Skip to main content
SpringerLink
Log in

Impact of Exercise Training Interventions on Flow-Mediated Dilation in Adults: An Umbrella Review

  • Systematic Review
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Background

Dysfunction of the endothelium is a key precursor of cardiovascular disease. Endothelial function, as assessed via the flow-mediated dilation test, is attenuated with chronic disease (e.g., type 2 diabetes mellitus, hypertension). Exercise training may mitigate this dysfunction and promote better vascular health.

Objective

The main objective of this umbrella review was to determine the impact of exercise training on flow-mediated dilation in healthy adults and those with chronic disease.

Methods

Studies were included if they conducted a systematic review and/or meta-analysis on flow-mediated dilation responses to exercise interventions in adults. Sources were searched in January 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier. National Institutes of Health quality assessment tools were used. The results were presented narratively.

Results

Twenty-seven systematic reviews, including 19 meta-analyses, (total: 5464 unique participants, 2181 reported unique female individuals) met the inclusion criteria. The average overall quality of included reviews was 8.8/11. The quality of studies within each included review varied from low to moderate using a variety of quality assessment scales. Reviews were conducted in healthy adults (n = 9, meta-analyses = 6), as well as those with type 2 diabetes (n = 5, meta-analyses = 4), cardiovascular conditions [i.e., conditions that impact the cardiovascular system, but excluding samples of only type 2 diabetes] (n = 11, meta-analyses = 7), and other chronic conditions (n = 2, meta-analyses = 2). Overall, the included reviews provided evidence that the type of training to optimally improve FMD may vary based on disease condition. Specifically, the evidence suggests that healthy adults benefitted most from higher intensity aerobic training and/or more frequent low-to-moderate resistance training. In addition, adults with type 2 diabetes benefitted most from low-intensity resistance or aerobic exercise training, whereas those with cardiovascular conditions should consider engaging in high-intensity aerobic training to improve endothelial function.

Conclusions

This information may help guide the design of specific exercise programs or recommendations for adults with chronic conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. World Health Organization. Cardiovascular diseases (CVDs). 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Accessed 10 Jan 2021.

  2. American Heart Association. What is cardiovascular disease. 2014. Available from: https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease. Accessed 30 Mar 2023.

  3. Howell MA, Colgan MP, Seeger RW, Ramsey DE, Sumner DS. Relationship of severity of lower limb peripheral vascular disease to mortality and morbidity: a six-year follow-up study. J Vasc Surg. 1989;9:691–7.

    Article  CAS  PubMed  Google Scholar 

  4. Brevetti G, Silvestro A, Schiano V, Chiariello M. Endothelial dysfunction and cardiovascular risk prediction in peripheral arterial disease. Circulation. 2003;108:2093–8.

    Article  PubMed  Google Scholar 

  5. Krüger-Genge A, Blocki A, Franke RP, Jung F. Vascular endothelial cell biology: an update. Int J Mol Sci. 2019;20:4411.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Vanhoutte PM, Shimokawa H, Feletou M, Tang EHC. Endothelial dysfunction and vascular disease: a 30th anniversary update. Acta Physiol. 2017;219:22–96.

    Article  CAS  Google Scholar 

  7. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340:1111–5.

    Article  CAS  PubMed  Google Scholar 

  8. Green DJ, Dawson EA, Groenewoud HMM, Jones H, Thijssen DHJ. Is flow-mediated dilation nitric oxide mediated? A meta-analysis Hypertension. 2014;63:376–82.

    CAS  PubMed  Google Scholar 

  9. Broxterman RM, Witman MA, Trinity JD, Groot HJ, Rossman MJ, Park SY, et al. Strong relationship between vascular function in the coronary and brachial arteries: a clinical coming of age for the updated flow-mediated dilation test? Hypertension. 2019;74:208–15.

    Article  CAS  PubMed  Google Scholar 

  10. Yeboah J, Folsom AR, Burke GL, Johnson C, Polak JF, Post W, et al. Predictive value of brachial flow-mediated dilation for incident cardiovascular events in a population-based study: the multi-ethnic study of atherosclerosis. Circulation. 2009;120:502–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ras RT, Streppel MT, Draijer R, Zock PL. Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis. Int J Cardiol. 2013;168:344–51.

