Is exercise-reporting quality associated with vascular benefits of aerobic training in individuals with cardiovascular disease? A systematic review and meta-analysis of randomized controlled trials

Abstract

Abstract Exercise is a key non-pharmacological intervention for managing cardiovascular diseases (CVDs), yet the quality and completeness of exercise reporting in randomized controlled trials (RCTs) remain inconsistent. This systematic review and meta-analysis evaluates how well exercise interventions in RCTs are reported using the Consensus on Exercise Reporting Template (CERT), and whether CERT-assessed reporting quality is associated with the observed effects of aerobic training (AT) on endothelial function, measured by brachial artery flow-mediated dilation ( ba FMD). A systematic search was conducted in PubMed, Web of Science, Embase, CINAHL, and EBSCOhost, encompassing RCTs that investigated AT interventions in individuals with CVDs. From 1818 reports identified through the search, 28 RCTs comprising 1659 unique randomized participants were included, yielding 34 intervention–control comparisons from six multi-arm studies. Overall reporting quality was moderate (mean CERT score = 12/19), with the lowest reporting completeness observed for the description of each exercise in sufficient detail to enable replication, non-exercise components, individual or group delivery, and home-program components. Meta-analysis revealed a significant improvement in ba FMD following AT (MD = 2.29%; 95% CI 1.63–2.95; p < 0.0001; I 2 = 91.90%). However, CERT score was not significantly associated with the magnitude of ba FMD improvement in either categorical subgroup analysis or meta-regression. Similarly, adherence rate and overall training volume were not significant predictors of ba FMD effects. These findings indicate that AT improves ba FMD in individuals with CVDs, but the effect magnitude should be interpreted cautiously, given substantial heterogeneity. The CERT checklist remains important for improving transparency, reproducibility, and clinical translation, but should be considered alongside risk-of-bias assessment, certainty-of-evidence assessment, and standardized methods for assessing vascular outcomes.