Edited by: Jun Sugawara, National Institute of Advanced Industrial Science and Technology, Japan
Reviewed by: Takanobu Okamoto, Nippon Sport Science University, Japan; Can Ozan Tan, Harvard Medical School, United States
*Correspondence: Anthony S. Leicht
This article was submitted to Exercise Physiology, a section of the journal Frontiers in Physiology
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Cardiovascular disease (CVD) is projected to remain the leading cause of death worldwide until 2030 with measures for early detection and progress monitoring essential to manage the condition and its associated health costs (Pereira et al.,
A recent systematic review and meta-analysis of 42 randomized, controlled trials reported that chronic aerobic training resulted in reduced cf-PWV and AIx, whereas chronic resistance and combined (aerobic + resistance) training had no effect on these measures (Ashor et al.,
While the effects of chronic exercise have been collated (Ashor et al.,
This systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Higgins and Green,
Studies were deemed eligible and included into the review if they examined all of the following criteria: (1) included apparently healthy young human adults ≤45 years; (2) investigated a single bout of aerobic and/or resistance exercise only or included a comparative intervention (e.g., no exercise); (3) included an exercise alone condition in studies with additional exposures (e.g., vascular occlusion); (4) reported pre- and post-intervention measurements or change values of cf-PWV, AIx, and/or AIx75 (aortic AIx only); and (5) described their study design. Exclusion criteria included studies that involved: (1) athletes or highly trained participants (e.g., ≥10 years of training history); (2) anaerobic exercise (e.g., Wingate) or isometric resistance exercise interventions; and (3) no pre- or post-intervention measurements. All studies were screened to ensure that participants had no pre-existing medical conditions that could affect arterial stiffness and wave reflection responses to exercise. To control for the potential influence of age, particularly older age, on these responses (Thiebaud et al.,
Using standardized terms, a search of the PubMed, Ovid MEDLINE, Cochrane Library, and SPORTDiscus databases from database inception until the search date (10-16/05/2017) was conducted. Searches were limited to studies involving “Humans” and reported in English. Keywords used in the searches were: “arterial stiffness,” “vascular stiffness,” “acute exercise,” “pulse wave velocity,” “pulse wave analysis,” “augmentation index,” “PWV,” “PWA,” “AIx,” “AIx75.” The PubMed search strategy is detailed in the Supplementary Material (Supplementary Figure
One reviewer (DP) conducted the initial searches and screening of all identified titles, abstracts, and full original articles in line with the eligibility criteria (Figure
Selection process detailing the implemented search procedure in assessing eligibility for inclusion in this systematic review and meta-analysis.
A customized form was used to extract information about study design, participant details (e.g., health status, number, age, sex, stage of menstrual cycle in females, smoking status, activity level, recruitment strategy), study aim and hypothesis, methodology (e.g., intervention details, outcome measures, data collection time points, instruments/systems used), main findings, limitations, and conclusions. Results for each study's outcome measures were then entered into Microsoft Excel with pre- and post-intervention values for each outcome measure and time point entered as mean ± standard deviation (
Methodological aspects were appraised using a modified PEDro scale. As blinding of participants or researchers to an exercise intervention was difficult, if not impossible, items 5–7 (i.e., blinding) of the original PEDro scale (Elkins et al.,
Corresponding authors were contacted where data were not clear or unavailable, and data were updated for inclusion into this review. Several studies investigating the acute effects of aerobic exercise were included in a previous review of acute aerobic exercise (Mutter et al.,
Reporting bias, including publication bias, was minimized by use of eligibility criteria, consensus of multiple reviewers, and inspection of funnel plots. Funnel plots are simple scatter plots with the studies' mean differences plotted on the x-axis and the standard error on the y-axis (Sterne and Egger,
Forest and funnel plots were generated using Review Manager Software (Review Manager [RevMan]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014), and data are presented as mean ±
A total of 45 and 41 studies met the eligibility criteria and were included into the qualitative review and meta-analysis, respectively. Figure
The total number of participants across all studies was 1,211 (889 men, 297 women, 25 not specified) with a mean sample size of 22.4 ± 17.2 (range 9–122) and participant age ranging from 18 to 45 years. Twenty-six studies included men only, no study included women only, 18 included both men and women, and sex distribution was not reported for one study (Table
Participant characteristics of included studies.
