Exercise-based cardiac rehabilitation may be an effective non-pharmacological
intervention for improving endothelial function in coronary artery disease
patients. Therefore, this systematic review with meta-analysis aimed to (a)
estimate the training-induced effect on endothelial and vascular smooth muscle
function, assessed by flow-mediated dilation and nitroglycerin-mediated
dilation, respectively, in coronary artery disease patients; and to (b) study
the influence of potential trial-level variables (i. e. study and
intervention characteristics) on the training-induced effect on endothelial and
vascular smooth muscle function. Electronic searches were performed in Pubmed,
Scopus, and Embase up to February 2021. Random-effects models of standardised
mean change were estimated. Heterogeneity analyses were performed by using the
Chi
2
test and I
2
index.
Our results showed that exercise-based cardiac rehabilitation significantly
enhanced flow-mediated dilation (1.04 [95% confidence
interval=0.76 to 1.31]) but did not significantly change
nitroglycerin-mediated dilation (0.05 [95% confidence
interval=–0.03 to 0.13]). Heterogeneity testing reached
statistical significance (p<.001) with high inconsistency for
flow-mediated dilation (I
2
=92%).
Nevertheless, none of the analysed variables influenced the training-induced
effect on flow-mediated dilation. Exercise-based cardiac rehabilitation seems to
be an effective therapeutic strategy for improving endothelial-dependent
dilation in coronary artery disease patients, which may aid in the prevention of
cardiovascular events.