Exercise and the Cardiovascular System

Table 1

Selected clinical trials on the cardiovascular effects of exercise.

Reference	Patient groups and characteristics	Intervention and followup	Measured parameters	Outcome
[163]	50 hypertensive patients divided in 2 groups and stratified for other variables; (a) Routine antihypertensive therapy; (b) Antihypertensive therapy plus 6 month exercise.	(i) Incremental CPET on a bicycle ergometer 30 min a day for 6 months.	Peak𝑉O2, powermax, AT, 𝑉O2AT, 𝑡AT, HRrest, LAVI, E/A ratio, DT, IVST, Ea/Aa ration.	Peak𝑉O2, powermax, AT, 𝑉O2AT, 𝑡AT were increased, HRrest decreased and LAVI, E/A ratio, DT, IVST, Ea/Aa ration improved in exercise group.
[164]	98 patients with moderate to severe (𝑛=34), mild (𝑛=33) and preserved (𝑛=31) LVEF that were randomized to: (a) Exercise training plus usual care.; (b) Usual care alone.	Exercise training on a treadmill or bicycle; ergometer three times a week for 6 months.	LVEF, E/A ratio, DT.	Exercise tolerance and LVEF increased in exercise group, ↑ E/A ratio and ↓ DT in patients with mild and preserved LVEF. ↓ E/A ratio and ↑ DT in patients with moderate to severe systolic dysfunction and advanced diastolic dysfunction.
[165]	496 old people categorized base on their daily physical activities; (a) <4 hr weekly; (b) 4 hr weekly; (c) At least 1 hr daily; (d) Sport at least twice weekly.		Echocardiographic assessment of cardiac structure and function.	Mean EF was lower among sedentary versus active women. No other significant differences (systolic or diastolic function) were observed.
[166]	64 patients with HFpEF randomized to: (a) Endurance/resistance training plus usual care; (b) Usual care alone.	Supervised, facility-based training program consisting of endurance and resistance training (32 sessions).	(i) Changes in 𝑉O2 after 3 months.; (ii) cardiac structure, diastolic function and Qol.	𝑉O2 increased, E/e and left atrial volume index decreased in ET group. Physical functioning score improved with ET group.
[167]	365 sedentary, overweight, hypertensive, postmenopausal women randomly assigned to: (a) Sedentary controls; (b) Exercise groups at: (a) 4 Kcal/kg/week; (b) 8 Kcal/kg/week; (c) 12 Kcal/kg/week.	Exercise group patients underwent 50% (4 Kcal/kg/week), 100% (8 Kcal/kg/week), or 150% (12 Kcal/kg/week) of the NIH-CDP physical activity guideline.	Time and frequency domain indices of HRV.	Parasympathetic indices of HRV increased in women that were >60 years old.
[168]	34 patients with stable symptoms of intermittent claudication randomized to: (a) Strength training (ST); (b) Walking training (WT).	ST consisted of eight exercises, 3 sets of 10 repetitions, intensity of 11–13 on 15 grade Borg scale. WT consisted of walking on treadmill, 15 bouts of 2 min, intensity of 11–13 on grade Brog scale.	Resting systolic BP, HR, rate-pressure product, maximal exercise time.	Resting systolic BP, HR and rate pressure product decreased in both groups.; Submaximal systolic BP and rate-pressure product also decreased in both groups. Maximal exercise time increased in both groups.
[169]	29 patients with stable chronic MI were assigned to: (a) Training group (𝑛=17); (b) Control (𝑛=12).	Exercise intensity set at 55–70% of  𝑉O2max, subjects perceived exertion rating of 12-13 Borg scale, 3 bouts a week for 12 weeks	Myocardial perfusion study.	Exercise induced perfusion changes in the infarct zone is proportional to the amount of residual viable myocardium.
[170]	26 young healthy subjects assigned to: (a) Training group (𝑛=13); (b) Control group (𝑛=13).	The subjects performed LSR twice a week at 50% of one repetition maximum for 10 weeks. Training consisted of 5 sets of ten repetitions with an interest rest period of 30 s.	Changes in baPWV and FMD.	FMD increased and baPWV decreased in exercise group.
[171]	38 type II diabetic patients were assigned to: (a) Exercise group (𝑛=21); (b) Control group (𝑛=17).	Exercise group received 3–5 bouts a week for 3 months, each bout consisted of 75 min combination of aerobic and resistance exercise.	Endothelial function (by FMD), insulin resistance, adipocytokines and inflammatory markers.	BMI decreased while 𝑉O2 and FMD were significantly increased in exercise group (changes in HbA1C, LDL and HDL cholesterol, adiponectin, hsCRP were similar in both groups).
[172]	37 patients with CHF randomly assigned to: (a) Exercise training group; (b) Sedentary.	12 weeks of exercise (20–30 min a day) on a bicycle ergometer adjusted to the work load of 50–60% of  𝑉O2max.	𝑉O2max, LVEF, number and functional capacity of CPC, FMD, and capillary density in skeletal muscles.	Exercise training improved  𝑉O2max, LVEF, FMD, CPC number and function also increased capillary density in skeletal muscles.
[173]	44 health young FH+ women, assigned to: (a) AIT (𝑛=16); (b) CMT (𝑛=16); (c) Controls with FH+ (𝑛=12); 15 healthy young women with normotensive parents and negative FH as the 2nd control group.	Exercise protocol consisted of 60 min (AIT or CMT) endurance exercise 3 times a week for 16 weeks.	ABP, insulin, insulin sensitivity, carotid-femoral PWV, NE, ET-1, NO𝑥.	AIT and CMT were equally effective in improving ABP, insulin and insulin sensitivity. AIT was superior in improving cardiovascular fitness, BP, NE, ET-1 and NO𝑥 response.
[174]	44 pre-pubertal obese children were randomly assigned to: (a) Exercise group (𝑛=22); (b) Control group (𝑛=22); (c) 22 lean matched controls.	The exercise group trained 60 min 3x a week for 3 months, then both groups trained twice per week for another 3 months.	BP, IMT, FMD, BMI, body fat,  𝑉O2max, physical activity and biological markers were assessed at 3 and 6 months.	After 3 months: significant differences in BP, BMI, abdominal fat, and  𝑉O2max.; After 6 months: significant changes changes in arterial stiffness and IMT were significant.

