Exercise and the cardiovascular system: clinical science and cardiovascular outcomes.

Substantial evidence has established the value of high levels of physical activity, exercise training (ET), and overall cardiorespiratory fitness in the prevention and treatment of cardiovascular diseases. This article reviews some basics of exercise physiology and the acute and chronic responses of ET, as well as the effect of physical activity and cardiorespiratory fitness on cardiovascular diseases. This review also surveys data from epidemiological and ET studies in the primary and secondary prevention of cardiovascular diseases, particularly coronary heart disease and heart failure. These data strongly support the routine prescription of ET to all patients and referrals for patients with cardiovascular diseases, especially coronary heart disease and heart failure, to specific cardiac rehabilitation and ET programs.

[1]  R. Paffenbarger,et al.  Physical activity, all-cause mortality, and longevity of college alumni. , 1986, The New England journal of medicine.

[2]  R S Paffenbarger,et al.  Physical fitness and all-cause mortality. A prospective study of healthy men and women. , 1989, JAMA.

[3]  J. Buring,et al.  An overview of randomized trials of rehabilitation with exercise after myocardial infarction. , 1989, Circulation.

[4]  D. Jacobs,et al.  Leisure time physical activity and coronary heart disease death. The US Railroad Study. , 1989, Circulation.

[5]  A. Amery,et al.  Heritability of aerobic power and anaerobic energy generation during exercise. , 1991, Journal of applied physiology.

[6]  J. Fleg,et al.  Effects of Age and Aerobic Capacit on Arterial Stiffness in Healthy Adults , 1993, Circulation.

[7]  Victor F. Froelicher,et al.  Exercise and the Heart , 1993 .

[8]  R S Paffenbarger,et al.  The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. , 1993, The New England journal of medicine.

[9]  C. Lavie,et al.  Effects of cardiac rehabilitation and exercise training on low-density lipoprotein cholesterol in patients with hypertriglyceridemia and coronary artery disease. , 1994, The American journal of cardiology.

[10]  K. Schechtman,et al.  Enhanced left ventricular performance in endurance trained older men. , 1994, Circulation.

[11]  J. Macintyre,et al.  Physical Fitness and All-Cause Mortality , 1995 .

[12]  R S Paffenbarger,et al.  Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. , 1995, JAMA.

[13]  C. Lavie,et al.  Effects of nonpharmacologic therapy with cardiac rehabilitation and exercise training in patients with low levels of high-density lipoprotein cholesterol. , 1996, The American journal of cardiology.

[14]  C. Lavie,et al.  Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients. , 1997, The American journal of cardiology.

[15]  K. Liestøl,et al.  Changes in physical fitness and changes in mortality , 1998, The Lancet.

[16]  S Goya Wannamethee,et al.  Changes in physical activity, mortality, and incidence of coronary heart disease in older men , 1998, The Lancet.

[17]  M. Laughlin,et al.  Exercise training-induced adaptations in the coronary circulation. , 1998, Medicine and science in sports and exercise.

[18]  G. Schuler,et al.  Effect of exercise on coronary endothelial function in patients with coronary artery disease. , 2000, The New England journal of medicine.

[19]  S. Ebrahim,et al.  Exercise‐based Rehabilitation for Coronary Heart Disease , 2001, The Cochrane database of systematic reviews.

[20]  W. Kraus,et al.  Effects of the amount and intensity of exercise on plasma lipoproteins. , 2002, The New England journal of medicine.

[21]  Markku Heliövaara,et al.  Associations of body mass index and obesity with physical activity, food choices, alcohol intake, and smoking in the 1982-1997 FINRISK Studies. , 2002, The American journal of clinical nutrition.

[22]  M. Marmot,et al.  Association of the metabolic syndrome with both vigorous and moderate physical activity. , 2003, International journal of epidemiology.

[23]  J. Wylie-Rosett,et al.  Exercise, body mass index, caloric intake, and cardiovascular mortality. , 2003, American journal of preventive medicine.

[24]  C. Lavie,et al.  Prevalence and profile of metabolic syndrome in patients following acute coronary events and effects of therapeutic lifestyle change with cardiac rehabilitation. , 2003, The American journal of cardiology.

