Comparison of vascular arterial stiffness parameters of adolescent wrestlers with healthy subjects: Is heavy training harmful for wrestlers?

Abstract

BACKROUND:

The effect of different exercise modalities on the vascular structure has been the subject of clinical trials but there is not enough data about wrestlers.

OBJECTIVE:

This study aimed to compare the arterial stiffness parameters in adolescent wrestlers with those of age-matched sedentary controls to show the effects of long and heavy training.

METHODS:

This study was carried out as a case-control study. Thirty three ( $N=$ 33) elite male adolescent wrestlers (12–18 years) and 35 age and sex-matched control subjects ( $P=$ 0.438) with a sedentary lifestyle were included the study. The data was obtained by using sonography and a sphygmomanometer. Systolic and diastolic diameters and intima media thickness (IMT) measurements were performed from the carotid arteries of the subjects. The arterial tension was measured in the same session, and arterial stiffness parameters were calculated using specific formulas.

RESULTS:

The mean age range was 15.9 $\pm$ 0.9 years and 16.0 $\pm$ 0.8 years for the wrestlers and control subjects, respectively ( $P=$ 0.43). Statistically, the Body Mass Index (BMI) was significantly higher in wrestlers (mean $=$ 23.7 $\pm$ 4.0 kg/m ${}^{2}$ ; $P=$ 0.00). The groups had no difference in height ( $P=$ 0.80) and weight ( $P=$ 0.05). The systolic blood pressure (SBP) was significantly higher in wrestlers (mean $=$ 120 $\pm$ 13.4 mmHg; $P=$ 0.00); the pulse was significantly lower in wrestlers (mean $=$ 69.61 $\pm$ 17.2 beats/min; $P=$ 0.00); the IMT was significantly lower in wrestlers (IMT mean $=$ 0.288 $\pm$ 0.1 mm; $P=$ 0.01); the diastolic wall stress (DWS) was significantly higher in wrestlers (DWS mean $=$ 933.64 $\pm$ 298.0 mmHg; $P=$ 0.03) than controls. No significant differences were found in the elastic modulus ( $P=$ 0.11), compliance ( $P=$ 0.86), and distensibility ( $P=$ 0.86) parameters between the groups.

CONCLUSION:

Bradycardia is an expected condition for athletes. SBP and DWS were found to be high in wrestlers, suggesting that arterial tissue is more susceptible to stress. The low IMT indicates the protective effect of regular exercise against atherosclerosis. It is known that regular exercise is good for the vascular structure while heavy exercise puts a load on the vascular structure. The fact that the elastic modulus, compliance, and distensibility do not differ between the groups suggests that structural changes in the adolescents have no effect on the vascular wall.

Keywords

Exercise arterial stiffness sonography wrestling

1. Introduction

Wrestling is an ancient Roman Olympic game and one of the oldest martial arts. An optimal cardiorespiratory fitness level is required during the game, regardless of sex and wrestling style, to provide motivation during the resting period [1]. For this reason, wrestlers undergo a long and heavy training program.

Overall, to achieve high-level wrestling perform-ance, training should be directed to developing anaerobic power and capacity, aerobic power, maximal dynamic and isometric strength, explosive strength, and strength endurance [2]. With regard to the anaerobic power and capacity, the available studies were in agreement about their critical importance toward reaching high-level wrestling success since these variables have discriminated well between successful and less-successful wrestlers regardless of age, weight classes, and wrestling styles [2, 3].

According to the current literature, low grade systemic inflammation increased late into the season, and a correlation was found with poor sleep quality in wrestlers. It is furthermore suggested that individual variability in oxidative stress status and lipid profile in wrestlers may modulate biochemical response to training. Based on this data, wrestlers may benefit from additional recovery time early into the season to prevent muscle fatigue and damage [4, 5].

Many ways of defining the biomechanical properties of the arterial wall exist. The most commonly used definition to express the viscoelastic property is stiffness, which expresses the relationship between change in pressure ( $\Delta$ P) and change in volume ( $\Delta$ V) [6]. Different studies have shown that training can either increase or decrease arterial stiffness [7]. To the best of our knowledge, this study is the first one to compare the arterial stiffness parameters of the elite male adolescent wrestlers with control subjects of the same age and sex with a sedentary lifestyle. It is aimed to demonstrate the effects of long-term and heavy training on the vascular structure in young wrestlers.

