Efeitos do exercício físico na circulação colateral coronária: uma revisão sistemática

Abstract

Background: Coronary collateral circulation is an adaptive pathway that protects the myocardium during ischemia. Physical exercise has been studied as a noninvasive stimulus capable of improving the prognosis of patients with coronary artery disease (CAD). Objectives: To analyze the evidence on the effects of physical exercise on the formation and functionality of coronary collateral circulation in patients with CAD. Methods: This systematic review followed PRISMA 2020 guidelines. Searches were performed in the PubMed, Scopus, and Web of Science databases using the descriptors coronary collateral circulation, exercise, physical activity, and coronary artery disease. Clinical studies evaluating physical exercise in the formation or functionality of collaterals by direct or indirect methods were included. Results: From 2,549 records identified, 17 studies met the inclusion criteria. Overall, the evidence showed that supervised physical exercise of moderate to high intensity improves the functionality of coronary collateral circulation, reflected by enhanced myocardial perfusion and reduced ischemic response. Regarding formation, the evidence was less consistent, with new vessel development mainly observed in prolonged or ischemic training protocols. Conclusions: Physical exercise enhances the functionality of coronary collateral circulation and may modestly favor structural formation, improving myocardial perfusion through collateral recruitment. These findings reinforce supervised exercise as a safe and effective therapeutic strategy for the rehabilitation of stable CAD patients.