Simon Endes

Aerobic, resistance and combined exercise training on arterial stiffness in normotensive and hypertensive adults: A review

Abstract Exercise training has different effects on arterial stiffness according to training modalities. The optimal exercise modality for improvement of arterial function in normotensive and hypertensive individuals has not been well established. In this review, we aim to evaluate the effects of aerobic, resistance and combined aerobic and resistance training on arterial stiffness in individuals with and without hypertension. We systematically searched the Pubmed and Web of Science database from 1985 until December 2013 for relevant randomised controlled trials (RCTs). The data were extracted by one investigator and checked by a second investigator. The training effects on arterial stiffness were estimated using weighted mean differences of the relative changes (%) with 95% confidence intervals (CIs). We finally reviewed the results from 17 RCTs. The available evidence indicates that aerobic exercise tends to have a beneficial effect on arterial stiffness in normotensive and hypertensive patients, but does not affect arterial stiffness in patients with isolated systolic hypertension. Resistance exercise has differing effects on arterial stiffness depending on type and intensity. Vigorous resistance training is associated with an increase in arterial stiffness. There seem to be no unfavourable effects on arterial stiffness if the training is of low intensity, in a slow eccentric manner or with lower limb in healthy individuals. Combined training has neutral or even a beneficial effect on arterial stiffness. In conclusion, our review shows that exercise training has varying effects on arterial stiffness depending on the exercise modalities.

Long-term physical activity is associated with reduced arterial stiffness in older adults: longitudinal results of the SAPALDIA cohort study

BACKGROUND longitudinal analyses of physical activity (PA) and arterial stiffness in populations of older adults are scarce. We examined associations between long-term change of PA and arterial stiffness in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). METHODS we assessed PA in SAPALDIA 2 (2001-03) and SAPALDIA 3 (2010-11) using a short questionnaire with a cut-off of at least 150 min of moderate-to-vigorous PA per week for sufficient activity. Arterial stiffness was measured oscillometrically by means of the brachial-ankle pulse wave velocity (baPWV) in SAPALDIA 3. We used multivariable mixed linear regression models adjusted for several potential confounders in 2,605 persons aged 50-81. RESULTS adjusted means of baPWV were significantly lower in persons with sufficient moderate-to-vigorous PA (i) in SAPALDIA 2 but not in SAPALDIA 3 (P = 0.048) and (ii) in both surveys (P = 0.001) compared with persons with insufficient activity in both surveys. There was a significant interaction between sex and the level of change in PA concerning baPWV (P = 0.03). The triples of parameter estimates describing the association between level of PA change and baPWV were not significantly different between the two sex-specific models (P = 0.07). CONCLUSIONS keeping up or adopting a physically active lifestyle was associated with lower arterial stiffness in older adults after a follow-up of almost a decade. Increasing the proportion of older adults adhering to PA recommendations incorporating also vigorous PA may have a considerable impact on vascular health at older age and may contribute to healthy ageing in general.

Reproducibility of oscillometrically measured arterial stiffness indices: Results of the SAPALDIA 3 cohort study

Abstract Background. There is an increasing interest in oscillometric arterial stiffness measurement for cardiovascular risk stratification. We assessed reproducibility of the cuff-based arterial stiffness measures cardio-ankle vascular index (CAVI), brachial-ankle pulse wave velocity (baPWV) and peripheral augmentation index (pAI) in a subsample of the second follow-up of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA 3). Methods. CAVI, baPWV and pAI were measured twice within 90 days in a representative subsample (n = 105) of SAPALDIA 3 with a mean age of 63 years (52.4% female). Results. The mean coefficient of variation for CAVI was 4.4%, baPWV 3.9%, and pAI 7.4%. The intraclass correlation coefficient ranged from 0.6 for pAI to 0.8 for CAVI, and 0.9 for baPWV. The mixed linear model revealed that 68.7%/80.1%/55.0% of the CAVI/baPWV/pAI variance was accounted for by the subject, 5.2%/8.1%/ < 0.01% by the fieldworker, 6.7%/7.8%/28.5% by variation between measurement days, and 19.4%/4%/16.5% by measurement error. Bland-Altman plots showed no particular dispersion patterns except for pAI. Conclusions. Oscillometric arterial stiffness measurement by CAVI and baPWV has proved to be highly reproducible in Caucasians. Results of the pAI showed lower reproducibility. CAVI and baPWV can be implemented as easy-to-apply arterial stiffness measures in population wide cardiovascular risk assessment in Caucasians.

