Author + information
- Received August 29, 2019
- Revision received October 2, 2019
- Accepted October 22, 2019
- Published online January 6, 2020.
- Anish N. Bhuva, MBBSa,b,
- Andrew D’Silva, MBBSc@AndrewJMDSilva,
- Camilla Torlasco, MDb,d,
- Siana Jones, PhDa,
- Niromila Nadarajan, MBBSa,
- Jet Van Zalen, MScb,
- Nish Chaturvedi, PhDa,
- Guy Lloyd, MDb,
- Sanjay Sharma, MDc,
- James C. Moon, MDa,b,
- Alun D. Hughes, PhDa and
- Charlotte H. Manisty, MDa,b,∗ (, )@mrimypacemaker
- aInstitute of Cardiovascular Science, University College London, London, United Kingdom
- bDepartment of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- cCardiology Clinical & Academic Group, St George’s, University of London, London, United Kingdom
- dIstituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Lucca, Italy
- ↵∗Address for correspondence:
Dr. Charlotte H. Manisty, Department of Cardiac Imaging, Barts Heart Centre, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom.
Background Aging increases aortic stiffness, contributing to cardiovascular risk even in healthy individuals. Aortic stiffness is reduced through supervised training programs, but these are not easily generalizable.
Objectives The purpose of this study was to determine whether real-world exercise training for a first-time marathon can reverse age-related aortic stiffening.
Methods Untrained healthy individuals underwent 6 months of training for the London Marathon. Assessment pre-training and 2 weeks post-marathon included central (aortic) blood pressure and aortic stiffness using cardiovascular magnetic resonance distensibility. Biological “aortic age” was calculated from the baseline chronological age-stiffness relationship. Change in stiffness was assessed at the ascending (Ao-A) and descending aorta at the pulmonary artery bifurcation (Ao-P) and diaphragm (Ao-D). Data are mean changes (95% confidence intervals [CIs]).
Results A total of 138 first-time marathon completers (age 21 to 69 years, 49% male) were assessed, with an estimated training schedule of 6 to 13 miles/week. At baseline, a decade of chronological aging correlated with a decrease in Ao-A, Ao-P, and Ao-D distensibility by 2.3, 1.9, and 3.1 × 10−3 mm Hg−1, respectively (p < 0.05 for all). Training decreased systolic and diastolic central (aortic) blood pressure by 4 mm Hg (95% CI: 2.8 to 5.5 mm Hg) and 3 mm Hg (95% CI: 1.6 to 3.5 mm Hg). Descending aortic distensibility increased (Ao-P: 9%; p = 0.009; Ao-D: 16%; p = 0.002), while remaining unchanged in the Ao-A. These translated to a reduction in “aortic age” by 3.9 years (95% CI: 1.1 to 7.6 years) and 4.0 years (95% CI: 1.7 to 8.0 years) (Ao-P and Ao-D, respectively). Benefit was greater in older, male participants with slower running times (p < 0.05 for all).
Conclusions Training for and completing a marathon even at relatively low exercise intensity reduces central blood pressure and aortic stiffness—equivalent to a ∼4-year reduction in vascular age. Greater rejuvenation was observed in older, slower individuals.
The Marathon Study was funded by the British Heart Foundation (FS/15/27/31465), Cardiac Risk in the Young, and the Barts Cardiovascular Biomedical Research Centre. The study received support from COSMED through the provision of cardiopulmonary exercise testing equipment and technical support. Dr. Bhuva is supported by a doctoral research fellowship from the British Heart Foundation (FS/16/46/32187). Dr. D’Silva was funded by a clinical research training fellowship from the British Heart Foundation (FS/15/27/31465). Drs. Moon and Manisty are directly and indirectly supported by the University College London Hospitals, NIHR Biomedical Research Centre, and Biomedical Research Unit at Barts Hospital. Dr. Hughes has received support from the British Heart Foundation (PG/13/6/29934) and the National Institute for Health Research University College London Hospitals Biomedical Research Centre; and has worked in a unit that receives support from the UK Medical Research Council (Programme Code MC_UU_12019/1). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 29, 2019.
- Revision received October 2, 2019.
- Accepted October 22, 2019.
- 2020 American College of Cardiology Foundation
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