April 21, 2022

Real Health in Focus: Angiogenesis – The Little-Known Big Benefit of Exercise

by Ari Levy

At SHIFT, we often talk about the importance of a consistent exercise program as part of an overall health strategy. While some of the benefits of exercise are common knowledge (e.g., weight control, stress management), we often don’t consider how exercise (and the mechanisms within our body that are at work every day) help to prevent and combat diseases and ultimately build health.

Angiogenesis is one of the body’s vital functions that promotes growth, healing, and the prevention of some diseases. In this article, we will define angiogenesis and how a proper exercise program can increase the positive effects of this function in the body, creating an insurance policy for our heart and overall health.

What Is Angiogenesis? 

Angiogenesis is the creation of new blood vessels. These new blood vessels act as pathways that allow blood to be diverted to tissue that really needs it. It helps create a more efficient system to deliver oxygen and other essential elements to various tissue.

Did you know that two thirds of heart attacks are preventable?1 Angiogenesis improves the health and robustness of heart and skeletal muscle and reduces your chances of having a heart attack as well as your risk of significant heart muscle damage if you have do have one.2

Vascular System 101

Let’s begin with some basics to set the stage. As blood leaves your heart, in the aorta, it transports essential nutrients and oxygen to the tissues of the body, which is necessary for their survival and optimal functioning. The aorta branches off into arteries, which continue to branch into smaller and smaller vessels (arterioles) until they reach the tissues that they supply. Within the tissues the smallest vessels (capillaries) release nutrition and oxygen. The capillaries then collect waste and empty into the venous system (increasingly big veins) which return blood to the heart. 

When you exercise, there is a greater need for oxygen to be delivered to the tissues (metabolic demand). This stimulates muscle tissue growth and angiogenesis of the capillaries, which makes the heart and skeletal muscle stronger, more effective, and more adaptable to changes in metabolic demand or disease. Imagine yourself building a stronger and more efficient system so that the next time you stress your system, it is better prepared.

The Role of Angiogenesis in Treating Disease

Your arteries and veins are like highways. Imagine a construction crew turns up to repair potholes in one of the lanes of the highway, forcing the traffic to slow down and flow into the remaining two lanes. Now it’s hard for the traffic to get where it needs to go. Angiogenesis constructs alternative routes; by building new off-ramps, interchanges, or thruways, traffic is diverted via new ways to reach the destination.

Without angiogenesis, if one of the three coronary arteries leading to the heart becomes blocked, the heart muscle will be deprived of oxygen and die. Angiogenesis creates new blood vessels that divert blood, oxygen and nutrients to the heart tissue supplied by a damaged artery. Ultimately, angiogenesis can reduce your risk of having a cardiac event overall as well as lessen the damage and severity of a heart attack.

There has been growing interest in the role of increasing angiogenesis in the treatment of disease, especially in the areas of heart disease, peripheral arterial disease, and wound healing. However, in the treatment of some diseases—cancer, eye conditions, and rheumatoid arthritis, among others—the goal is to decrease or inhibit angiogenesis.

Types of Angiogenesis

Healthy angiogenesis,also known as exercise-induced angiogenesis, occurs when you perform demanding, purposeful movement. This leads to increased vascularization, oxygenation, and nutrition supply to the heart. This makes the heart stronger and less susceptible to disease. 

Pathological (unhealthy) angiogenesis occurs in some cancers, eye disease, blindness, and rheumatoid arthritis. Here blood vessels proliferate abnormally, feeding cancer cells or causing damage to the retina of the eye or to joints and soft tissue. It also occurs when there is ischemia (inadequate blood supply) or infarction (tissue death, due to lack of blood flow), in the heart’s attempt to compensate.

Exercise is a stimulus for angiogenesis.

Exercise Induced Angiogenesis and its Benefits

When you are healthy and perform low intensity exercise, your blood supply can effortlessly meet the demands on your muscles for blood, oxygen, and nutrients. But when you exert yourself, pushing your muscles to work hard, the body needs to respond to meet additional metabolic needs. In a healthy body, demanding, purposeful movement stimulates angiogenesis in the heart and skeletal muscles, leading to an improvement in the function of all your organs and systems. In turn, you will feel more positive, energetic, and healthy and will have more vitality and vigor to enjoy your life.

Lack of exercise has the opposite effect, leading to repression of angiogenesis and loss of blood vessels. In turn, the heart, organs, and muscles become less healthy and less adaptive to changing demands. It’s a use-it-or-lose-it phenomenon. And, if you develop a blocked coronary artery, then the vascular system will not be able to divert blood and, consequently, heart muscle will die.

