Quindry John C, Michalak Ronald E
School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT, USA.
Sports Med Health Sci. 2025 Mar 28;7(5):366-374. doi: 10.1016/j.smhs.2025.03.009. eCollection 2025 Sep.
Acute myocardial infarction (AMI) remains the leading form of cardiovascular morbidity and mortality, while exercise is a preventative and therapeutic countermeasure. The collective benefits of exercise on the heart are called cardioprotection. Exercise-induced cardioprotection encompasses four broad areas: 1) cardiovascular disease (CVD) risk factor improvement, 2) anatomical remodeling of the heart, 3) improved cardiac physiologic function, and 4) mechanisms of exercise preconditioning.
With respect to the latter area of cardioprotection, research indicates that a few days of moderate intensity aerobic exercise preconditions the heart against cardiac dysrhythmias, ventricular pump dysfunction, and tissue death. The short duration protective timeframe, hours to days after exercise, indicates that the mechanisms are biochemical in nature. Protective mechanisms within exercised hearts include endogenous antioxidant enzymes, better regulation of cytosolic Ca, and more efficient bioenergetics. However, a formative body of work conducted over the last decade indicates that additional exogenous mechanisms may be receptor mediated, presumably providing cardioprotection via circulating factors. Preliminary findings indicate that tissue-to-tissue cross talk involves cardioprotective paracrine factors derived from muscle or autocrine factors originating from the heart itself. This protection is termed exogenous (or remote) cardiac preconditioning, and appears to include δ-opioid receptors, IL-6 receptors, and perhaps other surface receptors on exercised cardiac tissue.
The current review outlines existing knowledge on exercise and factors of cardiac preconditioning, and highlights the avenues for next-step scientific advances to understanding treatments against AMI.
急性心肌梗死（AMI）仍然是心血管疾病发病和死亡的主要形式，而运动是一种预防和治疗对策。运动对心脏的综合益处被称为心脏保护作用。运动诱导的心脏保护作用包括四个广泛领域：1）改善心血管疾病（CVD）危险因素；2）心脏的解剖结构重塑；3）改善心脏生理功能；4）运动预处理机制。
关于心脏保护作用的后一个领域，研究表明，几天的中等强度有氧运动可使心脏对心律失常、心室泵功能障碍和组织死亡产生预处理作用。运动后数小时至数天的短时间保护期表明，其机制本质上是生化性的。运动心脏内的保护机制包括内源性抗氧化酶、对胞质钙的更好调节以及更有效的生物能量学。然而，过去十年进行的一系列开创性研究表明，其他外源性机制可能是受体介导的，大概是通过循环因子提供心脏保护作用。初步研究结果表明，组织间的相互作用涉及源自肌肉的心脏保护旁分泌因子或源自心脏本身的自分泌因子。这种保护被称为外源性（或远程）心脏预处理，似乎包括δ-阿片受体、IL-6受体以及运动心脏组织上的其他表面受体。
本综述概述了关于运动和心脏预处理因素的现有知识，并强调了下一步科学进展的途径，以了解针对AMI的治疗方法。