[25]  D. Green,et al.  Exercise and the Nitric Oxide Vasodilator System , 2003, Sports medicine.

[26]  K. Chayama,et al.  Effect of Different Intensities of Exercise on Endothelium-Dependent Vasodilation in Humans: Role of Endothelium-Dependent Nitric Oxide and Oxidative Stress , 2003, Circulation.

[27]  Theodore J Thompson,et al.  Relationship of changes in physical activity and mortality among older women. , 2003, JAMA.

[28]  Body composition and prognosis in chronic systolic heart failure: the obesity paradox. , 2003 .

[29]  A. Kriska,et al.  Physical activity, obesity, and the incidence of type 2 diabetes in a high-risk population. , 2003, American journal of epidemiology.

[30]  M. Piepoli,et al.  Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH) , 2004, BMJ : British Medical Journal.

[31]  Terminology for describing the elastic behavior of arteries. , 2004, Hypertension.

[32]  J. Manson,et al.  Adiposity as Compared with Physical Activity in Predicting Mortality among Women , 2004 .

[33]  C. Lavie,et al.  Reduction in C-reactive protein through cardiac rehabilitation and exercise training. , 2004, Journal of the American College of Cardiology.

[34]  J. Tuomilehto,et al.  Low physical activity as a predictor for total and cardiovascular disease mortality in middle-aged men and women in Finland. , 2004, European heart journal.

[35]  J. Tuomilehto,et al.  Occupational, Commuting, and Leisure-Time Physical Activity in Relation to Total and Cardiovascular Mortality Among Finnish Subjects With Type 2 Diabetes , 2004, Circulation.

[36]  T. Marwick,et al.  Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. , 2004, The American journal of medicine.

[37]  B. Franklin,et al.  Exercise and Hypertension , 2004 .

[38]  B. Levine,et al.  Effect of Aging and Physical Activity on Left Ventricular Compliance , 2004, Circulation.

[39]  J. Tuomilehto,et al.  Relationship of Physical Activity and Body Mass Index to the Risk of Hypertension: A Prospective Study in Finland , 2004, Hypertension.

[40]  C. Lavie,et al.  Adverse psychological and coronary risk profiles in young patients with coronary artery disease and benefits of formal cardiac rehabilitation. , 2006, Archives of internal medicine.

[41]  D. Coyle,et al.  Effects of Aerobic Training, Resistance Training, or Both on Glycemic Control in Type 2 Diabetes , 2007, Annals of Internal Medicine.

[42]  C. Lavie,et al.  Impact of cardiac rehabilitation on depression and its associated mortality. , 2007, The American journal of medicine.

[43]  J. Tuomilehto,et al.  Occupational, commuting and leisure-time physical activity in relation to coronary heart disease among middle-aged Finnish men and women. , 2007, Atherosclerosis.

[44]  Y. Ohashi,et al.  Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. , 2007, Archives of internal medicine.

[45]  J. Manson,et al.  The joint effects of physical activity and body mass index on coronary heart disease risk in women. , 2008, Archives of internal medicine.

[46]  R. Bache,et al.  Regulation of coronary blood flow during exercise. , 2008, Physiological reviews.

[47]  R. Arena,et al.  The Clinical Significance of Aerobic Exercise Testing and Prescription: From Apparently Healthy to Confirmed Cardiovascular Disease , 2008 .

[48]  H. Knuttgen.  Basic Exercise Physiology , 2008 .

[49]  V. Somers,et al.  Prognostic importance of weight loss in patients with coronary heart disease regardless of initial body mass index , 2008, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[50]  M. Picard,et al.  The impact of endurance exercise training on left ventricular systolic mechanics. , 2008, American journal of physiology. Heart and circulatory physiology.

[51]  S. Normand,et al.  Cardiac rehabilitation and survival in older coronary patients. , 2009, Journal of the American College of Cardiology.

[52]  D. Panagiotakos,et al.  Responses of Blood Lipids to Aerobic, Resistance, and Combined Aerobic With Resistance Exercise Training: A Systematic Review of Current Evidence , 2009, Angiology.

