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A Meta-analysis

Satoru Kodama, MD; Shiro 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

Arch Intern Med. 2007;167(10):999-1008.

Background  Aerobic exercise is believed to reduce the risk of cardiovascular disease partially through increasing serum levels of high-density lipoprotein cholesterol (HDL-C). However, this effect varies considerably among exercise intervention studies.

Methods  Electronic database searches of MEDLINE (1966-2005) for randomized controlled trials that examined the effect of exercise training on HDL-C level.

Results  Twenty-five articles were included. Mean net change in HDL-C level was statistically significant but modest (2.53 mg/dL [0.065 mmol/L]; P<.001). Minimal weekly exercise volume for increasing HDL-C level was estimated to be 900 kcal of energy expenditure per week or 120 minutes of exercise per week. Univariate regression analysis indicated that every 10-minute prolongation of exercise per session was associated with an approximately 1.4-mg/dL (0.036-mmol/L) increase in HDL-C level. In contrast, there was no significant association between exercise frequency or intensity. Multiple meta-regression analyses demonstrated that subjects 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/dL [5.7 mmol/L] or more experienced an approximately 2.1-mg/dL (0.054-mmol/L) larger increase in HDL-C level than those with a body mass index of 28 or more and total cholesterol level less than 220 mg/dL (5.7 mmol/L).

Conclusions  Regular aerobic exercise modestly increases HDL-C level. There appears to exist a minimum exercise volume for a significant increase in HDL-C level. Exercise duration per session was the most important element of an exercise prescription. Exercise was more effective in subjects with initially high total cholesterol levels or low body mass index.

Author Affiliations: Department of Lifestyle Medicine and Nutritional Sciences, Ochanomizu University, Tokyo, Japan (Drs Kodama, Saito, Suzuki, Yamamoto, Kondo, and H. Sone and Mss Shu, Y. Sone, and Onitake); Departments of Sports Medicine and Health Sciences (Dr Kodama, Saito, Yamada, and H. Sone and Ms Shu) and Internal Medicine (Drs Kodama, Saito, Shimano, and H. Sone and Ms Shu), University of Tsukuba, Tsukuba, Japan; and Department of Biostatistics, Epidemiology, and Preventive Health Sciences, University of Tokyo (Mr Tanaka and Dr Ohashi).

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