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    2007 - Kodama - MA - Effect of Aerobic Exercise Training On Serum Levels of High-Density Lipoprotein Cholesterol

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    2007 - Kodama - MA - Effect of Aerobic Exercise Training On Serum Levels of High-Density Lipoprotein Cholesterol

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    2007_Kodama_MA_Effect of Aerobic Exercise Training on Serum Levels of High-Density Lipoprotein Cholesterol

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    2007 - Kodama - MA - Effect of Aerobic Exercise Training On Serum Levels of High-Density Lipoprotein Cholesterol

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    a Effect of Aerobic Exercise Training on Serum Levels of High-Density Lipoprotein Cholesterol A Meta-analysis Satoru Kodama, MD; Shira Tanaka, MS; Kazumi Saito, MD; Miao Shu, MS; Yasuko Sone, MS; Fumiko Onitake, MS, RD; Emiko Suzuki, PhD; Hitoshi Shimano, MD, PhD: Shigeru Yamamoto, PhD, RD; Kazuo Kondo, MD, PhD: Yasuo Ohashi, PhD; Nobuhiro Yamada, MD, PhD; Hirohito Sone, MD, PhD Background: Acrobic exercise is believed to reduce the risk of cardiovascular disease partially through increas- ing serum levels of high-density lipoprotein cholesterol (HDL-C). However, ths effect varies considerably among exercise intervention studies. Methods: Electronic database searches of MEDLINE (ase. amined the effect of exercise training on HDL-C level 2005) for randomized controlled trials that ex- Results: Twenty”! change in HDL-C level was statistically significant but modest (2.53 mg/dl. [0.065 mmol/L]; P<.001). Mi mal weekly exercise volume for increasing HDL-C level ‘was estimated to be 900 keal of energy expenditure per ‘week oF 120 minutes of exercise per week, Univatiat ‘gression analysis indicated that every 10-minute prolon- gation of exercise per session was associated with an ap- proximately 1.4-mg/dL (0.036-mmol/L) increase in HDL-C level. In contrast, there was no significant ass0- re articles were included. Mean net ciation between exercise frequency or intensity. Mul- Liple meta-regression analyses demonstrated that sub- jects with a body mass index (calculated as weight in kilograms divided by height in meters squared) less than 28 and total cholesterol level of 220 mg/l. [5.7 mmoV/L] ‘ormore experienced an approximately 2.l-mg/dL. (0.054- mmol/L larger increase in HDL-C level than these with a body mass index of 28 or more and total cholesterol level less than 220 mg/dL. (5.7 mmoVL). Conclusions: Regular acrobic exercise modestly in- ‘ereases HDL-C level. There appears to exist a minimum, ‘exercise volume fora significant increase in HDL-C level Exercise duration per session was the most importante ‘ment of an exercise prescription. Exercise was more fective in subjects with intially high total cholesterol le cls of low body mass index. Arch Intern Med. 2007;167:999-1008 ARDIOVASCULAR DISEASE (CVD) isthe leading cause of death worldwide.! Low blood levels of high- density lipoprotein choles- Author Affiliations Department of Lifestyle ‘Medicine and Nutsitional exercise required to increase HDL-C level, (2) determine the exercise characteris” tics most effective in increasing HDL-C level, and (3) investigate the characteris- lics of subjects who most bent from ex- Seienees, Ochanomizu University, Tokyo, Japan (Drs Kodama, Saito, Suzuk, ‘Yamamoto, Kondo, and