Which Physical Exercise Interventions Increase HDL-Cholesterol Levels? A Systematic Review of Meta-analyses of Randomize
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SYSTEMATIC REVIEW
Which Physical Exercise Interventions Increase HDL‑Cholesterol Levels? A Systematic Review of Meta‑analyses of Randomized Controlled Trials Antonio Palazón‑Bru1 · David Hernández‑Lozano1 · Vicente Francisco Gil‑Guillén1
© Springer Nature Switzerland AG 2020
Abstract Background Meta-analyses of randomized controlled trials (RCTs) have shown the beneficial effect of exercise on HDLcholesterol (HDL-C) levels. However, systematic reviews are not free of bias, and this could call into question their results. Objectives The aim of this work was to conduct a critical assessment of meta-analyses of RCTs that analyze the association between exercise and HDL-C levels, evaluating their results and the risk of bias (RoB). Methods This systematic review of MEDLINE and EMBASE included meta-analyses of RCTs that studied the effects of exercise on HDL-C levels in healthy adults or patients at cardiovascular risk. The RoB was determined using AMSTAR-2, and information was obtained on exercise and the variation in HDL-C levels. Results Twenty-three meta-analyses were included. Great variability was found in exercise (different types, frequencies or intensities in the studied interventions). All the analyses found an improvement in HDL-C levels, ranging from 0.27 to 5.41 mg/dl, in comparison with the control group (no exercise). The RoB was very high, with 18 reviews obtaining a critically low confidence level and the remaining works obtaining the highest confidence level. Conclusions Only one meta-analysis showed good quality, in which HDL-C levels increased by 3.09 mg/dl in healthy adults and patients at high cardiovascular risk who practiced yoga. The rest had high RoB. Therefore, new systematic reviews with low RoB are needed to apply the results to clinical practice. Register: CRD42020158471 (PROSPERO).
Key Points Meta-analyses have shown that exercise can increase HDL-C levels. Systematic reviews should have a low risk of bias for conclusions to be applicable to clinical practice. A systematic review was performed evaluating these meta-analyses, finding that only one work meets the accepted standards for this purpose (yoga). Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40279-020-01364-y) contains supplementary material, which is available to authorized users. * Antonio Palazón‑Bru [email protected] 1
Department of Clinical Medicine, Miguel Hernández University, Ctra Valencia‑Alicante S/N, San Juan de Alicante, 03550 Alicante, Spain Vol.:(0123456789)
1 Introduction Cardiovascular diseases (CVD) are a major cause of morbidity and the leading cause of premature death, with coronary heart disease and stroke being the types of events that produce the highest number of deaths [1, 2]. Traditionally, CVD has been considered to have a higher prevalence and incidence in men, although it is currently prevalent in women [3]. In addition, differences between the sexes can be seen in the various cardiovascular risk factors, such as high blood pre
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