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Int J Sports Med 2022; 43(11): 905-920
DOI: 10.1055/a-1717-1798
Review

Cardiac Rehabilitation Improves Endothelial Function in Coronary Artery Disease Patients

Agustín Manresa-Rocamora 
1   Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain
2   Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernandez University, 03550 Alicante, Spain
,
Fernando Ribeiro 
3   School of Health Sciences and Institute of Biomedicine- iBiMED, Universidade de Aveiro, Aveiro, Portugal
,
Antonio Casanova-Lizón
1   Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain
,
Andrew A. Flatt 
4   Health Sciences and Kinesiology, Georgia Southern University – Armstrong Campus, Savannah, United States
,
José Manuel Sarabia 
1   Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain
2   Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernandez University, 03550 Alicante, Spain
,
Manuel Moya-Ramón 
1   Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain
2   Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernandez University, 03550 Alicante, Spain
› Author Affiliations Funding The preparation of this article was financially supported by the Ministerio de Ciencia e Innovación (Plan Nacional de I+D+I; Ref: PID2019-107721RB-I00). A. Manresa-Rocamora was supported by a predoctoral grant given by the Ministerio de Educación, Cultura y Deporte, Spain (FPU17/01825).
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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.

Key words

flow-mediated dilation - nitroglycerin-mediated dilation - endothelium-dependent dilation - exercise-based cardiac rehabilitation - systematic review - meta-analysis

Supplementary Material



Publication History

Received: 16 July 2021

Accepted: 16 November 2021

Article published online:
25 April 2022

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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