การทบทวนวรรณกรรมแบบบรรยายเรื่องประสิทธิผลของแมกนีเซียมต่อความทนทาน ในการออกกำลังกายในผู้ป่วยโรคหลอดเลือดหัวใจตีบ

Parischamon Samilang; Thunnawat  Wattanaseth

Authors

Parischamon Samilang Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine Dhurakij Pundit University
Thunnawat Wattanaseth Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine Dhurakij Pundit University

Keywords:

Coronary artery disease, Heart Failure, Magnesium, Exercise tolerance

Abstract

Patients with coronary artery disease commonly experience reduced exercise tolerance, which directly impacts both prognosis and quality of life. However, limited access to cardiac rehabilitation programs has led to the increasing use of dietary supplementation as an alternative therapeutic approach. Among these, magnesium has emerged as a particularly important adjunct, as it enhances exercise tolerance through multiple physiological mechanisms, including the improvement of cardiovascular function, energy metabolism, and muscular system performance. This narrative review included nine human studies published between 1996 and 2026 evaluating oral magnesium supplementation in CAD patients, including those with concomitant heart failure. Data were analyzed by descriptive content analysis.

The study found that magnesium supplementation significantly improved exercise duration, walking distance, VO₂max, and METs. It also enhanced endothelial function and increased left ventricular ejection fraction (LVEF). In addition, it significantly reduced ST-segment depression and the incidence of cardiac arrhythmias. Among the nine studies, two assessed quality of life outcomes. Magnesium supplementation improved quality of life in CAD patients without heart failure, as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the Seattle Angina Questionnaire. However, no significant improvement was observed in patients with concomitant heart failure, as assessed by the Minnesota Living with Heart Failure Questionnaire (LHFQ). Reported adverse effects were mainly gastrointestinal symptoms, including abdominal pain and diarrhea.Overall, oral magnesium supplementation may improve exercise tolerance and quality of life in CAD patients, however, further studies are needed, particularly in patients with concomitant heart failure.

References

Khan MAB, Hashim MJ, Mustafa H, Baniyas MY, Al Suwaidi SKBM, AlKatheeri R, et al. Global epidemiology of ischemic heart disease: results from the Global Burden of Disease Study. Cureus. 2020;12(7):e9349. doi:10.7759/cureus.9349.

Zhu WW, Tian RY, Guo DC, Lin MM, Cai QZ, Qin YY, et al. Exercise intolerance in patients with chronic coronary syndrome: insights from exercise stress echocardiography. Front Cardiovasc Med 2024;11:1442263. doi:10.3389/fcvm.2024.1442263.

Del Buono MG, Arena R, Borlaug BA, Carbone S, Canada JM, Kirkman DL, et al. Exercise intolerance in patients with heart failure: JACC state-of-the-art review. J Am Coll Cardiol 2019; 73(17): 2209-25. doi:10.1016/j.jacc.2019.01.072.

Fuller A, Okwose N, Scragg J, Eggett C, Luke P, Bandali A, et al. The effect of age on mechanisms of exercise tolerance: reduced arteriovenous oxygen difference causes lower oxygen consumption in older people. Exp Gerontol 2021;149:111340. doi:10.1016/j.exger.2021.111340.

Verdicchio C, Freene N, Hollings M, Maiorana A, Briffa T, Gallagher R, et al. A clinical guide for assessment and prescription of exercise and physical activity in cardiac rehabilitation: a CSANZ position statement. Heart Lung Circ 2023;32(9):1035-48. doi:10.1016/j.hlc.2023.06.854.

American Thoracic Society; American College of Chest Physicians. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211-77. doi:10.1164/rccm.167.2.211.

Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, et al. ACC/AHA guidelines for exercise testing: executive summary. Circulation 1997;96(1):345-54. doi:10.1161/01.cir.96.1.345.

American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166(1):111-7. doi:10.1164/rccm.166/1/111.

Saif A, Saddique MA, Ahmad G, Jabeen K, Anjum S, Aslam MA. Correlation of coronary artery disease on coronary angiography with Dukes Treadmill score in patients undergoing exercise tolerance test. J Cardiovasc Dis 2024; 20(3). doi:10.55958/jcvd.v18i3.196.

Rendell M, Manorekang R, Williams G, Al Baraikan A, Newman T, Taylor D, et al. Exploring

the association between cardiac magnetic resonance parameters of cardiac function and exercise capacity in patients with coronary artery disease. Eur Heart J Cardiovasc Imaging. 2026;27 (Suppl 1): jeaf367.404. doi:10.1093/ehjci/jeaf367.404.

Hung RK, Al-Mallah MH, McEvoy JW, Whelton SP, Blumenthal RS, Nasir K, et al. Prognostic value of exercise capacity in patients with coronary artery disease: the FIT (Henry Ford ExercIse Testing) Project. Mayo Clin Proc 2014; 89(11): 1644-54. doi:10.1016/j.mayocp.2014.07.011.

