Effect of exercise on endothelial function among non-communicable diseases adults with overweight or obese: a systematic review and meta-analysis
DOI:
https://doi.org/10.47197/retos.v75.117395Keywords:
High-intensity interval training, moderate-intensity continuous training, flow-mediated dilation, non-communicable disease, obeseAbstract
Introduction: High-Intensity Interval Training (HIIT) and Moderate-Intensity Continuous Training (MICT) both provide notable benefits for endothelial function, metabolic health, and cardiovascular fitness in adults with non-communicable diseases who are overweight or obese. HIIT, due to its efficacy in enhancing VO₂ max and vascular function, may offer significant benefits in mitigating cardiovascular risk. This study underscores the need of structured exercise training in the management of vascular health, considering the growing prevalence of non-communicable diseases (NCDs).
Objective: To identify the effect of exercise on endothelial function among NCDs adults with overweight or obese.
Methods: A literature search was conducted using the internet database PubMed to compare HIIT and MICT studies focused on endothelial function, specifically assessed by FMD, in adults with NCDs with overweight or obese.
Results: HIIT led to a notable enhancement in FMD (0.48%; p=0.007) with a 41.14% increase, in contrast to 8.33% in MICT. VO₂ max showed a greater enhancement in HIIT (1.00%; p=0.003), with increases of 17.68 ml/kg/min (HIIT) compared to 13.17 ml/kg/min (MICT). HDL levels showed a modest increase in HIIT (5.61 mmol/L) compared to MICT (4.63 mmol/L) (p=0.022). Glucose results favor in HIIT than MICT. In contrast, LDL cholesterol exhibited a marginally greater decrease in MICT (-0.06; p=0.12). However, results suggest no clear advantages on neither HIIT nor MICT in reducing triglycerides. The results indicate that high-intensity interval training is more effective for improving vascular health and aerobic capacity, whereas moderate-intensity continuous training may be more beneficial for reducing LDL cholesterol levels.
Conclusion: HIIT demonstrates greater effectiveness for improving FMD and VO₂ max, HDL, and glucose whereas MICT is more effective for reducing LDL. A 12-week HIIT program (4×4 min at 85–95% HR max, 3 times/week) has the potential to greatly improve vascular health and overall fitness levels.
References
Du, L., Zhang, X., Chen, K., Ren, X., Chen, S., & He, Q. (2021). Effect of high-intensity interval training on physical health in coronary artery disease patients: A meta-analysis of randomized controlled trials. Journal of Cardiovascular Development and Disease, 8(11), Article 145. https://doi.org/10.3390/jcdd8110145
Gibala, M. J., Little, J. P., Macdonald, M. J., & Hawley, J. A. (2012). Physiological adaptations to low-volume, high-intensity interval training in health and disease. The Journal of Physiology, 590(5), 1077–1084. https://doi.org/10.1113/jphysiol.2011.224725
Green, D. J., & Smith, K. J. (2018). Vascular structure and health in humans. Cold Spring Harbor Perspec-tives in Medicine, 8(2), a029629. https://doi.org/10.1101/cshperspect.a029629
Green, D. J., Jones, H., Thijssen, D., Cable, N. T., & Atkinson, G. (2011). Flow-mediated dilation and cardi-ovascular event prediction: Does nitric oxide matter? Hypertension, 57(3), 363–369. https://doi.org/10.1161/HYPERTENSIONAHA.110.167015
Hansen, D., Abreu, A., Ambrosetti, M., Cornelissen, V., Gevaert, A., Kemps, H., ... & Vanhees, L. (2022). Ex-ercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: Why and how. European Journal of Preventive Cardiology, 29(1), 230–245. https://doi.org/10.1093/eurjpc/zwab007
Hasanzad, M., Sarhangi, N., Meybodi, H. R. A., Nikfar, S., Khatami, F., & Larijani, B. (2019). Precision med-icine in non-communicable diseases. International Journal of Molecular and Cellular Medicine, 8(1), 1–18.
