Effects of exercise-based cardiac rehabilitation on inflammatory biomarkers in patients with cardiovascular disease: a systematic review with meta-analysis

Abstract

Background: Evidence supports the anti-inflammatory effect of exercise-based cardiac rehabilitation (CR) in patients with cardiovascular disease (CVD). Nonetheless, the influence of training variables on the effects of exercise training is debateable. Therefore, this systematic review with meta-analysis aims to i) estimate the effects of exercise-based CR on the circulating levels of inflammatory biomarkers in patients with CVD based on the type of exercise, and ii) analyse the influence of other potential moderator variables. Methods: Electronic searches were performed in PubMed, Scopus, and Web of Science databases up to October 2022. A random-effects models of standardised mean difference (SMD) were used. Subgroup analyses and meta-regressions were used to carry out heterogeneity analyses. Results: Aerobic exercise diminished the levels of C-reactive protein compared with the control group in patients with CVD (SMD+ = –0.33 [95% CI = –0.47, –0.20), as well as the levels of tumor necrosis factor-alfa exclusively in patients with chronic heart failure (SMD+ = –0.38 [95% CI = –0.59, –0.17]). Moreover, heterogeneity analyses showed that the effect of aerobic exercise on vascular cell adhesion molecule-1 is higher in studies that carried out a CR programme based exclusively on exercise, as well as in studies that performed a shorter intervention period or carried out a lower number of exercise sessions (P ≤ 0.05). Conclusion: Our findings support the anti-inflammatory effect of aerobic exercise in patients with CVD. The low number of studies testing interventions using resistance or combined exercise precl