Effects of Exercise Training on Vascular Markers of Disease Progression in Patients with Small Abdominal Aortic Aneurysms

BACKGROUND: Currently, no medical therapy is effective in limiting progression of small abdominal aortic aneurysms (AAA; <= 5.5 cm). Previously, we have demonstrated safety and efficacy of exercise training in patients with AAA. However, the impact of exercise training on vascular markers of AAA progression, such as lipid accumulation product and matrix metalloproteinase 9 (MMP-9, linked to destruction of aortic matrix), is unknown. The aim of this study was to assess the impact of exercise training on AAA diameter, lipid accumulation product, MMP-9, and other risk markers of vascular disease. METHODS: In this randomized trial, complete data of 96 patients (male: n = 87, female: n = 9; exercise training (exercise) n = 42, usual care n = 54) were studied. Changes in AAA diameter, exercise capacity, lipid accumulation product (men = [waist circumference 65] x fasting triglycerides; women = [waist circumference - 58] x triglycerides) and MMP-9 were performed. RESULTS: The exercise group demonstrated a significant increase in maximal exercise time and estimated metabolic equivalent of tasks. Lipid accumulation product decreased in exercise and increased in usual care (P <.001 between groups); MMP-9 remained statistically unchanged in exercise, but increased significantly in usual care (P =.005; between groups P =.094). In both groups, there was a significant increase in transverse diameter, but no difference between groups; neither group assignment nor level of fitness correlated with AAA enlargement. No adverse clinical events occurred. CONCLUSIONS: This is the first study to demonstrate that in AAA, exercise beneficially modifies lipid accumulation product and MMP-9, both markers of vascular disease, without inducing aneurysmal growth beyond what is otherwise observed during usual care. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

Exercise training in patients with small abdominal aortic aneurysms was found to positively affect lipid accumulation product and matrix metalloproteinase 9, without inducing abnormal aneurysmal growth. The exercise group showed increased maximal exercise time and estimated metabolic equivalent of tasks.