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tonometer. It is a recently developed technology, which measures central aorticpressures calculated from peripheral arterial pressures (Smulyan et al. 2003;Yasmin and Brown 1999).Firstly, this thesis aims to establish the reliability of the arterial stiffnessestimates using the non-invasive and less intrusive applanation tonometry andits relationship with specific cardiovascular risk factors. Secondly, the thesisaims to establish the effects of a structured supervised exercise programme onarterial stiffness. Thirdly, the thesis aims to establish the effects of earlymanagement of cardiovascular risks in people with pre-existing metabolicsyndrome, using an unsupervised, home-based exercise programme, enhancedwith IT (information technology) support.The objectives of the thesis were:To review the existing literature regarding arterial stiffness and determinefuture research directionsTo assess the reproducibility of non-invasive equipment on measuringthe variables of arterial stiffnessTo establish the relationship between non-invasive arterial stiffnessmeasurement and adiposityTo establish the changes in arterial stiffness following acute exercises indifferent ethnic groupsTo establish the relationship between arterial stiffness and exercisecapacity using simple and advanced techniques4
Page 1 and 2: CHANGES IN ARTERIAL STIFFNESS AND O
Page 3 and 4: ACKNOWLEDGEMENTSWithout the support
Page 5 and 6: TABLE OF CONTENTSCHAPTER 1. INTRODU
Page 7 and 8: 3.1. Introduction .................
Page 9 and 10: 4.6. References ...................
Page 11 and 12: 6.2. Cardiac Rehabilitation (CR) ..
Page 13 and 14: 7.4.1. Pulse wave reflections .....
Page 15 and 16: 8.4.2. Management of insulin resist
Page 17 and 18: 10.1.1. Objectives ................
Page 19 and 20: 11.2.4. IT support ................
Page 21 and 22: LIST OF FIGURESFigure 1.1 The struc
Page 23 and 24: LIST OF TABLESTable 2.1 Commerciall
Page 25 and 26: Table 9.6 Chi-squared independence
Page 27 and 28: SBPSystolic blood pressureSEVRSuben
Page 29 and 30: differed from oxygen consumption un
Page 31: 12345678910111213141516171819202122
Page 35 and 36: een shown in a green font. The fina
Page 37 and 38: Chapter Two is a review of availabl
Page 39 and 40: 1.4. ReferencesBarenbrock, M., Spie
Page 41 and 42: coronary artery disease." Journal o
Page 43 and 44: AbstractCHAPTER 2. ARTERIAL STIFFNE
Page 45 and 46: Figure 2.2 Layers of arterial wallF
Page 47 and 48: Figure 2.4 Windkessel function of t
Page 49 and 50: limit. Beyond that yielding point,
Page 51 and 52: McNulty et al. 2007). They are form
Page 53 and 54: major arteries, which results in ra
Page 55 and 56: 15% the chance of a cardiac event a
Page 57 and 58: medicine 2600 years ago (Ghasemzade
Page 59 and 60: ‘Sphygmometer’, which is compos
Page 61 and 62: Figure 2.12 Von Basch's sphygmomano
Page 63 and 64: Figure 2.14 Mahomed’s sphygmograp
Page 65 and 66: 2006). What followed was enormous p
Page 67 and 68: velocity is calculated from the pul
Page 69 and 70: accurate propagation. However, it i
Page 71 and 72: Table 2.2 Indices of arterial stiff
Page 73 and 74: Figure 2.19 Schematic representatio
Page 75 and 76: 2.4.3. Augmentation pressureThe eje
Page 77 and 78: associated with the work of the hea
Page 79 and 80: 2.6. ReferencesAccetto, R., Rener,
Page 81 and 82: tonometric and piezo-electronic met
Page 83 and 84:
vasodilation in type II diabetes me
Page 85 and 86:
Grotenhuis, H. B., Westenberg, J. J
Page 87 and 88:
devices and phase-contrast magnetic
Page 89 and 90:
Leung, M. C., Meredith, I. T., and
Page 91 and 92:
velocity: influence of timing algor
Page 93 and 94:
O'Rourke, M. F. (1982). Arterial fu
Page 95 and 96:
Schimmler, W. (1965). "Studies on t
Page 97 and 98:
patients and response to nifedipine
Page 99 and 100:
comparison with a common tonometric
Page 101 and 102:
CHAPTER 3. REPRODUCIBILITY OF ARTER
Page 103 and 104:
studies, showing reproducibility of
Page 105 and 106:
The measurements were taken under o
Page 107 and 108:
3.3. ResultsIn total, 57 males and
Page 109 and 110:
indicates strong agreement; and >0.
