| Summary: |
The benefits of exercise training in modifiable risk factors, cardiorespiratory fitness, and exercise tolerance of coronary artery disease (CAD) patients are well known. However, regarding the effectiveness of exercise training in the mitigation of the endothelial dysfunction and vascular inflammation the strength of the evidence seems to be weak, as the majority of studies are nonrandomized, uncontrolled, merely observational, and without strict inclusion criteria [1]. Indeed, only three [2-4] randomized controlled studies (RCTs) have been conducted so far investigating the effects of exercise training on biomarkers of inflammation in CAD patients. However, even in these studies several methodological limitations could be pointed out, including the timing of the baseline assessment post acute event and the use of just one biomarker of inflammation, which might not provide the big picture of the inflammatory reaction underlying CAD [2, 3]. These limitations could explain the conflicting results raised by them.
Additionally, they did not control modifications in diet, physical activity, and body fat, hence not accounting their contribution to the alterations in endothelial dysfunction and inflammation and, consequently, not observing the independent effect of exercise in
the atherosclerotic process attenuation. Moreover, the above-mentioned studies did not assess any marker of endothelial function, which is paramount to the initiation and progression of atherosclerosis [4]. Furthermore, since endothelial dysfunction and
inflammation seem to be related to impaired autonomic function and increased artery stiffness [5], exercise training by mitigating the underlying processes of CAD should have a favorable impact on them. Nevertheless, to our best knowledge there is not a
single RCT assessing the impact of exercise training in a group of variables representing endothelial function, inflammation, arterial stiffness and autonomic function, and contributing to expla  |
Summary
The benefits of exercise training in modifiable risk factors, cardiorespiratory fitness, and exercise tolerance of coronary artery disease (CAD) patients are well known. However, regarding the effectiveness of exercise training in the mitigation of the endothelial dysfunction and vascular inflammation the strength of the evidence seems to be weak, as the majority of studies are nonrandomized, uncontrolled, merely observational, and without strict inclusion criteria [1]. Indeed, only three [2-4] randomized controlled studies (RCTs) have been conducted so far investigating the effects of exercise training on biomarkers of inflammation in CAD patients. However, even in these studies several methodological limitations could be pointed out, including the timing of the baseline assessment post acute event and the use of just one biomarker of inflammation, which might not provide the big picture of the inflammatory reaction underlying CAD [2, 3]. These limitations could explain the conflicting results raised by them.
Additionally, they did not control modifications in diet, physical activity, and body fat, hence not accounting their contribution to the alterations in endothelial dysfunction and inflammation and, consequently, not observing the independent effect of exercise in
the atherosclerotic process attenuation. Moreover, the above-mentioned studies did not assess any marker of endothelial function, which is paramount to the initiation and progression of atherosclerosis [4]. Furthermore, since endothelial dysfunction and
inflammation seem to be related to impaired autonomic function and increased artery stiffness [5], exercise training by mitigating the underlying processes of CAD should have a favorable impact on them. Nevertheless, to our best knowledge there is not a
single RCT assessing the impact of exercise training in a group of variables representing endothelial function, inflammation, arterial stiffness and autonomic function, and contributing to explain the relationship between them and, hence, enlightening the
mechanisms underlying the clinical benefits of exercise training. Therefore, the main purposes of this project are to analyze, in a RCT, in CAD patients the effects of an exercise-training program (i) on biomarkers of endothelial function, (ii) on biomarkers of
inflammation, (iii) on autonomic function, and (iv) on arterial stiffness. Additionally, we aim to analyze the (v) contribution of age and the changes in traditional risk factors to the modification of the endothelial dysfunction and inflammation, and (vi) the
contribution of the changes in inflammatory and endothelial function biomarkers to the modification of autonomic function and arterial stiffness. To accomplish these goals 64 consecutive patients after first myocardial infarction will be recruited and randomly
divided into exercise training and control groups. The patients in the exercise-training group will participate in an 8-week outpatient program. The control group will receive usual medical care. At baseline and after completion of the program both
groups will undergo the following evaluations: anthropometrics, lipid profile and metabolic parameters, resting haemodynamics, daily physical activity, dietary intake, left ventricular function (left ventricular ejection fraction at rest and circulating levels of Nterminal
pro-B-natriuretic peptide), cardiorespiratory fitness and haemodynamics at peak exercise, arterial stiffness, autonomic function (heart rate variability and circulating levels of norepinephrine, epinephrine, and angiotensin II), biomarker |