Exercise and Angiogenesis

Guest Post by Dr. Kahoano

Today we will begin a three part series regarding a topic that comes up frequently in the clinic,

Exercise!  More specifically, the healthy changes that exercise brings to our bodies and minds, and how these changes serve to protect and improve our function

The heart’s response to sustained exertion is to increase the flow of blood through the body, to better deliver oxygen to working muscles and to get rid of by-products of its work like carbon dioxide. To achieve this the heart must beat more frequently and squeeze harder. When done over a sustained period of time and with regularity, the whole body to include the mind will be driven to change and adapt

There are three major physiologic changes that happen with regular exercise

-The overall number of pipes/vessels carrying blood throughout the body will increase

-All involved muscles (to include the heart), supporting bones, nerves and brain pathways will change and adapt to perform the practiced exercises more efficiently

-And the body’s hormonal (cell messengers) and waste processing systems will be recruited to keep the body and mind at their best

When we increase the number of blood vessels we not only make the movement of blood through the body more efficient, we at the same time decrease peripheral resistance and lower blood pressures. There is certainly good (level two) evidence validating this.

In a study (Reference – Pas-a-Pas trial (BMC Public Health 2017 Jun 15;17(1):576 full-text) of 419 older adults of Spanish ancestry with a mean age 65 years (33% male 77% female) and unknown cardiac hx, participants were randomly assigned to a community-based supervised physical activity program vs. a control group who received standard of care and continued their usual lifestyle

At 9 months, Systolic Blood Pressures were observed to decrease on average by 4 points for those enrolled in the physical activity program group compared to the non-activity program group

Regular cardiovascular exercise will also increase the number of healthy blood vessels around the heart and the brain. From the same trial above, two year f/u, showed decreased instances of both acute myocardial infarction and cerebrovascular accidents. 2.5% vs. 10.5% (p < 0.05, NNT 13). This means that a person was 4.2 times more likely to have a heart attack or a stroke if they were not a part of the physical activity group

Good (level 2) evidence for the protective effect of regular exercise can also be found in a large prospective study (Reference – JAMA 2002 Oct 23;288(16):1994, commentary can be found in JAMA 2003 Jan 22/29;289(4):419 ) where 44,452 United States male health professionals were followed over a period of 32 years to examine how specific exercise regimens (Running 1 hour /week vs. Weight lifting > 30 minutes/ week vs. Rowing >1 hour /week) might decrease one’s risk for developing myocardial infarction and coronary death compared to no exercise at all

-Running for 1 hour / week, reduced one’s risk by 58% when compared to non exercising controls

-Weight lifting > 30 minutes/ week, reduced it by 77%

-And Rowing >1 hour /week, by 82%

So sustained, regular heart pumping exercise WILL… help to increase the number of healthy blood vessels you have throughout your body… it will lower your blood pressure and will directly protect you from heart attack and stroke.

Please remember that the best exercise is tailored to the individual to ensure positive returns, and prevent injury, so if you need some help getting started we are here to help

And that is your House of Health, Health tip of the week…

I am Dr. Kahoano

A word on levels of evidence…

 Level 1 (likely reliable) Evidence

-Representing research results addressing clinical outcomes and meeting an extensive set of quality criteria which minimizes bias. There are two types of conclusions which can earn a Level 1 label: levels of evidence for conclusions derived from individual studies and levels of evidence for conclusions regarding a body of evidence.

Level 2 (mid-level) Evidence

-Representing research results addressing clinical outcomes, and using some method of scientific investigation, but not meeting the quality criteria to achieve highest level 1 evidence labeling.

Level 3 (lacking direct) Evidence

-Representing reports that are not based on scientific analysis of clinical outcomes. Examples include case series, case reports, expert opinion, and conclusions extrapolated indirectly from scientific studies.