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Effects of aerobic exercise on coronary atherosclerosis: an in vivo intracoronary ultrasonography study

Comment from the author Erik Madssen, on behalf of the EACPR Exercise, Basic and Translational Research Section

1] Coronary atheroma regression and plaque characteristics assessed by grayscale and radiofrequency intravascular ultrasound after aerobic exercise.
E. Madssen, T. Moholdt,V. Videm, U. Wisløff, K. Hegbom, R. Wiseth
Am J Cardiol. 2014  doi: 10.1016/j.amjcard.2014.08.012.

2] Predictors of Beneficial Coronary Plaque Changes Following Aerobic Exercise.
E. Madssen, T. Moholdt,V. Videm, U. Wisløff, K. Hegbom, R. Wiseth
Med Sci Sports Exerc. 2015 Nov;47(11):2251-6
doi: 10.1249/MSS.0000000000000672.


Exercise training can improve vascular function and reduce overall cardiovascular risk factors. However, whether exercise training actually affects coronary atherosclerosis has not been studied so far. At the K.G. Jebsen Center of Exercise in Medicine at the Norwegian University of Science and Technology and Department of Cardiology, Trondheim University Hospital, we have therefore performed a randomized trial to investigate whether 12 weeks of aerobic exercise combined with optimal medical treatment would have an effect on coronary artery plaque volume and composition. All patients had established coronary artery disease and were treated with coronary stent implantation. The study endpoints were assessed by grayscale and radiofrequency intracoronary ultrasound. Patients were randomized to either aerobic interval training or moderate continuous training.

The main finding of the study was the demonstration of a 10 percent plaque burden reduction and a 3 percent reduction in necrotic core, the latter being a marker of plaque instability. There was no difference between patients exercising with high or moderate intensity [1]. Based on these findings, we believe that aerobic exercise attenuates progression of coronary atherosclerosis and maybe even induces beneficial effects with respect to the composition of coronary plaques.

In a post-hoc analysis of the data from the randomized trial, we aimed to identify clinical factors that were associated with beneficial changes in coronary plaques after exercise. Somewhat surprisingly, patients with stable coronary artery disease experienced larger reductions in necrotic core than patients who had suffered from an acute coronary syndrome [2]. An increased pro-inflammatory load may therefore render patients with non-ST elevation myocardial infarction more resistant to exercise-induced plaque stabilization than patients with stable coronary artery disease.


The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology