Effects of exercise on blood lipid for patients with hypertension: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

FEI Xi , LIU Mingxin , LI Chao ,  LI Hongjuan

Department of Sport and Science, Beijing Sport University, Beijing 100084, P.R.China;

Corresponding?author：

LI Hongjuan, Email: janerobin@126.com

Keywords：

Exercise; Hypertension; Blood lipid; Network meta-analysis

DOI：

10.7507/1672-2531.202109036

Video：

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Objective This study aimed to compare the effects of aerobic training, resistance training, and aerobic training combined with resistance training on blood lipid levels for patients with hypertension using network meta-analysis. Methods We searched the CNKI, VIP, WanFang Data, PubMed, Web of Science, The Cochrane Library, and EMbase databases to collect randomized controlled trials (RCTs) on the effects of exercise on blood lipid levels among patients with hypertension from inception to September 16^th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Stata 15.1 software and RevMan 5.0 software were then used to perform network meta-analysis. Results A total of 29 RCTs involving 2 519 patients were included. Compared with the control group, aerobic training (MD=?0.47, 95%CI ?0.62 to ?0.319, P<0.001), resistance training (MD=?0.37, 95%CI ?0.63 to ?0.11, P<0.05), and aerobic training combined with resistance training (MD=?0.61, 95%CI 0.88 to ?0.34, P=0.005) reduced total cholesterol levels; aerobic training (MD=0.14, 95%CI 0.08 to 0.20, P<0.001), resistance training (MD=0.10, 95%CI 0.02 to 0.19, P<0.05), and aerobic training combined with resistance training (MD=0.12, 95%CI 0.02 to 0.23, P=0.038) increased high-density lipoproteins; aerobic training (MD=?0.32, 95%CI ?0.48 to ?0.15, P=0.001), resistance training (MD=?0.19, 95%CI ?0.48 to ?0.01, P<0.05), and aerobic training combined with resistance training (MD=?0.40, 95%CI ?0.70 to ?0.11, P<0.05) reduced low-density lipoproteins. The SUCRA probability sorting results showed that aerobic training had the most significant effect on the improvement of systolic blood pressure and diastolic blood pressure; aerobic exercise combined with resistance training had the largest effect on total cholesterol, triglycerides, low-density lipoproteins, and high-density lipoproteins. Conclusions Aerobic training combined with resistance training is the most effective exercise method to improve blood lipid levels for patients with hypertension. Due to the limited quantity and quality of the included studies, the above conclusions are needed to be verified by more high-quality studies.

Citation： FEI Xi, LIU Mingxin, LI Chao, LI Hongjuan. Effects of exercise on blood lipid for patients with hypertension: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(12): 1424-1431. doi: 10.7507/1672-2531.202109036 Copy