Ismail, H., Tumijan, W., Omar, M., Kasim, S. S., Sharif, S., & Ilias, N. F. (2025). Validation of scoring tool for lipid profile interpretation in exercise training: SLIEX. Malaysian Journal of Medical Scienc-es, 32(2), 64–76. https://doi.org/10.21315/mjms2025.32.2.7
Klonizakis, M., Moss, J., Gilbert, S., Broom, D., Foster, J., & Tew, G. A. (2014). Low-volume high-intensity interval training rapidly improves cardiopulmonary function in postmenopausal women. Men-opause, 21(10), 1099–1105. https://doi.org/10.1097/GME.0000000000000216
Kokkinos, P., Myers, J., Faselis, C., Panagiotakos, D. B., Doumas, M., Pittaras, A., ... & Karasik, P. (2010). Exercise capacity and mortality in older men: A 20-year follow-up study. Circulation, 122(8), 790–797. https://doi.org/10.1161/CIRCULATIONAHA.110.939249
Ko, J. M., So, W. Y., & Park, S. E. (2025). Narrative review of high-intensity interval training: Positive impacts on cardiovascular health and disease prevention. Journal of Cardiovascular Develop-ment and Disease, 12(1), Article 18. https://doi.org/10.3390/jcdd12010018
Kraal, J. J., Vromen, T., Spee, R., Kemps, H. M. C., & Peek, N. (2017). The influence of training characteris-tics on the effect of exercise training in patients with coronary artery disease: Systematic re-view and meta-regression analysis. International Journal of Cardiology, 245, 52–58. https://doi.org/10.1016/j.ijcard.2017.07.051
Li, Y., Zhao, W., & Yang, Q. (2025). Effects of high-intensity interval training and moderate-intensity continuous training on mitochondrial dynamics in human skeletal muscle. Frontiers in Physiol-ogy, 16, Article 1523457. https://doi.org/10.3389/fphys.2025.1523457
Mahzan, N. N. A., Ilias, N. F., Razak, M. N. A., ... (2024). Effectiveness of exercise intensity in improving cardiorespiratory fitness and body fat percentage among obese adults: A systematic review and meta-analysis. Malaysian Journal of Sport Science and Recreation, 20(1). https://journal.uitm.edu.my/ojs/index.php/MJSSR/article/view/1133
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & the PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
Murad, M. H., Chu, H., Lin, L., & Wang, Z. (2018). The effect of publication bias magnitude and direction on the certainty in evidence. BMJ Evidence-Based Medicine, 23(3), 84–86. https://doi.org/10.1136/bmjebm-2018-110891
Pathak, M., Dwivedi, S. N., Thakur, B., & Vishnubhatla, S. (2020). Methods of estimating the pooled effect size under meta-analysis: A comparative appraisal. Clinical Epidemiology and Global Health, 8(1), 105–112. https://doi.org/10.1016/j.cegh.2019.05.004
Pedersen, B. K., & Saltin, B. (2015). Exercise as medicine: Evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal of Medicine & Science in Sports, 25(S3), 1–72. https://doi.org/10.1111/sms.12581
Petrick, H. L., King, T. J., Pignanelli, C., Vanderlinde, T. E., Cohen, J. N., Holloway, G. P., ... & Gurd, B. J. (2021). Endurance and sprint training improve glycemia and VO₂peak, but only frequent en-durance benefits blood pressure and lipidemia. Medicine & Science in Sports & Exercise, 53(6), 1194–1205. https://doi.org/10.1249/MSS.0000000000002578
Ross, R., Blair, S. N., Arena, R., Church, T. S., Després, J. P., Franklin, B. A., ... & American Heart Association Physical Activity Committee. (2016). Importance of assessing cardiorespiratory fitness in clini-cal practice: A case for fitness as a clinical vital sign. Circulation, 134(24), e653–e699. https://doi.org/10.1161/CIR.0000000000000461
Smart, N. A., Waldron, M., Ismail, H., Giallauria, F., Vigorito, C., Cornelissen, V., ... & Marwick, T. H. (2015). Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. International Journal of Evidence-Based Healthcare, 13(1), 9–18. https://doi.org/10.1097/XEB.0000000000000020
Tawfik, G. M., Dila, K. A. S., Mohamed, M. Y. F., Tam, D. N. H., Kien, N. D., Ahmed, A. M., ... & Huy, N. T. (2019). A step-by-step guide for conducting a systematic review and meta-analysis with simu-lation data. Tropical Medicine and Health, 47, Article 46. https://doi.org/10.1186/s41182-019-0165-6
Thijssen, D. H. J., Benda, N. M. M., Kerstens, T. P., Seeger, J. P. H., van Dijk, A. P. J., & Hopman, M. T. E. (2019). Twelve-week exercise training, independent of exercise type, attenuates endothelial is-chaemia-reperfusion injury in heart failure patients. Frontiers in Physiology, 10, 264. https://doi.org/10.3389/fphys.2019.00264
Wisløff, U., Støylen, A., Loennechen, J. P., Bruvold, M., Rognmo, Ø., Haram, P. M., ... & Ellingsen, Ø. (2007). Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: A randomized study. Circulation, 115(24), 3086–3094. https://doi.org/10.1161/CIRCULATIONAHA.106.675041
World Health Organization. (2021). Global health estimates: Leading causes of death 2021. https://www.who.int/data/global-health-estimates
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Afryna Batrisyia Md Soberi, Noor Fatihah Ilias, Muhammad Syazani Sohaimi, Noorfahzarina Amiuliya Abu Bakar, Sazzli Shahlan Kasim, Rahmat Adnan, Mazlifah Omar, Hashbullah Ismail
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
