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Aortic aneurysm is a major cause of death in the elderly. It has recently been suggested that patients with aneurysm have increased arterial wall activation of the sympathetic nervous system leading to increased vasoconstriction and hypertension, known as the ‘vasospastic phenotype’. We assessed the effect of strenuous exercise, known to activate the sympatho-adrenal system, on the arterial vasculature and its impact on survival in patients with abdominal aortic aneurysm (AAA). The hypothesis was tested that physical exercise can improve the vasospastic phenotype and consequently survival in patients with AAA. Thirty patients with AAA who had previously undertaken exercise training for 6 weeks following surgery (A group) or no exercise (control group) participated in a randomized cross-over study with exercise training (3 h/day, 5 days/week) or no exercise (A versus control group). At baseline and after training, cardiovascular responses to isometric handgrip were obtained as an index of sympathetic activity. Peripheral flow distribution after exercise during post-ischemic reactive hyperaemia was measured as an index of endothelial function. This was followed by testing of the survival rate. Baseline arterial vasoconstriction, endothelial dysfunction and handgrip stress responses were similar in the A and control group. After training there was increased cardiac index, stroke volume index and stroke work index. Aortic and brachial artery dilatations were also increased with training. Endothelial function was improved but the response to submaximal forearm ischaemia remained unaltered. Exercise improved survival rates (log-rank P = 0.005). Patients with AAA who have previously undertaken training showed improvements in cardiac and peripheral response to exercise. Exercise increased survival rates in patients with AAA. This may be due to changes in sympathetic activity and enhanced endothelial function.Q:
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