Medical Journal of Mashhad university of Medical Sciences

Medical Journal of Mashhad university of Medical Sciences

The impact of exercise training on vascular function in children and adolescents with overweigh and obesity: a systematic review with meta-analysis

Document Type : Review article

Authors
Mousa khalafi 1
Fatemeh-Sadat Tabatabaei 1
Fatemeh-Sadat Hosseini 1
Faeghe Ghasemi 2
1 Department of Sport Sciences, Faculty of Humanities, University of Kashan, Kashan, Iran
2 Faculty of Physical Education and Sport Sciences, University of Guilan, Guilan, Iran
10.22038/mjms.2025.85366.4898
Abstract
Introduction: This systematic review and meta-analysis aimed to investigate the effects of exercise training on flow-mediated dilation (FMD) in overweight and obese children and adolescents
Materials and Methods. Methods: A comprehensive search was conducted in three electronic databases including Scopus, PubMed, and Web of Science until April 2023 using keywords such as "exercise training", "endothelial function", "children and adolescents", and "obesity". Weighted mean difference (WMD) and 95% confidence intervals (95% CIs) were calculated using a random effects model to compare exercise training with the control group. Also, subgroup analysis was performed based on the duration of exercise intervention and the age of the subjects (age up to 10 years and age 10 to 18 years).
Results. A total of 379 overweight and obese children and adolescents from 9 studies were included in the meta-analysis. Exercise training significantly increased FMD compared to control [WMD: 1.36 (CI: 0.12 to 2.61), P=0.03], but had no significant effect on body weight [WMD: -0.54 (CI: -0.56 to -1.64), P=0.33]. Subgroup analysis by intervention duration showed that short-term interventions had a significant positive effect on FMD [WMD: 1.51 (CI: 0.17 to 2.84), P=0.02], while subgroup analysis by age showed no significant difference.
Conclusion. The results of the present study confirm that exercise can improve vascular function in overweight and obese children and adolescents without the need for weight loss and is effective as a non-pharmacological strategy in preventing cardiovascular diseases.
Keywords
Exercise training
Vascular function
Obesity
children and adolescents
Subjects
1. Khalafi M, Symonds ME. The impact of high intensity interval training on liver fat content in overweight or obese adults: A meta-analysis. Physiology & Behavior. 2021;236:113416. 2. Khalafi M, Sakhaei MH, Kheradmand S, Symonds ME, Rosenkranz SK. The impact of exercise and dietary interventions on circulating leptin and adiponectin in individuals with overweight and obesity: a systematic review and meta-analysis. Advances in Nutrition. 2022. 3. Singh AS, Mulder C, Twisk JW, Van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity reviews. 2008;9(5):474-88. 4. Doak C, Visscher T, Renders C, Seidell J. The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obesity reviews. 2006;7(1):111-36. 5. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics. 2001;108(3):712-8. 6. Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G. Mechanisms of obesity-induced hypertension. Hypertension research. 2010;33(5):386-93. 7. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter D, Miller O, Sullivan I, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. The lancet. 1992;340(8828):1111-5. 8. Sakhaei MH, Saidie P, Damirchi A. Effects of high-intensity interval versus moderate continuous exercise on plasma concentration of nitric oxide and level of blood pressure in inactive obese men. Journal of Applied Health Studies in Sport Physiology. 2022. 9. Sun H-J, Wu Z-Y, Nie X-W, Bian J-S. Role of endothelial dysfunction in cardiovascular diseases: the link between inflammation and hydrogen sulfide. Frontiers in pharmacology. 2020;10:1568. 10. Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, et al. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. The Lancet. 2001;358(9291):1400-4. 