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Association of Exercise Preconditioning With Immediate CardioprotectionA Review

Educational Objective
To describe the physiology of exercise-induced ischemic preconditioning and cardioprotection.
1 Credit CME

Importance  Exercise reduces the risk of cardiovascular events, including through an underrecognized, clinically useful form of acute cardioprotection accessible after a single episode of exercise, which is called cardiovascular preconditioning.

Observations  Preclinical evidence shows that 1 to 3 episodes of exercise per week will provide strong cardioprotection; gradual, modest cardiovascular risk factor modification or physiological artery remodeling cannot fully explain these benefits. This review highlights preclinical evidence that acute exercise-induced cardiac preconditioning has the ability to activate multiple pathways to confer immediate protection against ischemic events, reduce the severity of potentially lethal ischemic myocardiac injury, and act as a physiological first line of defense.

Conclusions and Relevance  Independent of the protective benefits of long-term exercise training on risk factors and adaptation of the cardiovascular system, cardiovascular preconditioning may contribute to the immediate cardioprotection of exercise. In practical terms, this means that 1 episode of exercise can create clinically relevant cardioprotection.

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Article Information

Corresponding Author: Dick H. J. Thijssen, PhD, Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, the Netherlands (

Accepted for Publication: October 8, 2017.

Published Online: November 29, 2017. doi:10.1001/jamacardio.2017.4495

Author Contributions: Dr Thijssen had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Thijssen, Redington, Hopman, Jones.

Acquisition, analysis, or interpretation of data: Redington, George, Jones.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Thijssen, Hopman, Jones.

Administrative, technical, or material support: Thijssen, Redington, George, Jones.

Study supervision: Thijssen, Redington, Hopman.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

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