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IHD CP – Increased blood flow to the heart

Evidence summary (Updated 2022)
A large body of good quality randomised controlled data shows physical activity will have improve coronary blood flow through better vascular endothelial function(1–8), reduced atherosclerosis(9–11) and better collateral flow(12–14) and perfusion(15,16). Two studies did however reveal acute or strenuous resistance(1) or aerobic exercise training(1,2) to be a potential risk of activating pro-inflammatory pathway of platelet aggregation.

Quality of Evidence
Grade A – moderate quality

Strength of recommendation
Grade 1 – strong recommendation

Physical activity can be recommended to improve the coronary flood flow in most patients with ischaemic heart disease and should be undertaken unless there are compelling reasons NOT to do so.


  1. Chen YW, Apostolakis S, Lip GY. Exercise-induced changes in inflammatory processes: implications for thrombogenesis in cardiovascular disease. Ann Med. 46:439–455.
  2. Adams V, Besler C, Fischer T, Riwanto M, Noack F, Hollriegel R, et al. Exercise training in patients with chronic heart failure promotes restoration of high-density lipoprotein functional properties. Circ Res. 113:1345–1355.
  3. Sixt S, Beer S, Bluher M, Korff N, Peschel T, Sonnabend M, et al. Long- but not short-term multifactorial intervention with focus on exercise training improves coronary endothelial dysfunction in diabetes mellitus type 2 and coronary artery disease. Eur Hear J. 31:112–119.
  4. Erbs S, Hollriegel R, Linke A, Beck EB, Adams V, Gielen S, et al. Exercise training in patients with advanced chronic heart failure (NYHA IIIb) promotes restoration of peripheral vasomotor function, induction of endogenous regeneration, and improvement of left ventricular function. Circ Hear Fail. 3:486–494.
  5. Wai-Keung Wong3, Sidney Tam3, Chu-Pak Lau1 and Hung-Fat Tse. Effects of exercise training upon endothelial function in patients with cardiovascular disease. Eur J Prev Card. 20012;19(4:830–839.
  6. Adams V, Linke A, Krankel N, Erbs S, Gielen S, Mobius-Winkler S, et al. Impact of regular physical activity on the NAD(P)H oxidase and angiotensin receptor system in patients with coronary artery disease. Circulation. 111:555–562.
  7. Henderson KK, Turk JR R, JW L, M.H. Endothelial function in coronary arterioles from pigs with early-stage coronary disease induced by high-fat, high-cholesterol diet: effect of exercise. J Appl Physiol. 97:1159–1168.
  8. Hambrecht R, Wolf A, Gielen S, Linke A, Hofer J, Erbs S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 342:454–460.
  9. M WT, N K, A H. Coronary plaque regression and lifestyle modification in patients treated with pravastatin: assessment mainly by daily aerobic exercise and an increase in the serum level of high- density lipoprotein cholesterol. Circ J. 74:954–961.
  10. Niebauer J, Hambrecht R, Marburger C, Hauer K, Velich T, Hodenberg E, et al. Impact of intensive physical exercise and low-fat diet on collateral vessel formation in stable angina pectoris and angiographically confirmed coronary artery disease. Am J Cardiol. 76:771–775.
  11. Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, et al. Can lifestyle changes reverse coronary heart disease? Lifestyle Hear Trial Lancet. 336:129–133.
  12. Scalone G, Coviello I, Barone L, Pisanello C, Sestito A, Lanza GA, et al. Brief low-workload myocardial ischaemia induces protection against exercise- related increase of platelet reactivity in patients with coronary artery disease. Heart. 96:263–268.
  13. Estorch M, Flotats A, Serra-Grima R, Mari C, Prat T, Martin JC, et al. Influence of exercise rehabilitation on myocardial perfusion and sympathetic heart innervation in ischaemic heart disease. Eur J Nucl Med. 27:333–339.
  14. Hambrecht R, Walther C, Mobius-Winkler S, Gielen S, Linke A, Conradi K, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation. 109(1371):1378.
  15. Mobius-Winkler S, Uhlemann M, Adams V, Sandri M, Erbs S, Lenk K, et al. Coronary collateral growth induced by physical exercise: results of the impact of intensive exercise training on coronary collateral circulation in patients with stable coronary artery disease (EXCITE) trial. Circulation. 133:1438–1448.
  16. Zbinden R, Zbinden S, Meier P, Hutter D, Billinger M, Wahl A, et al. Coronary collateral flow in response to endurance exercise training. Eur J Cardiovasc Prev Rehabil. 14(250):257.