11. Inaba Y, Chen JA, Bergmann SR. Prediction of future cardiovascular outcomes by flow-mediated vasodilatation of brachial artery: a meta-analysis. The international journal of cardiovascular imaging. 2010;26:631-40. 12. Cheng Y, Sun Z, Ya X, Zhou L, Wang M, Wang X, et al. Effect of exercise training on arterial stiffness in obese and overweight children: A meta-analysis. European Journal of Pediatrics. 2022;181(7):2633-42. 13. Pedersen BK, Saltin B. Exercise as medicine–evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian journal of medicine & science in sports. 2015;25:1-72. 14. Palermi S, Bragazzi NL, Cular D, Ardigò LP, Padulo J. How chest press-based exercises can alleviate the burden of cardiovascular diseases. Human Movement. 2021;22(1). 15. Khalafi M, Taghibeikzadehbadr P, Aria B, Mohammadi z. The effect of resistance training on endothelial function in young and older with chronic diseases and those with health conditions: a systematic review and meta-analysis. Journal of Sport and Exercise Physiology. 2023;16(2):105-20. 16. Moradian H, Hosseinpour Delavar S, Zabet A. The effects of eight weeks circuit resistance training on some endothelial markers, blood pressure and lipid profiles in pre-hypertensive obese women. Journal of Sport and Exercise Physiology. 2022;15(2):84-94. 17. Khalafi M, Symonds ME, Akbari A. The impact of exercise training versus caloric restriction on inflammation markers: a systemic review and meta-analysis. Critical Reviews in Food Science and Nutrition. 2022;62(15):4226-41. 18. Khalafi M, Sakhaei MH, Kazeminasab F, Symonds ME, Rosenkranz SK. The impact of high-intensity interval training on vascular function in adults: A systematic review and meta-analysis. Frontiers in Cardiovascular Medicine. 2022:1. 19. Khalafi M, Azali Alamdari K, Symonds ME, Rohani H, Sakhaei MH. A comparison of the impact of exercise training with dietary intervention versus dietary intervention alone on insulin resistance and glucose regulation in individual with overweight or obesity: a systemic review and meta-analysis. Critical Reviews in Food Science and Nutrition. 2022:1-15. 20. Halbert J, Silagy C, Finucane P, Withers R, Hamdorf P. Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials. European journal of clinical nutrition. 1999;53(7):514-22. 21. Versari D, Daghini E, Virdis A, Ghiadoni L, Taddei S. Endothelial dysfunction as a target for prevention of cardiovascular disease. Diabetes care. 2009;32(suppl_2):S314-S21. 22. Dias KA, Green DJ, Ingul CB, Pavey TG, Coombes JS. Exercise and vascular function in child obesity: a meta-analysis. Pediatrics. 2015;136(3):e648-e59. 23. Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin XE, Herrmann FR, Beghetti M. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. Journal of the American College of Cardiology. 2009;54(25):2396-406. 24. Murphy EC, Carson L, Neal W, Baylis C, Donley D, Yeater R. Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children. Int J Pediatr Obes. 2009;4(4):205-14. 25. Naylor LH, Davis EA, Kalic RJ, Paramalingam N, Abraham MB, Jones TW, et al. Exercise training improves vascular function in adolescents with type 2 diabetes. Physiological reports. 2016;4(4):e12713. 26. Woo KS, Chook P, Yu CW, Sung RY, Qiao M, Leung SS, et al. Effects of diet and exercise on obesity-related vascular dysfunction in children. Circulation. 2004;109(16):1981-6. 27. Agergaard J, Trøstrup J, Uth J, Iversen JV, Boesen A, Andersen JL, et al. Does vitamin-D intake during resistance training improve the skeletal muscle hypertrophic and strength response in young and elderly men? - a randomized controlled trial. Nutr Metab (Lond). 2015;12:32. 28. Chuensiri N, Suksom D, Tanaka H. Effects of High-Intensity Intermittent Training on Vascular Function in Obese Preadolescent Boys. Child Obes. 2018;14(1):41-9. 29. Kelly AS, Wetzsteon RJ, Kaiser DR, Steinberger J, Bank AJ, Dengel DR. Inflammation, insulin, and endothelial function in overweight children and adolescents: the role of exercise. The Journal of pediatrics. 2004;145(6):731-6. 30. Watts K, Beye P, Siafarikas A, Davis EA, Jones TW, O'Driscoll G, et al. Exercise training normalizes vascular dysfunction and improves central adiposity in obese adolescents. Journal of the American College of Cardiology. 