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

1.	世界卫生组织. 高血压. Available at: https://www.who.int/zh/news-room/fact-sheets/detail/hypertension.
2.	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2019概要. 中国循环杂志, 2020, 35(9): 833-854.
3.	陈源源, 王增武, 李建军, 等. 高血压患者血压血脂综合管理中国专家共识. 中华高血压杂志, 2019, 27(7): 605-614.
4.	中华医学会心血管病学分会高血压学组中华心血管病杂志编辑委员会. 中国高血压患者血压血脂综合管理的专家共识. 中华心血管病杂志, 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式太极拳治疗老年原发性高血压的临床疗效研究. 成都: 成都中医药大学, 2017.
21.	梁云花, 廖色青, 韩春蕾, 等. 八段锦运动干预对原发性高血压患者血压和血脂的影响. 河南中医, 2014, 34(12): 2380-2381.
22.	卢月丽, 管霞飞, 柳黎黎. 登山运动对1、2级高血压病患者血压及血脂的影响. 温州医学院学报, 2010, 40(3): 294-295.
23.	夏莉娟, 张琳, 罗慧琴, 等. 健步走对老年高血压患者血糖、血脂的干预作用. 中国老年学杂志, 2013, 33(21): 5233-5235.
24.	胡利勋, 杨建全. 健步走联合太极拳对老年高血压患者血压、血糖和血脂的影响. 海南医学, 2015, (14): 2053-2055.
25.	茅爱霞. 进行有氧运动对进行药物治疗的原发性高血压患者临床疗效的影响. 当代医药论丛, 2014, (4): 113-114.
26.	张娜. 抗阻训练对原发性高血压患者血压和脂质代谢的影响. 心血管康复医学杂志, 2018, 27(5): 498-501.
27.	王洁婷, 倪建芳. 有氧运动对老年高血压合并代谢综合征患者的影响. 心脑血管病防治, 2010, 10(2): 110-112.
28.	吴杰, 姜东辉. 有氧运动对老年高血压患者焦虑状况和生存质量及脂糖代谢的影响. 中国老年学杂志, 2019, 39(11): 2687-2689.
29.	王军玲, 张振英, 刘艳玲. 有氧运动联合抗阻运动对中青年高血压人群血压及危险因素的影响研究. 实用临床护理学电子杂志, 2018, 3(39): 86-87.
30.	邹飞, 郭海英, 孔维敏. 有氧运动训练对老年原发性高血压病脉压指数的影响. 中国康复, 2016, 31(1): 60-63.
31.	陆伟. 太极拳运动对社区中老年高血压患者降压效果的观察及其降压机制的探讨. 扬州: 扬州大学, 2015.
32.	陈金培, 谢映宜, 何志坚, 等. 阻抗训练联合有氧运动干预老年高血压患者的疗效评价. 中国初级卫生保健, 2019, 33(12): 51-53.
33.	张丽. 有氧和力量训练对原发性高血压患者血压和脂代谢影响的研究. 合肥工业大学, 2015.
34.	赵兰. 安徽: 有氧运动和抗阻运动干预原发性高血压低危患者的效果研究. 郑州: 郑州大学, 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.	易跃雄, 张蔚, 刘小媛, 等. 网状Meta分析图形结果解读. 中国循证医学杂志, 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.	陈姗, 张培珍. 运动训练对血脂代谢影响的研究进展. 中国预防医学杂志, 2019, 20(9): 881-886.
44.	张珊, 傅力. 有氧运动影响机体脂代谢平衡研究进展. 中国运动医学杂志, 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.	赵水平, 孙艺红. 高血压患者降胆固醇治疗一级预防中国专家共识. 中华心血管病杂志, 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. 世界卫生组织. 高血压. Available at: https://www.who.int/zh/news-room/fact-sheets/detail/hypertension.
2. 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2019概要. 中国循环杂志, 2020, 35(9): 833-854.
3. 陈源源, 王增武, 李建军, 等. 高血压患者血压血脂综合管理中国专家共识. 中华高血压杂志, 2019, 27(7): 605-614.
4. 中华医学会心血管病学分会高血压学组中华心血管病杂志编辑委员会. 中国高血压患者血压血脂综合管理的专家共识. 中华心血管病杂志, 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式太极拳治疗老年原发性高血压的临床疗效研究. 成都: 成都中医药大学, 2017.
21. 梁云花, 廖色青, 韩春蕾, 等. 八段锦运动干预对原发性高血压患者血压和血脂的影响. 河南中医, 2014, 34(12): 2380-2381.
22. 卢月丽, 管霞飞, 柳黎黎. 登山运动对1、2级高血压病患者血压及血脂的影响. 温州医学院学报, 2010, 40(3): 294-295.
23. 夏莉娟, 张琳, 罗慧琴, 等. 健步走对老年高血压患者血糖、血脂的干预作用. 中国老年学杂志, 2013, 33(21): 5233-5235.
24. 胡利勋, 杨建全. 健步走联合太极拳对老年高血压患者血压、血糖和血脂的影响. 海南医学, 2015, (14): 2053-2055.
25. 茅爱霞. 进行有氧运动对进行药物治疗的原发性高血压患者临床疗效的影响. 当代医药论丛, 2014, (4): 113-114.
26. 张娜. 抗阻训练对原发性高血压患者血压和脂质代谢的影响. 心血管康复医学杂志, 2018, 27(5): 498-501.
27. 王洁婷, 倪建芳. 有氧运动对老年高血压合并代谢综合征患者的影响. 心脑血管病防治, 2010, 10(2): 110-112.
28. 吴杰, 姜东辉. 有氧运动对老年高血压患者焦虑状况和生存质量及脂糖代谢的影响. 中国老年学杂志, 2019, 39(11): 2687-2689.
29. 王军玲, 张振英, 刘艳玲. 有氧运动联合抗阻运动对中青年高血压人群血压及危险因素的影响研究. 实用临床护理学电子杂志, 2018, 3(39): 86-87.
30. 邹飞, 郭海英, 孔维敏. 有氧运动训练对老年原发性高血压病脉压指数的影响. 中国康复, 2016, 31(1): 60-63.
31. 陆伟. 太极拳运动对社区中老年高血压患者降压效果的观察及其降压机制的探讨. 扬州: 扬州大学, 2015.
32. 陈金培, 谢映宜, 何志坚, 等. 阻抗训练联合有氧运动干预老年高血压患者的疗效评价. 中国初级卫生保健, 2019, 33(12): 51-53.
33. 张丽. 有氧和力量训练对原发性高血压患者血压和脂代谢影响的研究. 合肥工业大学, 2015.
34. 赵兰. 安徽: 有氧运动和抗阻运动干预原发性高血压低危患者的效果研究. 郑州: 郑州大学, 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. 易跃雄, 张蔚, 刘小媛, 等. 网状Meta分析图形结果解读. 中国循证医学杂志, 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. 陈姗, 张培珍. 运动训练对血脂代谢影响的研究进展. 中国预防医学杂志, 2019, 20(9): 881-886.
44. 张珊, 傅力. 有氧运动影响机体脂代谢平衡研究进展. 中国运动医学杂志, 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. 赵水平, 孙艺红. 高血压患者降胆固醇治疗一级预防中国专家共识. 中华心血管病杂志, 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.

Chinese Journal of Evidence-Based Medicine

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

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