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Effects of Resistance Training on Arterial Stiffness in Persons at Risk for Cardiovascular Disease: A Meta-analysis

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Abstract

Background

Arterial stiffness (AS) is a key measure in predicting risk for cardiovascular disease (CVD) and related events, independent of other risk factors. Resistance training (RT) has been shown to increase AS in young healthy subjects. However, the effects of RT on AS in persons with or at risk for CVD remain unclear; this uncertainty is a barrier to RT prescription in this population. Considering RT may be as effective as or superior to aerobic exercise prescription in treating some co-morbidities associated with CVD, it would be helpful to clarify whether RT does lead to clinically meaningful increases (detrimental) in AS in those with CVD or CVD risk factors.

Objectives

The aim of this study was to (1) assess the effects of RT on measures of AS in at-risk populations, and (2) discuss the implications of the findings for clinical exercise physiologists.

Data Sources

The electronic databases PubMed, Web of Science, SPORTDiscus, and Google Scholar were searched from inception to February 2018. The reference lists of eligible articles and reviews were also checked.

Study Selection

Inclusion criteria were: (1) the trial was a randomized controlled trial; (2) exercise prescription of RT or a combination of resistance and aerobic exercise for at least 8 weeks; (3) control group characteristics allowed for comparison of the main effects of the exercise prescription; (4) subjects had known CVD or a risk factor associated with CVD according to the American College of Sports Medicine (ACSM) guidelines; (5) article measured at least carotid to femoral pulse wave velocity (PWV) or augmentation index (AIx).

Appraisal and Synthesis Methods

Initially, 1427 articles were identified. After evaluation of study characteristics, quality and validity data from 12 articles and 13 cohorts involving 651 participants (223 women, 338 men, 90 unknown) were extracted for the meta-analysis. To enable comparisons between assessments, and to infer clinical significance, standardized mean differences (SMD) were calculated. When data were not available, values were estimated according to Cochrane guidelines.

Results

According to the JADAD scale, the mean quality of studies was 3 out of 5. The duration of the included studies ranged from 8 weeks to 24 months. RT trended towards decreasing (improving) PWV (SMD = − 0.168, 95% CI − 0.854 to 0.152, p = 0.057). There were no significant differences in AIx (SMD = − 0.286), diastolic blood pressure (SMD = − 0.147), systolic blood pressure (SMD = − 0.126), or central systolic blood pressure (SMD = − 0.405).

Conclusion

The available evidence suggests that RT does not increase (worsen) AS in patients who have or are at risk for CVD. Considering RT may be as effective as or superior to aerobic exercise prescription in treating some co-morbidities associated with CVD, these findings suggest that RT is a suitable exercise prescription in primary and secondary prevention settings.

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References

  1. Thompson PD, Buchner D, Piña IL, Balady GJ, Williams MA, Marcus BH, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation. 2003;107(24):3109.

    Article  PubMed  Google Scholar 

  2. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004;116(10):682–92. https://doi.org/10.1016/j.amjmed.

    Article  PubMed  Google Scholar 

  3. Bweir S, Al-Jarrah M, Almalty A-M, Maayah M, Smirnova IV, Novikova L, et al. Resistance exercise training lowers HbA1c more than aerobic training in adults with type 2 diabetes. Diabetol Metab Syndr. 2009;1:27. https://doi.org/10.1186/1758-5996-1-27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Baldi JC, Snowling N. Resistance training improves glycaemic control in obese type 2 diabetic men. Int J Sports Med. 2003;24(6):419–23. https://doi.org/10.1055/s-2003-41173.

    Article  CAS  PubMed  Google Scholar 

  5. Marques EA, Wanderley F, Machado L, Sousa F, Viana JL, Moreira-Goncalves D, et al. Effects of resistance and aerobic exercise on physical function, bone mineral density, OPG and RANKL in older women. Exp Gerontol. 2011;46(7):524–32. https://doi.org/10.1016/j.exger.2011.02.005.

    Article  CAS  PubMed  Google Scholar 

  6. Hanson ED, Sheaff AK, Sood S, Ma L, Francis JD, Goldberg AP, et al. Strength training induces muscle hypertrophy and functional gains in black prostate cancer patients despite androgen deprivation therapy. J Gerontol A Biol Sci Med Sci. 2013;68(4):490–8. https://doi.org/10.1093/gerona/gls206.

    Article  CAS  PubMed  Google Scholar 

  7. Smutok MA, Reece C, Kokkinos PF, Farmer C, Dawson P, Shulman R, et al. Aerobic versus strength training for risk factor intervention in middle-aged men at high risk for coronary heart disease. Metabolism. 1993;42(2):177–84. https://doi.org/10.1016/0026-0495(93)90032-J.

    Article  CAS  PubMed  Google Scholar 

  8. Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update. Circulation. 2007;116(5):572.

    Article  PubMed  Google Scholar 

  9. Miyachi M. Effects of resistance training on arterial stiffness: a meta-analysis. Br J Sports Med. 2013;47(6):393.

    Article  PubMed  Google Scholar 

  10. MacDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR. Arterial blood pressure response to heavy resistance exercise. J Appl Physiol. 1985;58(3):785–90. https://doi.org/10.1152/jappl.1985.58.3.785.