Barnes et al., |
Healthy young men (P1, |
27 | <2 days of exercise/week | ||
Boutcher et al., |
Healthy young men with no family history of hypertension (NFHT, |
40 | Both groups: moderate-intensity exercise > 30 min, 1–3 times/week for >2 years | ||
Burr et al., |
Healthy young men ( |
13 | 25 ± 6 | H: 175 ± 8 cm |
Recreationally active, not currently or previously engaged in eccentric exercise training |
Campbell et al., |
Healthy young men | 10 | 31 ± 5 | 24 ± 3 | Not participating in regular vigorous exercise |
Chandrakumar et al., |
Healthy young men | 15 | 20.2 ± 0.8 | 21.8 ± 1.4 | Not participating in aerobic exercise of >30 min duration more than 3 times/week |
Collier et al., |
Healthy young men | 10 | 24.9 ± 2.7 | H: 175.8 ± 1.48 cm |
Moderately active |
Doonan et al., |
Healthy young non-smoking ( |
53 | 23 ± 5.4 | 22.3 ± 2.2 | Not reported |
Doonan et al., |
Healthy young men (M, |
122 | Low PA (M/W): 12/13 Moderate PA (M/W): 33/26 High PA (M/W): 22/16 | ||
Fahs et al., |
Healthy young men | 17 | 24.2 ± 2.9 | 27.0 ± 4.9 | Not reported |
Figueroa and Vicil, |
Healthy young men ( |
23 | 22 ± 2 | 23 ± 2 | Physically active but not competitive athletes |
Gkaliagkousi et al., |
Healthy men ( |
15 | 39.3 ± 5.6 | 23.3 ± 2.8 | Not reported |
Hanssen et al., |
Healthy young men | 21 | 19–31 | 23 ± 1 | Not reported |
Heffernan et al., |
Healthy young men ( |
13 | 21.5 ± 2.5 | 25.7 ± 4.7 | Not reported |
Heffernan et al., |
Healthy young men | 13 | 25 ± 2.5 (21–29) | H: 174.7 ± 4.7 cm |
Moderately active |
Heffernan et al., |
Healthy young, resistance-trained (RT, |
30 | 3 days/week for 7.2 ± 3.3 years, aerobic exercise <1.5 h/week Sedentary/ recreationally active | ||
Heffernan et al., |
Healthy young men | 14 | 27.9 ± 7.5 | H: 180.6 ± 7.1 cm |
Not reported |
Heffernan et al., |
Healthy young African-American (AA, |
24 | Not reported | ||
Hu et al., |
Healthy young men ( |
15 | 26.2 ± 2.3 | 23.9 ± 3.5 | Sedentary/moderately active |
Hull et al., |
Healthy young men ( |
25 | 29.3 ± 5.8 | 23.1 ± 1.8 | Sedentary/recreationally active |
Kingsley et al., |
Healthy young men ( |
16 | 23 ± 3 | H: 1.74 ± 0.11 m |
Resistance training ≥3 days/week for ≥2 years |
Kingwell et al., |
Healthy young men | 12 | 24 ± 6 | 22.9 ± 3.1 | Sedentary |
Kobayashi et al., |
Healthy young men | 11 | 23.4 ± 1.9 | 21.5 ± 1.7 | Sedentary (≥2 years without regular exercise) |
Lane et al., |
Healthy young men (M, |
62 | Sedentary (>6 months no structured exercise activity of any kind lasting longer than 30 min more than once/week) | ||
Lefferts et al., |
Healthy young men | 12 | 22 ± 3 | 24.6 ± 2.8 | Physically active |
Lin et al., |
Healthy young men | 11 | 24 ± 4.9 | 23 ± 4.8 | Sedentary or recreationally active but not participating in any type of resistance or endurance training |
Lydakis et al., |
Healthy young men ( |
15 | 26.6 ± 3.6 | 24.3 ± 3.1 | Not reported |
Mak and Lai, |
Healthy young men | 18 | 21 ± 1 (20–24) | H: 169 ± 6 cm |
Not reported |
Melo et al., |
Healthy young men ( |
45 | 25.22 ± 6 (18–36) | BF: 21.62 ± 6.5% (BMI/Weight not reported) | Non-athletes |
Milatz et al., |
Healthy men | 32 | 33.7 ± 8 | 24.0 ± 2 | Recreationally active (moderate aerobic activity ≥2 times/week for 60 min) |
Moore et al., |
Healthy young men | 34 | 21.53 ± 3 | 22.68 ± 1.6 | Resistance training ≥3 times/week lasting at least 45 min/session |
Munir et al., |
Healthy young adults (male or female not reported) | 25 | 19–33 | Physical characteristics not reported | Recreationally active |
