Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

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Effects of Exercise on Endothelial Progenitor Cells in Cardiovascular Disease Patients: A Systematic Review

운동중재가 심혈관질환자의 혈관내피전구세포에 미치는 영향: 체계적 문헌고찰

  • Kim, Ahrin (Department of Nursing, Cheongju University) ;
  • Yang, In-Suk (Department of Nursing, Kyungil University)
  • Received : 2017.02.06
  • Accepted : 2017.04.07
  • Published : 2017.04.30
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Abstract

In this study, we performed a systematic review and meta-analysis to identify the effects of exercise on endothelial progenitor cells (EPCs) in patients with cardiovascular disease (CVD). We conducted database searches (Cochrane Library, PubMed, EMBASE, ScienceDirect, CINAHL, Scopus, KoreaMed, KISS, RISS, KMBASE) for the effect of exercise on cardiovascular disease, using heart disease, coronary artery disease, heart failure, cardiovascular disease, exercise, motor activity, rehabilitation, and endothelial progenitor cells as the keywords. Of the 539 studies identified, 9 met the inclusion and exclusion criteria. Comprehensive Meta-Analysis version 2.0 was used to analyze the effect size and the publication bias was checked with a funnel plot. Exercise was found to improve the VEGF (vascular endothelial growth factor), CD34+KDR+, and endothelial function, assessed via FMD (flow-mediated dilation), in the exercise vs. control groups, viz. 2.008 (95% CI 0.204-3.812), 1.399 (95% CI 0.310-2.489), and 1.881 (95% CI 0.848-2.914), respectively. Exercise improved the VEGF, number of EPCs, and endothelial function in the CVD patients. Considering the increasing prevalence and mortality rates for cardiovascular disease in Korea, the findings of this study that analyzed the effects of exercise on EPCs might provide guidelines for planning exercise interventions for patients with CVD.

본 연구는 운동중재가 심장질환자의 혈관내피전구세포에 미치는 효과에 대한 선행연구들을 체계적으로 고찰하고, 그 효과에 대한 메타분석을 위해 실시되었다. 국내외 데이터베이스인 Cochrane Library, PubMed, EMBASE, ScienceDirect, CINAHL, Scopus, KoreaMed, KISS, RISS, KMBASE 온라인 검색을 실시하였고, 검색어는 심질환, 관상동맥질환, 심부전, 심혈관질환, 운동, 신체활동, 재활, 혈관내피전구세포를 조합하여 사용하였다. 그 결과, 539편의 논문이 검색되었고, 논문 선정기준에 부합하는 9편의 논문을 최종 분석에 이용하였다. Comprehensive Meta-Analysis version 2.0을 활용하여 효과크기, 출판편중을 분석하였다. 운동군의 혈관내피성장인자(VEGF), 혈관내피세포의 수(CD34+KDR+), 혈관내피세포의 기능(FMD)은 대조군에 비해 각각 2.008 (95% CI 0.204-3.812), 1.399 (95% CI 0.310-2.489), 1.881 (95% CI 0.848-2.914) 효과크기가 나타났다. 따라서 운동 중재가 혈관내피성장인자와 혈과내피전구세포의 수를 증가시키고, 혈관내피세포의 기능을 향상시키는데 효과가 있음을 알 수 있다. 국내 심혈관질환자의 유병률과 사망률이 증가하고 있음을 고려할 때, 심혈관질환자를 대상으로 한 운동중재의 효과를 분석한 본 연구결과는 심혈관질환자의 운동중재를 계획하는데 있어 실질적인 가이드라인을 제시할 수 있을 것이다.

