Q J Med 2003; 96: 543
© 2003 Association of Physicians
Correspondence |
Increase of heat shock protein with exercise
Division of General Internal Medicine
Mayo Clinic
Rochester
USA
e-mail: ghosh.amit{at}mayo.edu
Sir,
Dr Press and colleagues1 make a forceful case in their editorial for the beneficial effect of exercise in the prevention of coronary artery disease. We would however like to point out that there is a large body of literature on the role of heat shock protein (HSP) in providing cellular protection in a variety of stresses.2 Exercise induces HSP in skeletal muscle, and exercise training increases HSP in the skeletal muscle of old rats.3 A role for HSP in cardioprotection has been postulated, and several studies addressing the cytoprotective effect of HSP in experimental models of cardiac ischaemia have been summarized in a review by Benjamin and McMillan.2
An approach to preventive measures is often difficult, as one is often trying to correct a risk that may not be perceived as imminent. Efforts to reduce cardiac risks by voluntary measures such as exercise often require a great deal of motivation, and the desired outcome (i.e. avoidance of a coronary event several years later), may not be completely appreciated by individuals. Additionally, physicians vary in their ability to emphasize the beneficial effects of exercise to their patients. This pattern of behavior is known as ‘clinical inertia’, and has been linked to poor control of hypertension and diabetes mellitus, despite awareness of evidence-based guidelines.4
The editorial1 is highly significant in its efforts to compile and summarize a large body of evidence on the beneficial effects of physical exercise in the prevention of coronary artery disease, which could be applied to a majority of our patients.
References
1. Press V, Freestone I, George CF. Physical activity: the evidence of benefit in the prevention of coronary heart disease. Q J Med 2003; 96:245–51.
2. Benjamin IJ, McMillan DR. Stress (Heat Shock) Proteins: Molecular chaperones in cardiovascular biology and disease. Circ Res 1998; 83:117–32.
3. Naito H, Powers SK, Demerel HA, et al. Exercise training increases heat shock protein in skeletal muscles of old rats. Med Sci Sports Exerc 2001; 33:729–34.[CrossRef][Web of Science][Medline]
4. Phillips LS, Branch WT, Cook CB et al. Clinical Inertia. Ann Intern Med 2001; 135:825–34.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||