Active Voice: Lifelong Exercise Yields Health Benefits After Myocardial Infarction

By Martijn F.H. Maessen, M.Sc., Dick H.J. Thijssen, Ph.D., and Maria T.E. Hopman, Ph.D., FASCM

Martijn F.H. Maessen, M.Sc. Dick H.J. Thijssen, Ph.D. Maria T.E. Hopman, Ph.D., FASCM
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Martijn F. Maessen, M.Sc., is a Ph.D. student at the Department of Physiology at the Radboudumc, Nijmegen, the Netherlands. He has focused his doctoral research on the impact of lifelong exercise training on cardiovascular health by conducting a mixture of epidemiological and physiological studies.

Dick H.J. Thijssen, Ph.D., is professor in cardiovascular physiology at the Liverpool John Moores University and Radboud University Medical Center. His research explores the impact of exercise training and physical (in)activity in the prevention of cardiovascular disease. Specifically, he focuses on understanding hemodynamic stimuli (e.g., shear stress) to mediate vascular adaptation in response to training and to identify factors moderating these effects (e.g., older age).

Maria. T.E. Hopman, Ph.D., FASCM, is professor of integrative physiology at the Department of Physiology, Radboudumc, Nijmegen and at Wageningen University, The Netherlands. The overall goal of her research is to improve health and to understand the concept of vitality of individuals as they age from conception to death by unraveling the mechanisms that explain the relationship between inactivity and the development of chronic diseases, as well as exercise, food and health.

This commentary presents the authors’ views on the topic of the research article that they and their colleagues had published in the January 2017 issue of
Medicine & Science in Sports & Exercise® (MSSE).

The health benefits of regular physical activity on the cardiovascular system are irrefutable. Hippocrates (460–370 B.C.E.) observed that a physically active lifestyle is an important factor to promote health. In the modern age, some of the first scientific evidence that physical activity lowers the risk for cardiovascular diseases originated from the ”London Transport Workers” study by Morris and colleagues (1950s). Since then, many studies have followed, with further and more refined approaches to assess the effects of physical activity on indicators of cardiovascular health. The cardio-protective effects of exercise training are only partly explained as a function of improvements in cardiovascular disease risk factors, such as decreases in blood pressure and body mass index associated with exercise training.

To support this notion and, even though athletes have a lower status on cardiovascular risk factors compared to sedentary peers, they are not exempted from development of ischemic coronary artery disease. Athletes who suffer from myocardial infarctions (MI) may question whether their physically active lifestyles were useless in terms of health. An often-heard question from these athletes is “I have been physically active all my life — why hasn’t it paid off?” In our study, as reported in the January 2017 MSSE, we tried to answer this question by examining vascular structure and function in veteran athletes, with and without a history of MI, in comparison to their sedentary peers. Eighteen asymptomatic veteran athletes, 18 sedentary controls, 20 post-MI veteran athletes and 19 post-MI sedentary controls underwent a comprehensive vascular ultrasound assessment. Veteran athletes were those who reported regular participation in moderate-vigorous exercise during the past 20 years. We measured peripheral vascular function (vascular stiffness and flow-mediated dilation) and vascular structure (intima-media thickness). Participants also performed an incremental exercise test, had lipid profiles assessed through fasting blood samples, and had cardiovascular disease risk status determined by calculating a lifetime risk score.

First, we found that some markers of vascular function (arterial stiffness) and structure (femoral intima-media thickness) were significantly better in veteran athletes compared to their sedentary peers. As expected, the veteran athletes also had better cardiorespiratory fitness and lower scores on the cardiovascular risk profile, compared to their sedentary peers. Unexpectedly, we found no differences in vascular function and structure between post-MI veteran athletes and post-MI sedentary controls. We speculate that these observations may be a consequence of prescriptive medication regimens affecting cardiovascular risk factors, which did not differ between post-MI groups. Nonetheless, post-MI veteran athletes had better cardiorespiratory fitness and cardiovascular risk profiles than their sedentary MI counterparts. Of special note is the fact that the post-MI veteran athletes reported no secondary cardiovascular events, which contrasts the occurrence of eight events in the post-MI sedentary control group.

Although not consistent for all vascular measures, some measures show better vascular function and structure in post-MI veteran athletes. Moreover, benefits of lifelong exercise training in post-MI veteran athletes, demonstrated by the fewer secondary events in post-MI veteran athletes, may also relate to a better cardiovascular fitness and lower cardiovascular risk status. Even though exercise cannot fully protect physically active humans against myocardial events, lifelong exercise before and after MI is associated with a lower risk and fewer cardiovascular events compared to their non-active peers. Importantly, these benefits are unlikely to be fully explained through changes in traditional cardiovascular risk factors only.