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3.	陳源源, 王增武, 李建軍, 等. 高血壓患者血壓血脂綜合管理中國專家共識. 中華高血壓雜志, 2019, 27(7): 605-614.
4.	中華醫學會心血管病學分會高血壓學組中華心血管病雜志編輯委員會. 中國高血壓患者血壓血脂綜合管理的專家共識. 中華心血管病雜志, 2021, 49(6): 554-563.
5.	Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 3. Effects in patients at different levels of cardiovascular risk-overview and meta-analyses of randomized trials. J Hypertens, 2014, 32(12): 2305-2314.
6.	Teramoto T, Kawamori R, Miyazaki S, et al. Lipid and blood pressure control for the prevention of cardiovascular disease in hypertensive patients: a subanalysis of the OMEGA study. J Atheroscler Thromb, 2015, 22(1): 62-75.
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9.	Shou XL, Wang L, Jin XQ, et al. Effect of Tai Chi exercise on hypertension in young and middle-aged in-service staff. J Altern Complement Med, 2019, 25(1): 73-78.
10.	Bateman LA, Slentz CA, Willis LH, et al. Comparison of aerobic versus resistance exercise training effects on metabolic syndrome (from the Studies of a Targeted Risk Reduction Intervention Through Defined Exercise - STRRIDE-AT/RT). Am J Cardiol, 2011, 108(6): 838-844.
11.	Dantas FF, Brasileiro-Santos Mdo S, Batista RM, et al. Effect of strength training on oxidative stress and the correlation of the same with forearm vasodilatation and blood pressure of hypertensive elderly women: a randomized clinical trial. PLoS One, 2016, 11(8): e0161178.
12.	Boeno FP, Ramis TR, Munhoz SV, et al. Effect of aerobic and resistance exercise training on inflammation, endothelial function and ambulatory blood pressure in middle-aged hypertensive patients. J Hypertens, 2020, 38(12): 2501-2509.
13.	Tsuda K, Yoshikawa A, Kimura K, et al. Effects of mild aerobic physical exercise on membrane fluidity of erythrocytes in essential hypertension. Clin Exp Pharmacol Physiol, 2003, 30(5-6): 382-386.
14.	Heffernan KS, Yoon ES, Sharman JE, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res, 2013, 36(5): 422-427.
15.	Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med, 2007, 147(6): 357-369.
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17.	Woo-Cheol, K. , Suk-Lip, C. , Sung-Woon, K. The effects of aquarobics on blood pressure, heart rate, and lipid profile in older women with hypertension. Indian J Sci Technol, 2016, 9(46): 1-7.
18.	Thomas GN, Hong AW, Tomlinson B, et al. Effects of Tai Chi and resistance training on cardiovascular risk factors in elderly Chinese subjects: a 12-month longitudinal, randomized, controlled intervention study. Clin Endocrinol (Oxf), 2005, 63(6): 663-669.
19.	Tully MA, Cupples ME, Chan WS, et al. Brisk walking, fitness, and cardiovascular risk: a randomized controlled trial in primary care. Prev Med, 2005, 41(2): 622-628.
20.	章代亮. 24式太極拳治療老年原發性高血壓的臨床療效研究. 成都: 成都中醫藥大學, 2017.
21.	梁云花, 廖色青, 韓春蕾, 等. 八段錦運動干預對原發性高血壓患者血壓和血脂的影響. 河南中醫, 2014, 34(12): 2380-2381.
22.	盧月麗, 管霞飛, 柳黎黎. 登山運動對1、2級高血壓病患者血壓及血脂的影響. 溫州醫學院學報, 2010, 40(3): 294-295.
23.	夏莉娟, 張琳, 羅慧琴, 等. 健步走對老年高血壓患者血糖、血脂的干預作用. 中國老年學雜志, 2013, 33(21): 5233-5235.
24.	胡利勛, 楊建全. 健步走聯合太極拳對老年高血壓患者血壓、血糖和血脂的影響. 海南醫學, 2015, (14): 2053-2055.
25.	茅愛霞. 進行有氧運動對進行藥物治療的原發性高血壓患者臨床療效的影響. 當代醫藥論叢, 2014, (4): 113-114.
26.	張娜. 抗阻訓練對原發性高血壓患者血壓和脂質代謝的影響. 心血管康復醫學雜志, 2018, 27(5): 498-501.
27.	王潔婷, 倪建芳. 有氧運動對老年高血壓合并代謝綜合征患者的影響. 心腦血管病防治, 2010, 10(2): 110-112.
28.	吳杰, 姜東輝. 有氧運動對老年高血壓患者焦慮狀況和生存質量及脂糖代謝的影響. 中國老年學雜志, 2019, 39(11): 2687-2689.
29.	王軍玲, 張振英, 劉艷玲. 有氧運動聯合抗阻運動對中青年高血壓人群血壓及危險因素的影響研究. 實用臨床護理學電子雜志, 2018, 3(39): 86-87.
30.	鄒飛, 郭海英, 孔維敏. 有氧運動訓練對老年原發性高血壓病脈壓指數的影響. 中國康復, 2016, 31(1): 60-63.
31.	陸偉. 太極拳運動對社區中老年高血壓患者降壓效果的觀察及其降壓機制的探討. 揚州: 揚州大學, 2015.
32.	陳金培, 謝映宜, 何志堅, 等. 阻抗訓練聯合有氧運動干預老年高血壓患者的療效評價. 中國初級衛生保健, 2019, 33(12): 51-53.
33.	張麗. 有氧和力量訓練對原發性高血壓患者血壓和脂代謝影響的研究. 合肥工業大學, 2015.
34.	趙蘭. 安徽: 有氧運動和抗阻運動干預原發性高血壓低危患者的效果研究. 鄭州: 鄭州大學, 2020.
35.	Ammar T. Effects of aerobic exercise on blood pressure and lipids in overweight hypertensive postmenopausal women. J Exerc Rehabil, 2015, 11(3): 145-150.
36.	Dos Santos ES, Asano RY, Filho IG, et al. Acute and chronic cardiovascular response to 16 weeks of combined eccentric or traditional resistance and aerobic training in elderly hypertensive women: a randomized controlled trial. J Strength Cond Res, 2014, 28(11): 3073-3084.
37.	Mersy DJ. Health benefits of aerobic exercise. Postgrad Med, 1991, 90(1): 103-107.
38.	Howley ET. Type of activity: resistance, aerobic and leisure versus occupational physical activity. Med Sci Sports Exerc, 2001, 33(6 Suppl): S364-369.
39.	Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1. 0). Available at: https://training.cochrane.org/handbook.
40.	易躍雄, 張蔚, 劉小媛, 等. 網狀Meta分析圖形結果解讀. 中國循證醫學雜志, 2015, 15(1): 103-109.
41.	Mann S, Beedie C, Jimenez A. Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations. Sports Med, 2014, 44(2): 211-221.
42.	Tambalis K, Panagiotakos DB, Kavouras SA, et al. Responses of blood lipids to aerobic, resistance, and combined aerobic with resistance exercise training: a systematic review of current evidence. Angiology, 2009, 60(5): 614-632.
43.	陳姍, 張培珍. 運動訓練對血脂代謝影響的研究進展. 中國預防醫學雜志, 2019, 20(9): 881-886.
44.	張珊, 傅力. 有氧運動影響機體脂代謝平衡研究進展. 中國運動醫學雜志, 2015, 34(1): 69-72.
45.	Egli L, Lecoultre V, Theytaz F, et al. Exercise prevents fructose-induced hypertriglyceridemia in healthy young subjects. Diabetes, 2013, 62(7): 2259-2265.
46.	Drenowatz C, Sui X, Fritz S, et al. The association between resistance exercise and cardiovascular disease risk in women. J Sci Med Sport, 2015, 18(6): 632-636.
47.	Alberga AS, Prud'homme D, Kenny GP, et al. Effects of aerobic and resistance training on abdominal fat, apolipoproteins and high-sensitivity C-reactive protein in adolescents with obesity: the HEARTY randomized clinical trial. Int J Obes (Lond), 2015, 39(10): 1494-1500.
48.	Kelley GA, Kelley KS, Pate RR. Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials. BMJ Open, 2019, 9(11): e031220.
49.	趙水平, 孫藝紅. 高血壓患者降膽固醇治療一級預防中國專家共識. 中華心血管病雜志, 2016, 44(8): 661-664.
50.	Vítovec J, Spinar J. First-dose hypotension after angiotensin-converting enzyme (ACE) inhibitors in chronic heart failure: a comparison of enalapril and perindopril. Slovak Investigator Group. Eur J Heart Fail, 2000, 2(3): 299-304.
51.	Tambalis K, Panagiotakos DB, Kavouras SA, et al. Responses of blood lipids to aerobic, resistance, and combined aerobic with resistance exercise training: a systematic review of current evidence. Angiology, 2009, 60(5): 614-632.
52.	Hanssen H, Boardman H, Deiseroth A, et al. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a consensus document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol, 2021: zwaa141.

