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Associa ions o ca dio espi a o y i ness, physical ac i i y, and BMI wi h a e ial heal h
in middle‐aged men and women
© 2020 The Au ho s. Physiological Repo s published by Wiley Pe iodicals, Inc. on behal o The Physiological Socie y and he Ame ican Physiological Socie y
Published e sion
Haapala, Ee o; Lee, E., Laukkanen, J. A.
Haapala, E., & Lee, E. (2020). Associa ions o ca dio espi a o y i ness, physical ac i i y, and BMI
wi h a e ial heal h in middle‐aged men and women. Physiological Repo s, 8(10), A icle
e14438. h ps://doi.o g/10.14814/phy2.14438
2020
Physiological Repo s. 2020;8:e14438.
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h ps://doi.o g/10.14814/phy2.14438
wileyonlinelib a y.com/jou nal/phy2
1
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INTRODUCTION
A e ial s i ness is an independen isk ac o o ca -
dio ascula diseases (Vlachopoulos, Aznaou idis, &
S e anadis,2010); which a e s ill he leading cause o mo bid-
i y and p ema u e mo ali y wo ldwide (Global s a us epo
on noncommunicable diseases:, 2014,2015). S i ening o a -
e ial wall dec eases compliance and dis ensibili y o a e ies
in esponse o p essu e changes and inc eases pulse p essu e.
This may lead o pa hophysiological le en icula hype o-
phy, and an inc eased isk o hype ension, ischemic hea dis-
ease, and hea ailu e (Zieman, Meleno sky, & Kass,2005).
DOI: 10.14814/phy2.14438
ORIGINAL RESEARCH
Associa ions o ca dio espi a o y i ness, physical ac i i y, and
BMI wi h a e ial heal h in middle-aged men and women
Ee o A.Haapala1,2
|
Ea icLee1
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Ja i A.Laukkanen1,3,4
This is an open access a icle unde he e ms o he C ea i e Commons A ibu ion License, which pe mi s use, dis ibu ion and ep oduc ion in any medium, p o ided he o iginal
wo k is p ope ly ci ed.
© 2020 The Au ho s. Physiological Repo s published by Wiley Pe iodicals, Inc. on behal o The Physiological Socie y and he Ame ican Physiological Socie y.
1Facul y o Spo and Heal h Sciences,
Uni e si y o Jy äskylä, Jy äskylä, Finland
2Physiology, Ins i u e o Biomedicine,
School o Medicine, Uni e si y o Eas e n
Finland, Kuopio, Finland
3Depa men o In e nal Medicine, Cen al
Finland Heal hca e Dis ic , Jy äskylä,
Finland
4Ins i u e o Public Heal h and Clinical
Nu i ion, Uni e si y o Eas e n Finland,
Kuopio, Finland
Co espondence
Ee o A. Haapala, Spo s & Exe cise
Medicine, Facul y o Spo and Heal h
Sciences, Uni e si y o Jy äskylä, PO
Box 35, FI-40014 Uni e si y o Jy äskylä,
Jy äskylä, Finland.
Email: [email p o ec ed].
Abs ac
We in es iga ed he associa ions o ca dio espi a o y i ness (CRF), physical ac i i y
(PA) wi h ega d o ae obic and esis ance aining, and body mass index (BMI) wi h
pulse wa e eloci y (PWV) and augmen a ion index (AIx) in middle-aged adul s
wi h a leas one ca dio ascula isk ac o . A o al o 84 (46 men and 38 women)
pa icipa ed in he s udy. Ca dio espi a o y i ness was measu ed using a maximal
g aded exe cise es on a cycle e gome e and was de ined as maximal powe ou pu
(Wmax) no malized o body weigh -0.35. Pa icipa ion in ae obic and esis ance ain-
ing was assessed by a de ailed ques ionnai e and BMI was calcula ed as weigh (kg)/
[heigh (m2)]. Pulse wa e eloci y and AIx we e measu ed using an applana ion o-
nome y be o e (p e), immedia ely a e (pos ), and a e 10min (pos 10) o maximal
exe cise es . Ca dio espi a o y i ness, PA, o BMI was no associa ed wi h PWV o
AIx. Pulse wa e eloci y dec eased signi ican ly om p e o pos 10 among hose in
he highes hi d o CRF (mean di e ence=−0.793m/s, 95% CI=−1.494 o −0.091,
p=.023) and in no mal weigh pa icipan s (p=.084 o ime*g oup in e ac ion
mean di e ence=−0.781m/s, 95% CI=−1.496 o −0.066, p=.029), bu no among
hose in he o he hi ds o CRF o o e weigh o obese pa icipan s. Pa icipan s
who had egula esis ance aining had con inuously highe AIx om p e o pos 10
han hose who had no egula esis ance aining (mean di e ence=−1.98, 95%
CI=−4.02 o 0.069, p=.058). In conclusion, exe cise may dec ease PWV and
AIx. Ou esul s sugges ha posi i e a e ial esponses o exe cise could be sligh ly
imp o ed in i and no mal weigh indi iduals.
KEYWORDS
A e ial s i ness, Exe cise, Fi ness, Obesi y
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HAAPALA e AL.
A e ial s i ness de elops h ough complica ed cellula and
molecula p ocesses leading o ayed and b oken elas in, and
inc eases wha is o en uno ganized and dys unc ional colla-
gen ibe con en in he a e y wall (Zieman e al.,2005).