H. Sone and Mss Shu, ¥ Sone, and Gnitake); Departments of Sports Medicine and Health Seiences (Dr Kodama Sato, Yamada, and H. Sone and ‘Me Sh) and Internal Medicine (Drs Kodama, Saito, Shimano, snd H. Sone snd Me Shu), University of Tsukuba ‘Teuku, Japan; and Department of Biostatistics, Epidemiology, and Preventive Health Seiences, University of ‘Tokyo (Mr Tanaka and Dr Ohashi), (aePnnyTED) ARGHINTERN WEDIVOLT terol (HDL-C) arean independent risk fac- tor for CVD.” Cross-sectional data provide strong evidence that people who are more physically aetive have higher HDL-C le els." Thus, the value of regular aerobic ex- cercise in increasing serum HDL-C level and, in reducing the risk of CVD has received widespread acceptance.’ In contrast, re= sults of aerobic exercise studies vary Con- siderably, depending on the exercise pro- ‘gram (eg, duration, intensity, or frequency) es of subjects at baseline.* examined which istics would alfect the response of and character However, few studies hav charact HDL-C level to exercise training, The objectives ofthis meta-analysis are to (2) estimate the minimum amount of cercise through increases in HDL-C level. Clarifying these issties would help in e lablishing exercise programs to achieve better lipid profiles in a clinical sewing, LESS LITERATURE SEARCH. ‘We searched MEDLINE ({rom 1966 to 2005) for all investigations of the effect of exercise fon serum HDL-C levels. The search was re= Stricted to studies using randomized con- twolled trials and that were published in En- alish. Search phrases were related 1 exercise, aerobic capacity, and HDL-C (available on re- {quest from the authors). Reference lists of previous articles about exercise and HDL-C (©2007 American Medical Association, All rights reserved. Downloaded From: by a UNIVERSITY OF SYDNEY LIBRARY User on 05/03/2018 ‘a8 aay a use ind Set Gnd Fond nM buasee Ug Rar stom thing Ser Toms Freon) Palos nes Sane nous ‘aan ea se Rote ial ‘ie 7 erat ‘ete ce se Re Sn Wisse nt Lad OC a 1 Deng egret C eet Eae ‘Yat Daton 20 year), HDL-C Imessurements at baseline and atthe end sth intervention, (3) taining period of Stlesst @ weeks, and 4) incuston of cxerce groupand a concurrent nonex- ce contol group. Aerobic exercise was defined as hythmicand repeated move ‘ments ofthe same argenusce groups (eg, walking, bicyling. and contnuous winning) for least 13 minutes" Co- intervention studies, such as those in- lading detinterention, were lex cluded because the elfect of exercise taining tel wouldbe obscured. Wealo ccd studies of subjects having spe- Sie medical problems in which tea ‘mente suchas with diet o drugs would Influence the eet of exercise Co, his- tory of cancer, hemodialysis treatment, snd coronary hear disease). Included studies provided informa- lon on exercise characteristics such as uration (defined stime spenton sex Slon of exercise), frequency (numberof txertse sessions per week), relative n- tensity (proportion of exercise inten iy to maximal aerobic capacity), and absolte intensity (expressed in meta- totic equivalents [METs)). One MET corresponds to oxygen consumption of S35 mig per minute. Fourteen stud- ies were excluded because excrlse ‘olume could ot be estimated in terms toa weekly energy expenditure (EE) Sind weekly exercise lengh (le, time penton exercise tsning per wee). Ac ordingly, we excluded 4 tal tht had resistance Using oF interval training (aepniyED) ARCHINTERN