© Springer Nature Singapore Pte Ltd. 2017 155
J. Xiao (ed.), Exercise for Cardiovascular Disease Prevention and Treatment,
Advances in Experimental Medicine and Biology 999,
DOI 10.1007/978-981-10-4307-9_10
Chapter 10
Cardiac Ischemia/Reperfusion Injury:
The Beneficial Effects of Exercise
Juliana Pereira Borges and Karine da Silva Verdoorn
Abstract Cardiac ischemia reperfusion injury (IRI) occurs when the myocardium is
revascularized after an episode of limited or absent blood supply. Many changes,
including free radical production, calcium overload, protease activation, altered mem-
brane lipids and leukocyte activation, contribute to IRI-induced myocardium damage.
Aerobic exercise is the only countermeasure against IRI that can be sustained on a
regular basis in clinical practice. Interestingly, both short-term (3–5 days) and long-
term (several weeks) exercise increase myocardial tolerance, reduce infarct size area
and arrhythmias induced by IRI. Exercise protects the heart against IRI in a biphasic
manner. The early phase of cardioprotection occurs between 30 min and 3 h following
an acute exercise bout, whilst the late phase is achieved within 24 h after the exercise
bout and persists for several days. As for the exercise intensity, although controversial
data exists, it is feasible that the amount of cardioprotection is proportional to exercise
intensity and only achieved above a critical threshold. It is known that aerobic exercise
produces a cardioprotective phenotype, however the mechanisms responsible for this
phenomenon remain unclear. Apparently, aerobic exercise-induced preconditioning is
dependent on several factors that work together to protect the heart. Altered nitric
oxide (NO) signaling, increased levels of heat shock proteins (HSPs), enhanced func-
tion of ATP-sensitive potassium channels, increased activation of opioids system, and
enhanced antioxidant capacity may contribute to exercise-induced cardioprotection.
Much has been discovered from animal models involving exercise-induced cardiopro-
tection against cardiac IRI, however translating these findings to clinical practice still
represents the major challenge in this field.
Keywords Heart • Ischemia/Reperfusion injury • Signaling • Myocardial
Electronic Supplementary Material The online version of this chapter (doi:10.1007/978-981-
10-4307-9_10) contains supplementary material, which is available to authorized users.
J.P. Borges (*)
Institute of Physical Education and Sports, State University of Rio de Janeiro,
Rio de Janeiro, RJ, Brazil
e-mail: [email protected]
K. da Silva Verdoorn
Federal University of Rio de Janeiro, Macaé, RJ, Brazil