Exercise perspective on common cardiac medications

Abstract

Medicinal tablets have been used for a long time to treat cardiovascular disease. However, mortality rate is steadily increasing partly because of the patients' sedentary lifestyle and unhealthy diet. By contrast, exercise has been systematically shown to have multiple benefits. Regular exercise training can prevent various diseases in healthy individuals. Combined exercise and cardiac medications may lead to the improvement of heart disease. Numerous exercise training pathways still need further investigations. How exercise can prevent, treat, or attenuate diseases remains somewhat elusive. Thus, this review will discuss cardiac medications in parallel with the mechanism of action of exercise.

Keywords: cardiac medication; exercise; heart disease.

Fig. 1

Overview of the systemic and cardiac-specific effects of exercise. Endurance exercise has multiple systemic effects, ranging from increased skeletal muscle growth to vascular remodeling and improved energetics. Exercise also exerts direct effects on the heart itself, including increased cardiac growth, protection against ischemic damage, and modulation of cardiac function, metabolism, and vascular supply. AMPK, AMP-activated kinase; C/EBP β, CCAAT/enhancer binding protein β; CITED4, cbp/p300-interacting trans-activator with Glu/Asprich carboxy-terminal domain 4; eNOS, endothelial nitric oxide synthase; IGF-1, insulin-like growth factor-1; MSTN, myostatin; Nrg1, neuregulin1; PGC-1α, peroxisome proliferator activated receptor gamma co-activator 1 α; PI3K, phosphoinositide kinase-3; Pim1, proto-oncogene serine/threonine-protein kinase-1; PLB, phospholamban; SERCA2a, sarco/endoplasmic reticulum Ca²⁺-ATPase, 2a; and VEGF, vascular endothelial growth factor. Reprinted with permission form Mann et al.

Fig. 2

Exercise effect on cardiac medication. Epi, epinephrine; NE, norephinephrine; DM, diabetes mellitus; AngII, angiotensin 2; ATr1, angiotensin receptor 1; ATr2, angiotensin receptor 2; ACE, angiotensin converting enzyme; MI, myocardial infarction; HDL, high density lipoprotein; NCX, Na⁺/Ca⁺ exchanger; RyR2, ryanodine recepter2; HF, heart failure; SERCA2a, cardiac sarcoplasmic reticulum calcium-ATPase.