For the purpose of the review, we follow the definition of exercise as “a subset of physical activity that is planned, structured, and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness ( 11).” These characteristics distinguish exercise from less structured and planned physical activity, which is often not solely for the purpose of maintaining or improving physical fitness. Thus, in this review, we provide a synopsis of the major known effects of exercise and physical activity on principal factors associated with risk for poor cardiovascular health including blood lipids, hypertension, and arterial stiffness. In parallel, valuable mechanistic insights have been garnered from experimental studies in animal models. In the past several decades, considerable research effort has aimed to identify the major physiological and biochemical contributors to the cardiovascular benefits of exercise, and as a result, significant advances have been made from observational and interventional studies with human participants. Recent work from cardiovascular cohorts shows that sustained physical activity is associated with a more favorable inflammatory marker profile, decreases heart failure risk, and improves survival at 30 years follow-up in individuals with coronary artery disease ( 8– 10).ĭespite the robust beneficial effects of physical activity and exercise on cardiovascular health, the processes and mechanisms by which frequent physical activity promotes cardiorespiratory fitness and decreases CVD risk remain unclear. Moreover, better fitness levels in both men and women can partially reverse the elevated rates of all-cause mortality as well as CVD mortality associated with high body mass index ( 6, 7). Consistent with this notion, death rates among men and women have been found to be inversely related to cardiorespiratory fitness levels, even in the presence of other predictors of cardiovascular mortality such as smoking, hypertension, and hyperlipidemia ( 5). Several long-term studies have shown that increased physical activity is associated with a reduction in all-cause mortality and may modestly increase life expectancy, an effect which is strongly linked to a decline in the risk of developing cardiovascular and respiratory diseases ( 4). Conversely, regular exercise and physical activity are associated with remarkable widespread health benefits and a significantly lower CVD risk. Among the many risk factors that predispose to CVD development and progression, a sedentary lifestyle, characterized by consistently low levels of physical activity, is now recognized as a leading contributor to poor cardiovascular health. In the United States, CVD accounts for ~600,000 deaths (25%) each year ( 1, 2), and after a continuous decline over the last 5 decades, its incidence is increasing again ( 3). Further studies are needed to identify the mechanisms that impart cardiovascular benefits of exercise in order to develop more effective exercise regimens, test the interaction of exercise with diet, and develop pharmacological interventions for those unwilling or unable to exercise.Ĭardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Nevertheless, a specific dose response relationship between the extent and duration of exercise and the reduction in cardiovascular disease risk and mortality remains unclear. Even though moderate levels of exercise have been found to be consistently associated with a reduction in cardiovascular disease risk, there is evidence to suggest that continuously high levels of exercise (e.g., marathon running) could have detrimental effects on cardiovascular health. Both cardiac and vascular changes have been linked to a variety of changes in tissue metabolism and signaling, although our understanding of the contribution of the underlying mechanisms remains incomplete. Acutely, exercise increases cardiac output and blood pressure, but individuals adapted to exercise show lower resting heart rate and cardiac hypertrophy. Exercise has also been found to have beneficial effects on the heart. Animal models of exercise show that repeated physical activity suppresses atherogenesis and increases the availability of vasodilatory mediators such as nitric oxide. Physically active individuals have lower blood pressure, higher insulin sensitivity, and a more favorable plasma lipoprotein profile. Frequent exercise is robustly associated with a decrease in cardiovascular mortality as well as the risk of developing cardiovascular disease. It is widely accepted that regular physical activity is beneficial for cardiovascular health.
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