2004;43(10):1823-7. 31. Watts K, Beye P, Siafarikas A, O'Driscoll G, Jones TW, Davis EA, et al. Effects of exercise training on vascular function in obese children. The Journal of pediatrics. 2004;144(5):620-5. 32. Chandler J, Cumpston M, Li T, Page MJ, Welch V. Cochrane handbook for systematic reviews of interventions. Hoboken: Wiley. 2019;4. 33. Ingul CB, Dias KA, Tjonna AE, Follestad T, Hosseini MS, Timilsina AS, et al. Effect of High Intensity Interval Training on Cardiac Function in Children with Obesity: A Randomised Controlled Trial. Progress in cardiovascular diseases. 2018;61(2):214-21. 34. Khalafi M, Sakhaei MH, Rosenkranz SK, Symonds ME. Impact of concurrent training versus aerobic or resistance training on cardiorespiratory fitness and muscular strength in middle-aged to older adults: A systematic review and meta-analysis. Physiology & Behavior. 2022:113888. 35. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. New England journal of medicine. 2002;346(11):793-801. 36. Barry VW, Baruth M, Beets MW, Durstine JL, Liu J, Blair SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Progress in cardiovascular diseases. 2014;56(4):382-90. 37. Higashi Y, Sasaki S, Kurisu S, Yoshimizu A, Sasaki N, Matsuura H, et al. Regular aerobic exercise augments endothelium-dependent vascular relaxation in normotensive as well as hypertensive subjects: role of endothelium-derived nitric oxide. Circulation. 1999;100(11):1194-202. 38. Sciacqua A, Candigliota M, Ceravolo R, Scozzafava A, Sinopoli F, Corsonello A, et al. Weight loss in combination with physical activity improves endothelial dysfunction in human obesity. Diabetes Care. 2003;26(6):1673-8. 39. Montero D, Walther G, Benamo E, Perez-Martin A, Vinet A. Effects of exercise training on arterial function in type 2 diabetes mellitus: a systematic review and meta-analysis. Sports medicine. 2013;43:1191-9. 40. Walsh JH, Bilsborough W, Maiorana A, Best M, O'Driscoll GJ, Taylor RR, et al. Exercise training improves conduit vessel function in patients with coronary artery disease. Journal of Applied Physiology. 2003;95(1):20-5. 41. Hambrecht R, Walther C, Mobius-Winkler S, Gielen S, Linke A, Conradi K, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation. 2004;109(11):1371-8. 42. Maiorana A, O'Driscoll G, Dembo L, Cheetham C, Goodman C, Taylor R, et al. Effect of aerobic and resistance exercise training on vascular function in heart failure. American Journal of Physiology-Heart and Circulatory Physiology. 2000;279(4):H1999-H2005. 43. Maiorana A, O’Driscoll G, Taylor R, Green D. Exercise and the nitric oxide vasodilator system. Sports Medicine. 2003;33:1013-35. 44. Green DJ, Maiorana A, O'Driscoll G, Taylor R. Effect of exercise training on endothelium‐derived nitric oxide function in humans. The Journal of physiology. 2004;561(1):1-25. 45. Tinken TM, Thijssen DH, Hopkins N, Dawson EA, Cable NT, Green DJ. Shear stress mediates endothelial adaptations to exercise training in humans. Hypertension. 2010;55(2):312-8. 46. Green DJ, Walsh JH, Maiorana A, Best MJ, Taylor RR, O'Driscoll JG. Exercise-induced improvement in endothelial dysfunction is not mediated by changes in CV risk factors: pooled analysis of diverse patient populations. American Journal of Physiology-Heart and Circulatory Physiology. 2003;285(6):H2679-H87. 47. Green DJ, Eijsvogels T, Bouts YM, Maiorana AJ, Naylor LH, Scholten RR, et al. Exercise training and artery function in humans: nonresponse and its relationship to cardiovascular risk factors. Journal of Applied Physiology. 2014;117(4):345-52. 48. Maiorana A, O’Driscoll G, Cheetham C, Dembo L, Stanton K, Goodman C, et al. The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes. Journal of the American College of Cardiology. 2001;38(3):860-6. 49. Vona M, Codeluppi G, Iannino T, Ferrari E, Bogousslavsky J, Von Segesser L. Effects of different types of exercise training followed by detraining on endothelium-dependent dilation in patients with recent myocardial infarction. Circulation. 