Association between arterial stiffness and autonomic recovery following graded aerobic exercise in healthy young adults ‒ an exploratory pilot study
DOI:
https://doi.org/10.15584/ejcem.2026.2.18Keywords:
aortic stiffness, carotid–femoral pulse wave velocity, autonomic recovery, heart rate variability, heart rate recovery, submaximal aerobic exerciseAbstract
Introduction and aim. Arterial stiffness reflects vascular properties that can influence blood pressure (BP) and heart rate (HR) responses to exercise, but its association with post-exercise autonomic recovery in healthy young adults remains unclear. This exploratory pilot study investigated the relationship between baseline aortic stiffness and post-exercise hemodynamic and autonomic recovery following graded submaximal aerobic exercise.
Material and methods. Thirty healthy young adults (17 women, 13 males; mean age 22.7±2.5 years) underwent baseline evaluation of carotid–femoral pulse wave velocity (cf-PWV), central BP, and pulse wave analysis. Participants completed a graded submaximal cycling protocol from 20 to 80% of the maximum oxygen uptake in 3-minute stages, followed by 5 minutes of seated recovery. HR was continuously recorded and BP measured at 1, 3, and 5 minutes of recovery. Autonomic recovery was assessed using heart rate recovery (HRR) and heart rate variability (HRV) indices. Associations were analyzed using correlation and multivariate linear regression adjusted for age, sex, and body mass index.
Results. Higher baseline cf-PWV was associated with higher peak HR and systolic BP during exercise (p<0.01), and slower HRR at 1 min (r=-0.517, p=0.002). Cf-PWV independently predicted early HRR after adjustment.
Conclusion. In this pilot sample of healthy young adults, greater aortic stiffness was associated with higher BP responses during exercise and slower early autonomic recovery. These findings suggest an association between vascular properties and early postexercise recovery, which should be confirmed in larger studies.
Downloads
References
Iurciuc S, Cimpean AM, Mitu F, Heredea R, Iurciuc M. Vascular aging and subclinical atherosclerosis: why such a "never ending" and challenging story in cardiology? Clin Interv Aging. 2017;12:1339-1345. doi:10.2147/CIA.S141265
Jakovljevic DG. Physical activity and cardiovascular aging: Physiological and molecular insights. Exp Gerontol. 2018;109:67-74. doi:10.1016/j.exger.2017.05.016
Castelli R, Gidaro A, Casu G, et al. Aging of the arterial system. Int J Mol Sci. 2023;24(8):6910. doi:10.3390/ijms24086910
de Waal EEC. Arterial stiffness, assessed with carotid-femoral pulse- wave velocity, and vasopressor response. J Cardiothorac Vasc Anesth. 2021;35(1):81-83. doi:10.1053/j.jvca.2020.09.124
Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588-2605. doi:10.1093/eurheartj/ehl254
Kaya M, Balasubramanian V, K-J Li J. Augmentation index in the assessment of wave reflections and systolic loading. Comput Biol Med. 2019;113:103418. doi:10.1016/j.compbiomed.2019.103418
Sharman JE, Davies JE, Jenkins C, Marwick TH. Augmentation index, left ventricular contractility, and wave reflection. Hypertension. 2009;54(5):1099-1105. doi:10.1161/HYPERTENSIONAHA.109.133066
Moulton MJ, Secomb TW. A fast computational model for circulatory dynamics: effects of left ventricle-aorta coupling. Biomech Model Mechanobiol. 2023;22(3):947-959. doi:10.1007/s10237-023-01690-w
Yang IH, Hwang HJ, Jeon HK, et al. Slow heart rate recovery is associated with increased exercise-induced arterial stiffness in normotensive patients without overt atherosclerosis. J Cardiovasc Imaging. 2019;27(3):214-223. doi:10.4250/jcvi.2019.27.e27
Saz-Lara A, Cavero-Redondo I, Álvarez-Bueno C, Notario-Pacheco B, Ruiz-Grao MC, Martínez-Vizcaíno V. The acute effect of exercise on arterial stiffness in healthy subjects: a meta-analysis. J Clin Med. 2021;10(2):291. doi:10.3390/jcm10020291
Farinatti P, da Silva Itaborahy A, de Paula T, Monteiro WD, Neves MF. Effects of aerobic, resistance and concurrent exercise on pulse wave reflection and autonomic modulation in men with elevated blood pressure. Sci Rep. 2021;11(1):760. doi:10.1038/s41598-020-80800-5
Calleja-Romero A, Vicente-Rodríguez G, Garatachea N. Acute effects of long-distance races on heart rate variability and arterial stiffness: A systematic review and meta-analysis. J Sports Sci. 2022;40(3):248-270. doi:10.1080/02640414.2021.1986276
Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318-1327. doi:10.1016/j.jacc.2009.10.061
Pierce GL, Harris SA, Seals DR, Casey DP, Barlow PB, Stauss HM. Estimated aortic stiffness is independently associated with cardiac baroreflex sensitivity in humans: role of ageing and habitual endurance exercise. J Hum Hypertens. 2016;30(9):513-520. doi:10.1038/jhh.2016.3
Kaminsky LA, Arena R, Myers J, et al. Updated reference standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing: data from the fitness registry and the importance of exercise national database (FRIEND). Mayo Clin Proc. 2022;97(2):285-293. doi:10.1016/j.mayocp.2021.08.020
Storer TW, Davis JA, Caiozzo VJ. Accurate prediction of VO2max in cycle ergometry. Med Sci Sports Exerc. 1990;22(5):704-712. doi:10.1249/00005768-199010000-00024
Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation. 1996;93(5):1043-1065.
