NYMC Faculty Publications

Functional and Structural Adaptations of the Coronary Macro- and Microvasculature to Regular Aerobic Exercise by Activation of Physiological, Cellular, and Molecular Mechanisms: ESC Working Group on Coronary Pathophysiology and Microcirculation Position Paper

Akos Koller, Department of Translational Medicine, Semmelweis University, Budapest, Hungary.
M Harold Laughlin, Department of Biomedical Sciences, University of Missouri, Columbia, MO 65211, USA.
Edina Cenko, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Cor de Wit, Institut für Physiologie, Universitat zu Lübeck, Lübeck, Germany.
Kálmán Tóth, Division of Cardiology, 1st Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.
Raffaele Bugiardini, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Danijela Trifunovits, Cardiology Department, Clinical Centre of Serbia and Faculty of Medicine University of Belgrade, Belgrade, Serbia.
Marija Vavlukis, University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, Republic of Macedonia.
Olivia Manfrini, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Adam Lelbach, Departmental Group of Geriatrics, Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Dr. Rose Private Hospital, Budapest, Hungary.
Gabriella Dornyei, Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
Teresa Padro, Cardiovascular Program-ICCC, Research Institute Hospital Santa Creu i Sant Pau, IIB-Sant Pau, CiberCV-Institute Carlos III, Barcelona, Spain.
Lina Badimon, Cardiovascular Program-ICCC, Research Institute Hospital Santa Creu i Sant Pau, IIB-Sant Pau, CiberCV-Institute Carlos III, Barcelona, Spain.
Dimitris Tousoulis, First Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece.
Stephan Gielen, Department of Cardiology, Angiology, and Intensive Care Medicine, Klinikum Lippe, Detmold, Germany.
Dirk J. Duncker, Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Author Type(s)

Faculty

Journal Title

Cardiovascular Research

First Page

357

Last Page

371

Document Type

Article

Publication Date

1-29-2022

Department

Physiology

Abstract

Regular aerobic exercise (RAEX) elicits several positive adaptations in all organs and tissues of the body, culminating in improved health and well-being. Indeed, in over half a century, many studies have shown the benefit of RAEX on cardiovascular outcome in terms of morbidity and mortality. RAEX elicits a wide range of functional and structural adaptations in the heart and its coronary circulation, all of which are to maintain optimal myocardial oxygen and nutritional supply during increased demand. Although there is no evidence suggesting that oxidative metabolism is limited by coronary blood flow (CBF) rate in the normal heart even during maximal exercise, increased CBF and capillary exchange capacities have been reported. Adaptations of coronary macro- and microvessels include outward remodelling of epicardial coronary arteries, increased coronary arteriolar size and density, and increased capillary surface area. In addition, there are adjustments in the neural and endothelial regulation of coronary macrovascular tone. Similarly, there are several adaptations at the level of microcirculation, including enhanced (such as nitric oxide mediated) smooth muscle-dependent pressure-induced myogenic constriction and upregulated endothelium-dependent/shear-stress-induced dilation, increasing the range of diameter change. Alterations in the signalling interaction between coronary vessels and cardiac metabolism have also been described. At the molecular and cellular level, ion channels are key players in the local coronary vascular adaptations to RAEX, with enhanced activation of influx of Ca2+ contributing to the increased myogenic tone (via voltage-gated Ca2+ channels) as well as the enhanced endothelium-dependent dilation (via TRPV4 channels). Finally, RAEX elicits a number of beneficial effects on several haemorheological variables that may further improve CBF and myocardial oxygen delivery and nutrient exchange in the microcirculation by stabilizing and extending the range and further optimizing the regulation of myocardial blood flow during exercise. These adaptations also act to prevent and/or delay the development of coronary and cardiac diseases.

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