Sports Medicine

, Volume 48, Issue 12, pp 2785–2795 | Cite as

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

  • William Evans
  • Quentin Willey
  • Erik D. Hanson
  • Lee StonerEmail author
Systematic Review



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.


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.


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).


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.


Author 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.

Compliance with Ethical Standards


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.


  1. 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.CrossRefGoogle Scholar
  2. 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. Scholar
  3. 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. Scholar
  4. 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. Scholar
  5. 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. Scholar
  6. 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. Scholar
  7. 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. Scholar
  8. 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.CrossRefGoogle Scholar
  9. 9.
    Miyachi M. Effects of resistance training on arterial stiffness: a meta-analysis. Br J Sports Med. 2013;47(6):393.CrossRefGoogle Scholar
  10. 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. Scholar
  11. 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. Scholar
  12. 12.
    Belz GG. Elastic properties and Windkessel function of the human aorta. Cardiovasc Drugs Ther. 1995;9(1):73–83.CrossRefGoogle Scholar
  13. 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. Scholar
  14. 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. Scholar
  15. 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. Scholar
  16. 16.
    Higgins J, Green S, Cochrane Collaboration, editors. In: Cochrane handbook for systematic reviews of interventions. Cochrane book series. Chichester: Wiley; 2008.Google Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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. Scholar
  19. 19.
    Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.CrossRefGoogle Scholar
  20. 20.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. Scholar
  21. 21.
    Ryan R. Cochrane consumers and communication review group: meta-analysis. Accessed 17 May 2015.
  22. 22.
    Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Hoboken: Wiley; 2008.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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. Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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.CrossRefGoogle Scholar
  27. 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. Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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. Scholar
  30. 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. Scholar
  31. 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. Scholar
  32. 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. Scholar
  33. 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.CrossRefGoogle Scholar
  34. 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. Scholar
  35. 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.CrossRefGoogle Scholar
  36. 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. Scholar
  37. 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. Scholar
  38. 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.CrossRefGoogle Scholar
  39. 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.CrossRefGoogle Scholar
  40. 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.CrossRefGoogle Scholar
  41. 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.CrossRefGoogle Scholar
  42. 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.CrossRefGoogle Scholar
  43. 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.CrossRefGoogle Scholar
  44. 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. Scholar
  45. 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. Scholar
  46. 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.CrossRefGoogle Scholar
  47. 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. Scholar
  48. 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. Scholar
  49. 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. Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Exercise and Sport ScienceThe University of North CarolinaChapel HillUSA

Personalised recommendations