Short‐term exercise‐induced protection of cardiovascular function and health: why and how fast does the heart benefit from exercise?

Abstract

Regular exercise training has potent and powerful protective effects against the development of cardiovascular disease. These cardioprotective effects of regular exercise training are partly explained through the effects of exercise on traditional cardiovascular risk factors and improvement in cardiac and vascular health, which take several weeks to months to develop. This review focuses on the observation that single bouts of exercise may also possess an underrecognized, clinically useful form of immediate cardioprotection. Studies, performed in both animals and humans, demonstrate that single or short‐term exercise‐induced protection (SEP) attenuates the magnitude of cardiac and/or vascular damage in response to prolonged ischaemia and reperfusion injury. This review highlights preclinical evidence supporting the hypothesis that SEP activates multiple pathways to confer immediate protection against ischaemic events, reduce the severity of potentially lethal ischaemic myocardial injury, and therefore act as a physiological first line of defence against injury. Given the fact that the extent of SEP could be modulated by exercise‐related and subject‐related factors, it is important to recognize and consider these factors to optimize future clinical implications of SEP. This review also summarizes potential effector signalling pathways (i.e. communication between exercising muscles to vascular/cardiac tissue) and intracellular pathways (i.e. reducing tissue damage) that ultimately confer protection against cardiac and vascular injury. Finally, we discuss potential future directions for designing adequate human and animal studies that will support developing effective SEP strategies for the (multi‐)diseased and aged individual. Key points Single or short‐term exercise‐induced protection (SEP) attenuates the magnitude of cardiac and/or vascular damage in response to prolonged ischaemia and reperfusion injury (IR injury). SEP activates multiple pathways to confer cardiac protection, which develops remotely at the site of the activated muscle by release of circulating molecules, which transfer towards activation of intramyocardial signalling that promotes cell survival during episodes of IR injury. SEP represents an attractive intervention in aged individuals and in those with co‐morbidities. The immediate protection, low cost and simplicity to increase the ‘dose’ of SEP offers unique opportunities in the clinical applications of SEP.

Remote ischaemic preconditioning – translating cardiovascular benefits to humans

“…Thus, there may be further clinical benefit by administering multiple bouts of RIPC (Table 2). The pattern and underlying mechanisms of cardiovascular protection with repeated RIPC may be similar to that observed after short-term aerobic exercise (Thijssen et al, 2018;Thijssen et al, 2022). In heart failure patients, 1 week of RIPC increased coronary artery flow reserve by ∼20% (Kono et al, 2014).…”

“…Lastly, considering the ischaemia and reperfusion experienced during exercise, aerobic fitness or prior physical activity may alter the efficacy of RIPC. This topic regarding the potentially additive or overlapping adaptations of exercise and RIPC is effectively addressed in recent review papers (Thijssen et al, 2018(Thijssen et al, , 2022. Collectively, multiple factors have been identified that potentially affect the clinical use and efficacy of RIPC.…”

Protective Role of Chronic Exercise Training in Modulating the Impact of Hyperglycemia on Vascular Sensitivity to Ischemia-Reperfusion

“…The main originality of our work was to evaluate the effects of a widely recognized cardiovascular protective strategy on the exacerbation of HG-induced I/R injury on the vasculature. Among protective strategies, a large number of studies have been able to demonstrate positive effects of exercise on vascular function [ 16 , 39 ]. More specifically, exercise training was proven to be able to limit endothelial vulnerability to I/R in both human [ 16 , 17 ] and rodent models [ 18 , 40 ].…”

The effect of exercise on the prevention of gestational hypertension in obese and overweight pregnant women: An updated meta-analysis

“…Exercise is widely recognized as a health maintenance method and it has numerous benefits ( 19 , 20 ). It is acknowledged that exercise may accelerate metabolism, build cardiorespiratory capacity, improve immunity, and relieve mental stress ( 21 – 23 ).…”