While a e ial s i ness inc eases na u ally wi h in-
c easing age (McEnie y, Yasmin, Qasem, Wilkinson, &
Cockc o , 2005), i has been sugges ed ha low ca dio-
espi a o y i ness, lack o physical ac i i y, obesi y, and
being o e weigh leads o ea ly ascula aging and p ema-
u e inc eases in a e ial s i ness (Nilsson,2008). Highe
ca dio espi a o y i ness has been in e sely associa ed
wi h lowe a e ial s i ness in child en (Veijalainen e al.,
2016), adolescen s and young adul s (Bo eham e al.,2004;
Haapala, Laukkanen, Takken, Kujala, & Finni,2018), and
middle-aged and olde adul s (Vai ke icius e  al., 1993).
P e ious s udies in adul s ha e in es iga ed he associa ions
o measu es o ca dio espi a o y i ness scaled by body
weigh (BW); ye simple a io scaling by BW has been ound
o be physiologically and s a is ically inapp op ia e me hod
o emo e he e ec o body size on ca dio espi a o y i -
ness (K achle e  al., 2015; Tanne , 1949; Welsman &
A ms ong,2019). The e o e, use o a io s anda d scaling
may ha e obscu ed ou unde s anding on he ole o ca dio-
espi a o y i ness in he de elopmen o a e ial s i ening.
Physical ac i i y and pa icula ly igo ous in ensi y physi-
cal ac i i y has been in e sely associa ed wi h a e ial s i ness
in c oss-sec ional (Endes e al., 2016) and longi udinal s udies
( Laa e al.,2011). Exe cise in e en ions ha e also p o ided
some e idence ha egula ae obic exe cise (Asho , La a, Sie o,
Celis-Mo ales, & Ma he s,2014; Li e al.,2015), bu no esis-
ance exe cise (Miyachi,2013), may dec ease a e ial s i ness,
bu he posi i e e ec o ae obic exe cise aining on a e ial
s i ness has no been con i med in all s udies (Mon e o, Roche,
& Ma inez-Rod iguez,2014). Fu he mo e, s udies on he ole
o ca dio espi a o y i ness, body mass index (BMI), o blood
p essu e in he e ec s o acu e maximal exe cise on a e ial s i -
ness and a e ial dila a ion capaci y emain somewha limi ed.
The ole o ca dio espi a o y i ness, exe cise aining, and
weigh s a us in a e ial s i ness and a e ial one is s ill lim-
i ed and inconsis en . The e o e, he aim o his s udy was o
in es iga e he ole o ca dio espi a o y i ness no malized o
BW using allome y and a io s anda d, endu ance and esis-
ance exe cise, BMI, and blood p essu e wi h a e ial s i ness
and a e ial one. We also s udied he associa ions o ca dio-
espi a o y i ness, endu ance and esis ance exe cise, and
BMI wi h blood p essu e. Finally, we in es iga ed he ole o
ca dio espi a o y i ness, endu ance and esis ance exe cise,
BMI, and blood p essu e on changes in a e ial s i ness and
a e ial dila a ion one in esponse o a maximal g aded ex-
e cise es . We hypo hesized ha ca dio espi a o y i ness,
endu ance exe cise aining, and o e weigh and obesi y, and
ele a ed blood p essu e a e associa ed wi h poo e a e ial
heal h in adul s wi h a leas one ca dio ascula isk ac o .
2
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METHODS
2.1
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Pa icipan s
A o al o 102 pa icipan s we e ec ui ed om he ci y
o Jy äskylä, Cen al Finland egion, h ough he local
ou -o -hospi al heal h ca e cen e . The s udy g oup con-
sis ed o asymp oma ic pa icipan s (no ca dio ascula
symp oms) wi h a leas one ca dio ascula isk ac o ,
such as a his o y o smoking, dyslipidemia, hype ension,
obesi y, diabe es, o amily his o y o co ona y hea dis-
ease. All pa icipan s wi h diagnosed ca dio ascula dis-
eases we e excluded. P io o pa icipa ion in he s udy,
all pa icipan s we e in o med abou he esea ch pu -
poses and measu emen p ocedu es and we e sc eened
by a ca diac specialis . A o al o 84 (46 men and 38
women) had he comple e da a used in hese analyses.
The esea ch p o ocol and s udy design we e app o ed
by he ins i u ional e iew boa d o he Cen al Finland
Hospi al Dis ic e hical commi ee, Jy äskylä, Finland
(Dn o 5U/2016). All s udy pa icipan s p o ided w i -
en in o med consen p io o he inclusion in he s udy.
The s udy was pe o med as s a ed by he Decla a ion o
Helsinki.
2.2
|
Assessmen o ca dio espi a o y i ness
A maximal exe cise es was conduc ed on an elec omag-
ne ically b aked cycle e gome e (Mona k Exe cise AB,
Sweden) u ilizing a g aded exe cise es p o ocol wi h con-
inuous ECG eco dings (Ca dioSo so wa e V.1.84, GE
Heal hca e, F eibu g, Ge many) o assess he le el o ae obic
exe cise capaci y (Laukkanen e  al., 2018). The symp om-
limi ed exe cise es was s a ed wi h 3-min wa m-up wi hou
wo kload o each pa icipan and con inued wi h 20W in-
c emen s applied e e y 1min un il oli ional exhaus ion. All
exe cise es s we e supe ised by an expe ienced physician
wi h he assis ance o a ained nu se.
We de ined ca dio espi a o y i ness as he maximal powe
ou pu (Wmax) de ined as he wo kload a he end o he ex-
e cise es scaled by BW-1 and allome ically scaled Wmax by
BW-0.35, because Wmax/BW-1 had a s ong in e se associa ion
wi h BW (β=−0.587, 95% con idence in e al (CI)=−0.782
o −0.392, p<.001) indica ing ha a io scaling by BW-1 was
no able o emo e he e ec o body size on ca dio espi a o y
i ness. The e o e, allome ic scaling o Wmax was pe o med
by log-linea eg ession models (Agbaje e  al., 2019). The
scaling exponen o BM was 0.35 (95% CI=0.14 o 0.56).