Page 111 and 112:
Figure 3.1 Bland - Altman limits of
Page 113 and 114:
visits, the time difference between
Page 115 and 116:
similar sample size and reproducibi
Page 117 and 118:
Papaioannou, T. G., Stamatelopoulos
Page 119 and 120:
CHAPTER 4. ACUTE CHANGES IN ARTERIA
Page 121 and 122:
the artery sites. Arterial stiffnes
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study, (ii) not to drink alcohol or
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• Failure of testing equipmentThe
Page 127 and 128:
VCO 2 , respiratory rate (RR), tida
Page 129 and 130:
Table 4.3 Difference between groups
Page 131 and 132:
Table 4.5 Difference in arterial st
Page 133 and 134:
Table 4.7 Significance in Analysis
Page 135 and 136:
4.3.4. Relationship between variabl
Page 137 and 138:
Figure 4.3 VO 2 peak vs. Augmentati
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exercise, then a decline in pulse w
Page 141 and 142:
the exercise capacity may be due to
Page 143 and 144:
difference ethnic groups who are in
Page 145 and 146:
Dawson, E. A., Black, M. A., Pybis,
Page 147 and 148:
O'Brien, E., Asmar, R., Beilin, L.,
Page 149 and 150:
AbstractCHAPTER 5. RELATIONSHIP BET
Page 151 and 152:
adults (Kemper et al. 1999).Body ma
Page 153 and 154:
mid-points. Each skinfold was firml
Page 155 and 156:
Body density = C [M (log 10 sum of
Page 157 and 158:
Table 5.2 Differences in arterial s
Page 159 and 160:
There were no significant correlati
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thickness and post occlusive skin c
Page 163 and 164:
(Chen et al. 2008; Scherrer et al.
Page 165 and 166:
sedentary behaviours such as watchi
Page 167 and 168:
5.6. ReferencesAcree, L. S., Montgo
Page 169 and 170:
artery stiffness at the age of 36 y
Page 171 and 172:
Salmon, J., Bauman, A., Crawford, D
Page 173 and 174:
CHAPTER 6. REVIEW OF LITERATURE- ER
Page 175 and 176:
6.1.2. Erection physiologyThe penis
Page 177 and 178:
Figure 6.1 Impact of age on erectil
Page 179 and 180:
Figure 6.2 The range of causes of e
Page 181 and 182:
and decreased endothelial and neuro
Page 183 and 184:
6.1.6. ED as a predictor of CADIt h
Page 185 and 186:
2006). Litwin et al (1998) studied
Page 187 and 188:
Step 1: Sexual function should be a
Page 189 and 190:
of veno-occlusive mechanism (Lue an
Page 191 and 192:
The target groups for CR are acute
Page 193 and 194:
• Cardio-protective diet• Sensi
Page 195 and 196:
Phase IIIPhase III is a well recogn
Page 197 and 198:
Increased vagal activity, on the ot
Page 199 and 200:
6.2.2.2. Effects of cardiac rehabil
Page 201 and 202:
performance of a healthy lifestyle
Page 203 and 204:
Israel. The sexual therapy patients
Page 205 and 206:
6.4. ReferencesBacon, C. G., Mittle
Page 207 and 208:
Goldstein, I. (2000). "Male sexual
Page 209 and 210:
Lavie, C. J., and Milani, R. V. (20
Page 211 and 212:
NSF. (2000). "Coronary heart diseas
Page 213 and 214:
CHAPTER 7. CHANGES IN ERECTILE DYSF
Page 215 and 216:
Modern cardiac rehabilitation (CR)
Page 217 and 218:
Research & Governance, a patient ed
Page 219 and 220:
demonstrates a high reliability and
Page 221 and 222:
The medications administered to the
Page 223 and 224:
change the category of their ED sev
Page 225 and 226:
Table 7.4 The pulse wave analysis r
Page 227 and 228:
affected the number of participants
Page 229 and 230:
7.4.1.2. Augmentation Index (AIx)Th
Page 231 and 232:
effective in improving the arterial
Page 233 and 234:
individuals irrespective of the sev
Page 235 and 236:
Sildenafil accounted for a successf
Page 237 and 238:
The study was not designed to ident
Page 239 and 240:
Enko, K., Sakuragi, S., and Kusano,
Page 241 and 242:
Oliver, J. J., and Webb, D. J. (200
Page 243 and 244:
AbstractCHAPTER 8. METABOLIC SYNDRO
Page 245 and 246:
The World Health Organisation (WHO)
Page 247 and 248:
Table 8.1 Comparison of the criteri
Page 249 and 250:
according to the number of metaboli
Page 251 and 252:
8.2.2. Insulin resistanceInsulin re
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over 60 years in American men. Amon
Page 255 and 256:
cardiorespiratory fitness and young
Page 257 and 258:
8.3. Prevalence of metabolic syndro
Page 259 and 260:
heart diseases occur more often and
Page 261 and 262:
of antihypertensive drugs has been
Page 263 and 264:
8.4.5. LifestyleLifestyle change is
Page 265 and 266:
childhood. Healthy eating habits sh
Page 267 and 268:
