Key result
Caloric restriction alone and combined with exercise demonstrated the most positive effects on cardiovascular health indicators, ranking highest for reducing triglycerides, total cholesterol, and LDL.
Why the study?
Substantial variability exists in the efficacy of different exercise and dietary interventions on CVD outcomes, and a lack of direct comparisons complicates determining their relative effects.
Do exercise and dietary interventions (alone or combined) improve cardiovascular health indicators in adults?
Meta-Analysis (n=2,023)
Do exercise and dietary interventions (alone or combined) improve cardiovascular health indicators in adults?
Calorie restriction, either alone or combined with exercise, appears to be the most effective lifestyle intervention strategy for improving lipid profiles and blood pressure compared to other fasting or ketogenic diets.
BACKGROUND: Numerous studies have shown that exercise and dietary interventions positively impact CVD outcomes; however, there is substantial variability in the efficacy of different interventions. The absence of direct comparisons between multiple interventions complicates the determination of their relative effects. This study aims to synthesize the literature on the impacts of exercise, dietary, and combined interventions on cardiovascular health indicators, and to perform a network meta-analysis to rank the efficacy of these approaches, providing a theoretical foundation for selecting optimal intervention strategies. METHODS: We systematically reviewed the literature from database inception through September 2024, searching PubMed, Web of Science, Embase, and the Cochrane Library. Data were aggregated and analyzed using network meta-analysis, with intervention efficacy ranked according to Surface Under the Cumulative Ranking (SUCRA) curves. RESULTS: The efficacy of these interventions was ranked as follows: 1). Triglycerides (TG) Reduction: CR + EX > CR > 5/2F + EX > TRF + EX > KD > 5/2F > KD + EX > EX > CON > TRF. 2). Total Cholesterol (TC) Reduction: CR + EX > CR > 5/2F + EX > 5/2F > TRF + EX > EX > CON > KD > TRF > KD + EX. 3). High-Density Lipoprotein (HDL) Increase: 5/2F > KD > KD + EX > TRF + EX > CON > EX > TRF > 5/2F + EX > CR + EX > CR. 4). Low-Density Lipoprotein (LDL) Reduction: CR + EX > CR > TRF + EX > KD + EX > EX > KD > 5/2F > CON > 5/2F + EX > TRF. 5). Systolic Blood Pressure (SBP) Reduction: 5/2F > CR + EX > CR > EX > TRF > TRF + EX > CON > 5/2F + EX. 6). Diastolic Blood Pressure (DBP) Reduction: CR > CR + EX > TRF > 5/2F > TRF + EX > EX > CON > 5/2F + EX. CONCLUSION: CR and CR + EX demonstrated the most positive effects on cardiovascular health indicators. In contrast, 5/2F + EX ranked relatively low in effectiveness, with its impact on several indicators being even lower than that of CON.
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Yongchao Xie (2025) conducted a meta-analysis in Healthy individuals (n=2,023). Exercise combined with dietary interventions (Caloric Restriction, Intermittent Fasting, Ketogenic Diet) vs. Control, exercise alone, or diet alone was evaluated on Cardiovascular health indicators (TG, TC, HDL, LDL, SBP, DBP). Caloric restriction alone and combined with exercise demonstrated the most positive effects on cardiovascular health indicators, ranking highest for reducing triglycerides, total cholesterol, and LDL.
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