Original Article
Habitual Exercise and Blood Pressure: Age Dependency and
Underlying Mechanisms
Barry J. McDonnell1, Kaisa M. Maki-Petaja2, Margaret Munnery3, Yasmin2, Ian B. Wilkinson2,
John R. Cockcroft3, and Carmel M. McEniery2
Background
Regular exercise is associated with a reduction in cardiovascular risk,
but the precise mechanisms responsible are unknown. The aim of the
current study was to examine the relationship between regular exer-
cise, aortic stiffness, and wave reflections, and to determine whether
this relationship differs by age.
METHODS
Younger (<30 years) and older (>50 years) individuals, who were either sed-
entary or undertook regular aerobic exercise, were drawn from the Anglo-
Cardiff Collaborative Trial population. This yielded 1,036 individuals, all
of whom were nonsmokers, and were free of cardiovascular disease and
medication. All individuals undertook a detailed lifestyle and medical his-
tory questionnaire including details of physical activity. Brachial and central
blood pressure, together with aortic stiffness, wave reflections, cardiac
output, and peripheral vascular resistance were assessed in all individuals.
RESULTS
In younger individuals, regular exercise was associated with lower
diastolic blood pressure but elevated pulse pressure. In contrast, both
Lack of physical activity is an independent risk factor for
cardiovascular disease (CVD)1 and increased physical
activity and physical fitness are associated with a decreased
incidence of coronary artery disease (CAD) events.2–3 The
mechanisms whereby exercise reduces cardiovascular (CV)
risk are unclear but may involve an improvement in tra-
ditional cardiovascular risk factors such as hypertension,
hyperglycemia, and hypercholesterolemia.4 However, recent
evidence suggests that the cardiovascular protective effect is
still evident after adjusting for such factors.5
Although the importance of blood pressure in CV risk
prediction is firmly established,6 recently, aortic stiffness
and wave reflections have emerged as important, independ-
ent risk factors for CV events.7–10 Moreover, increased aortic
stiffness may underlie the development of hypertension.11
While the relationship between exercise and indices such as
pulse wave velocity (PWV) and augmentation index (AIx)
Correspondence: Barry J. McDonnell (bmcdonnell@cardiffmet.ac.uk).
Initially submitted June 19, 2012; date of first revision September 25,
2012; accepted for publication October 14, 2012.
334  American Journal of Hypertension  26(3)  March 2013
systolic and pulse pressure were lower in older active individuals, com-
pared with their sedentary counterparts. Moreover, regular exercise
was associated with lower wave reflections and peripheral vascular
Downloaded from https://academic.oup.com/ajh/article/26/3/334/190703 by guest on 31 October 2022
resistance in younger individuals, but lower large artery stiffness in
older individuals.
Conclusions
These data suggest that regular exercise is associated with a benefi-
cial vascular profile. However, this differs between younger and older
individuals such that the smaller preresistance and resistance vessels
are involved in younger individuals whereas the large elastic arteries
are involved in older individuals. Despite these differential findings, the
current data provide support for strategies that increase habitual physi-
cal activity levels in the general population.
Keywords: age; blood pressure; hypertension; large artery stiffness;
exercise.
doi:10.1093/ajh/hps055
have been investigated previously,12–21 the results have been
conflicting, owing to differences between populations, type
of exercise, and variations in methods used to assess arterial
stiffness. Moreover, chronic exercise tends to decrease blood
pressure,22 making it difficult to assess whether any observed
changes in arterial stiffness are independent of reductions in
blood pressure. Furthermore, indices such as AIx and aor-
tic PWV (aPWV) are differentially affected by aging,23 and
whether aging influences the relationship between regular
exercise and arterial properties is unclear.
The aim of the current study was to examine the relation-
ship between regular exercise, aortic stiffness, and wave
reflections, in a large group of healthy individuals across a
wide age range. Specifically, we wished to determine whether
the relationship between regular exercise and cardiovas-
cular hemodynamics differs between younger and older
individuals.
1Cardiff School of Health Sciences, Cardiff Metropolitan University,
Cardiff, UK; 2Clinical Pharmacology Unit, University of Cambridge,
Addenbrooke’s Hospital, Cambridge, UK; 3Department of Cardiology,
Wales Heart Research Institute, Cardiff University, Cardiff, UK.
© American Journal of Hypertension, Ltd 2013. All rights reserved.
For Permissions, please email: journals.permissions@oup.com

