Physical exercise training and coronary artery disease

Robert Höllriegel, Norman Mangner, Gerhard Schuler, Sandra Erbs



Coronary artery disease (CAD) is a leading cause of death worldwide, despite improvements in medical and interventional therapies. Based on many studies in large cohorts, regular physical exercise training plays a central and indispensable role in both the primary and secondary prevention of CAD. Exercise training was shown to improve blood pressure control, lipid profile, glucose control, and enhance weight loss in obese patients. Moreover, exercise training not only affects clinical symptoms, it reduces CAD mortality and morbidity in addition to dietary, pharmacological and interventional treatments. Different kinds of exercise training (aerobic, interval, resistance training) have been studied and all are feasible, well tolerated, and beneficial in patients with CAD. Therefore, exercise training has the highest recommendation class (I) and level of evidence (A) in the European guidelines for patients with coronary artery disease. Nonetheless, exercise training is underutilized in patients with cardiac diseases and only a minority of eligible patients is referred to a cardiac rehabilitation or structured exercise training program by their physician.


Physical exercise training; Coronary artery disease; Cardiovascular risk factors

Full Text



  • Perk J, De BG, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012; 33: 1635-701;
  • Boden WE, Franklin BA, Wenger NK. Physical activity and structured exercise for patients with stable ischemic heart disease. JAMA 2013; 309: 143-4;
  • Ross J. The pathogenesis of atherosclerosis: A perspective for the 1990s. Nature 1993; 362: 801-9;
  • Kannel WB, Sorlie P, Castelli WP, et al. Blood pressure and survival after myocardial infarction: The Framingham study. Am J Cardiol 1980; 45: 326-30;
  • Pescatello LS, Franklin BA, Fagard R, Farquhar et al. This pronouncement was written for the American College of Sports Medicine by: Exercise and Hypertension. Medicine & Science in Sports & Exercise 2004; 36: 533-53;
  • Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Medicine & Science in Sports & Exercise 2001; 33: S484-92;
  • Halbert JA, Silagy CA, Finucane P, et al. The effectiveness of exercise training in lowering blood pressure: a meta-analysis of randomised controlled trials of 4 weeks or longer. J Hum Hypertens 1997; 11: 641-9;
  • Whelton SP, Chin A, Xin X, et al. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002; 136: 493-503;
  • Kannel WB. Contributions of the Framingham Study to the conquest of coronary artery disease. Am J Cardiol 1988; 62: 1109-12;
  • Tran ZV, Brammell HL. Effects of Exercise Training on Serum Lipid and Lipoprotein Levels in Post-MI Patients: A Meta-analysis. Journal of Cardiopulmonary Rehabilitation and Prevention 1989; 9: 250-5;
  • Ahmed HM, Blaha MJ, Nasir K, et al. Effects of physical activity on cardiovascular disease. Am J Cardiol 2012; 109: 288-95;
  • Carroll S, Dudfield M. What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome. Sports Med 2004; 34: 371-418;
  • Kokkinos PF, Holland JC, Narayan P, et al. Miles run per week and high-density lipoprotein cholesterol levels in healthy, middle-aged men. A dose-response relationship. Arch Intern Med 1995; 155: 415-20;
  • Gielen S, Landmesser U. A new look at HDL in coronary disease: can we escape natural history? Heart 2011; 97: 1899-901;
  • Marwick TH, Hordern MD, Miller T, et al., on behalf of the American Heart Association Exercise CRaPCotCoCC, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, Council on Nutrition P. Exercise Training for Type 2 Diabetes Mellitus. Circulation 2009; 119: 3244-62;
  • Sigal RJ, Kenny GP, Boule NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007; 147: 357-69;
  • Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes care 2006; 29: 2518-27;
  • No authors listed. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352: 837-53
  • Ishii T, Yamakita T, Sato T, et al. Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake. Diabetes care 1998; 21: 1353-5;
  • Cuff DJ, Meneilly GS, Martin A, et al. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes care 2003; 26: 2977-82;
  • Goodyear LJ, Hirshman MF, King PA, et al. Skeletal muscle plasma membrane glucose transport and glucose transporters after exercise. J Appl Physiol 1990; 68: 193-8
  • Rattigan S, Wallis MG, Youd JM, et al. Exercise training improves insulin-mediated capillary recruitment in association with glucose uptake in rat hindlimb. Diabetes 2001; 50: 2659-65;
  • Eriksson J, Taimela S, Eriksson K, et al. Resistance training in the treatment of non-insulin-dependent diabetes mellitus. Int J Sports Med 1997; 18: 242-6;
  • Hubert HB, Feinleib M, McNamara PM, et al. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow- up of participants in the Framingham Heart Study. Circulation 1983; 67: 968-77;
  • Brochu M, Poehlman ET, Ades PA. Obesity, body fat distribution, and coronary artery disease. J Cardiopulm Rehabil 2000; 20: 96-108;
  • Lavie CJ, Milani RV. Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk farctors, behavioral characteristics, and quality of life in obese coronary patients. Am J Cardiol 1997; 79: 397-401;