The powe unc ion a io emo ed he associa ions o Wmax
wi h BW (β=−0.061, 95% CI=−0.317 o 0.195, p=.636)
sugges ing he alidi y in scaling ca dio espi a o y i ness o
body size.
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HAAPALA e AL.
2.3
|
Assessmen o physical ac i i y
We assessed ae obic and esis ance exe cise by a ques ion-
nai e (Lakka e al., 2010). The pa icipan s illed in a ques-
ionnai e whe he hey pa icipa ed in ae obic o esis ance
exe cise. This is a de ailed quan i a i e ques ionnai e based
on common physical ac i i ies and enables he assessmen
o key componen s o physical ac i i y. Pa icipan s we e
asked o eco d he equency (numbe o sessions pe
week), a e age du a ion (hou s and minu es pe session),
and in ensi y o hei physical ac i i y. Because o missing
da a on he equency, a e age du a ion, and he in ensi y
o physical ac i i y, we di ided pa icipan s as hose who
pa icipa ed in ae obic o esis ance aining and hose who
did no .
2.4
|
Assessmen o a e ial s i ness and
blood p essu e
Pulse wa e eloci y (PWV) and augmen a ion index (AIx)
as measu es o a e ial s i ness we e measu ed be o e, im-
media ely a e , and 10min a e he maximal g aded exe -
cise es by a single ained esea che (EL) using a PulsePen
de ice (DiaTecne s. .l., Milan, I aly; www.pulse pen.com)
which includes one onome e and an in eg a ed ECG uni
(Lee e al.,2018, 2019). The measu emen o a e ial s i ness
and a e ial dila a ion capaci y ollowed closely es ablished
guidelines (Tomlinson,2012; Van Bo el e al.,2012).
Pulse wa e eloci y was measu ed by eco ding ca o id
and pe iphe al ( emo al) wa e o ms in apid succession a a
sample a e o 1kHz, and de ined as he ansi dis ance be-
ween he measu ing si es di ided by he ime delay be ween
he dis al pulse and p oximal pulse wa e, using he ECG ace
as e e ence. T ansi dis ances we e assessed by body su -
ace measu emen s using a ape measu e om he sup as e -
nal no ch o each pulse eco ding si e (ca o id and emo al).
Di ec ca o id o emo al measu emen was adjus ed o 80%
(common ca o id a e y–common emo al a e y×0.8) o
he calcula ion o PWV as ecommended by cu en guide-
lines. T ansi ime was de ined as he di e ence be ween he
delay o he dis al pulse wa e o he R wa e belonging o he
ECG qRs complex and he delay o he p oximal pulse wa e
o he R wa e belonging o he ECG qRs complex. The pulse
wa e delay was de e mined by calcula ing he ime elapsed
om he peak o he R wa e and he “ oo ” o he p essu e
pulse wa e.
Augmen a ion index is ano he measu e ha has been
used o desc ibe cen al a e ial s i ness bu AIx also e lec s
pe iphe al a e ial one. Changes in AIx in esponse o ex-
e cise may e lec a e ial dila a ion and opening o pe iph-
e al a e ial ee. AIx was ob ained om he ca o id p essu e
wa e o m analysis. AIx is a pa ame e which p o ides an
indica ion o he con ibu ion o e lec ed wa es o he o al
pulse p essu e and was de ined as he di e ence be ween
he second and i s sys olic peak on a e ial pulse wa e o m
and was exp essed as a pe cen age o cen al pulse p essu e
((AIx)=augmen ed p essu e/pulse p essu e×100).
Supine b achial sys olic blood p essu e and dias olic blood
p essu e we e ob ained using an oscillome ic Mic oli e
BP A200 blood p essu e moni o (Mic oli e Co p., Taipei,
Taiwan) o be e sensi i i y and accu acy. Two sequen ial
eadings we e eco ded, and he mean alues we e used.
Pa icipan s es ed in he supine posi ion o 10min be o e
PWV was measu ed a baseline. Howe e , due o he na u e
o he s udy, a e ial s i ness was measu ed immedia ely and
10min a e he exe cise es exposu e wi hou ha ing laid
supine o 10min.
The p essu e alues eco ded by onome y we e cali-
b a ed o he blood p essu e alues ob ained a he b achial
a e y; whe e hey we e assigned o he app op ia e pix-
els and he alues o mean a e ial p essu e and all o he
p essu e- ela ed pa ame e s we e e-es ablished. The alues
deduced by he so wa e apply he es ablished concep ha
he mean a e ial p essu e emains unchanged in he ac
om he ao a o he pe iphe al a e ies. Mean a e ial p es-
su e was calcula ed by he so wa e as dias olic blood p es-
su e+1/3(sys olic blood p essu e–dias olic blood p essu e).
2.5
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S a is ical me hods
S a is ical analyses we e pe o med by SPSS s a is ical so -
wa e, e sion 23.0 (IBM co p. A monk, NY, USA). Basic
cha ac e is ics be ween sexes we e compa ed using S uden 's
es o no mally dis ibu ed con inuous a iables, he
Mann–Whi ney U es o skewed con inuous a iables, o
chi-squa ed es o ca ego ical a iables. The associa ions o
ca dio espi a o y i ness and BMI wi h PWV, AIx, sys olic
and dias olic blood p essu e, and mean a e ial p essu e we e
in es iga ed using linea eg ession analyses adjus ed o age
and sex. Linea eg ession analyses we e also used o in es i-
ga e he associa ions o sys olic and dias olic blood p essu e,
and mean a e ial p essu e wi h PWV and AIx. Di e ences
in PWV and AIx be ween hose who egula ly engaged in
ae obic o esis ance aining and hose who did no we e
s udied wi h ANOVA adjus ed o age and sex. The associa-
ions o ca dio espi a o y i ness, BMI, ae obic exe cise, and
esis ance exe cise wi h PWV we e u he adjus ed o mean
a e ial p essu e and hose wi h AIx o hea a e (Wilkinson
e al.,2000) and mean a e ial p essu e.