METHODS
Study population
Participants were drawn from the ACCT study popu-
lation, which consists of more than 12,000 individuals,
selected at random from local General Practice lists and
open-access Cardiovascular Risk Assessment Clinics, across
East Anglia and Wales. To examine the influence of age, we
elected to study two groups of individuals: those <30 years
(younger) and those >50 years (older). Within each group,
comparisons were made between sedentary and active indi-
viduals, who were matched for age using frequency match-
ing. This approach yielded 1,036 healthy nonsmokers, who
were free from cardiovascular disease and medication, and
who had undertaken a detailed lifestyle and medical history
questionnaire that included questions concerning physical
activity (see below). Ethical approval was obtained from the
local research ethics committees and written informed con-
sent provided by all participants.
Protocol
Height and weight were assessed and a medical history
questionnaire, including details of medication and physi-
cal activity completed. Following 15 minutes of supine rest,
brachial blood pressure (BP) and radial artery waveforms
were recorded, and aPWV was determined. Ten milliliters
of blood were then drawn from the antecubital fossa into
plain tubes. The samples were centrifuged at 4°C, and the
serum separated and stored at –80°C for subsequent analy-
sis. Cholesterol, triglycerides, and glucose were determined
using standard methodology in an accredited laboratory.
Assessment of physical activity
The International Physical Activity Questionnaire
(October 2002)  was used to assess each individual’s physi-
cal activity levels over the previous 12  months. Based on
the questionnaire data, those individuals who did not par-
ticipate in any structured physical activity throughout their
average week were deemed sedentary. The active group
consisted of subjects who reported that they participated in
moderate to high-intensity aerobic exercise (e.g., running,
cycling, swimming), ≥3 times per week and for at least 1
hour duration (American College of Sports Medicine guide-
lines, 1998). To ensure a clear separation of the groups in
terms of the amount of physical activity undertaken, indi-
viduals who undertook regular resistance training and/or
low-intensity physical activity were excluded from the analy-
ses. Individuals who took part in a mixture of resistance and
aerobic physical activity were also excluded.
Hemodynamic measurements
Brachial blood pressure was measured with the subject
resting supine, using a validated semiautomated oscillomet-
ric device24 (HEM-705CP, Omron Corporation), according
to British Hypertension Society guidelines. All measurements
were taken in duplicate and mean values used in the subse-
quent analyses. Pulse wave analysis was performed using the
Exercise, Aging, and Arterial Function
SphygmoCor system (SphygmoCor, Atcor Medical, Sydney,
Australia) as previously described.25 This method allows non-
invasive generation of a central (ascending aortic) waveform
from that recorded at the radial artery, using a validated gen-
eralized transfer function.26 Using the integral software, aug-
mentation pressure was calculated as the difference between
the second and first systolic peaks, and AIx (a measure of
wave reflection) as the augmentation pressure expressed as
a percentage of the pulse pressure. Nonaugmented systolic
pressure was identified as the first systolic peak. Heart rate
was determined from the aortic waveform and mean arterial
pressure (MAP) was obtained by integration of the waveform.
Aortic PWV was measured using the same device by sequen-
tially recording electrocardiography-gated carotid and femo-
ral artery waveforms, as previously described in detail.27 Path
Downloaded from https://academic.oup.com/ajh/article/26/3/334/190703 by guest on 31 October 2022
length for the determination of aPWV was measured as the
surface distance between the suprasternal notch and femoral
site minus the distance between the suprasternal notch and
carotid site, using a tape measure.
Cardiac output and stroke volume were assessed with the
subject resting supine, using a validated,28 noninvasive, inert gas
rebreathing technique. In brief, while resting, subjects continu-
ously rebreathed a gas mixture (1% SF6, 5% N20, and 94% O2)
over 20 seconds, with a breathing rate of 15 breaths per minute.
Expired gases were sampled continuously and analyzed by an
infrared photoacoustic gas analyzer (InnoCor, Innovision A/S,
Denmark), for the determination of cardiac output and stroke
volume. Peripheral vascular resistance (PVR) was calculated
using the equation [PVR = (80 * MAP)/CO].
Statistical analysis
All data were analyzed using SPSS (version 17.0) software
for windows. Unpaired 2 tailed t tests were used to deter-
mine differences between groups. Unless otherwise stated,
results are expressed as mean (SD). A P value of <0.05 was
used to determine significance.
RESULTS
Younger and older participants were stratified according
to their level of habitual physical activity. This yielded a total
of 487 young (194 sedentary and 293 active) and 549 older
(320 sedentary and 229 active) participants in whom com-
plete data were available for the current analyses. The data
presented here are for males and females, since separate anal-
yses based on gender showed the same trends throughout.
Anthropometric characteristics
Anthropometric characteristics for the two groups are
presented in Table 1. The sedentary vs. active subjects within
each group were matched for age. In younger individuals,
there were no differences in weight, body mass index (BMI),
or waist circumference between active and sedentary indi-
viduals. However, in older individuals, regular exercise was
associated with significantly lower body weight, BMI, and
waist circumference. A  comparison of younger and older
subjects within the sedentary and active groups revealed that
although body weight, BMI, and waist circumference were
American Journal of Hypertension  26(3)  March 2013  335
McDonnell et al.

