Brislane, Áine ORCID: https://orcid.org/0000-0002-3214-6544, Sculthorpe, Nicholas, Davenport, Margie and Beaumont, Alexander ORCID: https://orcid.org/0000-0002-5773-6356 (2022) Exercise Training and Vascular Function in Post-menopausal Individuals: A Systematic Review and Meta-analysis. Menopause, 29 (8). pp. 982-992.

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Abstract

Importance
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality for menopausal individuals. Flow-mediated dilation (FMD), a surrogate marker of CVD, improves with aerobic exercise training in healthy and nonhealthy cohorts. However, systematic evaluation and precise estimate of this effect for menopausal individuals are unknown.

Objective
We conducted a systematic review with meta-analysis to evaluate the influence of exercise training on FMD in postmenopausal individuals.

Evidence Review
Studies were identified from systematic search of major electronic databases (PubMed, ScienceDirect, and Cochrane Library) from inception to February 2021. Healthy, postmenopausal individuals were included, following an aerobic exercise intervention assessing FMD. A random-effects meta-analysis was used to calculate a pooled effect size (mean difference [MD]) with 95% confidence interval. Heterogeneity was assessed using I2 statistics. Metaregression was used to assess the association between changes in FMD and physical characteristics (eg, blood pressure, age, baseline FMD) and intervention details (metabolic equivalents and change in maximal oxygen uptake [ΔV˙o2max]). For variables that significantly correlated, a multiple metaregression model was used to assess the accounted variance in between-study ΔFMD%. Study quality was assessed using the National Heart, Lung, and Blood Institute assessment tool.

Findings
Nine studies, including 11 interventions (6 controlled interventions and 5 pre-post interventions; N = 182), with age range of 52 ± 4 to 64 ± 7 years underwent quantitative pooling of data. Exercise training significantly improved ΔFMD% (MD, 0.99; 95% confidence interval, 0.46-1.52; P < 0.001). Between-study heterogeneity was large and statistically significant (I2 = 93.8%, P < 0.001). Post hoc analysis based on study design identified significant heterogeneity in the MD in ΔFMD% between controlled and pre-post study interventions (P < 0.05). According to multiple metaregression, diastolic and systolic blood pressure and ΔV˙o2max significantly predicted ΔFMD% (Q = 15.74, df = 3, P < 0.01, R2 = 0.72).

Conclusions and Relevance
Aerobic exercise training improves FMD for postmenopausal individuals, and this observation was greater among controlled versus pre-post interventions. A higher resting blood pressure and the greatest ΔV˙o2max yielded the largest improvements in FMD.

Item Type:	Article
Status:	Published
DOI:	https://doi.org/10.1097/GME.0000000000002000
Subjects:	Q Science > QP Physiology R Medicine > RG Gynecology and obstetrics
School/Department:	School of Science, Technology and Health
URI:	https://ray.yorksj.ac.uk/id/eprint/6114

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