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

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          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.

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          Most cited references188

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          Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals.

          Philip Greenland, Laurie LaBree, Stanley Azen … (2004)
          Guidelines advise that all adults undergo coronary heart disease (CHD) risk assessment to guide preventive treatment intensity. Although the Framingham Risk Score (FRS) is often recommended for this, it has been suggested that risk assessment may be improved by additional tests such as coronary artery calcium scoring (CACS). To determine whether CACS assessment combined with FRS in asymptomatic adults provides prognostic information superior to either method alone and whether the combined approach can more accurately guide primary preventive strategies in patients with CHD risk factors. Prospective observational population-based study, of 1461 asymptomatic adults with coronary risk factors. Participants with at least 1 coronary risk factor (>45 years) underwent computed tomography (CT) examination, were screened between 1990-1992, were contacted yearly for up to 8.5 years after CT scan, and were assessed for CHD. This analysis included 1312 participants with CACS results; excluded were 269 participants with diabetes and 14 participants with either missing data or had a coronary event before CACS was performed. Nonfatal myocardial infarction (MI) or CHD death. During a median of 7.0 years of follow-up, 84 patients experienced MI or CHD death; 70 patients died of any cause. There were 291 (28%) participants with an FRS of more than 20% and 221 (21%) with a CACS of more than 300. Compared with an FRS of less than 10%, an FRS of more than 20% predicted the risk of MI or CHD death (hazard ratio [HR], 14.3; 95% confidence interval [CI]; 2.0-104; P =.009). Compared with a CACS of zero, a CACS of more than 300 was predictive (HR, 3.9; 95% CI, 2.1-7.3; P<.001). Across categories of FRS, CACS was predictive of risk among patients with an FRS higher than 10% (P<.001) but not with an FRS less than 10%. These data support the hypothesis that high CACS can modify predicted risk obtained from FRS alone, especially among patients in the intermediate-risk category in whom clinical decision making is most uncertain.
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            AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee.

            Thomas A Pearson, Steven N. Blair, Stephen R Daniels … (2002)
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              Mortality trends in the general population: the importance of cardiorespiratory fitness

              Duck-Chul Lee, Enrique G Artero, Xuemei Sui … (2010)
              Cardiorespiratory fitness (CRF) is not only an objective measure of habitual physical activity, but also a useful diagnostic and prognostic health indicator for patients in clinical settings. Although compelling evidence has shown that CRF is a strong and independent predictor of all-cause and cardiovascular disease mortality, the importance of CRF is often overlooked from a clinical perspective compared with other risk factors such as hypertension, diabetes, smoking, or obesity. Several prospective studies indicate that CRF is at least as important as the traditional risk factors, and is often more strongly associated with mortality. In addition, previous studies report that CRF appears to attenuate the increased risk of death associated with obesity. Most individuals can improve their CRF through regular physical activity. Several biological mechanisms suggest that CRF improves insulin sensitivity, blood lipid profile, body composition, inflammation, and blood pressure. Based on the evidence, health professionals should encourage their patients to improve CRF through regular physical activity.
              Article 0 comments Cited 154 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Am Heart Assoc
                Journal ID (iso-abbrev): J Am Heart Assoc
                Journal ID (publisher-id): jah3
                Title: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                Publisher: John Wiley & Sons, Ltd (Chichester, UK )
                ISSN (Print): 2047-9980
                ISSN (Electronic): 2047-9980
                Publication date Collection: July 2015
                Publication date (Electronic): 25 June 2015
                Volume: 4
                Issue: 7
                Electronic Location Identifier: e002014
                Affiliations
                [1 ]Department of Epidemiology, School of Public Health, Brown University Providence, RI
                [2 ]Division of Cardiology and Veterans Affairs Medical Center, Department of Medicine, Alpert Medical School, Brown University Providence, RI
                [3 ]Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University Indianapolis, IN
                [4 ]Center for the Youth Sport Research and Development, China Institute of Sport Science Beijing, China
                [5 ]Geriatrics, Research, Education and Clinical Centers, VA Greater Los Angeles Healthcare System Los Angeles, CA
                [6 ]Department of Kinesiology, Center for Physical Activity in Wellness and Prevention, Indiana University-Purdue University at Indianapolis IN
                [7 ]Division of Endocrinology, Department of Medicine, Rhode Island Hospital Providence, RI
                Author notes
                Correspondence to: Simin Liu, MD, ScD, Department of Epidemiology and Medicine, Brown University, 121 South Main St, Providence, RI 02903. E-mail: Simin_liu@ 123456brown.edu and Yiqing Song, MD, ScD, Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, 714 North Senate Avenue, Indianapolis, IN 46202. E-mail: yiqsong@ 123456iu.edu
                Article
                DOI: 10.1161/JAHA.115.002014
                PMC ID: 4608087
                PubMed ID: 26116691
                SO-VID: c5faa310-96b5-45cb-b5aa-21110810af29
                Copyright © © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
                License:

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date received : 02 April 2015
                Date accepted : 30 April 2015
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: biomarker,cardiometabolic health,cardiovascular disease prevention,exercise training
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: biomarker, cardiometabolic health, cardiovascular disease prevention, exercise training

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