Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease
2003; Lippincott Williams & Wilkins; Volume: 23; Issue: 8 Linguagem: Inglês
10.1161/01.atv.0000087143.33998.f2
ISSN1524-4636
Autores Tópico(s)Cardiovascular Effects of Exercise
ResumoHomeArteriosclerosis, Thrombosis, and Vascular BiologyVol. 23, No. 8Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBExercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease Paul D. Thompson Paul D. ThompsonPaul D. Thompson Department of Preventive Cardiology and Cardiovascular Research, Division of Cardiology, Hartford Hospital, and Department of Medicine, University of Connecticut, Farmington, Conn. Originally published1 Aug 2003https://doi.org/10.1161/01.ATV.0000087143.33998.F2Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:1319–1321Dr Paul Dudley White, the Boston cardiologist famous for consulting on President Eisenhower when Eisenhower suffered a myocardial infarction in 1955, believed that "a normal person should exercise seven hours a week. If you could not exercise an hour everyday, make up the difference on the weekend."1 So familiar was White's advocacy of exercise that his obituary in the New England Journal of Medicine started with the statement, "Practically everyone knows that Dr Paul Dudley White rode a bicycle and preached exercise."2See page e42Cardiovascular preventive and therapeutic treatments have advanced remarkably since White's death in 1973, but a recently released Scientific Statement from the American Heart Association Counsels of Clinical Cardiology and Nutrition, Physical Activity and Metabolism3 emphasizes that exercise remains a valuable therapeutic strategy for patients with, or at risk for, atherosclerotic cardiovascular disease. Whenever possible, the Statement's conclusions and recommendations were based on summary articles and meta-analyses. This editorial reviews the salient recommendations and their supporting evidence from that Statement.The Statement summarizes strong epidemiologic evidence that physical activity reduces the incidence of atherosclerotic heart disease. In addition, exercise is useful in managing several atherosclerotic risk factors. A meta-analysis of 52 exercise training trials lasting >12 weeks including 4700 subjects demonstrated an average increase in HDL-C levels of 4.6% and reductions in triglycerides and LDL-C concentrations of 3.7% and 5.0%, respectively.4,5 Such results suggest that exercise serves primarily as adjunctive therapy for most patients with lipid disorders, although some individuals experience greater lipid effects, and few studies have examined the effect of exercise in patients with dyslipidemia. A meta-analysis of 44 randomized controlled trials including 2674 participants6 demonstrated average reductions in systolic and diastolic blood pressure of 2.6 and 1.8 mm Hg in normotensive subjects and 7.4 and 5.8 mm Hg in hypertensive subjects, respectively. These results suggest that exercise may serve as the only therapy required in some mildly hypertensive subjects. A review of 9 trials examining the effect of exercise training in 337 type II diabetic subjects noted an average reduction of hemoglobin (Hgb) A1c of 0.5% to 1%,7 although these results may underestimate the exercise effect because concomitant reductions in diabetic medications were allowed in some of the studies. This review preceded the Diabetes Prevention Program (DPP).7 In the DPP, an average 4-kg decrease in body weight and a 593-kcal increase in weekly energy expenditure (approximately 6 miles of walking) reduced the onset of type II diabetes in individuals at high risk for this disease by 58% compared with usual care.8 The lifestyle intervention was also significantly more powerful than the 31% reduction in the onset of diabetes produced by metformin 850 mg taken twice daily. The National Weight Control Registry supports a role of physical activity in achieving and maintaining weight loss.9 This registry includes 3000 individuals who maintained an average weight loss of 30 kg for