We s udied changes in PWV and AIx in esponse o a
maximal g aded exe cise es and he ole o ca dio espi-
a o y i ness, BMI, exe cise, and blood p essu e in hese
changes using epea ed measu es ANOVA. In hese analyses,
we used only Wmax/BW-0.35 as a measu e o ca dio espi a o y
4 o 10
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HAAPALA e AL.
i ness because i e icien ly emo ed he e ec o body size
on ca dio espi a o y i ness. We in es iga ed he ole o ca -
dio espi a o y i ness as hi ds, weigh s a us (no mal weigh ,
o e weigh , obesi y), ae obic and esis ance exe cise (yes/
no; N o esis ance exe cise=82), blood p essu e (no mo-
ensi e (sys olic blood p essu e<120mmHg and dias olic
blood p essu e<80mmHg), high (sys olic blood p essu e
120–129mmHg and dias olic blood p essu e<80mmHg),
s age 1 (sys olic blood p essu e 130–139mmHg o dias olic
blood p essu e 80–89mmHg), s age 2 (sys olic blood p es-
su e≥140mmHg o dias olic blood p essu e≥90mmHg)
(Whel on e al., 2018)), and PWV a he p eassessmen as
hi ds by s udying ime*g oup in e ac ions om p e o pos 10
assessmen s using epea ed measu e ANOVA. Di e ences
in PWV and AIx om p e o pos 10 assessmen s be ween
adul s in he hi ds o ca dio espi a o y i ness, be ween no -
mal weigh , o e weigh , and obese adul s, be ween adul s in
he ae obic o esis ance exe cise g oups, be ween adul s in
he blood p essu e g oups, and be ween hose in he PWV
hi ds we e in es iga ed using epea ed measu es ANOVA
wi h Sidak co ec ion o mul iple compa isons. These da a
we e u he adjus ed o age and sex. p<.05 was conside ed
s a is ically signi ican .
3
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RESULTS
3.1
|
Basic cha ac e is ics
Men we e alle and hea ie , had highe blood p essu e,
lowe AIx, and highe ca dio espi a o y i ness exp essed as
Wmax/BW-0.35 and Wmax/BW-1 han women (Table1). Men
also pa icipa ed in esis ance aining less equen ly han
women.
3.2
|
Associa ions o ca dio espi a o y i ness,
physical ac i i y, and BMI wi h a e ial s i ness,
a e ial dila a ion capaci y, and blood p essu e
Ca dio espi a o y i ness exp essed as Wmax/BW-0.35 o
Wmax/BW-1 we e no associa ed wi h PWV o AIx a e ad-
jus men o age and sex (Table2). Fu he adjus men o
mean a e ial p essu e o hea a e had no e ec on hese
associa ions. Ne e heless, ca dio espi a o y i ness ex-
p essed as Wmax/BW-1 was posi i ely associa ed wi h PWV
in women (β=0.253, p=.145) bu in e sely associa ed wi h
PWV in men (β=−0.256, p=.056; p=.019 o in e ac ion).
All (n=84)
Men
(n=46)
Women
(n=38) p
Age 53.1 (9.9) 53.3 (11.1) 52.9 (8.3) .849
Heigh 172.7 (9.1) 179.0 (6.5) 165.1 (5.0) <.001
Weigh 81.4 (15.7) 88.0 (13.3) 73.4 (14.8) <.001
Body mass index 27.2 (4.4) 27.5 (3.9) 26.9 (4.9) .564
Weigh s a us .502
No mal weigh (%) 31.0 28.3 34.2
P e alence o o e weigh (%) 46.4 52.2 39.5
P e alence o obesi y (%) 22.6 19.6 26.3
Sys olic blood p essu e 137.3 (15.6) 140.7 (14.0) 133.2 (16.7) .027
Dias olic blood p essu e 84.8 (10.3) 87.0 (10.7) 82.0 (9.3) .026
Mean a e ial p essu e 102.3 (11.4) 104.9 (11.1) 99.1 (11.0) .018
Ao ic pulse wa e eloci y 9.7 (2.1) 9.9 (2.0) 9.3 (2.0) .172
Ao ic augmen a ion index 10.9 (14.2) 6.3 (13.7) 16.6 (12.8) .001
Maximal powe ou pu (W) 229.9 (53.0) 261.6 (45.4) 191.6 (32.1) <.001
Maximal powe ou pu (W/kg o
BW−0.35)
49.3 (10.2) 54.7 (9.2) 42.8 (6.9) <.001
Maximal powe ou pu (W/kg o
BW−1)
2.9 (0.6) 3.0 (0.6) 2.7 (0.5) .008
Maximal hea a e achie ed in
he exe cise es
173.5 (13.9) 176.0 (15.7) 170.5 (10.7) .961
Endu ance exe cise (%) 70.4 65.9 75.7 .338
Resis ance aining (%) 42.7 31.8 55.3 .032
Da a a e om he S uden 's es o con inuous a iables and chi-squa ed es o ca ego ical a iables and a e
displayed as means (SD) o pe cen ages (%). p alues e e o s a is ical signi icance o di e ences be ween
men and women. BW=body weigh .
