The Association of Physical Activity with Arterial Stiffness and Inflammation: Insight from the "Corinthia" Study

Association between leisure-time physical activity and arterial stiffness in adults of the ELSA-Brasil study: a mediation analysis

OBJECTIVES

We aimed at defining the direct and the mediated pathways for the association between leisure-time physical activity (LTPA) and carotid-to-femoral pulse wave velocity (cf-PWV), and also to identify whether these effects are influenced by sex and age.

METHODS

Cross-sectional data from 13 718 adults (35-74 years) were obtained at the baseline of the ELSA-Brasil study. The cf-PWV was obtained by measuring the pulse transit time and the distance traveled by the pulse between the carotid and the femoral, as well as clinical and anthropometric parameters were measured. The levels of LTPA were determined by applying the long form of the International Physical Activity Questionnaire (IPAQ).

RESULTS

Classical cardiovascular risk factors were independently associated with cf-PWV. Path analysis showed that increased levels of LTPA were directly associated with lower cf-PWV in both men and women (β: -0.123 ± 0.03 vs. 0.065 ± 0.029, P for sex = 0.165), except for diabetes. Also, the mediated effect of LTPA on SBP and DBPs, heart rate, BMI, and fasting glucose, was associated with lower cf-PWV in men and women (β: -0.113 ± 0.016 vs. -0.104 ± 0.016, P for sex = 0.692), except for diabetes. When age was tested as a moderator, the direct effect did not change significantly according to participants' age, regardless of sex. However, the mediated effect increases in both men and women over 50 years.

CONCLUSION

Our findings support that LTPA in adults reduces cf-PWV by acting in different ways according to age. Physical activity in older individuals improves cardiometabolic risk factors and thus mitigates the stiffening of large arteries.

Association of Physical Activity and Exercise with Physical Performance and Muscle Mass in Older Adults: Results from the Longevity Check-Up (Lookup) 7+ Project

Regular engagement in physical activity (PA) or physical exercise (PE) is effective at improving physical performance and body composition in older adults. Less is known about the benefits that may be obtained through combining PA with PE and whether the effects of activity habits differ between men and women. This study cross-sectionally investigated the association of PA and/or PE with physical performance and anthropometric measures in a large and relatively unselected sample of older adults enrolled in the Longevity Check-up (Lookup) 7+ project. Participants were individuals 65 years and older living in the community who were recruited in unconventional settings across Italy. Adherence to PA or PE was operationalized as involvement in light walking or various types of exercise, respectively, at least twice weekly for a minimum of 30 min per session throughout the last 12 months. Physical performance measures included handgrip strength and five-time sit-to-stand (5STS) tests. Lower-limb muscle power and appendicular skeletal muscle mass (ASM) were estimated through validated equations. We analyzed data of 4119 participants, of whom 2222 (53.4%) were women. The mean age was 72.8 ± 5.8 years in men and 72.1 ± 5.4 years in women. Regular engagement in PA + PE was reported by 139 (7.3%) men and 100 (4.5%) women. Results indicated that regular walking activity and/or PE were significantly associated with better physical performance and greater ASM with sex-specific patterns. Associations were also influenced by the type of activity, physical performance assessment tool, and anthropometric parameters. Men engaged in PA + PE performed better on the 5STS test and had greater handgrip strength, ASM, and relative and specific muscle power than those practicing either PA or PE. In women, the combination of PA and PE was associated with greater handgrip strength. The findings of this study indicate that older adults regularly practicing PA + PE had better physical performance than those who only engaged in either modality. In men, the combination of PA and PE was also associated with greater ASM.

Increase in Vascular Function Parameters According to Lifestyles in a Spanish Population without Previous Cardiovascular Disease-EVA Follow-Up Study