Is physical activity a modifier of the association between air pollution and arterial stiffness in older adults: The SAPALDIA cohort study

INTRODUCTION AND OBJECTIVES Air pollution and insufficient physical activity have been associated with inflammation and oxidative stress, molecular mechanisms linked to arterial stiffness and cardiovascular disease. There are no studies on how physical activity modifies the association between air pollution and arterial stiffness. We examined whether the adverse cardiovascular effects of air pollution were modified by individual physical activity levels in 2823 adults aged 50-81 years from the well-characterized Swiss Cohort Study on Air Pollution and Lung and Heart Diseases (SAPALDIA). METHODS We assessed arterial stiffness as the brachial-ankle pulse wave velocity (baPWV [m/s]) with an oscillometric device. We administered a self-reported physical activity questionnaire to classify each subjects physical activity level. Air pollution exposure was estimated by the annual average individual home outdoor PM10 and PM2.5 (particulate matter <10μm and <2.5μm in diameter, respectively) and NO2 (nitrogen dioxide) exposure estimated for the year preceding the survey. Exposure estimates for ultrafine particles calculated as particle number concentration (PNC) and lung deposited surface area (LDSA) were available for a subsample (N=1353). We used mixed effects logistic regression models to regress increased arterial stiffness (baPWV≥14.4m/s) on air pollution exposure and physical activity while adjusting for relevant confounders. RESULTS We found evidence that the association of air pollution exposure with baPWV was different between inactive and active participants. The probability of having increased baPWV was significantly higher with higher PM10, PM2.5, NO2, PNC and LDSA exposure in inactive, but not in physically active participants. We found some evidence of an interaction between physical activity and ambient air pollution exposure for PM10, PM2.5 and NO2 (pinteraction=0.06, 0.09, and 0.04, respectively), but not PNC and LDSA (pinteraction=0.32 and 0.35). CONCLUSIONS Our study provides some indication that physical activity may protect against the adverse vascular effects of air pollution in low pollution settings. Additional research in large prospective cohorts is needed to assess whether the observed effect modification translates to high pollution settings in mega-cities of middle and low-income countries.

Carotid Stiffness and Physical Activity in Elderly—A Short Report of the SAPALDIA 3 Cohort Study

Introduction Regular physical activity has been shown to reduce cardiovascular disease risk in the general population. While smaller studies in specified groups (highly trained versus untrained individuals) indicate a certain dose-dependent effect of physical activity on the reduction of carotid stiffness (an indicator of subclinical vascular disease), it is unclear whether this association is present in a representative sample. Thus, we investigated this question cross-sectionally in participants from the population-based Swiss Cohort Study on Air Pollution And Lung and Heart Diseases In Adults (SAPALDIA). Methods Self-reported total, moderate and vigorous physical activity and distensibility as a measure of local arterial stiffness among 1636 participants aged 50 to 81 years without clinically manifest diseases were evaluated. Mixed regression models were used to examine associations of physical activity intensity with distensibility. Results Vigorous physical activity, but not total nor moderate physical activity, was significantly associated with increased distensibility (= reduced carotid stiffness) in univariate analyses (percent change in the geometric mean and 95% confidence interval per 1 standard deviation increment in vigorous physical activity = 2.54 (0.69; 4.43), p<0.01; in total physical activity = 1.62 (-0.22; 3.50), p = 0.08; in moderate physical activity = 0.70 (-1.12; 2.56), p = 0.45). These associations disappeared when we additionally adjusted for age. Conclusion After adjustment for the most important confounders and risk factors, we found no evidence for an association of physical activity with carotid stiffness in the general middle aged to elderly population.

Associations of Novel and Traditional Vascular Biomarkers of Arterial Stiffness: Results of the SAPALDIA 3 Cohort Study

Background and Objectives There is a lack of evidence concerning associations between novel parameters of arterial stiffness as cardiovascular risk markers and traditional structural and functional vascular biomarkers in a population-based Caucasian cohort. We examined these associations in the second follow-up of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA 3). Methods Arterial stiffness was measured oscillometrically by pulse wave analysis to derive the cardio-ankle vascular index (CAVI), brachial-ankle (baPWV) and aortic pulse wave velocity (aPWV), and amplitude of the forward and backward wave. Carotid ultrasonography was used to measure carotid intima-media thickness (cIMT) and carotid lumen diameter (LD), and to derive a distensibility coefficient (DC). We used multivariable linear regression models adjusted for several potential confounders for 2,733 people aged 50–81 years. Results CAVI, aPWV and the amplitude of the forward and backward wave were significant predictors of cIMT (p < 0.001). All parameters were significantly associated with LD (p < 0.001), with aPWV and the amplitude of the forward wave explaining the highest proportion of variance (2%). Only CAVI and baPWV were significant predictors of DC (p < 0.001), explaining more than 0.3% of the DC variance. Conclusion We demonstrated that novel non-invasive oscillometric arterial stiffness parameters are differentially associated with specific established structural and functional local stiffness parameters. Longitudinal studies are needed to follow-up on these cross-sectional findings and to evaluate their relevance for clinical phenotypes.

