Heart 98:5-10 doi:10.1136/heartjnl-2011-300639
  • Review

Physiological cardiac remodelling in response to endurance exercise training: cellular and molecular mechanisms

  1. Daniele Torella1,2
  1. 1The Stem Cell and Regenerative Biology Unit (BioStem), Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
  2. 2Laboratory of Molecular and Cellular Cardiology, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
  1. Correspondence to Georgina M Ellison, Liverpool John Moores University, The Stem Cell and Regenerative Biology Unit (BioStem), Research Institute for Sport and Exercise Sciences, Room 1.41, Tom Reilly Building, Byrom Street, Liverpool L3 3AF, UK; g.m.ellison{at}
  1. Contributors GME designed and performed experiments, analysed data and wrote the paper. DT designed experiments, analysed data and wrote the paper. CDW and CV performed experiments and analysed data.

  • Accepted 30 July 2011
  • Published Online First 31 August 2011


Exercise training fosters the health and performance of the cardiovascular system, and represents nowadays a powerful tool for cardiovascular therapy. Exercise exerts its beneficial effects through reducing cardiovascular risk factors, and directly affecting the cellular and molecular remodelling of the heart. Traditionally, moderate endurance exercise training has been viewed to determine a balanced and revertible physiological growth, through cardiomyocyte hypertrophy accompanied by appropriate neoangiogenesis (the Athlete's Heart). These cellular adaptations are due to the activation of signalling pathways and in particular, the IGF-1/IGF-1R/Akt axis appears to have a major role. Recently, it has been shown that physical exercise determines cardiac growth also through new cardiomyocyte formation. Accordingly, burgeoning evidence indicates that exercise training activates circulating, as well as resident tissue-specific cardiac, stem/progenitor cells. Dissecting the mechanisms for stem/progenitor cell activation with exercise will be instrumental to devise new effective therapies, encompassing myocardial regeneration for a large spectrum of cardiovascular diseases.


  • Funding Funding was received from British Heart Foundation, Marie Curie FP7, Italian Ministry of Health, FIRB-Futuro-in-Ricerca and Associazione Italiana per la Ricerca sul Cancro (AIRC). Grant numbers PG/08/085, PIRG02-GA-2007-224853, GR-2008-1142673, RBFR081CCS and MFAG-2008.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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