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Meta-Analysis
. 2015 Jun 26;4(7):e002014.
doi: 10.1161/JAHA.115.002014.

Effects of Exercise Training on Cardiorespiratory Fitness and Biomarkers of Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Xiaochen Lin  1 , Xi Zhang  2 , Jianjun Guo  3 , Christian K Roberts  4 , Steve McKenzie  5 , Wen-Chih Wu  6 , Simin Liu  7 , Yiqing Song  2
Affiliations
Meta-Analysis

Effects of Exercise Training on Cardiorespiratory Fitness and Biomarkers of Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Xiaochen Lin et al. J Am Heart Assoc. .

Abstract

Background: Guidelines recommend exercise for cardiovascular health, although evidence from trials linking exercise to cardiovascular health through intermediate biomarkers remains inconsistent. We performed a meta-analysis of randomized controlled trials to quantify the impact of exercise on cardiorespiratory fitness and a variety of conventional and novel cardiometabolic biomarkers in adults without cardiovascular disease.

Methods and results: Two researchers selected 160 randomized controlled trials (7487 participants) based on literature searches of Medline, Embase, and Cochrane Central (January 1965 to March 2014). Data were extracted using a standardized protocol. A random-effects meta-analysis and systematic review was conducted to evaluate the effects of exercise interventions on cardiorespiratory fitness and circulating biomarkers. Exercise significantly raised absolute and relative cardiorespiratory fitness. Lipid profiles were improved in exercise groups, with lower levels of triglycerides and higher levels of high-density lipoprotein cholesterol and apolipoprotein A1. Lower levels of fasting insulin, homeostatic model assessment-insulin resistance, and glycosylated hemoglobin A1c were found in exercise groups. Compared with controls, exercise groups had higher levels of interleukin-18 and lower levels of leptin, fibrinogen, and angiotensin II. In addition, we found that the exercise effects were modified by age, sex, and health status such that people aged <50 years, men, and people with type 2 diabetes, hypertension, dyslipidemia, or metabolic syndrome appeared to benefit more.

Conclusions: This meta-analysis showed that exercise significantly improved cardiorespiratory fitness and some cardiometabolic biomarkers. The effects of exercise were modified by age, sex, and health status. Findings from this study have significant implications for future design of targeted lifestyle interventions.

Keywords: biomarker; cardiometabolic health; cardiovascular disease prevention; exercise training.

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Figures

Figure 1
Figure 1
Summary of study selection process. In total, 6135 articles were retrieved from the literature search that evaluated the effect of exercise interventions on CRF or cardiometabolic biomarkers. We excluded 5796 articles after abstract review and 170 after full text examination. After exclusion, 160 RCTs reported in 169 articles were included in the meta-analysis. Apo AI indicates apolipoprotein A1; Apo AII, apolipoprotein A2; Apo B, apolipoprotein B; CRF, cardiorespiratory fitness; CRP, C-reactive protein; FFA, free fatty acid; HbA1c, glycosylated hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; HOME-B, homeostatic model assessment-beta cell function; HOMA-IR, homeostatic model assessment–insulin resistance; HOMA-S, homeostatic model assessment-insulin sensitivity; ICAM-1, intercellular adhesion molecule 1; IGF-1, insulin-like growth factor 1; IGF-BP, insulin-like growth factor binding protein; IL, interleukin; LDL-C, low-density lipoprotein cholesterol; Lp(a), lipoprotein(a); PAI-1, plasminogen activator inhibitor-1; RCTs, randomized controlled trials; TC, total cholesterol; TG, triglycerides; TNF-α, tumor necrosis factor α; VCAM-1, vascular cell adhesion molecule 1; VLDL-C, very low-density lipoprotein cholesterol.
Figure 2
Figure 2
Assessment of risk of bias: summary for items of bias.
Figure 3
Figure 3
Forest plot of effects of exercise interventions on cardiorespiratory fitness, TC, TG, HDL-C, LDL-C, Fasting glucose, and fasting insulin within subgroups. The WMDs (diamonds) and corresponding CIs (extended line) between exercise groups and control groups are shown for each subgroup. Abs. CRF indicates absolute cardiorespiratory fitness; BMI, body mass index; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Rel. CRF, relative cardiorespiratory fitness; TC, total cholesterol; TG, triglycerides; WMDs, weighted mean differences.
Figure 4
Figure 4
Mechanisms by which exercise training may improve cardiovascular health.
See this image and copyright information in PMC

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