Exercise & Heart Health

Woman exercising on ground
Read Time: 5 Minutes

While sedentary behaviors have been shown to increase cardiovascular and mortality risk,1 movement and exercise have many well-established health benefits, including enhanced mental and emotional well-being, increased physical fitness, and prevention of chronic diseases. As part of a healthy lifestyle, exercise routines and increased movement specifically contribute to improved cardiovascular fitness, reduced systemic inflammation,2,3 and a lower risk of cardiovascular disease (CVD).4 Many different types of physical activities, from simple movement to high intensity, are all beneficial for heart health. Consideration of the range of exercise options helps to personalize treatment strategies that address a patient’s medical needs, align with their personal goals, and meet them where they are to help increase sustainability. Importantly, for lifestyle interventions such as structured exercise interventions to be adopted by patients, clinicians need to ensure that behavior change programs are mapped against a patient’s priorities and values and adapted to their level of readiness and intention to engage with the target behavior.5

Fitness and the Healthy Heart

According to the American Heart Association, moderate and vigorous aerobic activity, muscle strengthening through resistance training, increasing daily movement while decreasing sedentary behavior, and adding intensity to physical activity are among the recommendations for enhancing cardiorespiratory fitness in adults.6 Flexibility and balance training are additional functional medicine exercise strategies, and the benefits of specific exercise routines and activities continue to be studied to determine the impacts of each on prevention and improvement of cardiovascular health. A recent review found that acute stretching, an exercise modality widely used for flexibility improvement, may be an effective adjunct therapy for declines in cardiovascular health.7 Although the mechanisms by which stretching training improves cardiac autonomic function are not yet well understood, increases in baroreflex sensitivity, relaxation, and nitric oxide bioavailability seem to play important roles.7

Aerobic and Resistance Training

Aerobic and resistance training programs may have different routines, but both have shown similar benefits for cardiovascular fitness. Two 2020 randomized controlled trials (RCTs) investigated the heart health impact of aerobic, resistance, and combination training for patients with hypertension and found that all three types of training significantly decreased blood pressure levels.8,9 In addition, after eight weeks of training in aerobic, resistance, or a combination of the two activities, one RCT also found that all routines were similarly effective in improving endothelial function evaluated using flow-mediated dilation.9

Interval and Continuous Training

Two recent meta-analyses compared the effectiveness of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) in patients with hypertension and within cardiac rehabilitation programs.10,11 A 2020 meta-analysis found that both interventions increased the maximal oxygen uptake (VO2max) for hypertensive patients compared to control groups and promoted a reduction in systolic blood pressure, while HIIT decreased diastolic blood pressure to a greater extent.10 Investigators concluded that overall, HIIT may be more beneficial for improvement of cardiorespiratory fitness in hypertensive patients.10 A second meta-analysis of 17 studies (n=953) echoed this conclusion for those patients in cardiac rehabilitation programs.11 HIIT was superior to MICT in improving cardiorespiratory fitness with a reported standardized mean difference (SMD) of 0.34 mL/kg/min in VO2peak measurements; studies with programs lasting seven to twelve weeks resulted in the largest cardiorespiratory improvements for patients with coronary artery disease (SMD of 0.43 mL/kg/min); and HIIT was reported to be as safe as MICT for this population.11

Dancing, Walking, and Running

Dancing, walking, and running are aerobic exercises that benefit heart function by improving cardiovascular fitness.6 For hypertensive patients, research studies have shown dancing’s positive impact through the reduction of systolic and diastolic blood pressure compared to control groups.12 A 2018 RCT compared the effects of 60-minute sessions of dancing (3x/week), walking (3x/week), or stretching (1x/week) for eight weeks on cardiovascular risk for sedentary women over 60 years of age.12 Results indicated:13

  • Those who followed either the dancing or walking routines had similar increases in peak oxygen consumption (VO2peak) and improvements in balance and lower body muscle strength while those in the active control group (stretching) did not.
  • All routines resulted in improved cholesterol, C-reactive protein and TNF-? measurements, flexibility, and daily physical activity levels.

