Effect of Aerobic Exercise Training on Serum Levels of High-Density Lipoprotein Cholesterol: A Meta-analysis
Abstract
Background Aerobic exercise is believed to reduce the risk of cardiovascular disease partially through increasing serum levels of high-density lipoprotein cholesterol (HDL-C). However, this effect varies considerably among exercise intervention studies.Methods Electronic database searches of MEDLINE (1966-2005) for randomized controlled trials that examined the effect of exercise training on HDL-C level.Results Twenty-five articles were included. Mean net change in HDL-C level was statistically significant but modest (2.53 mg/dL [0.065 mmol/L]; P<.001). Minimal weekly exercise volume for increasing HDL-C level was estimated to be 900 kcal of energy expenditure per week or 120 minutes of exercise per week. Univariate regression analysis indicated that every 10-minute prolongation of exercise per session was associated with an approximately 1.4-mg/dL (0.036-mmol/L) increase in HDL-C level. In contrast, there was no significant association between exercise frequency or intensity. Multiple meta-regression analyses demonstrated that subjects with a body mass index (calculated as weight in kilograms divided by height in meters squared) less than 28 and total cholesterol level of 220 mg/dL [5.7 mmol/L] or more experienced an approximately 2.1-mg/dL (0.054-mmol/L) larger increase in HDL-C level than those with a body mass index of 28 or more and total cholesterol level less than 220 mg/dL (5.7 mmol/L).Conclusions Regular aerobic exercise modestly increases HDL-C level. There appears to exist a minimum exercise volume for a significant increase in HDL-C level. Exercise duration per session was the most important element of an exercise prescription. Exercise was more effective in subjects with initially high total cholesterol levels or low body mass index.
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Previous work has shown combined training with the aerobic component conducted at vigorous or high intensity to be optimal.
“Previous work has shown CT [15] with the aerobic component conducted at vigorous [9] or high intensity [5] to be optimal.”
From The Effect of Exercise Training on Blood Lipids: A Systematic Review and Meta-analysis (2025) · cites this paper as [9]
In people who are overweight, attenuation of exercise training-induced changes in lipids may occur.
“Work has shown that, in people who are overweight, attenuation of exercise training-induced changes in lipids may occur [9], while exercise with diet-induced weight loss has been shown to improve the lipid profile [38].”
From The Effect of Exercise Training on Blood Lipids: A Systematic Review and Meta-analysis (2025) · cites this paper as [9]
Our findings and those of some others contradict the suggestion that a weekly expenditure of 900 kcal or 120 min is the energy volume threshold required to elicit favourable changes in HDL.
“Our findings and those of some others contradict this [9, 13].”
From The Effect of Exercise Training on Blood Lipids: A Systematic Review and Meta-analysis (2025) · cites this paper as [9]
A priori aerobic exercise training intervention covariates (intensity, frequency, session duration and intervention duration) have been shown to influence lipid outcomes.
“A priori AET intervention covariates (intensity, frequency, session duration and intervention duration) that have been shown to influence lipid outcomes were analysed [19, 45, 46].”
An aerobic exercise training protocol of at least 180 min per week at > 40% VO2MAX or > 1200 kcal/week has a beneficial influence on lipids.
“Other studies have found that an AET protocol of at least 180 min per week at > 40% VO2MAX or > 1200 kcal/week has a beneficial influence on lipids [45, 46, 108, 109].”
Kodama et al.'s meta-analysis of 25 randomized controlled trials found HDL-C increased by 2.53 mg/dL when aerobic exercise was 5.3 MET (64.8% maximal aerobic capacity), in people who only exercised without medications or dietary therapy.
“they found HDL-C increased by 2.53 mg/dL when aerobic exercise was 5.3 MET (64.8% maximal aerobic capacity).”
From Effects of aerobic exercise on lipids and lipoproteins (2017) · cites this paper as [28]
Among 8 reports of systematic review and meta-analysis of RCTs comparing exercise and non-exercise control, significant decreases in LDL-C and TG levels were reported in two articles, respectively.
“Among 8 reports of systematic review and metaanalysis of RCTs with comparison of exercise and non-exercise control including Japanese participants and were published after 2,000, significant decreases in LDL-C and TG levels were reported in two articles, respectively.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [610]
Aerobic exercise is effective in improving lipid metabolism.
“Aerobic exercise is effective in improving lipid metabolism607–615).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [610]
Six of the 8 reports of systematic review and meta-analysis reported a significant increase in HDL-C levels.
“Six reported a significant increase in HDL-C levels, which was the most frequently observed effect of exercise on serum lipids577, 607–613).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [610]
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- Authors
- Kodama, S.
- Affiliations
- Ochanomizu University (JP)
- Corresponding author
- Kodama, Satoru
- ORCID
- Kodama, Satoru
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2007-05-28
- Volume
- 167
- Issue
- 10
- Pages
- 999
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2097491325
- Cited by
- 5
- References
- 82
- Citations by year
- 2021: 1 · 2019: 1 · 2015: 2
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- aerobic exercise training, HDL cholesterol, serum lipids, exercise and lipid metabolism
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