Keywords

References

  1. Statistics Korea. Annual Report on the Cause of Death Statistics [Internet]. Daejeon: Statistics Korea, c2016 [cited 2016 Sep 27]. Available from: http://kosis.kr/ statisticsList/statisticsList_01List.jsp?vwcd=MT_ZTITLE &parentId=D (accessed Jan., 09, 2017)
  2. OECD. Health at glance 2015: OECD Indicators [Internet], Paris: OECD publishing; c2015 [cited 2015 Nov 04]. Available from: http://www.oecd-ilibrary.org/social-issues-migration-healt h/health-at-a-glance-2015_health_glance-2015-en (accessed Jan., 09, 2017)
  3. H. J. Kim, Y. Kim, Y. Cho, B. Jun, K. W. Oh, "Trends in the Prevalence of Major Cardiovascular Disease Risk Factors among Korean Adults: Results from the Korea National Health and Nutrition Examination Survey, 1998 -2012", International Journal of Cardiology, Vol. 174, No. 1, pp. 64-72, 2014. DOI: http://doi.org/10.1016/j.ijcard.2014.03.163
  4. Health Insurance Review & Assessment Service. Statistics on Concerned Disease [Internet]. Wonju: Health Insurance Review & Assessment Service; c2016 [cited 2015]. Available from: http://opendata.hira.or.kr/ op/opc/olapMfrnIntrsIlnsInfo.do (accessed Jan., 09, 2017)
  5. S. M. Dunlay, Q. R. Pack, R. J. Thomas, J. M. Killian, V. L. Roger, "Participation in Cardiac Rehabilitation, Readmissions, and Death after Acute Myocardial Infarction", The American Journal of Medicine, Vol. 127, No. 6, pp. 538-546, 2014. DOI: http://doi.org/10.1016/j.amjmed.2014.02.008
  6. C. Lewinter, P. Doherty, C. P. Gale, S. Crouch, L. Stirk, R. J. Lewin, et al. "Exercise-based Cardiac Rehabilitation in Patients with Heart Failure: A Meta-analysis of Randomised Controlled Trials between 1999 and 2013", European Journal of Preventive Cardiology, Vol. 22, No. 12, pp. 1504-1512, 2015. DOI: http://doi.org/10.1177/2047487314559853
  7. F. Ribeiro, I. P. Ribeiro, A. J. Alves, M. do Ceu Monteiro, N. L. Oliveira, J, Oliveira, et al., "Effects of Exercise Training on Endothelial Progenitor Cells in Cardiovascular Disease: A Systematic Review", American Journal of Physical Medicine & Rehabilitation, Vol. 92, No. 11, pp. 1020-1030, 2013. DOI: http://doi.org/10.1097/PHM.0b013e31829b4c4f
  8. E. Eleuteri, A. Mezzani, A. Di Stefano, D. Vallese, I. Gnemmi, L. Delle Donne, et al., "Aerobic Training and Angiogenesis Activation in Patients with Stable Chronic Heart Failure: A Preliminary Report", Biomarkers, Vol. 18, No. 5, pp. 418-424, 2013. DOI: http://doi.org/10.3109/1354750X.2013.805342
  9. L. Beck, P. A. D'Amore, "Vascular Development: Cellular and Molecular Regulation", The FASEB Journal, Vol. 11, No. 5, pp. 365-373, 1997. DOI: http://doi.org/10.1126/science.275.5302.964
  10. T. Asahara, T. Murohara, A. Sullivan, M. Silver, R. van der Zee, T. Li et al., "Isolation of Putative Progenitor Endothelial Cells for Angiogenesis", Science, Vol. 275, No. 5302, pp. 964-967, 1997. DOI: https://doi.org/10.1126/science.275.5302.964
  11. M. Koutroumpi, S. Dimopoulos, K. Psarra, T. Kyprianou, S. Nanas, "Circulating Endothelial and Progenitor Cells: Evidence from Acute and Long Term Exercise Effects", World Journal of Cardiology, Vol. 4, No. 12, pp. 312-326, 2012. DOI: http://doi.org/10.4330/wjc.v4.i12.312
  12. V. Bhattacharya, P. A. McSweeney, Q. Shi, B. Bruno, A. Ishida, R. Nash et al., "Enhanced Endothelialization and Microvessel Formation in Polyester Grafts Seeded with CD34 (+) Bone Marrow Cells", Blood. Vol. 95, No. 2, pp. 581-585, 2000.