A 2020 systematic review of 17 prospective studies (n>30,000) suggested that adding 1,000 walking steps per day helps to lower the risk of all-cause mortality and CVD morbidity and mortality in adults.14 The review indicated that for each 1,000 daily step count increase at baseline, estimated risk reductions were 6-36% for all-cause mortality and 5-21% for CVD at follow-up. Further, while the number of daily steps needed for optimal health is not clear, studies indicate health benefits are present below 10,000 steps per day.14

A 2020 meta-analysis of 14 prospective cohort studies (n=232,149) suggested that running was associated with lower risks of all-cause (27%), cardiovascular (30%), and cancer (23%) mortality compared with no running.15 Researchers further noted that analysis did not reveal any significant dose-response trends for weekly running frequency, duration, pace, or total volume, with even the smallest doses of running (i.e., ?1 time a week, <50 min a week, and <6 mph) showing significant all-cause mortality benefits.15

Pilates, Tai Chi, and Yoga

Increasing daily movement, even in low-impact ways, is essential for improving heart health. Similar to dancing, Pilates training addresses flexibility, strength, and balance. Specific to cardiovascular fitness, results from two small 2020 RCTs suggested that Pilates is an effective intervention for the improvement of vascular function and blood pressure in hypertensive patients and in populations at risk for hypertension.16,17 A 2020 meta-analysis of RCTs investigated the effects of tai chi exercises on CVD risk factors and quality of life for patients with essential hypertension.18 Results indicated that for this population, tai chi reduced blood pressure, total cholesterol, triglycerides, LDL-C, and blood glucose while improving quality of life.18

Recent meta-analyses also continue to suggest the cardiovascular benefits of practicing yoga. A 2016 meta-analysis of 37 RCTs found that compared to non-exercise controls, improvements of LDL and HDL cholesterols, body mass index, and systolic blood pressure were shown for those who practiced yoga.19 In 2019, a meta-analysis of 49 controlled trials (n=3,517) found that yoga interventions (practiced 4.8+/-3.4 sessions per week; 59.2+/-25 minutes per session; 13.2+/-7.5 weeks) resulted in moderate reductions in systolic and diastolic blood pressure compared with controls.20 In addition, for hypertensive patients that specifically practiced yoga interventions that included breath work or meditation/mental relaxation three times per week, greater blood pressure reductions were noted.20

Circadian Impacts

Research suggests that coordinating exercise timing with a patient’s chronotype may optimize the health benefits of exercise routines.21 Chronotype is based on a person’s underlying clock and refers to their predisposition toward either early or late sleep/wake cycles, or in between those two extremes. Exercise may also be used as a zeitgeber (timing cue) to reset potentially disrupted molecular circadian clocks.21 A 2018 systematic review suggested that exercise promoted chronobiological homeostasis as a time cue supporting optimal health and performance.22 A 2020 randomized clinical study investigated whether timed exercise interventions impacted internal circadian rhythm through phase shifts, defined as the delay/advancement of wake-up times and bedtimes.23 The study focused on sedentary adults and measured dim light melatonin onset before and after either five days of morning (n=26) or evening (n=26) exercise.23 Results indicated that morning exercise induced greater phase advance shifts than evening exercise. In addition, researchers concluded that “late” chronotypes may have circadian benefit from morning or evening exercise while evening exercise may promote circadian misalignment for “early” chronotypes.23

Understanding a patient’s circadian rhythm is just one component that may help clinicians personalize exercise interventions and other lifestyle treatment strategies to address CVD risk factors and chronic cardiovascular diseases. For the latest research on cardiovascular and metabolic health and personalized, effective, and sustainable treatment strategies, learn more from functional medicine experts at IFM’s Cardiometabolic Advanced Practice Module (APM).

Learn More About Cardiometabolic Function

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  2. Thompson G, Davison GW, Crawford J, Hughes CM. Exercise and inflammation in coronary artery disease: a systematic review and meta-analysis of randomised trials. J Sports Sci. 2020;38(7):814-826. doi:10.1080/02640414.2020.1735684
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