Abstract
Aerobic exercise has been confirmed to improve endothelial function (EF). However, the effect of resistance exercise (RE) on EF remains controversial. We conducted this systematic review and meta-analysis on randomized controlled trials (RCTs) to determine the effect of RE and its intensities on EF. We searched Web of Science, PubMed/MEDLINE, Scopus, and Wiley Online Library, and included 15 articles (17 trials) for the synthesis. Overall, RE intervention significantly improved flow-mediated dilatation (FMD) in brachial artery (SMD = 0.76; 95% CI: 0.47, 1.05; p < 0.00001), which represents improved EF. Meta-regression showed that the RE intensity was correlated with changes in FMD (Coef. = −0.274, T = −2.18, p = 0.045). We found both intensities of RE improved FMD, but the effect size for the low- to moderate-intensity (30–70%1RM) was bigger (SMD = 1.02; 95% CI: 0.60, 1.43; p < 0.0001) than for the high-intensity (≥70%1RM; SMD = 0.48; 95% CI: 0.21, 0.74; p = 0.005). We further noticed that RE had a beneficial effect (SMD = 0.61; 95% CI: 0.13, 1.09; p = 0.01) on the brachial artery baseline diameter at rest (BADrest), and the age variable was correlated with the changes in BADrest after RE (Coef. = −0.032, T = −2.33, p = 0.038). Young individuals (<40 years) presented with a bigger effect size for BADrest (SMD = 1.23; 95% CI: 0.30, 2.15; p = 0.009), while middle-aged to elderly (≥40 years) were not responsive to RE (SMD = 0.07; 95% CI: −0.28, 0.42; p = 0.70). Based on our findings, we conclude that RE intervention can improve the EF, and low- to moderate-intensity is more effective than high-intensity.
Highlights
Vascular endothelial dysfunction is an independent risk factor for predicting cardiovascular diseases (CVDs), and is closely associated with the occurrence of several CVDs, such as hypertension, atherosclerosis, heart failure, and metabolic syndrome [1,2,3].Impaired endothelial function (EF) can lead to the deterioration of the blood vessel wall, and eventually accelerate the atherosclerotic process, and is used as an overall physiological indicator of vascular health [4]
We found that resistance exercise (RE) had a significant effect on Flow-mediated dilatation (FMD) improvement (SMD = 0.76; 95% confidence interval (CI): 0.47, 1.05; p < 0.00001)
The test for subgroup differences between low- to moderate-intensity and high-intensity were statistically significant (Chi2 = 4.64, I2 = 78.4%, p = 0.03). These findings indicate that improved FMD with a low- to moderate-intensity RE is more effective than highintensity RE
Summary
Vascular endothelial dysfunction is an independent risk factor for predicting cardiovascular diseases (CVDs), and is closely associated with the occurrence of several CVDs, such as hypertension, atherosclerosis, heart failure (stroke), and metabolic syndrome [1,2,3].Impaired endothelial function (EF) can lead to the deterioration of the blood vessel wall, and eventually accelerate the atherosclerotic process, and is used as an overall physiological indicator of vascular health [4]. Vascular endothelial dysfunction is an independent risk factor for predicting cardiovascular diseases (CVDs), and is closely associated with the occurrence of several CVDs, such as hypertension, atherosclerosis, heart failure (stroke), and metabolic syndrome [1,2,3]. It uses the ultrasound method to measure the diameter of the arteries at baseline, as well as after reactive hyperaemia secondary to temporary occlusion, and calculates the percentage increase of the peak diameter compared with baseline. The reliability and validity of the brachial artery FMD has been confirmed as a valid marker for assessing cardiovascular risk [5,6], and the data support the stability and reproducibility of brachial FMD [6].
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