Exercise Training for the Modification of Arterial Stiffness and Wave Reflections



Clinically significant modulating effects of lifestyle factors on both age- and disease-related arterial stiffening – particularly those relating to habitual physical activity – are widely recognised. Consequently, exercise training may represent an important strategy in the non-pharmacological treatment of arterial stiffening and related complications – often apparent even at an early stage of the cardiometabolic disease continuum. Observational and interventional data relevant to this context are reviewed in the current chapter.

Arterial de-stiffening certainly appears achievable with aerobic exercise in young adults, and may even begin at a lower volume threshold than current exercise guidelines. However, the response in older individuals and those with cardiovascular risk factors appears highly variable. Where short-term training adaptations are evident (weeks to months), these probably reflect functional mechanisms related to blood pressure-lowering. Intrinsic changes in arterial wall structure are difficult to assess in humans, but may be possible when exercise is commenced in young adulthood and performed continually throughout the life course. Resistance training promotes arterial stiffening at high intensities, but may otherwise have a neutral or beneficial effect – particularly in combination with aerobic exercise.


Aerobic Exercise Aortic Stiffness Arteriosclerosis Exercise Pulse Wave Analysis Pulse Wave Velocity Resistance Training Vascular Stiffness 


  1. 1.
    Dart AM, Kingwell BA. Pulse pressure–a review of mechanisms and clinical relevance. J Am Coll Cardiol. 2001;37(4):975–84.PubMedCrossRefGoogle Scholar
  2. 2.
    Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol. 2005;25(5):932–43.PubMedCrossRefGoogle Scholar
  3. 3.
    Vlachopoulos C, Alexopoulos N, Stefanadis C. Lifestyle modification and arterial stiffness and wave reflections: a more natural way to prolong arterial health. Artery Res. 2006;1(Supplement 1):S15–22.CrossRefGoogle Scholar
  4. 4.
    Seals DR, Desouza CA, Donato AJ, Tanaka H. Habitual exercise and arterial aging. J Appl Physiol. 2008;105(4):1323–32.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Gates PE, Seals DR. Decline in large elastic artery compliance with age: a therapeutic target for habitual exercise. Br J Sports Med. 2006;40(11):897–9.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Kingwell BA, Jennings GL, Cameron JD. Nonpharmacological treatment for increased arterial stiffness and altered wave reflections. In: Safar ME, O’Rourke MF, editors. Arterial stiffness in hypertension. United Kingdom: Elsevier; 2006. p. 567–80.Google Scholar
  7. 7.
    O’Rourke MF, Hashimoto J. Arterial stiffness: a modifiable cardiovascular risk factor? J Cardiopulm Rehabil Prev. 2008;28(4):225–37.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    Mohiaddin RH, Underwood SR, Bogren HG, Firmin DN, Klipstein RH, Rees RS, et al. Regional aortic compliance studied by magnetic resonance imaging: the effects of age, training, and coronary artery disease. Br Heart J. 1989;62(2):90–6.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Edwards DG, Lang JT. Augmentation index and systolic load are lower in competitive endurance athletes. Am J Hypertens. 2005;18(5 Pt 1):679–83.PubMedCrossRefGoogle Scholar
  11. 11.
    D’Andrea A, Cocchia R, Riegler L, Salerno G, Scarafile R, Citro R, et al. Aortic stiffness and distensibility in top-level athletes. J Am Soc Echocardiogr. 2012;25(5):561–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Vaitkevicius PV, Fleg JL, Engel JH, O’Connor FC, Wright JG, Lakatta LE, et al. Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation. 1993;88(4 Pt 1):1456–62.PubMedCrossRefGoogle Scholar
  13. 13.
    Tanaka H, Dinenno FA, Monahan KD, Clevenger CM, DeSouza CA, Seals DR. Aging, habitual exercise, and dynamic arterial compliance. Circulation. 2000;102(11):1270–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Tanaka H, DeSouza CA, Seals DR. Absence of age-related increase in central arterial stiffness in physically active women. Arterioscler Thromb Vasc Biol. 1998;18(1):127–32.PubMedCrossRefGoogle Scholar
  15. 15.
    Aoyagi Y, Park H, Kakiyama T, Park S, Yoshiuchi K, Shephard RJ. Yearlong physical activity and regional stiffness of arteries in older adults: the Nakanojo Study. Eur J Appl Physiol. 2010;109(3):455–64.PubMedCrossRefGoogle Scholar
  16. 16.
