Exercise and Arterial Stiffness in the Elderly: A Combined Cross-Sectional and Randomized Controlled Trial (EXAMIN AGE)

Arne Deiseroth, Lukas Streese, Sabrina Köchli, Romy Sandra Wüst, Denis Infanger, Arno Schmidt-Trucksäss, Henner Hanssen, Arne Deiseroth, Lukas Streese, Sabrina Köchli, Romy Sandra Wüst, Denis Infanger, Arno Schmidt-Trucksäss, Henner Hanssen

Abstract

Introduction: Arterial stiffness (AST) is a main determinant of cardiovascular (CV) mortality. Long-term physical activity (PA) is considered to decrease age-related progression of AST but effects of short-term exercise interventions on AST remain unclear.

Methods: In a combined cross-sectional and interventional study approach, we investigated the effects of long-term PA and short-term high-intensity interval training (HIIT) on AST in an older population. 147 older individuals (mean age 59 ± 7 years) were assigned to three groups according to their PA and CV risk profile and compared: healthy active (HA, n = 35), healthy sedentary (HS, n = 33) and sedentary at risk (SR, n = 79). In addition, SR were randomized to either 12 weeks of HIIT or standard recommendations. Pulse wave velocity (PWV) was measured by applanation tonometry. Cardiorespiratory fitness (CRF) was performed by symptom-limited spiroergometry to determine maximal oxygen uptake (VO2max).

Results: Higher CRF was associated with lower PWV (p < 0.001) and VO2max explained 18% of PWV variance. PWV was higher in SR (8.2 ± 1.4 m/s) compared to HS (7.5 ± 1.6 m/s) and HA (7.0 ± 1.1 m/s; p < 0.001). 12 weeks of HIIT did not change PWV in SR. HIIT-induced reduction in systolic BP was associated with a reduction in PWV (p < 0.05).

Discussion: SR show higher PWV compared to HS and long-term PA is associated with lower PWV. Reduction of AST following short-term HIIT seems to depend on a concomitant decrease in blood pressure. Our study puts into perspective the effects of long- and short-term exercise on arterial wall integrity as treatment options for CV prevention in an older population.

Clinical trial registration: ClinicalTrials.gov: NCT02796976 (https://ichgcp.net/clinical-trials-registry/NCT02796976).

Keywords: aging; cardiovascular risk; high-intensity interval training; physical activity; pulse wave velocity.

Figures

FIGURE 1
FIGURE 1
Flow-chart.
FIGURE 2
FIGURE 2
Scatterplot showing maximal oxygen uptake by central pulse wave velocity (PWV) for healthy active (HA) and sedentary (HS) as well as sedentary at risk (SR). Regression line and 95% confidence intervall of mean standard deviation are visualized. Multiple linear regression was adjusted for age and sex.
FIGURE 3
FIGURE 3
Number of risk factors in participants and the corresponding mean central pulse wave velocity (PWV). ∗Jonckheere Trend Test.
FIGURE 4
FIGURE 4
Central pulse wave velocity in the cross-sectional (A) and interventional (B) approach. HA, healthy active; HS, healthy sedentary; SR, sedentary at risk; ∗p < 0.05; ∗∗p < 0.01; ∗∗∗p < 0.001.
FIGURE 5
FIGURE 5
Regression line and 95% confidence interval of standard deviation are visualized. Deltas were calculated subtracting pre- from post-value. ∗Multiple linear regression adjusted for age and sex, baseline central PWV and body mass index. Abbreviations: BP, blood pressure; PWV, pulse wave velocity.

