Acta Cardiol Sin 2017;33:539-541

Editorial Comment doi: 10.6515/ACS20170604A

Circadian Rhythm, Exercise, and Heart

Circadian rhythm is an evolutionarily conserved stolic blood pressure.9 The exercise dose required to de-
mechanism from archaea to human. To deal with the crease body weight appears to be significantly higher
day-night changes in the environment on earth, circadian than the minimal dose required to have beneficial car-
rhythm modulates the biological function to coordinate diovascular effects. Moreover, comprehensive lifestyle
an appropriate timing for each process. Circadian rhythm interventions, which include exercise, diet, and weight
and exercise have important impacts on each other. Exer- loss, are needed to prevent metabolic syndrome and di-
cise is a strong entrainment signal for mammalian circa- abetes mellitus.
dian clock.1 Proper exercise can have a significant circa- Exercise induces the release of several myokines
dian phase-shifting effect and affect the sleep and wake from skeletal muscle and adipokines from adipose tis-
schedule in human.2 Disruption of the circadian rhythm sues. In mice, aerobic exercise induces the production of
also has significant influences on the exercise function. irisin from muscle.10 The irisin promotes the conversion
The circadian gene CLOCK mutation in mice results in sig- of white fat to brown fat in mice and probably in hu-
nificantly reductions in muscle power and exercise endur- mans.11 The levels of irisin are associated with chronic
ance.3 Moreover, CLOCK mutation also disturbs muscle kidney diseases,12 metabolic syndrome,13 and cardiovas-
myofiber and mitochondrial functions.4 The close interac- cular diseases. 14 The macrophage colony-stimulating
tions between circadian rhythm and exercise are further factor-1, which influences macrophage homeostasis, is
strengthened by the findings that the diurnal variations also increased in skeletal muscle after exercise.15 With
of musculoskeletal functions and the impact of the circa- secretome analysis, various myokines are induced by
dian clock on energy metabolism and bone.5 acute exercise and exercise training.16 However, the ex-
The benefits of exercise to the heart is well-studied. act roles of these exercise-related myokines are still un-
Aerobic exercise reduces myocardial infarction and stroke der extensive studies and their physiological functions
risks by lowering blood pressure, reducing cholesterol will shed lights on our understanding of cardiovascular
level, and improving body weight control.6 The Harvard diseases in the future. Based on these myokine discover-
Alumni Health Study which began in 1962 with 17000 ies, the influences of exercise are beyond body weight
healthy male alumni has shown a direct relationship be- control, metabolism regulation, and blood pressure low-
tween exercise dose and mortality.7 The meta-analysis ering. With the strong links between circadian rhythm
found that routine exercise produced a clinically favor- and exercise, it is logical to assume that exercise can
able reduction in low-density lipoprotein cholesterol exert its beneficial effects on cardiovascular system
and increase in high-density lipoprotein cholesterol.8 Ex- through circadian modulation.
ercise training has a clinically significant benefit in blood Cimen and colleagues observed that acute exercise
pressure control with a 3 to 5 mmHg reduction in sys- resulted in depletions of energy charge, decreases of
tolic blood pressure and 2 to 4 mmHg reduction in dia- the adenosine triphosphate levels, and elevation of the
malondialdehyde and 3-nitrotyrosine abundances of the
rat heart tissue. These results indicated that acute inten-
sive exercise could elevate oxidative stress and suppress
Received: May 31, 2017 Accepted: June 4, 2017
Department of Cardiology, Chang Gung Memorial Hospital, and anti-oxidant activity in the heart. Although abundant ev-
Chang Gung University College of Medicine, Taoyuan, Taiwan. idence supported the beneficial effects of exercise, ex-
Corresponding author: Dr. Chao-Yung Wang, Department of Cardiology,
cessive exercise indeed breaks the balances of energy
Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Taoyuan 333,
Taiwan. Tel: 886-3-328-1200 ext. 8750; Fax: 886-3-328-9134; E-mail: utilization. Strenuous exercise increases the myocardial
[email protected] edema. Long-term marathon training is associated with

539 Acta Cardiol Sin 2017;33:539-541

myocardial fibrosis.17 The exact mechanism maintains search Institute (NHRI-EX106-10617SI), National Science
the balance between exercise and myocardial protec- Council (105-2628-B-182-009-MY4) and Chang Gung
tion or injury is still unclear. Cimen and colleagues fur- Memorial Hospital (CMRPG3B1643).
ther treated the increased oxidative stress in the heart
after acute exercise with melatonin. Their data showed
that melatonin is able to decrease the oxidative stress DISCLOSURE
and recover the energy charge after acute exercise.
The melatonin is isolated in 1958 from bovine pineal. The authors report no proprietary or commercial in-
The synthesis and release of the melatonin are tightly terest in any product mentioned or concept discussed in
controlled by the circadian clock and light exposure. this article.
Working as a major circadian hormonal output, the
melatonin distributes temporal cues to the tissues with
melatonin receptors. These melatonin signals synchronize REFERENCES
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This work was supported by the National Health Re- 14. Wang H, Zhao YT, Zhang S, et al. Irisin plays a pivotal role to pro-

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