    Sugawara J, Otsuki T, Tanabe T, Hayashi K, Maeda S, Matsuda M. Physical activity duration, intensity, and arterial stiffening in postmenopausal women. Am J Hypertens. 2006;19(10):1032–6.PubMedCrossRefGoogle Scholar
  17. 17.
    van de Laar RJ, Ferreira I, van Mechelen W, Prins MH, Twisk JW, Stehouwer CD. Lifetime vigorous but not light-to-moderate habitual physical activity impacts favorably on carotid stiffness in young adults: the amsterdam growth and health longitudinal study. Hypertension. 2010;55(1):33–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Boreham CA, Ferreira I, Twisk JW, Gallagher AM, Savage MJ, Murray LJ. Cardiorespiratory fitness, physical activity, and arterial stiffness: the Northern Ireland Young Hearts Project. Hypertension. 2004;44(5):721–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Knez WL, Sharman JE, Jenkins DG, Coombes JS. Central hemodynamics in ultra-endurance athletes. J Sci Med Sport. 2008;11(4):390–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Vlachopoulos C, Kardara D, Anastasakis A, Baou K, Terentes-Printzios D, Tousoulis D, et al. Arterial stiffness and wave reflections in marathon runners. Am J Hypertens. 2010;23(9):974–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Cameron JD, Dart AM. Exercise training increases total systemic arterial compliance in humans. Am J Physiol. 1994;266(2 Pt 2):H693–701.PubMedGoogle Scholar
  22. 22.
    Kingwell BA, Cameron JD, Gillies KJ, Jennings GL, Dart AM. Arterial compliance may influence baroreflex function in athletes and hypertensives. Am J Physiol. 1995;268(1 Pt 2):H411–8.PubMedGoogle Scholar
  23. 23.
    Currie KD, Thomas SG, Goodman JM. Effects of short-term endurance exercise training on vascular function in young males. Eur J Appl Physiol. 2009;107(2):211–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Kakiyama T, Sugawara J, Murakami H, Maeda S, Kuno S, Matsuda M. Effects of short-term endurance training on aortic distensibility in young males. Med Sci Sports Exerc. 2005;37(2):267–71.PubMedCrossRefGoogle Scholar
  25. 25.
    Ciolac EG, Bocchi EA, Bortolotto LA, Carvalho VO, Greve JM, Guimaraes GV. Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypertens Res. 2010;33(8):836–43.PubMedCrossRefGoogle Scholar
  26. 26.
    Maeda S, Tanabe T, Otsuki T, Sugawara J, Ajisaka R, Matsuda M. Acute exercise increases systemic arterial compliance after 6-month exercise training in older women. Hypertens Res. 2008;31(2):377–81.PubMedCrossRefGoogle Scholar
  27. 27.
    Moreau KL, Donato AJ, Seals DR, DeSouza CA, Tanaka H. Regular exercise, hormone replacement therapy and the age-related decline in carotid arterial compliance in healthy women. Cardiovasc Res. 2003;57(3):861–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Hayashi K, Sugawara J, Komine H, Maeda S, Yokoi T. Effects of aerobic exercise training on the stiffness of central and peripheral arteries in middle-aged sedentary men. Jpn J Physiol. 2005;55(4):235–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Miyaki A, Maeda S, Choi Y, Akazawa N, Tanabe Y, Ajisaka R. Habitual aerobic exercise increases plasma pentraxin 3 levels in middle-aged and elderly women. Appl Physiol Nutr Metab. 2012;37(5):907–11.PubMedCrossRefGoogle Scholar
  30. 30.
    Yoshizawa M, Maeda S, Miyaki A, Misono M, Choi Y, Shimojo N, et al. Additive beneficial effects of lactotripeptides and aerobic exercise on arterial compliance in postmenopausal women. Am J Physiol Heart Circ Physiol. 2009;297(5):H1899–903.PubMedCrossRefGoogle Scholar
  31. 31.
    Sugawara J, Akazawa N, Miyaki A, Choi Y, Tanabe Y, Imai T, et al. Effect of endurance exercise training and curcumin intake on central arterial hemodynamics in postmenopausal women: pilot study. Am J Hypertens. 2012;25(6):651–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Joyner MJ, Green DJ. Exercise protects the cardiovascular system: effects beyond traditional risk factors. J Physiol. 2009;587(Pt 23):5551–8.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Kingwell BA, Sherrard B, Jennings GL, Dart AM. Four weeks of cycle training increases basal production of nitric oxide from the forearm. Am J Physiol. 1997;272(3 Pt 2):H1070–7.PubMedGoogle Scholar
  34. 34.