  13. A. C. Alba, S. D. Lalonde, V. Rao, S. D. Walter, G. H. Guyatt, H. J. Ross, "Changes in Circulating Progenitor Cells Are associated with Outcome in Heart Failure Patients: A Longitudinal Study", Canadian Journal of Cardiology, Vol. 29, No. 12, pp. 1657-1664, 2013. DOI: http://doi.org/10.1016/j.cjca.2013.06.010
  14. N. Werner, S. Kosiol, T. Schiegl, P. Ahlers, K. Walenta, A. Link, et al., "Circulating Endothelial Progenitor Cells and Cardiovascular Outcomes", New England Journal of Medicine, Vol. 353, No. 10, pp. 999-1007, 2005. DOI: http://doi.org/10.1056/NEJMoa043814
  15. W. Wojakowski, A. Pyrlik, M. Krol, P. Buszman, A. Ochala, K. Milewski, et al., "Circulating Endothelial Progenitor Cells Are Inversely Correlated with In-stent Restenosis in Patients with Non-ST-segment Elevation Acute Coronary Syndromes Treated with EPC-capture Stents (JACK-EPC Trial)", Minerva Cardioangiologica. Vol. 61, No. 3, pp. 301-311, 2013.
  16. A. M. Leone, M. Valgimigli, M. B. Giannico, V, Zaccone, M, Perfetti, D, D'Amario, et al., "From Bone Marrow to the Arterial Wall: The Ongoing Tale of Endothelial Progenitor Cells", European Heart Journal, Vol. 30, No. 8, pp. 890-899, 2009. D DOI: http://doi.org/10.1093/eurheartj/ehp078
  17. J. P. T. Higgins, S. Green, Cochrane Handbook of Systematic Reviews of Intervention. Version 5.1.0 (updated March 2011) [Internet]. London: The Cochrane Collaboration, c2011[cited 2011 Mar]. Available from: www.handbook.cochrane.org. (accessed Jul., 01, 2016)
  18. D. Moher, A. Liberati, J. Tetzlaff, D. G. Altman, Prisma Group. "Preferred Reporting Items for Systematic Reviews and Meta-analyses: The PRISMA Statement", PLoS Medicine, Vol. 6, No. 7, e1000097, 2009. DOI: http://doi.org/10.1371/journal.pmed.1000097
  19. E. Pelosi, G. Castelli, U. Testa, "Endothelial Progenitors", Blood Cells, Molecules & Diseases, Vol. 52, No. 4, pp. 186-194, 2014. DOI: http://doi.org/10.1016/j.bcmd.2013.11.004
  20. K. Slim, E. Nini, D. Forestier, F. Kwiatkowski, Y. Panis, J. Chipponi, "Methodological Index for Non‐ Randomized Studies (MINORS): Development and Validation of a New Instrument", ANZ Journal of Surgery, Vol. 73, No. 9, pp. 712-716, 2003. DOI: https://doi.org/10.1046/j.1445-2197.2003.02748.x
  21. Hedges LV, Olkin I. Statistical Methods for Meta-analysis. Orlando, FL: Academic Press, 1985.
  22. Cohen J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.
  23. S. Erbs, R. Hollriegel, A. Linke, E. B. Beck, V. Adams, S. Gielen, et al., "Exercise Training in Patients with Advanced Chronic Heart Failure (NYHA IIIb) Promotes Restoration of Peripheral Vasomotor Function, Induction of Endogenous Regeneration, and Improvement of Left Ventricular Function", Circulation: Heart Failure, Vol. 3, No. 4, pp. 486-494, 2010. DOI:　http://doi.org/10.1161/CIRCHEARTFAILURE.109.868992
  24. J. A. Gagliardi, N. Maciel, J. L. Castellano, O. Masoli, V. Miksztowicz, G. Berg, et al., "Relationship between Endothelial Progenitor Cells and Vascular Endothelial Growth Factor and Its Variation with Exercise", Thrombosis Research, Vol. 137, pp. 92-96. 2016. DOI: http://doi.org/10.1016/j.thromres.2015.11.012
  25. D. Hansen, B. O. Eijnde, M. Roelants, T. Broekmans, J. L. Rummens, K. Hensen, et al., "Clinical Benefits of the Addition of Lower Extremity Low-intensity Resistance Muscle Training to Early Aerobic Endurance Training Intervention in Patients with Coronary Artery Disease: A Randomized Controlled", Journal of Rehabilitation Medicine, Vol. 43, No. 9, pp. 800-807, 2011. DOI: http://dx.doi.org/10.2340/16501977-0853