an average of 5.5 years. Eighty-one percent of the registrants reported increased physical activity, with women and men reporting weekly expenditures of 2445 and 3298 kcal, respectively. In summary, the Statement provides compelling evidence for the use of exercise as primary or adjunctive therapy for reducing several of the major cardiovascular risk factors.The Statement also reviews the benefits of exercise training in patients with cardiovascular disease. A meta-analysis of 51 randomized, controlled trials including 8440 patients examined the effect of exercise-based cardiac rehabilitation on cardiac events.10 Reports were divided into those cardiac rehabilitation programs using only exercise training and those including exercise plus psychosocial and/or educational interventions.10 The exercise programs consisted of 2 to 6 months of supervised exercise training followed by unsupervised exercise.11,12 Results were based on a mean follow-up of 2.4 years.10 Total mortality decreased 27% (P<0.05) with the exercise only intervention, but only 13% (P=NS) with the more comprehensive rehabilitation programs suggesting that the exercise training is critically important for the beneficial effect. Cardiac mortality was reduced 31% (P<0.05) and 26% (P<0.05) for the exercise only and comprehensive programs, respectively. Neither the exercise only nor the comprehensive intervention significantly reduced the rate of nonfatal myocardial infarction. Too few trials examined the effect of exercise training on sudden death or subsequent bypass surgery to evaluate these outcomes. The reduction in cardiac mortality without a reduction in nonfatal events suggests that exercise training may enhance electrical stability thereby reducing ventricular fibrillation13 or that exercise may reduce myocardial damage either directly or via such factors as ischemic preconditioning.14 Unfortunately, all studies in this meta analysis were published before January 1, 1999; most preceded the widespread use of acute thrombolytic therapy, primary angioplasty, aggressive lipid management, and angiotensin converting enzyme inhibitors, so it is not clear that exercise therapy would have as great an impact on mortality in the present era of cardiovascular disease management. Nevertheless, these results provide strong support for the use of therapeutic exercise training in virtually all patients with coronary disease.The Statement also summarizes data demonstrating the utility of exercise training in reducing symptoms in patients with angina pectoris, an effect known since 1772 when Heberden described a patient with angina who was "nearly cured" by sawing wood for half an hour daily.15 The Statement recommends using exercise training in angina patients who are not candidates for revascularization therapy. Exercise reduces the severity of angina pectoris by reducing the heart rate response to exertion16and by improving endothelial function.17The benefits of exercise training in patients with heart failure has recently been addressed in an American Heart Association (AHA) Statement directed to this topic.18 Exercise performance, measured as peak oxygen uptake, in 426 heart failure patients enrolled in 15 randomized, controlled trials of exercise training, increased 20.5% (range, 12% to 31%).18 Consequently, exercise training can greatly improve effort tolerance and quality of life in these patients, although no trial has documented a reduction in morbitiy and mortality. The HF-ACTION Trial (Heart Failure: A CHF Trial Investigating Outcomes of Exercise Training) is an National Institutes of Health–funded study which will randomly assign patients to a formal exercise training program or usual care program to examine the effect of exercise training on cardiac events and survival in the heart failure population.The Statement also documents that physical activity is an effective symptomatic treatment for patients with claudication. A meta-analysis of 21 studies demonstrated that exercise training increased the average walking