2009;119(12):1601-8. 50. Charakida M, Jones A, Falaschetti E, Khan T, Finer N, Sattar N, et al. Childhood obesity and vascular phenotypes: a population study. Journal of the American College of Cardiology. 2012;60(25):2643-50. 51. Tryggestad JB, Thompson DM, Copeland KC, Short KR. Obese children have higher arterial elasticity without a difference in endothelial function: the role of body composition. Obesity. 2012;20(1):165-71. 52. Tinken TM, Thijssen DH, Black MA, Cable NT, Green DJ. Time course of change in vasodilator function and capacity in response to exercise training in humans. The Journal of physiology. 2008;586(20):5003-12. 53. Murphy EC, Carson L, Neal W, Baylis C, Donley D, Yeater R. Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children. International Journal of Pediatric Obesity. 2009;4(4):205-14. 54. Kelly AS, Wetzsteon RJ, Kaiser DR, Steinberger J, Bank AJ, Dengel DR. Inflammation, insulin, and endothelial function in overweight children and adolescents: the role of exercise. The Journal of pediatrics. 2004;145(6):731-6. 1. Khalafi M, Symonds ME. The impact of high intensity interval training on liver fat content in overweight or obese adults: A meta-analysis. Physiology & Behavior. 2021;236:113416. 2. Khalafi M, Sakhaei MH, Kheradmand S, Symonds ME, Rosenkranz SK. The impact of exercise and dietary interventions on circulating leptin and adiponectin in individuals with overweight and obesity: a systematic review and meta-analysis. Advances in Nutrition. 2022. 3. Singh AS, Mulder C, Twisk JW, Van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity reviews. 2008;9(5):474-88. 4. Doak C, Visscher T, Renders C, Seidell J. The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obesity reviews. 2006;7(1):111-36. 5. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics. 2001;108(3):712-8. 6. Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G. Mechanisms of obesity-induced hypertension. Hypertension research. 2010;33(5):386-93. 7. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter D, Miller O, Sullivan I, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. The lancet. 1992;340(8828):1111-5. 8. Sakhaei MH, Saidie P, Damirchi A. Effects of high-intensity interval versus moderate continuous exercise on plasma concentration of nitric oxide and level of blood pressure in inactive obese men. Journal of Applied Health Studies in Sport Physiology. 2022. 9. Sun H-J, Wu Z-Y, Nie X-W, Bian J-S. Role of endothelial dysfunction in cardiovascular diseases: the link between inflammation and hydrogen sulfide. Frontiers in pharmacology. 2020;10:1568. 10. Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, et al. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. The Lancet. 2001;358(9291):1400-4. 11. Inaba Y, Chen JA, Bergmann SR. Prediction of future cardiovascular outcomes by flow-mediated vasodilatation of brachial artery: a meta-analysis. The international journal of cardiovascular imaging. 2010;26:631-40. 12. Cheng Y, Sun Z, Ya X, Zhou L, Wang M, Wang X, et al. Effect of exercise training on arterial stiffness in obese and overweight children: A meta-analysis. European Journal of Pediatrics. 2022;181(7):2633-42. 13. Pedersen BK, Saltin B. Exercise as medicine–evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian journal of medicine & science in sports. 2015;25:1-72. 14. Palermi S, Bragazzi NL, Cular D, Ardigò LP, Padulo J. How chest press-based exercises can alleviate the burden of cardiovascular diseases. Human Movement. 2021;22(1). 15. Khalafi M, Taghibeikzadehbadr P, Aria B, Mohammadi z. The effect of resistance training on endothelial function in young and older with chronic diseases and those with health conditions: a systematic review and meta-analysis. Journal of Sport and Exercise Physiology. 2023;16(2):105-20. 16. Moradian H, Hosseinpour Delavar S, Zabet A. The effects of eight weeks circuit resistance training on some endothelial markers, blood pressure and lipid profiles in pre-hypertensive obese women. Journal of Sport and Exercise Physiology. 