ABP: ambulatorial blood pressure; AIT: high-intensity aerobic interval training; AT: anaerobic threshold; baPWV: brachial ankle pulse wave velocity; BMI: body mass index; CMT: moderate-intensity continuous exercise training; CPC: circulating progenitor cells; CPET: cardiopulmonary exercise test; DT: deceleration time of the mitral E wave; E/A ratio: peak mitral filling velocities during early (E) and late (A) diastole; E/e ratio: the ratio of mitral velocity to early diastolic velocity of the mitral annulus; Ea/Aa ratio: tissue Doppler indices mean; EF: ejection fraction; Et: exercise training; ET-1: endothelin-1; FH+: positive family history of hypertension; FMD: brachial flow mediated dilation; HDL: high density lipoprotein; HFpEF: heart failure with preserved ejection fraction; HR_rest: heart rate at rest; HRV: heart rate variability; hsCRP: high sensitivity C-reactive protein; IMT: arterial intima-media thickness; IVST: interventricular septum thickness in diastole; LAVI: left atrial volume index; LDL: low density lipoprotein; LSR: low intensity resistance training with short inter-set rest period; LVEF: left ventricular ejection fraction; NE: norepinephrine; NIG-CDP: national institutes of health consensus development panel;NO_𝑥: nitrite/nitrate level; PWV: pulse wave velocity; Qol: qullity of life; 𝑡_AT time from beginning to anaerobic threshold; 𝑉_O2 volume of consumed oxygen; 𝑉_O2AT: volume of consumed oxygen at anaerobic threshold; 𝑉_O2max: maximal oxygen consumption.