  • Milani RV, Lavie CJ. Prevalence and profile of metabolic syndrome in patients following acute coronary events and effects of therapeutic lifestyle change with cardiac rehabilitation. Am J Cardiol 2003; 92: 50-4:
  • Lavie CJ, Milani RV. Cardiac rehabilitation and exercise training programs in metabolic syndrome and diabetes. J Cardiopulm Rehabil 2005; 25: 59-66;
  • Lavie CJ, Milani RV, Artham SM, et al. The obesity paradox, weight loss, and coronary disease. Am J Med 2009; 122: 1106-14;
  • Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009; 53: 1925-32;
  • Sierra-Johnson J, Romero-Corral A, Somers VK, et al. Prognostic importance of weight loss in patients with coronary heart disease regardless of initial body mass index. Eur J Cardiovasc Prev Rehabil 2008; 15: 336-340;
  • Marcus BH, Albrecht AE, Niaura RS, et al. Exercise enhances the maintenance of smoking cessation in women. Addict Behav 1995; 20: 87-92;
  • Ussher MH, Taylor A, Faulkner G. Exercise interventions for smoking cessation. Cochrane Database Syst Rev 2012; 1: CD002295
  • Witt BJ, Jacobsen SJ, Weston SA, et al. Cardiac rehabilitation after myocardial infarction in the community. J Am Coll Cardiol 2004; 44: 988-96;
  • Hammill BG, Curtis LH, Schulman KA, et al. Relationship Between Cardiac Rehabilitation and Long-Term Risks of Death and Myocardial Infarction Among Elderly Medicare Beneficiaries. Circulation 2010; 121 :63-70;
  • Martin BJ, Hauer T, Arena R, et al. Cardiac Rehabilitation Attendance and Outcomes in Coronary Artery Disease Patients/Clinical Perspective. Circulation 2012; 126: 677-87;
  • Goel K, Lennon RJ, Tilbury RT, et al. Impact of Cardiac Rehabilitation on Mortality and Cardiovascular Events After Percutaneous Coronary Intervention in the Community/Clinical Perspective. Circulation 2011;123: 2344-52;
  • Suaya JA, Stason WB, Ades PA, et al. Cardiac Rehabilitation and Survival in Older Coronary Patients. J Am Coll Cardiol 2009; 54: 25-33;
  • Hambrecht R, Walther C, Möbius-Winkler S, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease - a randomized trail. Circulation 2004; 109: 1371-8;
  • Belardinelli R, Paolini I, Cianci G, et al. Exercise training intervention after coronary angioplasty: the ETICA trial. J Am Coll Cardiol 2001; 37: 1891-900;
  • Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004; 116: 682-92;
  • Taylor RS, Unal B, Critchley JA, et al.Mortality reductions in patients receiving exercise-based cardiac rehabilitation: how much can be attributed to cardiovascular risk factor improvements? Eur J Cardiovasc Prev Rehabil 2006; 13: 369-74;
  • Drexler H, Coats AJS. Explaining fatigue in congestive heart failure. Annu Rev Med 1996; 47: 241-56;
  • Hasking GJ, Esler MD, Jennings GL, et al. Norepinephrine spillover to plasma in patients with congestive heart failure. Evidence of increased overall and cardiorenal sympathetic nervous activity. Circulation 1986; 73: 615-21;
  • Coats AJS. The muscle hypothesis of chronic heart failure. J Mol Cell Cardiol 1996; 28: 2255-62;
  • Valgimigli M, Rigolin GM, Fucili A, et al. CD34+ and Endothelial Progenitor Cells in Patients With Various Degrees of Congestive Heart Failure. Circulation 2004; 110: 1209-12;
  • Giannuzzi P, Temporelli PL, Corra U, et al. Attenuation of unfavorable remodeling by exercise training in postinfarction patients with left ventricular dysfunction: results of the Exercise in Left Ventricular Dysfunction (ELVD) trial. Circulation 1997; 96: 1790-7;
  • Hambrecht R, Fiehn E, Niebauer J, et al.Two-year-follow-up of exercise training in patients with chronic heart failure: effects on cardiorespiratory fitness and left ventricular function. Circulation 1995; 92: I-398
  • Hambrecht R, Gielen S, Linke A, et al. Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: A randomized trial. JAMA 2000; 283: 3095-101;
  • Belardinelli R, Georgiou D, Cianci G, et al. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure. Circulation 1999; 99: 1173-82;
  • Dubach P, Myers J, Dziekan G, et al. Effect of exercise training on myocardial remodeling in patients with reduced left ventricular function after myocardial infarcation. Circulation 1997; 95: 2060-7;
  • Hambrecht R, Gielen S, Linke A, et al. Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure. A randomised trial. JAMA 2000; 283: 3095-101;
  • Linke A, Adams V, Schulze PC, et al. Antioxidative effects of exercise training in patients with chronic heart failure. Increase in radical scavenger enzyme activity in skeletal muscle. Circulation 2005; 111: 1763-70;
  • Gielen S, Adams V, Möbius-Winkler S, et al. Anti-inflammatory effects of exercise training in the skeletal muscle of patients with Chronic Heart Failure. J Am Coll Cardiol 2003; 42: 861-8;
  • Erbs S, Höllriegel R, Linke A, et al. Exercise training in patients with advanced chronic heart failure (NYHAIIIb) promotes restoration of peripheral vasomotor function, induction of endogenous regeneration, and improvement of left ventricular function. Circ Heart Fail 2010; 3: 486-94;
  • Piepoli MF, Davos C, Francis DP, et al. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ 2004; 328: 189-92;
  • O`Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-action randomized controlled trial. JAMA 2009; 301: 1439-50;


Abstract: 1325 views
HTML: 1673 views
PDF: 157 views


  • There are currently no refbacks.

© SEEd srl