distance to pain onset by 179% or 225 m, and the average distance to maximal tolerated pain increased 122% or 397 m.19 These increases in walking distance are greater than those reported for the most widely used medicines, pentoxyphyline and cilostozol. The greatest improvement with exercise training occurred when patients trained to maximal tolerated pain, when training lasted at least 6 months, and when walking was the primary mode of exercise.19 A review of randomized controlled trials suggests that exercise training may also be superior to peripheral angioplasty in improving exercise tolerance in claudication patients,20 although a direct comparison of invasive and supervised exercise training found improvement only in the invasively treated patients at one year.21 No trials have examined the effect of exercise training on the need for revascularization, subsequent cardiovascular events, or mortality in claudication patients. Nevertheless, a walking program is an acceptable alternative to invasive therapy in many patients with claudication.The Statement also addresses the orthopedic and cardiac risks of physical activity.The most common risk of physical activity in adults is musculoskeletal injury.22,23 Approximately 25% of adults age 20 to 85 years with above-average activity levels develop a musculoskeletal injury yearly,22 and 30% of injured adults stopped exercising. Risk of injury increases with obesity, volume of exercise, and participation in competitive sports. Physical activity should be increased gradually over time to reduce the risk of orthopedic problems. Walking, the most popular moderate intensity activity, carries little orthopedic risk.Of more concern are observations that vigorous physical activity acutely increases the risk of sudden cardiac death24,25and myocardial infarction26,27 among individuals with both diagnosed and occult heart disease. Inherited abnormalities are primarily responsible for exercise-related cardiac events in young subjects whereas atherosclerotic coronary disease is the overwhelming cause of exercise-related deaths in adults.24,25 The incidence has been estimated to be one exertion-related death per year for every 15 00024 to 18 00025 ostensibly healthy adult men, but these rates are based on small numbers of subjects and have wide confidence limits. The relative risk of both exercise-related myocardial infarction and sudden death is greatest in individuals who are the least physically active and who were performing unaccustomed vigorous physical activity.25–27 Consequently, sedentary adults should avoid unaccustomed vigorous activity, and increase their activity levels gradually over time. The utility of routinely exercise testing active adults to reduce exercise-related events has not been established and was not recommended by the Writing Committee.The Statement makes recommendations to health care providers designed to support patient physical activity throughout the lifespan. In a novel approach, the Statement recommends that health professionals personally engage in an active lifestyle to familiarize themselves with the issues involved and to set a positive example for patients and the public. The Statement also encourages health care providers to support public health programs designed to increase community levels of physical activity. Finally, the Statement recommends research designed to increase the adoption and maintenance of an active lifestyle.The Centers for Disease Control and Prevention and the American College of Sports Medicine have recommended that adults participate in 30 minutes or more of moderate intensity physical activity such as brisk walking on most, preferably all, days of the week,28 a recommendation endorsed by the new AHA Statement. This prescription is not greatly different from that proposed by Dr White more than a quarter century ago. The current AHA Statement buttresses the scientific rationale for Dr White's conviction and suggests ways that health care providers can encourage physical activity among their patients and the public.FootnotesCorrespondence to Paul D. Thompson, MD, Cardiology, Hartford Hospital, 80 Seymour St, Hartford, CT 06102. E-mail [email protected] References 1 Hurst JW. Paul Dudley White: to know him better. Am J Cardiol. 