TABLE 1 Basic cha ac e is ics

|
5 o 10
HAAPALA e AL.
Fu he adjus men o mean a e ial p essu e a enua ed he
associa ion be ween Wmax/BW-1 and PWV in men (β-0.121,
p = .230). In addi ion, ca dio espi a o y i ness exp essed
as Wmax/BW-1 was in e sely associa ed wi h dias olic blood
p essu e a e adjus men o age and sex. Howe e , ca di-
o espi a o y i ness was no associa ed wi h dias olic blood
p essu e when i app op ia ely exp essed as Wmax/BW-0.35.
Sex modi ied he associa ions o esis ance aining and
PWV (p = .036 o sex in e ac ion), bu he di e ences be-
ween women (9.8 s. 8.8 m/s, mean di e ence = 1.0 m/s,
95% CI=−0.279 o 2.281, p=.121) o men (9.3 s. 10.1m/s,
mean di e ence = −0.820 m/s, 95% CI = −2.002 o 0.361,
p=.161) who esis ance ained and hose who did no we e
no s a is ically signi ican . Fu he adjus men o mean a e ial
p essu e augmen ed he di e ences in men (9.2 s. 10.1m/s,
mean di e ence=−0.864 m/s, 95% CI = −1.650 o −0.078,
p=.032), bu i had no e ec on he di e ences in women (da a
no shown). Pa icipan s who esis ance ained had highe AIx
han hose who did no (14.9% s. 8.0%, mean di e ence 6.8%,
95% CI = 1.1 o 12.6, p = .020). This di e ence emained
s a is ically signi ican a e u he adjus men o hea a e.
The e we e no o he s a is ically signi ican di e ences be ween
ae obic o esis ance aining g oups.
Body mass index was no associa ed wi h PWV o AIx
in men and women combined. Howe e , BMI was posi i ely
associa ed wi h PWV in men (β= 0.264, p = .048) and in-
e sely wi h PWV in women (β=−0.247, p=.121, p=.012
o in e ac ion). Fu he adjus men o mean a e ial p essu e
s eng hened he associa ion in women (β=−0.317, p=.034)
bu a enua ed i in men (β=−0.037, p=.730). Sys olic blood
p essu e, dias olic blood p essu e, and mean a e ial p essu e
we e di ec ly associa ed wi h PWV and AIx (Table2).
3.3
|
E ec s o ca dio espi a o y i ness,
ae obic and esis ance aining, and weigh
s a us on changes in a e ial s i ness in
esponse o a maximal g aded exe cise es
Pulse wa e eloci y dec eased om p e- o pos - es (mean
di e ence = −0.420 m/s, 95% CI = −0.893 o 0.052,
p=.096) bu was highe a pos 10 han p eassessmen (mean
di e ence (p e s. pos 10)=0.258m/s, 95% CI=−0.494 o
0.258, p=.043 o main e ec ).
Ca dio espi a o y i ness exp essed as Wmax/BW-0.35 did
no modi y he changes in PWV in esponse o exe cise
(p = .196 o Wmax/BW-0.35* ime in e ac ion, Figu e 1a).
Howe e , pa icipan s in he lowes hi d o Wmax/BW-0.35
had con inuously highe PWV om p e o pos 10 han hose
in he second hi d (mean di e ence 1.3m/s, 95% CI=0.1
o 2.5, p=.022, p=.027 o he main e ec ). This di e -
ence was no longe s a is ically signi ican a e u he ad-
jus men o age and sex (p=.462). Fu he adjus men o
TABLE 2 Associa ions o ca dio espi a o y i ness, exe cise, and body mass index wi h a e ial s i ness and dila a ion capaci y and blood p essu e. N=84
Ao ic pulse wa e eloci y Augmen a ion index Sys olic blood p essu e Dias olic blood p essu e Mean a e ial p essu e
β (95% CI) pβ (95% CI) pβ (95% CI) pβ (95% CI) pβ (95% CI) p
Maximal powe ou pu /
BW−0.35
−0.047 (−0.309 o
0.216)
.725 0.033 (−0.227 o
0.293)
.799 0.049 (−0.213 o
0.311)
.710 −0.031 (−0.302 o
0.239)
.818 0.003 (−0.262 o
0.267)
.982
Maximal powe ou pu /
BW−1
−0.051 (−267 o
0.267)
.639 0.023 (−0.191 o
0.237)
.831 −0.082 (−0.294 o
0.133)
.450 −0.223 (−0.440 o
−0.005)
.045 −0.172 (−0.387
o 0.042)
.113
Body mass index 0.002 (−0.200 o
0.204)
.986 0.007 (−0.193 o
0.208)
.942 0.123 (−0.077 o
0.324)
.224 0.325 (0.129 o
0.520)
.001 0.253 (0.057 o
0.448)
.012
Sys olic blood p essu e 0.494 (0.301 o
0.688)
<.001 0.357 (0.152 o
0.563)
.001
Dias olic blood p essu e 0.496 (0.311 o
0.682)
<.001 0.414 (0.222 o
0.607)
<.001
Mean a e ial p essu e 0.538 (0.352 o
0.352)
<.001 0.424 (0.226 o
0.621)
<.001
No e: The da a a e s anda dized eg ession coe icien s and hei 95% con idence in e als adjus ed o age and sex. BW=body weigh .
6 o 10
|
HAAPALA e AL.
mean a e ial p essu e s eng hened hese di e ences (p o
he main e ec =0.043), bu he pos hoc compa isons we e
no s a is ically signi ican . Addi ional analyses showed ha
PWV dec eased signi ican ly om p e o pos 10 only in he
highes hi d o Wmax/BW-0.35 (mean di e ence=−0.793m/s,
95% CI=−1.494 o −0.091, p=.023) a e adjus men o
age and sex.
