Carotid morphofunctional responses to maximal aerobic exercise in patients with coronary artery disease
Original article - e255667 - Published 2026 Aug 12
DOI:
https://doi.org/10.33233/rbfex.v25i2.5667Keywords:
physical exercise, atherosclerosis, endothelial dysfunction, coronary artery diseaseAbstract
Objective: To evaluate the acute effects of maximal aerobic exercise on carotid morphofunctional markers in patients with coronary artery disease (CAD) and healthy individuals. Methods: Patients with CAD (n = 8; 62.3 ± 4.3 years; 27.1 ± 3.1 kg/m²) who had completed phase II of a cardiac rehabilitation program (CRP) and healthy individuals (CONT; n = 5; 61.6 ± 3.5 years; 27.3 ± 3.2 kg/m²) were evaluated for carotid morphofunctional markers by ultrasonography before and after a cardiopulmonary exercise test (CPET). Results: Maximal oxygen uptake was lower in the CAD group compared with CONT (16.7 ± 3.5 vs. 24.0 ± 5.2 mL•kg⁻¹•min⁻¹; P = 0.01). Before CPET, no differences were observed between groups for systolic diameter (CAD: 6.05±0.65 vs. CONT: 6.23 ± 0.20 mm; P = 0.6), diastolic diameter (CAD: 5.41 ± 0.73 vs. CONT: 5.73 ± 0.15 mm; P = 0.4), peak systolic velocity (CAD: 66.27 ± 12.24 vs. CONT: 61.33± 15.67 cm•s⁻¹; P = 0.4), or end-diastolic velocity (CAD: 20.63 ± 4.15 vs. CONT: 21.07 ± 3.97 cm•s⁻¹; P = 0.4). Carotid intima–media thickness (cIMT) was borderline higher in the CAD group (0.93 ± 0.23 vs. 0.71 ± 0.10 mm; P = 0.07). After CPET, both groups showed increases in systolic diameter (CAD: +0.26; CONT: +0.16 mm; P < 0.001), diastolic diameter (CAD: +0.31; CONT: +0.17 mm; P = 0.03), and peak systolic velocity (CAD: + 9.80; CONT: + 8.66 cm·s⁻¹; P = 0.04). End-diastolic velocity (CAD: + 0.60; CONT: −3.75 cm·s⁻¹; P = 0.4) and cIMT (CAD: −0.02; CONT: −0.01 mm; P = 0.1) did not change significantly in either group (P>0.05). No between-group differences were observed in CPET-induced changes. Conclusion: Patients with CAD who had completed phase II of a cardiac rehabilitation program exhibited preserved vascular responses to maximal exercise.
References
1. Tan SCW, Zheng BB, Tang ML, Chu H, Zhao YT, Weng C. Global burden of cardiovascular diseases and its risk factors, 1990-2021: a systematic analysis for the global burden of disease study 2021. QJM. 2025;118(6):411-22. doi: 10.1093/qjmed/hcaf022
2. Libby P, Buring JE, Badimon L, Hansson GK, Deanfield J, Bittencourt MS, et al. Atherosclerosis. Nat Rev Dis Primers. 2019;5(1):56. doi: 10.1038/s41572-019-0106-z
3. Baumgartner R, Forteza MJ, Ketelhuth DFJ. The interplay between cytokines and the Kynurenine pathway in inflammation and atherosclerosis. Cytokine. 2019;122:154148. Cytokine. doi: 10.1016/j.cyto.2017.09.004
4. Jebari-Benslaiman S, Galicia-García U, Larrea-Sebal A, Olaetxea JR, Alloza I, Vandenbroeck K, et al. Pathophysiology of atherosclerosis. Int J Mol Sci. 2022;23(6):3346. doi: 10.3390/ijms23063346
5. Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res. 2014;114(12):1852-66. doi: 10.1161/CIRCRESAHA.114.302721
6. Libby P. The changing landscape of atherosclerosis. Nature. 2021;592(7855):524-33. doi.:10.1038/s41586-021-03392-8
7. Lee W. General principles of carotid Doppler ultrasonography. Ultrasonography. 2014;33(1):11-7. doi: 10.14366/usg.13018
8. Carvalho T, Milani M, Ferraz AS, Silveira ADD, Herdy AH, Hossri CAC, et al. Brazilian Cardiovascular Rehabilitation Guideline - 2020. Arq Bras Cardiol. 2020;114(5):943-87. doi: 10.36660/abc.20200407
9. Byrkjeland R, Stensaeth KH, Anderssen S, Njerve IU, Arnesen H, Seljeflot I, et al. Effects of exercise training on carotid intima-media thickness in patients with type 2 diabetes and coronary artery disease. Influence of carotid plaques. Cardiovasc Diabetol. 2016;15:13. doi: 10.1186/s12933-016-0336-2
10. Wang Y, Wu H, Sun J, Wei M, Wang J, Li H, et al. Effect of exercise on carotid artery intima–media thickness in adults: A systematic review and meta-analysis. J Phys Act Health. 2022;19(12):855-67. doi: 10.1123/jpah.2022-0372
