Non-pharmacological interventions for vascular health and the role of the endothelium

Samuel Weaver*, Catarina Rendeiro, Becky Lucas, Nigel Cable, Tom E. Nightingale, Helen McGettrick, Sam Lucas

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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The most common non-pharmacological intervention for both peripheral and cerebral vascular health is regular physical activity (e.g., exercise training), which improves function across a range of exercise intensities and modalities. Numerous non-exercising approaches have also been suggested to improved vascular function, including repeated ischemic preconditioning (IPC); heat therapy such as hot water bathing and sauna; and pneumatic compression. Chronic adaptive responses have been observed across a number of these approaches, yet the precise mechanisms that underlie these effects in humans are not fully understood. Acute increases in blood flow and circulating signalling factors that induce responses in endothelial function are likely to be key moderators driving these adaptations. While the impact on circulating factors and environmental mechanisms for adaptation may vary between approaches, in essence, they all centre around acutely elevating blood flow throughout the circulation and stimulating improved endothelium-dependent vascular function and ultimately vascular health. Here, we review our current understanding of the mechanisms driving endothelial adaptation to repeated exposure to elevated blood flow, and the interplay between this response and changes in circulating factors. In addition, we will consider the limitations in our current knowledge base and how these may be best addressed through the selection of more physiologically relevant experimental models and research. Ultimately, improving our understanding of the unique impact that non-pharmacological interventions have on the vasculature will allow us to develop superior strategies to tackle declining vascular function across the lifespan, prevent avoidable vascular-related disease, and alleviate dependency on drug-based interventions.
Original languageEnglish
Pages (from-to)2493–2514
Number of pages22
JournalEuropean Journal of Applied Physiology
Issue number12
Early online date23 Sept 2022
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
This work was supported by the Biotechnology and Biological Sciences Research Council (BBSRC) as part of S.R. Weaver’s PhD Studentship Award (ref: 1943514) through the Midlands Integrative Biosciences Training Program (MIBTP).

Publisher Copyright:
© 2022, The Author(s).


  • Endothelial
  • Exercise
  • Heat
  • Hypoxia
  • Ischemic preconditioning
  • Non-pharmacological intervention
  • Vascular function

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Physiology (medical)
  • Orthopedics and Sports Medicine


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