Arterial stiffness adaptations to chronic resistance and aerobic exercise: a systematic review of exercise modalities

Background: Arterial stiffness is a strong predictor of cardiovascular morbidity and mortality, especially in older adults. Despite exercise being shown to positively influence arterial health, the relative effectiveness of various exercise modalities remains unclear. Objectives: This systematic review aimed to examine the effects of resistance training (RT), aerobic training (AER), and concurrent aerobic plus resistance training (CON) on arterial stiffness in older adults, a recognised modifiable and independent cardiovascular risk factor. Methods: A comprehensive search of Medline (EBSCO), EMBASE, the Cochrane Database of Systematic Reviews, and clinicaltrials.gov was conducted. The robust search strategy, which also included systematic reviews being hand-searched for relevant articles and a forward and backwards citation search on the included articles, was employed to reduce the risk of selection and publication biases. Studies included in the review assessed arterial stiffness using pulse wave velocity (PWV) and focused on individuals aged 60 years and above who participated in a chronic (≥ 8 weeks) structured exercise intervention (RT, AER, or CON). Only randomised controlled trials were included. Sixteen studies met the inclusion criteria, and their methodological quality was evaluated using the PEDro scale. Results: The findings indicated that resistance training generally had a neutral effect (mean difference, MD: 0.06 m/s. SD: ±0.45) on arterial stiffness, whilst aerobic training produced modest improvements (MD: -0.62 m/s, SD: ±0.51). Notably, concurrent training consistently reduced arterial stiffness across diverse older adult(s) populations (MD: -0.85 m/s, SD: ±0.63). Conclusion: Combined aerobic and resistance training is the most effective non-pharmacological strategy for reducing arterial stiffness in older adults. This approach may offer essential benefits for cardiovascular health and healthy ageing. Further long-term studies are needed to explore the mechanisms involved and to inform tailored exercise interventions in geriatric populations.