Aortic and Systemic Arterial Stiffness Responses to Acute Exercise in Patients With Small Abdominal Aortic Aneurysms

Abstract

WHAT THIS PAPER ADDS Elevated arterial stiffness is associated with aneurysm progression and probably contributes to the high cardiovascular risk of patients with abdominal aortic aneurysms (AAA). It is demonstrated herein that the changes in aortic and systemic arterial stiffness are lower in patients with AAA after exercise compared with seated rest. This effect was most marked following higher intensity interval exercise. This attenuation in arterial stiffness suggests there may be an acute cardiovascular benefit of exercise in patients with AAA. The findings support the use of interval based high intensity exercise as a safe intervention to improve cardiovascular function in patients with AAA and adds to the evidence that exercise prescription should be part of the routine care of patients with AAA.Objective/background: Elevated arterial stiffness is a characteristic of abdominal aortic aneurysm (AAA), and is associated with AAA growth and cardiovascular mortality. A bout of exercise transiently reduces aortic and systemic arterial stiffness in healthy adults. Whether the same response occurs in patients with AAA is unknown. The effect of moderate-and higher intensity exercise on arterial stiffness was assessed in patients with AAA and healthy adults. Methods: Twenty-two men with small diameter AAAs (36 AE 5 mm; mean age 74 AE 6 years) and 22 healthy adults (mean age 72 AE 5 years) were included. Aortic stiffness was measured using carotid to femoral pulse wave velocity (PWV), and systemic arterial stiffness was estimated from the wave reflection magnitude (RM) and augmentation index (Alx75). Measurements were performed at rest and during 90 min of recovery following three separate test sessions in a randomised order: (i) moderate intensity continuous exercise; (ii) higher intensity interval exercise; or (iii) seated rest. Results: At rest, PWV was higher in patients with AAA than in healthy adults (p < .001), while AIx75 and RM were similar between groups. No differences were observed between AAA patients and healthy adults in post-exercise aortic and systemic arterial stiffness after either exercise protocol. When assessed as the change from baseline (delta, D), post-exercise DAIx75 was not different to the seated rest protocol. Conversely, post-exercise DPWV and DRM were both lower at all time points than seated rest (p < .001). DPWV was lower immediately after higher intensity than after moderate intensity exercise (p ¼ .015). Conclusion: High resting aortic stiffness in patients with AAA is not exacerbated after exercise. There was a similar post-exercise attenuation in arterial stiffness between patients with AAA and healthy adults compared with seated rest. This effect was most pronounced following higher intensity interval exercise, suggesting that this form of exercise may be a safe and effective adjunctive therapy for patients with small AAAs.

Long Chain Omega-3 Polyunsaturated Fatty Acids Improve Vascular Stiffness in Abdominal Aortic Aneurysm: A Randomized Controlled Trial

“…Vascular stiffness is increased in patients with AAA compared to healthy adults of a similar age. This finding is concordant with data arising from studies involving similarly aged aneurysm patients [30,31]. AAA confers a cardiovascular comorbidity burden prior to surgical intervention and a higher risk of adverse cardiovascular events in the 5 years following elective surgery [32].…”

“…Vascular stiffness, heart rate and central blood pressure indices were assessed by two operators at baseline, week 3 and week 12 using the SphygmoCor Xcel (SphygmoCor ver 6.31, AtCor Medical Pty. Ltd., Sydney, Australia) and a previously described protocol [30]. RDW was measured in whole blood as part of full blood count analyses.…”

The physiological and clinical importance of cardiorespiratory fitness in people with abdominal aortic aneurysm

“…A recent large retrospective study reported a mean reduction of 13.6 ml kg −1 min −1 [95% confidence interval (CI) 12.0−15.2, P < 0.001] in VO 2 peak in people with AAA (n = 124) compared with apparently healthy age-matched individuals (n = 108) (Rose et al, 2018). In support of this finding, a recent comparative study reported that people with a small AAA (<5.5 cm) demonstrate significantly lower cardiorespiratory fitness (n = 22, VO 2 peak 19.0 ± 3.5 ml kg −1 min −1 ) when compared with those without an AAA (n = 22, VO 2 peak 24.5 ± 2.8 ml kg −1 min −1 , P ≤ 0.001) (Perissiou et al, 2019).…”

“…A recent large retrospective study reported a mean reduction of 13.6 ml kg −1 min −1 [95% confidence interval (CI) 12.0−15.2, P < 0.001] in $${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{peak}}}}$$ in people with AAA ( n = 124) compared with apparently healthy age‐matched individuals ( n = 108) (Rose et al., 2018). In support of this finding, a recent comparative study reported that people with a small AAA (<5.5 cm) demonstrate significantly lower cardiorespiratory fitness ( n = 22, $${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{peak}}}}$$ 19.0 ± 3.5 ml kg −1 min −1 ) when compared with those without an AAA ( n = 22, $${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{peak}}}}$$ 24.5 ± 2.8 ml kg −1 min −1 , P ≤ 0.001) (Perissiou et al., 2019). These findings from comparative studies suggest there is at least a ∼25% deficit in cardiorespiratory fitness in people with AAA.…”

“…Importantly, vascular endothelial dysfunction and elevated arterial stiffness are factors known to impact blood flow and oxygen delivery directly (Kadoglou et al., 2012; Siasos et al., 2015). We recently demonstrated that aortic stiffness and endothelial dysfunction are associated with lower cardiorespiratory fitness ($${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{peak}}}}$$) in people with a small AAA (Bailey et al., 2017; Perissiou et al., 2019). There is evidence that increased arterial stiffness is directly associated with impaired muscle oxygenation during exercise in hypertensive patients (Dipla et al., 2017).…”