Front Physiol. 2026 Aug 18;17:1911464. doi: 10.3389/fphys.2026.1911464. eCollection 2026.
ABSTRACT
BACKGROUND: In 2023, cardiovascular diseases caused an estimated 19.2 million deaths worldwide, accounting for approximately one-third of all global deaths. Despite this heavy burden, there is limited evidence comparing the effects of various exercise modalities on functional capacity, arterial stiffness, and lipid profiles in patients with atherosclerotic cardiovascular disease (ASCVD). This network meta-analysis evaluated 12 exercise interventions to guide personalized exercise prescriptions.
METHODS: A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted from their inception until June 10, 2026, to identify randomized controlled trials assessing exercise interventions in adults with ASCVD. The primary outcomes measured included the 6-minute walk distance (6MWD), pulse wave velocity (PWV), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). A network meta-analysis was conducted, and the ranking of interventions was determined using the surface under the cumulative ranking curve (SUCRA). The protocol was registered with PROSPERO (registration No. CRD420261412964).
RESULTS: A comprehensive analysis incorporating 29 RCTs with a cumulative sample size of 2,496 participants was conducted. The network meta-analysis (NMA) indicated that various exercise modalities exhibited unique benefits for specific health outcomes. Resistance Training (RT) was identified as the most effective intervention for enhancing the 6MWD. Both Qigong combined with Dancing (QD) and Aerobic Exercise (AE) were associated with the most pronounced improvements in PWV. In terms of lipid profile modulation, QD was the most efficacious in reducing total cholesterol levels and increasing HDL-C, whereas RT combined with Blood Flow Restriction (BFRT) was superior in improving LDL-C levels.
CONCLUSION: Different exercise interventions yield specific benefits in managing ASCVD. This study endorses the concept of "goal-oriented exercise prescription" and suggests that exercise regimens should be meticulously tailored to align with patients' individualized treatment goals, in conjunction with standard pharmacological therapy.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261412964, identifier CRD420261412964.
PMID:42682396 | PMC:PMC13529447 | DOI:10.3389/fphys.2026.1911464