WEDVOL I, MATIN VALIDITY ASSESSMENT AND DATA ABSTRACTION The methodologic quality ofeach i Cluded il was assessed by means ofthe instrument dseriedby adel = Two of aur investigators lependenly re Siewed each published arucle and ex tracted eleva information, Discrepan Ss were sive by deen who third author. We collected data on sub fests coerce progrenn and ree tion outcomes (e, change ia HDL-C Ievel). Mean age Cin yeas, se Gna cated by percentage of men) HDL-C lve Gn millgrams pe deter), maximal aerobic pec presented by max tl ope oxjgem wpa (Vous oF Vospea in miitess pee logram per time), body wight (in kilograms), Boul mas index (BMI ealeubted sveight logs vided by height in teers squared), percentage of oa trigheeride levels miligrams pede lies) -andtotl cholesterol) level Gn mills pe dei) were extracted SS chumetraties of subjects The cha ret f the exces rtenaionin- chided exer dation, quency. ela Sve intensity, and able tensity ‘Relive tensity was extracted di- relly fom studies restated rom the eos best ate reserve ora propor tn of ere bear ets wo asin scowling toa previously eabied for tule Abstlate intensity was alex ited by multiplying relative intensity, maximal aerobic capacity. In 3 stud- {es absolute intensity as ea tuned by linet regrenion lis of saleng speed in miles pe how ith teers imersty in MEFs accoding i Hendciman etal” Exercise volume Was assesed by both total weekly excrise iength and woul weekly estimated EE Weekly EE was caeulnted by maliply- ing exerene intensity (1 MET coree= sponds 00.0175 Kel by weekly exer= be length and body mass. ‘Mean difference in HDL-C change ahi tnning beeen etree oe xercise conta groups (MDHC) was Calculated as the net HDL-C effect af aster taining. Stnded coor was dircely extracted or atherwise calcu Inte fom standard deviation, eon dence intervals, or P values for HDL-C ‘lies within groups To estimate tan- dard ero, acoreation of 0.5 between arias at basline and at fllow-up vib each group ws ented cron Ingo Follnton etal follows =| Chey * Ce SEW 05. Eaaa) ™ Ena) Soe ee a sober mge k isp Sts ser eet (©2007 American Medical Association, All rights reserved. Downloaded From: by a UNIVERSITY OF SYDNEY LIBRARY User on 05/03/2018 ‘Table 1. Population Characteristies in Randomized Controlled Trlals of Exercise intervention and HOL-C "ee Seen wove, Te, Ta, war source Yea (erent) con mgitt_—_mgiit—git— asm Cant ‘Niro otal 195 © 0 i tN Bhar tal 1986 som = 0s) tw Busy tai 1085 0 2 6 i 7 ND 26 ns Cunningham tal." 1987 starts) too SH N82 Duncan tal 1001 mo «0 165) to Skt Tha 1228) 1057185 ROSH 1s) 1053 tkC ak Fahlman ta 2002 m0 1 6% 4 im 8 ND m9 185) Grangjan at 1006 N00 75k Houmad eta" 1904 48 1013 (18) 7 3 mmo 185 82 ma Huten otal 1979 1m ©4460) STN wa Sane tal 1987 4 1 = 00) hm 7 03g) Koklinos ota 1098 se tm 157) tt NSH Kaus tl 2002 9 % 2 mm 10 NO 291 205 s)7 % 4 mM sf 2 % 4 me kN 0a Kaktonon-Harastal® 1968 4100568) «5S SO OH_CSC«‘iS kw Lindi ot a 14 0 mo 8 27S tieman tl 2002 6 0 4 2 4 mM Ww 83 me Za aay tal 1005 8 CL Santiago etal 1005, 3t oe Hm Sopko ata 1085 2 1m 9 @ 3m =k 2D ‘Stance ta" 1008 51 tm ats) ms SLOT ‘Sanat 21000 Ca ee m St 5G “Thomas eta 1084 132 15 6 3 1 #2 ie MD 560 0 7 6 4 im #8 18 MD 545 o 9 6 4 7 8 te MDa o on 6 4 i 8 279 MD m3 “Thomas tal 1085 mm it Ce en en Wood etal 1088 4% 1 5s) okt tk Woot fy ta ® 1908 7 1 10 58 tN OT 0 6 5 7B mm 15 ND 22 3 Woot fy ta 190 5 5 4% mh MD kd 5 o 8 @ @ mm ww ND 26 m4 ‘Abretons: BF, ody fa ML body mass indo (clued as weight ia Kogrars ddd by haghtin mses square) C-, number in catal group xn, number enti grup: HDL-C, hgh ene Soprtein cholera Max Cp. maximal arable apa aceseed by masa openk oxigen apa ND, no eat: TC, taal enlestaro 6, lyons. ‘Sf conerson actors To convert HOL-C and TC io illmels pa it, mip by 0.029, TG to miles per tr, multiply by 0.0113, “Mumba in exateisegroup at printer {stnated by enargyexpendlure and oxigen consumption dung excise; expressed as mites of oxygen po agra pe minut pooled data, Missing data were input by ‘means of a regression model if needed: [BML was regressed by percentage of men and body mass, and percentage of body fat was regressed by percentage of men, body mass, and maximal aerobic capac ity. AP<.05 was considered statistically significant, All analyses were performed. with SPSS statistical software (version, 1440, SPSS Inc, Chicago, I AEE STUDY CHARACTERISTICS There were 137 potentially relevant articles on randomized controlled. trials based on the search terms (Figure 1). Of 32 studies meeting the initial inclusion criteria, 4 ar- (aepnurED) ARCHINTERN WEDIVOL IST WAY SR ticles were exclude because the pat- tern of change in energy intake dif- fered between exercise and control groups," 1 was excluded because of poor compliance (<60% adher- ence to the program)," and 2 were excluded because of a erossover de- sign in which carryover effeets could not be ignored." Finally, 25 articles (35 rls) met our inclusion criteria. Sample sizes varied between 9 and 200, with a total of 1404 subjects (mean age range, 23-75 years) (Table 1). The ‘mean intervention period was 27.4 weeks. Subjects were not limited to specific ethnie groups, but in many sludies information on ethnicity was lacking. yon The quality of tials was assessed. according to the scale described by Jadad etal? with each trial evalu- ated according to randomization, double-blinding, withdrawals, and dropouts. The mean (SD) score was comparatively low (1.5 [0.5] ofa pos- sible 5 points). The quality assess- ment criterion that permitted dis- crimination between studies involved withdrawals and dropouts. Twelve trials* reported the number of with- ddrawals and reasons for withdrawal, while 13 uialst did not. The drop- ‘out rate of subjects ranged from 4% + References 30-32, 5,7, 5053, 5 “References 46, 48,49, 34, 36, 57, 59-63, 3 (©2007 American Medical Association, All rights reserved. Downloaded From: by a UNIVERSITY OF SYDNEY LIBRARY User on 05/03/2018 Table 2. Exerlse Intervention Characteristis in Randomized Controlled Trials of Exercise Intervention and HDL-C Tnormaton or etary ree ntarvontonCharaeeiste hesessment B, Weeky cypeat’ "etary etary source Wests Freq ___Presebed Exercise intensity minke MET. Exes sruclon’ Rocorat Tera 12 61 Biskwalng mean oarcselmansly, 25-77 «SR WN W W TW of HRmax Berta 2020 Gil 75i HRA i s0 WW Y Y Busty tat® 12 30 7080" ot Hae mm 30 Wd N N Cunningamctal” «52-25 (=60maxmal METStO/% of AR SSB SW N N Duncan eta 24 5.0 Wiahing sped, 8.0 rh % i? ¥ ¥ 24 5D Wialing sped 6.4 kv im 51 Wd Y Y 24 5.0 Wialing sped, 48 kmh 11688 Y Y Fabian ta 12 20. That BRR ms Wd ¥ ¥ Granjan et a® 12 40 Progessieyinceasdintnsiy (rom 49 1200 5B N N 60% 10% of Vomax to 70-80% of Voxmax) Howard ota 1428 Progassiveyincreasdintnsiy (rom 411245. 