Perdomo et al., |
Healthy young men (M, |
30 | Not reported | ||
Peres et al., |
Healthy young men ( |
18 | 20 ± 5 | 21.28 ± 2.63 | Sedentary |
Ranadive et al., |
Healthy young men ( |
15 | 25 ± 5 (18–45) | 22.9 ± 3.4 | Not reported |
Ribeiro et al., |
Healthy young men | 14 | 31.0 ± 3.7 | 26.6 ± 3.4 | Non-athletes |
Sharman et al., |
Healthy young men | 12 | 29 ± 3.5 | 23.8 ± 3.1 | Not reported |
Siasos et al., |
Healthy young men | 20 | 22.6 ± 3.3 | Not reported | Not reported |
Siasos et al., |
Healthy young men | 20 | 22.6 ± 3.3 | 22.03 ± 1.6 | Not reported |
Sugawara et al., |
Healthy young men | 23 | 22 ± 4 | 21.9 ± 1.8 | Not reported |
Sun et al., |
Healthy Caucasian (CA) men and women ( |
62 | Sedentary | ||
Tai et al., |
Healthy young men ( |
15 | 23 ± 3 (18–28) | H: 1.74 ± 0.11 m |
Resistance training ≥ 3 days/week for ≥ 2 years |
Thiebaud et al., |
Healthy young men (YG, |
12 | Recreationally active | ||
Yan et al., |
Healthy young African-American men (AAM, |
100 | Not reported | ||
Yan et al., |
Healthy young African-American men ( |
49 | Most recreationally active | ||
Yoon et al., |
Healthy young men | 13 | 20.8 ± 2.2 (20–29) | 23.4 ± 1.9 | Resistance exercise ~3 times/week |
The study designs were variable and included 17 cross-over studies (Kingwell et al.,
Summary of studies that examined carotid-femoral pulse wave velocity and/or augmentation indices post aerobic exercise intervention.
Boutcher et al., |
Healthy young men with no family history of HT ( |
Cycling Ergometer | 20 min | 60% VO2max | Rest & 30 min post; SphygmoCor/AT | 9 | |
Burr et al., |
Healthy young men ( |
Treadmill running | 40 min, 5 min active recovery | 12% decline, 60% VO2max | Rest & 10 min, 6, 24, 48, and 72 h post; SphygmoCor/AT | 9 | |
Campbell et al., |
Healthy young men ( |
Cycling Ergometer | To volitional exhaustion after 3 min warm-up | Warm-up at 60 W at 60 rpm, then increasing by 30 W min−1 | Rest & 0–5 min, 6–10 min and 11–15 min post; SphygmoCor/AT | 10 | |
Chandrakumar et al., |
Healthy young overweight (OW, |
Cycling Ergometer | 30 min | 65% VO2max at 60–80 rpm | 8 | ||
Collier et al., |
Healthy young men ( |
Cycling Ergometer | 30 min | 65% VO2peak | Rest & 40 min and 60 min post;Doppler probes, ECG, BioPac MP100 | 10 | |
Doonan et al., |
Healthy young non-smoking men ( |
Treadmill running | To volitional exhaustion | Bruce protocol | Rest & 2, 5, 10, and 15 min post; SphygmoCor/AT | 9 | |
Doonan et al., |
Healthy young men ( |
Treadmill running | To volitional exhaustion | Bruce protocol | Rest & 2, 5, 10 and 15 min post; SphygmoCor/AT | 8 | |
Gkaliagkousi et al., |
Healthy men ( |
Treadmill running | To volitional exhaustion | Bruce protocol | Rest & 10, 30 and 60 min post; SphygmoCor/AT | 9 | |
Hanssen et al., |
Healthy young men ( |
Treadmill running | Rest & 5, 20, 35, and 50 min post, every 2 h for 24 h post; SphygmoCor/AT (rest- and post- measurements) Mobil-O-Graph (24 h ambulatory monitoring) | 10 | |||
Heffernan et al., |
Healthy young men ( |
Cycling Ergometer | 30 min | 65% VO2peak | Rest & 20 min post; Doppler probes, ECG, BioPac MP100 | 9 | |
Heffernan et al., |
Healthy young resistance-trained (RT, |
Cycling Ergometer | To volitional exhaustion | First workload at 50 W, then increased by 30 W every 2 min | Rest & 10, 20, and 30 min post; SphygmoCor/AT | 9 | |
Heffernan et al., |
Healthy young African-American (AA, |
