Hippokratia 2003, 7(1):3-11
G.H Antonakoudis, H.G Antonakoudis
Asklipiion Hospital Vulas, Athens, Greece
Sedentary life is a very important coronary risk factor while there is no doubt that dislipoproteinemia consists the most important factor. Physical activity and exercise training not only improves physical performance but also improves endothelial function and modiles almost all coronary risk factors. Especially it improves all three components of atherogenic lipid profile as LDL (especially the most atherogenic LDL 6 subfraction) decreases, triglyceride decreases and HDL increases, especially the most atherogenic subfraction HDL 2 . The mechanisms leading to these exercise induced lipid changes have been proved and well documented by muscle biopsies and their description is the main target of this article.Working muscle plays a central role on the control of lipid metabolism.Increased physical activity induces a number of positive changes on lipid metabo-lism. The exercise induced increased activity of lecithino -cholestero – acyltransfase and lipoproteine lipase and decreased activity of hepatic lipase lead to LDL reduction,tryglicerides ’reduction and HDL increase.All these enzymatic changes have been documented by muscle biopsies. Exercise induced lipid changes are much more prominent in the era of primary prevention and especially in, so called, primordial prevention which means the prevention of risk factor development.In the era of secondary prevention, where the target of lipid levels are much more lower, the contribution of exercise is also signilcant but aggressive drug therapy must be suggested in parallel to exercise and diet. Recently significant importance is given to direct antiatheromatic ef fect of exercise,as significant benelcial ef fect on endothelial function has been proved, both in animal and human studies. According to recent guidelines on Cardiac Rehabilitation multifactorial intervention (exercise, diet, education, counseling with or without lipid lowering drug therapy) result in asignificant improvement in blood lipid levels and are strongly recommended as components of cardiac rehabilitation. On the other hand, cardiac rehabilitation exercise training is not recommended as a sole intervention for lipid modification. Optimal lipid management requires specifically directed dietary and a medically indicated pharmacological management in addition to exercise training.