Weigh s a us modi ied he e ec s o a maximal g aded
exe cise es on PWV (p=.084 o in e ac ion, Figu e1b).
Pulse wa e eloci y dec eased om p e o pos 10 assessmen
(mean di e ence=−0.781m/s, 95% CI=−1.496 o −0.066,
p=.029) only in no mal weigh pa icipan s (p=.034 o
he main e ec ). The e we e no di e ences in PWV among
no mal weigh , o e weigh , and obese pa icipan s (p=.914
o he main e ec ). Addi ional adjus men o mean a e ial
p essu e had no e ec on hese esul s.
Res ing blood p essu e did no modi y he exe cise esponse
on PWV (p=.930 o in e ac ion, Figu e1c). No mo ensi e
pa icipan s had lowe PWV om p e o pos 10 han hose a
s age 1 (mean di e ence=−1.70, 95% CI=−3.42 o −0.11,
p=.052) and s age 2 hype ension (mean di e ence=−2.79,
95% CI=−4.45 o −1.12, p<.001, p<.001 o main e ec ).
P e-PWV modi ied he e ec o a maximal g aded exe -
cise es on PWV (p=.003 o in e ac ion, Figu e1d). Pulse
wa e eloci y dec eased only in highes hi d om p e o pos
(mean di e ence=−1.2, 95% CI=−2.2 o −0.1, p=.026)
and pos 10 (mean di e ence=−1.1, 95% CI=−1.9 o −0.4,
p=.003). Pa icipan s who we e in he highes hi d o PWV
a he p eassessmen had con inuously highe PWV om p e
o pos 10 han hose he middle (mean di e ence=1.9, 95%
CI=1.1 o 2.7, p=.003) and he lowes hi d (mean di e -
ence=3.4, 95% CI=2.6 o 4.2, p<.001, p<.001 o main
e ec ). Fu he adjus men s had no e ec on hese esul s.
Ae obic endu ance aining o esis ance aining did no
modi y PWV esponses o exe cise. The e we e no s a is i-
cally signi ican di e ences in PWV be ween hose who ex-
e cised egula ly and hose who did no .
3.4
|
E ec s o ca dio espi a o y i ness,
ae obic and esis ance aining, and weigh
s a us on changes in a e ial one in esponse o
a maximal g aded exe cise es
AIx dec eased linea ly om p e o pos 10 (mean di e ence
p e s. pos =−9.2%, 95% CI=−13.7 o −4.7, p<.001; pos
s. pos 10=−8.0%, 95% CI=−12.6 o 3.5, p<.001 o
main e ec ).
Weigh s a us pa ly modi ied he e ec o a maxi-
mal g aded exe cise es on AIx (p= .062 o in e ac ion,
FIGURE 1 Changes in ao ic pulse wa e eloci y (PWV) om p e- o pos - and pos 10-exe cise assessmen s among adul s in he hi ds
o ca dio espi a o y i ness exp essed as maximal powe ou pu (Wa s) scaled by body weigh in kilog ams0.35 (N o he lowes , middle, and
he highes hi d we e 29, 28, and 27, espec i ely) (a), no mal weigh (N=26), o e weigh (N=39), and obese (N=19) adul s (b), adul s wi h
no mal blood p essu e (N=9), wi h ele a ed blood p essu e (N=11), wi h s age 1 hype ension (N=28), and s age 2 hype ension (N=36) (c),
and adul s in he hi ds o PWV (N o he lowes , middle, and he highes hi d we e 29, 29, and 26, espec i ely) (d). Da a a e mean and 95%
con idence in e al. * deno es s a is ically signi ican (p<.05) change in PWV
P e Pos Pos 10
7
8
9
10
11
12
Ao ic PWV
Lowes hi dMiddle hi dHighes hi d
Ca dio espi a o y i ness (Wmax/BM
–0.35
)
*
P ePos Pos 10
7
8
9
10
11
Ao ic PWV
No mal
weigh
O e weigh
Obesi
y
Weigh s a us
*
P e Pos Pos 10
4
6
8
10
12
Ao ic PWV
No mal
Ele a ed
S age 1 hype ension
S age 2 hype ension
Blood p essu e
P e Pos Pos 10
6
8
10
12
14
Ao ic PWV
Lowes hi dMiddle hi dHighes hi d
Pulse wa e eloci y
*
*
ab
cd
|
7 o 10
HAAPALA e AL.
Figu e2a). In no mal weigh pa icipan s, AIx a pos 10 was
lowe han in p e (mean di e ence=−20.5, 95% CI=−27.2
o −13.8, p < .001) and pos (mean di e ence = −15.7,
95% CI=−22.8 o −8.6, p<.001) (p<.001 o he main
e ec ). In o e weigh pa icipan s, AIx a pos (mean di -
e ence=−10.6, 95% CI=−17.9 o −3.2, p=.003) and
pos 10 (mean di e ence=−16.3, 95% CI=−23.0 o −9.6,
p<.001, p<.001 o main e ec ) we e lowe han p e-ex-
e cise AIx. Simila ly, in obese pa icipan s pos (mean di -
e ence=−12.5, 95% CI=−21.2 o −3.9, p=.004) and
pos 10 (mean di e ence=−14.8, 95% CI=−23.5 o −6.2,
p = .001, p < .001 o main e ec ) AIx we e lowe han
p e-exe cise AIx. Fu he adjus men o hea a e had no
e ec on hese esul s.
