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The Role of Exercise Preconditioning in Cardioprotection against Ischemia- Reperfusion Injury

Cardiovascular diseases are still the main cause of mortality around the world. Therefore, it is essential to develop 
practical means to reduce their burden. A wealth of evidence supports the role of physical exercise in attenuating many 
of the risk factors of cardiovascular diseases. Moreover, endurance training warrants protection against myocardial 
infarction. Exercise, even if performed only in a few days, can protect the heart against ischemia-reperfusion (IR) 
injury, and this protection will be even more in longer exercises. It is yet to be clarified how exercise maneuvers 
provide protection against IR. However, it is suggested that some molecular and cellular mechanisms in addition to 
metabolic and hormonal alterations are seemingly involved in exercise-induced cardioprotection (EICP), such as 
increased capacity of antioxidant system, higher expression of heat shock proteins, improvement in ATP-sensitive 
potassium channels, change in nitric oxide production, and adaptive cardiac mitochondrial modulations. This paper 
discusses the current data on molecular and cellular mechanisms of EICP. Understanding the molecular basis of EICP 
against IR injury will provide us with the required knowledge for development of preventive and therapeutic 
approaches. In addition, exercise characteristics leading to more pronounced cardioprotection will be concisely 
addressed.