    Article  PubMed  Google Scholar 

  12. Gimbrone MA, García-Cardeña G. Endothelial cell dysfunction and the pathobiology of atherosclerosis. Circ Res. 2016;118:620–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. O’Brien MW, Johns JA, Robinson SA, Bungay A, Mekary S, Kimmerly DS. Impact of high-intensity interval training, moderate-intensity continuous training, and resistance training on endothelial function in older adults. Med Sci Sport Exerc. 2020;52:1057–67.

    Article  Google Scholar 

  14. Rakobowchuk M, Tanguay S, Burgomaster KA, Howarth KR, Gibala MJ, MacDonald MJ. Sprint interval and traditional endurance training induce similar improvements in peripheral arterial stiffness and flow-mediated dilation in healthy humans. Am J Physiol Regul Integr Comp Physiol. 2008;295:R236–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Sawyer BJ, Tucker WJ, Bhammar DM, Ryder JR, Sweazea KL, Gaesser GA. Effects of high-intensity interval training and moderate-intensity continuous training on endothelial function and cardiometabolic risk markers in obese adults. J Appl Physiol. 2016;121:279–88.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sales ARK, Azevedo LF, Silva TOC, Rodrigues AG, Oliveira PA, Jordão CP, et al. High-intensity interval training decreases muscle sympathetic nerve activity and improves peripheral vascular function in patients with heart failure with reduced ejection fraction. Circ Heart Fail. 2020;13: e007121.

    Article  PubMed  Google Scholar 

  17. Ashor AW, Lara J, Siervo M, Celis-Morales C, Oggioni C, Jakovljevic DG, et al. Exercise modalities and endothelial function: a systematic review and dose–response meta-analysis of randomized controlled trials. Sport Med. 2015;45:279–96.

    Article  Google Scholar 

  18. Early KS, Stewart A, Johannsen N, Lavie CJ, Thomas JR, Welsch M. The effects of exercise training on brachial artery flow-mediated dilation. J Cardiopulm Rehabil Prev. 2017;37:77–89.

    Article  PubMed  Google Scholar 

  19. Ramos JS, Dalleck LC, Tjonna AE, Beetham KS, Coombes JS. The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sport Med. 2015;45:679–92.

    Article  Google Scholar 

  20. Campbell A, Grace F, Ritchie L, Beaumont A, Sculthorpe N. Long-term aerobic exercise improves vascular function into old age: a systematic review, meta-analysis and meta regression of observational and interventional studies. Front Physiol. 2019;10:31.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Larisa Way K, Elizabeth Keating S, Kevin Baker M, Helaine Chuter V, Anthony JN. The effect of exercise on vascular function and stiffness in type 2 diabetes: a systematic review and meta-analysis. Curr Diabetes Rev. 2016;12:369–83.

    Article  Google Scholar 

  22. de Souza JAF, Araújo BTS, de Lima GHC, Dornelas de Andrade A, Campos SL, de Aguiar MIR, et al. Effect of exercise on endothelial function in heart transplant recipients: systematic review and meta-analysis. Heart Fail Rev. 2020;25:487–94.

    Article  PubMed  Google Scholar 

  23. Parmenter BJ, Raymond J, Dinnen P, Lusby RJ, Fiatarone Singh MA. High-intensity progressive resistance training improves flat-ground walking in older adults with symptomatic peripheral arterial disease. J Am Geriatr Soc. 2013;61:1964–70.

    Article  PubMed  Google Scholar 

  24. Lee J-H, Lee R, Hwang M-H, Hamilton MT, Park Y. The effects of exercise on vascular endothelial function in type 2 diabetes: a systematic review and meta-analysis. Diabetol Metab Syndr. 2018;10:15.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ashton RE, Tew GA, Aning JJ, Gilbert SE, Lewis L, Saxton JM. Effects of short-term, medium-term and long-term resistance exercise training on cardiometabolic health outcomes in adults: systematic review with meta-analysis. Br J Sports Med. 2020;54:341–8.

    PubMed  Google Scholar 

  26. Fusar-Poli P, Radua J. Ten simple rules for conducting umbrella reviews. Evid Based Ment Heal. 2018;21:95–100.

    Article  Google Scholar 

  27. Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews. Int J Evid Based Healthc. 2015;13:132–40.

    Article  PubMed  Google Scholar 

  28. O’Brien MW, Liu H, Shivgulam ME, Langley JE, Bray NW, Kimmerly DS. The impact of exercise training interventions on flow-mediated dilation: an umbrella review protocol. Heal Popul J. 2022;2:106–15.