2. Methods

This study was designed as a case-control study. Thirty three ( $N=$ 33) elite male adolescent wrestlers (12–18 years) and 35 age and sex-matched control subjects ( $P=$ 0.438) with a sedentary lifestyle were included the study. Wrestlers studied at the Sports College of Sütçü İmam University, Turkey. The data was obtained using sonography and sphygmomanometer. Systolic and diastolic diameters and intima media thickness (IMT) measurements were performed from the carotid arteries of the subjects. The arterial tension was measured in the same session, and arterial stiffness parameters were calculated using specific formulas.

The carotid artery was evaluated using a high-resolution Doppler ultrasound system (Aplio 400 Platinum; Toshiba Medical Systems Corporation, Tochigi, Japan) attached to a broadband linear transducer (PLT-704SBT) by an experienced radiologist. The transducer was placed 2 cm anterior to the bifurcation of the right carotid artery. The measurements included IMT and lumen diameters (diastolic diameter (DP) and sistolik diameter (DP)) of the artery during the end-diastolic and end-systolic phases of the cardiac cycle. Simultaneously, the pulse rate and pressures (systolic pressure (SP) and diastolic pressure (DP)) were measured using an automatic sphygmomanometer (OCR Vitagnost 2015; MARS, Taiwan) attached to the left arm.

The measurements from sonography and sphygmomanometer were pooled together to calculate the quantitative parameters reflecting arterial stiffness using the following formulas [8, 9]:

$\text{Cross-sectional compliance}=[\pi(\text{SD}^{2}-\text{DD}^{2})]/$

$\quad[4(\text{SP}-\text{DP})];$

$\text{Cross-sectional distensibility}=(\text{SD}^{2}-\text{DD}^{2})/$

$\quad[\text{DD}^{2}(\text{SP}-\text{DP})];$

$\text{Diastolic wall stress}=[\text{DD}/(2\times\text{IMT})]\times$

$\quad[(\text{SP}+\text{SD})/2];$

$\text{Cross-sectional lumen area}=\pi\times\text{DD}^{2}/4;$

$\text{Cross-sectional wall area}=\pi[(\text{DD}/2)+\text{IMT}]^{2}-$

$\quad\pi(\text{DD}/2)^{2};$

and

Elastic modulus $=$ [3/(1 $+$ cross-sectional lumen area/cross-sectional wall area)]/cross-sectional distensibility.

Table 1
The descriptive and analytic data of the groups

	Group	Mean $\pm$ std		$P$
Age	Control	16.09	$\pm$ 0.98	0.43
	Athletes	15.91	$\pm$ 0.87
Height	Control	165.25	$\pm$ 6.36	0.80
	Athletes	166.15	$\pm$ 9.48
Weight*	Control	53.62	$\pm$ 5.9	0.05
	Athletes	66.54	$\pm$ 17.9
BMI*	Control	19.59	$\pm$ 1.23	0.00
	Athletes	23.71	$\pm$ 4.06
TAS*	Control	105.63	$\pm$ 12.03	0.00
	Athletes	120	$\pm$ 13.4
TAD	Control	69.74	$\pm$ 5.59	0.20
	Athletes	72	$\pm$ 8.55
Pulse*	Control	92.63	$\pm$ 18.74	0.02
	Athletes	69.61	$\pm$ 17.21
IMT*	Control	0.35	$\pm$ 0.11	0.01
	Athletes	0.28	$\pm$ 0.10
COMP	Control	0.233	$\pm$ 0.09	0.86
	Athletes	0.237	$\pm$ 0.104
DIST	Control	0.0120	$\pm$ 0.006	0.86
	Athletes	0.011	$\pm$ 0.005
DWS*	Control	737.064	$\pm$ 445.53	0.03
	Athletes	933.640	$\pm$ 298.035
ELAS	Control	73.592	$\pm$ 50.82	0.11
	Athletes	57.405	$\pm$ 0.04

Abbreviations: DWS: diastolic wall stress, TAD: tension diastolic, TAS: tension systolic, IMT: intima media thickness, ELAS: elastic modulus, DIST: distensibility, COMP: compliance; BMI: Body Mass Index. ${}^{*}$ Statistically significant difference. $P<$ 0.05.

The approval for this study was granted by the Institutional Ethics Committee (protocol number: 200; 2016). After providing informed consent, volunteers were recruited from healthy individuals who had sedentary lifestyles, as assessed by the International Physical Activity Questionnaire (first category, inactive: $<$ 600 metabolic equivalent task minutes/week). The exclusion criteria for the study were based on the risk factors associated with coronary artery diseases as well as the signs and symptoms of cardiovascular, pulmonary, and respiratory diseases. These selected individuals met the physical activity standards as required by the criteria of the American College of Sports Medicine on age, health status, symptoms, and risk factors [10].

