What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: High risk for cardiovascular disease (n=2034). Intervention: Combined training vs. No intervention, routine care, or health education. Primary outcome: Pulse wave velocity (PWV) (SMD -0.69, 95% CI -1.17 to -0.21, p=<0.0001).

What does this research mean for the field?

Combined training is the most effective exercise intervention for reducing pulse wave velocity (arterial stiffness) in individuals at high risk for cardiovascular disease, while interval training is most effective for lowering systolic blood pressure. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 27, 2025Open Access

Comparative effectiveness of exercise interventions on arterial stiffness in individuals at risk for cardiovascular disease: a systematic review and network meta-analysis

Q: What are the key findings of this study?

Combined training significantly reduced pulse wave velocity (SMD -0.69) compared to control in individuals at high risk for cardiovascular disease, ranking as the most effective exercise intervention.

Q: What does this research mean for the field?

Combined training is the most effective exercise intervention for reducing pulse wave velocity (arterial stiffness) in individuals at high risk for cardiovascular disease, while interval training is most effective for lowering systolic blood pressure. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

RWRongwei WuHunan University of Science and Technology YZYan ZhangZhejiang Chinese Medical University XYXinwang YuanBeijing Sport University

Key Result

Combined training significantly reduced pulse wave velocity (SMD -0.69) compared to control in individuals at high risk for cardiovascular disease, ranking as the most effective exercise intervention.

Study Design

Type

Meta-Analysis (n=2,034)

Structured PICO

Do different exercise interventions (interval, aerobic, resistance, or combined training) improve arterial stiffness and blood pressure in individuals at high risk for cardiovascular disease?

Population

2,034 participants from 43 randomized controlled trials, individuals at high risk for cardiovascular disease (CVD) as per American College of Sports Medicine guidelines (including obesity, diabetes, hypertension, metabolic syndrome, older adults, and postmenopausal women), aged 10-75 years, approximately 51% women.

Intervention

Exercise interventions including interval training (INT), aerobic exercise (AE), resistance exercise (RT), and combined exercise (CT) at moderate to high intensity, 3 to 7 times per week, 30-90 minutes per session, for a duration of 8 to 96 weeks.

Comparator

Control groups engaging in no intervention, routine care, or health education.

Outcome

Pulse wave velocity (PWV) as a measure of arterial stiffnesssurrogate

In individuals at high risk for cardiovascular disease, combined training is the most effective exercise modality for improving arterial stiffness, while interval training is most effective for lowering systolic blood pressure.

Main Result

Effect estimate: SMD -0.69 (95% CI -1.17 to -0.21)

p-value: p=<0.0001

Limitations

Excluded other forms of exercise like mental and physical exercises, stretching, and pharmacological treatments
Did not include other measures of arterial stiffness such as augmentation index, blood lipids, and blood sugar
Insufficient sample size for subgroup analyses on exercise intensity
Significant unresolved heterogeneity in the combined training (CT) studies

Abstract

Background: Previous studies have shown that exercise can improve arterial stiffness (AS). However, it remains unclear which type of exercise is most effective for managing AS, particularly in individuals at high risk for cardiovascular diseases (CVD). This review aims to evaluate the effects of various exercises on AS and related variables in individuals at high risk for CVD. Methods: A comprehensive search strategy was employed to systematically explore MEDLINE (PubMed), Embase, Cochrane Library, EBSCOhost, and Web of Science to identify relevant studies. Inclusion criteria were: (1) randomized controlled trials; (2) participants with known CVD risk factors as per the American College of Sports Medicine guidelines; (3) interventions including interval training (INT), aerobic exercise (AE), resistance exercise, and combined exercise (CT); (4) control groups engaging in no intervention, routine care, or health education; (5) outcome measures of pulse wave velocity (PWV), systolic blood pressure (SBP), and diastolic blood pressure; and (6) studies published in English. Studies were assessed using the Cochrane risk of bias tool and analyzed with a random-effects network meta-analysis. Results: = 43%) significantly reduced SBP. Surface under the cumulative ranking curve (SUCRA) showed that CT (SUCRA = 87.2) was the most effective for lowering PWV, while INT (SUCRA = 81.3) was the most effective for lowering SBP. Conclusion: In high-risk populations for CVD, CT was most effective in improving AS, while INT demonstrated the greatest reduction in SBP. AE showed greater benefits at moderate to low intensities. Due to significant heterogeneity in CT, its results should be interpreted with caution. Further research with larger sample sizes is needed to confirm these findings.

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