Cardiac benefits of sport

September 05, 2005

When asked about his personal recipe for old age, Winston Churchill used to answer: "First of all: No sports." While being a visionary figure in world politics researchers in cardiovascular exercise science today would unanimously reply to his medical hypothesis: "Sorry, you are wrong."

A large number of long-term observational studies clearly documented that increased levels of average daily physical activity were correlated to a reduced rate of coronary heart disease and reduced cardiac and all-cause mortality. Moderately active persons were 30-40% less likely to die from heart disease as compared to the inactive "couch potato." Despite this solid epidemiologic evidence, the proportion of people who do not engage in sports at all is ever increasing: About two thirds of all Americans, for example, do not participate in regular leisure-time physical activity. This lack of sports is closely related to the epidemic of other risk factors for future heart attacks: Obesity, diabetes, high blood pressure, and elevated cholesterol levels. Together, these inactivity-related diseases cost about US$76 billion per year to treat in the US.

But physical activity is not only beneficial in healthy people to prevent cardiovascular diseases. Also patients with stable coronary artery disease can extend their life-expectancy by engaging in sports: A recent meta-analysis revealed a significant 27% reduction of total mortality among training patients and a significant 31% reduction in cardiac mortality. Even when compared to sophisticate interventional procedures, exercise training is surprisingly effective in improving the patient's well-being. In a recent study which randomized patients with coronary 1- or 2-vessel disease to either the standard interventional treatment or to regular exercise training, we found a higher event-free survival in the training group and a similar improvement of cardiac symptoms. This finding confirms again that there is no cardiac gain without the pain of changing your inactive lifestyle.

But how does such a non-specific intervention as exercise training achieve these impressive results? Atherosclerosis - the chronic disease process finally leading to coronary narrowings and heart attacks - begins as a vascular malfunction before plaques develop. Normally, a healthy vessel dilates and gets larger with increases of blood flow, which is especially important during activity to meet the increased demand for oxygen by the working muscles. In atherosclerosis, the artery loses its ability to dilate under these conditions, which leads to reduced blood supply during exercise. The key mediator which regulates vessel diameter is nitric oxide (NO), which is generated in endothelial cells by a special enzyme called "endothelial nitric oxide synthase" or eNOS. It has been found that NO production is reduced and NO degradation is increased in the early stages of heart disease - leading to endothelial dysfunction.

Exercise training and sports lead to repetitive increases in shear stress on the endothelium and can thereby stimulate the eNOS enzyme to produce more NO. Endothelial dysfunction is rare among active people and occurs later in life as compared to inactive individuals. In the last years we found that patients with stable coronary artery disease often have severe endothelial dysfunction, which can be dramatically improved by a four week training program - to an extent which is comparable with the effects of established medications such as lipid-lowering drugs (i.e. statins). This improvement of vessel dilation increases blood flow to the myocardium and thereby reduces clinical symptoms. In addition, endothelial dysfunction is regarded as the initial step toward atherosclerosis and plaque formation. By treating endothelial dysfunction with regular exercise training we can therefore retard the development of new coronary stenoses.

The key message emerging from these clinical studies is that sports and exercise - in addition to preventing obesity and diabetes - directly improve vascular function and reduce atherosclerosis. Considering that the majority of people do not engage in regular physical activities one can only say: The health of your heart is in your own hands. If you want to protect it: First of all, engage in regular sports activities!
Hambrecht R et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation. 2004;109(11):1371-8. Hambrecht R et al. Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation. 2003;107(25):3152-8. Hambrecht R et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 2000;342(7):454-60.

European Society of Cardiology

Related Heart Disease Articles from Brightsurf:

Cellular pathway of genetic heart disease similar to neurodegenerative disease
Research on a genetic heart disease has uncovered a new and unexpected mechanism for heart failure.

Mechanism linking gum disease to heart disease, other inflammatory conditions discovered
The link between periodontal (gum) disease and other inflammatory conditions such as heart disease and diabetes has long been established, but the mechanism behind that association has, until now, remained a mystery.

New 'atlas' of human heart cells first step toward precision treatments for heart disease
Scientists have for the first time documented all of the different cell types and genes expressed in the healthy human heart, in research published in the journal Nature.

With a heavy heart: How men and women develop heart disease differently
A new study by researchers from McGill University has uncovered that minerals causing aortic heart valve blockage in men and women are different, a discovery that could change how heart disease is diagnosed and treated.

Heart-healthy diets are naturally low in dietary cholesterol and can help to reduce the risk of heart disease and stroke
Eating a heart-healthy dietary pattern rich in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, vegetable oils and nuts, which is also limits salt, red and processed meats, refined-carbohydrates and added sugars, is relatively low in dietary cholesterol and supports healthy levels of artery-clogging LDL cholesterol.

Pacemakers can improve heart function in patients with chemotherapy-induced heart disease
Research has shown that treating chemotherapy-induced cardiomyopathy with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can significantly improve patient outcomes.

Arsenic in drinking water may change heart structure raising risk of heart disease
Drinking water that is contaminated with arsenic may lead to thickening of the heart's main pumping chamber in young adults, according to a new study by researchers at Columbia University Mailman School of Public Health.

New health calculator can help predict heart disease risk, estimate heart age
A new online health calculator can help people determine their risk of heart disease, as well as their heart age, accounting for sociodemographic factors such as ethnicity, sense of belonging and education, as well as health status and lifestyle behaviors.

Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure
Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.

Heart failure: The Alzheimer's disease of the heart?
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.

Read More: Heart Disease News and Heart Disease Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to