  26. T. H. Luk, Y. L. Dai, C. W. Siu, K. H. Yiu, H. T. Chan, S. W. Lee, et al., "Effect of Exercise Training on Vascular Endothelial Function in Patients with Stable Coronary Artery Disease: A Randomized Controlled Trial", European Journal of Preventive Cardiology, Vol. 19, No. 4, pp. 830-839, 2012. DOI: http://dx.doi.org/10.1177/1741826711415679
  27. M. Sandri, M. Viehmann, V. Adams, K. Rabald, N. Mangner, R. Höllriegel, et al., "Chronic Heart Failure and Aging - Effects of Exercise Training on Endothelial Function and Mechanisms of Endothelial Regeneration: Results from the Leipzig Exercise Intervention in Chronic heart failure and Aging (LEICA) Study", European Journal of Preventive Cardiology. Vol. 23, No. 4, pp. 349-358, 2016. DOI: http://dx.doi.org/10.1177/2047487315588391
  28. S. Steiner, A. Niessner, S. Ziegler, B. Richter, D. Seidinger, J. Pleiner, et al., "Endurance Training Increases the Number of Endothelial Progenitor Cells in Patients with Cardiovascular Risk and Coronary Artery Disease", Atherosclerosis, Vol. 181, No. 2, pp. 305-310, 2005. DOI: https://doi.org/10.1016/j.atherosclerosis.2005.01.006
  29. E. M. Van Craenenbroeck, V. Y. Hoymans, P. J. Beckers, N. M. Possemiers, K. Wuyts, B. P. Paelinck, et al., "Exercise Training Improves Function of Circulating Angiogenic Cells in Patients with Chronic Heart Failure", Basic Research in Cardiology, Vol. 105, No. 5, pp. 665-676, 2010. DOI: http://dx.doi.org/10.1007/s00395-010-0105-4
  30. E. M. Van Craenenbroeck, G. Frederix, N. Pattyn, P. Beckers, A. H. Van Craenenbroeck, A. Gevaert, et al., "Effects of Aerobic Interval Training and Continuous Training on Cellular Markers of Endothelial Integrity in Coronary Artery Disease: A SAINTEX-CAD Substudy", American Journal of Physiology-Heart and Circulatory Physiology, Vol. 309, No. 11, H1876-1882, 2015. DOI: http://dx.doi.org/10.1152/ajpheart.00341.2015
  31. C. J. Kim, "Cardiovascular Diseases and Sports Medicine", Journal of the Korean Medical Association, Vol. 54, No. 7, pp. 674-684, 2011. DOI: https://doi.org/10.5124/jkma.2011.54.7.705
  32. M. L. Pollock, B. A. Franklin, G. J. Balady, B. L. Chaitman, J. L. Fleg, B. Fletcher, et al., "Resistance Exercise in Individuals with and without Cardiovascular Disease: Benefits, Rationale, Safety, and Prescription: An Advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; Position Paper endorsed by the American College of Sports Medicine", Circulation, Vol. 101, No. (7), pp. 828-833, 2000. https://doi.org/10.1161/01.CIR.101.7.828
  33. E. Ahn, S. Park, H. Lee, S. Hea, "Effect on Release of Nitric Oxide and the Concentration of Lactate by Difference Exercise Type", The Korean Journal of Exercise Nutrition, Vol. 7, No. 3, pp. 291-296, 2003.
  34. M. J. Pearson, N. A. Smart. "Effect of Exercise Training on Endothelial Function in Heart Failure Patients: A Systematic Review Meta-analysis", International Journal of Cardiology, in press, 28 Dec. 2016. DOI: http://doi.org/10.1016/j.ijcard.2016.12.145
  35. C. De Biase, R. De Rosa, R. Luciano, S. De Luca, E. Capuano, B. Trimarco, et al., "Effects of Physical Activity on Endothelial Progenitor Cells (EPCs)", Frontiers in Physiology, Vol. 4, pp. 414-420, 2014. DOI: http://doi.org/10.3389/fphys.2013.00414
  36. H. Palmefors, S. DuttaRoy, B. Rundqvist, M. Börjesson, "The Effect of Physical Activity or Exercise on Key Biomarkers in Atherosclerosis-A Systematic review", Atherosclerosis, Vol. 235, No. 1, pp. 150-161, 2014. DOI: http://doi.org/10.1016/j.atherosclerosis.2014.04.026
  37. A. Maiorana, G. O'Driscoll, R. Taylor, D. Green, "Exercise and the Nitric Oxide Vasodilator System", Sports Medicine, Vol. 33, No. 14, pp. 1013-1035, 2003. DOI: https://doi.org/10.2165/00007256-200333140-00001