Exercise and cardiovascular risk reduction: Time to update the rationale for exercise?

Although it is generally accepted that the promotion of exercise accords with clinical best practice, the anecdotal experience of many primary care physicians, cardiologists, and exercise physiologists is that, even when exercise prescriptions are adhered to, risk factors often fail to demonstrate marked improvement. Since modification of traditional risk factors fails to fully explain the magnitude of exercise-mediated risk reduction (18), we propose that there are direct effects of exercise on the vascular wall, which confer cardioprotection via a vascular conditioning effect