Resis ance aining modi ied he esponse o AIx o a
maximal g aded exe cise es (p=.026 o ime*g oup in-
e ac ion, Figu e2b) and he dec ease in AIx was la ge in
pa icipan s wi h egula esis ance aining. AIx dec eased
om p e o pos (mean di e ence=−11.6, 95% CI=−18.8
o −4.4, p = .001) and pos 10 (mean di e ence = −22.6,
95% CI = −29.1 o −16.1, p < .001) in pa icipan s who
had egula esis ance aining. AIx a pos was also highe
han a pos 10 (mean di e ence = 11.0, 95% CI = 3.4 o
18.5, p=.002). Among hose who had no egula aining
AIx a p e was highe han a pos (mean di e ence=7.5,
95% CI=−1.8 o 13.2, p=.006) and pos 10 (mean di e -
ence=−12.9, 95% CI=7.9 o 18.0, p<.001). Fu he mo e,
pa icipan s who had egula esis ance aining had con inu-
ously highe AIx om p e o pos 10 han hose who had no
egula esis ance aining (p=.058 o he main e ec , mean
di e ence =−1.98, 95% CI= −4.02 o 0.069, p = .058).
This di e ence s eng hened a e adjus men o age and sex
(p=.037). Fu he adjus men o hea a e had no e ec on
hese di e ences. Ae obic endu ance aining did no modi y
AIx esponses o exe cise.
Wmax/BW-0.35, blood p essu e, o PWV did no modi y he
esponse o AIx o a maximal g aded exe cise es and he e
we e no di e ences in AIx be ween he hi ds o Wmax/BW-
0.35, blood p essu e g oups, o hi ds o PWV. The esul s on
he associa ions o blood p essu e wi h AIx emained simila
when no mo ensi e and ele a ed g oups we e combined.
4
|
DISCUSSION
The mos consis en inding in ou s udy was ha a highe
sys olic blood p essu e, dias olic p essu e, and mean a e-
ial p essu e we e s ongly associa ed wi h highe PWV and
AIx. We ound no associa ion o ca dio espi a o y i ness o
he le el o exe cise aining wi h a e ial s i ness o a e ial
one in middle-aged subjec s wi h ca dio ascula isk ac o s.
Ne e heless, we obse ed an in e se associa ion be ween
ca dio espi a o y i ness exp essed as Wmax/BW-1 and dias-
olic blood p essu e. Howe e , his associa ion a enua ed
when ca dio espi a o y i ness was app op ia ely no malized
o BM using allome y and exp essed as Wmax/BW-0.35. We
also obse ed ha a highe BMI was ela ed o highe dias-
olic blood p essu e and mean a e ial p essu e. Fu he mo e,
PWV dec eased among pa icipan s wi h highe i ness le el
and no mal body weigh in esponse o a maximal g aded
exe cise wi h inc easing wo kloads. Finally, we obse ed a
sligh ly augmen ed AIx esponse o a maximal g aded ex-
e cise es in no mal weigh compa ed o obese pa icipan s.
In con as wi h he esul s o some p e ious s udies show-
ing an in e se associa ion be ween ca dio espi a o y i ness
and a e ial s i ness in child en (Veijalainen e al.,2016),
adolescen s and young adul s (Bo eham e  al., 2004;
Haapala e  al., 2018), and olde adul s (Vai ke icius
e  al., 1993), we ound no ela ionship o ca dio espi a-
o y i ness o a e ial s i ness and a e ial one. Howe e ,
ou esul s ag ee wi h indings showing weak associa ion
be ween ca dio espi a o y i ness and a e ial s i ness in
young and middle-aged adul s while showing an in e se
associa ion in olde adul s (Vai ke icius e al.,1993). One
eason o weak associa ions be ween ca dio espi a o y i -
ness and a e ial s i ness may be ha ou s udy popula ion
had no diagnosed ca dio ascula diseases, which may lead
o a e ial s i ening o endo helial dys unc ion. The e o e,
FIGURE 2 Changes in augmen a ion
index (AIx) om p e- o pos - and pos 10-
exe cise assessmen s among (a), no mal
weigh (N=26), o e weigh (N=39),
and obese (N=19) adul s, and (b), adul s
wi h (N=35) and wi hou (N=47) egula
esis ance aining. Da a a e mean and 95%
con idence in e al. *(p<.05), ** (p<.01),
and *** (p<.001) deno es s a is ically
signi ican change in AIx
P e Pos Pos 10
–20
–10
0
10
20
30
Ao ic AIx
No mal weigh O e weigh Obesi y
Weigh s a us
***
**
***
***
***
**
P ePos Pos 10
–
20
–
10
0
10
20
30
Ao ic AIx
No esis ance ainining
Resis ance aining
Resis ance aining
**
***
**
**
***
ab
8 o 10
|
HAAPALA e AL.
i is possible ha he associa ions o ca dio espi a o y i -
ness and exe cise wi h a e ial heal h a e s onge in in-
di iduals wi h mo e ad anced ch onic diseases (G een,
Spence, Halliwill, Cable, & Thijssen,2011). Fu he mo e,
p e ious s udies ha e also sugges ed ha ela i ely highe
exe cise load is equi ed o imp o e ascula unc ions in
asymp oma ic heal hy adul s (G een e al.,2011). Ano he
eason may be ha ou s udy sample was qui e homogenous
and he e we e no enough a ia ion and he e o e s udies
in la ge samples a e needed. Fu he mo e, as expec ed, we
obse ed ha ca dio espi a o y i ness exp essed as Wmax/
BW-1 was in e sely associa ed wi h dias olic blood p es-
su e. Howe e , his associa ion was no longe seen when
he e ec o body size on ca dio espi a o y i ness was
app op ia ely con olled using allome y. This obse a ion
sugges s ha he associa ion be ween ca dio espi a o y i -
ness and dias olic blood p essu e was la gely explained by
di e ences in body size and composi ion.
