Breakthrough findings by Swiss cardiologists have suggested that physical exercise might well improve coronary circulation in coronary artery disease and is certainly well worth investigating as a treatment.

The cardiologists have shown for the first time that a physical endurance exercise programme in a human volunteer increased coronary flow through arteriogenesis— transformation of existing collateral arteriolar pathways into conducting vessels.

A 46 year old male healthy cardiologist with a 25 year history of amateur marathon running, who was put through a long term controlled programme of aerobic endurance training, showed a collateral flow index raised by over 60% at high fitness relative to intermediate fitness. The increased coronary flow could be attributed only to arteriogenesis because he had normal coronary arteries and had never before the tests experienced anginal pain, therefore ruling out exercise induced ischaemia, which stimulates vessel growth by angiogenesis—formation of a new capillary network.

Coronary circulation was assessed non-invasively and invasively at baseline; intermediate fitness; and high fitness, just after completing an alpine ultramarathon of 78.5 km and height profile of 2000 m. Low fitness (baseline) comprised two hours’ training a week continuously; intermediate fitness four hours a week for four months; and high fitness 8–9 hours a week for four months.

In heart disease when the coronary arteries become blocked remodelling in arteriogenesis comes about by high shear forces at the vessel wall. This means that exercise should open up collateral coronary circulation, but that remained to be proved—until now.