2022;15(2):84-94. 17. Khalafi M, Symonds ME, Akbari A. The impact of exercise training versus caloric restriction on inflammation markers: a systemic review and meta-analysis. Critical Reviews in Food Science and Nutrition. 2022;62(15):4226-41. 18. Khalafi M, Sakhaei MH, Kazeminasab F, Symonds ME, Rosenkranz SK. The impact of high-intensity interval training on vascular function in adults: A systematic review and meta-analysis. Frontiers in Cardiovascular Medicine. 2022:1. 19. Khalafi M, Azali Alamdari K, Symonds ME, Rohani H, Sakhaei MH. A comparison of the impact of exercise training with dietary intervention versus dietary intervention alone on insulin resistance and glucose regulation in individual with overweight or obesity: a systemic review and meta-analysis. Critical Reviews in Food Science and Nutrition. 2022:1-15. 20. Halbert J, Silagy C, Finucane P, Withers R, Hamdorf P. Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials. European journal of clinical nutrition. 1999;53(7):514-22. 21. Versari D, Daghini E, Virdis A, Ghiadoni L, Taddei S. Endothelial dysfunction as a target for prevention of cardiovascular disease. Diabetes care. 2009;32(suppl_2):S314-S21. 22. Dias KA, Green DJ, Ingul CB, Pavey TG, Coombes JS. Exercise and vascular function in child obesity: a meta-analysis. Pediatrics. 2015;136(3):e648-e59. 23. Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin XE, Herrmann FR, Beghetti M. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. Journal of the American College of Cardiology. 2009;54(25):2396-406. 24. Murphy EC, Carson L, Neal W, Baylis C, Donley D, Yeater R. Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children. Int J Pediatr Obes. 2009;4(4):205-14. 25. Naylor LH, Davis EA, Kalic RJ, Paramalingam N, Abraham MB, Jones TW, et al. Exercise training improves vascular function in adolescents with type 2 diabetes. Physiological reports. 2016;4(4):e12713. 26. Woo KS, Chook P, Yu CW, Sung RY, Qiao M, Leung SS, et al. Effects of diet and exercise on obesity-related vascular dysfunction in children. Circulation. 2004;109(16):1981-6. 27. Agergaard J, Trøstrup J, Uth J, Iversen JV, Boesen A, Andersen JL, et al. Does vitamin-D intake during resistance training improve the skeletal muscle hypertrophic and strength response in young and elderly men? - a randomized controlled trial. Nutr Metab (Lond). 2015;12:32. 28. Chuensiri N, Suksom D, Tanaka H. Effects of High-Intensity Intermittent Training on Vascular Function in Obese Preadolescent Boys. Child Obes. 2018;14(1):41-9. 29. Kelly AS, Wetzsteon RJ, Kaiser DR, Steinberger J, Bank AJ, Dengel DR. Inflammation, insulin, and endothelial function in overweight children and adolescents: the role of exercise. The Journal of pediatrics. 2004;145(6):731-6. 30. Watts K, Beye P, Siafarikas A, Davis EA, Jones TW, O'Driscoll G, et al. Exercise training normalizes vascular dysfunction and improves central adiposity in obese adolescents. Journal of the American College of Cardiology. 2004;43(10):1823-7. 31. Watts K, Beye P, Siafarikas A, O'Driscoll G, Jones TW, Davis EA, et al. Effects of exercise training on vascular function in obese children. The Journal of pediatrics. 2004;144(5):620-5. 32. Chandler J, Cumpston M, Li T, Page MJ, Welch V. Cochrane handbook for systematic reviews of interventions. Hoboken: Wiley. 2019;4. 33. Ingul CB, Dias KA, Tjonna AE, Follestad T, Hosseini MS, Timilsina AS, et al. Effect of High Intensity Interval Training on Cardiac Function in Children with Obesity: A Randomised Controlled Trial. Progress in cardiovascular diseases. 2018;61(2):214-21. 34. Khalafi M, Sakhaei MH, Rosenkranz SK, Symonds ME. Impact of concurrent training versus aerobic or resistance training on cardiorespiratory fitness and muscular strength in middle-aged to older adults: A systematic review and meta-analysis. Physiology & Behavior. 2022:113888. 35. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. New England journal of medicine. 2002;346(11):793-801. 36. Barry VW, Baruth M, Beets MW, Durstine JL, Liu J, Blair SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Progress in cardiovascular diseases. 