    Article  CAS  PubMed  Google Scholar 

  11. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588–605. https://doi.org/10.1093/eurheartj/ehl254.

    Article  PubMed  Google Scholar 

  12. Belz GG. Elastic properties and Windkessel function of the human aorta. Cardiovasc Drugs Ther. 1995;9(1):73–83.

    Article  CAS  PubMed  Google Scholar 

  13. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318–27. https://doi.org/10.1016/j.jacc.2009.10.061.

    Article  PubMed  Google Scholar 

  14. Ashor AW, Lara J, Siervo M, Celis-Morales C, Mathers JC. Effects of exercise modalities on arterial stiffness and wave reflection: a systematic review and meta-analysis of randomized controlled trials. PLOS One. 2014;9(10):e110034. https://doi.org/10.1371/journal.pone.0110034.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. https://doi.org/10.1186/2046-4053-4-1.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Higgins J, Green S, Cochrane Collaboration, editors. In: Cochrane handbook for systematic reviews of interventions. Cochrane book series. Chichester: Wiley; 2008.

  17. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.

    Article  CAS  PubMed  Google Scholar 

  18. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1(2):97–111. https://doi.org/10.1002/jrsm.12.

    Article  PubMed  Google Scholar 

  19. Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.

    Article  CAS  PubMed  Google Scholar 

  20. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. https://doi.org/10.1136/bmj.327.7414.557.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ryan R. Cochrane consumers and communication review group: meta-analysis. http://cccrg.cochrane.org. Accessed 17 May 2015.

  22. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Hoboken: Wiley; 2008.

    Book  Google Scholar 

  23. Beck DT, Martin JS, Casey DP, Braith RW. Exercise training reduces peripheral arterial stiffness and myocardial oxygen demand in young prehypertensive subjects. Am J Hypertens. 2013;26(9):1093–102.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Croymans DM, Krell SL, Oh CS, Katiraie M, Lam CY, Harris RA, et al. Effects of resistance training on central blood pressure in obese young men. J Hum Hypertens. 2014;28(3):157–64. https://doi.org/10.1038/jhh.2013.81.

    Article  CAS  PubMed  Google Scholar 

  25. DeVallance E, Fournier S, Lemaster K, Moore C, Asano S, Bonner D, et al. The effects of resistance exercise training on arterial stiffness in metabolic syndrome. Eur J Appl Physiol. 2016;116(5):899–910.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Dobrosielski DA, Gibbs BB, Ouyang P, Bonekamp S, Clark JM, Wang N-Y, et al. Effect of exercise on blood pressure in type 2 diabetes: a randomized controlled trial. J Gen Intern Med. 2012;27(11):1453–9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Figueroa A, Park SY, Seo DY, Sanchez-Gonzalez MA, Baek YH. Combined resistance and endurance exercise training improves arterial stiffness, blood pressure, and muscle strength in postmenopausal women. Menopause. 2011;18(9):980–4. https://doi.org/10.1097/gme.0b013e3182135442.

    Article  PubMed  Google Scholar 

  28. Greenwood SA, Koufaki P, Mercer TH, MacLaughlin HL, Rush R, Lindup H, et al. Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory fitness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis. 2015;65(3):425–34.

    Article  PubMed  Google Scholar 

  29. Heffernan KS, Yoon ES, Sharman JE, Davies JE, Shih YT, Chen CH, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res. 2013;36(5):422–7. https://doi.org/10.1038/hr.2012.198.

    Article  PubMed  Google Scholar 

  30. Horner K, Barinas-Mitchell E, DeGroff C, Kuk JL, Drant S, Lee S. Effect of aerobic versus resistance exercise on pulse wave velocity, intima media thickness and left ventricular mass in obese adolescents. Pediatr Exerc Sci. 2015;27(4):494–502. https://doi.org/10.1123/pes.2015-0067.

    Article  PubMed  Google Scholar 

  31. Stewart KJ, Bacher AC, Turner KL, et al. Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med. 2005;165(7):756–62. https://doi.org/10.1001/archinte.165.7.756.

    Article  PubMed  Google Scholar 

  32. Lee YH, Park SH, Yoon ES, Lee CD, Wee SO, Fernhall B, et al. Effects of combined aerobic and resistance exercise on central arterial stiffness and gait velocity in patients with chronic poststroke hemiparesis. Am J Phys Med Rehabil. 2015;94(9):687–95. https://doi.org/10.1097/phm.0000000000000233.

    Article  PubMed  Google Scholar 

  33. Ho SS, Radavelli-Bagatini S, Dhaliwal SS, Hills AP, Pal S. Resistance, aerobic, and combination training on vascular function in overweight and obese adults. J Clin Hypertens. 2012;14(12):848–54.

    Article  Google Scholar 

  34. Loimaala A, Groundstroem K, Rinne M, Nenonen A, Huhtala H, Parkkari J, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol. 2009;103(7):972–7. https://doi.org/10.1016/j.amjcard.2008.12.026.

