Changes in the ratio of HDL to total cholesterol that take place with regular physical activity reduce the risk of atherogenesis and coronary artery disease in active people, as compared with those who are sedentary. A lack of exercise is now established as a risk factor for coronary heart disease similar in magnitude to hypercholesterolemia, hypertension, and smoking. A reduced risk grows out of the changes in lipid profiles noted above, reduced insulin requirements and increased insulin sensitivity, and reduced cardiac (-adrenergic responsiveness and increased vagal tone. When coronary ischemia does occur, increased vagal tone may reduce the risk of fibrillation.
Regular exercise often, but not always, reduces resting blood pressure. Why some people respond to chronic activity with a resting blood pressure decline and others do not remains unknown. Responders typically show diminished resting sympathetic tone, so that systemic vascular resistance falls. In obesity-linked hypertension, declining insulin secretion and increasing insulin sensitivity with exercise may explain the salutary effects of combining training with weight loss. Nonetheless, because some obese people who exercise and lose weight show no blood pressure changes, exercise remains adjunctive therapy for hypertension.
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