# Effects of exercise training on systemic arterial pulse wave velocity in postmenopausal women: an updated systematic review and meta-analysis of randomized controlled trials

## TL;DR

Exercise training may reduce arterial stiffness in postmenopausal women, especially in younger women and those doing aerobic exercise regularly.

## Contribution

This study provides an updated meta-analysis on the effects of exercise on arterial stiffness in postmenopausal women, identifying key moderating factors.

## Key findings

- Exercise significantly improved carotid-femoral and central pulse wave velocity in postmenopausal women.
- Women under 65, those exercising ≥3 times per week, and those doing aerobic exercise showed the greatest improvements.
- The overall effect on systemic arterial pulse wave velocity was marginally significant, requiring further validation.

## Abstract

Postmenopausal women experience accelerated ageing of arterial vessels and increased cardiovascular disease risk. Exercise training, as a non-pharmacological intervention, holds great value in improving cardiovascular issues such as arterial stiffness.

The present systematic review and meta-analysis aimed to: (1) synthesize current evidence on the efficacy of exercise in improving systemic arterial pulse wave velocity (SAPWV) in postmenopausal women; (2) clarify differential effects of exercise interventions on central versus peripheral PWV; and (3) quantify the statistical moderating effects of exercise protocol parameters and participant characteristics.

Six electronic databases (EMBASE, EBSCOhost, Scopus, Web of Science, PubMed, Cochrane CENTRAL) were systematically searched up to August 7, 2024, and updated on April 4, 2025. Randomized controlled trials (RCTs) examining the effects of exercise training on PWV in postmenopausal women were included. A three-level meta-analysis was conducted using a random-effects model, as applied in R. Study quality was assessed with the Physiotherapy Evidence Database (PEDro) scale.

Nine studies (27 RCTs) were included. Compared with the control group, the overall effect of exercise on SAPWV reached only marginal significance [g = -1.07; 95% confidence intervals (CI) = -2.15, 0.00, p = 0.05], with the CI including zero—indicating that the true effect could be null or even negative. Additionally, exercise had significant improvements on SAPWV sub-indicators, including carotid-femoral PWV (cfPWV; g = -2.44; 95% CI = -3.94, -0.93) and central PWV (g = -1.57; 95% CI = -2.84, -0.30). The improvement in SAPWV was more pronounced when participants aged < 65 years (g = -1.52; 95% CI = -2.80, -0.24), exercising ≥ 3 times per week (g = -1.14; 95% CI = -2.25, -0.04), and engaging in aerobic exercise (g = -1.76, 95% CI = -3.13, -0.40). PWV sub-indicators, regional PWV, and exercise type moderated the effects of exercise training on SAPWV.

The present study demonstrated that exercise training may improve arterial stiffness in postmenopausal women, with particularly pronounced effects on cfPWV and central PWV. Subgroup analysis further revealed that participants aged < 65 years, those exercising ≥ 3 times weekly, and those engaging in aerobic exercise interventions all demonstrated significant reductions in SAPWV. Although the overall effect of exercise on SAPWV reached only marginal significance, more pronounced effects were observed within specific populations and exercise modalities. Future large-sample studies are needed to validate these findings further.

The online version contains supplementary material available at 10.1186/s13102-025-01382-1.

Exercise leads to particularly pronounced reductions in stiffness of central arteries, as evidenced by significant improvements in both carotid-femoral PWV and central PWV - indicators strongly linked to cardiovascular mortality.The greatest improvements in SAPWV occur in women aged < 65 years, those exercising ≥ 3 times per week, and those participating in aerobic exercise training, highlighting key moderating factors for efficacy.The overall effect analysis indicated a marginally significant effect of exercise on SAPWV in postmenopausal women, but this finding must be interpreted with caution due to high heterogeneity, publication bias, and the marginal nature of the statistical significance.

Exercise leads to particularly pronounced reductions in stiffness of central arteries, as evidenced by significant improvements in both carotid-femoral PWV and central PWV - indicators strongly linked to cardiovascular mortality.

The greatest improvements in SAPWV occur in women aged < 65 years, those exercising ≥ 3 times per week, and those participating in aerobic exercise training, highlighting key moderating factors for efficacy.

The overall effect analysis indicated a marginally significant effect of exercise on SAPWV in postmenopausal women, but this finding must be interpreted with caution due to high heterogeneity, publication bias, and the marginal nature of the statistical significance.

The online version contains supplementary material available at 10.1186/s13102-025-01382-1.