How can exercise reduce cardiovascular disease risk? A primer for the clinician

Despite advances in drug development and medical treatments, cardiovascular diseases (CVDs) remain a leading cause of mortality across the globe. Fortunately, CVD can be delayed by engaging in appropriate lifestyle behaviors. An abundance of epidemiological evidence supports a direct association between increased levels of physical activity or cardiovascular fitness and reduced premature CVD morbidity and mortality. These data have been used as the basis for many medical organizations to issue physical activity guidelines to citizens to improve physical activity participation and, ultimately, reduce the risk of CVDs and other chronic diseases. Despite these efforts, physical activity participation around the globe remains low. The medical professional is well suited to promote exercise as a preventative treatment for CVD, although promotion efforts may be less effective without a clear understanding of the mechanisms through which exercise confers cardioprotection. Thus, the purpose of this review is to highlight the cardioprotective effects of exercise training and to explore the underlying mechanistic pathways that might explain these benefits. The review will focus on those physiological pathways that are directly involved in atherosclerotic disease development. They include hypercholesterolemia, hypertension, chronic inflammation, and insulin resistance.