Background:Obesity may accelerate age-related increases in aortic stiffness. Although aerobic exercise training generally has favorable effects on aortic structure and function, exercise alone may not be sufficient to improve aortic stiffness in older adults with obesity. We determined the effects of aerobic exercise training with and without moderate- to high-caloric restriction (CR) on the structure and function of the proximal aorta in 160 older (65–79 years) men and women with obesity (body mass index=30–45 kg/m²).Methods:Participants were randomly assigned to 1 of 3 groups: aerobic exercise training only (treadmill 4 days/week for 30 minutes at 65% to 70% of heart rate reserve; n=56), aerobic exercise training plus moderate CR (n=55), or aerobic exercise training plus more intensive CR (n=49) for 20 weeks. Aortic pulse wave velocity, aortic distensibility, and other measures of aortic structure and function were assessed by cardiovascular magnetic resonance imaging. Pearson correlation coefficients were examined to assess associations between changes in proximal aortic stiffness and changes in fitness, fatness, and other potential confounders.Results:Weight loss in the aerobic exercise training plus moderate CR (−8.0 kg [95% CI, −9.17 to −6.87]) and aerobic exercise training plus more intensive CR (−8.98 kg [95% CI, −10.23 to −7.73) groups was significantly greater compared with the aerobic exercise training–only group (−1.66 kg [95% CI, −2.94 to −0.38]; P<0.017 for both). There were significant treatment effects for descending aorta distensibility (P=0.008) and strain (P=0.004) and aortic arch pulse wave velocity (P=0.01) with the aerobic exercise training plus moderate CR group having a 21% increase in distensibility (P=0.016) and an 8% decrease in pulse wave velocity (P=0.058). None of the aortic stiffness measures changed significantly in the aerobic exercise training–only or aerobic exercise training plus more intensive CR groups, and there were no significant changes in any other measure of aortic structure or function in these groups. Overall, increases in aortic distensibility were correlated with improvements in body weight and body fat distribution, but these associations were not statistically significant after adjustment for multiple comparisons.Conclusions:In older adults with obesity, combining aerobic exercise with moderate CR leads to greater improvements in proximal aortic stiffness than exercise alone.Registration:URL: https://clinicaltrials.gov; Unique identifier: NCT01048736.

中文翻译：

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运动和减肥对肥胖老年人近端主动脉僵硬的影响

背景：肥胖可能会加速与年龄相关的主动脉僵硬度增加。尽管有氧运动训练通常对主动脉结构和功能有良好的影响，但单独运动可能不足以改善肥胖老年人的主动脉僵硬度。我们在 160 名老年（65-79 岁）肥胖男性和女性（体重指数 = 30 –45 公斤/平方米²).方法：参与者被随机分配到 3 组中的 1 组：仅有氧运动训练（跑步机 4 天/周，持续 30 分钟，心率储备的 65% 至 70%；n=56），有氧运动训练加中度 CR（ n = 55），或有氧运动训练加上更密集的 CR（n = 49），持续 20 周。通过心血管磁共振成像评估主动脉脉搏波速度、主动脉扩张性和主动脉结构和功能的其他测量值。检查 Pearson 相关系数以评估近端主动脉硬度变化与健康、肥胖和其他潜在混杂因素变化之间的关联。结果：有氧运动训练中的体重减轻加上中度 CR（-8.0 kg [95% CI，-9.17 至-6.87]）和有氧运动训练加上更强化的 CR（-8.98 kg [95% CI，-10.23 至 -7。两者的P <0.017）。降主动脉扩张性（ P =0.008）和应变（P =0.004）和主动脉弓脉搏波速度（P =0.01）有显着的治疗效果，有氧运动训练加中度CR组扩张性增加21%（P = 0.016) 和脉搏波速度降低 8% ( P=0.058）。在仅有氧运动训练或有氧运动训练加更密集的 CR 组中，主动脉僵硬度测量值均未发生显着变化，并且这些组中任何其他主动脉结构或功能测量值均无显着变化。总体而言，主动脉扩张性的增加与体重和体脂分布的改善相关，但在调整多重比较后，这些关联在统计学上不显着。结论：在肥胖的老年人中，有氧运动与中度 CR 相结合会导致更大的改善近端主动脉僵硬比单独运动。注册：URL：https://clinicaltrials.gov；唯一标识符：NCT01048736。