What are the Benefits of Exercise for the Heart?

Carlos Sánchez 9 min. of reading Well-being habits Leave a comment

World Heart Day is an excellent excuse to remind our readers of the benefits of exercise for the heart.

A medicine is good when it is effective in preventing or treating disease and when, at the same time, it has a good safety profile.

Physical exercise fulfils both of these conditions, but this was not always the case.

I always comment on how physical exercise, until not too long ago, was little more than a leisure activity through which we could burn some calories and look better in the mirror.

In fact, initially, it was thought in the medical community hat the cardiovascular adaptations occurring in the exercising heart were negative.

With luck and effort, this picture changed.

Physical exercise became one of the pillars in the prevention and rehabilitation of cardiovascular diseases, and remains so today, many years later.

In this post, we will remind you of the positive effects that regular exercise can have on the cardiovascular system in healthy people (primary prevention), in people with pre-symptomatic pathologies (secondary prevention) or even after the disease has developed and manifested itself (tertiary prevention).

Index

1 What does an athlete’s heart look like?
2 What does exercise reduce in the heart?
3 Why is exercise so important?
4 How does exercise strengthen your heart?
5 What are the recommended exercises for people with heart problems?
6 What’s ahead?

What does an athlete’s heart look like?

An athlete’s heart is different from that of a sedentary person.

Very different…

Our physiology “anticipates” that we are likely to return to this effort in the future, and therefore prepares the organism (cardiovascular system, respiratory system, skeletal muscle, metabolism) to cope better with the next session of physical exercise.

This is the magic of physiology that has many of us fascinated.

These differences could be summarised in the following points:

Enlargement of the heart chambers, especially the left ventricle (increased diastolic volume).

This allows a greater filling of the heart in diastole (relaxation), so that in the contraction phase, more volume is ejected to the different parts of the body.

Increased wall thickness.

It is an adaptation that is a direct result of training. Just as the quadriceps or biceps grows in response to contraction and relaxation, so does the heart muscle to some extent.

Functional improvement of the heart as a pump.

The athletic heart does its job better. A trained heart can eject more than five times the volume of blood ejected by a sedentary heart per minute, without flinching.

Improvement in lung capacity, accompanying improvement in cardiac function.
Peripheral improvement in the efficiency of skeletal muscle to utilise oxygen.

Cardiopulmonary adaptations would be nothing without the peripheral adaptations produced in skeletal muscle, which becomes much more efficient in using oxygen and producing energy from different energy substrates (glucose, fat, phosphates).

Reduced arterial “stiffness”.

Remember that today we are talking about the role of exercise in the prevention and treatment of cardiovascular diseases. And coronary heart disease remains the number one killer in the West.

A lot has to change for some other condition to dethrone it from this position.

Reduced oxidative stress and inflammatory markers.
Increased production of nitric oxide (NO) and increased vasodilation of peripheral vessels.

The athlete’s cardiovascular system, therefore, “mutates” in an allostatic effort: that is, in an adaptive response to an environmental stressor, which in this case is the physical effort involved in exercise.

What does exercise reduce in the heart?

There is no pill in the world that can give you all the health benefits of physical exercise.

This is paradoxical, given that we have firm, clear and redundant evidence about the benefits of physical exercise in the prevention of cardiovascular and non-cardiovascular pathologies.

There is still little scientific consensus on the veracity of this assertion.

The reasons to give your heart a dose of regular exercise are many, but we will mention just a few of the most relevant ones:

It increases the ischaemia threshold.

When faced with an “ischaemic insult”, the heart is much more likely to survive when it is trained than when it is not.

In other words, if we were to interrupt the blood supply momentarily in a trained heart, it would have a much better chance of coming out with little damage or unscathed than in the case of a sedentary heart.

Lower prevalence of arrhythmias such as the very common atrial fibrillation.
Reduced risk of thrombotic disorders.

Such as superficial and deep vein thrombosis or pulmonary thromboembolism, which are responsible for a large proportion of sudden deaths.

Lower risk of sudden death..

Although in popular culture sudden death is associated with physical exercise, especially competitive exercise, the fact is that regular physical exercise significantly reduces the risk of sudden death.

It is worth mentioning that before starting regular sports practice, it is essential to undergo a basic cardiovascular study to detect the main congenital pathologies that cause sudden death.