1. 世界衛生組織. 高血壓. Available at: https://www.who.int/zh/news-room/fact-sheets/detail/hypertension.
2. 中國心血管健康與疾病報告編寫組. 中國心血管健康與疾病報告2019概要. 中國循環雜志, 2020, 35(9): 833-854.
3. 陳源源, 王增武, 李建軍, 等. 高血壓患者血壓血脂綜合管理中國專家共識. 中華高血壓雜志, 2019, 27(7): 605-614.
4. 中華醫學會心血管病學分會高血壓學組中華心血管病雜志編輯委員會. 中國高血壓患者血壓血脂綜合管理的專家共識. 中華心血管病雜志, 2021, 49(6): 554-563.
5. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 3. Effects in patients at different levels of cardiovascular risk-overview and meta-analyses of randomized trials. J Hypertens, 2014, 32(12): 2305-2314.
6. Teramoto T, Kawamori R, Miyazaki S, et al. Lipid and blood pressure control for the prevention of cardiovascular disease in hypertensive patients: a subanalysis of the OMEGA study. J Atheroscler Thromb, 2015, 22(1): 62-75.
7. Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation, 2003, 107(24): 3109-3116.
8. Tsai JC, Yang HY, Wang WH, et al. The beneficial effect of regular endurance exercise training on blood pressure and quality of life in patients with hypertension. Clin Exp Hypertens, 2004, 26(3): 255-265.
9. Shou XL, Wang L, Jin XQ, et al. Effect of Tai Chi exercise on hypertension in young and middle-aged in-service staff. J Altern Complement Med, 2019, 25(1): 73-78.
10. Bateman LA, Slentz CA, Willis LH, et al. Comparison of aerobic versus resistance exercise training effects on metabolic syndrome (from the Studies of a Targeted Risk Reduction Intervention Through Defined Exercise - STRRIDE-AT/RT). Am J Cardiol, 2011, 108(6): 838-844.
11. Dantas FF, Brasileiro-Santos Mdo S, Batista RM, et al. Effect of strength training on oxidative stress and the correlation of the same with forearm vasodilatation and blood pressure of hypertensive elderly women: a randomized clinical trial. PLoS One, 2016, 11(8): e0161178.
12. Boeno FP, Ramis TR, Munhoz SV, et al. Effect of aerobic and resistance exercise training on inflammation, endothelial function and ambulatory blood pressure in middle-aged hypertensive patients. J Hypertens, 2020, 38(12): 2501-2509.
13. Tsuda K, Yoshikawa A, Kimura K, et al. Effects of mild aerobic physical exercise on membrane fluidity of erythrocytes in essential hypertension. Clin Exp Pharmacol Physiol, 2003, 30(5-6): 382-386.
14. Heffernan KS, Yoon ES, Sharman JE, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res, 2013, 36(5): 422-427.
15. Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med, 2007, 147(6): 357-369.
16. Sun J, Buys N. Community-based mind-body meditative Tai Chi program and its effects on improvement of blood pressure, weight, renal function, serum lipoprotein, and quality of life in Chinese adults with hypertension. Am J Cardiol, 2015, 116(7): 1076-1081.
17. Woo-Cheol, K. , Suk-Lip, C. , Sung-Woon, K. The effects of aquarobics on blood pressure, heart rate, and lipid profile in older women with hypertension. Indian J Sci Technol, 2016, 9(46): 1-7.
18. Thomas GN, Hong AW, Tomlinson B, et al. Effects of Tai Chi and resistance training on cardiovascular risk factors in elderly Chinese subjects: a 12-month longitudinal, randomized, controlled intervention study. Clin Endocrinol (Oxf), 2005, 63(6): 663-669.
19. Tully MA, Cupples ME, Chan WS, et al. Brisk walking, fitness, and cardiovascular risk: a randomized controlled trial in primary care. Prev Med, 2005, 41(2): 622-628.
20. 章代亮. 24式太極拳治療老年原發性高血壓的臨床療效研究. 成都: 成都中醫藥大學, 2017.
21. 梁云花, 廖色青, 韓春蕾, 等. 八段錦運動干預對原發性高血壓患者血壓和血脂的影響. 河南中醫, 2014, 34(12): 2380-2381.
22. 盧月麗, 管霞飛, 柳黎黎. 登山運動對1、2級高血壓病患者血壓及血脂的影響. 溫州醫學院學報, 2010, 40(3): 294-295.
23. 夏莉娟, 張琳, 羅慧琴, 等. 健步走對老年高血壓患者血糖、血脂的干預作用. 中國老年學雜志, 2013, 33(21): 5233-5235.
