Sakellariou XM, Papafaklis MI, Domouzoglou EM, Katsouras CS, Michalis LK, Naka KK. Exercise-mediated adaptations in vascular function and structure: Beneficial effects in coronary artery disease. World J Cardiol 2021; 13(9): 399-415 [PMID: 34621486 DOI: 10.4330/wjc.v13.i9.399]
Corresponding Author of This Article
Michail I Papafaklis, MD, PhD, FESC, Attending Doctor, Consultant Physician-Scientist, Michailideion Cardiac Centre, University of Ioannina, Stavrou Niarchou Avenue, Ioannina 45100, Epirus, Greece. m.papafaklis@yahoo.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Sep 26, 2021; 13(9): 399-415 Published online Sep 26, 2021. doi: 10.4330/wjc.v13.i9.399
Exercise-mediated adaptations in vascular function and structure: Beneficial effects in coronary artery disease
Xenofon M Sakellariou, Michail I Papafaklis, Eleni M Domouzoglou, Christos S Katsouras, Lampros K Michalis, Katerina K Naka
Xenofon M Sakellariou, Michail I Papafaklis, Eleni M Domouzoglou, Christos S Katsouras, Lampros K Michalis, Katerina K Naka, Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
Michail I Papafaklis, Christos S Katsouras, Lampros K Michalis, Katerina K Naka, 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
Eleni M Domouzoglou, Department of Pediatrics, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
Author contributions: Sakellariou X and Papafaklis M contributed to the conception and design of the research; Sakellariou X and Domouzoglou E drafted the manuscript; Papafaklis M, Katsouras C, Michalis L, and Naka K critically revised the manuscript for important intellectual content; all authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests for this article
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michail I Papafaklis, MD, PhD, FESC, Attending Doctor, Consultant Physician-Scientist, Michailideion Cardiac Centre, University of Ioannina, Stavrou Niarchou Avenue, Ioannina 45100, Epirus, Greece. m.papafaklis@yahoo.com
Received: March 25, 2021 Peer-review started: March 25, 2021 First decision: May 13, 2021 Revised: May 30, 2021 Accepted: July 21, 2021 Article in press: July 21, 2021 Published online: September 26, 2021
Abstract
Exercise exerts direct effects on the vasculature via the impact of hemodynamic forces on the endothelium, thereby leading to functional and structural adaptations that lower cardiovascular risk. The patterns of blood flow and endothelial shear stress during exercise lead to atheroprotective hemodynamic stimuli on the endothelium and contribute to adaptations in vascular function and structure. The structural adaptations observed in arterial lumen dimensions after prolonged exercise supplant the need for acute functional vasodilatation in case of an increase in endothelial shear stress due to repeated exercise bouts. In contrast, wall thickness is affected by rather systemic factors, such as transmural pressure modulated during exercise by generalized changes in blood pressure. Several mechanisms have been proposed to explain the exercise-induced benefits in patients with coronary artery disease (CAD). They include decreased progression of coronary plaques in CAD, recruitment of collaterals, enhanced blood rheological properties, improvement of vascular smooth muscle cell and endothelial function, and coronary blood flow. This review describes how exercise via alterations in hemodynamic factors influences vascular function and structure which contributes to cardiovascular risk reduction, and highlights which mechanisms are involved in the positive effects of exercise on CAD.
Core Tip: Exercise has beneficial effects on the function and structure of the vasculature, thereby leading to a reduction of the cardiovascular risk. Hemodynamic forces, in particular endothelial shear stress, play a critical role in modulating the endothelial cell phenotype towards atherogenesis or atheroprotection. Exercise improves clinical outcomes in patients with coronary artery disease (CAD). We herein discuss the alterations induced by exercise on vascular function and structure, and the mechanisms involved in the benefits of exercise regarding patients with CAD.