1985; 56: 169–177.CrossrefMedlineGoogle Scholar2 Ingelfinger FJ. Editorial: Paul Dudley White, 1886–1973. N Engl J Med. 1973; 289: 1251.Google Scholar3 Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, Berra K, Blair SN, Costa F, Franklin B, Fletcher GF, Gordon NF, Pate RR, Rodriguez BL, Yancey AK, Wenger NK. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003; 107: 3109–3116.LinkGoogle Scholar4 Leon AS, Sanchez OA. Response of blood lipids to exercise training alone or combined with dietary intervention. Med Sci Sports Exerc. 2001; 33 (6 Suppl): S502–S515.CrossrefMedlineGoogle Scholar5 Leon AS, Sanchez OA. Meta-analysis of the effects of aerobic exercise training on blood lipids. Circulation. 2001; 104: II-414–II-415.Google Scholar6 Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001; 33 (6 Suppl): S484–S492.CrossrefMedlineGoogle Scholar7 Thompson PD, Crouse SF, Goodpaster B, Kelley D, Moyna N, Pescatello L. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001; 33 (6 Suppl): S438–S445.CrossrefMedlineGoogle Scholar8 Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346: 393–403.CrossrefMedlineGoogle Scholar9 Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001; 21: 323–341.CrossrefMedlineGoogle Scholar10 Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2001; (1): CD001800.MedlineGoogle Scholar11 Oldridge NB, Guyatt GH, Fischer ME, Rimm AA. Cardiac rehabilitation after myocardial infarction: combined experience of randomized clinical trials. JAMA. 1988; 260: 945–950.CrossrefMedlineGoogle Scholar12 O'Connor GT, Buring JE, Yusuf S, Goldhaber SZ, Olmstead EM, Paffenbarger RS Jr, Hennekens CH. An overview of randomized trials of rehabilitation with exercise after myocardial infarction1. Circulation. 1989; 80: 234–244.CrossrefMedlineGoogle Scholar13 Billman GE. Aerobic exercise conditioning: a nonpharmacological antiarrhythmic intervention. J Appl Physiol. 2002; 92: 446–454.CrossrefMedlineGoogle Scholar14 Hamilton KL, Powers SK, Sugiura T, Kim S, Lennon S, Tumer N, Mehta JL. Short-term exercise training can improve myocardial tolerance to I/R without elevation in heat shock proteins. Am J Physiol Heart Circ Physiol. 2001; 281: H1346–H1352.CrossrefMedlineGoogle Scholar15 Heberden W. Commentary on the history and cure of disease. In: Willius F, Keys T, eds. Cardiac Classics. St Louis, MO: CV Mosby Company; 1941:224.Google Scholar16 Clausen JP, Trap-Jensen J. Heart rate and arterial blood pressure during exercise in patients with angina pectoris: effects of training and of nitroglycerin. Circulation. 1976; 53: 436–442.CrossrefMedlineGoogle Scholar17 Hambrecht R, Wolf A, Gielen S, Linke A, Hofer J, Erbs S, Schoene N, Schuler G. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 2000; 342: 454–460.CrossrefMedlineGoogle Scholar18 Piña IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, Fletcher BJ, Fleg JL, Myers JN, Sullivan MJ. Exercise and heart failure: a statement from the Committee on Exercise, Rehabilitation, and Prevention. Circulation. 2003; 107: 1210–1225.LinkGoogle Scholar19 Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis. JAMA. 1995; 274: 975–980.CrossrefMedlineGoogle Scholar20 Whyman MR, Ruckley CV. Should claudicants receive angioplasty or just exercise training? Cardiovasc Surg. 1998; 6: 226–231.CrossrefMedlineGoogle Scholar21 Gelin J, Jivegard L, Taft C, Karlsson J, Sullivan M, Dahllof AG, Sandstrom R, Arfvidsson B, Lundholm K. Treatment efficacy of intermittent claudication by surgical intervention, supervised physical exercise training compared to no treatment in unselected randomised patients, I: one year results of functional and physiological improvements. Eur J Vasc Endovasc Surg. 2001; 22: 107–113.CrossrefMedlineGoogle Scholar22 Hootman JM, Macera CA, Ainsworth BE, Addy CL, Martin M, Blair SN. Epidemiology of musculoskeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc. 2002; 34: 838–844.CrossrefMedlineGoogle Scholar23 Sutton AJ, Muir KR, Mockett S, Fentem P. A case-control study to investigate the relation between low and moderate levels of physical activity and osteoarthritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey. Ann Rheum Dis. 2001; 60: 756–764.CrossrefMedlineGoogle Scholar24 Thompson PD, Funk EJ, Carleton RA, Sturner WQ. Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA. 1982; 247: 2535–2538.CrossrefMedlineGoogle Scholar25 Siscovick DS, Weiss NS, Fletcher RH, Lasky T. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984; 311: 874–877.CrossrefMedlineGoogle Scholar26 Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE. Triggering of acute myocardial infarction by heavy physical exertion: protection against triggering by regular exertion—Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med. 1993; 329: 1677–1683.CrossrefMedlineGoogle Scholar27 Giri S, Thompson PD, Kiernan FJ, Clive J, Fram DB, Mitchel JF, Hirst JA, McKay RG, Waters DD. Clinical and angiographic characteristics of exertion-related acute myocardial infarction. JAMA. 1999; 282: 1731–1736.CrossrefMedlineGoogle Scholar28 Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the Am College of Sports Medicine. JAMA. 1995; 273: 402–407.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Son S (2022) The Effects of Prolonged Sitting in a Cross-legged Posture on Pulmonary Function in Young Adults, The Journal of Korean Physical Therapy, 10.18857/jkpt.2022.34.1.1, 34:1, (1-5), Online publication date: 28-Feb-2022. Selzler A, Moore V, Habash R, Ellerton L, Lenton E, Goldstein R and Brooks D (2020) The Relationship between Self-Efficacy, Functional Exercise Capacity and Physical Activity in People with COPD: A Systematic Review and Meta-Analyses, COPD: Journal of Chronic Obstructive Pulmonary Disease, 10.1080/15412555.2020.1782866, 17:4, (452-461), Online publication date: 3-Jul-2020. Saghiv M and Sagiv M (2020) Introduction to Exercise Physiology Basic Exercise Physiology, 10.1007/978-3-030-48806-2_1, (1-31), . Caru M, Curnier D, Bousquet M and Kern L (2018) Evolution of depression during rehabilitation program in patients with cardiovascular diseases, Disability and Rehabilitation, 10.1080/09638288.2018.1499824, 42:3, (378-384), Online publication date: 30-Jan-2020. Li Y, Sun D, Zheng Y and Cheng Y (2020) Swimming exercise activates aortic autophagy and limits atherosclerosis in ApoE−/− mice, Obesity Research & Clinical Practice, 10.1016/j.orcp.2020.04.008, 14:3, (264-270), Online publication date: 1-May-2020. Hately G and Mandic S (2019) Physical activity, physical function and quality of life in community-based maintenance cardiac rehabilitation, Health Education Journal, 10.1177/0017896918823821, 78:5, (524-536), Online publication date: 1-Aug-2019. Miyagi R, Sasawaki Y and Shiotani H (2018) The influence of short-term sedentary behavior on circadian rhythm of heart rate and heart rate variability, Chronobiology International, 10.1080/07420528.2018.1550422, 36:3, (374-380), Online publication date: 4-Mar-2019. Verschueren S, Eskes A, Maaskant J, Roest A, Latour C and op Reimer W (2018) The effect of exercise therapy on depressive and anxious symptoms in patients with ischemic heart disease: A systematic review, Journal of Psychosomatic Research, 10.1016/j.jpsychores.2017.11.018, 105, (80-91), Online publication date: 1-Feb-2018. Zhang M, Zhai Y, Sun Y, Zhang W, Li Q, Brann D and Wang R (2018) Swimming improves cognitive reserve in ovariectomized rats and enhances neuroprotection after global cerebral ischemia, Brain Research, 10.1016/j.brainres.2018.05.020, 1692, (110-117), Online publication date: 1-Aug-2018. Li K, Ochoa E, Lipsey T and Nelson T (2018) Correlates of atherosclerotic cardiovascular disease risk in older Colorado firefighters, Occupational Medicine, 10.1093/occmed/kqx192, 68:1, (51-55), Online publication date: 16-Feb-2018. Reibe S, Hjorth