49d " " TD'-8%of HAmaxto 825% ot Hae) ard earese drain (30. rinfeeson to 4 mileeso) Hutunen ot P| 16 20 Progassveyinceasdintnsiy (rom 58§ 27D Y " {0% of HAR to 6B of HAR) 15 min ‘waming up: 10min cooing down ane taf 24 50° Mean rise inensiy, 72% otHRmax 4717253 Wd y N 24 50 Meanie inesiy, Bot Rmx $4 11753. Y N Kaldinos et aF> 16 20. Gh-d0% of imax “um 21 N N Kaus etal 25 2A 40554 otVarpak 2 mm 33 0 ¥ ¥ 25 20 GS-80 of Vpak 1356 Y Y 26 2B GBt-80s ot Vspak % 13 54 oo Y Y Kaktonon-taraeta® 15 40.70% af Vosmax 6 1m 78 wu ¥ ¥ Lindi at a" 2% 20 Thal Hiimax m om 33 ¢ N N ema ea 12 50 Progessiveyinceasdintnsiy (rom 45115183 Wid N N 654-70 of HAmaxto 70% 00s ot Hamas Ray ot a* 2% 49. Stor HRR soe 33 WW y y Santiago etal 4040. Traadillvaking, 48 krisssion; mean 08753 Wid N Y Sopkostal® 12 50. ewets aes y y ‘Stel ta! 52 23 Waling sped, 1.90 mis m8 55 Wd N ¥ ‘Sanaa 2 © 24 2a eionshk sm 34 ¥ ¥ Thomas ea 12-20. TSteot max my 1078 Wd N N 12 20. T8heot Bmax pg ek? Wd N N 12 20. T8heot Bmax mg 188 1 Wd N N 1220. Theat Bmax ss 58d N N Thomas eta 120 78s ot imax ms ao N N Wood tab 5225 T%-85% ofmasinalanobiccapacty 28) 111778 Wid N ¥ Woot ey et a 18 60 Bot Vomax mm az N N 18 60 68% of Vormax mm ko N N Woot ey tat 18 4d Approxirately 70%-75% of Vowmak $5130 ¥ N 18 4d Approximately 70%-75%ofVownak 55d Y N ‘Abretons: G,cjlng obj ergot, exe duration pe eeson Fen, excise requency exprseed a numba of exarae sessions par wed HL highdensiyUpopotinenoletrl HRmax maximal heat rate: HAR, Pert ae eer; MET abo vec tana n metals equivalents (1 MET Carrspads 03 mi af Och pet minut) no, rforation was ot previo O, eer pee seeing program (swing sking ose of ab tlipial wie Wa, wang or ogging; wes E, estate energy expenditure per Wetk; Vogmax maximal agen uptake Vo peak gen Uptake a5 Uitniormaton ae pode, Subjects wer suc a maintain repular eating habits or not atop to change body mass. Dianne ws recorded lore nd arte trenton othe sacle and none groups. $HMsan erie durton pr sssion durbg venta ‘Estate by energy exgenditure and oxygen cansumation during xia ifesumg tnt tmnt of warp cotapond oS mit of ree aig. to 30%. In none of the 25 random- Rabble 2). Mean estimated relative EFFECT OF EXERCISE ized controlled tals were methodsof and absolute intensity ofthe aerobic ON HDL-C LEVELS randomization described. Mean pre- exercise were 64.8% of maximal aero- scribed exercise interventions in- bic capacity and 5.3 METs, respec-__ Each MDH and the pooled MDHC cluded a mean of 3.7 sessions per __ tively. Meanestimated weekly BE was are shown in Figure 2. Overall net week, each averaging 40.5 minutes 1019 keal/wk change in HDL-C level was modest (@epRuTED) ARCHINTERN WEDIVOL IGT MAVSR S00? _WWWARCHINTERNNED COM (©2007 American Medical Association, All rights reserved. Downloaded From: by a UNIVERSITY OF SYDNEY LIBRARY User on 05/03/2018 although statistically significant (2.53 mg/dl [0.005 mmol/L]; 95% confidence interval, 1.36-3.70 mg/dl. [0.035-0.096 mmoVL]). EVALUATION OF PUBLICATION BIAS Figure 3 shows funnel plot for the visual assessment of publication bias. Both the Begg adjusted rank test and the Macaskil regression asymmetry test indicated no evidence of poten- tial publication bias (P=.67 for Begg lest; P=.97 for Macaskil test). One study (black squarein Figure 3)" was statistically an outl 29), and. the following meta-analyses were per- formed after exclusion of this study. RELATIONSHIP BETWEEN EXERCISE VOLUME AND HDL-C LEVEL Findings from stratified meta- analyses based on weekly EE and weekly exercise length are