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Which Physical Exercise Interventions Increase HDL-Cholesterol Levels? A Systematic Review of Meta-analyses of Randomized Controlled Trials

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Abstract

Background

Meta-analyses of randomized controlled trials (RCTs) have shown the beneficial effect of exercise on HDL-cholesterol (HDL-C) levels. However, systematic reviews are not free of bias, and this could call into question their results.

Objectives

The aim of this work was to conduct a critical assessment of meta-analyses of RCTs that analyze the association between exercise and HDL-C levels, evaluating their results and the risk of bias (RoB).

Methods

This systematic review of MEDLINE and EMBASE included meta-analyses of RCTs that studied the effects of exercise on HDL-C levels in healthy adults or patients at cardiovascular risk. The RoB was determined using AMSTAR-2, and information was obtained on exercise and the variation in HDL-C levels.

Results

Twenty-three meta-analyses were included. Great variability was found in exercise (different types, frequencies or intensities in the studied interventions). All the analyses found an improvement in HDL-C levels, ranging from 0.27 to 5.41 mg/dl, in comparison with the control group (no exercise). The RoB was very high, with 18 reviews obtaining a critically low confidence level and the remaining works obtaining the highest confidence level.

Conclusions

Only one meta-analysis showed good quality, in which HDL-C levels increased by 3.09 mg/dl in healthy adults and patients at high cardiovascular risk who practiced yoga. The rest had high RoB. Therefore, new systematic reviews with low RoB are needed to apply the results to clinical practice.

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Data availability statement

There are no underlying data in this work.

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Acknowledgements

The authors thank Maria Repice and Ian Johnstone for their help with the English version of the text.

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Authors and Affiliations

  1. Department of Clinical Medicine, Miguel Hernández University, Ctra Valencia-Alicante S/N, San Juan de Alicante, 03550, Alicante, Spain

    Antonio Palazón-Bru, David Hernández-Lozano & Vicente Francisco Gil-Guillén

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  1. Antonio Palazón-Bru
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  2. David Hernández-Lozano
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  3. Vicente Francisco Gil-Guillén
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Contributions

AP conceived the idea of the review, designed the review, drafted the paper and performed the systematic review; DH participated in the review design, performed the systematic review and contributed to writing the manuscript; VFG participated in the review design and critically reviewed the manuscript. All the authors approved the final version of the text to be submitted for publication.

Corresponding author

Correspondence to Antonio Palazón-Bru.

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Funding

No external funding was received for this review.

Conflict of interest

Antonio Palazón-Bru, David Hernández-Lozano and Vicente Francisco Gil-Guillén declare that they have no conflicts of interest relevant to the content of this review.

Electronic supplementary material

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40279_2020_1364_MOESM1_ESM.docx

Electronic Supplementary Material Appendix S1. Information about the search strategy. Electronic Supplementary Material Appendix S2. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist (DOCX 15 kb)

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Palazón-Bru, A., Hernández-Lozano, D. & Gil-Guillén, V.F. Which Physical Exercise Interventions Increase HDL-Cholesterol Levels? A Systematic Review of Meta-analyses of Randomized Controlled Trials. Sports Med 51, 243–253 (2021). https://doi.org/10.1007/s40279-020-01364-y

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