Effect of physical activity and exercise on telomere length: Systematic review with meta‐analysis

Purpose To compare a physically active lifestyle or structured exercise program to physically inactive lifestyle or control groups on telomere length (TL). Method We searched PubMed, EMBASE, Cochrane Library, and Open Gray databases up to March 31, 2020. We calculated standardized mean differences (SMD) with 95% confidence intervals (CI) of TL comparing physically active to physically inactive individuals and exercise intervention to control groups. Risk of bias was judged using the Risk of Bias Assessment tool for Non‐randomized Studies (RoBANS) for physical activity (PA) studies and the Cochrane risk‐of‐bias (RoB2) for exercise intervention studies. Certainty of evidence was judged using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results We included 30 studies (24 assessing the effects of PA and 6 assessing the effects of exercise interventions) comprising 7418 individuals. Physically active individuals had longer telomeres (SMD = 0.70, 95% CI 0.12–1.28, very‐low certainty), especially in middle‐aged individuals (SMD = 0.90, 95% CI 0.08–1.72, very‐low certainty) and when considering only athletes (SMD = 0.54, 95% CI 0.18–0.90, very‐low certainty). Trim‐and‐fill analyses revealed that most of the pooled effects were overestimated. Exercise interventions did not yield any significant effect on TL. Conclusion There is very‐low certainty that physically active individuals have longer telomeres with a moderate effect, but this effect is probably overestimated. See related Editorial by Pignolo et al.