Physical activity reduces cardiovascular disease risk in older adults

Commentary on: Soares-Miranda L, Siscovick DS, Psaty BM, et al. Physical activity and risk of coronary heart disease and stroke in older adults: the cardiovascular health study. Circulation 2016;133:147–55[OpenUrl][1][Abstract/FREE Full Text][2]. Currently, at least 150 min per week of moderate-to-vigorous physical activity is recommended for adults of all ages to beneficially influence individual and population health and cardiovascular mortality.1 Adhering to current physical activity guidelines has been shown to be associated with a 20% lower mortality risk compared to physically inactive persons.2 A physically active lifestyle is linked with decreased risk of cardiovascular disease (CVD) and CVD events, such as myocardial infarction or stroke, at all ages, and in some improvements in atherosclerotic processes and stiffening of the arteries.3–6 Walking is a low-risk activity and … [1]: {openurl}?query=rft.jtitle%253DCirculation%26rft_id%253Dinfo%253Adoi%252F10.1161%252FCIRCULATIONAHA.115.018323%26rft_id%253Dinfo%253Apmid%252F26538582%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=circulationaha&resid=133/2/147&atom=%2Febmed%2F21%2F5%2F191.atom

Feasibility of oscillometric aortic pressure and stiffness assessment using the VaSera VS-1500: comparison with a common tonometric method.

ObjectivesA number of operator-independent oscillometric devices to measure hemodynamics and arterial stiffness became available recently, but some and in particular VaSera VS-1500 do not provide estimates of aortic pressures and aortic pulse wave velocity (aPWV). The aim of this work was the retrospective application of the ARCSolver algorithm to pulse wave signals acquired with the VaSera VS-1500 device to estimate central systolic blood pressure (cSBP) and aPWV. Materials and methodsARCSolver estimates of cSBP and aPWV, on the basis of brachial cuff measurements, were compared pair-wise with results from the tonometric SphygmoCor device in 68 individuals (mean age 51±18 years). We used variation estimates, correlation coefficients, age group-related t-tests, and the Bland–Altman method to analyze the reproducibility and agreement of the two methods. ResultscSBP reproducibility expressed as variability was 14.9% for ARCSolver and 11.6% for SphygmoCor. PWV reproducibility was better for ARCSolver, with a variation estimate of 6.5%, compared with 20.9% using SphygmoCor. The mean cSBP difference was 0.5 mmHg (SD 6.9 mmHg) and 0.32 m/s (SD 1.20 m/s) for PWV, respectively. The age-related differences between ARCSolver and SphygmoCor are in line with previous studies. Bland–Altman plots showed considerable agreement between the two methods without signs of systematic bias. ConclusionThese results show that the combined application of the ARCSolver method with the VaSera VS-1500 device is feasible and the results are comparable with tonometric determination of cSBP and aPWV. This successful application of the ARCSolver may potentially help to improve cardiovascular risk stratification and prevention at an early stage in a community setting.

Does exercise capacity attenuate coronary artery calcification in view of mortality

Improvement of diagnosis is essential for disease risk stratification and prediction. This holds true especially for persons at intermediate risk, accounting for around 40% of the US adult population [1]. These persons have at least one risk factor such as smoking, high cholesterol, high systolic or diastolic blood pressure, overweight, or family history of heart disease. Lifestyle interventions including cessation of smoking, reduction of alcohol consumption, healthy diet or/and higher amounts of physical activity are recommended for persons at intermediate risk [2]. In these persons further diagnosis especially by non-invasive, easily applicable testing may improve risk prediction to counsel effective lifestyle interventions or drug treatment. Coronary artery calcification (CAC) testing is recommended by ACCF/SCCT guidelines and the 2012 European Society for Cardiovascular Disease Prevention guidelines for persons at increased risk [2,3]. By using a non-invasive computed tomography technique, CAC scoring has proven to provide a more accurate prediction of adverse cardiovascular events and death [4e6]. Vice versa low CAC scores have been shown to be positively associated with low cardiovascular risk and mortality [7]. A recent population based prospective cohort study showed that over a mean follow-up time of 14 years CAC scores produce useful information for the development of coronary events andmortality also in hypertensive persons