Abstract
There is an emerging body of literature relating to the effectiveness of frequent aerobic exercise as a prophylactic for age-associated dysfunction of large arteries, yet systematic evaluation and precise estimate of this effect is unknown. We conducted a systematic review and meta-analysis of controlled studies examining flow mediated dilatation (FMD) of athletic older persons and otherwise healthy sedentary counterparts to (i) compare FMD as a determinant of endothelial function between athletes and sedentary individuals and, (ii) summarize the effect of exercise training on FMD in studies of sedentary aging persons. Studies were identified from systematic search of major electronic databases from inception to January 2018. Study quality was assessed before conducting a random effects meta-analysis to calculate a pooled ES (mean difference) with 95% CI's. Thirteen studies [4 interventional (n = 125); 10 cross-sectional [including one study from the interventional analysis; (n = 485)] with age ranges from 62 to 75 years underwent quantitative pooling of data. The majority of study participants were male. Older athletes had more favorable FMD compared with sedentary controls (2.1%; CI: 1.4, 2.8%; P < 0.001). There was no significant improvement in the vascular function of sedentary cohorts following a period of exercise training (0.7%; CI: −0.675, 2.09%; P = 0.316). However, there was a significant increase in baseline diameter from pre to post intervention (0.1 mm; CI: 0.07, 0.13 mm; P < 0.001). In addition, there was no significant difference in endothelial independent vasodilation between the trained and sedentary older adults (1.57%; CI: −0.13, 3.27%; P = 0.07), or from pre to post exercise intervention (1.48%; CI: −1.34, 4.3%; P = 0.3). In conclusion, long-term aerobic exercise appears to attenuate the decline in endothelial vascular function, a benefit which is maintained during chronological aging. However, currently there is not enough evidence to suggest that exercise interventions improve vascular function in previously sedentary healthy older adults.
Highlights
Impaired vascular function as a result of aging occurs due to the coalition of environment, oxidative stress and inflammation (Donato et al, 2007; Seals et al, 2011)
NS arbitrated any disagreements in study inclusion
Fifty-five studies were excluded for the following reasons: nonreporting of scaling used in flow mediated dilatation (FMD) analysis (n = 1); occlusion of the upper arm during the FMD protocol (n = 3); no intervention group (n = 1); no sedentary group (n = 2); participants were under 60 years of age (n = 11); participants were unhealthy (n = 2); FMD was not used (n = 6); brachial artery (BA) FMD was not performed
Summary
Impaired vascular function as a result of aging occurs due to the coalition of environment, oxidative stress and inflammation (Donato et al, 2007; Seals et al, 2011). Multiple lines of evidence, including both human and pre-clinical models demonstrate that those individuals who are regularly active enjoy superior vascular function, with lower levels of systemic inflammation and oxidative stress (Eskurza et al, 2004; Lesniewski et al, 2013; Seals, 2014; Grace et al, 2015) Despite this more than 1 in 4 of all adults, (The World Health Organization, 2017) and 85–90% of older adults in developed countries fail to meet the PA guidelines to maintain cardiovascular health (Sparling et al, 2015). This represents a contemporary challenge for researchers and healthcare providers to provide evidence-based strategies to improve engagement with PA, and to improve vascular function in older adults as a primary therapeutic target (The World Health Organization, 2010)
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