References

    1. Ahmadi-Abhari S., Sabia S., Shipley M. J., Kivimaki M., Singh-Manoux A., Tabak A., et al. (2017). Physical activity, sedentary behavior, and long-term changes in aortic stiffness: the whitehall II study. J. Am. Heart Assoc. 6:e005974. 10.1161/JAHA.117.005974
    1. Ainsworth B. E., Haskell W. L., Herrmann S. D., Meckes N., Bassett D. R., Jr, Tudor-Locke C., et al. (2011). 2011 Compendium of physical activities: a second update of codes and MET values. Med. Sci. Sports Exerc. 43 1575–1581. 10.1249/MSS.0b013e31821ece12
    1. Ashor A. W., Lara J., Siervo M., Celis-Morales C., Mathers J. C. (2014). Effects of exercise modalities on arterial stiffness and wave reflection: a systematic review and meta-analysis of randomized controlled trials. PLoS One 9:e110034. 10.1371/journal.pone.0110034
    1. Ben-Shlomo Y., Spears M., Boustred C., May M., Anderson S. G., Benjamin E. J., et al. (2014). Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J. Am. Coll. Cardiol. 63 636–646. 10.1016/j.jacc.2013.09.063
    1. Ciolac E. G., Bocchi E. A., Bortolotto L. A., Carvalho V. O., Greve J. M., Guimaraes G. V. (2010). Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypertens. Res. 33 836–843. 10.1038/hr.2010.72
    1. Frey I., Berg A., Grathwohl D., Keul J. (1999). Freiburg questionnaire of physical activity–development, evaluation and application. Soz. Praventivmed. 44 55–64.
    1. Gando Y., Yamamoto K., Murakami H., Ohmori Y., Kawakami R., Sanada K., et al. (2010). Longer time spent in light physical activity is associated with reduced arterial stiffness in older adults. Hypertension 56 540–546. 10.1161/HYPERTENSIONAHA.110.156331
    1. Guimaraes G. V., Ciolac E. G., Carvalho V. O., D’avila V. M., Bortolotto L. A., Bocchi E. A. (2010). Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypertens. Res. 33 627–632. 10.1038/hr.2010.42
    1. Huang C., Wang J., Deng S., She Q., Wu L. (2016). The effects of aerobic endurance exercise on pulse wave velocity and intima media thickness in adults: a systematic review and meta-analysis. Scand. J. Med. Sci. Sports 26 478–487. 10.1111/sms.12495
    1. Kim E. J., Park C. G., Park J. S., Suh S. Y., Choi C. U., Kim J. W., et al. (2007). Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study. J. Hum. Hypertens. 21 141–148. 10.1038/sj.jhh.1002120
    1. Kim H. K., Hwang C. L., Yoo J. K., Hwang M. H., Handberg E. M., Petersen J. W., et al. (2017). All-extremity exercise training improves arterial stiffness in older adults. Med. Sci. Sports Exerc. 49 1404–1411. 10.1249/MSS.0000000000001229
    1. Kodama S., Saito K., Tanaka S., Maki M., Yachi Y., Asumi M., et al. (2009). Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301 2024–2035. 10.1001/jama.2009.681
    1. Madden K. M., Lockhart C., Cuff D., Potter T. F., Meneilly G. S. (2009). Short-term aerobic exercise reduces arterial stiffness in older adults with type 2 diabetes, hypertension, and hypercholesterolemia. Diabetes Care 32 1531–1535. 10.2337/dc09-0149
    1. McGeechan K., Liew G., Macaskill P., Irwig L., Klein R., Klein B. E., et al. (2009). Prediction of incident stroke events based on retinal vessel caliber: a systematic review and individual-participant meta-analysis. Am. J. Epidemiol. 170 1323–1332. 10.1093/aje/kwp306
    1. Montero D., Roberts C. K., Vinet A. (2014a). Effect of aerobic exercise training on arterial stiffness in obese populations: a systematic review and meta-analysis. Sports Med. 44 833–843. 10.1007/s40279-014-0165-y
    1. Montero D., Roche E., Martinez-Rodriguez A. (2014b). The impact of aerobic exercise training on arterial stiffness in pre- and hypertensive subjects: a systematic review and meta-analysis. Int. J. Cardiol. 173 361–368. 10.1016/j.ijcard.2014.03.072
    1. Myers J., Bellin D. (2000). Ramp exercise protocols for clinical and cardiopulmonary exercise testing. Sports Med. 30 23–29. 10.2165/00007256-200030010-00003
    1. Pescatello L. S. American College of Sports Medicine (2014). ACSM’S Guidelines for Exercise Testing and Prescription. Philadelphia, PA: Lippincott Williams & Wilkins Health.
