Journal of Exercise Physiology in Special Populations

The Effects of Endurance, Resistance, and Walking Exercise on Nitric Oxide Levels and Endothelial Function in Adults: A Systematic Review and Meta-Analysis

Document Type : Review article

Authors

1 Department of Physical Education and Sport Sciences, School of Educational Sciences and Psychology, City Ardabili, Iran

2 Department of Physical Education and Sport Sciences, Faculty of Education Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

3 Department of Physical Education and Sport Sciences, Faculty of Education Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.

Abstract

Objectives:
Impairment in NO bioavailability is directly associated with cardiovascular diseases. This study aimed to investigate the effects of exercise training on nitric oxide levels and endothelial function in adults.
Methods:
A systematic search was conducted in PubMed, Scopus, and Web of Science databases from January 2000 to September 2025. Human studies with a clinical trial design that examined the effects of exercise training on NO and VCAM-1 levels were included. Meta-analyses were performed using a random-effects model and CMA software version 4. Subgroup analyses were conducted based on exercise type, duration, and intensity.
Findings:
Exercise training significantly increased NO bioavailability (SMD = 1.30, 95% CI: 0.67 to 1.93, p = 0.001).while aerobic training (SMD = 1.02, p = 0.16) and resistance training (SMD = 0.27, p = 0.52) did not show significant effects. Additionally, exercise training significantly reduced VCAM-1 levels (SMD = -0.96, 95% CI: -1.41 to -0.52, p = 0.001). Training duration of more than 6 weeks (SMD = 1.51, p = 0.001), high-intensity training (SMD = 1.40, p = 0.034), and moderate-intensity training (SMD = 3.35, p = 0.0002) were associated with significant increases in NO.
Conclusion:
Exercise training, particularly walking and training with durations exceeding 6 weeks and moderate-to-high intensity, increases nitric oxide bioavailability and reduces the endothelial adhesion marker VCAM-1. These findings indicate the effective role of exercise training in improving endothelial function. Given the high heterogeneity, further studies with standardized training protocols are recommended.

Keywords

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Journal of Exercise Physiology in Special Populations
Volume 3, Issue 2
September 2026
Pages 1-19