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Deep dive into why exercise is vital for heart health – Scientific Inquirer



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New four-part series in American Journal of Cardiology emphasized how important exercise is for the prevention and treatment of heart disease.

The series, coordinated by Institute Professor Jason Kovacic, also explores the field of sports cardiology and provides unique insight into the inner workings of the hearts of elite athletes.

Professor Kovacic, executive director of the Victor Chang Institute of Cardiac Research, says: “Exercise doesn’t just change how you look; it also affects and changes virtually every aspect of our cardiovascular system.

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“It is vital that cardiologists and the wider public understand how important exercise is to our heart health and how much we should be doing if we want to live long and healthy lives.”

Physical exercises for primary and secondary prevention of cardiovascular diseases

In the first part of a series of focus seminars, the authors describe how long-term aerobic exercise changes the heart. They show how:

  • The weight and size of the heart increases, allowing it to pump much more blood.
  • It affects the health of the body’s major arteries.
  • It can also lead to changes in skeletal muscle that can cause an increase in the mitochondrial network, the body’s main powerhouse.
  • Exercise can also improve glucose control and increase insulin sensitivity.
  • Blood pressure can be reduced to 7 mm Hg.
  • Exercise can also increase the level of good cholesterol in the body.

Despite the significant health benefits of exercise, only one in four (24.5%) Australian adults meet the physical activity guidelines, which recommend 150-300 minutes of moderate-intensity physical activity, or 75-150 minutes of vigorous-intensity physical activity, or the equivalent a combination of both, per week.

Professor Kovacic says: “Most Australians know that exercise is good for our health, but the challenge is getting people to get off the couch and put on their sports gear. We hope that by explaining the incredible benefits that exercise can bring to our hearts; it could encourage more Australians to take up sport.

“Even small increases in aerobic fitness can reduce the likelihood of developing heart disease and premature death.”

The heart of an athlete – problems and contradictions

The researchers, led by Associate Professor Andre La Gerche from St Vincent’s Hospital in Melbourne and the Baker Institute, focused on whether the effects of exercise are always beneficial and protective for professional athletes.

They show how exercise-induced cardiac remodeling (also known as “athlete’s heart”) can contribute to the development of arrhythmias in some people. Regular exercise can promote cardiac remodeling, and significant remodeling is rarely associated with adverse clinical effects such as atrial fibrillation or other arrhythmias. The authors highlight how extreme heart attacks in an athlete can potentially develop into cardiovascular disease. Additionally, the knowledge gap between male and female athletes and their cardiovascular health is the focus of this article.

A/Professor La Gerche says: “Exercise is of course extremely positive for heart health. Fortunately, exercise very rarely increases the risk of cardiac death. However, even in these very rare cases, it is important to understand who is most at risk and why. This is a rapidly evolving field that we hope will lead to safer exercise regimens for all athletes.”

Heart failure with preserved ejection fraction as an exercise deficit syndrome

The authors discuss an increasingly recognized cause of heart failure — when the heart becomes too rigid and does not relax properly between beats. In medical terms, this is called HFpEF – or heart failure with preserved ejection fraction. The authors suggest that cardiovascular status and HFpEF (“stiff heart”) are inversely related; the effects of a sedentary lifestyle combined with aging and other comorbidities may contribute to increased cardiac stiffness and HFpEF. Heart failure rates begin to increase by age 60, and sedentary habits may have already been formed by that age.

Increased physical activity is associated with increases in cardiac mass, stroke volume, cardiac output, and peak oxygen consumption, and overall fewer clinical events. Exercise and cardiorespiratory fitness training can improve quality of life and can be used as a preventive measure to avoid the development of heart stiffness and HFpEF.

Sports activities for patients with hypertrophic cardiomyopathy and other inherited cardiovascular diseases

Individuals with inherited cardiovascular diseases such as hypertrophic cardiomyopathy (HCM) have historically been limited in competitive sports because of the risk of sudden cardiac death. Current 2020 AHA/ACC Guidelines for Hypertrophic Cardiomyopathy found that physician-patient shared decision making can be used to determine whether an athlete with HCM can safely participate in sports.

The authors explain that based on previous research, individuals with HCM or other inherited cardiovascular disease may be considered for exercise or sports, and that physicians should develop an individualized approach to exercise and competitive sports with such patients.


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