Table 1.  Anthropometric characteristics in sedentary and active younger and older individuals

<30 years >50 years

Parameter Sedentary (n = 194) Active (n = 293) P value Sedentary (n = 320) Active (n = 229) P value

Age (years) 21 ± 5 21 ± 3 NS 63 ± 7 63 ± 6 NS

Gender (% male) 46 53 0.01 39 49 0.02
Height (m) 1.71 ± 0.1 1.74 ± 0.1 <0.001 1.66 ± 0.1 1.68 ± 0.1 0.03
Weight (kg) 69 ± 16 70 ± 12 NS 80 ± 15 72 ± 14 <0.001
BMI (kg/m2) 23.5 ± 4.5 23.0 ± 2.9 NS 28.8 ± 4.7 25.4 ± 4.0 <0.001
Waist circumference (cm) 78 ± 11 78 ± 8 NS 93 ± 16 88 ± 11   0.002

Data are mean ± SD.

Abbreviations: BMI, body mass index; NS, not significant.

Downloaded from https://academic.oup.com/ajh/article/26/3/334/190703 by guest on 31 October 2022

Table 2.  Hemodynamic indices in sedentary and active younger and older individuals

<30 years >50 years

Parameter Sedentary (n = 194) Active (n = 293) P value Sedentary (n = 320) Active (n = 229) P value

Brachial SBP (mm Hg) 121 ± 17 120 ± 15 NS 142 ± 21 133 ± 18 <0.001

Brachial DBP (mm Hg) 77 ± 11 72 ± 9 <0.001 85 ± 10 83 ± 10  0.008
Central SBP (mm Hg) 105 ± 14 102 ± 12 0.02 132 ± 20 123 ± 18 <0.001
Non-augmented central SBP 103 ± 14 101 ± 11 0.05 118 ± 16 112 ± 14 <0.001
  (mm Hg)
Heart rate (bpm) 71 ± 11 64 ± 11 <0.001 67 ± 10 63 ± 10   0.003
Ejection duration (ms) 319 ± 18 329 ± 22 <0.001 328 ± 23 331 ± 21 NS
Cardiac output (L/min) 7.5 ± 1.9 7.9 ± 2.3 NS 4.6 ± 1.1 5.2 ± 1.4 0.02
Cardiac index (L/min/m2) 4.2 ± 0.9 4.3 ± 1.0 NS 2.5 ± 0.6 3.0 ± 0.9 0.002
Augmentation pressure (mm Hg) 0.9 ± 4.6 –0.3 ± 4.1 0.004 14.1 ± 6.9 13.3 ± 6.6 NS

Data are mean ± SD.

Abbreviations: DBP, diastolic blood pressure; NS, not significant; SPB, systolic blood pressure.

all higher in older individuals, the magnitude of the diffe-
rence between age groups was reduced in active individuals
(Supplementary Table 1).
Hemodynamic indices
Haemodynamic indices are presented in Table  2 and
Figures 1 and 2. Regular exercise was associated with lower
diastolic pressure and lower central, but not brachial systolic
pressure in younger individuals. In contrast, in older individ-
uals, regular exercise was associated with lower brachial and
central systolic pressures. Interestingly, regular exercise was
associated with lower brachial and aortic pulse pressures in
older individuals, but higher brachial and aortic pulse pres-
sures in younger individuals (Figure 1). Regular exercise was
also associated with significantly higher stroke volume in
both age groups; however, cardiac output and cardiac index
were significantly higher only in older active vs. sedentary
individuals. AIx was significantly lower in younger active vs.
sedentary individuals, even after adjustment for confound-
ers (Figure 2), and this was accompanied by a significantly
lower PVR in active subjects. In contrast, aPWV was signifi-
cantly lower in older active vs. sedentary individuals, which
persisted after adjustment for age and MAP (Figure 2). All
trends persisted following adjustment for differences in BMI
between the older groups (data not shown).
As expected, all indices of blood pressure were higher
in older individuals, regardless of physical activity level.
However, the magnitude of the differences in brachial and
aortic pulse pressures between age groups was consider-
ably lower in active individuals (Supplementary Table 2).
Similarly, AIx and aPWV were higher in older subjects.
However, whereas the age-related difference in AIx was simi-
lar between sedentary and active subjects, the difference in
aPWV in the active individuals was of a smaller magnitude.
Biochemical indices
Overall, regular exercise was associated with a favorable
biochemical profile in both younger and older individuals,
although the magnitude of the differences between seden-
tary and active younger individuals was small (Table  3).
After performing multiple regression analyses on younger
and older groups, these data illustrated that no biochemi-
cal parameter had any impact on vascular hemodynamic
parameters studied.