11. Nesti L, Santoni L, Frascerra S, Chiriacò M, Natali AJIJoSN, Metabolism E. Comparison of ramp and step graded cardiopulmonary exercise tests for the estimate of substrate oxidation rates in recreationally active individuals. Int J Sport Nutr Exerc Metab. 2025 May 30;35(5):394-403. doi: 10.1123/ijsnem.2024-0236
12. Lind L, Michaëlsson KJCP, Imaging F. Detailed investigation of multiple resting cardiovascular parameters in relation to physical fitness. Clin Physiol Funct Imaging. 2023;43(2):120-7. doi: 10.1111/cpf.12800
13. Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586. doi: 10.1136/bmj.e7586
14. Matthews CE, Heil DP, Freedson PS, Pastides H. Classification of cardiorespiratory fitness without exercise testing. Medicine and science in sports and exercise. Med Sci Sports Exerc. 1999;31(3):486-93. doi: 10.1097/00005768-199903000-00019
15. Cunha F, Midgley A, Montenegro R, Vasconcellos F, Farinatti PJIjosm. Utility of a non-exercise VO2max prediction model for designing ramp test protocols. Int J Sports Med. 2015;36(10):796-802. doi: 10.1055/s-0034-1395590
16. Pescatello LS. ACSM's guidelines for exercise testing and prescription. Philadelphia: Lippincott Williams & Wilkins; 2013
17. Michalski AC, Ferreira AS, Midgley AW, Costa VAB, Fonseca GF, da Silva NSL, et al. Mixed circuit training acutely reduces arterial stiffness in patients with chronic stroke: a crossover randomized controlled trial. Eur J Appl Physiol. 2023;123(1):121-34. doi: 10.1007/s00421-022-05061-8
18. Howley ET, Bassett DR, Welch HG. Criteria for maximal oxygen uptake: review and commentary. Med Sci Sports Exerc. 1995 Sep;27(9):1292-301. PMID: 8531628
19. Größer V, Weyh C, Böttrich T, Frech T, Nolte S, Sommer N, et al. Association of cardiorespiratory fitness level with vascular function and subclinical atherosclerosis in the elderly. Eur J Appl Physiol. 2024;124(5):1487-97. doi: 10.1007/s00421-023-05375-1
20. Nayor M, Gajjar P, Miller P, Murthy VL, Shah RV, Houstis NE, et al. Arterial stiffness and cardiorespiratory fitness impairment in the community. Heart Assoc. 2023;12(21):e029619. doi: 10.1161/JAHA.123.029619
21. Green DJ, Hopman MT, Padilla J, Laughlin MH, Thijssen DHJPr. Vascular adaptation to exercise in humans: role of hemodynamic stimuli. Physiol Rev. 2017;97(2):495-528. doi: 10.1152/physrev.00014.2016
22. Thijssen DH, Bruno RM, van Mil AC, Holder SM, Faita F, Greyling A, et al. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans. Eur Heart J. 2019;40(30):2534-47. doi: 10.1093/eurheartj/ehz350
23. Liu HB, Yuan WX, Wang QY, Wang YX, Cao HW, Xu J, et al. Carotid arterial stiffness and hemodynamic responses to acute cycling intervention at different times during 12-week supervised exercise training period. Biomed Res Int. 2018;2018:2907548. doi: 10.1155/2018/2907548
24. Yuan W, Liu H, Luan Z, Zhao Z, Shen B. Acute effect of high-intensity interval cycling on carotid arterial stiffness and hemodynamics. Biomed Res Int. 2019:2019:6260286. doi: 10.1155/2019/6260286
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Gabriela Andrade Paz, André Luiz Conveniente Soares, Tatiana Rodrigues dos Santos, Caio Luan Farias Costa, Cláudia de Mello Meirelles, Paulo Sergio Chagas Gomes, Maria das Graças Coelho de Souza, Juliana Pereira Borges
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms: Authors retain the copyright and grant the journal the right of first publication, with the work simultaneously licensed under the Creative Commons Attribution License which allows the sharing of work with acknowledgment of authorship and initial publication in this magazine; Authors are authorized to assume additional contracts separately, for non-exclusive distribution of the version of the work published in this journal (eg, publish in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal; Authors are allowed and encouraged to publish and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this can generate productive changes as well as increase impact and citation of published work (See The Effect of Open Access).