Cycling Ergometer | To volitional exhaustion | First workload 50 W, then increased by 30 W every 2 min | Rest & 15 and 30 min post; SphygmoCor/AT | 7 | |
Hu et al., |
Healthy young men ( |
Cycling Ergometer | To volitional exhaustion | First workload 50 W, then increased by 30 W every 2 min | Rest & 3 min post; SphygmoCor/AT | 8 | |
Hull et al., |
Healthy young men ( |
Cycling Ergometer | 10 min | 60% of age-predicted HRmax (50–60 rpm) | Rest & 0 min post; SphygmoCor/AT | 8 | |
Kingwell et al., |
Healthy young men ( |
Cycling Ergometer | 30 min | 65% VO2max | Rest & 30 and 60 min post; Custom-built software/AT | 9 | |
Kobayashi et al., |
Healthy young men ( |
Cycling Ergometer | 15, 30, and 45 min | 65% VO2peak | Rest & 30, 60, and 90 min post; Calculation/AT | 9 | |
Lane et al., |
Healthy young men ( |
Cycling Ergometer | To volitional exhaustion | First workload at 50 W, then increased by 30 W every 2 min | Rest & 15 and 30 min post; SphygmoCor/AT | 8 | |
Lefferts et al., |
Healthy young men ( |
Treadmill walking | 3 × 20 min bouts with 20 min rest between bouts (100 min total) | 5% incline, ≈ 40% VO2max (75–80% HRmax) | Rest & 15–30 min post; SphygmoCor/AT | 9 | |
Lin et al., |
Healthy young men ( |
Treadmill running | 30 min | 10% decline, 75% VO2peak | Rest & 90 min, 24, 48 and 72 h post; Millar Inc-Biopac/AT | 10 | |
Melo et al., |
Healthy young men ( |
Treadmill running | To volitional exhaustion | Started at self-selected pace, then increments of 1 mph every 2 min for 4 min followed by 2.5% increase in grade every min | Rest & 10 min post; Complior/AT | 7 | |
Milatz et al., |
Healthy men ( |
Cycling Ergometer | 60 min | 45% VO2max | Rest & 1, 15, 30, 45, and 60 min post; Mobil-O-Graph | 8 | |
Moore et al., |
Healthy overweight (OW, |
Treadmill running | To volitional exhaustion | 3-min progressive speed and grade stages | Rest & 2, 5, 10, 20, 30, 45, and 60 min post; SphygmoCor/AT | 8 | |
Munir et al., |
Healthy young adults ( |
Cycling Ergometer | 12 min or to volitional exhaustion | Start at 25 W, increased by 25 W in 2 min intervals to a max. of 150 W | Rest & 1–3, 15, 30 and 60 min post; SphygmoCor/AT | 5 | |
Perdomo et al., |
Healthy young men ( |
Treadmill running | 30 min | 70–75% of age-predicted HRmax | Rest & 24 h post; Complior Analyse/piezoelectric sensors | 8 | |
Peres et al., |
Healthy young men ( |
Cycling Ergometer | 14 min or signs and symptoms of dyspnea, exhaustion, fatigue, myocardial ischemia or BP ≥160/100 | Load increase every 2 min (60 rpm) | Rest & 0 min post; Complior/AT | 8 | |
Ranadive et al., |
Healthy young men ( |
Arm vs. leg cycling Ergometer | To volitional exhaustion | Leg: Start at 50 W, then 30 W increase every 2 min Arm: Start at 15 W and 15 W increases every 2 min | Rest & 10 min post; SphygmoCor/AT | 9 | |
Ribeiro et al., |
Healthy young men ( |
Treadmill walking | 10 min | 5 km h−1 | Rest & 0 min post; SphygmoCor SCOR-PX/AT | 9 | |
Sharman et al., |
Healthy young men ( |
Cycling Ergometer | To reach 10-min period at steady-state HR | 60% HRmax | Rest & 2 and 10 min post; SphygmoCor version 7.01/AT | 12 | |
Siasos et al., |
Healthy young men ( |
Cycling Ergometer | Rest & 10 min post; SphygmoCor/AT | 7 | |||
Siasos et al., |
Healthy young men ( |
Cycling Ergometer | Rest & 10 min post; SphygmoCor/AT | 8 | |||
Sugawara et al., |
Healthy young men ( |
Cycling Ergometer | 50 min | Warm-up: 65% HRR, thereafter 65–75% HRR | Rest & 20 and 50 min post; Omron-Colin/AT | 7 | |
