Cardiac Rehabilitation Improves Endothelial Function in Coronary Artery Disease Patients

Abstract

Exercise-based cardiac rehabilitation may be an effective non-pharmacological intervention for improving endothelial function in coronary artery disease patients. Therefore, this systematic review with meta-analysis aimed to (a) estimate the training-induced effect on endothelial and vascular smooth muscle function, assessed by flow-mediated dilation and nitroglycerin-mediated dilation, respectively, in coronary artery disease patients; and to (b) study the influence of potential trial-level variables (i. e. study and intervention characteristics) on the training-induced effect on endothelial and vascular smooth muscle function. Electronic searches were performed in Pubmed, Scopus, and Embase up to February 2021. Random-effects models of standardised mean change were estimated. Heterogeneity analyses were performed by using the Chi 2 test and I 2 index. Our results showed that exercise-based cardiac rehabilitation significantly enhanced flow-mediated dilation (1.04 [95% confidence interval=0.76 to 1.31]) but did not significantly change nitroglycerin-mediated dilation (0.05 [95% confidence interval=–0.03 to 0.13]). Heterogeneity testing reached statistical significance (p<.001) with high inconsistency for flow-mediated dilation (I 2 =92%). Nevertheless, none of the analysed variables influenced the training-induced effect on flow-mediated dilation. Exercise-based cardiac rehabilitation seems to be an effective therapeutic strategy for improving endothelial-dependent dilation in coronary artery disease patients, which may aid in the prevention of cardiovascular events.

Effects and optimal dose of exercise on endothelial function in patients with heart failure: a systematic review and meta-analysis

“…Regarding the degree of heterogeneity of the studies we included, our pooled analysis showed high inconsistency of the results which coincides with the conclusions of previous meta-analyses (20,23,75).…”

“…Additionally, Manresa-Rocamora et al (75) reported a FMD improvement of 3.62% (95% CI = 2.62, 4.62%) in favour of exercise-based CR in patients with CAD, while Qiu et al (76) found a FMD increase of 1.77% (95% CI = 0.94, 2.59%) in patients with type 2 diabetes. The lower training-induced effect on endothelial function in patients with diabetes could be due to the reduced ability of the endothelium of these patients to produce NO as a consequence of hyperglycaemia (77).…”

Does Exercise Training Improve Cardiac-Parasympathetic Nervous System Activity in Sedentary People? A Systematic Review with Meta-Analysis

“…Thus, practical interventions that improve cardiac PNS activity are of clinical interest. Exercise training is considered a highly effective treatment for autonomic imbalance in healthy [ 52 ] and diseased people [ 53 , 54 , 55 , 56 ]. However, training prescription variables (e.g., exercise type [i.e., aerobic training, resistance training, and combined aerobic and resistance training], aerobic training method [i.e., high-intensity interval training (HIIT) and moderate intensity training (MIT)], and training frequency) should be taken into account to properly design exercise programmes aimed at improving cardiac PNS activity.…”

“…However, training prescription variables (e.g., exercise type [i.e., aerobic training, resistance training, and combined aerobic and resistance training], aerobic training method [i.e., high-intensity interval training (HIIT) and moderate intensity training (MIT)], and training frequency) should be taken into account to properly design exercise programmes aimed at improving cardiac PNS activity. Aerobic training is the most common exercise type used [ 52 , 53 , 55 ], while the effect of resistance training, alone or combined with aerobic training, has been less investigated. For instance, Sandercock, Bromley and Brodie [ 52 ] found that aerobic training enhances PNS modulation (i.e., HF ms 2 ) in both sedentary and physically active healthy people, while the training-induced effect on PNS reactivation (i.e., HRR) was not investigated.…”

Is It All about Endothelial Dysfunction? Focusing on the Alteration in Endothelial Integrity as a Key Determinant of Different Pathological Mechanisms

“…Another translational aspect that has emerged is the possibility of directly treating endothelial dysfunction, not only as a welcome pleiotropic effect of routine pharmacological and rehabilitation strategies but also as a consequence of novel approaches specific to the endothelium or at least driven by its response. In this regard, based on a better knowledge of the mechanisms underlying endothelial homeostasis, some promising candidates and epigenetic approaches have been proposed and tested, with encouraging findings [ 10 , 34 ].…”