Shaffer F, Ginsberg JP. An Overview of heart rate variability metrics and norms. Front Public Health. 2017;5:258. doi:10.3389/fpubh.2017.00258
Burr RL. Interpretation of normalized spectral heart rate variability indices in sleep research: a critical review. Sleep. 2007;30(7):913-919. doi:10.1093/sleep/30.7.913
Peçanha T, Silva-Júnior ND, Forjaz CL. Heart rate recovery: autonomic determinants, methods of assessment and association with mortality and cardiovascular diseases. Clin Physiol Funct Imaging. 2014;34(5):327-339. doi:10.1111/cpf.12102
Haarala A, Kähönen E, Koivistoinen T, et al. Pulse wave velocity is related to exercise blood pressure response in young adults. The cardiovascular risk in young Finns study. Blood Press. 2020;29(4):256-263. doi:10.1080/08037051.2020.1750944
Liu Z, Kuang J, Yan W, Zhu Y, Yang X, Xu Y. Mediating role of arterial stiffness in the association between physical activity and cardiovascular disease risk: a prospective cohort study. Sci Rep. 2025;15(1):38740. doi:10.1038/s41598-025-22442-z
Koivistoinen T, Lyytikäinen LP, Aatola H, et al. Pulse wave velocity predicts the progression of blood pressure and development of hypertension in young adults. Hypertension. 2018;71(3):451-456. doi:10.1161/HYPERTENSIONAHA.117.10368
Tzemos N, Lim PO, Mackenzie IS, et al. Exaggerated exercise blood pressure response and future cardiovascular disease. J Clin Hypertens (Greenwich). 2015;17(11):837-844. doi:10.1111/jch.12629
Michael S, Graham KS, Davis GM. Cardiac autonomic responses during exercise and post-exercise recovery using heart rate variability and systolic time intervals: a review. Front Physiol. 2017;8:301. doi:10.3389/fphys.2017.00301
Park S, Kim HL, Park KT, et al. Association between arterial stiffness and autonomic dysfunction in participants underwent treadmill exercise testing: a cross-sectional analysis. Sci Rep. 2024;14(1):3588. doi:10.1038/s41598-024-53681-1
Kingsley JD, Mayo X, Tai YL, Fennell C. Arterial stiffness and autonomic modulation after free-weight resistance exercises in resistance trained individuals. J Strength Cond Res. 2016;30(12):3373-3380. doi:10.1519/JSC.0000000000001461
Mäki-Petäjä KM, Barrett SM, Evans SV, Cheriyan J, McEniery CM, Wilkinson IB. The role of the autonomic nervous system in the regulation of aortic stiffness. Hypertension. 2016;68(5):1290-1297. doi:10.1161/HYPERTENSIONAHA.116.08035
Gronwald T, Kock H, Röglin L, et al. Recovery of linear and nonlinear heart rate variability metrics after short-term moderate versus vigorous intensity exercise: A cross-sectional randomized cross-over study. Eur J Sport Sci. 2025;25(11):e70077. doi:10.1002/ejsc.70077
Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ. The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol. 2000;525 Pt 1(Pt 1):263-270. doi:10.1111/j.1469-7793.2000.t01-1-00263.x
Pierce DR, Doma K, Leicht AS. Acute effects of exercise mode on arterial stiffness and wave reflection in healthy young adults: A systematic review and meta-analysis. Front Physiol. 2018;9:73. doi:10.3389/fphys.2018.00073
Draghici AE, Taylor JA. The physiological basis and measurement of heart rate variability in humans. J Physiol Anthropol. 2016;35(1):22. doi:10.1186/s40101-016-0113-7
Sandercock GR, Bromley PD, Brodie DA. The reliability of short-term measurements of heart rate variability. Int J Cardiol. 2005;103(3):238-247. doi:10.1016/j.ijcard.2004.09.013
Kleiger RE, Stein PK, Bosner MS, Rottman JN. Time domain measurements of heart rate variability. Cardiol Clin. 1992;10(3):487-498.
Mušić T, Radolović M, Kabaklić A. Autonomic nervous system testing in cardiovascular patients: from research to clinical application. Cardiol Croat. 2026;21(3-4):71-92. doi:10.15836/ccar2026.71
Vivekananthan DP, Blackstone EH, Pothier CE, Lauer MS. Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol. 2003;42(5):831-838. doi:10.1016/s0735-1097(03)00833-7
Qiu S, Cai X, Sun Z, et al. Heart rate recovery and risk of cardiovascular events and all-cause mortality: a meta-analysis of prospective cohort studies. J Am Heart Assoc. 2017;6(5):e005505. doi:10.1161/JAHA.117.005505
Fei DY, Arena R, Arrowood JA, Kraft KA. Relationship between arterial stiffness and heart rate recovery in apparently healthy adults. Vasc Health Risk Manag. 2005;1(1):85-89. doi:10.2147/vhrm.1.1.85.58938
Kim MJ. Carotid arterial stiffness and attenuated heart rate recovery in uncomplicated hypertensive patients. J Cardiovasc Imaging. 2019;27(3):224-226. doi:10.4250/jcvi.2019.27.e39
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 European Journal of Clinical and Experimental Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