Sun et al., |
Healthy Caucasian men and women ( |
Treadmill running | 45 min | 70% HRR | Rest & 30 and 60 min post; SphygmoCor/AT | 6 | |
Yan et al., |
Healthy young African-American men (AAM, |
Cycling Ergometer | To volitional exhaustion | First workload 50 W, then increased by 30 W every 2 min | Rest & 15 and 30 min post; SphygmoCor/AT | 7 | |
Yan et al., |
Healthy young AAM and AAW ( |
Treadmill running | 45 min | 70% HRR | Rest & 30, 60, and 90 min post; SphygmoCor/AT | 11 |
Summary of studies that examined carotid-femoral pulse wave velocity and/or augmentation indices post resistance exercise intervention.
Barnes et al., |
Healthy young men (P1, |
Rest & 90 min, 24 48 and 72 h post; Omron-Colin VP2000/AT | 8 | ||||
Collier et al., |
Healthy young men ( |
Bench press, bent-over row, leg extension, leg curl, shoulder press, biceps curl, triceps bench press, abdominal crunch | 3 × 10 reps of each exercise, 90 s rest between sets | 100% of 10-RM | Rest & 40 and 60 min post; Doppler probes, ECG, BioPac MP100 | 10 | |
Fahs et al., |
Healthy young men ( |
Bench press, biceps curl | 10 reps of bench press warm-up |
50% of 1-RM for warm-up |
Rest & within 15 min post; SphygmoCor/AT | 12 | |
Figueroa and Vicil, |
Healthy young men ( |
Bilateral leg extension, leg curl without vascular occlusion | 3 × 10 reps of each bilateral leg extension and leg curl | 40% of 1-RM | Rest & 0–2 min and 30 min post; SphygmoCor/AT | 9 | |
Heffernan et al., |
Healthy young men ( |
Unilateral leg press (dominant limb) | 6 sets to volitional fatigue | 85% of 1-RM | Rest & 5 and 25 min post; SphygmoCor/AT | 8 | |
Heffernan et al., |
Healthy young men ( |
Bench press, bent-over row, leg extension, leg curl, shoulder press, biceps curl, triceps bench press, abdominal crunch | 3 × 10 reps of each exercise, 90 s rest between sets | 100% of 10-RM | Rest & 20 min post; Doppler probes, ECG, BioPac MP100 | 9 | |
Heffernan et al., |
Healthy young men ( |
Unilateral leg press and leg extension | 15 × 10 reps with alternating legs 70 s rest between sets | 75% of 1-RM | Rest & 20 min post; SphygmoCor/AT | 9 | |
Kingsley et al., |
Healthy young men ( |
Squat, bench press, and deadlift | 3 × 10 reps of each exercise 2 min rest between sets | 75% of 1-RM, | Rest & 10 min post; SphygmoCor/AT | 10 | |
Lydakis et al., |
Healthy young men ( |
Unilateral knee extension | To volitional fatigue | Resistance increase by 10 W (men) and 5W (women) every 2 min | Rest & 0 min post; SphygmoCor/AT | 7 | |
Mak and Lai, |
Healthy young men ( |
Unilateral biceps curl without VM | 10 × 10 reps 90 s between sets | 75% of 1-RM | Rest & 0 and 15 min post; Esaote MyLabSat Ultrasound system | 8 | |
Tai et al., |
Healthy young men ( |
Squat, bench press and deadlift | 3 × 10 reps of each exercise 2 min rest between sets | 75% of 1-RM, | Rest & 10–20 min post; SphygmoCor/AT | 12 | |
Thiebaud et al., |
Healthy young men (YG, |
Leg press, chest press, knee flexion, lat pull down, knee extension | 3 × 10 reps 2–3 min rest between sets and 2 min rest between exercises | 65% of 1-RM | Rest & 5 min post; SphygmoCor/AT | 11 | |
Yoon et al., |
Healthy young men ( |
Bench press, squat, lat pull down, biceps curl, leg extension, leg curl, upright row, triceps extension | 2 × 15 reps | 60% of 1-RM | Rest & 20 and 40 min post; SphygmoCor/AT | 9 |
Summary of studies that examined carotid-femoral pulse wave velocity and/or augmentation indices post control (seated rest) intervention.