M, Febbraio M and Whitham M (2018) GeneXX: an online tool for the exploration of transcript changes in skeletal muscle associated with exercise, Physiological Genomics, 10.1152/physiolgenomics.00127.2017, 50:5, (376-384), Online publication date: 1-May-2018. Siddiqui F, Koivula R, Kurbasic A, Lindblad U, Nilsson P and Bennet L (2018) Physical Activity in a Randomized Culturally Adapted Lifestyle Intervention, American Journal of Preventive Medicine, 10.1016/j.amepre.2018.04.016, 55:2, (187-196), Online publication date: 1-Aug-2018. Bosak K, Papa V, Brucks M, Savage C, Donnelly J and Martin L (2018) Novel Biomarkers of Physical Activity Maintenance in Midlife Women: Preliminary Investigation, BioResearch Open Access, 10.1089/biores.2018.0010, 7:1, (39-46), Online publication date: 1-May-2018. Stolberg C, Mundbjerg L, Funch-Jensen P, Gram B, Juhl C and Bladbjerg E (2018) Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis, Surgery for Obesity and Related Diseases, 10.1016/j.soard.2018.03.022, 14:7, (918-926), Online publication date: 1-Jul-2018. Mundbjerg L, Stolberg C, Cecere S, Bladbjerg E, Funch-Jensen P, Gram B and Juhl C (2018) Supervised Physical Training Improves Weight Loss After Roux-en-Y Gastric Bypass Surgery: A Randomized Controlled Trial, Obesity, 10.1002/oby.22143, 26:5, (828-837), Online publication date: 1-May-2018. Grace M and Dunstan D (2018) Sedentary Behaviour and Mortality Sedentary Behaviour Epidemiology, 10.1007/978-3-319-61552-3_14, (339-378), . Stolberg C, Mundbjerg L, Funch-Jensen P, Gram B, Bladbjerg E and Juhl C (2018) Effects of gastric bypass surgery followed by supervised physical training on inflammation and endothelial function: A randomized controlled trial, Atherosclerosis, 10.1016/j.atherosclerosis.2018.04.002, 273, (37-44), Online publication date: 1-Jun-2018. Bozzini S and Falcone C (2017) Genetic Factors Associated with Longevity in Humans Senescence - Physiology or Pathology, 10.5772/intechopen.69637 Pappas Y, Všetečková J, Poduval S, Tseng P and Car J (2018) Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature, Acta Medica (Hradec Kralove, Czech Republic), 10.14712/18059694.2018.1, 60:3, (97-107), . Farrell S, Finley C, Barlow C, Willis B, DeFina L, Haskell W and Vega G (2017) Moderate to High Levels of Cardiorespiratory Fitness Attenuate the Effects of Triglyceride to High-Density Lipoprotein Cholesterol Ratio on Coronary Heart Disease Mortality in Men, Mayo Clinic Proceedings, 10.1016/j.mayocp.2017.08.015, 92:12, (1763-1771), Online publication date: 1-Dec-2017. Häusser J and Mojzisch A (2017) The physical activity-mediated Demand–Control (pamDC) model: Linking work characteristics, leisure time physical activity, and well-being, Work & Stress, 10.1080/02678373.2017.1303759, 31:3, (209-232), Online publication date: 3-Jul-2017. Casquero A, Berti J, Teixeira L and de Oliveira H (2017) Chronic Exercise Reduces CETP and Mesterolone Treatment Counteracts Exercise Benefits on Plasma Lipoproteins Profile: Studies in Transgenic Mice, Lipids, 10.1007/s11745-017-4299-1, 52:12, (981-990), Online publication date: 1-Dec-2017. Yang J, Cao R, Gao R, Mi Q, Dai Q and Zhu F (2017) Physical Exercise Is a Potential "Medicine" for Atherosclerosis Exercise for Cardiovascular Disease Prevention and Treatment, 10.1007/978-981-10-4307-9_15, (269-286), . Kamil-Rosenberg S and Garber C (2016) Cardiac conditioning for healthy individuals: primary prevention of heart disease, Current Physical Medicine and Rehabilitation Reports, 10.1007/s40141-016-0130-9, 4:3, (223-232), Online publication date: 1-Sep-2016. Blair H, Sepulveda J and Papachristou D (2016) Nature and nurture in atherosclerosis: The roles of acylcarnitine and cell membrane-fatty acid intermediates, Vascular Pharmacology, 10.1016/j.vph.2015.06.012, 78, (17-23), Online publication date: 1-Mar-2016. Stumpf C, Simon M, Wilhelm M, Zimmermann S, Rost C, Achenbach S and Brem M (2016) Left atrial remodeling, early repolarization pattern, and inflammatory cytokines in professional soccer players, Journal