Mixed
Repeated exercise-induced increases in arterial blood flow and shear stress directly cause structural remodeling (lumenal expansion) and functional improvements (endothelial NO-mediated dilation) in human conduit and resistance arteries.
To improve your blood vessel health, you need to generate high blood flow and shear stress. This happens during dynamic exercises like running, cycling, or swimming, and even resistance training if you use moderate weights with higher reps. Simply sitting still or doing very low-intensity movement won't trigger the structural changes in your arteries. Consistency is key: repeated bouts of exercise are required to remodel the vessel walls.
Exercise induces adaptations in the vessel wall that are anti-atherogenic... including effects on endothelial and smooth muscle cell function, along with structural remodeling of the arteries.
Why this rating
The paper cites multiple human studies using advanced imaging (ultrasound, plethysmography) and experimental manipulation (cuff clamping) to establish causality, though it is a review of observational and experimental studies rather than a single RCT.
Source
Effects of Exercise on Vascular Function, Structure, and Health in Humans
Daniel J. Green et al. · Cold Spring Harbor Perspectives in Medicine · 2017
DOI 10.1101/cshperspect.a029819
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