    Google Scholar 

  29. Aromataris E, Fernandez R, Godfrey C, Holly C, Khalil H, Tungpunkom P. Chapter 10: umbrella reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI. Adelaide, Australia. 2020

  30. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Rethlefsen ML, Kirtley S, Waffenschmidt S, Ayala AP, Moher D, Page MJ, et al. PRISMA-S: an extension to the PRISMA Statement for reporting literature searches in systematic reviews. Syst Rev. 2021;10:39.

    Article  PubMed  PubMed Central  Google Scholar 

  32. O’Brien MW, Robinson SA, Frayne R, Mekary S, Fowles JR, Kimmerly DS. Achieving Canadian physical activity guidelines is associated with better vascular function independent of aerobic fitness and sedentary time in older adults. Appl Physiol Nutr Metab. 2018;43:1003–9.

    Article  PubMed  Google Scholar 

  33. O’Brien MW, Johns JA, Robinson SA, Mekary S, Kimmerly DS. Relationship between brachial and popliteal artery low-flow-mediated constriction in older adults: impact of aerobic fitness on vascular endothelial function. J Appl Physiol. 2019;127:134–42.

    Article  PubMed  Google Scholar 

  34. Bray NW, Jones GJ, Rush KL, Jones CA, Jakobi JM. Multi-component exercise with high-intensity, free-weight, functional resistance training in pre-frail females: a quasi-experimental, pilot study. J Frailty Aging. 2020;9:111–7.

    CAS  PubMed  Google Scholar 

  35. Ferguson B. ACSM’s guidelines for exercise testing and prescription 9th ed. 2014. J Can Chiropractic Assoc. 2014;58:328.

    Google Scholar 

  36. Silva JKTNF, Menêses AL, Parmenter BJ, Ritti-Dias RM, Farah BQ. Effects of resistance training on endothelial function: a systematic review and meta-analysis. Atherosclerosis. 2021;333:91–9.

    Article  CAS  PubMed  Google Scholar 

  37. Zhang Y, Zhang YJ, Zhang HW, Ye WB, Korivi M. Low-to-moderate-intensity resistance exercise is more effective than high-intensity at improving endothelial function in adults: a systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18:6723.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Horiuchi M, Okita K. Blood flow restricted exercise and vascular function. Int J Vasc Med. 2012;2012:1–17.

    Article  Google Scholar 

  39. Witkowski S, Serviente C. Endothelial dysfunction and menopause: is exercise an effective countermeasure? Climacteric. 2018;21:267–75.

    Article  CAS  PubMed  Google Scholar 

  40. Pereira-Neto EA, Lewthwaite H, Boyle T, Johnston K, Bennett H, Williams MT. Effects of exercise training with blood flow restriction on vascular function in adults: a systematic review and meta-analysis. PeerJ. 2021;9: e11554.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Qiu S, Cai X, Yin H, Sun Z, Zügel M, Steinacker JM, et al. Exercise training and endothelial function in patients with type 2 diabetes: a meta-analysis. Cardiovasc Diabetol. 2018;17:64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Dos Araujo Santos JE, Macedo FN, Barreto AS, Viana Dos Santos MR, Antoniolli AR, Quintans-Junior LJ. Effects of resistance and combined training on vascular function in type 2 diabetes: a systematic review of randomized controlled trials. Rev Diabet Stud. 2019;15:16–25.

    Article  Google Scholar 

  43. Brockow T, Conradi E, Ebenbichler G, Michalsen A, Resch KL. The role of mild systemic heat and physical activity on endothelial function in patients with increased cardiovascular risk: Results from a systematic review. Forsch Komplementarmed. 2011;18:24–30.

    Article  Google Scholar 

  44. Pearson MJ, Smart NA. Aerobic training intensity for improved endothelial function in heart failure patients: a systematic review and meta-analysis. Cardiol Res Pract. 2017;2017:1–10.

    Article  Google Scholar 

  45. Pearson MJ, Smart NA. Effect of exercise training on endothelial function in heart failure patients: a systematic review meta-analysis. Int J Cardiol. 2017;231:234–43.

    Article  CAS  PubMed  Google Scholar 

  46. Fecchio RY, Brito LC, Peçanha T, de Moraes Forjaz CL. Potential mechanisms behind the blood pressure-lowering effect of dynamic resistance training. Curr Hypertens Rep. 2021;23:35.