Figure 1.

Distribution of the intima media thickness (IMT) of carotid arteries according to the groups.

3. Statistics

Measurements and calculations derived from sonography and sphygmomanometer were expressed as mean $\pm$ standard deviation. The Shapiro-Wilk test was used to examine the fitness of the variables for the normal distribution. Student’s t tests were used for normally distributed continuous variables and Mann-Whitney U tests when the distribution was skewed. When $P$ value was less than 0.05, the result was considered statistically significant.

4. Results

The mean age was 15.9 $\pm$ 0.9 years and 16.0 $\pm$ 0.8 years for the wrestlers and control subjects, respectively. Statistically, the Body Mass Index (BMI) was significantly higher in wrestlers (BMI mean $=$ 23.7 $\pm$ 4.0 kg/m ${}^{2}$ ; $P=$ 0.00). The groups had no difference in height ( $P=$ 0.80) and weight ( $P=$ 0.05). The systolic blood pressure (SBP) was significantly higher in wrestlers (SBP $=$ 120 $\pm$ 13.4 mmHg; $P=$ 0.00); the pulse was significantly lower in wrestlers (pulse $=$ 69.61 $\pm$ 17.2 beats/min; $P=$ 0.00); the IMT was significantly lower in wrestlers (IMT mean $=$ 0.288 $\pm$ 0.1 mm; $P=$ 0.01) (Fig. 1); the diastolic wall stress (DWS) was significantly higher in wrestlers (DWS mean $=$ 933.64 $\pm$ 298.0 mmHg; $P=$ 0.03) than controls (Fig. 2).

Figure 2.

Distribution of the diastolic wall stress (DWS, mmHg) of carotid arteries according to the groups.

No significant differences were found in the elastic modulus ( $P=$ 0.11), compliance ( $P=$ 0.86), and distensibility ( $P=$ 0.86) parameters between the groups. The descriptive and analytic data are shown in Table 1.

5. Discussion

Physical fitness parameters such as maximal dynamic strength, isometric strength, explosive strength, and strength endurance are closely related to high-level wrestling performance [2, 3]. Physical fitness has positive effects on vascularization in humans. Acute exercise causes rapid changes in arterial function, while recurrent exercise episodes cause chronic functional adaptation and structural arterial remodeling. These changes depend on the characteristic of the load [11].

Cardiovascular structures are constantly exposed to physical, chemical, and biological stresses during lifetime and subsequently develop vascular muscular hypertrophy and increased cross-linking of connective tissue, resulting in increased collagen deposition and marked distortion in elastin structures [12].

These events collectively accelerate with physical inactivity, subsequently leading to alterations in the biomechanical properties of the arterial wall and the development of increased stiffness or decreased distensibility [13]. The reduced elastic capabilities of the arteries are also associated with numerous diseases. Increased arterial stiffness serves as not only an indicator of vascular aging but also a predictor of end-stage organ damage. Therefore, arterial stiffness is often used as a clinical sign of mortality and morbidity, regardless of other risk factors [14].

Exercise modifies blood flow, luminal wall stress, arterial pressure, and tangential wall stress, resulting in changes in arterial diameter, wall thickness, and function. Some emerging adaptations resulting from hemodynamic stimulation after exercise training have significant clinical effects such as reduction of atherosclerotic risk in arteries, blood pressure control in veins, oxygen distribution and diffusion, and maintenance of microvascular health [15, 16, 17].

The effect of different exercise modalities on the vascular structure has been investigated in the literature. It has not been yet determined which exercise types (aerobic, resistance, or combination) are effective in cardiovascular health. There is no definitive answer to which is more effective on vascular health. Combination exercises are recommended in current practice. The fact that central arterial stiffness after maximal exercise was found to be higher in obese subjects than in healthy individuals suggests that arterial stiffness can be used as a tool to detect subclinical vascular dysfunction [18]. Large elastic arteries were found to harden with age, thereby increasing the risk of cardiovascular diseases. It has been observed that lower extremity interval exercise reduces central arterial stiffness in elderly individuals independently of aerobic exercise and systemic disease [19].

Resistant exercise training (RET) has different effects on arterial stiffness. Au et al. [20] found that RETs caused a decrease in central arterial stiffness in young healthy males regardless of the load weight and inactivity in local carotid artery distensibility or left ventricule mass [14]. RET has a positive effect on the vascular function. It is known that doing regular exercise is good for the vascular structure while heavy exercise creates a vasculature load. Resistance training (RT) has been widely recognized as an effective stimulus for increasing skeletal muscle size and strength. Resistance training is thought to stimulate muscle hypertrophy by increasing muscle activation and muscle swelling [21, 22].