We ound ha egula ae obic endu ance exe cise was no
associa ed wi h a e ial s i ness. P e ious s udies ha e shown
ha ae obic exe cise aining can imp o e ascula unc ions
(G een e al.,2011; Thijssen e al.,2010). Howe e , ae obic
exe cise aining has been ound o ha e only limi ed e ec s
o exe cise aining on a e ial s i ness in obese (Mon e o,
Robe s, & Vine ,2014) o p ehype ensi e o hype ensi e
adul s (Mon e o, Roche, e al., 2014). The e o e, i is possible
ha he e ec s o ae obic exe cise aining on a e ial s i ness
equi e subs an ial educ ion also in o he ca diome abolic
isk ac o s (Mon e o, Roche, e al., 2014). Ano he explana-
ion o hese con as ing indings may be ha we used a ough
dicho omy assessmen me hod o sepa a e hose who ha e a
his o y o egula ae obic exe cise. Second, ou me hodology
o egula physical ac i i y was no de ailed enough o assess
in ensi y o exe cise. I is possible ha he epo ed egula
ae obic exe cise may ha e been o oo low in in ensi y and/
o du a ion o cause bene icial e ec s on a e ial s i ness in
his popula ion wi h ca dio ascula isk ac o s. Indeed, shea
s ess agains he a e y wall has been shown o be an impo -
an ac o o imp o ing ascula unc ion (G een e al.,2011).
While he e is e idence showing ha s eng h aining has none
o inc easing e ec s on a e ial s i ness (Miyachi,2013), we
ound some e idence on he dimo phic associa ions acco ding
o gende be ween s eng h aining g oups in PWV showing
ha women who esis ance ained had s i e a e ies han
hose who did no ained while opposi e was obse ed in
men, al hough hese di e ences did no each s a is ical sig-
ni icance. The eason o hese opposing associa ions is no
well unde s ood. Menopause has been ound o ampli y a e-
ial s i ening (Takahashi e al.,2005), and i is possible ha
women who p e e ed esis ance aining we e al eady meno-
pausal and hey we e encou aged o egula ly pa icipa e in
a esis ance aining p og am. Howe e , possible sex-di e -
ences in hese associa ions wa an s u he s udies.
We obse ed ha BMI was ela ed o dias olic blood p es-
su e and mean a e ial p essu e, bu no wi h a e ial s i ness.
Fu he mo e, in line wi h p e ious s udies (Sa a e al.,2018)
blood p essu e was s ongly and di ec ly associa ed wi h
PWV and AIx. Inc eased blood p essu e has been ound o
dec ease elas ic po en ial o a e y wall by causing excessi e
collagen p oduc ion (Zieman e al.,2005), and change as-
cula smoo h muscle cell ac ion, he eby (Sa a e al.,2018)
inc easing a e ial s i ness. In addi ion, inc eased a e ial
s i ness may pa ly explain ele a ed blood p essu e (Sa a
e al.,2018).
A g aded exe cise wi h inc easing wo kload had a small
o e all e ec on PWV. Howe e , we ound ha hose pa -
icipan s wi h he highes ca dio espi a o y i ness, no mal
weigh , and hose wi h he highes PWV demons a ed a
sligh dec ease in PWV in esponse o a maximal g aded ex-
e cise es . We also ound a sligh dec ease in PWV in obese
pa icipan s om p e o pos , bu PWV e u ned o p e le els
wi hin 10min. These esul s may imply ha indi iduals wi h
highe ca dio espi a o y i ness and no mal weigh can be e
egula e ascula unc ion and blood conduc ance o ma ch
pe iphe al oxygen equi emen s. P e ious s udies ha e shown
ha seden a y indi iduals ha e blun ed ni ic oxide-depen-
den asodila a ion ha can be p e en ed by exe cise (Black,
G een, & Cable,2008).
Fu he mo e, obesi y has been associa ed wi h impai ed
ni ic oxide-dependen asodila a ion (Higashi, Sasaki,
Nakagawa, & Ma suu a,2001) sugges ing ha obese adul s
could no inc ease a e ial dila a ion in a simila manne o
no mal weigh adul s, which is an essen ial ascula adap-
ion o inc easing exe cise wo kload. These obse a ions a e
pa ly suppo ed by ou indings showing ha only no mal
weigh pa icipan s exhibi ed a consis en dec ease AIx in
esponse o a maximal g aded exe cise es . We also ound
ha al hough hose who esis ance ained had highe AIx
p eassessmen , he AIx dec eased o he same le el a e a
maximal g aded exe cise es han in o he pa icipan s. A
plausible explana ion o dec eased AIx in esponse o a
maximal g aded exe cise es is exe cise-induced ni ic ox-
ide-dependen pe iphe al asodila ion (G een e  al., 2011).
The eason o highe AIx in esis ance aining pa icipan s
may be ha esis ance aining induced peaks in blood p es-
su e may ha e inc ease ascula smoo h muscle one (Sa a
e al.,2018).
The s eng hs o his s udy include a measu emen o
ca dio espi a o y i ness using a maximal exe cise es and
alid and ep oducible measu es o a e ial s i ness. We
no only in es iga ed c oss-sec ional associa ions o ca dio-
espi a o y i ness, BMI, exe cise aining, and blood p es-
su e wi h a e ial s i ness bu also hei ole in he e ec s
o a maximal g aded exe cise es , which is commonly used
in clinical p ac ice, allowing us o cap u e mo e comp e-
hensi e pic u e o de e minan s o a e ial heal h. We also