Exercise as Medicine: New Approaches to Understanding Why It Works in Heart Failure

ROWE: Hi. My name is Glenn Rowe, I’m from the University of Alabama at Birmingham. LIBONATI: And I’m Joe Libonati. I’m from the University of Pennsylvania, and we just moderated a session called
Exercise and Heart Disease where we had some excellent talks about the benefits of exercise on
the cardiovascular system. ROWE: And one of the things that it really brings to mind is that exercise actually is medicine, and this is with regards to things when we speak about dosing of exercise and being able to
prescribe exercise as a way to treat patients with different
types of illnesses including that of the
cardiovascular system. LIBONATI: And so we heard some very interesting presentations about looking for
specific pathways that improved the heart’s function and how blood vessels might improve with
exercise, both of which do, and trying to find molecular targets
that might be “exercise-mimetics” quote/unquote, that might be useful tools in developing
drugs to help people get an exercise affect in those
folks that can’t actually exercise. ROWE: So it brings to mind the idea of overall exercise intolerance and intolerance, an inability for one to
respond to exercise, and these topics that we heard today range from genetic molecules in the form of microRNAs which may be able to act as exercise mimetics as well as
metabolites, which too, may also be able to act in the form of exercise mimetics. LIBONATI: One of the things that
struck me, Glen, was that the presentations really span
from, you know, cell culture, really a
reductionist approach, all the way out to translational medicine, those observations in humans. ROWE: So that really brings to mind the whole idea of bench to bedside where we can do the experiments in the actual laboratory and
be able to take it all in vivo and even think about the idea of
even preclinical approaches in order to try to get to these questions of exercise
mimetics to really narrow down and deal with the population of people who are not going to exercise or who are unable
to exercise. I think that’s definitely where, you know,
the emphasis needs to go going forward. We think about these
approaches on a molecular level. LIBONATI: And I also thought the presentations did a very fine job in looking at different doses of
exercise in different modalities of exercise. That it’s not so simple to just cluster all
forms of exercise into one pot. That we have to think about each
form of exercise–whether it be cycling or rowing or swimming or running– all takes on it’s own phenotype, and we need to be
appreciative of that in the adaptations that occur with each of those exercise stresses to search for the mechanisms that are
associated with the the putative protection. ROWE: And while not even directly being addressed but the other thing is the high limit of it.
You know is there such a thing as too much exercise and what stress that will have and play on
the heart and the cardiovascular system if you do too much of and the wrong kind of exercise, so that, you know, too much of a good thing could be bad at
some point. LIBONATI: Yeah. I also found it really
interesting that the study of the benefits and the
cardiovascular system associated with exercise really do
stem back quite a number of years, over 100 years, and as the technology picks up and we’re getting more and more mechanistic in to try and understand the putative benefits I’m quite sure, and I’m sure you’ll agree,
that it’s going to be a growing number of
different targets and not just one. It’s very difficult to be reductionist in studying the benefits of
exercise because there are so many things going on simultaneously. ROWE: I mean, we’re definitely in the molecular era of exercise physiology. I think the idea that exercise is good and exercise has great
benefits has been known, as you pointed out, for decades at this point, even longer
actually, but I think now we’re figuring out what
the targets are, what are the molecules, what are the things that we could potentially target and use, you know, the exercise-in-a-pill type approach. LIBONATI: So, this session really re-emphasized the
importance of being physically active and exercise.
Everyone should really incorporate some sort of physical activity into
their life. It has pretty much an outstanding effect on overall
health both for patients with cardiovascular
disease as well as for those are just trying to prevent
the development of cardiovascular disease, and I think understanding the molecular
basis for that is really going to have widespread revelation in unlocking therapeutic approaches of the future. ROWE: I would agree, and I think that overall, you know, exercise, as I said
at the beginning, is definitely the best medicine.

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