Katsi V, Georgiopoulos G, Mitropoulou P, Kontoangelos K, Kollia Z, Tzavara C, et al. Exercise tolerance and quality of life in patients with known or suspected coronary artery disease. Qual Life Res 2021;30(9):2541-50. doi:10.1007/s11136-021-02844-y.

Shanmugasegaram S, Oh P, Reid RD, McCumber T, Grace SL. Cardiac rehabilitation barriers

by rurality and socioeconomic status: a cross-sectional study. Int J Equity Health 2013;12:72. doi:10.1186/1475-9276-12-72.

De Baaij JHF, Hoenderop JGJ, Bindels RJM. Magnesium in man: implications for health and disease. Physiol Rev 2015;95(1):1-46. doi:10.1152/physrev.00012.2014.

Tangvoraphonkchai K, Davenport A. Magnesium and cardiovascular disease. Adv Chronic Kidney Dis 2018;25(3):251-60. doi:10.1053/j.ackd.2018.02.010.

Shechter M. Does magnesium have a role in the treatment of patients with coronary artery disease? Curr Opin Cardiol 2003;18(4):231-6. doi:10.1097/00001573-200307000-00005.

Mathers TW, Beckstrand RL. Oral magnesium supplementation in adults with coronary heart disease or coronary heart disease risk. J Am Acad Nurse Pract 2009;21(12):651-7. doi:10.1111/j.1745-7599.2009.00460.x.

Geiss KR, Stergiou N, Jester J, Neuenfeld HU, Jester HG. Effects of magnesium orotate on exercise tolerance in patients with coronary heart disease. Clin Trial Cardiovasc Drugs Ther 1998;12 (Suppl 2): 153-6. doi:10.1023/a:1007796515957.

Shechter M, Sharir M, Labrador MJ, Forrester J, Silver B, Bairey Merz CN. Oral magnesium therapy improves endothelial function in patients with coronary artery disease. Circulation 2000;102(19): 2353-8. doi:10.1161/01.cir.102.19.2353.

Shechter M, Bairey Merz CN, Stuehlinger HG, Slany J, Pachinger O, Rabinowitz B. Effects of oral magnesium therapy on exercise tolerance, exercise-induced chest pain, and quality of life in patients with coronary artery disease. Am J Cardiol 2003;91(5):517-21. doi:10.1016/S0002-9149(02)03297-6.

Pokan R, Hofmann P, von Duvillard SP, Smekal G, Wonisch M, Lettner K, et al. Oral magnesium therapy, exercise heart rate, exercise tolerance, and myocardial function in coronary artery disease patients. Br J Sports Med 2006;40(9):773-8. doi:10.1136/bjsm.2006.027250.

Abdullayev R, Quliyeva A, Abdullayeva R, Isayeva M, Muradova S, Abdullayeva I. Study of the effect of magnesium preparations on physical tolerance in patients with chronic coronary syndrome. J Heart Dis Ther 2025;2(1):1-2. doi:10.71295/jhdt.2025.020102.

Fuentes JC, Salmon AA, Silver MA. Acute and chronic oral magnesium supplementation: effects on endothelial function, exercise capacity, and quality of life in patients with symptomatic heart failure. Congest Heart Fail 2006;12(1):9-13. doi:10.1111/j.1527-5299.2006.04692.x.

Amin A, Chitsazan M, Chitsazan M, Haghighattalab A, Taghavi S, Naderi N. Effects of magnesium replacement therapy in patients with chronic stable heart failure and normal magnesium level. Res Cardiovasc Med 2019;8(1): 23-8. doi:10.4103/rcm.rcm_29_18.

Jara Valderrama JJ, Gonzales Gonzales GA, Gutierrez Altuna XZ, Rodriguez Carbonell JA, Gutierrez Asmat FM, Sagastegui Avalos AA, et al. Oral magnesium citrate effect in exercise tolerance in chronic heart failure. Eur J Prev Cardiol 2025;32(Suppl 1):zwaf236.037. doi:10.1093/eurjpc/zwaf236.037.

Kobryn OT, Vakaliuk IP. Anti-inflammatory effects of magnesium orotate in revascularized patients with CAD and HFmrEF: a randomized study. Bukov Med Herald 2025;29(4):16-22. doi:10.24061/2413-0737.29.4.116.2025.3.

Duncan AM, Francis DP, Gibson DG, Henein MY. Limitation of exercise tolerance in chronic heart failure: distinct effects of left bundle-branch block and coronary artery disease. J Am Coll Cardiol 2004;43(9):1667-74. doi:10.1016/j.jacc.2003.11.051.