    1. Piepoli M. F., Hoes A. W., Agewall S., Albus C., Brotons C., Catapano A. L., et al. (2016). 2016 european guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts)developed with the special contribution of the european association for cardiovascular prevention & rehabilitation (EACPR). Eur. Heart J. 37 2315–2381. 10.1093/eurheartj/ehw106
    1. Reference Values for Arterial Stiffness Collaboration (2010). Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: establishing normal and reference values. Eur. Heart J. 31 2338–2350. 10.1093/eurheartj/ehq165
    1. Sacre J. W., Jennings G. L., Kingwell B. A. (2014). Exercise and dietary influences on arterial stiffness in cardiometabolic disease. Hypertension 63 888–893. 10.1161/hypertensionaha.113.02277
    1. Schulz K. F., Altman D. G., Moher D., Group C. (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 8:18. 10.1186/1741-7015-8-18
    1. Seidelmann S. B., Claggett B., Bravo P. E., Gupta A., Farhad H., Klein B. E., et al. (2016). Retinal vessel calibers in predicting long-term cardiovascular outcomes: the atherosclerosis risk in communities study. Circulation 134 1328–1338. 10.1161/circulationaha.116.023425
    1. Shibata S., Levine B. D. (2012). Effect of exercise training on biologic vascular age in healthy seniors. Am. J. Physiol. Heart Circ. Physiol. 302 H1340–H1346. 10.1152/ajpheart.00511.2011
    1. Streese L., Deiseroth A., Schafer J., Schmidt-Trucksass A., Hanssen H. (2018). Exercise, arterial crosstalk-modulation, and inflammation in an aging population: the examin age study. Front. Physiol. 9:116. 10.3389/fphys.2018.00116
    1. Streese L., Khan A. W., Deiseroth A., Hussain S., Suades R., Tiaden A., et al. (2019). High-intensity interval training modulates retinal microvascular phenotype and DNA methylation of p66Shc gene: a randomized controlled trial (EXAMIN AGE). Eur. Heart J. 10.1093/eurheartj/ehz196 [Epub ahead of print].
    1. Tedesco M. A., Natale F., Di Salvo G., Caputo S., Capasso M., Calabro R. (2004). Effects of coexisting hypertension and type II diabetes mellitus on arterial stiffness. J. Hum. Hypertens. 18 469–473. 10.1038/sj.jhh.1001690
    1. Tjonna A. E., Lee S. J., Rognmo O., Stolen T. O., Bye A., Haram P. M., et al. (2008). Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation 118 346–354. 10.1161/circulationaha.108.772822
    1. Townsend R. R., Wilkinson I. B., Schiffrin E. L., Avolio A. P., Chirinos J. A., Cockcroft J. R., et al. (2015). Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the American Heart Association. Hypertension 66 698–722. 10.1161/hyp.0000000000000033
    1. Vaitkevicius P. V., Fleg J. L., Engel J. H., O’connor F. C., Wright J. G., Lakatta L. E., et al. (1993). Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 88 1456–1462. 10.1161/01.cir.88.4.1456
    1. van Dijk S. C., Swart K. M., Ham A. C., Enneman A. W., Van Wijngaarden J. P., Feskens E. J., et al. (2015). Physical fitness, activity and hand-grip strength are not associated with arterial stiffness in older individuals. J. Nutr. Health Aging 19 779–784. 10.1007/s12603-015-0519-7
    1. Vickers A. J., Altman D. G. (2001). Statistics notes: analysing controlled trials with baseline and follow up measurements. BMJ 323 1123–1124. 10.1136/bmj.323.7321.1123
    1. Vlachopoulos C., Aznaouridis K., Stefanadis C. (2010). Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J. Am. Coll. Cardiol. 55 1318–1327. 10.1016/j.jacc.2009.10.061
    1. Way K. L., Sultana R. N., Sabag A., Baker M. K., Johnson N. A. (2019). The effect of high Intensity interval training versus moderate intensity continuous training on arterial stiffness and 24h blood pressure responses: a systematic review and meta-analysis. J. Sci. Med. Sport 22 385–391. 10.1016/j.jsams.2018.09.228
    1. World Health Organization [WHO] (2018). World Health Statistics 2018: Monitoring Health for the SDGS, Sustainable Development Goals. Geneva: World Health Organization.
    1. World Medical Association [WMA] (2013). World medical association declaration of helsinki: ethical principles for medical research involving human subjects. JAMA 310 2191–2194.
    1. Zieman S. J., Melenovsky V., Kass D. A. (2005). Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler. Thromb. Vasc. Biol. 25 932–943. 10.1161/01.atv.0000160548.78317.29

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