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Physical activity is associated with lower pulsatile stress but not carotid stiffness in children


The cardiovascular disease (CVD) process may begin early in life when accompanied by atherosclerotic risk factors. CVD risk factors in children are associated with stiffening of the large elastic arteries, a reflection of subclinical atherosclerosis. Physical activity is a preventative lifestyle strategy that may benefit arterial stiffness by attenuating the hemodynamic stress on the artery wall. This study examined the relations between physical activity, carotid pulsatile stress, and carotid stiffness in children. One hundred and forty children (9–11 yrs; 50.0% male, 57.9% African-American, 42.10% Caucasian, body mass index (BMI) 20.1 ± 4.7 kg/m2) participated in this study. Physical activity counts were measured using a wrist-worn accelerometer and averaged over 7 days. Carotid artery β-stiffness and pulse pressure (calibrated to brachial mean and diastolic pressure) were assessed as via ultrasound and tonometry, respectively. Pulsatile stress was calculated as the product of carotid pulse pressure and heart rate. Physical activity counts were correlated with pulsatile stress (r = −0.27), and BMI (r = −0.23), but were unrelated to carotid stiffness. In multivariate models, associations between physical activity counts and pulsatile stress remained (B = −1.3 [95%CI, −2.4, −0.2], β = −0.20, p < 0.05) after covariate adjustment for age, race, sex, pubertal stage, and BMI. Carotid pulsatile stress was related to regional carotid stiffness (r = 0.45, p < 0.05). These data suggest that higher levels of physical activity at young age are associated with lower hemodynamic stress in the carotid artery. Findings are discussed in the context of an inverse relationship between hemodynamic pulsatile stress and carotid stiffness in children.

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Fig. 1: Associations between physical activity counts and vascular parameters in children.


  1. 1.

    Berenson GS, Srinivasan SR, Bao W, Newman WP, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med. 1998;338:1650–6.

    CAS  Article  Google Scholar 

  2. 2.

    McGill J, McMahan CA, Herderick EE, Malcom GT, Tracy RE, Jack P Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr. 2000; 72,

  3. 3.

    Senzaki H, Akagi M, Hishi T, Ishizawa A, Yanagisawa M, Masutani S, et al. Age-associated changes in arterial elastic properties in children. Eur J Pediatr. 2002;161:547–51.

    Article  Google Scholar 

  4. 4.

    Pais C, Correia-Costa L, Moura C, Mota C, Severo M, Guerra A, et al. Accelerated growth during childhood is associated with increased arterial stiffness in prepubertal children. Int J Cardiol. 2016;204:83–5.

    Article  Google Scholar 

  5. 5.

    Pandit D, Kinare A, Chiplonkar S, Khadilkar A, Khadilkar V. Carotid arterial stiffness in overweight and obese Indian children. J Pediatr Endocrinol Metab. 2011;24:97–102.

    CAS  Article  Google Scholar 

  6. 6.

    Cote AT, Phillips AA, Harris KC, Sandor GGS, Panagiotopoulos C, Devlin AM. Obesity and arterial stiffness in children: Systematic review and meta-analysis. Arterioscler Thromb Vasc Biol. 2015;35:1038–44.

    CAS  Article  Google Scholar 

  7. 7.

    Iannuzzi A, Licenziati MR, Acampora C, Renis M, Agrusta M, Romano L, et al. Carotid artery stiffness in obese children with the metabolic syndrome. Am J Cardiol. 2006;97:528–31.

    Article  Google Scholar 

  8. 8.

    Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, et al. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet. 2001;358:1400–4.

    CAS  Article  Google Scholar 

  9. 9.

    Urbina EM, Kimball TR, McCoy CE, Khoury PR, Daniels SR, Dolan LM. Youth with obesity and obesity-related type 2 diabetes demonstrate abnormalities in carotid structure and function. Circulation. 2009;119:2913–9.

    CAS  Article  Google Scholar 

  10. 10.

    Proudfoot NA, King-Dowling S, Cairney J, Bray SR, MacDonald MJ, Timmons BW Physical activity and trajectories of cardiovascular health indicators during early childhood. Pediatrics. 2019; 144,

  11. 11.

    Köchli S, Endes K, Steiner R, Engler L, Infanger D, Schmidt-Trucksäss A, et al. Obesity, high blood pressure, and physical activity determine vascular phenotype in young children. Hypertens (Dallas, Tex 1979). 2019;73:153–61.

    Article  Google Scholar 

  12. 12.

