BACKGROUND: Previous studies have found that aerobic exercise was more effective in improving vascular endothelial function than resistance training, high-intensity interval training (HIIT), and other types of exercise, while the effects between different intensities and durations of aerobic exercise were unclear. Therefore, we performed this meta-analysis to investigate the effects of different intensities and durations of aerobic exercise on the vascular endothelial function of middle-aged and elderly people. METHODS: Databases were searched up to April 2021 for studies evaluating the influences of different intensities and durations of aerobic exercise on endothelial function assessed by flow-mediated dilation (FMD) among healthy middle-aged and elderly people. Data were pooled using random-effects models to obtain the weighted mean difference (WMD) and 95% confidence intervals (CIs). RESULTS: A total of 9 studies involving 221 participants fulfilled the inclusion criteria. Aerobic exercise improved the overall FMD of healthy middle-aged and elderly people (WMD 1.33; 95% CI 0.37 to 2.28, p < 0.05). Specifically, vigorous-intensity exercise increased FMD significantly in healthy middle-aged and elderly people (WMD 1.10; 95% CI 0.27 to 1.93, p < 0.05), while moderate-intensity exercise had no significant association with FMD (WMD 1.49; 95% CI -0.62 to 3.60, p = 0.17). In addition, long-term (8 weeks or above) aerobic exercise increased the FMD in healthy middle-aged and elderly people (WMD 1.63; 95% CI 0.61 to 2.66, p < 0.05), while one-time acute aerobic exercise had no significant association with FMD of healthy middle-aged and elderly people (WMD 0.89; 95% CI -1.47 to 3.24, p = 0.46). Specifically, 8 weeks or above of vigorous-intensity exercise increased FMD significantly in healthy middle-aged and elderly people (WMD 1.48; 95% CI 1.06 to 1.90, p < 0.01), while 8 weeks or above of moderate aerobic exercise had no significant association with FMD (WMD 1.49; 95% CI -0.62 to 3.60, p = 0.17). CONCLUSION: Aerobic exercise, especially 8 weeks or above of vigorous-intensity aerobic exercise, improved the endothelial function in healthy middle-aged and elderly people.

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