![]() ![]() ![]() Although lifetime strenuous endurance exercise has been associated with higher CAC scores and a greater prevalence of atherosclerotic plaques, the plaque composition might be more benign and potentially associated with fewer CVD events. Regular exercise improves elastin and collagen content resulting in less lipid accumulation and stenosis, stabilizes atherosclerotic plaque, and reduces both the necrotic core area and plaque burden. Both aerobic exercise and resistance training improve endothelial function in a dose-response relationship among people with or without CVD, mediated by repetitive increases in shear stress resulting in improved endothelium-dependent coronary vasodilation and nitric oxide (NO) bioavailability. Regular endurance exercise helps to maintain endothelial cell integrity through mechanisms including a) improved release of circulating angiogenic cells, b) inhibition of neointima formation, c) enhanced angiogenesis, d) activation of antioxidant scavenger mechanisms via mitohormesis, e) a decline in endothelium-derived adhesion molecules, and f) reduced angiotensin II-mediated vasoconstriction in patients with symptomatic CHD. Promotion of cellular maintenance and repair processes, including attenuation of endoplasmic reticulum stress in atherosclerotic coronary arterioles, promotion of endogenous antioxidant defense capacity, protection against exogenously induced DNA damage, reduction in vascular reactive oxygen species in patients with coronary heart disease (CHD), and attenuation of telomere length attrition in heart tissue. Attenuation of low-grade, noninfective systemic chronic inflammation and.Improved blood lipid profiles, with aerobic exercise followed by resistance training seemingly the most effective intervention to improve high-density lipoprotein (HDL) cholesterol. ![]() Metabolism, inflammation, and cellular integrity.Exercise training is contraindicated in some circumstances, including uncontrolled arrhythmia, active myocarditis or pericarditis, severe symptomatic aortic stenosis, decompensated heart failure, acute aortic dissection, acute pulmonary embolism, and in the first 2 days after acute coronary syndrome. In general, exercise should include 150-300 minutes/week of moderate-intensity or 75-150 minutes/week of vigorous-intensity aerobic exercise or a combination of the two, at least moderate-intensity muscle-strengthening activities involving all major muscle groups at least twice weekly, and limiting sedentary time. ![]() An active lifestyle is a cornerstone for secondary CVD prevention. Although data suggest that long-term exposure to strenuous endurance exercise might be associated with coronary artery calcification (CAC), atrial fibrillation, and myocardial fibrosis, exposure to very high levels of leisure-time moderate or vigorous physical activity does not appear to increase the risk of CVD or related clinical events.
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