24. 胡利勛, 楊建全. 健步走聯合太極拳對老年高血壓患者血壓、血糖和血脂的影響. 海南醫學, 2015, (14): 2053-2055.
25. 茅愛霞. 進行有氧運動對進行藥物治療的原發性高血壓患者臨床療效的影響. 當代醫藥論叢, 2014, (4): 113-114.
26. 張娜. 抗阻訓練對原發性高血壓患者血壓和脂質代謝的影響. 心血管康復醫學雜志, 2018, 27(5): 498-501.
27. 王潔婷, 倪建芳. 有氧運動對老年高血壓合并代謝綜合征患者的影響. 心腦血管病防治, 2010, 10(2): 110-112.
28. 吳杰, 姜東輝. 有氧運動對老年高血壓患者焦慮狀況和生存質量及脂糖代謝的影響. 中國老年學雜志, 2019, 39(11): 2687-2689.
29. 王軍玲, 張振英, 劉艷玲. 有氧運動聯合抗阻運動對中青年高血壓人群血壓及危險因素的影響研究. 實用臨床護理學電子雜志, 2018, 3(39): 86-87.
30. 鄒飛, 郭海英, 孔維敏. 有氧運動訓練對老年原發性高血壓病脈壓指數的影響. 中國康復, 2016, 31(1): 60-63.
31. 陸偉. 太極拳運動對社區中老年高血壓患者降壓效果的觀察及其降壓機制的探討. 揚州: 揚州大學, 2015.
32. 陳金培, 謝映宜, 何志堅, 等. 阻抗訓練聯合有氧運動干預老年高血壓患者的療效評價. 中國初級衛生保健, 2019, 33(12): 51-53.
33. 張麗. 有氧和力量訓練對原發性高血壓患者血壓和脂代謝影響的研究. 合肥工業大學, 2015.
34. 趙蘭. 安徽: 有氧運動和抗阻運動干預原發性高血壓低危患者的效果研究. 鄭州: 鄭州大學, 2020.
35. Ammar T. Effects of aerobic exercise on blood pressure and lipids in overweight hypertensive postmenopausal women. J Exerc Rehabil, 2015, 11(3): 145-150.
36. Dos Santos ES, Asano RY, Filho IG, et al. Acute and chronic cardiovascular response to 16 weeks of combined eccentric or traditional resistance and aerobic training in elderly hypertensive women: a randomized controlled trial. J Strength Cond Res, 2014, 28(11): 3073-3084.
37. Mersy DJ. Health benefits of aerobic exercise. Postgrad Med, 1991, 90(1): 103-107.
38. Howley ET. Type of activity: resistance, aerobic and leisure versus occupational physical activity. Med Sci Sports Exerc, 2001, 33(6 Suppl): S364-369.
39. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1. 0). Available at: https://training.cochrane.org/handbook.
40. 易躍雄, 張蔚, 劉小媛, 等. 網狀Meta分析圖形結果解讀. 中國循證醫學雜志, 2015, 15(1): 103-109.
41. Mann S, Beedie C, Jimenez A. Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations. Sports Med, 2014, 44(2): 211-221.
42. Tambalis K, Panagiotakos DB, Kavouras SA, et al. Responses of blood lipids to aerobic, resistance, and combined aerobic with resistance exercise training: a systematic review of current evidence. Angiology, 2009, 60(5): 614-632.
43. 陳姍, 張培珍. 運動訓練對血脂代謝影響的研究進展. 中國預防醫學雜志, 2019, 20(9): 881-886.
44. 張珊, 傅力. 有氧運動影響機體脂代謝平衡研究進展. 中國運動醫學雜志, 2015, 34(1): 69-72.
45. Egli L, Lecoultre V, Theytaz F, et al. Exercise prevents fructose-induced hypertriglyceridemia in healthy young subjects. Diabetes, 2013, 62(7): 2259-2265.
46. Drenowatz C, Sui X, Fritz S, et al. The association between resistance exercise and cardiovascular disease risk in women. J Sci Med Sport, 2015, 18(6): 632-636.
47. Alberga AS, Prud'homme D, Kenny GP, et al. Effects of aerobic and resistance training on abdominal fat, apolipoproteins and high-sensitivity C-reactive protein in adolescents with obesity: the HEARTY randomized clinical trial. Int J Obes (Lond), 2015, 39(10): 1494-1500.
48. Kelley GA, Kelley KS, Pate RR. Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials. BMJ Open, 2019, 9(11): e031220.
49. 趙水平, 孫藝紅. 高血壓患者降膽固醇治療一級預防中國專家共識. 中華心血管病雜志, 2016, 44(8): 661-664.
50. Vítovec J, Spinar J. First-dose hypotension after angiotensin-converting enzyme (ACE) inhibitors in chronic heart failure: a comparison of enalapril and perindopril. Slovak Investigator Group. Eur J Heart Fail, 2000, 2(3): 299-304.
51. Tambalis K, Panagiotakos DB, Kavouras SA, et al. Responses of blood lipids to aerobic, resistance, and combined aerobic with resistance exercise training: a systematic review of current evidence. Angiology, 2009, 60(5): 614-632.
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Chinese Journal of Evidence-Based Medicine

Effects of exercise on blood lipid for patients with hypertension: a network meta-analysis

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