Another study found that short-term aerobic exercise in sedentary individuals has some long-term effects on DWS and elastic module, but has no effects on arterial stiffness and distensibility. Short-term regular exercise also affects arterial stiffness parameters [22, 23]. Nishiwaki et al. [24] observed that 1-h stepwise exercise per week (8 weeks) in elderly women had a small but significant effect on the arterial stiffness [24]. They also observed that arterial stiffness was lower in young swimmers than in sedentary coevals [25]. Chung et al. [26] observed low arterial stiffness in middle-aged men with high cardiorespiratory endur-ance, muscle strength, and flexibility. Arterial stiffness was inversely correlated with fitness in healthy men. Regular exercise is recommended for middle-aged men to avoid arterial stiffness.

A BMI difference in adolescent males with no difference in height and weight was an indicator of having relatively higher muscle mass than fat mass in wrestlers in the present study. Bradycardia was also expected for all athletes. Long term endurance training, as done by elite athletes, is associated with cardiac neural remodeling in favor of cardioprotective vagal mechanisms, resulting in resting bradycardia and augmented contribution of cardiac parasympathetic nerve activity [27]. Systolic BP and DWS were high in wrestlers, suggesting that the arterial tissues of these individuals were more susceptible to stress. Ventricular wall stress is fundamentally involved in cardiac function. Increased ventricular wall stress is known to exhibit unfavorable consequences e.g. an adverse remodeling and imbalance between oxygen consumption and supply. It is hypothesized whether end-diastolic and end-systolic ventricular wall stress is associated with ventricular ejection and diastolic filling [28]. Wrestlers should be followed in terms of cardiac function regularly.

Intima-media thickness (IMT), also called intimal medial thickness, is the measure of the thickness of the innermost two layers of the arterial wall called tunica intima and tunica media. It is usually used for detecting atherosclerotic diseases. It was first described by Paolo Pignoli [29] in 1984. IMT became a useful tool to monitor the noninvasive changes on the artery wall [29]. IMT depends on several factors such as local hemodynamics, blood pressure, and stress. This measurement is usually done by external ultrasonography (US) and rarely by the internal invasive US catheters [30]. Exercise-related vascular health improvements can be evaluated by a number of clinical modalities: flow-mediated dilatation, carotid artery intima-media thickness and arterial stiffness measured by pulse pressure and augmentation index, etc. [31]. The low IMT values of adolescent wrestlers indicated the protective effect of regular exercise against atherosclerosis.

The study by Mangine et al. [32] suggests that following a short-duration training program (8-weeks), baseline size and strength have little impact on performance gains in resistance-trained individuals who possess similar years of experience [32]. Vascular smooth muscle cells are essential components that keep the tonus of the arterial network, which is the channel used to conduct the blood from the heart to the peripheral areas of the body. It is known that mechanical and architectural changes may lead to functional modifications in the cardiovascular system [33]. The cardioprotective effects of exercise training, including direct effects on vascular function and lumen dimension, have been consistently reported in asymptomatic subjects and those with cardiovascular risk factors and diseases [34].

Arterial distensibility is a measure of arterial ability to expand and contract with cardiac pulsation and relaxation. Low distensibility (increased arterial wall stiffness) has been introduced as a risk factor for cardiovascular disease [35, 36, 37]. In our study, an increase in distensibility due to regular exercise was expected in wrestlers. But no difference was found in elastic modulus, compliance, and distensibility parameters between the two groups. It could be concluded that the structural changes in the vascular wall of adolescents were not affected by the exercise training.

6. Conclusion

Physical fitness is essential for vascular health. Exercise-related studies have shown that exercise exerts a direct hemodynamic effect on the arterial wall. High-resolution sonography techniques can accurately measure the arterial wall motion and thus detect vascular pathological changes. Exercise reduces arterial stiffness. Sonography is a cost-effective method that assesses training performance by measuring arterial stiffness.

According to this study, the sonography results revealed that adolescent wrestlers have high BMI, systolic BP, DWS and low IMT and pulse in comparison to healthy controls. No significant structural changes were observed in the vascular wall of wrestlers.

Footnotes

Conflict of interest

None to report.

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Comparison of vascular arterial stiffness parameters of adolescent wrestlers with healthy subjects: Is heavy training harmful for wrestlers?

Abstract

BACKROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Methods

Table 1 The descriptive and analytic data of the groups

4. Results

6. Conclusion

Footnotes

Conflict of interest

References

Table 1
The descriptive and analytic data of the groups