    Article  PubMed  Google Scholar 

  47. Kolmos M, Krawcyk RS, Kruuse C. Effect of high-intensity training on endothelial function in patients with cardiovascular and cerebrovascular disease: a systematic review. SAGE Open Med. 2016;4:205031211668225.

    Article  Google Scholar 

  48. Vuckovic KM, Piano MR, Phillips SA. Effects of exercise interventions on peripheral vascular endothelial vasoreactivity in patients with heart failure with reduced ejection fraction. Hear Lung Circ. 2013;22:328–40.

    Article  Google Scholar 

  49. Waclawovsky G, Pedralli ML, Eibel B, Schaun MI, Lehnen AM. Effects of different types of exercise training on endothelial function in prehypertensive and hypertensive individuals: a systematic review. Arq Bras Cardiol. 2021;116:938–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Beaudry RI, Liang Y, Boyton ST, Tucker WJ, Brothers RM, Daniel KM, et al. Meta-analysis of exercise training on vascular endothelial function in cancer survivors. Integr Cancer Ther. 2018;17:192–9.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Peçanha T, Bannell DJ, Sieczkowska SM, Goodson N, Roschel H, Sprung VS, et al. Effects of physical activity on vascular function in autoimmune rheumatic diseases: a systematic review and meta-analysis. Rheumatology. 2021;60:3107–20.

    Article  PubMed  Google Scholar 

  52. Montero D, Walther G, Benamo E, Perez-Martin A, Vinet A. Effects of exercise training on arterial function in type 2 diabetes mellitus: a systematic review and meta-analysis. Sport Med. 2013;43:1191–9.

    Article  Google Scholar 

  53. Pedralli ML, Eibel B, Waclawovsky G, Schaun MI, Nisa-Castro-Neto W, Umpierre D, et al. Effects of exercise training on endothelial function in individuals with hypertension: a systematic review with meta-analysis. J Am Soc Hypertens. 2018;12:e65-75.

    Article  PubMed  Google Scholar 

  54. Di FS, Sciartilli A, Di VV, Di BA, Gallina S. The effect of physical exercise on endothelial function. Sport Med. 2009;39:797–812.

    Article  Google Scholar 

  55. Parmenter BJ, Dieberg G, Smart NA. Exercise training for management of peripheral arterial disease: a systematic review and meta-analysis. Sport Med. 2015;45:231–44.

    Article  Google Scholar 

  56. Tesfamariam B, DeFelice AF. Endothelial injury in the initiation and progression of vascular disorders. Vascul Pharmacol. 2007;46:229–37.

    Article  CAS  PubMed  Google Scholar 

  57. Horiuchi M, Stoner L. Macrovascular and microvascular responses to prolonged sitting with and without bodyweight exercise interruptions: a randomized cross-over trial. Vasc Med. 2022;27:127–35.

    Article  CAS  PubMed  Google Scholar 

  58. Mendes R, Sousa N, Almeida A, Subtil P, Guedes-Marques F, Reis VM, et al. Exercise prescription for patients with type 2 diabetes: a synthesis of international recommendations: narrative review: Table 1. Br J Sports Med. 2016;50:1379–81.

    Article  PubMed  Google Scholar 

  59. Kanaley JA, Colberg SR, Corcoran MH, Malin SK, Rodriguez NR, Crespo CJ, et al. Exercise/physical activity in individuals with type 2 diabetes: a consensus statement from the American college of sports medicine. Med Sci Sports Exerc. 2022;54:353–68.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Tangvarasittichai S. Oxidative stress, insulin resistance, dyslipidemia and type 2 diabetes mellitus. World J Diabetes. 2015;6:456.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care. 2006;29:2518–27.

    Article  PubMed  Google Scholar 

  62. Praet SFE, van Loon LJC. Optimizing the therapeutic benefits of exercise in type 2 diabetes. J Appl Physiol. 2007;103:1113–20.

    Article  PubMed  Google Scholar 

  63. Hansen D, Niebauer J, Cornelissen V, Barna O, Neunhäuserer D, Stettler C, et al. Exercise prescription in patients with different combinations of cardiovascular disease risk factors: a consensus statement from the EXPERT working group. Sport Med. 2018;48:1781–97.

    Article  Google Scholar 

  64. Rajendran P, Rengarajan T, Thangavel J, Nishigaki Y, Sakthisekaran D, Sethi G, et al. The vascular endothelium and human diseases. Int J Biol Sci. 2013;9:1057–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Ross R, Tremblay M. Introduction to the Canadian 24-hour movement guidelines for adults aged 18–64 years and adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2020;45:v–xi.

