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Effectiveness of Fixed-Dose Combination Therapy (Polypill) Versus Exercise to Improve the Blood-Lipid Profile: A Network Meta-analysis

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Abstract

Background

Both exercise and polypills are recommended treatments to improve the blood-lipid profile.

Objective

The aim of this study was to compare head-to-head the effectiveness of polypill and exercise strategies in improving the blood-lipid profile in high-risk cardiovascular patients.

Methods

We performed an electronic search in Web of Science, EMBASE, Cochrane Database of Systematic Reviews, MEDLINE and SPORTDiscus, from inception to August 2021. Randomized controlled trials (RCTs) testing the effectiveness of exercise interventions or treatment with fixed-dose combination therapy (polypill) in improving the blood-lipid profile in adults with atherosclerotic cardiovascular disease or presenting at least one well recognized cardiovascular risk factor were included.

Results

A total of 131 RCTs were included: 15 and 116 studies analyzing the effects of polypills and exercise, respectively, on blood-lipid levels. Both exercise and polypill strategies were effective in reducing low-density lipoprotein cholesterol (LDL-c) and total cholesterol (TC), but only exercise interventions improved high-density lipoprotein cholesterol (HDL-c) and triglyceride levels compared with the control group. The results of the network meta-analyses showed that the polypill without antiplatelet therapy was the most effective pharmacological treatment for improving the lipid profile, while aerobic interval exercise was the most effective exercise intervention.

Conclusions

Considering that both polypills and exercise are effective in reducing LDL-c and TC but only exercise improves HDL-c and triglycerides, and that exercise provides further health benefits (e.g., increases in physical fitness and decreases in adiposity), it seems reasonable to recommend exercise as the first treatment option in dyslipidemia when the patient’s general condition and symptoms allow it.

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CRD42019122794.

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Authors and Affiliations

  1. Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain

    Vicente Martínez-Vizcaíno, Rubén Fernández-Rodríguez, Miriam Garrido-Miguel, Iván Cavero-Redondo & Diana P. Pozuelo-Carrascosa

  2. Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile

    Vicente Martínez-Vizcaíno

  3. Department of Physiology. Faculty of Medicine, University of Granada, Parque Tecnológico de la Salud, Av. de la Investigación, 11, 18016, Granada, Spain

    Francisco J. Amaro-Gahete

  4. PROmoting FITness and Health Through Physical Activity Research Group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain

    Francisco J. Amaro-Gahete

  5. Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Echaurren Street 140, 2nd Floor, 72819, Santiago, Chile

    Iván Cavero-Redondo

  6. Universidad de Castilla-La Mancha, Faculty of Nursing, Cuenca, Spain

    Diana P. Pozuelo-Carrascosa

  7. Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Toledo, Spain

    Diana P. Pozuelo-Carrascosa

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  1. Vicente Martínez-Vizcaíno
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  2. Francisco J. Amaro-Gahete
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  6. Diana P. Pozuelo-Carrascosa
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Corresponding author

Correspondence to Francisco J. Amaro-Gahete.

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Conflict of interest

Vicente Martínez-Vizcaíno, Francisco Amaro-Gahete, Rubén Fernández-Rodríguez, Miriam Garrido-Miguel, Iván Cavero-Redondo, and Diana Pozuelo-Carrascosa declare that they have no conflicts of interest relevant to the content of this review.

Funding

This study was funded by the Consejería de Educación, Cultura y Deportes—Junta de Comunidades de Castilla-La Mancha and FEDER funds (SBPLY/17/180501/000533). The funding source had no involvement in the meta-analysis.

Author contributions

VMV conceptualized and designed the study with the support of DPPC. VMV, and DPPC drafted the initial manuscript and, along with FAG, approved the final manuscript as submitted. DPPC, FAG, and VMV designed the data collection instruments, and coordinated and supervised data collection. DPPC, FAG, and RFR extracted and analyzed the data. DPPC, FAG, ICR, VMV, MGM, and RFR were involved in the analysis and interpretation of data, and reviewed and revised the manuscript, approving the final manuscript as submitted.

Data availability

Data sharing is not applicable to this article as no datasets were generated during the current meta-analysis.

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Martínez-Vizcaíno, V., Amaro-Gahete, F.J., Fernández-Rodríguez, R. et al. Effectiveness of Fixed-Dose Combination Therapy (Polypill) Versus Exercise to Improve the Blood-Lipid Profile: A Network Meta-analysis. Sports Med 52, 1161–1173 (2022). https://doi.org/10.1007/s40279-021-01607-6

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