Effects of exercise modalities on central hemodynamics, arterial stiffness and cardiac function in cardiovascular disease: Systematic review and meta-analysis of randomized controlled trials

Yahui Zhang; Lin Qi; Lisheng Xu; Xingguo Sun; Wenyan Liu; Shuran Zhou; Frans van de Vosse; Stephen E Greenwald

doi:10.1371/journal.pone.0200829

Effects of exercise modalities on central hemodynamics, arterial stiffness and cardiac function in cardiovascular disease: Systematic review and meta-analysis of randomized controlled trials

PLoS One. 2018 Jul 23;13(7):e0200829. doi: 10.1371/journal.pone.0200829. eCollection 2018.

Authors

Yahui Zhang¹, Lin Qi¹, Lisheng Xu^{1

2}, Xingguo Sun³, Wenyan Liu¹, Shuran Zhou¹, Frans van de Vosse^{1

4}, Stephen E Greenwald⁵

Affiliations

¹ Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China.
² Key Laboratory of Medical Image Computing, Ministry of Education, Northeastern University, Shenyang, Liaoning, China.
³ Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Beijing, China.
⁴ Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
⁵ Blizard Institute, Barts & The London School of Medicine &Dentistry, Queen Mary University of London, London, United Kingdom.

Abstract

Background: Exercise is accepted as an important contribution to the rehabilitation of patients with cardiovascular disease (CVD). This study aims to better understand the possible causes for lack of consensus and reviews the effects of three exercise modalities (aerobic, resistance and combined exercise) on central hemodynamics, arterial stiffness and cardiac function for better rehabilitation strategies in CVD.

Methods: The electronic data sources, Cochrane Library, MEDLINE, Web of Science, EBSCO (CINAHL), and ScienceDirect from inception to July 2017 were searched for randomized controlled trials (RCTs) investigating the effect of exercise modalities in adult patients with CVD. The effect size was estimated as mean differences (MD) with 95% confidence intervals (CI). Subgroup analysis and meta-regression were used to study potential moderating factors.

Results: Thirty-eight articles describing RCTs with a total of 2089 patients with CVD were included. The pooling revealed that aerobic exercise [MD(95%CI) = -5.87 (-8.85, -2.88), P = 0.0001] and resistance exercise [MD(95%CI) = -7.62 (-10.69, -4.54), P<0.00001] significantly decreased aortic systolic pressure (ASP). Resistance exercise significantly decreased aortic diastolic pressure [MD(95%CI) = -4(-5.63, -2.37), P<0.00001]. Aerobic exercise significantly decreased augmentation index (AIx) based on 24-week exercise duration and patients aged 50-60 years. Meanwhile, aerobic exercise significantly improved carotid-femoral pulse wave velocity (cf-PWV) [MD(95%CI) = -0.42 (-0.83, -0.01), P = 0.04], cardiac output (CO) [MD(95% CI) = 0.36(0.08, 0.64), P = 0.01] and left ventricular ejection fraction (LVEF) [MD(95%CI) = 3.02 (2.11, 3.93), P<0.00001]. Combined exercise significantly improved cf-PWV [MD(95%CI) = -1.15 (-1.95, -0.36), P = 0.004] and CO [MD(95% CI) = 0.9 (0.39, 1.41), P = 0.0006].

Conclusions: Aerobic and resistance exercise significantly decreased ASP, and long-term aerobic exercise reduced AIx. Meanwhile, aerobic and combined exercise significantly improved central arterial stiffness and cardiac function in patients with CVD. These findings suggest that a well-planned regime could optimize the beneficial effects of exercise and can provide some evidence-based guidance for those involved in cardiovascular rehabilitation of patients with CVD.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adult
Aged
Blood Pressure
Cardiac Rehabilitation
Cardiovascular Diseases / physiopathology*
Exercise*
Female
Heart / physiology*
Heart Rate
Hemodynamics
Humans
Male
Middle Aged
Pulse Wave Analysis
Randomized Controlled Trials as Topic
Regression Analysis
Vascular Stiffness*
Ventricular Function, Left
Young Adult

Grants and funding

The research reported here was, in part, supported by the National Natural Science Foundation of China (Nos. 61773110, 61374015, and 61202258 to LX), and the Fundamental Research Funds for the Central Universities (N161904002 to LX, N172008008 to LQ and N171904009 to LX). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.