    Nualnim N, Parkhurst K, Dhindsa M, Tarumi T, Vavrek J, Tanaka H. Effects of swimming training on blood pressure and vascular function in adults >50 years of age. Am J Cardiol. 2012;109(7):1005–10.PubMedCrossRefGoogle Scholar
  35. 35.
    Matsuda M, Nosaka T, Sato M, Ohshima N. Effects of physical exercise on the elasticity and elastic components of the rat aorta. Eur J Appl Physiol Occup Physiol. 1993;66(2):122–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Koutsis G, Kadi F, Vandewalle H, Lechat P, Hadjiisky P, Monod H. Effects of an endurance training programme on the passive and noradrenaline-activated compliances of rat aorta. Eur J Appl Physiol Occup Physiol. 1995;71(2–3):173–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Kingwell BA, Arnold PJ, Jennings GL, Dart AM. Spontaneous running increases aortic compliance in Wistar-Kyoto rats. Cardiovasc Res. 1997;35(1):132–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Kingwell BA, Arnold PJ, Jennings GL, Dart AM. The effects of voluntary running on cardiac mass and aortic compliance in Wistar-Kyoto and spontaneously hypertensive rats. J Hypertens. 1998;16(2):181–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Matsuda M, Nosaka T, Sato M, Iijima J, Ohshima N, Fukushima H. Effects of exercise training on biochemical and biomechanical properties of rat aorta. Angiology. 1989;40(1):51–8.PubMedCrossRefGoogle Scholar
  40. 40.
    McEniery CM, Wilkinson IB, Avolio AP. Age, hypertension and arterial function. Clin Exp Pharmacol Physiol. 2007;34(7):665–71.PubMedCrossRefGoogle Scholar
  41. 41.
    Shibata S, Levine BD. Biological aortic age derived from the arterial pressure waveform. J Appl Physiol. 2011;110(4):981–7.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Shibata S, Levine BD. Effect of exercise training on biologic vascular age in healthy seniors. Am J Physiol Heart Circ Physiol. 2012;302(6):H1340–6.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005;46(4):667–75.PubMedCrossRefGoogle Scholar
  44. 44.
    Westhoff TH, Franke N, Schmidt S, Vallbracht-Israng K, Meissner R, Yildirim H, et al. Too old to benefit from sports? The cardiovascular effects of exercise training in elderly subjects treated for isolated systolic hypertension. Kidney Blood Press Res. 2007;30(4):240–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Guimaraes GV, Ciolac EG, Carvalho VO, D’Avila VM, Bortolotto LA, Bocchi EA. Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypertens Res. 2010;33(6):627–32.PubMedCrossRefGoogle Scholar
  46. 46.
    Ferrier KE, Waddell TK, Gatzka CD, Cameron JD, Dart AM, Kingwell BA. Aerobic exercise training does not modify large-artery compliance in isolated systolic hypertension. Hypertension. 2001;38(2):222–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Seals DR, Tanaka H, Clevenger CM, Monahan KD, Reiling MJ, Hiatt WR, et al. Blood pressure reductions with exercise and sodium restriction in postmenopausal women with elevated systolic pressure: role of arterial stiffness. J Am Coll Cardiol. 2001;38(2):506–13.PubMedCrossRefGoogle Scholar
  48. 48.
    Westhoff TH, Schmidt S, Gross V, Joppke M, Zidek W, van der Giet M, et al. The cardiovascular effects of upper-limb aerobic exercise in hypertensive patients. J Hypertens. 2008;26(7):1336–42.PubMedCrossRefGoogle Scholar
  49. 49.
    Dimeo F, Pagonas N, Seibert F, Arndt R, Zidek W, Westhoff TH. Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension. 2012;60(3):653–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Zebekakis PE, Nawrot T, Thijs L, Balkestein EJ, van der Heijden-Spek J, Van Bortel LM, et al. Obesity is associated with increased arterial stiffness from adolescence until old age. J Hypertens. 2005;23(10):1839–46.PubMedCrossRefGoogle Scholar
  51. 51.
    Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41(2):459–71.PubMedCrossRefGoogle Scholar
  52. 52.
