Effect of exercise modality and intensity on endothelial function in patients with cardiovascular disease: a systematic review and network meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of clinical trials
PubMed 41709755 · doi:10.1093/eurjpc/zwag118
What was done
A systematic review and frequentist network meta-analysis evaluated the effects of exercise modality (aerobic, resistance, combined) and intensity on brachial flow-mediated dilation (FMD) in adults with coronary artery disease or chronic heart failure. Literature was searched through April 2025 across randomized and non-randomized trials. Interventions were classified into usual care (UC), moderate-intensity aerobic exercise (MAE), high-intensity interval aerobic exercise (HIIE), moderate-intensity resistance exercise (MRE), high-intensity resistance exercise (HRE), moderate-intensity combined exercise (MCE), and high-intensity combined exercise (HCE). Mean differences (MD) with 95% confidence intervals (CI) and surface under the cumulative ranking curve (SUCRA) were calculated.
What was found
Across 37 studies (80 groups; n = 6,818 participants): - Compared to UC, significant improvements in FMD occurred with MAE (MD: 2.04%, 95% CI: 1.01 to 3.07), HIIE (MD: 3.47%, 95% CI: 2.02 to 4.92), MCE (MD: 2.71%, 95% CI: 0.05 to 5.36), and HCE (MD: 8.25%, 95% CI: 3.18 to 13.32). - MRE did not significantly improve FMD compared to UC. - HIIE significantly outperformed MAE (MD: 1.43%, 95% CI: 0.09 to 2.78). - HCE had the highest SUCRA (98.2%), but this estimate relied on only a single group. HIIE showed the most robust performance in sensitivity analyses (SUCRA: 84.0%) compared to MRE (61.6%) and MCE (61.3%).
Why it matters
This network meta-analysis provides comparative evidence that high-intensity interval aerobic exercise achieves superior improvements in endothelial function compared to traditional moderate-intensity continuous exercise in cardiac rehabilitation.
Limits
The review included non-randomized trials alongside randomized trials. The highest-ranked intervention (high-intensity combined exercise) was evaluated in only one group, resulting in wide confidence intervals. Clinical cardiovascular outcomes (such as rehospitalization or mortality) were not evaluated.
Cited by
- supports In volume-matched randomized controlled trials, high-intensity interval training consistently produces greater improvements in vascular endothelial function and arterial stiffness compared to moderate-intensity training.