2014;56(4):382-90. 37. Higashi Y, Sasaki S, Kurisu S, Yoshimizu A, Sasaki N, Matsuura H, et al. Regular aerobic exercise augments endothelium-dependent vascular relaxation in normotensive as well as hypertensive subjects: role of endothelium-derived nitric oxide. Circulation. 1999;100(11):1194-202. 38. Sciacqua A, Candigliota M, Ceravolo R, Scozzafava A, Sinopoli F, Corsonello A, et al. Weight loss in combination with physical activity improves endothelial dysfunction in human obesity. Diabetes Care. 2003;26(6):1673-8. 39. Montero D, Walther G, Benamo E, Perez-Martin A, Vinet A. Effects of exercise training on arterial function in type 2 diabetes mellitus: a systematic review and meta-analysis. Sports medicine. 2013;43:1191-9. 40. Walsh JH, Bilsborough W, Maiorana A, Best M, O'Driscoll GJ, Taylor RR, et al. Exercise training improves conduit vessel function in patients with coronary artery disease. Journal of Applied Physiology. 2003;95(1):20-5. 41. Hambrecht R, Walther C, Mobius-Winkler S, Gielen S, Linke A, Conradi K, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation. 2004;109(11):1371-8. 42. Maiorana A, O'Driscoll G, Dembo L, Cheetham C, Goodman C, Taylor R, et al. Effect of aerobic and resistance exercise training on vascular function in heart failure. American Journal of Physiology-Heart and Circulatory Physiology. 2000;279(4):H1999-H2005. 43. Maiorana A, O’Driscoll G, Taylor R, Green D. Exercise and the nitric oxide vasodilator system. Sports Medicine. 2003;33:1013-35. 44. Green DJ, Maiorana A, O'Driscoll G, Taylor R. Effect of exercise training on endothelium‐derived nitric oxide function in humans. The Journal of physiology. 2004;561(1):1-25. 45. Tinken TM, Thijssen DH, Hopkins N, Dawson EA, Cable NT, Green DJ. Shear stress mediates endothelial adaptations to exercise training in humans. Hypertension. 2010;55(2):312-8. 46. Green DJ, Walsh JH, Maiorana A, Best MJ, Taylor RR, O'Driscoll JG. Exercise-induced improvement in endothelial dysfunction is not mediated by changes in CV risk factors: pooled analysis of diverse patient populations. American Journal of Physiology-Heart and Circulatory Physiology. 2003;285(6):H2679-H87. 47. Green DJ, Eijsvogels T, Bouts YM, Maiorana AJ, Naylor LH, Scholten RR, et al. Exercise training and artery function in humans: nonresponse and its relationship to cardiovascular risk factors. Journal of Applied Physiology. 2014;117(4):345-52. 48. Maiorana A, O’Driscoll G, Cheetham C, Dembo L, Stanton K, Goodman C, et al. The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes. Journal of the American College of Cardiology. 2001;38(3):860-6. 49. Vona M, Codeluppi G, Iannino T, Ferrari E, Bogousslavsky J, Von Segesser L. Effects of different types of exercise training followed by detraining on endothelium-dependent dilation in patients with recent myocardial infarction. Circulation. 2009;119(12):1601-8. 50. Charakida M, Jones A, Falaschetti E, Khan T, Finer N, Sattar N, et al. Childhood obesity and vascular phenotypes: a population study. Journal of the American College of Cardiology. 2012;60(25):2643-50. 51. Tryggestad JB, Thompson DM, Copeland KC, Short KR. Obese children have higher arterial elasticity without a difference in endothelial function: the role of body composition. Obesity. 2012;20(1):165-71. 52. Tinken TM, Thijssen DH, Black MA, Cable NT, Green DJ. Time course of change in vasodilator function and capacity in response to exercise training in humans. The Journal of physiology. 2008;586(20):5003-12. 53. Murphy EC, Carson L, Neal W, Baylis C, Donley D, Yeater R. Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children. International Journal of Pediatric Obesity. 2009;4(4):205-14. 54. Kelly AS, Wetzsteon RJ, Kaiser DR, Steinberger J, Bank AJ, Dengel DR. Inflammation, insulin, and endothelial function in overweight children and adolescents: the role of exercise. The Journal of pediatrics. 2004;145(6):731-6.
Medical Journal of Mashhad university of Medical Sciences
Volume 69, Issue 6
June 2026
Pages 614-626