Low-to-Moderate-Intensity Resistance Exercise Effectively Improves Arterial Stiffness in Adults: Evidence From Systematic Review, Meta-Analysis, and Meta-Regression Analysis

Effectiveness of exercise training on arterial stiffness and blood pressure among postmenopausal women: a systematic review and meta-analysis

BACKGROUND

The acute and long-term benefits of exercise training on cardiovascular health have been well established. The systematic review and meta-analysis aimed to systematically assess the effectiveness of exercise training on arterial stiffness and blood pressure among postmenopausal women with elevated blood pressure.

METHODS

A comprehensive search was conducted on PubMed, Embase, Web of Science, ProQuest, Cochrane Library, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov website from inception to September 30, 2023, to identify the randomized controlled trials (RCTs), which evaluated the effectiveness of exercise training on arterial stiffness and blood pressure in postmenopausal women. Standardized mean differences (SMD), weighted mean differences (WMD), and 95% confidence intervals (95% CIs) were calculated using random/fixed effects models. Quality assessment was performed using the modified Jadad scale and the Cochrane Risk of Bias Tool. Sensitivity analysis and subgroup analysis were conducted based on drug dosage, treatment duration, and age of administration to further explore potential heterogeneity. Funnel plots were performed to assess publication bias and Begg's regression test was carried out for funnel plot asymmetry.

RESULTS

Twenty-two RCTs involving 1978 participants were included in the quantitative analysis. The mean quality of eligible studies was 4.2 out of 7 based on the modified Jadad scale. The results indicated that exercise training had a significant effect on reducing brachial-ankle pulse wave velocity [MD = - 0.69, 95%CI (- 1.11, - 0.27), P = 0.001], decreasing augmentation index (AIx) [MD = - 6.00, 95%CI (- 6.39, - 5.61), P < 0.00001] and AIx normalized to a heart rate of 75 beats per minute (AIx@75%) [MD = - 7.01, 95%CI - 7.91 to - 6.12, P < 0.00001], lowering systolic blood pressure [MD = - 6.19, 95%CI - 9.24 to - 3.15, P < 0.0001], diastolic blood pressure [MD = - 3.57, 95%CI (- 6.10, - 1.03), P = 0.006) and pulse pressure [MD = - 8.52, 95%CI (- 16.27, - 0.76), P = 0.03]. Subgroup analysis revealed that baseline blood pressure levels had a large impact on the effect of exercise training.

CONCLUSIONS

The systematic review and meta-analysis suggested that exercise training may ameliorate arterial stiffness and reduce blood pressure in postmenopausal women with elevated blood pressure. However, the optimal mode of exercise training that improves arterial stiffness and blood pressure in this population requires further investigation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021211268.

Appendicular Muscle Mass Index was Stronger than Body Mass Index in Association with Atherosclerosis in the Community-Dwelling Elderly

AIMS

Low muscle mass is associated with advanced atherosclerosis. However, only very few studies on the elderly have investigated a dose-response relationship between muscle mass and atherosclerosis. Furthermore, whether the relationship between muscle mass and atherosclerosis is stronger than that between body mass index (BMI) and atherosclerosis among the elderly population remains to be determined.

METHODS

A community-based sample of apparently healthy elderlies (≥ 65 years) was cross-sectionally examined for the association between appendicular skeletal muscle mass (ASM) and brachial-ankle pulse wave velocity (baPWV), a measure of atherosclerosis. We categorized the participants according to sex-specific quintiles of the ASM index (ASM/height2) or BMI. Using multivariable linear regression, we compared the slope of one standard deviation higher ASM index for baPWV with the corresponding slope of BMI, separately (single-index model) and jointly (simltaneously-adjusted model).

RESULTS

The ASM index and BMI of a total of 995 participants (60.0% women, mean age 73 years) were significantly inversely associated with baPWV in a dose-response manner across the quintiles in both sexes. The slope for the ASM index tended to be greater than that for BMI in the single-index and simultaneously-adjusted models in both sexes after adjusting for confounders.

CONCLUSIONS

Among a community-dwelling elderly population, the association between ASM and baPWV was stronger than, and independent of that between BMI and baPWV. These findings suggest that ASM provides more important information on atherosclerosis in the elderly than BMI does.

Optimum Dose of Resistance Exercise for Cardiovascular Health and Longevity: Is More Better?

PURPOSE OF REVIEW

Although there is extensive research on how much aerobic exercise to prescribe in order to reduce the risks of cardiovascular disease (CVD) and premature mortality, there is limited research on how much resistance exercise to prescribe. This review is to help fill important gaps in knowledge on effective minimum dose, beneficial optimum dose, and safe maximum dose of resistance exercise for CVD prevention and longevity.

RECENT FINDINGS

In contrast to aerobic exercise where "some is good, more is better," recent observational studies suggested a J-shaped relation where more time in resistance exercise was associated with lower CVD risk and mortality only up to 40-60 min/week, beyond which risk reductions attenuated or even disappeared. While it remains unclear, postulated mechanisms that may underlie the higher CVD risk and mortality with higher resistance exercise doses include increased arterial stiffness and chronic inflammation. Current observational data suggest that "more may not be better" for dose-response relations of resistance exercise with CVD and mortality; however, this requires confirmation, especially from randomized controlled trials that directly test and compare multiple doses of resistance exercise. Until these data exist, it is prudent to recommend small doses of resistance exercise for cardiovascular health and longevity.

Vascular ageing: moving from bench towards bedside

Prevention of cardiovascular disease (CVD) remains one of the largest public health challenges of our time. Identifying individuals at increased cardiovascular risk at an asymptomatic, sub-clinical stage is of paramount importance for minimizing disease progression as well as the substantial health and economic burden associated with overt CVD. Vascular ageing (VA) involves the deterioration in vascular structure and function over time and ultimately leads to damage in the heart, brain, kidney, and other organs. Vascular ageing encompasses the cumulative effect of all cardiovascular risk factors on the arterial wall over the life course and thus may help identify those at elevated cardiovascular risk, early in disease development. Although the concept of VA is gaining interest clinically, it is seldom measured in routine clinical practice due to lack of consensus on how to characterize VA as physiological vs. pathological and various practical issues. In this state-of-the-art review and as a network of scientists, clinicians, engineers, and industry partners with expertise in VA, we address six questions related to VA in an attempt to increase knowledge among the broader medical community and move the routine measurement of VA a little closer from bench towards bedside.