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Endurance exercise improves cholesterol levels and heart health in people with coronary artery disease

Chen YC, Tsai JC, Liou YM, and Chan P. Effectiveness of endurance exercise training in patients with coronary artery disease: A meta-analysis of randomised controlled trials Eur J Cardiovasc Nurs. 2016;16:397-408.

Review question

Does endurance exercise help reduce the risk of heart disease, increase endurance or improve heart function in people with coronary artery disease? What type of exercise program is most effective?


Coronary artery disease (CAD) is a common condition in which the vessels supplying blood to the heart become blocked. People with CAD are often instructed to exercise to prevent worsening of their condition. This review examined if and how endurance (aerobic) exercise can benefit people with CAD, as well as if certain types of exercise programs are more beneficial than others.

How the review was done

This is a systematic review of 18 randomized controlled trials conducted from 2000 to 2014, including a total of 1286 participants. All the studies were considered to be of fair to good quality.

  • All participants were 20 years and older, with the average age being 57 years. Participants all had known CAD ─ meaning that they previously experienced a heart attack, had a surgery or procedure to treat CAD, and/or had a clinical diagnosis of CAD.
  • Study participants exercised as part of a home and/or supervised program between three to seven times per week for a total of eight to 24 weeks. Exercise sessions in the various studies ranged from 20 to 60 minutes long. The programs involved moderately intense endurance exercises, including cycling, walking and jogging.
  • Researchers measured participants’ blood pressure and cholesterol (two known risk factors for CAD), peak oxygen consumption (a measure of cardiovascular endurance) and left ventricular ejection fraction (a measure of the heart’s ‘pumping’ function).
  • Results were compared to control groups who did not participate in the exercise programs.

What the researchers found

Endurance exercise programs help improve risk factors for CAD. Specifically, the exercises helped decrease systolic blood pressure and low density lipoprotein (‘bad’ cholesterol) and increase high density lipoprotein (‘good’ cholesterol). Participants in the exercise programs also showed improvements in endurance and heart function. Programs that were up to 12 weeks long improved blood pressure and endurance, whereas longer programs also improved cholesterol levels and heart function. People who exercised for 60 to 90 minutes per week had the same results as people who exercised for more than 90 minutes.


Exercise programs appear to be an effective way to improve CAD risk factors – including cholesterol levels – as well as increase cardiovascular endurance and heart function.


Control group
A group that receives either no treatment or a standard treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Risk factors
Aspects making a condition more likely.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Web Resources

  • Coronary artery disease risk screening

    Health Link B.C.
    Men over 40 and women past menopause or over 50 should get screened for coronary artery disease (CAD) every 1 to 3 years. Your risk is higher if you have diabetes, high blood pressure, abdominal obesity, kidney disease, family history of CAD or if you smoke.
  • High cholesterol: Does reducing the amount of fat in your diet help?

    Informed Health Online
    Eat less saturated fats in your diet to help prevent heart disease. Eat less meat, butter, cheese and cream to improve your health long-term.
  • Statins: Should I Take Them to Prevent a Heart Attack or Stroke?

    This patient decision aid helps people considering taking medicines called statins to lower their risk of heart attack and stroke by comparing the benefits, risks, and side effects of both options. It also includes alternative treatment options to taking statins such as trying to lower risk with lifestyle changes.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

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