of Cardiology, 10.1016/j.jjcc.2015.08.013, 68:1, (64-70), Online publication date: 1-Jul-2016. Benda N, Hopman M, van Dijk A, Oxborough D, George K, Thijssen D and Eijsvogels T (2016) Impact of prolonged walking exercise on cardiac structure and function in cardiac patients versus healthy controls, European Journal of Preventive Cardiology, 10.1177/2047487316631389, 23:12, (1252-1260), Online publication date: 1-Aug-2016. Cardoso S, Carvalho C, Correia S, Seiça R and Moreira P (2016) Alzheimer's Disease: From Mitochondrial Perturbations to Mitochondrial Medicine, Brain Pathology, 10.1111/bpa.12402, 26:5, (632-647), Online publication date: 1-Sep-2016. Szostak J, Miguet-Alfonsi C, Berthelot A and Laurant P (2015) Training-induced anti-atherosclerotic effects are associated with increased vascular PPARgamma expression in apolipoprotein E-deficient mice, Acta Physiologica, 10.1111/apha.12615, 216:2, (221-230), Online publication date: 1-Feb-2016. Yeh H, Chou Y, Yang N, Cheng C and Huang N (2016) Association Between Physical Therapy and Risk of Coronary Artery Disease and Dyslipidemia Among Osteoarthritis Patients: A Nationwide Database Study, Archives of Physical Medicine and Rehabilitation, 10.1016/j.apmr.2015.08.410, 97:1, (8-16), Online publication date: 1-Jan-2016. GUERREIRO L, ROCHA A, MARTINS C, RIBEIRO J, WALLY C, STRIEDER D, CARISSIMI C, OLIVEIRA M, PEREIRA A, BIONDI H, MONSERRAT J and GONÇALVES C (2016) Oxidative Status of the Myocardium in Response to Different Intensities of Physical Training, Physiological Research, 10.33549/physiolres.933185, (737-749), Online publication date: 30-Oct-2016. Rodrigues A, Ferreira E, Carneiro-Júnior M, Natali A and Bressan J (2016) Effects of exercise on the circulating concentrations of irisin in healthy adult individuals: A review, Science & Sports, 10.1016/j.scispo.2016.07.005, 31:5, (251-260), Online publication date: 1-Oct-2016. Hjorth M, Pourteymour S, Görgens S, Langleite T, Lee S, Holen T, Gulseth H, Birkeland K, Jensen J, Drevon C and Norheim F (2015) Myostatin in relation to physical activity and dysglycaemia and its effect on energy metabolism in human skeletal muscle cells, Acta Physiologica, 10.1111/apha.12631, 217:1, (45-60), Online publication date: 1-May-2016. Fuentes E, Forero-Doria O, Alarcón M and Palomo I (2014) Inhibitory effects of Cyperus digitatus extract on human platelet function in vitro , Platelets, 10.3109/09537104.2014.997689, 26:8, (764-770), Online publication date: 17-Nov-2015. Johnson E, Dieter B and Marsh S (2015) Evidence for distinct effects of exercise in different cardiac hypertrophic disorders, Life Sciences, 10.1016/j.lfs.2015.01.007, 123, (100-106), Online publication date: 1-Feb-2015. Rasiah R, Thangiah G, Yusoff K, Manikam R, Chandrasekaran S, Mustafa R and Bakar N (2015) The impact of physical activity on cumulative cardiovascular disease risk factors among Malaysian adults, BMC Public Health, 10.1186/s12889-015-2577-5, 15:1, Online publication date: 1-Dec-2015. Higgins T, Baker M, Evans S, Adams R and Cobbold C Heterogeneous responses of personalised high intensity interval training on type 2 diabetes mellitus and cardiovascular disease risk in young healthy adults, Clinical Hemorheology and Microcirculation, 10.3233/CH-141857, 59:4, (365-377) Sushames A, Edwards A, Mein J, Sinclair K and Maguire G (2015) Utility of field-based techniques to assess Indigenous Australians' functional fitness and sedentary time, Public Health, 10.1016/j.puhe.2015.07.024, 129:12, (1656-1661), Online publication date: 1-Dec-2015. Imstepf V, Braun C, Ricklin M and Exadaktylos A (2015) Time for a Break: Admissions to an Urban Emergency Department after Working Out—A Retrospective Study from Switzerland, BioMed Research International, 10.1155/2015/610137, 2015, (1-7), . Mathews M, Liebenberg L and Mathews E (2015) The mechanism by which moderate alcohol consumption influences coronary heart disease, Nutrition Journal, 10.1186/s12937-015-0011-6, 14:1, Onli
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