This applies to both elite and amateur athletes.

Lower prevalence of high blood pressure
Positive impact on metabolic disease.

Why is exercise so important?

Let me explain it in 4 critical points, which I think will make the potential health benefits of exercise quite clear:

Obesity.

The increased mortality caused by obesity is attenuated by physical exercise. In other words, an obese patient who trains regularly will have lower mortality than a sedentary obese patient.

Dyslipidemia.

Directly related to atherosclerotic plaque formation in coronary heart disease.

Metabolic syndrome.

Associated with multiple cardiovascular risk factors..

Diabetes type 2.

Along with obesity, another major pandemic that is costing us billions every year, in addition to the cost in quality of life (and lives).

Now that you’ve seen its importance, you’d think that access to a physical exercise programme should be assured for everyone at risk of cardiovascular disease, wouldn’t you?

Well, sadly, no.

How does exercise strengthen your heart?

Although most tertiary public hospitals have some form of cardiovascular rehabilitation programme, there are still many, many patients (and future patients) who are not benefiting from this majestic polypill.

Evidence on the efficacy of cardiac (CR)/cardiovascular rehabilitation programmes is overwhelming:

In patients with coronary heart disease, CR programmes can reduce the prevalence of metabolic syndrome by up to 37% (Milani & Lavie, 2003)..
In coronary patients, high-sensitivity CRP, a marker of inflammation, falls by 40% in those who have completed a CR programme vs. those who did not (Milani et al., 2004).
There is a lower likelihood of hospitalisation for decompensated heart failure and lower mortality, once hospitalised (O’Connor et al., 2009).
Ability to almost completely reverse the pathophysiological aspects of “heart failure myopathy”.

What are the recommended exercises for people with heart problems?

I will address this point by explaining why exercise should be “prescribed as medicine”.

However, it will be the job of the professional treating the patient to assess individual capacity and the possibility of incorporating one type of training or another.

The aim of this prescription is to achieve, among others, the following points:

Improve VO2 Max.
Restore vascular flexibility.
Improve myocardial contractility.
Increase eccentric hypertrophy (sarcomeric disposition in series).
Shift VT1 and VT2.
Improve venous return.
Increase peripheral angiogenesis.

Both cardiovascular exercise and strength training, contrary to popular belief, are absolutely necessary.

What’s ahead?

There is still a need for more financial investment in physical exercise and rehabilitation programmes.

Not only aimed at patients with cardiovascular problems, but also at others with metabolic pathologies (obesity, type 2 diabetes, metabolic syndrome, fatty liver, etc.).

This would, over the years and contrary to political beliefs, save the public purse millions and, more importantly, create a culture and mindset of physical exercise as medicine rather than entertainment.

That is the change we have to bring about in the coming years.

Bibliography

Brandt, C., & Pedersen, B. K. (2010). The role of exercise-induced myokines in muscle homeostasis and the defense against chronic diseases. Journal of Biomedicine & Biotechnology, 2010, 520258.
Milani, R. V., & Lavie, C. J. (2003). Prevalence and profile of metabolic syndrome in patients following acute coronary events and effects of therapeutic lifestyle change with cardiac rehabilitation. American Journal of Cardiology.
Milani, R. V., Lavie, C. J., & Mehra, M. R. (2004). Reduction in C-reactive protein through cardiac rehabilitation and exercise training. Journal of the American College of Cardiology.
O’Connor, C. M., Whellan, D. J., Lee, K. L., Keteyian, S. J., Cooper, L. S., Ellis, S. J., Leifer, E. S., Kraus, W. E., Kitzman, D. W., Blumenthal, J. A., Rendall, D. S., Miller, N. H., Fleg, J. L., Schulman, K. A., McKelvie, R. S., Zannad, F., & Piña, I. L. (2009). Efficacy and safety of exercise training in patients with chronic heart failure HF-ACTION randomized controlled trial. JAMA – Journal of the American Medical Association.
Pedersen, B. K., & Saltin, B. (2006). Evidence for prescribing exercise as therapy in chronic disease. In Scandinavian Journal of Medicine and Science in Sports.
Pedersen, B., & Saltin, B. (2015). Exercise as medicine–evidence for prescribing exercise as therapy in 26 different chronic diseases. Journal of Medicine & Science in Sports.

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