Aerobic Exercise-induced Effect on Endothelial Function in Patients with Ischaemic Heart Disease

Inclusion Criteria:

• Men and women aged between 45 and 75 years.

• Diagnosed with acute myocardial infarction, unstable or stable angina.

• Treated with percutaneous coronary intervention, coronary artery bypass grafting, orconservative treatment.

• Event or intervention within 3 to 12 months prior to participation in the study.

• Fluency in speaking and reading Spanish.

• Residing in Elche or surrounding areas and able to attend evaluations and theexercise programme (not planning to be absent for more than one week during theprogramme).

• Functional Class I-II according to the New York Heart Association (NYHA)classification.

• No physical limitations for exercise.

• Stable optimal medical treatment.

• Physically inactive, defined as 1) not meeting the World Health Organizationrecommendations for both aerobic and strength exercise, and 2) not participating ina structured exercise programme at least 3 days per week for more than 3 months.Both conditions must be met for inclusion. Note: Casual walking is not consideredgrounds for exclusion.

Exclusion Criteria:

• Use of walking assistive devices.

• Treatment with chemotherapy for any type of cancer in the past 2 years.

• Hospitalisation in an intensive care unit in the past 6 months for reasons otherthan the ischaemic event.

• Acute myocardial infarction group IV Killip-Kimball.

• Obesity grade III (≥40.0 kg/m²).

• Medical contraindication for inclusion in an exercise programme.

• Diabetes with uncontrolled blood glucose levels.

• Poorly controlled hypertension: resting blood pressure > 180/110 mmHg.

• Chest pain with exertion or ST-segment changes suggestive of residual ischemiaduring ergometry. Residual ischemia.

• Severely reduced functional capacity on initial ergometry (<5 metabolicequivalent of task).

• Left ventricular ejection fraction less than 50%.

• Severe stenosis of the left main coronary artery (>50% significant disease).

• Severe aortic stenosis, left ventricular outflow tract obstruction (e.g.,obstructive hypertrophic cardiomyopathy) or aortic dissection.

• Severe valvulopathy.

• Acute pulmonary embolism or deep vein thrombosis.

• Severe pulmonary hypertension.

• Acute heart failure.

• Acute endocarditis, myocarditis, or pericarditis.

• Acute or chronic renal insufficiency (estimated glomerular filtration rate <30ml/min).

• Pulmonary fibrosis or interstitial disease (severe respiratory insufficiency orconfirmed chronic obstructive pulmonary disease).

• Uncontrolled cardiac arrhythmias/hemodynamically unstable.

• Permanent or persistent/paroxysmal atrial fibrillation with episodes in the past 6months.

• High-grade cardiac block.

• Presence of implantable devices: cardiac resynchronization therapy pacemaker,implantable cardioverter defibrillators, or pacemaker.

• Presence of ischaemic symptoms during the incremental exercise test performed beforethe intervention.

• Severe autonomic or peripheral neuropathy.

• Use of nitrates in pharmacological treatment.

• Any planned surgical or medical intervention during the study period.

• Plans to participate in or current participation in other studies that may interferewith this study.

• Current pregnancy or intention to become pregnant during the study period.