Effect of Physical Activity on Cardiorespiratory Fitness and Markers of Cardiovascular Disease Risk During Menopause: A Systematic Review and Meta-Analysis of Randomised-Controlled Trials

Abstract Purpose The menopause transition is associated with increased cardiovascular disease (CVD) risk. Cardiorespiratory fitness (CRF) is inversely associated with CVD risk in healthy populations. CRF thus represents a responsive target for physical activity (PA) interventions in menopausal populations. The aims were: (1) to investigate the impact of PA interventions on CRF and CVD risk factors, respectively, in perimenopausal and menopausal women, and (2) to examine the association between changes in CRF and CVD risk factors following PA interventions. Methods Five databases (PubMed, EMBASE, Web of Science, CENTRAL, SPORTDiscus) were searched from inception to December 2023 for randomised controlled trials of PA interventions in menopausal females with non-active controls. The primary outcome was CRF, presented as VO 2max . The Cochrane Risk of Bias Tool was used to assess bias. Heterogeneity was observed using I 2 . Effect measures were presented as Mean Difference (MD) with 95% Confidence Interval (CI). Meta-regression was conducted to examine the relationship between changes in VO 2max and reduction in CVD risk. Results Seventy-eight studies with 5332 participants were included in meta-analysis. For VO 2max , there was a favourable effect of exercise versus control (3.51 mL/kg/min, 95% CI 2.75 to 4.27, 1968 participants, 30 trials). Considerable heterogeneity was observed. Meta-regression indicated a small, significant inverse association between changes in VO 2max and changes in systolic blood pressure in sensitivity analysis. Conclusions All types of PA improved CRF. Moreover, improvements in CRF through PA intervention may be associated with concomitant reductions in systolic blood pressure, which is a major risk for CVD. Many outcomes had unexplained heterogeneity and unclear risk of bias due to lack of transparent reporting. Future research should investigate age and PA intensity as moderator variables. Future RCTs should focus on transparent reporting.