336  American Journal of Hypertension  26(3)  March 2013

 Exercise, Aging, and Arterial Function

Downloaded from https://academic.oup.com/ajh/article/26/3/334/190703 by guest on 31 October 2022

Figure 1.  Brachial (a) and central (b) pulse pressure in younger and older sedentary (solid bars) and active (clear bars) individuals. **P < 0.01, ***P < 0.001
vs. sedentary. Abbreviation: PP, pulse pressure.

Figure 2.  Relationship between regular exercise and augmentation index (AIx; a), aortic pulse wave velocity (PWV; b), stroke volume (c), and peripheral
vascular resistance (PVR; d). Solid bars represent sedentary, clear bars represent active. *P < 0.05, **P < 0.01, ***P < 0.001 vs. sedentary. AIx was adjusted
for heart rate and height. Aortic PWV was adjusted for age and mean arterial pressure.

Discussion pressure, and provides a comprehensive insight into the

underlying hemodynamic mechanisms. Our major, novel
This is the largest study describing the influence of age finding was that the relationship between regular exercise
on the relationship between regular exercise and blood and blood pressure, wave reflections, and arterial stiffness

American Journal of Hypertension  26(3)  March 2013  337

McDonnell et al.
Table 3.  Biochemical profile of sedentary and active younger and older individuals
<30 years
Parameter Sedentary (n = 194) Active (n = 293)
Total cholesterol (mmol/l) 4.1 ± 0.9 4.0 ± 0.7
LDL (mmol/l) 2.3 ± 0.8 2.2 ± 0.6
HDL (mmol/l) 1.4 ± 0.4 1.5 ± 0.4
Triglycerides (mmol/l) 1.1 ± 0.7 0.9 ± 0.5
Glucose (mmol/l) 4.9 ± 0.9 4.7 ± 0.7
Data are mean ± SD.
Abbreviations: HDL, high-density lipoprotein; LDL, low-density lipoprotein; NS, not significant.
differed significantly between younger and older individuals.
In younger individuals, regular exercise was associated with
lower diastolic blood pressure, but elevated pulse pressure. In
contrast, both systolic and pulse pressure were lower in older
active individuals. Moreover, regular exercise was associated
with lower wave reflections and PVR in younger individu-
als, but lower large artery stiffness in older individuals. These
data suggest that regular exercise is associated with a benefi-
cial vascular profile, involving the smaller preresistance and
resistance vessels in younger individuals, whereas the large
elastic arteries are involved in older individuals. Despite
these differential age-related findings, the current data pro-
vide further support for strategies which increase habitual
physical activity levels in the general population.
A recent meta-analysis22 emphasised the well-accepted
view that regular exercise confers beneficial effects on brachial
systolic and diastolic blood pressure, although the authors did
not distinguish between younger and older individuals. To
our knowledge, the current study is the first to demonstrate
that the relationship between regular exercise and blood pres-
sure may be dependent on age, where exercise is associated
with lower brachial diastolic pressure in younger individu-
als, but systolic pressure in older individuals. Interestingly,
diastolic blood pressure is more predictive of cardiovascular
risk in younger subjects.29 Whereas in older individuals it is
systolic and pulse pressure which have superior predictive
value.30 Therefore, the relationships between regular exercise
and blood pressure observed in the current study appear to be
consistent with a longer-term reduction in cardiovascular risk.
Pulse pressure, the difference between systolic and diastolic
pressure, is often considered a surrogate of large artery stiff-
ness, and has even greater predictive value for cardiovascular
events than either systolic or diastolic pressure alone, in older
individuals.30 Interestingly, regular exercise was associated
with opposite patterns of pulse pressure in younger and older
individuals. Both brachial and central pulse pressures were ele-
vated in younger individuals who undertook regular exercise.
However, in older active individuals, both brachial and central
pulse pressures were significantly lower relative to sedentary
controls. Physiologically, the major determinants of pulse pres-
sure, and, in particular, nonaugmented pulse pressure, are the
stroke volume and aortic stiffness, representing the volume
of blood flowing into the aorta, and the ability of the aorta to
buffer this volume and thus minimize any rise in intra-arterial
pressure. As expected, regular exercise was associated with a
338  American Journal of Hypertension  26(3)  March 2013
>50 years
P value Sedentary (n = 320) Active (n = 229) P value
NS 5.7 ± 1.1 5.5 ± 1.0 NS
NS 3.5 ± 1.0 3.4 ± 0.9 NS
0.01 1.4 ± 0.4 1.6 ± 0.5 <0.001
 0.002 1.9 ± 1.0 1.4 ± 0.8 <0.001
0.01 5.5 ± 2.1 5.0 ± 1.1 NS
Downloaded from https://academic.oup.com/ajh/article/26/3/334/190703 by guest on 31 October 2022
higher stroke volume in both younger and older individuals, an
adaptation which has been described previously.22, 31 However,
despite the higher stroke volume, there were no differences in
brachial or nonaugmented central systolic pressures between
active and sedentary younger individuals. Instead, the widened
pulse pressure in younger active individuals was associated
with a significantly lower diastolic pressure.
The lower diastolic blood pressure is likely to involve
exercise-related adaptations of the smaller, preresistance and
resistance vessels, which have a greater influence on diastolic,
rather than systolic, pressure. Indeed, in younger individuals,
regular exercise was associated with a lower PVR, and a lower
AIx, indicating diminished wave reflections, which is also
likely to explain the lower central systolic pressure observed
in younger active individuals. These data are in agreement
with other studies showing that increased habitual physi-
cal activity is associated with a lower AIx in young female
twins,32 in competitive, endurance trained athletes vs. recrea-
tionally active controls,20 and in patients with systemic lupus
erythematosus.33 Although the mechanisms underlying the
lower PVR and AIx cannot be confirmed in the current study,
likely candidates include altered insulin sensitivity,34 shear
stress,35 nitric oxide bioavailability35 and decreased sympa-
thetic activity,36 as a result of regular exercise.
In older individuals, the lower brachial and central pulse
pressures observed in active subjects were due predomi-
nantly to lower systolic pressures in these individuals, with
a much more modest influence of diastolic pressure. Since
stroke volume was significantly increased in active individu-
als, the lower systolic pressures observed in this age group
are likely to be due, at least in part, to a lower level of large
artery stiffness. Indeed, aPWV was significantly lower in
active than sedentary individuals. Previous data describing
the influence of exercise on arterial stiffness remain difficult
to interpret, in part due to the wide variety of methods used
to measure arterial properties, and differences in age ranges
and exercise modalities. Nevertheless, cross-sectional17,37–40
and interventional41 studies have previously demonstrated
that regular exercise is associated with beneficial effects on
large artery stiffness in older individuals, although others
have shown only modest42 or no effects15 of regular exercise.
In contrast to the situation in older individuals, there were
no differences in aPWV between younger active and seden-
tary individuals in the current study, despite the higher pulse
pressures observed in active individuals. This illustrates that

