Training for a first marathon reverses vascular ageing

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MarathonNovice marathoners experienced a four-year reduction in arterial age and a 4 mmHg drop in systolic blood pressure.s, found a study on London Marathon participants. Older and slower runners benefited the most.

The research was presented at EuroCMR 2019, a scientific congress of the European Society of Cardiology (ESC). The study found that older and slower runners benefit the most.

Study author Dr Anish Bhuva, a British Heart Foundation fellow at University College London, UK, said: “Novice runners who trained for six months and completed their first marathon had a four-year reduction in arterial age and a 4 mmHg drop in systolic blood pressure. This is comparable to the effect of medication, and if maintained translates to approximately 10% lower risk of stroke over a lifetime.”

A hallmark of normal ageing is stiffening of the blood vessels, which increases the risk of stroke and heart disease even in healthy people. Compared to their peers, lifelong athletes have biologically younger blood vessels. This study investigated whether training for a marathon could modify aortic stiffness even in novice runners.

The study by Bhuva and colleagues at St Georges University of London, San Luca Hospital (Milan), and Barts Heart Centre (London), included 139 healthy first-time marathon runners aged 21-69 years who were advised to follow a first-time finisher training programme and ran an estimated 6-13 miles (10-20 km) a week for six months ahead of completing the 2016 or 2017 London Marathon.

Before they started training and two weeks after completing the marathon, participants had magnetic resonance imaging (MRI) and ultrasound scans of the heart and blood vessels, a fitness test, and measurements of blood pressure and heart rate. Biological age of the aorta was calculated at both time points.

After completing the marathon, aortic stiffness had reduced and the aorta was four years younger than before training. Older participants and those with longer marathon finish times had greater reductions in aortic stiffness after training. Reductions in aortic stiffness were independent of changes in blood pressure.

Bhuva said: “You don’t have to be an elite athlete to gain the benefits from marathon running, in fact the benefits appeared greatest in those who were older and slower. By completing training, and getting to the finish line, it is possible to rejuvenate the cardiovascular system of first-time marathon runners.”

Fitness improved and heart rate dropped after training – both to a modest extent. “The minimal impact on these conventional markers of health suggests that study participants trained within their personal limits,” said Bhuva. “Aortic stiffness and blood pressure changed more than fitness and heart rate.”

Bhuva noted that participants had been running for less than two hours a week before marathon training and their finish times were slower than average, which was expected as it was their first race. “The study shows that the health gains of lifelong exercise start to appear after a relatively brief training programme,” he said. “Training for a marathon can be a good motivator to keep active. Many people enjoy it and continue running, which should increase the likelihood of sustaining the benefits.”

Professor Sanjay Sharma, medical director of the London Marathon and an author of the study, said: “The benefits of exercise on the heart and circulation are well established, and are associated with lower cardiovascular disease and mortality. Recent studies have shown that exercise may retard ageing of the cardiovascular system. Our study shows that a first-time marathon makes the cardiovascular system ‘younger’ therefore participants will reap these benefits whilst running for a good cause.”

Abstract
Background: Ageing is strongly associated with aortic stiffening, contributing to increased cardiovascular risk even in healthy individuals. Aortic stiffness is reduced in lifelong athletes, but whether training in novice runners can modify this process remains unclear.
Purpose: To assess the impact of first-time marathon training on age-related increases in aortic stiffness.
Methods: Untrained healthy volunteers were recruited prior to starting training for the London Marathon. Assessment pre-training and two weeks post-marathon included central (aortic) BP (cBP), and phase contrast 1.5T CMR in the ascending (Ao-A) and descending thoracic aorta at two levels (pulmonary artery bifurcation and diaphragm – Ao-P and Ao-D). Aortic distensibility and beta-stiffness (ß, a pressure-independent measure) were measured and correlated with chronological age at baseline to derive biological aortic age before and after training. Data are mean changes (95% confidence intervals).
Results: The cohort comprised 139 first-time marathon completers (age range 21-69 years, 50% male). As expected, increasing age decade was associated with decreasing distensibility by 2.3, 1.9 and 3.1 x10-3mmHg-1 for the Ao-A, Ao-P, and Ao-D respectively (partial r=0.4-0.5), Figure.
Training decreased cSBP and cDBP by 4(2.5-5.3) and 3mmHg (1.6-3.6), Table. With training, descending aortic distensibility increased at both Ao-P and Ao-D levels (by 9%,p=0.009 and 17%,p=0.001), whilst unchanged in the ascending aorta. This translated to a reduction in biological aortic age at Ao-P by 3.9(1.1-7.5) and Ao-D 4.5years (1.8-8.2). ß decreased by 7% at the Ao-D level,p=0.02. Participants with slower marathon running times (Ao-P partial r:-0.20,p<0.05), and older age (Figure) showed a greater increase in descending aortic distensibility with training.
Conclusions: Training for and completing a marathon improves central blood pressure and aortic stiffness even in novice athletes. These changes are the equivalent to a ~4-year reduction in vascular age. These benefits were greatest in older, less fit individuals.

Authors
A Bhuva, A D’silva, C Torlasco, S Jones, N Nadarajan, J Van Zalen, R Boubertakh, N Chaturvedi, G Lloyd, S Sharma, JC Moon, AD Hughes, CH Manisty

European Society of Cardiology material
ESC365 abstract


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