Effects of exercise on lipoproteins and hemostatic factors
- Lynne T Braun, PhD, RN, CNP
Lynne T Braun, PhD, RN, CNP
- UpToDate NP Advisory Board Member
- Professor of Nursing
- Rush University College of Nursing
- Robert S Rosenson, MD
Robert S Rosenson, MD
- Section Editor — Lipids
- Professor of Medicine
- Mount Sinai School of Medicine
- Director, Cardiometabolic Disorders
- Mount Sinai Heart
Regular physical activity is important for the primary and secondary prevention of coronary heart disease (CHD).
●In terms of primary prevention, numerous epidemiologic studies have shown that physically active individuals have a lower incidence of CHD compared with sedentary people. Furthermore, cardiorespiratory fitness is associated with a lower incidence of mortality from cardiovascular disease and from all causes. (See "Exercise and fitness in the prevention of cardiovascular disease".)
●In terms of secondary prevention, exercise rehabilitation in people with known CHD reduces cardiovascular and total mortality by 26 and 20 percent, respectively, but it does not significantly reduce nonfatal myocardial infarction . Furthermore, high levels of physical activity (2200 kcal/week) may be associated with regression of existing lesions . (See "Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary heart disease".)
Although the mechanisms by which physical activity protects against CHD are not fully understood, the benefits may be mediated, in part, by the favorable influence of aerobic exercise on plasma lipoproteins and hemostatic factors. This topic will review the influence of aerobic training on lipoproteins as a function of exercise intensity and frequency in both healthy subjects and patients with CHD and describe the evidence for beneficial changes in hemostatic factors.
INFLUENCE OF EXERCISE ON LIPIDS
Early cross-sectional studies comparing middle-aged male runners to sedentary men suggested a beneficial effect of exercise on lipoproteins [3,4]. The runners had significantly lower serum levels of total cholesterol, low density lipoprotein (LDL)-cholesterol, very low density lipoprotein (VLDL)-cholesterol, and triglycerides, and a higher concentration of high density lipoprotein (HDL)-cholesterol.
- Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004; 116:682.
- Hambrecht R, Niebauer J, Marburger C, et al. Various intensities of leisure time physical activity in patients with coronary artery disease: effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions. J Am Coll Cardiol 1993; 22:468.
- Wood PD, Haskell W, Klein H, et al. The distribution of plasma lipoproteins in middle-aged male runners. Metabolism 1976; 25:1249.
- Williams PT, Krauss RM, Wood PD, et al. Lipoprotein subfractions of runners and sedentary men. Metabolism 1986; 35:45.
- Giada F, Vigna GB, Vitale E, et al. Effect of age on the response of blood lipids, body composition, and aerobic power to physical conditioning and deconditioning. Metabolism 1995; 44:161.
- Schwartz RS. Effects of exercise training on high density lipoproteins and apolipoprotein A-I in old and young men. Metabolism 1988; 37:1128.
- Kiens B, Jörgensen I, Lewis S, et al. Increased plasma HDL-cholesterol and apo A-1 in sedentary middle-aged men after physical conditioning. Eur J Clin Invest 1980; 10:203.
- Weintraub MS, Rosen Y, Otto R, et al. Physical exercise conditioning in the absence of weight loss reduces fasting and postprandial triglyceride-rich lipoprotein levels. Circulation 1989; 79:1007.
- Rubinstein A, Burstein R, Lubin F, et al. Lipoprotein profile changes during intense training of Israeli military recruits. Med Sci Sports Exerc 1995; 27:480.
- Thompson PD, Cullinane EM, Sady SP, et al. Modest changes in high-density lipoprotein concentration and metabolism with prolonged exercise training. Circulation 1988; 78:25.
- Després JP, Lamarche B. Low-intensity endurance exercise training, plasma lipoproteins and the risk of coronary heart disease. J Intern Med 1994; 236:7.
- Peltonen P, Marniemi J, Hietanen E, et al. Changes in serum lipids, lipoproteins, and heparin releasable lipolytic enzymes during moderate physical training in man: a longitudinal study. Metabolism 1981; 30:518.
- Motoyama M, Sunami Y, Kinoshita F, et al. The effects of long-term low intensity aerobic training and detraining on serum lipid and lipoprotein concentrations in elderly men and women. Eur J Appl Physiol Occup Physiol 1995; 70:126.
- Williams PT, Stefanick ML, Vranizan KM, Wood PD. The effects of weight loss by exercise or by dieting on plasma high-density lipoprotein (HDL) levels in men with low, intermediate, and normal-to-high HDL at baseline. Metabolism 1994; 43:917.
- Wood PD, Stefanick ML, Williams PT, Haskell WL. The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women. N Engl J Med 1991; 325:461.
- Stefanick ML, Mackey S, Sheehan M, et al. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. N Engl J Med 1998; 339:12.
- King AC, Haskell WL, Young DR, et al. Long-term effects of varying intensities and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged 50 to 65 years. Circulation 1995; 91:2596.
- Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003; 107:3109.
- Kraus WE, Houmard JA, Duscha BD, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med 2002; 347:1483.
- Halverstadt A, Phares DA, Wilund KR, et al. Endurance exercise training raises high-density lipoprotein cholesterol and lowers small low-density lipoprotein and very low-density lipoprotein independent of body fat phenotypes in older men and women. Metabolism 2007; 56:444.
- Wood PD, Haskell WL, Blair SN, et al. Increased exercise level and plasma lipoprotein concentrations: a one-year, randomized, controlled study in sedentary, middle-aged men. Metabolism 1983; 32:31.
- Kokkinos PF, Holland JC, Narayan P, et al. Miles run per week and high-density lipoprotein cholesterol levels in healthy, middle-aged men. A dose-response relationship. Arch Intern Med 1995; 155:415.
