EFFECTS OF AEROBIC TRAINING ON VASCULAR ENDOTHELIAL FUNCTION AND ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

The aim of this review was to investigate the effects of aerobic training (AT) on vascular endothelial function and arterial stiffness in prehypertensive and hypertensive individuals, as well as to identify potential moderating factors that may influence its impact on the vascular health of this population. A systematic electronic search was conducted in the following databases: PUBMED, EMBASE, Web of Science, ScienceDirect, SCOPUS, CENTRAL (COCHRANE), CINAHL, SPORTDiscus, PEDro, LILACS, and Scielo up to December 2024. Methodological quality and risk of bias were assessed using the PEDro (Physiotherapy Evidence Database) scale. The certainty of the evidence was rated according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. For the meta-analysis calculations, the effect measure used was the post-intervention mean and standard deviation of the aerobic training and control groups. Linear meta-regression analyses were performed to determine how changes in systolic (SBP) and diastolic blood pressure (DBP) could predict variations in flow-mediated dilation (FMD) and pulse wave velocity (PWV).

A total of 3,732 potentially relevant studies were identified, of which 22 were considered eligible for the meta-analysis. After screening the references, one additional study met the eligibility criteria and was included, resulting in a total of 23 studies analyzed. Primary analyses indicated that AT significantly improved vascular endothelial function (SMD = 0.72 [95% CI 0.48, 0.95]; p = 0.00) and arterial stiffness (SMD = -1.95 [95% CI -3.36, -0.53]; p = 0.007), with moderate and high certainty of evidence, respectively. Subgroup analyses revealed that for endothelial function, potential moderating factors did not exert a significant influence, whereas for arterial stiffness, some moderators may affect the response to aerobic training.

CONCLUSION: This systematic review of randomized controlled trials concluded that aerobic training is effective in improving vascular endothelial function and arterial stiffness in prehypertensive and hypertensive individuals, as assessed by FMD and PWV, respectively.