The Physiological Effect of n-3 Polyunsaturated Fatty Acids (n-3 PUFAs) Intake and Exercise on Hemorheology, Microvascular Function, and Physical Performance in Health and Cardiovascular Diseases; Is There an Interaction of Exercise and Dietary n-3 PUFA Intake?

Marko Stupin,Ines Drenjančević,Kristina Selthofer-Relatić,Ana Stupin,Anita Matić,Zrinka Mihaljević,Martina Mihalj,Ivana Jukić,Aleksandar Kibel

doi:10.3389/fphys.2019.01129

Abstract

Physical activity has a beneficial effect on systemic hemodynamics, physical strength, and cardiac function in cardiovascular (CV) patients. Potential beneficial effects of dietary intake of n-3 polyunsaturated fatty acids (n-3 PUFAs), such as α-linolenic acid, eicosapentaenoic acid, and docosahexaenoic acid on hemorheology, vascular function, inflammation and potential to improve physical performance as well as other CV parameters are currently investigated. Recent meta-analysis suggests no effect of n-3 PUFA supplementation on CV function and outcomes of CV diseases. On the other hand, some studies support beneficial effects of n-3 PUFAs dietary intake on CV and muscular system, as well as on immune responses in healthy and in CV patients. Furthermore, the interaction of exercise and dietary n-3 PUFA intake is understudied. Supplementation of n-3 PUFAs has been shown to have antithrombotic effects (by decreasing blood viscosity, decreasing coagulation factor and PAI-1 levels and platelet aggregation/reactivity, enhancing fibrinolysis, but without effects on erythrocyte deformability). They decrease inflammation by decreasing IL-6, MCP-1, TNFα and hsCRP levels, expression of endothelial cell adhesion molecules and significantly affect blood composition of fatty acids. Treatment with n-3 PUFAs enhances brachial artery blood flow and conductance during exercise and enhances microvascular post-occlusive hyperemic response in healthy humans, however, the effects are unknown in cardiovascular patients. Supplementation of n-3 PUFAs may improve anaerobic endurance and may modulate oxygen consumption during intense exercise, may increase metabolic capacity, enhance endurance capacity delaying the onset of fatigue, and improving muscle hypertrophy and neuromuscular function in humans and animal models. In addition, n-3 PUFAs have anti-inflammatory and anti-nociceptive effects and may attenuate delayed-onset muscle soreness and muscle stiffness, and preserve joint mobility. On the other hand, effects of n-3 PUFAs were variably observed in men and women and they vary depending on dietary protocol, type of supplementation and type of sports activity undertaken, both in healthy and cardiovascular patients. In this review we will discuss the physiological effects of n-3 PUFA intake and exercise on hemorheology, microvascular function, immunomodulation and inflammation and physical performance in healthy persons and in cardiovascular diseases; elucidating if there is an interaction of exercise and diet.

Highlights

It is well-accepted that physical activity has a beneficial effect on systemic hemodynamics, physical strength and cardiac function in cardiovascular (CV) patients (Joyner and Green, 2009; Smith et al, 2011c; Piepoli et al, 2016)
This manuscript aimed to provide a comprehensive review of less studied effects of diet and lifestyle on hemorheology, n-3 PUFAs and Exercise – The Effects in Cardiovascular Patients inflammation, and vascular function in healthy persons and CV patients
Since n-3 PUFA supplements are widely used in the general population and prescribed to CV patients, the focus of this review was on n-3 PUFAs effects complementary or interactive with physical activity

Summary

INTRODUCTION

It is well-accepted that physical activity has a beneficial effect on systemic hemodynamics, physical strength and cardiac function in cardiovascular (CV) patients (Joyner and Green, 2009; Smith et al, 2011c; Piepoli et al, 2016). Authors concluded that meta-analysis and sensitivity analyses in their review suggested little or no effect of increased DHA/EPA intake on all-cause mortality (high-quality evidence), CV mortality, CV events (high-quality evidence), coronary heart disease (CHD) mortality, stroke or arrhythmia. From the literature search it is evident that a respective number of studies investigated the effect of n-3 PUFA supplementation on hemorheology, vascular/endothelial function/microcirculation, inflammation, and skeletomuscular system in both CV patients and healthy population (panel A). There is no available data (total of 5 research results) on the combined effect of n-3 PUFA supplementation in the form of functional foods and regular aerobic exercise on hemorheology, vascular/endothelial function/microcirculation and inflammation in both healthy population and CV patients (panel D)

METABOLISM OF POLYUNSATURATED FATTY ACIDS

Effects of Exercise on Hemorheology and Coagulability in CV Patients

SUMMARY AND CONCLUSION