[53]  B. Pedersen.  Edward F. Adolph distinguished lecture: muscle as an endocrine organ: IL-6 and other myokines. , 2009, Journal of applied physiology.

[54]  Yasuo Ohashi,et al.  Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. , 2009, JAMA.

[55]  C. Lavie,et al.  The obesity paradox, weight loss, and coronary disease. , 2009, The American journal of medicine.

[56]  W. Kraus,et al.  Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. , 2009, JAMA.

[57]  J. Harvey-Berino,et al.  High-Calorie-Expenditure Exercise: A New Approach to Cardiac Rehabilitation for Overweight Coronary Patients , 2009, Circulation.

[58]  K. Schulman,et al.  Relationship Between Cardiac Rehabilitation and Long-Term Risks of Death and Myocardial Infarction Among Elderly Medicare Beneficiaries , 2010, Circulation.

[59]  P. Krustrup,et al.  Improvement of systolic and diastolic heart function after physical training in sedentary women , 2010, Scandinavian journal of medicine & science in sports.

[60]  B. Levine,et al.  Cardiovascular Effects of 1 Year of Progressive and Vigorous Exercise Training in Previously Sedentary Individuals Older Than 65 Years of Age , 2010, Circulation.

[61]  S. Carlson,et al.  Trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans. , 2010, American journal of preventive medicine.

[62]  H. Middlekauff.  Making the Case for Skeletal Myopathy as the Major Limitation of Exercise Capacity in Heart Failure , 2010, Circulation. Heart failure.

[63]  Ross Arena,et al.  Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. , 2010, Circulation.

[64]  B. Franklin,et al.  American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. , 2011, Medicine and science in sports and exercise.

[65]  G. Balady,et al.  The role of exercise training in heart failure. , 2011, Journal of the American College of Cardiology.

[66]  J. O’Keefe,et al.  Impact of exercise training on psychological risk factors. , 2011, Progress in cardiovascular diseases.

[67]  S. Fröhling,et al.  Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. , 2011, Journal of the American College of Cardiology.

[68]  D. Kitzman.  Exercise training in heart failure with preserved ejection fraction: beyond proof-of-concept. , 2011, Journal of the American College of Cardiology.

[69]  Benjamin Willis,et al.  Lifetime risks for cardiovascular disease mortality by cardiorespiratory fitness levels measured at ages 45, 55, and 65 years in men. The Cooper Center Longitudinal Study. , 2011, Journal of the American College of Cardiology.

[70]  C. Lavie,et al.  Body composition and coronary heart disease mortality--an obesity or a lean paradox? , 2011, Mayo Clinic proceedings.

[71]  K. Goel,et al.  Impact of Cardiac Rehabilitation on Mortality and Cardiovascular Events After Percutaneous Coronary Intervention in the Community , 2010, Circulation.

[72]  C. Lavie,et al.  Impact of exercise training and depression on survival in heart failure due to coronary heart disease. , 2011, The American journal of cardiology.

[73]  S. Keteyian.  Exercise training in congestive heart failure: risks and benefits. , 2011, Progress in cardiovascular diseases.

[74]  J. Tucker,et al.  Physical activity in U.S.: adults compliance with the Physical Activity Guidelines for Americans. , 2011, American journal of preventive medicine.

[75]  Hui Ting Chan,et al.  Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study , 2011, The Lancet.

[76]  H. Kohl,et al.  Long-Term Effects of Changes in Cardiorespiratory Fitness and Body Mass Index on All-Cause and Cardiovascular Disease Mortality in Men: The Aerobics Center Longitudinal Study , 2012 .

[77]  T. Church,et al.  Impact of Physical Activity, Cardiorespiratory Fitness, and Exercise Training on Markers of Inflammation , 2011, Journal of cardiopulmonary rehabilitation and prevention.

[78]  C. Lavie,et al.  Body Composition and Survival in Stable Coronary Heart Disease Impact of Lean Mass Index and Body Fat in the “ Obesity Paradox ” , 2012 .

[79]  A. Baggish,et al.  Exercise-induced cardiac remodeling. , 2012, Progress in cardiovascular diseases.