- Sunami Y, Motoyama M, Kinoshita F, et al. Effects of low-intensity aerobic training on the high-density lipoprotein cholesterol concentration in healthy elderly subjects. Metabolism 1999; 48:984.
- Williams PT. Relationship of distance run per week to coronary heart disease risk factors in 8283 male runners. The National Runners' Health Study. Arch Intern Med 1997; 157:191.
- Williams PT. High-density lipoprotein cholesterol and other risk factors for coronary heart disease in female runners. N Engl J Med 1996; 334:1298.
- Kelley GA, Kelley KS. Aerobic exercise and HDL2-C: a meta-analysis of randomized controlled trials. Atherosclerosis 2006; 184:207.
- Couillard C, Després JP, Lamarche B, et al. Effects of endurance exercise training on plasma HDL cholesterol levels depend on levels of triglycerides: evidence from men of the Health, Risk Factors, Exercise Training and Genetics (HERITAGE) Family Study. Arterioscler Thromb Vasc Biol 2001; 21:1226.
- Racil G, Ben Ounis O, Hammouda O, et al. Effects of high vs. moderate exercise intensity during interval training on lipids and adiponectin levels in obese young females. Eur J Appl Physiol 2013; 113:2531.
- Casella-Filho A, Chagas AC, Maranhão RC, et al. Effect of exercise training on plasma levels and functional properties of high-density lipoprotein cholesterol in the metabolic syndrome. Am J Cardiol 2011; 107:1168.
- Rosenson RS, Brewer HB Jr, Ansell B, et al. Translation of high-density lipoprotein function into clinical practice: current prospects and future challenges. Circulation 2013; 128:1256.
- Roberts CK, Ng C, Hama S, et al. Effect of a short-term diet and exercise intervention on inflammatory/anti-inflammatory properties of HDL in overweight/obese men with cardiovascular risk factors. J Appl Physiol (1985) 2006; 101:1727.
- Mendoza SG, Carrasco H, Zerpa A, et al. Effect of physical training on lipids, lipoproteins, apolipoproteins, lipases, and endogenous sex hormones in men with premature myocardial infarction. Metabolism 1991; 40:368.
- Tran ZV, Brammell HL. Effects of exercise training on serum lipid and lipoprotein levels in post-MI patients: A meta-analysis. J Cardpulm Rehabil 1989; 9:250.
- Cowan GO. Influence of exercise on high-density lipoproteins. Am J Cardiol 1983; 52:13B.
- Heath GW, Ehsani AA, Hagberg JM, et al. Exercise training improves lipoprotein lipid profiles in patients with coronary artery disease. Am Heart J 1983; 105:889.
- Warner JG Jr, Brubaker PH, Zhu Y, et al. Long-term (5-year) changes in HDL cholesterol in cardiac rehabilitation patients. Do sex differences exist? Circulation 1995; 92:773.
- Savage PD, Brochu M, Ades PA. Gender alters the high-density lipoprotein cholesterol response to cardiac rehabilitation. J Cardiopulm Rehabil 2004; 24:248.
- Kelley GA, Kelley KS, Franklin B. Aerobic exercise and lipids and lipoproteins in patients with cardiovascular disease: a meta-analysis of randomized controlled trials. J Cardiopulm Rehabil 2006; 26:131.
- Seip RL, Moulin P, Cocke T, et al. Exercise training decreases plasma cholesteryl ester transfer protein. Arterioscler Thromb 1993; 13:1359.
- Marniemi J, Dahlström S, Kvist M, et al. Dependence of serum lipid and lecithin: cholesterol acyltransferase levels on physical training in young men. Eur J Appl Physiol Occup Physiol 1982; 49:25.
- Houmard JA, Bruno NJ, Bruner RK, et al. Effects of exercise training on the chemical composition of plasma LDL. Arterioscler Thromb 1994; 14:325.
- Williams PT, Krauss RM, Vranizan KM, Wood PD. Changes in lipoprotein subfractions during diet-induced and exercise-induced weight loss in moderately overweight men. Circulation 1990; 81:1293.
- Thompson PD, Tsongalis GJ, Seip RL, et al. Apolipoprotein E genotype and changes in serum lipids and maximal oxygen uptake with exercise training. Metabolism 2004; 53:193.
- Seip RL, Otvos J, Bilbie C, et al. The effect of apolipoprotein E genotype on serum lipoprotein particle response to exercise. Atherosclerosis 2006; 188:126.
- Ruaño G, Seip RL, Windemuth A, et al. Apolipoprotein A1 genotype affects the change in high density lipoprotein cholesterol subfractions with exercise training. Atherosclerosis 2006; 185:65.
- Wang JS, Jen CJ, Chen HI. Effects of exercise training and deconditioning on platelet function in men. Arterioscler Thromb Vasc Biol 1995; 15:1668.
- Stevenson ET, Davy KP, Seals DR. Hemostatic, metabolic, and androgenic risk factors for coronary heart disease in physically active and less active postmenopausal women. Arterioscler Thromb Vasc Biol 1995; 15:669.
- Koenig W, Sund M, Döring A, Ernst E. Leisure-time physical activity but not work-related physical activity is associated with decreased plasma viscosity. Results from a large population sample. Circulation 1997; 95:335.
- Levine GN, O'Malley C, Balady GJ. Exercise training and blood viscosity in patients with ischemic heart disease. Am J Cardiol 1995; 76:80.
- Killewich LA, Macko RF, Montgomery PS, et al. Exercise training enhances endogenous fibrinolysis in peripheral arterial disease. J Vasc Surg 2004; 40:741.