Improvement of Arterial Stiffness by Aerobic Exercise in Elderly Subjects

Abstract

Arterial stiffness increases with aging (1), and is accelerated by common diseases such as hypertension, type 2 diabetes, and metabolic syndrome. Among various indices of arterial stiffness, pulse wave velocity (PWV) and the augmentation index (AI) are commonly used in clinical settings, because these parameters can be easily and noninvasively measured. PWV mainly reflects the vascular stiffness (2). On the other hand, AI is calculated based on the analysis of arterial pulse waveform. AI is not simply determined by the wall stiffness of large arteries but influenced by the intensity of wave reflection, which is determined by the diameter and elasticity of small arteries and arterioles (2).PWV (3) and AI (4) predict cardiovascular events. In addition, arterial stiffness also relates to microvascular diseases in the brain and the kidney (5). Increased arterial stiffness may at least partly explain the high incidence of cardiovascular diseases in elderly persons or in patients with hypertension, diabetes, or metabolic syndrome. Thus, a therapeutic regimen to effectively reduce arterial stiffness would exert a beneficial effect in preventing cardiovascular events and progression of microvascular diseases. In fact, the CAFE study, a substudy of the ASCOT, demonstrated that patients receiving an amlodipine regimen exhibited significantly lower values of indices of arterial stiffness, including AI, and better cardiovascular outcomes compared with those receiving an atenolol regimen (6). As for the other classes of antihypertensive drugs, the angiotensin receptor blocker valsartan decreased brachial to ankle PWV independent of blood pressure lowering in elderly hypertensive patients (7). An angiotensin converting enzyme inhibitor, perindopril, also decreased arterial stiffness in hypertensive patients with type 2 diabetes (8).Lifestyle modification also improves arterial stiffness. Dietary sodium restriction to < 100 mmol/day for 3 months significantly decreased aortic PWV and carotid AI in postmenopausal women with systolic blood pressure between 130 and 159 mmHg (9). More strict sodium restriction to 54±11 mmol/day improved carotid artery compliance and β-stiffness index in elderly patients with systolic hypertension in 1 to 2 weeks (10). More recently, in untreated hypertensive patients, current and ex-smokers showed significantly higher PWV and AI than nonsmokers (11). There was a significant linear relationship between smoking status and PWV and AI, and in ex-smokers, longer duration of smoking cessation was associated with lower values of PWV and AI (11). Therefore, smoking cessation also seems to reduce the arterial stiffness.Many cross-sectional observations already have noticed an association between habitual aerobic exercise and lower arterial stiffness. In this issue of Hypertension Research, Tabara et al. (12) report that in sedentary elderly subjects, habitual aerobic exercise of mild to moderate intensity significantly reduced arterial stiffness and blood pressure. Both hypertensive and normotensive subj...

Physical Performance, Cardiovascular Health and Psychosocial Wellbeing in Older Adults Compared to Oldest-Old Residential Seniors

“…Nonetheless, the effects of exercise on arterial stiffness in elderly patients are conflicting due to a lack of research in this field. Certain studies show that mild to moderate aerobic exercise reduces arterial stiffness in 50-year old individuals [38], while other authors found no reduction in PWV in 60-year olds at risk of cardiovascular disease after a high-intensity exercise intervention [39]. This implies reduced vascular adaptability with increasing age.…”

Exercise duration as a determinant of vascular function and antioxidant balance in patients with coronary artery disease

“…On the contrary, the beneficial effects of regular moderate-intensity exercise on vascular stiffness are better documented. Regular exercise training is associated with beneficial effects on arterial elastic properties in various populations such as elderly subjects19 and individuals at high cardiovascular risk 20…”