Healthy Angiogenesis: How to Initiate Angiogenesis with Exercise 

A combination of endurance exercise and high intensity training has been shown to stimulate angiogenesis.3 (Please consult your doctor before starting a new exercise routine.)

Endurance exercise. For those in good health, endurance exercises such as swimming, cycling, or running should be performed for 60 to 90 minutes once or twice a week to stimulate healthy angiogenesis. Engaging in endurance exercise for more than 120 minutes or more than twice a week can be problematic, as it may lead to electrolyte imbalances and joint issues.

High intensity training. Characterized by extreme, short bursts of explosive energy with periods of rest in between, high intensity training can stimulate healthy angiogenesis. These workouts are known generally as HIIT (high-intensity interval training) or Tabata (named for Dr. Izumi Tabata, a Japanese exercise physiologist who invented a specific form of this type of training). 

These two types of exercise sessions should be spread out over the course of the week (but not performed on the same day) for optimal results.

Angiogenesis and Your Muscles

Skeletal muscles are very “plastic:” They grow and change shape. When you perform strenuous or endurance exercise, the muscle is temporarily put into a hypoxic state (blood vessels can’t supply enough oxygen). Researchers believe this hypoxia, plus acidosis and the production of nitrous oxide (NO) in the muscles, activates angiogenic growth factors (including vascular endothelial growth factor), which stimulate angiogenesis. This process improves the blood supply to the muscles.

Alongside the angiogenesis process, muscle tissue is growing stronger. The stress of exercise causes slight damage to muscle fibers. Post-workout your body repairs and replaces damaged muscle fibers, which fuse to form myofibrils (new muscle protein strands). These increase in number and thickness to create muscle growth (hypertrophy).

What can Angiogenesis do for your body? Purposeful movement leads to healthy angiogenesis.
Image from Gorski T, De Bock K. Vasc Biol, 2019.4
This illustration shows what angiogenesis can do for your body. Remember that exercise—specifically purposeful movement that alternates high-intensity and endurance activities for at least 60 minutes twice a week—leads to healthy angiogenesis.

In conclusion, the right kind of regular exercise acts as a powerful insurance policy for your health. While it is true that some illness is not preventable, you are more in control of your health than you may know. The lifestyle decisions you make every day have the potential to stack the odds in your favor by reducing risk of chronic disease and expediting recovery when you get sick. Angiogenesis is one of the mechanisms that makes exercise such an essential part of a healthy lifestyle, helping make your heart and your muscles stronger and more resilient to damage. Consistency is key—you need to invest in your health every day to reap health benefits now and in the years to come.

To learn more about your specific health risks or for a personalized exercise program, please reach out to your SHIFT team.

In Real Health,
Dr. Ari Levy


  1. CDC Prevention Programs. American Heart Association, 2018. https://www.heart.org/en/get-involved/advocate/federal-priorities/cdc-prevention-programs.
  2. Ardakanizade, M., 2018. The effects of mid- and long-term endurance exercise on heart angiogenesis and oxidative stress. Iran J Basic Med Sci., 21(8): 800–805. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6118080/
  3. Miao, C., Chen, S., Macedo, R., Lai, S., Liu, K., Li, D., Wasserman, B. A., Vogel-Claussen, J., Lima, J. A., & Bluemke, D. A. (2009). Positive remodeling of the coronary arteries detected by magnetic resonance imaging in an asymptomatic population: MESA (Multi-Ethnic Study of Atherosclerosis). Journal of the American College of Cardiology53(18), 1708–1715. https://doi.org/10.1016/j.jacc.2008.12.063
  4. Gorski T & De Bock K. Metabolic regulation of exercise-induced angiogenesis. Vasc Biol. 2019; 1(1):H1-H8. https://vb.bioscientifica.com/view/journals/vb/1/1/VB-19-0008.xml.

Additional References

Kwak S, Lee J, Zhang D & Song W. Angiogenesis: focusing on the effects of exercise in aging and cancer. J Exerc Nutrition Biochem. 2018; 22(3):21-26.

Adair TH, Montani JP. Angiogenesis. San Rafael, CA. Morgan & Claypool Life Sciences. 2010.

Benefits of Physical Activity. CDC, 2021.https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

Wagner PD. Skeletal muscle angiogenesis: A possible role for hypoxia. Adv Exp Med Biol. 2001; 502:21-38. https://pubmed.ncbi.nlm.nih.gov/11950140/.




angiogenesis, cardiac health, cardiac risk, exercise, medical, movement

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