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This issue of Heart focuses on exercise and cardiovascular (CV) health featuring a state-of-the-art review on the basic science behind the CV effects of exercise by Prof Matthew Wilson (see page 758), jointly published with the British Journal of Sport Medicine. The effects of a prolonged period (>6 months) of regular intensive exercise include a decrease in resting heart rate by 5 to 20 beats per minute, an increase in stroke volume by about 20% and increased myocardial contractility. Myocardial mass increases with a small increase in wall thickness along with increased chamber volumes (Figure 1). The physiological adaptation to exercise differs from pathological cardiac remodeling at the tissue level both in terms of activation of signaling pathways and upregulation of growth factors. Exercise induced adaptations of the endothelium and blood vessels also contribute to the beneficial effect of exercise. Prof Wilson concludes: “Since aerobic capacity is a prognostic marker of CV disease and mortality more than any other established risk factor, clinicians should promote the expansive benefits of exercise in all spectrums of society, be it the casual exerciser, the sedentary individual or those with established CV disease.”