pulse pressure may not be a reliable surrogate of large artery
stiffness in younger individuals. Previous cross-sectional stud-
ies in younger subjects show an inverse association between
cardiorespiratory fitness and aPWV16 and between regular
physical activity and measures of carotid artery stiffness.43–44
However, intervention studies have failed to detect an effect of
aerobic exercise training on aPWV in young rats14 or carotid
stiffness in young humans.45 In addition, and in keeping with
previous cross-sectional data,19 we did not observe any differ-
ences in AIx between older sedentary and active individuals,
although previous intervention studies have demonstrated
significant reductions in AIx during acute dynamic exercise46
and following exercise training in older healthy subjects21 and
those with coronary artery disease.47 Aging exerts one of the
most potent effects on the cardiovascular system. Indeed, pre-
vious data from the ACCT study suggest that aging exerts a
differential effect on arterial stiffness and wave reflections,23
and that associations between traditional cardiovascular risk
factors and AIx are stronger in younger individuals, whereas
risk factors are more strongly related to aPWV in older indi-
viduals.48 The findings of the current study are in keeping with
these previous observations, particularly with regard to the
lower AIx observed in younger active individuals, but lower
aPWV observed in older active individuals, compared with
sedentary subjects. Unfortunately we cannot clarify the mech-
anisms underlying the apparent beneficial effects of regular
exercise on aPWV in older individuals. However, it is possible
that life-course exposure to regular exercise may retard the
process of large artery stiffening, which is prevalent in this age
group, whereas the smaller, more muscular vessels appear to
be less affected by the longer-term benefits of regular exercise
in older individuals.
The current findings also support the concept that lifestyle
factors such as physical activity levels may affect the relation-
ship between age and markers of cardiovascular health, such
as blood pressure. Indeed, age-related differences in blood
pressure and large artery stiffness were blunted in individu-
als who undertook regular exercise. Irrespective of whether
age affects the relationship between regular exercise and
the cardiovascular system or whether undertaking regular
exercise influences “cardiovascular aging” per se, the current
data suggest that the beneficial effects of regular exercise on
the cardiovascular system are consistent with longer-term
age-specific reductions in cardiovascular risk. Finally, body
weight, BMI, and waist circumference were all significantly
reduced in older active individuals compared with their sed-
entary counterparts, demonstrating that those undertaking
regular exercise had a more favorable anthropometric profile
and therefore, lower cardiovascular risk.
The current study has a number of limitations. The clas-
sification of “physically active” vs. “sedentary” was based on
self-report, using a questionnaire administered at the time
hemodynamic measurements were undertaken. Moreover,
although the same criteria were applied to define levels of
regular exercise in each age group, the average level of exer-
cise undertaken by each of the “active” groups may have
differed. Nevertheless, every effort was made to include
only those individuals undertaking regular moderate-to-
high intensity exercise, in order to minimise heterogene-
ity between the groups. Moreover, the major comparisons
Exercise, Aging, and Arterial Function
focussed on differences between active and sedentary indi-
viduals within each age group, although it is apparent from
our data that age-related differences in hemodynamic vari-
ables also varied according to the level of physical activity
undertaken. In addition, we did not record the number of
years over which an individual has exercised at their cur-
rent level and therefore we cannot quantify life-course expo-
sure to physical activity, which is bound to differ between
younger and older individuals. Finally, because of the cross-
sectional nature of these analyses, we cannot examine causal
relationships. For example, as alluded to above, it may be the
case that exercise induces beneficial age-related changes in
cardiovascular hemodynamics, or simply that healthier indi-
viduals are more likely to undertake regular exercise, espe-
cially later in life.
Downloaded from https://academic.oup.com/ajh/article/26/3/334/190703 by guest on 31 October 2022
Blood pressure is a major risk factor for cardiovascular
events. However, it is now widely recognised that aging influ-
ences the association between blood pressure and cardiovas-
cular risk, such that elevated diastolic pressure is associated
with increased risk in younger individuals, whereas systolic
and pulse pressures hold greater predictive value in older
individuals. Interestingly, in the current study, the relation-