    Article  PubMed  Google Scholar 

  35. Townsend RR, et al. Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the American Heart Association. Hypertension. 2015;66(3):698–722.

    Article  CAS  PubMed  Google Scholar 

  36. Hashimoto J, Imai Y, O’Rourke MF. Indices of pulse wave analysis are better predictors of left ventricular mass reduction than cuff pressure. Am J Hypertens. 2007;20(4):378–84. https://doi.org/10.1016/j.amjhyper.2006.09.019.

    Article  PubMed  Google Scholar 

  37. Vlachopoulos C, Aznaouridis K, O’Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J. 2010;31(15):1865–71. https://doi.org/10.1093/eurheartj/ehq024.

    Article  PubMed  Google Scholar 

  38. Stoner L, Faulkner J, Lowe A, Lambrick DM, Young JM, Love R, et al. Should the augmentation index be normalized to heart rate? J Atheroscler Thromb. 2014;21(1):11–6.

    Article  PubMed  Google Scholar 

  39. Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: aging arteries: a “set up” for vascular disease. Circulation. 2003;107(1):139–46.

    Article  PubMed  Google Scholar 

  40. Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L. Impact of resistance training on blood pressure and other cardiovascular risk factors. Hypertension. 2011;58(5):950.

    Article  CAS  PubMed  Google Scholar 

  41. Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T, et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension. 2007;50(1):197–203.

    Article  CAS  PubMed  Google Scholar 

  42. Safar ME, Blacher J, Pannier B, Guerin AP, Marchais SJ, Guyonvarc’h P-M, et al. Central pulse pressure and mortality in end-stage renal disease. Hypertension. 2002;39(3):735–8.

    Article  CAS  PubMed  Google Scholar 

  43. Pini R, Cavallini MC, Palmieri V, Marchionni N, Di Bari M, Devereux RB, et al. Central but not brachial blood pressure predicts cardiovascular events in an unselected geriatric population: the ICARe Dicomano Study. J Am Coll Cardiol. 2008;51(25):2432–9.

    Article  PubMed  Google Scholar 

  44. Cheng HM, Chuang SY, Sung SH, Yu WC, Pearson A, Lakatta EG, et al. Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term cardiovascular risks. J Am Coll Cardiol. 2013;62(19):1780–7. https://doi.org/10.1016/j.jacc.2013.06.029.

    Article  PubMed  Google Scholar 

  45. McEniery CM, Cockcroft JR, Roman MJ, Franklin SS, Wilkinson IB. Central blood pressure: current evidence and clinical importance. Eur Heart J. 2014;35(26):1719–25. https://doi.org/10.1093/eurheartj/eht565.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Madden KM, Lockhart C, Cuff D, Potter TF, Meneilly GS. Short-term aerobic exercise reduces arterial stiffness in older adults with type 2 diabetes, hypertension, and hypercholesterolemia. Diabetes Care. 2009;32(8):1531–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Koh KP, Fassett RG, Sharman JE, Coombes JS, Williams AD. Effect of intradialytic versus home-based aerobic exercise training on physical function and vascular parameters in hemodialysis patients: a randomized pilot study. Am J Kidney Dis. 2010;55(1):88–99. https://doi.org/10.1053/j.ajkd.2009.09.025.

    Article  PubMed  Google Scholar 

  48. Madden KM, Lockhart C, Cuff D, Potter TF, Meneilly GS. Aerobic training-induced improvements in arterial stiffness are not sustained in older adults with multiple cardiovascular risk factors. J Hum Hypertens. 2013;27(5):335–9. https://doi.org/10.1038/jhh.2012.38.

    Article  CAS  PubMed  Google Scholar 

  49. Fryer S, Stone K, Dickson T, Faulkner J, Lambrick D, Corres P, et al. Reliability of oscillometric central blood pressure responses to lower limb resistance exercise. Atherosclerosis. 2018;268:157–62. https://doi.org/10.1016/j.atherosclerosis.2017.11.031.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Exercise and Sport Science, The University of North Carolina, 306 Woollen Gym, CB# 8605, Chapel Hill, NC, 27599-8700, USA

    William Evans, Quentin Willey, Erik D. Hanson & Lee Stoner

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  1. William Evans
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  2. Quentin Willey
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Contributions

LS is the guarantor. WE, LS, and QW drafted the manuscript. QW, LS, and WE contributed to the selection criteria and data extraction. LS provided statistical expertise and data analysis. LS and EH contributed substantially to the interpretation and revisions of the article. All authors read, responded with feedback, and agreed on the final manuscript.

Corresponding author

Correspondence to Lee Stoner.

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Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

William Evans, Quentin Willey, Erik Hanson, and Lee Stoner declare that they have no conflicts of interest relevant to the content of this review.

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Evans, W., Willey, Q., Hanson, E.D. et al. Effects of Resistance Training on Arterial Stiffness in Persons at Risk for Cardiovascular Disease: A Meta-analysis. Sports Med 48, 2785–2795 (2018). https://doi.org/10.1007/s40279-018-1001-6

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