    Haapala EA, Väistö J, Veijalainen A, Lintu N, Wiklund P, Westgate K, et al. Associations of objectively measured physical activity and sedentary time with arterial stiffness in pre-pubertal children. Pediatr Exerc Sci. 2017;29:326–35.

    Article  Google Scholar 

  13. 13.

    Urbina EM, Williams RV, Alpert BS, Collins RT, Daniels SR, Hayman L, et al. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: A scientific statement from the american heart association. Hypertension. 2009;54:919–50.

    CAS  Article  Google Scholar 

  14. 14.

    Lefferts WK, DeBois JP, Gump BB, Heffernan KS. Carotid artery stiffness and cerebral pulsatility in children Wesley. Artery Res. 2018;22:64–7.

    Article  Google Scholar 

  15. 15.

    Mikola H, Pahkala K, Ronnemaa T, Viikari JSA, Niinikoski H, Jokinen E, et al. Distensibility of the aorta and carotid artery and left ventricular mass from childhood to early adulthood. Hypertension. 2015;65:146–52.

    CAS  Article  Google Scholar 

  16. 16.

    Cheung YF, Wong SJ, Ho MHK. Relationship between carotid intima-media thickness and arterial stiffness in children after Kawasaki disease. Arch Dis Child. 2007;92:43–47.

    Article  Google Scholar 

  17. 17.

    Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, et al. Recommendations for improving and standardizing vascular research on arterial stiffness. Hypertension. 2015;66:698–722.

    CAS  Article  Google Scholar 

  18. 18.

    Juonala M, Järvisalo MJ, Mäki-Torkko N, Kähönen M, Viikari JSA, Raitakari OT. Risk factors identified in childhood and decreased carotid artery elasticity in adulthood: the cardiovascular risk in young finns study. Circulation. 2005;112:1486–93.

    Article  Google Scholar 

  19. 19.

    Liang Y, Hou D, Shan X, Zhao X, Hu Y, Jiang B, et al. Cardiovascular remodeling relates to elevated childhood blood pressure: Beijing Blood Pressure Cohort Study. Int J Cardiol. 2014;20:836–9.

    Article  Google Scholar 

  20. 20.

    Chu C, Dai Y, Jianjun M, Yang R, Wang M, Yang J, et al. Associations of risk factors in childhood with arterial stiffness 26 years later. J Hypertens. 2017;35:S10–S15.

    CAS  Article  Google Scholar 

  21. 21.

    Jae SY, Heffernan KS, Yoon ES, Park SH, Choi YH, Fernhall B, et al. Pulsatile stress, inflammation and change in arterial stiffness. J Atheroscler Thromb. 2012;19:1035–42.

    Article  Google Scholar 

  22. 22.

    Greenwald SE. Ageing of the conduit arteries. J Pathol. 2007;211:157–72.

    CAS  Article  Google Scholar 

  23. 23.

    Lear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Iqbal R, et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet. 2017;390:2643–54.

    Article  Google Scholar 

  24. 24.

    Karatzi K, Moschonis G, Botelli S, Androutsos O, Chrousos, George P, et al. Physical activity and sedentary behavior thresholds for identifying childhood hypertension and its phenotypes: The Healthy Growth Study. J Am Soc Hypertens. 2018;12:714–22.

    Article  Google Scholar 

  25. 25.

    Pälve KS, Pahkala K, Magnussen CG, Koivistoinen T, Juonala M, Kähönen M, et al. Association of physical activity in childhood and early adulthood with carotid artery elasticity 21 years later: the cardiovascular risk in Young Finns Study. J Am Heart Assoc. 2014;3:1–10.

    Article  Google Scholar 

  26. 26.

    Juonala M, Viikari JSA, Kähönen M, Taittonen L, Laitinen T, Hutri-Kähönen N, et al. Life-time risk factors and progression of carotid atherosclerosis in young adults: the Cardiovascular Risk in Young Finns study. Eur Heart J. 2010;31:1745–51.

    CAS  Article  Google Scholar 

  27. 27.

    Lefferts WK, Augustine JA, Spartano NL, Atallah-Yunes NH, Heffernan KS, Gump BB. Racial differences in aortic stiffness in children. J Pediatr. 2017;180:62–7.

    Article  Google Scholar 

  28. 28.

    Gump BB, Dykas M, MacKenzie JA, Dumas AK, Hruska B, Ewart CK, et al. High normal lead and mercury exposures: psychological and behavioral problems in children. Enviromental Res. 2017;158:576–82.

