Smart, Neil A; Downes, David; Van Der Touw, Tom; Hada, Swastika; Dieberg, Gudrun; Pearson, Melissa J; Wolden, Mitch; King, Nicola; Goodman, Stephen P J

Author(s)

Smart, Neil A

Downes, David

Van Der Touw, Tom

Hada, Swastika

Dieberg, Gudrun

Pearson, Melissa J

Wolden, Mitch

King, Nicola

Goodman, Stephen P J

Publication Date

2025-01

Abstract

Background Dyslipidemia is a primary risk factor for cardiovascular disease (CVD). Exercise training (EXTr) improves some lipid markers but not others; the literature is dated and analyses may be underpowered. Objectives To clarify which lipid markers are altered with ExTr and establish if information size had yet reached futility. Methods We conducted a systematic review/meta-analysis, with meta-regression, to establish expected effect size in lipid profile with aerobic (AT), resistance (RT) and combined (CT=AT+RT) ExTr. We conducted trial sequence analysis (TSA) to control for type I and II error and establish if information size had reached futility. Results We included 148 relevant randomized controlled trials (RCTs) of ExTr, with 227 intervention groups, total 8673 participants; exercise 5273, sedentary control 3400. Total cholesterol (TC) MD – 5.90 mg/dL (95% confidence interval (CI) – 8.14, – 3.65), high-density lipoprotein cholesterol (HDL) 2.11 (95% CI 1.43, 2.79), low-density lipoprotein cholesterol (LDL) – 7.22 (95% CI – 9.08, – 5.35), triglycerides – 8.01 (95% CI – 10.45, – 5.58) and very low-density lipoprotein cholesterol (VLDL) – 3.85 (95% CI – 5.49, – 2.22) all showed significant but modest 3.5–11.7%, improvements following ExTr. TSA indicated all analyses exceeded minimum information size to reach futility. CT was optimal for dyslipidemia management. Meta-regression showed every extra weekly aerobic session reduced TC – 7.68 mg/dL and for every extra week of training by – 0.5 mg/dL. Each minute of session time produced an additional 2.11 mg/dL HDL increase. Conclusion TSA analysis revealed sufficient data exist to confirm ExTr will improve all five lipid outcomes. CT is optimal for lipid management. The modest effect observed may moderate dyslipidemia medication for primary prevention. Prediction intervals suggest TC, HDL, LDL and TGD are only improved in one-quarter of studies.

Citation

Sports Medicine, 55(1), p. 67-78

ISSN

1179-2035

0112-1642

Link

https://hdl.handle.net/1959.11/63183

Publisher

Adis International Ltd

Rights

Attribution 4.0 International

Title

The Effect of Exercise Training on Blood Lipids: A Systematic Review and Meta‑analysis

Type of document

Journal Article

Entity Type

Publication

Name	Size	format	Description	Link
administrative/TheEffectSmartVanDerTouwDiebergPearsonWoldenKingGoodman2024JournalArticleEarlyOnline.pdf	767.197 KB	application/pdf	Early Online Version	View document
openpublished/TheEffectSmartVanDerTouwDiebergPearsonWoldenKingGoodman2025JournalArticle.pdf	753.093 KB	application/pdf	Published Version	View document

Author(s)	Smart, Neil A Downes, David Van Der Touw, Tom Hada, Swastika Dieberg, Gudrun Pearson, Melissa J Wolden, Mitch King, Nicola Goodman, Stephen P J
Publication Date	2025-01
Abstract	<p><b>Background</b> Dyslipidemia is a primary risk factor for cardiovascular disease (CVD). Exercise training (EXTr) improves some lipid markers but not others; the literature is dated and analyses may be underpowered.</p> <p><b>Objectives</b> To clarify which lipid markers are altered with ExTr and establish if information size had yet reached futility.</p> <p><b>Methods</b> We conducted a systematic review/meta-analysis, with meta-regression, to establish expected effect size in lipid profile with aerobic (AT), resistance (RT) and combined (CT=AT+RT) ExTr. We conducted trial sequence analysis (TSA) to control for type I and II error and establish if information size had reached futility.</p> <p><b>Results</b> We included 148 relevant randomized controlled trials (RCTs) of ExTr, with 227 intervention groups, total 8673 participants; exercise 5273, sedentary control 3400. Total cholesterol (TC) MD – 5.90 mg/dL (95% confidence interval (CI) – 8.14, – 3.65), high-density lipoprotein cholesterol (HDL) 2.11 (95% CI 1.43, 2.79), low-density lipoprotein cholesterol (LDL) – 7.22 (95% CI – 9.08, – 5.35), triglycerides – 8.01 (95% CI – 10.45, – 5.58) and very low-density lipoprotein cholesterol (VLDL) – 3.85 (95% CI – 5.49, – 2.22) all showed significant but modest 3.5–11.7%, improvements following ExTr. TSA indicated all analyses exceeded minimum information size to reach futility. CT was optimal for dyslipidemia management. Meta-regression showed every extra weekly aerobic session reduced TC – 7.68 mg/dL and for every extra week of training by – 0.5 mg/dL. Each minute of session time produced an additional 2.11 mg/dL HDL increase.</p> <p><b>Conclusion</b> TSA analysis revealed sufficient data exist to confirm ExTr will improve all five lipid outcomes. CT is optimal for lipid management. The modest effect observed may moderate dyslipidemia medication for primary prevention. Prediction intervals suggest TC, HDL, LDL and TGD are only improved in one-quarter of studies.</p>
Citation	Sports Medicine, 55(1), p. 67-78
ISSN	1179-2035 0112-1642
Link	https://hdl.handle.net/1959.11/63183
Publisher	Adis International Ltd
Rights	Attribution 4.0 International
Title	The Effect of Exercise Training on Blood Lipids: A Systematic Review and Meta‑analysis
Type of document	Journal Article
Entity Type	Publication

The Effect of Exercise Training on Blood Lipids: A Systematic Review and Meta‑analysis

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