend," they write. Data have also indicated large amounts of physical activity and exercise might be associated with higher coronary artery calcium scores and atrial fibrillation. However, according to the reviewers, the clinical implications of these findings are still being studied.

The reviewers summarize regular physical activity and exercise can induce significant beneficial effects concerning primary and secondary CVD prevention. Also, the benefits of an active lifestyle are fundamentally dose-dependent (with some evidence for PA benefits even above current WHO recommendations).

They noted that various biological mechanisms support exercise-induced CV benefits involving the heart tissue and the inflammatory and metabolic milieu. "Indeed, the recognition of the multisystem benefits of exercise can help to create a more holistic perspective in cardiovascular research as well as in patient care," the team concluded.

Reference:

Pedro L Valenzuela, Luis M Ruilope, Alejandro Santos-Lozano, Matthias Wilhelm, Nicolle Kränkel, Carmen Fiuza-Luces, Alejandro Lucia, Exercise benefits in cardiovascular diseases: from mechanisms to clinical implementation, European Heart Journal, 2023;, ehad170, https://doi.org/10.1093/eurheartj/ehad170