[80]  S. Blair,et al.  Effects of Muscular Strength on Cardiovascular Risk Factors and Prognosis , 2012, Journal of cardiopulmonary rehabilitation and prevention.

[81]  Harshal R. Patil,et al.  Potential adverse cardiovascular effects from excessive endurance exercise. , 2012, Mayo Clinic proceedings.

[82]  W. Frontera,et al.  Principles of Exercise Physiology: Responses to Acute Exercise and Long‐term Adaptations to Training , 2012, PM & R : the journal of injury, function, and rehabilitation.

[83]  Federico Schena,et al.  Metabolic Effects of Aerobic Training and Resistance Training in Type 2 Diabetic Subjects , 2012, Diabetes Care.

[84]  The obesity paradox, cardiorespiratory fitness, and coronary heart disease. , 2012, Mayo Clinic proceedings.

[85]  S. Blair,et al.  Changes in fitness and fatness on the development of cardiovascular disease risk factors hypertension, metabolic syndrome, and hypercholesterolemia. , 2012, Journal of the American College of Cardiology.

[86]  R. Arena,et al.  Should high-intensity-aerobic interval training become the clinical standard in heart failure? , 2012, Heart Failure Reviews.

[87]  W. Kraus,et al.  Relation between volume of exercise and clinical outcomes in patients with heart failure. , 2012, Journal of the American College of Cardiology.

[88]  R. Arena,et al.  Formal cardiac rehabilitation and exercise training programs in heart failure: evidence for substantial clinical benefits. , 2013, Journal of cardiopulmonary rehabilitation and prevention.

[89]  R. Arena,et al.  Adiposity facilitates increased strength capacity in heart failure patients with reduced ejection fraction. , 2013, International journal of cardiology.

[90]  J. O’Keefe,et al.  Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. , 2013, Circulation journal : official journal of the Japanese Circulation Society.

[91]  Daniel P. Morin,et al.  Atrial fibrillation in the 21st century: a current understanding of risk factors and primary prevention strategies. , 2013, Mayo Clinic proceedings.

[92]  C. Lavie,et al.  Relation of body fat categories by Gallagher classification and by continuous variables to mortality in patients with coronary heart disease. , 2013, The American journal of cardiology.

[93]  R. Arena,et al.  High-intensity interval training in patients with cardiovascular diseases and heart transplantation. , 2013, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[94]  D. Thijssen,et al.  Effects of acute exercise on flow-mediated dilatation in healthy humans. , 2013, Journal of applied physiology.

[95]  E. Ashley,et al.  Impact of cardiorespiratory fitness on the obesity paradox in patients with heart failure. , 2013, Mayo Clinic proceedings.

[96]  Daniel E Forman,et al.  Exercise standards for testing and training: a scientific statement from the American Heart Association. , 2013, Circulation.

[97]  C. Ayers,et al.  Physical Fitness and Risk for Heart Failure and Coronary Artery Disease , 2013, Circulation. Heart failure.

[98]  S. Blair,et al.  Physical activity promotion in the health care system. , 2013, Mayo Clinic proceedings.

[99]  B. Franklin,et al.  Exercise-based cardiac rehabilitation and improvements in cardiorespiratory fitness: implications regarding patient benefit. , 2013, Mayo Clinic proceedings.

[100]  M. Drazner,et al.  2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. , 2013, Journal of the American College of Cardiology.

[101]  Theresa M. Beckie,et al.  The Importance of Cardiorespiratory Fitness in the United States: The Need for a National Registry A Policy Statement From the American Heart Association , 2013, Circulation.

[102]  S. Blair,et al.  Leisure-time running reduces all-cause and cardiovascular mortality risk. , 2014, Journal of the American College of Cardiology.

[103]  B. Levine.  Response to la Gerche and Heidbuchel , 2014 .

[104]  K. Michaëlsson,et al.  OUTCOME AFTER MYOCARDIAL INFARCTION IN A COHORT STUDY OF CROSS COUNTRY SKIERS IN SWEDEN , 2014 .

[105]  B. Franklin,et al.  Exercising for health and longevity vs peak performance: different regimens for different goals. , 2014, Mayo Clinic proceedings.