    Baynard T, Carhart Jr RL, Weinstock RS, Ploutz-Snyder LL, Kanaley JA. Short-term exercise training improves aerobic capacity with no change in arterial function in obesity. Eur J Appl Physiol. 2009;107(3):299–308.PubMedCrossRefGoogle Scholar
  53. 53.
    Miyaki A, Maeda S, Yoshizawa M, Misono M, Saito Y, Sasai H, et al. Effect of habitual aerobic exercise on body weight and arterial function in overweight and obese men. Am J Cardiol. 2009;104(6):823–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care. 2006;29(11):2518–27.PubMedCrossRefGoogle Scholar
  55. 55.
    Yokoyama H, Emoto M, Fujiwara S, Motoyama K, Morioka T, Koyama H, et al. Short-term aerobic exercise improves arterial stiffness in type 2 diabetes. Diabetes Res Clin Pract. 2004;65(2):85–93.PubMedCrossRefGoogle Scholar
  56. 56.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    Choi KM, Han KA, Ahn HJ, Hwang SY, Hong HC, Choi HY, et al. Effects of exercise on sRAGE levels and cardiometabolic risk factors in patients with type 2 diabetes: a randomized controlled trial. J Clin Endocrinol Metab. 2012;97(10):3751–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Briet M, Bozec E, Laurent S, Fassot C, London GM, Jacquot C, et al. Arterial stiffness and enlargement in mild-to-moderate chronic kidney disease. Kidney Int. 2006;69(2):350–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99(18):2434–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Mustata S, Chan C, Lai V, Miller JA. Impact of an exercise program on arterial stiffness and insulin resistance in hemodialysis patients. J Am Soc Nephrol. 2004;15(10):2713–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Toussaint ND, Polkinghorne KR, Kerr PG. Impact of intradialytic exercise on arterial compliance and B-type natriuretic peptide levels in hemodialysis patients. Hemodial Int. 2008;12(2):254–63.PubMedCrossRefGoogle Scholar
  62. 62.
    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.PubMedCrossRefGoogle Scholar
  63. 63.
    Mustata S, Groeneveld S, Davidson W, Ford G, Kiland K, Manns B. Effects of exercise training on physical impairment, arterial stiffness and health-related quality of life in patients with chronic kidney disease: a pilot study. Int Urol Nephrol. 2011;43(4):1133–41.PubMedCrossRefGoogle Scholar
  64. 64.
    Bertovic DA, Waddell TK, Gatzka CD, Cameron JD, Dart AM, Kingwell BA. Muscular strength training is associated with low arterial compliance and high pulse pressure. Hypertension. 1999;33(6):1385–91.PubMedCrossRefGoogle Scholar
  65. 65.
    Miyachi M. Effects of resistance training on arterial stiffness: a meta-analysis. Br J Sports Med. 2013;47(6):393–6.PubMedCrossRefGoogle Scholar
  66. 66.
    McCartney N. Acute responses to resistance training and safety. Med Sci Sports Exerc. 1999;31(1):31–7.PubMedCrossRefGoogle Scholar
  67. 67.
    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: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116(5):572–84.PubMedCrossRefGoogle Scholar
  68. 68.
    Okamoto T, Masuhara M, Ikuta K. Effect of low-intensity resistance training on arterial function. Eur J Appl Physiol. 2011;111(5):743–8.PubMedCrossRefGoogle Scholar
  69. 69.
    Yang SJ, Hong HC, Choi HY, Yoo HJ, Cho GJ, Hwang TG, et al. Effects of a three-month combined exercise programme on fibroblast growth factor 21 and fetuin-A levels and arterial stiffness in obese women. Clin Endocrinol (Oxf). 2011;75(4):464–9.CrossRefGoogle Scholar
  70. 70.
    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.PubMedCrossRefGoogle Scholar
  71. 71.
    Stewart KJ, Bacher AC, Turner KL, Fleg JL, Hees PS, Shapiro EP, et al. Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med. 2005;165(7):756–62.PubMedCrossRefGoogle Scholar
  72. 72.
    Spina RJ, Meyer TE, Peterson LR, Villareal DT, Rinder MR, Ehsani AA. Absence of left ventricular and arterial adaptations to exercise in octogenarians. J Appl Physiol. 2004;97(5):1654–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Metabolic and Vascular PhysiologyBaker IDI Heart and Diabetes InstituteMelbourneAustralia

Personalised recommendations