Exercise Modalities and Endothelial Function: A Systematic Review and Dose–Response Meta-Analysis of Randomized Controlled Trials
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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.
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.
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.
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).
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.
KeywordsEndothelial Function Exercise Intensity Resistance Exercise Aerobic Exercise Exercise Intervention
AA is funded by the Ministry of Higher Education and Scientific Research of Iraq. JL and JCM acknowledge support from the LiveWell Programme, a research project funded through a collaborative grant from the Lifelong Health and Wellbeing (LLHW) initiative, managed by the Medical Research Council (MRC) (Grant number G0900686). The authors have no potential conflicts of interest that are directly relevant to the content of this review.
PROSPERO Database registration: CRD42014008988, http://www.crd.york.ac.uk/prospero/.
- 17.Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. http://www.cochrane-handbook.org.
- 21.Howley ET. Type of activity: resistance, aerobic and leisure versus occupational physical activity. Med Sci Sports Exerc. 2001;33(6 Suppl):S364–9; discussion S419–20.Google Scholar
- 25.Belardinelli R, Capestro F, Misiani A, et al. Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. Eur J Cardiovasc Prev Rehabil. 2006;13(5):818–25.PubMedCrossRefGoogle Scholar
- 28.Bhutani S, Klempel MC, Kroeger CM, et al. Alternate day fasting with or without exercise: Effects on endothelial function and adipokines in obese humans. e-SPEN J. 2013;8(5):e205–9.Google Scholar
- 29.Blumenthal JA, Sherwood A, Babyak MA, et al. Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: Results from the UPBEAT (understanding the prognostic benefits of exercise and antidepressant therapy) study. J Am Coll Cardiol. 2012;60(12):1053–63.PubMedCentralPubMedCrossRefGoogle Scholar
- 35.Erbs S, Hollriegel R, Linke A, et al. Exercise training in patients with advanced chronic heart failure (NYHA IIIb) promotes restoration of peripheral vasomotor function, induction of endogenous regeneration, and improvement of left ventricular function. Circul Heart Fail. 2010;3(4):486–94.CrossRefGoogle Scholar
- 40.Kitzman DW, Brubaker PH, Herrington DM, et al. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol. 2013;62(7):584–92.PubMedCentralPubMedCrossRefGoogle Scholar
- 42.Kwon HR, Min KW, Ahn HJ, et al. Effects of aerobic exercise vs. resistance training on endothelial function in women with type 2 diabetes mellitus. Diabetes Metab J. 2011;35(4):364–73. doi: 10.4093/dmj.2011.35.4.364.
- 43.Lavrenčič A, Salobir BG, Keber I. Physical training improves flow-mediated dilation in patients with the polymetabolic syndrome. Arterioscler Thromb Vasc Biol. 2000;20(2):551–5.Google Scholar
- 47.Munk PS, Staal EM, Butt N, et al. High-intensity interval training may reduce in-stent restenosis following percutaneous coronary intervention with stent implantation: a randomized controlled trial evaluating the relationship to endothelial function and inflammation. Am Heart J. 2009;158(5):734–41. doi: 10.1016/j.ahj.2009.08.021.PubMedCrossRefGoogle Scholar
- 49.Ramirez-Velez R, Aguilar de Plata AC, Escudero MM, et al. Influence of regular aerobic exercise on endothelium-dependent vasodilation and cardiorespiratory fitness in pregnant women. J Obstet Gynaecol Res. 2011;37(11):1601–8. doi: 10.1111/j.1447-0756.2011.01582.x.
- 54.Swift DL, Earnest CP, Blair SN, et al. The effect of different doses of aerobic exercise training on endothelial function in postmenopausal women with elevated blood pressure: results from the DREW study. Br J Sports Med. 2012;46(10):753–8. doi: 10.1136/bjsports-2011-090025.PubMedCrossRefGoogle Scholar
- 72.Okamoto T, Masuhara M, Ikuta K. Combined aerobic and resistance training and vascular function: effect of aerobic exercise before and after resistance training. J Appl Physiol (1985). 2007;103(5):1655-61. doi: 10.1152/japplphysiol.00327.2007.
- 73.Walsh JH, Bilsborough W, Maiorana A, et al. Exercise training improves conduit vessel function in patients with coronary artery disease. J Appl Physiol (1985). 2003;95(1):20–5. doi: 10.1152/japplphysiol.00012.2003.
- 75.Newcomer SC, Thijssen DH, Green DJ. Effects of exercise on endothelium and endothelium/smooth muscle cross talk: role of exercise-induced hemodynamics. J Appl Physiol (1985). 2011;111(1):311–20. doi: 10.1152/japplphysiol.00033.2011.