[106]  P. Savage,et al.  Potential benefits of weight loss in coronary heart disease. , 2014, Progress in cardiovascular diseases.

[107]  H. Heidbuchel,et al.  Can Intensive Exercise Harm the Heart?: You Can Get Too Much of a Good Thing , 2014, Circulation.

[108]  C. Lavie,et al.  Coronary Artery Plaque and Cardiotoxicity as a Result of Extreme Endurance Exercise. , 2014, Missouri medicine.

[109]  D. Seals,et al.  Aerobic exercise and other healthy lifestyle factors that influence vascular aging. , 2014, Advances in physiology education.

[110]  Neil M. Johannsen,et al.  The role of exercise and physical activity in weight loss and maintenance. , 2014, Progress in cardiovascular diseases.

[111]  C. Lavie,et al.  The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. , 2014, Progress in cardiovascular diseases.

[112]  Paul T. Williams,et al.  Increased cardiovascular disease mortality associated with excessive exercise in heart attack survivors. , 2014, Mayo Clinic proceedings.

[113]  C. Lavie,et al.  Obesity paradox, cachexia, frailty, and heart failure. , 2014, Heart failure clinics.

[114]  B. Levine.  Can intensive exercise harm the heart? The benefits of competitive endurance training for cardiovascular structure and function. , 2014, Circulation.

[115]  W. Kraus,et al.  Skeletal muscle abnormalities and exercise intolerance in older patients with heart failure and preserved ejection fraction. , 2014, American journal of physiology. Heart and circulatory physiology.

[116]  R. Arena,et al.  Analysis of skeletal muscle gene expression patterns and the impact of functional capacity in patients with systolic heart failure. , 2014, Journal of cardiac failure.

[117]  Michael W. Beets,et al.  Fitness vs. fatness on all-cause mortality: a meta-analysis. , 2014, Progress in cardiovascular diseases.

[118]  J. O’Keefe,et al.  Increased Coronary Artery Plaque Volume Among Male Marathon Runners. , 2014, Missouri medicine.

[119]  V. Somers,et al.  The prognostic importance of weight loss in coronary artery disease: a systematic review and meta-analysis. , 2014, Mayo Clinic proceedings.

[120]  C. Wen,et al.  Minimal amount of exercise to prolong life: to walk, to run, or just mix it up? , 2014, Journal of the American College of Cardiology.

[121]  C. Celis-Morales,et al.  Effects of Exercise Modalities on Arterial Stiffness and Wave Reflection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials , 2014, PloS one.

[122]  S. Blair,et al.  Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. , 2014, Journal of the American College of Cardiology.

[123]  B. Levine,et al.  Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training , 2014, Circulation.

[124]  Duck-chul Lee,et al.  Optimal dose of running for longevity: is more better or worse? , 2015, Journal of the American College of Cardiology.

[125]  R. Squires,et al.  Safety of early enrollment into outpatient cardiac rehabilitation after open heart surgery. , 2015, The American journal of cardiology.

[126]  M. Drazner,et al.  Changes in mid-life fitness predicts heart failure risk at a later age independent of interval development of cardiac and noncardiac risk factors: the Cooper Center Longitudinal Study. , 2015, American heart journal.

[127]  R. Arena.  Functional capacity and exercise training have earned a primary role in the assessment and treatment of patients with heart failure. , 2015, Heart failure clinics.

[128]  Mark A Williams,et al.  Reasonable expectations: how much aerobic capacity, muscle strength, and quality of life can improve with exercise training in heart failure. , 2015, Heart failure clinics.

[129]  R. Arena,et al.  Critical impact of fitness in the prevention and treatment of heart failure. , 2015, American heart journal.

[130]  J. O’Keefe,et al.  Part 1: potential dangers of extreme endurance exercise: how much is too much? Part 2: screening of school-age athletes. , 2015, Progress in cardiovascular diseases.

[131]  Benjamin D. Levine,et al.  Physical activity versus cardiorespiratory fitness: two (partly) distinct components of cardiovascular health? , 2015, Progress in cardiovascular diseases.

[132]  Paul McAuley,et al.  Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status. , 2015, Progress in cardiovascular diseases.