Barnes et al., |
Heathy young men ( |
Quiet, seated rest | 25 min | Rest & 90 min, 24, 48 and 72 h post; Colin VP2000/AT | 8 | |
Figueroa and Vicil, |
Healthy young men ( |
Seated rest | not reported | Rest & 0–2 min and 30 min post; SphygmoCor/AT | 9 | |
Kingsley et al., |
Healthy young men ( |
Supine rest | 30 min | Rest & 10 min post; SphygmoCor/AT | 10 | |
Kingwell et al., |
Healthy young men ( |
Armchair reading | 30 min | Rest & 30 and 60 min post; Custom-built software/AT | 9 | |
Lin et al., |
Healthy young men ( |
Seated rest | Not reported | Rest & 90 min, 24, 48 and 72 h post; Millar Inc-Biopac/AT | 10 | |
Tai et al., |
Healthy young men ( |
Supine rest | 30 min | Rest & 10–20 min post; SphygmoCor/AT | 12 | |
Thiebaud et al., |
Healthy young men (YG, |
Seated rest | ~ 20 min (+20 min waiting period) | Rest & 10 min post waiting period; SphygmoCor/AT | 11 | |
Yoon et al., |
Healthy young men ( |
Seated rest | Not reported | Rest & 20 and 40 min post; SphygmoCor/AT | 9 |
Exercise intensity was expressed in relative (i.e., a percentage of maximum heart rate) or absolute (i.e., Watt or km h−1) terms, and duration was either limited by time (10–60 min) or participant fatigue. Resistance exercise was executed using lower body only (four studies), upper body only (two studies), or whole-body exercise (seven studies) with varying repetitions (5 to fatigue), sets (1–15), intensities (10–110% of one repetition maximum) and rest periods (70 s to 4 min).
Outcome measures were assessed as follows: cf-PWV only in 23 studies (18 aerobic, 7 resistance, 2 assessed both exercise modes), AIx only in 4 studies (2 aerobic, 2 resistance), AIx75 only in 2 studies (2 aerobic), cf-PWV, and AIx/AIx75 in 9 studies (8 aerobic, 1 resistance), AIx and AIx75 in 3 studies (2 aerobic, 1 resistance), and cf-PWV, AIx, and AIx75 in 4 studies (2 aerobic, 2 resistance). In summary, 29 studies (64.4%) reported only one, 12 studies (26.7%) reported two and 4 studies (8.9%) reported three outcome measures.
The timing of outcome measures varied amongst studies from 0 min to 72 h; however, most (93.3%) examined variables at 0–30 min (91.2% of aerobic, 84.6% of resistance, 75% of the control group) of the post-intervention period. Time points for studies included in the meta-analysis varied from 0 to 60 min for aerobic studies and from 0 to 40 min for resistance studies. There was a weak, but significant, negative correlation (
Mean score for methodological quality was 8.6 ± 1.4 (range 5–12) out of a possible maximum score of 13. The main reasons for poor scoring were: (a) lack of randomization of participants to interventions (26 studies, 57.8%) largely due to study design (i.e., pre-post intervention studies with only one intervention; (b) lack of control group (37 studies, 82.2%); and (c) no reporting of dropout/participation rates (24 studies, 53.3%). All but five studies (Kingwell et al.,
No significant change in cf-PWV was identified following aerobic exercise, and we found significant heterogeneity within this comparison (Figure
Forest plots showing the effect of acute aerobic and resistance exercise on cf-PWV. HW, healthy weight; 30-minEX, 30-min exercise duration; NRT, non-resistance trained; 45-minEX, 45-min exercise duration; AA, African American; CAM, Caucasian men; M, men; CA, Caucasian; CAE, continuous aerobic exercise; 15-minEX, 15-min exercise duration; NHS, no heat stress; HIAE, high-intensity aerobic exercise; Leg, leg ergometry; OW, overweight; CAW, Caucasian women; W, women; WH, white; NS, non-smokers; CH, Chinese; AAW, African American women; Arm, arm ergometry; RT, resistance trained; AAM, African-American men; NVM, no Valsalva maneuvre; YG, young group.