ship between regular exercise and blood pressure was also
age-dependent, where diastolic pressure and wave reflec-
tions were lower in the young but systolic and pulse pres-
sures, together with large artery stiffness, were lower in older
individuals. Therefore, the current data support the concept
that strategies designed to increase habitual physical activity
levels in the general population may have considerable ben-
efits in reducing cardiovascular risk, regardless of age.
Supplementary material
Supplementary materials are available at the American
Journal of Hypertension online (http://www.oxfordjournals.
org/our_journals/ajh/). Supplementary materials consist of
data provided by the author that are published to benefit the
reader. The posted materials are not copyedited. The con-
tents of all supplementary data are the sole responsibility of
the authors. Questions or messages regarding errors should
be addressed to the author.
Acknowledgments
The ACCT Study Investigators: Samantha Benedict, John
Cockcroft, Lisa Day, Stacey Hickson, Julia Howard, Kaisa
Maki-Petaja, Barry McDonnell, Carmel McEniery, Karen
Miles, Maggie Munnery, Pawan Pusalkar, Christopher
Retallick, Chloe Rowe, James Sharman, Jane Smith, Rachel
Stainsby, Edna Thomas, Ian Wilkinson, Susannah Williams,
Jean Woodcock-Smith, Yasmin.
Disclosure
Ian B.  Wilkinson is a BHF Senior Fellow and Carmel
M. McEniery is a BHF Intermediate Fellow. This work was
supported, in part, by the National Institute for Health
American Journal of Hypertension  26(3)  March 2013  339
McDonnell et al.
Research Cambridge Biomedical Research Centre Award.
The authors declared no conflict of interest.
References
1. Safar ME, London GM. Therapeutic studies and arterial stiff-
ness in hypertension: recommendations of the European Society
of Hypertension. The Clinical Committee of Arterial Structure and
Function. Working Group on Vascular Structure and Function of the
European Society of Hypertension. J Hypertens 2000;18:1527–1535.
2. Lee IM, Paffenbarger RS Jr, Hennekens CH. Physical activity, physical
fitness and longevity. Aging (Milano) 1997;9:2–11.
3. Blair SN, Jackson AS. Physical fitness and activity as separate heart dis-
ease risk factors: a meta-analysis. Med Sci Sports Exerc 2001;33:762–764.
4. Huonker M, Schmidt-Trucksass A, Heiss HW, Keul J. Effects of physi-
cal training and age-induced structural and functional changes in
cardiovascular system and skeletal muscles. Z Gerontol Geriatr 2002;
35:151–156.
5. Mora S, Cook N, Buring JE, Ridker PM, Lee IM. Physical activity and
reduced risk of cardiovascular events: potential mediating mechanisms.
Circulation 2007;116:2110–2118.
6. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific rel-
evance of usual blood pressure to vascular mortality: a meta-analysis of
individual data for one million adults in 61 prospective studies. Lancet
2002;360:1903–1913.
7. Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P,
Laurent S. Aortic stiffness is an independent predictor of primary coro-
nary events in hypertensive patients: a longitudinal study. Hypertension
2002;39:10–15.
8. Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG.
Aortic pulse-wave velocity and its relationship to mortality in diabe-
tes and glucose intolerance: an integrated index of vascular function?
Circulation 2002;106:2085–2090.
9. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L,
Ducimetiere P, Benetos A. Aortic stiffness is an independent predic-
tor of all-cause and cardiovascular mortality in hypertensive patients.
Hypertension 2001;37:1236–1241.
10. Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM,
Bos ML, Schalekamp MA, Asmar R, Reneman RS, Hoeks AP, Breteler
MM, Witteman JC. Arterial stiffness and risk of coronary heart disease
and stroke: the Rotterdam Study. Circulation 2006;113:657–663.
11. Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arte-
rial stiffness and pulse pressure in hypertension and cardiovascular dis-
eases. Circulation 2003;107:2864–2869.
12. Vaitkevicius PV, Fleg JL, Engel JH, O’Connor FC, Wright JG, Lakatta
LE, Yin FC, Lakatta EG. Effects of age and aerobic capacity on arterial
stiffness in healthy adults. Circulation 1993;88(4 Pt 1):1456–1462.
13. Tanaka H, DeSouza CA, Seals DR. Absence of age-related increase in
central arterial stiffness in physically active women. Arterioscler Thromb
Vasc Biol 1998;18:127–132.
14. Niederhoffer N, Kieffer P, Desplanches D, Lartaud-Idjouadiene I, Sornay
MH, Atkinson J. Physical exercise, aortic blood pressure, and aortic wall
elasticity and composition in rats. Hypertension 2000;35:919–924.
15. 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;38:222–226.
16. Boreham CA, Ferreira I, Twisk JW, Gallagher AM, Savage MJ, Murray
LJ. Cardiorespiratory fitness, physical activity, and arterial stiff-
ness: the Northern Ireland Young Hearts Project. Hypertension 2004;
44:721–726.
17. Havlik RJ, Phillips CL, Brock DB, Lohman K, Haskell W, Snell P, O’Toole
