Key result
Structured exercise post-PCI improves functional capacity and prognosis but its effect on ISR remains unproven.
Why the study?
Structured exercise is a cornerstone of secondary prevention after PCI, but its specific relationship with in-stent restenosis is less well characterized.
Does structured exercise training reduce in-stent restenosis in patients after percutaneous coronary intervention?
Does structured exercise training reduce in-stent restenosis in patients after percutaneous coronary intervention?
While structured exercise is a guideline-endorsed cornerstone of post-PCI care with established functional benefits, its direct anti-restenotic effect remains biologically plausible but not firmly established in the contemporary thin-strut DES era.
Reinforces exercise-based rehabilitation as standard post-PCI care; leaves open confirmation of anti-restenotic effect in contemporary randomized trials.
PURPOSE OF REVIEW: Structured exercise is a cornerstone of secondary prevention after percutaneous coronary intervention (PCI), yet its specific relationship with in-stent restenosis (ISR) is less well characterized. This narrative review summarizes the biological rationale, clinical evidence, safety, and practical prescription of exercise training in patients with coronary stents, with a focus on its potential impact on ISR. RECENT FINDINGS: Exercise training improves endothelial nitric oxide bioavailability, reduces systemic inflammation, and favorably modulates neointimal proliferation in experimental and clinical studies. Pooled clinical data suggest that exercise-based cardiac rehabilitation after PCI is associated with a reduction in angiographically defined restenosis, although individual trials, largely from the bare-metal and early drug-eluting stent (DES) eras, have shown inconsistent results on binary restenosis endpoints. Available contemporary data do not suggest an excess risk of stent thrombosis, clinically relevant arrhythmias, or adverse ventricular remodeling when exercise is initiated in clinically stable patients using an individualized and supervised approach. The direct anti-restenotic effect of exercise remains biologically plausible and clinically suggestive but is not yet firmly established, particularly in the contemporary thin-strut DES era. Nevertheless, the well-documented benefits of exercise on functional capacity, endothelial health, and cardiovascular prognosis justify its role as an essential, time-sensitive component of post-PCI care. Larger, contemporary trials with standardized intracoronary imaging endpoints are needed to clarify whether, and in which patient subsets, exercise meaningfully affects the biology of ISR.
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Spadafora et al. (2026) conducted a review in In-stent restenosis after percutaneous coronary intervention. Structured exercise training vs. Usual care or no exercise was evaluated. Structured exercise after percutaneous coronary intervention improves functional capacity and cardiovascular prognosis, though its direct effect on reducing in-stent restenosis remains biologically plausible but not firmly established in the contemporary drug-eluting stent era.
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