    CAS  Article  Google Scholar 

  29. 29.

    Petersen AC, Crockett L, Richards M, Boxer A. A self-report measure of pubertal status: Reliability, validity, and initial norms. J Youth Adolesc. 1988;17:117–33.

    CAS  Article  Google Scholar 

  30. 30.

    Orsso CE, Silva MIB, Gonzalez MC, Rubin DA, Heymsfield SB, Prado CM, et al. Assessment of body composition in pediatric overweight and obesity: a systematic review of the reliability and validity of common techniques. Obes Rev. 2020;21:1–18.

    Article  Google Scholar 

  31. 31.

    Gump BB, MacKenzie JA, Dumas AK, Palmer CD, Parsons PJ, Segu ZM, et al. Fish consumption, low-level mercury, lipids, and inflammatory markers in children. Enviromental Res. 2012; 112;204–11.

    CAS  Article  Google Scholar 

  32. 32.

    Lefferts WK, Deblois JP, Receno CN, Barreira TV, Brutsaert TD, Carhart RL, et al. Effects of acute aerobic exercise on arterial stiffness and cerebrovascular pulsatility in adults with and without hypertension. J Hypertens. 2018;36:1743–52.

    CAS  Article  Google Scholar 

  33. 33.

    Lefferts WK, DeBlois JP, Augustine JA, Keller AP, Heffernan KS. Age, sex, and the vascular contributors to cerebral pulsatility and pulsatile damping. J Appl Physiol. 2020;129:1092–101.

    CAS  Article  Google Scholar 

  34. 34.

    Kaess BM, Larson MG, Hamburg NM, Vita JA, Levy D, Benjamin EJ. Aortic stiffness, blood pressure progression, and incident. Hypertension 2012;308:875–81.

    CAS  Google Scholar 

  35. 35.

    Zachariah JP, Graham DA, de Ferranti SD, Vasan RS, Newburger JW, Mitchell GF. Temporal trends in pulse pressure and mean arterial pressure during the rise of pediatric obesity in US children. J Am Heart Assoc. 2014;3:1–10.

    Article  Google Scholar 

  36. 36.

    Farah BQ, Christofaro DGD, Balagopal PB, Cavalcante BR, de Barros MVG, Ritti-Dias RM. Association between resting heart rate and cardiovascular risk factors in adolescents. Eur J Pediatr. 2015;174:1621–8.

    Article  Google Scholar 

  37. 37.

    McEniery CM, Spratt M, Munnery M, Yarnell J, Lowe GD, Rumley A, et al. An analysis of prospective risk factors for aortic stiffness in men: 20-year follow-up from the caerphilly prospective study. Hypertension. 2010;56:36–43.

    CAS  Article  Google Scholar 

  38. 38.

    Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin XE, Herrmann FR, Beghetti M. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol. 2009;54:2396–406.

    CAS  Article  Google Scholar 

  39. 39.

    Oliveira RS, Barker AR, Wilkinson KM, Abbott RA, Williams CA. Is cardiac autonomic function associated with cardiorespiratory fitness and physical activity in children and adolescents? A systematic review of cross-sectional studies. Int J Cardiol. 2017;236:113–22.

    Article  Google Scholar 

  40. 40.

    Pandit D, Khadilkar A, Chiplonkar S, Khadilkar V, Kinare A. Arterial stiffness in obese children: role of adiposity and physical activity. Indian J Endocrinol Metab. 2014;18:70–6.

    Article  Google Scholar 

  41. 41.

    Cooke AB, Daskalopoulou SS, Dasgupta K. The impact of accelerometer wear location on the relationship between step counts and arterial stiffness in adults treated for hypertension and diabetes. J Sci Med Sport. 2018;21:398–403.

    Article  Google Scholar 

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This study was funded by NIH NIEHS R01 ES023252 02 (PI: BBG). WKL is currently supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number T32HL134634. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We wish to express our gratitude to the participants and their families/guardians for their willingness to participate in this study, and to the Environmental Exposures and Child Health Outcomes (EECHO) research team for their help with logistics and data collection.


This study was funded by NIH NIEHS R01 ES023252 02 (PI: BBG). WKL is currently supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number T32HL134634. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Lima, N.S., Krishna, H., Gerber, B.S. et al. Physical activity is associated with lower pulsatile stress but not carotid stiffness in children. J Hum Hypertens (2021).

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