Forest plots showing the effect of seated rest on cf-PWV, AIx, and AIx75. YG, young group.
A significant reduction in AIx was identified following aerobic exercise, and we found significant heterogeneity within this comparison (Figure
Forest plots showing the effect of acute aerobic and resistance exercise on AIx. W, women; CAW, Caucasian women; AAW, African American women; M, men; AAM, African American men; CAM, Caucasian men; NRT, non-resistance trained; HIIT, high-intensity interval training; RT- resistance trained; NFHT, no family history of hypertension; FHT, family history of hypertension; MCT, moderate continuous training; OW, overweight; HW, healthy weight; NVO, no vascular occlusion.
A significant increase in AIx75 was identified following both aerobic and resistance exercise, and we found significant heterogeneity within each comparison (Figure
Forest plots showing the effect of acute aerobic and resistance exercise on AIx75. CAE, continuous aerobic exercise; CAW, Caucasian women; AAW, African American women; HIAE, high-intensity aerobic exercise; AAM, African American men; MCT, moderate continuous training; NRT, non-resistance trained; CAM, Caucasian men; HIIT, high-intensity interval training; RT, resistance trained; W, women; M, men; NS, non-smokers; YG, young group.
The current systematic review and meta-analysis demonstrated that, overall, distinct arterial stiffness recovery responses existed following a single bout of aerobic and resistance exercise with the differences possibly originating from unique cardiovascular (i.e., blood pressure, heart rate) and non-cardiovascular (i.e., inflammatory products) processes. Additionally, the results from the present review and meta-analysis demonstrate the limitations of current research designs that can assist in improving the experimental approach of future studies.
Unlike the mean difference following resistance exercise, mean difference for cf-PWV following aerobic exercise in the present meta-analysis was not significant overall, which suggested an inability for aerobic exercise to significantly alter arterial stiffness responses. Although the exact mechanisms regulating modal differences in cf-PWV have not been identified, several mechanisms have been implicated in previous studies (Yoon et al.,
While blood pressure increases during both acute aerobic and resistance exercise, the magnitude and nature of this increase differs between modes (MacDougall et al.,
Reduced left ventricular ejection time, as seen with tachycardia during and following acute exercise, has also been implicated as an independent predictor of cf-PWV with Salvi et al. (
Compared to more concentrically-biased aerobic activities (e.g., cycling), substantially elevated inflammation (Barnes et al.,
Previously, increased cf-PWV was reported for both healthy young men and women at 2-min following a treadmill protocol to volitional exhaustion (Doonan et al.,
While attention to the exercise bout itself should be considered, factors such as diversity of measuring techniques and participants may also be crucial to the current cf-PWV findings. Different assessment techniques, including automated devices, applanation tonometry/calculation, and direct/subtraction methods, have been utilized with variable findings after aerobic exercise. Further, several studies (Lydakis et al.,
In summary, acute resistance exercise induces adverse effects on cf-PWV due to cardiovascular and/or non-cardiovascular mechanisms. In contrast, acute aerobic exercise effects were minimal due to these cardiovascular and/or non-cardiovascular mechanisms with findings also potentially influenced by exercise protocols (e.g., muscle groups exercised), timing of measurement, duration and intensity of exercise, measuring techniques, and/or participants that remain to be elucidated.