    Article  PubMed  Google Scholar 

  66. Strath SJ, Holleman RG, Ronis DL, Swartz AM, Richardson CR. Objective physical activity accumulation in bouts and nonbouts and relation to markers of obesity in US adults. Prev Chronic Dis. 2008;5:A131.

    PubMed  PubMed Central  Google Scholar 

  67. Clarke J, Janssen I. Sporadic and bouted physical activity and the metabolic syndrome in adults. Med Sci Sports Exerc. 2014;46:76–83.

    Article  CAS  PubMed  Google Scholar 

  68. Glazer NL, Lyass A, Esliger DW, Blease SJ, Freedson PS, Massaro JM, et al. Sustained and shorter bouts of physical activity are related to cardiovascular health. Med Sci Sports Exerc. 2013;45:109–15.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Debasso R, Åstrand H, Bjarnegård N, Ahlgren ÅR, Sandgren T, Länne T. The popliteal artery, an unusual muscular artery with wall properties similar to the aorta: implications for susceptibility to aneurysm formation? J Vasc Surg. 2004;39:836–42.

    Article  CAS  PubMed  Google Scholar 

  70. Zumsteg JM, Cooper JS, Noon MS. Systematic review checklist: a standardized technique for assessing and reporting reviews of life cycle assessment data. J Ind Ecol. 2012;16:S12-21.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Thijssen DHJ, Black MA, Pyke KE, Padilla J, Atkinson G, Harris RA, et al. Assessment of flow-mediated dilation in humans: a methodological and physiological guideline. Am J Physiol Circ Physiol. 2011;300:H2-12.

    Article  CAS  Google Scholar 

  72. Thijssen DHJ, Bruno RM, van Mil ACCM, Holder SM, Faita F, Greyling A, et al. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans. Eur Heart J. 2019;40:2534–47.

    Article  PubMed  Google Scholar 

  73. Kowalczyk A, Kleniewska P, Kolodziejczyk M, Skibska B, Goraca A. The role of endothelin-1 and endothelin receptor antagonists in inflammatory response and sepsis. Arch Immunol Ther Exp (Warsz). 2015;63:41–52.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada

    Madeline E. Shivgulam, Haoxuan Liu, Beverly D. Schwartz, Jodi E. Langley, Derek S. Kimmerly & Myles W. O’Brien

  2. Cumming School of Medicine, Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada

    Nick W. Bray

  3. School of Physiotherapy (Faculty of Health) and Department of Medicine (Faculty of Medicine), Dalhousie University, Halifax, Nova Scotia, Canada

    Myles W. O’Brien

Authors
  1. Madeline E. Shivgulam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haoxuan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Beverly D. Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jodi E. Langley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nick W. Bray
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Derek S. Kimmerly
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Myles W. O’Brien
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Myles W. O’Brien.

Ethics declarations

Funding

MWO, HL, MES, and BDS were supported by a Nova Scotia Graduate Scholarship. MWO was also supported by a Heart & Stroke BrightRed Scholarship, a Research Nova Scotia—Scotia Scholars Award, a Killam PreDoctoral Scholarship, and a Fredrick Banting and Charles Best CIHR Doctoral Award. No other sources of funding were used to assist in the preparation of this article.

Conflicts of Interest/Competing Interests

Madeline Shivgulam, Haoxuan Liu, Beverly Schwartz, Jodi Langley, Nick Bray, Derek Kimmerly, and Myles O’Brien have no conflicts of interest that are directly relevant to the content of this article.

Ethics Approval

Not applicable.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Availability of Data and Material

Extracted data are available from the corresponding author upon reasonable request.

Code Availability

Not applicable.

Authors’ Contributions

MWO, JEL, and NWB conceptualized the study design and developed the search strategy and inclusion/exclusion criteria. MES, BDS, and HL screened identified articles for inclusion, extracted data, and conducted quality assessment of articles. MES and MWO drafted the manuscript. All authors edited, read, and approved the final manuscript.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 33 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shivgulam, M.E., Liu, H., Schwartz, B.D. et al. Impact of Exercise Training Interventions on Flow-Mediated Dilation in Adults: An Umbrella Review. Sports Med 53, 1161–1174 (2023). https://doi.org/10.1007/s40279-023-01837-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-023-01837-w

Search

Navigation