M, Ribisl P, Vaitkevicius P, Spurgeon HA, Lakatta EG, Pullen P. Walking
may be related to less vascular stiffness in the Activity Counseling Trial
(ACT). Am Heart J 2005;150:270–275.
18. 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;55:235–239.
19. Nualnim N, Barnes JN, Tarumi T, Renzi CP, Tanaka H. Comparison of
central artery elasticity in swimmers, runners, and the sedentary. Am J
Cardiol 2011;107:783–787.
340  American Journal of Hypertension  26(3)  March 2013
20. Edwards DG, Lang JT. Augmentation index and systolic load are lower
in competitive endurance athletes. Am J Hypertens 2005;18(5 Pt 1):
679–683.
21. Tabara Y, Yuasa T, Oshiumi A, Kobayashi T, Miyawaki Y, Miki T, Kohara
K. Effect of acute and long-term aerobic exercise on arterial stiffness in
the elderly. Hypertens Res 2007;30:895–902.
22. Cornelissen VA, Fagard RH. Effects of endurance training on blood
pressure, blood pressure-regulating mechanisms, and cardiovascular
risk factors. Hypertension 2005;46:667–675.
23. McEniery CM, Yasmin, Hall IR, Qasem A, Wilkinson IB, Cockcroft JR.
Normal vascular aging: differential effects on wave reflection and aor-
tic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT).
J Am Coll Cardiol 2005;46:1753–1760.
24. O’Brien E, Mee F, Atkins N, Thomas M. Evaluation of three devices
for self-measurement of blood pressure according to the revised British
Hypertension Society Protocol: the Omron HEM-705CP, Philips
HP5332, and Nissei DS-175. Blood Press Monit 1996;1:55–61.
25. Wilkinson IB, Cockcroft JR, Webb DJ. Pulse wave analysis and arterial
Downloaded from https://academic.oup.com/ajh/article/26/3/334/190703 by guest on 31 October 2022
stiffness. J Cardiovasc Pharmacol 1998;32(Suppl 3):S33–37.
26. Pauca AL, O’Rourke MF, Kon ND. Prospective evaluation of a method
for estimating ascending aortic pressure from the radial artery pressure
waveform. Hypertension 2001;38:932–937.
27. Wilkinson IB, Fuchs SA, Jansen IM, Spratt JC, Murray GD, Cockcroft
JR, Webb DJ. Reproducibility of pulse wave velocity and augmenta-
tion index measured by pulse wave analysis. J Hypertens 1998;16(12 Pt
2):2079–2084.
28. Clemensen P, Christensen P, Norsk P, Gronlund J. A modified photo-
and magnetoacoustic multigas analyzer applied in gas exchange meas-
urements. J Appl Physiol 1994;76:2832–2839.
29. Sundstrom J, Neovius M, Tynelius P, Rasmussen F. Association of blood
pressure in late adolescence with subsequent mortality: cohort study of
Swedish male conscripts. BMJ 2011;342:d643.
30. Franklin SS, Larson MG, Khan SA, Wong ND, Leip EP, Kannel WB,
Levy D. Does the relation of blood pressure to coronary heart disease
risk change with aging? The Framingham Heart Study. Circulation
2001;103:1245–1249.
31. Ogawa T, Spina RJ, Martin WH, 3rd, Kohrt WM, Schechtman KB,
Holloszy JO, Ehsani AA. Effects of aging, sex, and physical training on
cardiovascular responses to exercise. Circulation 1992;86:494–503.
32. Greenfield JR, Samaras K, Campbell LV, Jenkins AB, Kelly PJ, Spector
TD, Hayward CS. Physical activity reduces genetic susceptibility to
increased central systolic pressure augmentation: a study of female
twins. J Am Coll Cardiol 2003;42:264–270.
33. Barnes JN, Nualnim N, Sugawara J, Sommerlad SM, Renzi CP, Tanaka
H. Arterial stiffening, wave reflection, and inflammation in habitually
exercising systemic lupus erythematosus patients. Am J Hypertens 2011;
24:1194–1200.
34. Petrie JR, Ueda S, Webb DJ, Elliott HL, Connell JM. Endothelial nitric
oxide production and insulin sensitivity. A  physiological link with
implications for pathogenesis of cardiovascular disease. Circulation
1996;93:1331–1333.
35. Campbell R, Fisher JP, Sharman JE, McDonnell BJ, Frenneaux MP.
Contribution of nitric oxide to the blood pressure and arterial responses
to exercise in humans. J Hum Hypertens 2011;25:262–270.
36. Jennings G, Nelson L, Nestel P, Esler M, Korner P, Burton D, Bazelmans
J. The effects of changes in physical activity on major cardiovascular
risk factors, hemodynamics, sympathetic function, and glucose utili-
zation in man: a controlled study of four levels of activity. Circulation
1986;73:30–40.
37. Cook JN, DeVan AE, Schleifer JL, Anton MM, Cortez-Cooper MY,
Tanaka H. Arterial compliance of rowers: implications for combined
aerobic and strength training on arterial elasticity. Am J Physiol Heart
Circ Physiol 2006;290:H1596–600.
38. Mackey RH, Sutton-Tyrrell K, Vaitkevicius PV, Sakkinen PA, Lyles MF,
Spurgeon HA, Lakatta EG, Kuller LH. Correlates of aortic stiffness in
elderly individuals: a subgroup of the Cardiovascular Health Study. Am
J Hypertens 2002;15(1 Pt 1):16–23.
39. Moreau KL, Silver AE, Dinenno FA, Seals DR. Habitual aerobic exercise is
associated with smaller femoral artery intima-media thickness with age in
healthy men and women. Eur J Cardiovasc Prev Rehabil 2006; 13:805–811.
40. Nualnim N, Barnes JN, Tarumi T, Renzi CP, Tanaka H. Comparison of
central artery elasticity in swimmers, runners, and the sedentary. Am J
Cardiol 2011;107:783–787.

