What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Adults (various health statuses) (n=1370). Intervention: Exercise vs. Usual care. Primary outcome: Carotid intima-media thickness (cIMT) (WMD -0.02, 95% CI -0.03 to -0.01, p=0.006).

January 1, 2022

Effect of Exercise on Carotid Artery Intima–Media Thickness in Adults: A Systematic Review and Meta-Analysis

Key Result

Exercise significantly reduced carotid intima-media thickness in adults compared with usual care controls (WMD -0.02 mm).

Study Design

Type

Meta-Analysis (n=1,370)

Structured PICO

Does exercise reduce carotid intima-media thickness in adults?

Population

1370 adult participants (aged ≥18 y) from 26 studies (32 study groups). 24 study groups evaluated participants with diseases. Multinational (Asia n=14, United States n=6, Europe n=5).

Intervention

Physical activity (exercise) as a single intervention, including aerobic exercise, resistance exercise, combined aerobic and resistance exercise (CARE), high-intensity interval exercises (HIIE), moderate-intensity continuous exercise (MICE), and endurance exercise. Duration of intervention ranged from 2 to 12 months.

Comparator

Usual care (allowed participation in unplanned, unstructured, daily exercises). Studies using individuals with a sedentary lifestyle as controls were excluded.

Outcome

Carotid intima-media thickness (cIMT) measured by B-mode sonographysurrogate

Exercise, particularly aerobic exercise for more than 6 months, is associated with a significant reduction in carotid intima-media thickness in adults, suggesting a beneficial effect on subclinical atherosclerosis.

Main Result

Effect estimate: WMD -0.02 (95% CI -0.03 to -0.01)

p-value: p=0.006

Limitations

The included studies did not report safety indicators with exercise.
The meta-analysis only included publicly available documents and excluded unpublished documents.
Some subgroups in the analysis included fewer studies and had higher heterogeneity.

Abstract

BACKGROUND: Carotid intima-media thickness (cIMT) is a validated surrogate marker of atherosclerosis that is independently associated with the risk for cardiovascular disease. Recent studies on the effect of exercise on cIMT have yielded conflicting results. METHODS: Studies that were available up until October 30, 2021 from the PubMed, Cochrane Library, Embase, and Web of Science databases were included in the analysis. Subgroup analyses were performed to determine the effects of the type, intensity, and duration of exercise on cIMT. RESULTS: This review included 26 studies with 1370 participants. Compared with control participants, those who engaged in exercise showed a decline in cIMT (weighted mean difference WMD -0.02; 95% confidence interval CI, -0.03 to -0.01; I2 = 90.1%). Participants who engaged in aerobic (WMD -0.02; 95% CI, -0.04 to -0.01; I2 = 52.7%) or resistance (WMD -0.01; 95% CI, -0.02 to -0.00; I2 = 38.5%) exercise showed lower cIMT compared with control participants. An exercise duration of >6 months was associated with a 0.02 mm reduction in cIMT. In participants with low cIMT at baseline (<0.7 mm), exercise alone was not associated with a change in cIMT (WMD -0.01; 95% CI, -0.03 to 0.00; I2 = 93.9%). CONCLUSIONS: Exercise was associated with reduced cIMT in adults. Aerobic exercise is associated with a greater decline in cIMT than other forms of exercise. Large, multicenter, randomized controlled trials are required to establish optimal exercise protocols for improving the pathological process of atherosclerosis.

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