pre- sented in Fable 3. For 21 tials in which the weekly estimated EE was greater than 900 keal, the pooled. MDHC was significant (zscore, 5.16; P<.001), but it was not significant for 13 tals in which EE did not ex- ceed 900 keal/wk (z score, 0.95; P=.34). Por 25 trials in which the weekly total exercise length was more than 120 minutes, pooled MDHC was significant (zscore, 3.60; P<.001); no significance was ob- served for 9 trials in which weekly exercise length was not more than 120 minutes (zscore, 1.15; P=.25). EFFECT OF EXERCISE CHARACTERISTICS ON CHANGE IN HDL-C LEVEL AFTER EXERCISE TRAINING We caleulated the correlation re- gression to explore which charac leristic of an exercise program (le, duration, frequency, and relative oF absolute intensity) was the best pre- sy Ove 5 0. gt. finmae oe tasers Bile toa) dio a? a rattowsse, Grad — sicisene Sina os taunt, ‘Thomas et I eO-eTwIE7) Thomas ets -——1 49(-3110129) ‘Kraus eles —— 46 (-25t0117) Ha 4 sees ‘Sopko etal? HS 35(-16.3t0232) Met en ie sacioaa* —— ae Thomas eta oo 27 (4.910123) Randy a a 23(-49t0135) Dasma —— Bases Dunc ta 1 20730113) Coneahoseat a 15¢ad964) Dacrat" sscase 28 s3¢27es3) te a 134410087) ‘Woolt-May at a we (Tw IA) Juneau et a? — 10¢41 081) maa nr onc77i085) ‘ulna Harjla ta HH 08(-1.9t036) din nm o4(a0%e8s) Baya — 20(40%069) Sina om, aocise 18) tim — oarranss) Toma — sovarin6) Toma — socazie72) Horm — s3er9e87) Unain eo aaciam6m ty ta a ase) Weta a5(2080 138) aa we 29038027 a a MDAC 5%, mp. Figure 2. Mean difreces in ig dest ipopotsinchlestrl HDL-C change (HOHO) Between ‘arcs and noice contol groupe nrandomiod cong rae. The tao ch saris Proportional tothe vere lsu variance inh tai. Damon eae average net change FoPClevl: paonta ine inete 95% consene marl Ce). The" ae for eeogenaty at 387 (Pot) ad th sor, standardized mean ference) for oval eet was 423 (P00), to 74 minutes per session, Further- not associated with other exercise more, we investigated the effect of measures such as frequency, abso- relatively short session of continu- lute intensity, or relative intensity fous exercise because about 30 min- ‘Since exercise volume is often dictorofan increase in HDL-Clevel___utes of exercise per day has been r quite limited in daily life, multivar- (Figure 4). Univariate analysis ommended for maintaining good _iate analyses of exercise character- showed that exercise duration was health.” However, the pooled istics and MDH were performed by the strongest predictor of MDHC, MDHC wasnotsignificantwhenex- adjusting for weekly EE or weekly and each 10-minute increase in ex-__ercise duration was 30 minutes or exercise length (able @). When ereise duration corresponded to an less per session (0.27 mg/dL. [0.007 _weekly EE was controlled for, exer- approximately 1.4-mg/dL (0.036- mmol/L]; 05% confidence interval, _cise duration remained positively as- mmol/L) netinerease in HDL-Clevel -2.04 to 2.50 mg/dL [-0.053 to sociated with MDHC, while exer- when the duration ranged from 230.067 mmoV/L]). The MDHC was cise intensity did not influence (@epnuTED) ARCHINTERN WEDIVOL IGT MAVSR S00? _WWWARCHINTERNNED. COM (©2007 American Medical Association, All rights reserved. Downloaded From: by a UNIVERSITY OF SYDNEY LIBRARY User on 05/03/2018 MDHC. When we controlled for weekly exercise length, exercise dit- ration was postlively and exercise Irequency was negatively assoc: ated with MDHC. Univariate and multivariate analyses