Evidence summary (Updated 2022)
A large body of good quality randomised controlled data shows consistently that physical activity improves vascular endothelial function(1–8) by improving nitric oxide production and attenuating the triggers of vasoconstriction and platelet aggregation. These studies demonstrated statistically significant improvements of flow mediated dilatation or prevention of vasoconstriction, which will thus improve coronary blood flow and peripheral circulation. One study alluded to an improvement being superior from resistance training(1).
Quality of evidence
A – High quality
Strength of recommendation
Physical activity can be recommended to improve the blood flow around the heart and body in most patients with ischaemic heart disease and should be undertaken unless there are compelling reasons NOT to do so.
- Chen YW, Apostolakis S, Lip GY. Exercise-induced changes in inflammatory processes: implications for thrombogenesis in cardiovascular disease. Ann Med. 46:439–455.
- Adams V, Besler C, Fischer T, Riwanto M, Noack F, Hollriegel R, et al. Exercise training in patients with chronic heart failure promotes restoration of high-density lipoprotein functional properties. Circ Res. 113:1345–1355.
- Sixt S, Beer S, Bluher M, Korff N, Peschel T, Sonnabend M, et al. Long- but not short-term multifactorial intervention with focus on exercise training improves coronary endothelial dysfunction in diabetes mellitus type 2 and coronary artery disease. Eur Hear J. 31:112–119.
- Erbs S, Hollriegel R, Linke A, Beck EB, Adams V, Gielen S, et al. Exercise training in patients with advanced chronic heart failure (NYHA IIIb) promotes restoration of peripheral vasomotor function, induction of endogenous regeneration, and improvement of left ventricular function. Circ Hear Fail. 3:486–494.
- Wai-Keung Wong3, Sidney Tam3, Chu-Pak Lau1 and Hung-Fat Tse. Effects of exercise training upon endothelial function in patients with cardiovascular disease. Eur J Prev Card. 20012;19(4:830–839.
- Adams V, Linke A, Krankel N, Erbs S, Gielen S, Mobius-Winkler S, et al. Impact of regular physical activity on the NAD(P)H oxidase and angiotensin receptor system in patients with coronary artery disease. Circulation. 111:555–562.
- Henderson KK, Turk JR R, JW L, M.H. Endothelial function in coronary arterioles from pigs with early-stage coronary disease induced by high-fat, high-cholesterol diet: effect of exercise. J Appl Physiol. 97:1159–1168.
- Hambrecht R, Wolf A, Gielen S, Linke A, Hofer J, Erbs S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 342:454–460.