Clinical InvestigationCoronary Artery DiseaseExercise intervention and inflammatory markers in coronary artery disease: A meta-analysis
Section snippets
Background
In patients with coronary artery disease (CAD), exercise interventions confer long-term survival benefit and reduce the risk of recurrent events.1 Roles of immune activity in the development and progression of atherosclerosis are now appreciated.2, 3 Monocytes recruited by vascular endothelial cell signals (eg, vascular cell adhesion molecule 1 [VCAM-1]) are activated during plaque formation to produce metalloproteinases, nitric oxide, and the proinflammatory cytokines tumor necrosis factor α
Data sources
Methodology followed PRISMA guidelines.21 English-language literature was searched using MEDLINE, Embase, the Cochrane Collaboration, AMED, and CINAHL up to June 2011 for original reports of inflammatory biomarker changes after exercise in patients with CAD (see online Appendix A).
Study selection
Inclusion criteria were (1) inflammatory biomarkers measured before and after aerobic exercise intervention; (2) intervention ≥2 weeks; (3) diagnosis of CAD by history of myocardial infarction, percutaneous coronary
Population characteristics
Twenty-three studies met inclusion criteria (Figure 1) ranging in size from 12 to 393 subjects (Table I). Subjects (73.0% male, mean age 63.1 ± 7.6 years) had a 20.1% prevalence of diabetes (antidiabetic use inconsistently reported), and 73.1% were prescribed a cholesterol-lowering medication. Mean exercise prescriptions were 41.5 ± 15.8 (20-80) minutes, 3.9 ± 1.7 (2-7) sessions per week, for 11.3 ± 5.3 (2-24) weeks with estimated energy expenditures ranging from 1,918 to 14,654 kJ per week (
Discussion
Collectively, the evidence supports a reduction in inflammatory activity associated with exercise training in patients with CAD as indicated by lower CRP, fibrinogen, IL-6, and VCAM-1 after intervention. Associations between these biomarkers and risk of mortality10, 11, 12,14, 15 emphasize the potential significance of these findings. Controlled studies strengthened this evidence, showing lower final concentrations of CRP and fibrinogen in those who undertook exercise compared with controls.
The
Acknowledgements
The authors thank Drs Anita Shumacher, Sanja Balen, and Kari Peersen for their valued correspondence and Maureen Pakosh, BA, MISt, for information resources support.
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