The aim of this longitudinal descriptive observational study was to analyze the influence of different lifestyles on arterial stiffness (AS) throughout five years of follow-up and to describe the differences by sex in a Spanish adult population without cardiovascular disease at the start of the study. A random stratified sampling by age and sex was used to obtain 501 subjects included in the initial assessment. No cardiovascular disease was allowed in the subjects. The average age was 55.9 years, and 50.3% were women. A total of 480 subjects were analyzed again five years later. Alcohol and tobacco consumption were collected with standardized questionnaires. Adherence to the Mediterranean diet was assessed with the Mediterranean diet adherence screener (MEDAS) questionnaire. Physical activity was assessed with the short version of the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and sedentary time was assessed with the Marshall Sitting Questionnaire (MSQ). AS was assessed by measuring carotid-femoral pulse wave velocity (cfPWV) and central augmentation index (CAIx) with SphygmoCor System®, and ankle pulse wave velocity (baPWV) and cardio ankle vascular index (CAVI) with Vasera VS-1500®. Increases in vascular function measures per year of follow-up were: cfPWV = 0.228 ± 0.360 m/s, baPWV = 0.186 ± 0.308 m/s, CAVI = 0.041 ± 0.181 m/s, and CAIx = 0.387 ± 2.664 m/s. In multiple regression analysis, positive association was shown between an increase in baPWV and tobacco index (β = 0.007) and alcohol consumption (β = 0.005). Negative association was shown between CAVI and Mediterranean diet score (β = -0.051). In multinomial logistic regression analysis, the OR of tobacco index of subjects with a cfPWV increase >P75 was OR = 1.025 and of subjects classified between P25 and P75 was OR = 1.026 regarding subjects classified with an increase P75 was OR = 1.006 regarding subjects classified with an increase P75, and an OR = 0.841 was found of subjects classified between P25-75 regarding subjects classified with an increase Collapse

Key Words

• arterial stiffness
• lifestyle
• longitudinal study
• mediterranean diet

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MESH Headings

• Adult
• Female
• Humans
• Male
• Middle Aged
• Ankle Brachial Index
• Cardiovascular Diseases/epidemiology
• Follow-Up Studies
• Life Style
• Pulse Wave Analysis
• Longitudinal Studies

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Grants

• RD21/0016/0010 Instituto de Salud Carlos III
• GRS 1193/B/15; GRS2303/B/21 Gerencia Regional de Salud de la Junta de Castilla y León

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Affiliation(s)

Alicia Navarro Cáceres Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.) Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain
Elena Navarro-Matías Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.) Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain
Marta Gómez-Sánchez Home Hospitalization Service, Marqués de Valdecilla University Hospital, 39008 Santander, Spain;
Olaya Tamayo-Morales Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.) Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain
Cristina Lugones-Sánchez Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.) Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain
Susana González-Sánchez Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.) Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain
Emiliano Rodríguez-Sánchez Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.) Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain Department of Medicine, University of Salamanca, 28046 Salamanca, Spain
Luis García-Ortiz Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.) Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain Department of Biomedical and Diagnostic Sciences, University of Salamanca, 37007 Salamanca, Spain
Leticia Gómez-Sánchez Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.) Emergency Service, University Hospital of La Paz, 37007 Madrid, Spain
Manuel A. Gómez-Marcos Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Institute of Biomedical Research of Salamanca (IBSAL), 37005 Salamanca, Spain; (A.N.C.); (E.N.-M.); (O.T.-M.); (C.L.-S.); (S.G.-S.); (E.R.-S.); (L.G.-O.) Castilla and León Health Service-SACYL, Regional Health Management, 37005 Salamanca, Spain Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 37005 Salamanca, Spain Department of Medicine, University of Salamanca, 28046 Salamanca, Spain
EVA-Follow-Up Investigators Group

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Gender dimension in cardio-pulmonary continuum

Cardio-pulmonary diseases, which were once regarded as a man's illness, have been one of the leading causes of morbidity and mortality for both men and women in many countries in recent years. Both gender and sex influence the functional and structural changes in the human body and therefore play an important role in disease clinical manifestation, treatment choice, and/or response to treatment and prognosis of health outcomes. The gender dimension integrates sex and gender analysis in health sciences and medical research, however, it is still relatively overlooked suggesting the need for empowerment in the medical research community. Latest advances in the field of cardiovascular research have provided supportive evidence that the application of biological variables of sex has led to the understanding that heart disease in females may have different pathophysiology compared to males, particularly in younger adults. It has also resulted in new diagnostic techniques and a better understanding of symptomatology, while gender analysis has informed more appropriate risk stratification and prevention strategies. The existing knowledge in the pulmonary field shows the higher prevalence of pulmonary disorders among females, however, the role of gender as a socio-cultural construct has yet to be explored for the implementation of targeted interventions. The purpose of this review is to introduce the concept of gender dimension and its importance for the cardiopulmonary continuum with a focus on shared pathophysiology and disease presentation in addition to interrelation with chronic kidney disease. The review presents basic knowledge of what gender dimension means, and the application of sex and gender aspects in cardiovascular medicine with a specific focus on early pulmonary development, pulmonary hypertension, and chronic obstructive pulmonary disease (COPD). Early vascular aging and inflammation have been presented as a potential pathophysiological link, with further interactions between the cardiopulmonary continuum and chronic kidney disease. Finally, implications for potential future research have been provided to increase the impact of gender dimension on research excellence that would add value to everybody, foster toward precision medicine and ultimately improve human health.