indicated that exercise duration was the most im- portant predictor of MDH. EFFECTS OF SUBJECT CHARACTERISTICS ON CHANGE IN HDL-C LEVEL BY EXERCISE TRAINING Multivariate analysis was per- formed by means of regression mod- els o investigate the extent to which, characteristics of subjects indepen- dently contributed to the change in HDL-C level (Rabble 5). Two step- wise regression analyses using model 1 and model 2 showed that subjects with a higher TC level oF ‘who were less obese responded be ler to exercise training, In model in subjects with a mean TC level of 220 mg/dL (5.7 mmol/L) or greater and mean BMI less than 28, ‘ise training resulted in an average of 2.L-mp/dl. (0.054-mmol/L) (5.1 limes) larger net elevation in HDL-C level than when the mean TC level was less than 220 mg/dL (5.7 mmol/L) and mean BMI was 28 or areater. By contrast, age, percent age of men, HDL-C level, and aero- bic capacity were not significant pre- dictors of MDHC. See ‘Our meta-analysis indicated that the effect of aerobic training resulted. in a 2.53-mg/dL (0.065-mmol/L) elevation of net HDL-C change (Figure 2). In a previous observa- tional study,“ every L-mg/dl (0.026- mmol/L) increment in HDL-C level was reported to be associated with, a 2%and 3% decreased risk of CVD inmen and women, respectively. If this observation were applied to our results, the increase in HDL-C level by exercise determined by thisanaly- sis would, by a rough estimate, re- sult in a CVD tisk reduced by ap- proximately 5.1% in men and 7.6% in women. Thisis potentially of sub- stantial importance in public health, although the effect of reducing car diovascular risk by increasing (aepniyED) ARCHINTERN WEDVOL I, MATIN ou. Woe aoe BE 00. 0 ow gi ‘Figure 3. Fue plot explore publeation basin 85 andor conrad was of excise and high-density ipgproten cheletrl(HL-O) level, pan squares preset inveulals. Mean Aiferance HDL-C change (MOH) s plated against he weigh ator Vecproal ols standard eran, Tha tunel plot vas roughly symmetial with ogard to mean eet siz (vrealin) xapt fran suting study" whichis pte with Blak square To convert HOL-Ct limos er it, multiply yaaa Table 3, Tes for Pooled Mean Diference In HDL-C Change Between Exerc ‘and Control Groups Through Exercise sear (P val o.otsiatg eee Pate) voile (voc otexerisers) Unagjstoa _Aduseg tf Asusoa 29 Wool E kel “600, Sit) a73¢4r) 76,48) 094,35) 01-900 Sime) 060(58) 06651) 086,58) 01-1200 91228) 21503) 278603) 17208) >1200 zien) tons) 286008) 2.13 (002) Wool exis length, ‘ne 5 (186) 788) 02580) 07 (36) 1-120 ais) tat (46) 140648) 121 (23) 121-180 7078) 196,05) 153,05) 1.0006) >180 1a(ass) 3.00002) 3.04002) 2.19001) Abbravitons: HDL-C, high-density ipoprtein cholesterol wooly EF, estimated eergy ependture per woot “Te 2 scores acute y ding ech pooled mean trees in HDL-C change by th standard devisten "sed for age and intervention pati dus ra nario etd ad otal cholera tage of mec), HDL-C HDL-C level might be smaller than The current results support those that by tse of medications such as inthe review by Durstine etal”=that fibrates or niacin.