41. Tanaka H, Dinenno FA, Monahan KD, Clevenger CM, DeSouza CA,
Seals DR. Aging, habitual exercise, and dynamic arterial compliance.
Circulation 2000;102:1270–1275.
42. Schmitz KH, Arnett DK, Bank A, Liao D, Evans GW, Evenson KR,
Stevens J, Sorlie P, Folsom AR. Arterial distensibility and physical activ-
ity in the ARIC study. Med Sci Sports Exerc 2001;33:2065–2071.
43. Kozakova M, Palombo C, Mhamdi L, Konrad T, Nilsson P, Staehr PB,
Paterni M, Balkau B. Habitual physical activity and vascular aging in a
young to middle-age population at low cardiovascular risk. Stroke 2007;
38:2549–2555.
44. 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;55:33–39.
Exercise, Aging, and Arterial Function
45. Wijnen JA, Kool MJ, Kooman JP, van Baak MA, Hoeks AP, Struijker
Boudier HA, Van Bortel LM. Vessel wall properties of large arteries and
endurance training. J Hypertens 1993;11:S88–89.
46. Martin JS, Casey DP, Gurovich AN, Beck DT, Braith RW. Association
of age with timing and amplitude of reflected pressure waves during
exercise in men. Am J Hypertens 2011;24:415–420.
47. Edwards DG, Schofield RS, Magyari PM, Nichols WW, Braith RW.
Effect of exercise training on central aortic pressure wave reflection in
coronary artery disease. Am J Hypertens 2004; 17:540–543.
48. McEniery CM, Yasmin, Maki-Petaja KM, McDonnell BJ, Munnery M,
Hickson SS, Franklin SS, Cockcroft JR, Wilkinson IB; Anglo-Cardiff
Collaboration Trial Investigators. The impact of cardiovascular risk
factors on aortic stiffness and wave reflections depends on age: the
Anglo-Cardiff Collaborative Trial (ACCT III). Hypertension 2010; 56:
591–597.
Downloaded from https://academic.oup.com/ajh/article/26/3/334/190703 by guest on 31 October 2022
American Journal of Hypertension  26(3)  March 2013  341