Exercise training for the management of dyslipidaemia. A position statement from Exercise and Sports Science Australia (ESSA)

OBJECTIVES: This position stand will aim to summarise the effect of different lipid markers on cardiovascular disease (CVD) progression; determine the exercise prescription (ExRx) to optimise favourable lipid profile changes; ascertain if an optimal exercise prescription exists for different types of dyslipidaemias; and provide recommendations for ExRx for dyslipidaemia. METHODS: Synthesis of published literature on exercise training and lipid profiles. RESULTS: Total cholesterol (TC), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), triglycerides (TG) and very low density lipoprotein (VLDL-C) respond favourably to exercise training, but the effect sizes are moderate compared to lipid lowering medication (LLM). Apolipoproteins respond favourably to exercise training, but less evidence currently exists. A combination (CT) of aerobic (AT) and resistance (RT) training is optimal to improve lipid profile. For dyslipidaemia and hyperlipidaemia, one should consider greater emphasis on AT, whilst for hypoalphalipoproteinemia RT may be prioritised. Lipid changes observed with exercise are modest but offer a valuable complement to dietary therapy and may delay onset or reduce initial dose of dyslipidaemia medication in people treated for primary CVD prevention. Each extra week of exercise training appears to induce a -0.5 mg/dl reduction in TC. Session time, exercise intensity and frequency should be increased in this order for programme progression. CONCLUSIONS: Lipids and apolipoproteins respond favourably to exercise training and the effect size is moderate. Both AT and CT improved all lipids, only HDL was improved with RT, so CT appears optimal. It appears that greater exercise programme volume, defined primarily by longer session (minutes) and programme (weeks) times, and hence cardiorespiratory fitness, seems to lead to further improvements in lipid profile.