©” However, the a minimum exercise volume may e modest elevation in HDL-C level ist above which an HDL-C eleva- demonstrated by this analysis is of tion occurs. However, the required clinical importance and was not far exercise volume to produce a sig- from findings of previous meta- nificant change in HDL-C differed analyses wherein Kelley etal” and between our findings and theirs. Halbert etal"t reported mean net el- They also reported that weekly EE evationsin HDL-Clevelof 1.2 mg/dL greater than 1200 kealAvk was fr (0.031 mmol/L) and 1.9 mg/dl (0.05 quently associated wit elevations in mmol/L), respectively HDL-C level, while our analysis in- (©2007 American Medical Association, All rights reserved. Downloaded From: by a UNIVERSITY OF SYDNEY LIBRARY User on 05/03/2018 dicated a value of approximately 900 kal of weekly EE (Table 3). The rea- sons for this large discrepancy might be that their review included non— randomized controlled trial studies or studies lacking nonexercise con- trol groups, and might therefore have lovwer internal vali Belore this analysis, it was incon- clusive whether exercise character- istics (eg, duration, frequency, oFin- tensity) effect a change in HDL-C level. Differences in controled vari- ables among studies, sich a5 exe cise duration and volume, could ac- count for the varied results" Therefor, we performed both unad- justed (Figure 4) and muluivariae (Table 4) analyses (adjusted fore timated weekly exerese volume) © investigate the association between cach exercise characteristic and the change in HDL-C level. Exercise in- lensily was not associated with MDHC when adjusted for weekly EE. his result indicated that vigorous ecse intensity Was not necessary f EE by exercise is sufficient, which supported previous results” Controlling for weekly exereise length and excreise duration (note eeise frequency) was positively as- sociated with MDHC (Table 4). This Suggests that in improving blood HDL-C values, increasing time per session is beiter than performing smultiple brie exercise sessions when total time for exercise is lated, a3 is the case for many people. Al- though the Centers for Disease Con- trol and Prevention and the Ameri- can College of Sports Medicine’? recommend about 30 minutes of moderateintensity physical activ- itysuchasbrisk walking on most (or preferably all) days, our analyses suggest that a longer duration per session of continuous exercise than that recommendation is necessary for a significant inerease tn HDL-C level. However, no study in this analysis reported weekly exercise frc- quency of twice oF less: the fre- quency in those studies ranged from 2.3106.1 workouts per week. Ther. fore, additional research is needed to determine the minimal exercise frequency required to modily HDL-C levels. Ibis important from a clinical viewpoint to examine whe cercise training is more effective in (aepniyED) ARCHINTERN WEDVOL I, MATIN prado "087 (Pt) . . to. . to. . + care. eo 10 + Baa wae enton minSecn Frei Sess to. . to. of % . ao Le Bu. a er wf os oo. ae a a a_i Felten Woman Abo sy MENS Figure 4. Artcione between xara characterises and mean dernce in figh-desySpopaa ‘holstaol (HDL-C) change (MOC) between eeroee an conl gauge. Each wae wepned by the inverse of th sul si of sch eerie group. Tea ofthe cls proportional tothe study ‘ight vers ofthe sarpe su), MET eats alte eercse mens in metabolic equivalents (Ter coraspands to mt of Oper minut), Vonax, maximal oxygen ake. To comer HDL-C tomilmels por sr, tip by 00258. Table 4, Rel jetwoen Exerlse Characteristics and Mean Difference in HOL-£ Char Exercise and Control Groups When Weekly Exercise Volume Is Controlled ‘atest coatlent ($8) a iMoaalte 0 015,00) 086

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