Sports Medicine

, Volume 45, Issue 2, pp 279–296 | Cite as

Exercise Modalities and Endothelial Function: A Systematic Review and Dose–Response Meta-Analysis of Randomized Controlled Trials

  • Ammar W. Ashor
  • Jose Lara
  • Mario Siervo
  • Carlos Celis-Morales
  • Clio Oggioni
  • Djordje G. Jakovljevic
  • John C. Mathers
Systematic Review

Abstract

Background

Regular exercise is associated with enhanced nitric oxide (NO) bioavailability. Flow-mediated dilation (FMD) is used widely to assess endothelial function (EF) and NO release.

Objectives

The aims of this systematic review and meta-analysis were to (i) investigate the effect of exercise modalities (aerobic, resistance or combined) on FMD; and (ii) determine which exercise and participant characteristics are most effective in improving FMD.

Methods

We searched the MEDLINE, Embase, Cochrane Library, and Scopus databases for studies that met the following criteria: (i) randomized controlled trials of exercise with comparative non-exercise, usual care or sedentary groups; (ii) duration of exercise intervention ≥4 weeks; (iii) age ≥18 years; and (iv) EF measured by FMD before and after the intervention. Weighted mean differences (WMDs) with 95 % confidence interval were entered into a random effect model to estimate the pooled effect of the exercise interventions.

Results

All exercise modalities enhanced EF significantly: aerobic (WMD 2.79, 95 % CI 2.12–3.45, p = 0.0001), resistance (WMD 2.52, 95 % CI 1.11–3.93, p = 0.0001) and combined (WMD 2.07, 95 % CI 0.70–3.44, p = 0.003). A dose–response relationship was observed between aerobic exercise intensity and improvement in EF. A 2 metabolic equivalents (MET) increase in absolute exercise intensity or a 10 % increase in relative exercise intensity resulted in a 1 % unit improvement in FMD. There was a positive relationship between frequency of resistance exercise sessions and improvement in EF (β 1.14, CI 0.16–2.12, p = 0.027).

Conclusions

All exercise modalities improve EF significantly and there was a significant, positive relationship between aerobic exercise intensity and EF. Greater frequency, rather than intensity, of resistance exercise training enhanced EF.

Supplementary material

40279_2014_272_MOESM1_ESM.pdf (819 kb)
Supplementary material 1 (PDF 819 kb)

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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Ammar W. Ashor
    • 1
    • 2
  • Jose Lara
    • 1
  • Mario Siervo
    • 1
  • Carlos Celis-Morales
    • 1
  • Clio Oggioni
    • 1
  • Djordje G. Jakovljevic
    • 3
  • John C. Mathers
    • 1
  1. 1.Human Nutrition Research Centre, Institute of Cellular MedicineNewcastle UniversityNewcastle on TyneUK
  2. 2.College of MedicineUniversity of Al-MustansiriyahBaghdadIraq
  3. 3.Institute of Cellular MedicineNewcastle UniversityFramlington PlaceUK

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