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 to 79 years) men and women with obesity (body mass index 30 to 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.
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