Overall, the mean difference for AIx was large and negative following aerobic exercise, representing a substantial reduction in wave reflection, whereas it was small following resistance exercise, indicating no acute change. Results from studies investigating acute aerobic exercise were largely homogenous with most studies reporting decreased AIx. Previously, aerobic exercise was reported to promote nitric oxide-induced vasodilation via increased blood flow and shear stress, resulting in reduced wave reflection (Munir et al.,
The current review extensively evaluated the acute influence of exercise mode on indices of arterial stiffness and wave reflection, including AIx75, which has rarely been examined in terms of exercise mode. Based upon the meta-analysis, AIx75 was overall significantly increased following both acute aerobic and resistance exercise with the mean difference following resistance exercise nearly five times that following aerobic exercise (15.02 vs. 3.54%). This considerably greater and non-heart rate mediated (i.e., cf-PWV, left ventricular ejection time, and peripheral vasomotor tone) response following resistance exercise further exemplified the modal differences in arterial stiffness and wave reflection responses. Additionally, these results indicated that AIx75 may be a more useful measure of left ventricular afterload, compared to AIx, when comparing exercise responses in future studies.
The meta-analysis reported here combined data from many studies to estimate acute intervention effects on arterial stiffness and wave reflection with more precision than possible in a single study. The main limitation of this approach was the heterogeneity amongst studies in terms of participants, exercise protocols (i.e., exercise mode, duration and intensity), and outcome assessment (e.g., timing of measurement). The modified PEDro scale and risk of bias assessment using the Cochrane tool identified several possible sources for risk of bias within the studies. For example, lack of random sequence generation in 57.8% of all studies (item 2 on PEDro scale), largely due to study design (i.e., pre-post intervention design without control intervention) and lack of allocation concealment (item 3), may have caused an unclear risk of selection bias. Similarly, the nature of the interventions, that is aerobic, resistance or no exercise, made blinding of participants and outcome assessors impossible, which may have led to performance or detection bias. However, participants were likely unaware of the expected outcome associated with their individual intervention or the mechanisms affecting these outcomes; therefore, attempts at manipulating outcomes were unlikely. Assessors may have been aware of expected outcomes with each intervention, but automated measurement techniques of cf-PWV and wave reflection likely minimized the possibility of detection bias. A lack of reporting of dropout/participation rates (item 12) in more than 50% of studies raised the issue of attrition bias. However, no trend between any components of bias and mean difference was identified.
During this review, several common, methodological concerns were also noted. Firstly, very few studies employed a specific exercise protocol recommended for improving health of the general population (Garber et al.,
Like most reviews, several limitations need to be acknowledged. The current systematic review and meta-analysis was based upon studies reported in English. The use of English search terms may have led to omission of studies reported in other languages. To minimize the risk of English-language bias, several databases, including The Cochrane Controlled Trials Register that has been reported as the best single source of trials for inclusion in systematic reviews and meta-analyses (Egger et al.,
Increased central arterial stiffness (i.e., cf-PWV) and wave reflection measures (i.e., AIx/AIx75) following acute resistance exercise were observed for healthy adults in the present meta-analysis. This transient increase may not be cause for concern in a young, healthy population group with low baseline levels of central arterial stiffness, as the observed, average 0.46 ms−1 increase in cf-PWV was well below the 1 ms−1 increase associated with a 15% increase in CVD risk (Vlachopoulos et al.,
In conclusion, distinct arterial stiffness recovery responses were identified following a single acute bout of aerobic and resistance exercise. Overall, acute aerobic exercise did not change cf-PWV but resulted in reduced AIx and increased AIx75. In contrast, acute resistance was likely to induce an adversarial effect on arterial stiffness with overall increases in both cf-PWV and AIx75, potentially arising from cardiovascular and non-cardiovascular factors. Common limitations of current research designs, including great diversity in exercise protocols, selective timing of measurements, and lack of control group should be addressed in future studies to facilitate interpretation and improve generalizability of arterial stiffness findings to cardiovascular health.
All authors contributed ideas to the design of this study and developed the search strategy. DP conducted the literature search and the study quality assessment. All authors decided on the final selection of studies to be included in this review and meta-analysis. DP extracted study information and outcome data. KD performed the statistical analyses. DP developed the first paper draft, and all authors revised the manuscript for important intellectual content and approved the final version of the article.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The Supplementary Material for this article can be found online at:
The PubMed search strategy employed in the current review.
Funnel plot analyses for studies investigating cf-PWV
Risk of Bias summary.
Augmentation index
Augmentation index corrected for heart rate of 75 beats per minute
Carotid-femoral pulse wave velocity
Cardiovascular disease
Standard deviation.