8.6. ReferencesAbbasi, F., Brown, B
Page 269 and 270:
the International Diabetes Federati
Page 271 and 272:
Camus, J. P. (1966). "[Gout, diabet
Page 273 and 274:
Dumas, M. A. (2003). "Reversing the
Page 275 and 276:
Freire, R. D., Cardoso, M. A., Gime
Page 277 and 278:
Dose-Responses to Exercise Training
Page 279 and 280:
findings from the Third National He
Page 281 and 282:
Lichtman, S. W., Pisarska, K., Berm
Page 283 and 284:
Indian children is associated with
Page 285 and 286:
Perel, P., Langenberg, C., Ferrie,
Page 287 and 288:
metabolic characteristics of an obe
Page 289 and 290:
syndrome in overweight and obese Ja
Page 291 and 292:
9.1. IntroductionAccording to the W
Page 293 and 294:
is essential to initiate early dete
Page 295 and 296:
Hypertension was defined according
Page 297 and 298:
squared test. Odds Ratios (ORs) and
Page 299 and 300:
9.3.1. Obesity, diabetes and hypert
Page 301 and 302:
percentages of individual MS risk f
Page 303 and 304:
274Table 9.4 Demographic details an
Page 305 and 306:
Table 9.7 lists the chi-squared ind
Page 307 and 308:
9.4. DiscussionIt is important to o
Page 309 and 310:
polyunsaturated fats (PUFA) and tra
Page 311 and 312:
an important factor because metabol
Page 313 and 314:
9.6. ReferencesAmerican Heart Assoc
Page 315 and 316:
Misra, A., Khurana, L., Isharwal, S
Page 317 and 318:
CHAPTER 10. ACUTE CHANGES IN ARTERI
Page 319 and 320:
(Kingwell 2002). Acute exercise res
Page 321 and 322:
with metabolic syndrome were invite
Page 323 and 324:
the homogeneity of the variances. T
Page 325 and 326:
and diastolic (atrial diastole) par
Page 327 and 328:
10.3.3. Age group changesThe differ
Page 329 and 330:
Table 10.3 Comparison of changes in
Page 331 and 332:
Table 10.5 Comparison of pre ISWT a
Page 333 and 334:
Table 10.6 Correlations between exe
Page 335 and 336:
the distensibility of the artery is
Page 337 and 338:
10.4.2. Age and arterial stiffnessT
Page 339 and 340:
significantly predict mortality and
Page 341 and 342:
10.6. ReferencesAmerican Thoracic S
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hypertriglyceridemia in healthy men
Page 345 and 346:
haemodynamics in healthy young men.
Page 347 and 348:
11.1. Introduction11.1.1. Metabolic
Page 349 and 350:
equally effective as supervised hos
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H2- There will be significant effec
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11.2.3. Exercise programmeAll the p
Page 355 and 356:
variables in relation to sex and ag
Page 357 and 358:
11.3.2. Changes in health related q
Page 359 and 360:
11.3.3. Changes in metabolic syndro
Page 361 and 362:
11.3.4. Effects of age and genderTh
Page 363 and 364:
circumference and BMI were not chan
Page 365 and 366:
No measurements were taken on infla
Page 367 and 368:
Nevertheless, this study showed no
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mobile texts and calls, improves th
Page 371 and 372:
on exercise modalities and independ
Page 373 and 374:
Grundy, S. M., Cleeman, J. I., Dani
Page 375 and 376:
Laaksonen, D. E., Lakka, H. M., Sal
Page 377 and 378:
Roberts, C. K., Ng, C., Hama, S., E
Page 379 and 380:
CHAPTER 12. SUMMARY AND CONCLUSIONS
Page 381 and 382:
CHAPTER 5: RELATIONSHIP BETWEEN BOD
Page 383 and 384:
CHAPTER 9: PREVALENCE OF HYPERTENSI
Page 385 and 386:
12.3. Practical limitations of the
Page 387 and 388:
syndrome is not known in many devel
Page 389 and 390:
endothelial function due to increas
Page 391 and 392:
Figure A.1.2. Bland - Altman limits
Page 393 and 394:
Figure A.1.4 Bland - Altman limits
Page 395 and 396:
Figure A.1.6. Bland - Altman limits
Page 397 and 398:
Page 399 and 400:
Page 401 and 402:
APPENDIX II.Scatter graphs showing
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Fig. A.2.3 VO 2 Peak vs. augmentati
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Fig. A.2.5 VO 2 Peak vs.augmentatio
Page 407 and 408:
Fig. A.2.7 VO 2 Peak vs. aortic aug
Page 409 and 410:
Fig. A.2.9 VO 2 Peak vs. aortic pul
Page 411 and 412:
Fig. A.2.11 VO 2 Peak vs. aortic sy
Page 413 and 414:
Fig. A.2.13 VO2 Peak vs. aortic Dai
Page 415 and 416:
Fig. A.2.15 VO2 Peak vs. mean press
Page 417 and 418:
Fig. A.2.17 VO2 Peak vs. aortic eje
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Fig. A.2.19 VO2 Peak vs. subendocar
Page 421 and 422:
Fig. A.2.21 VO2 Peak vs. heart rate
Page 423 and 424:
APPENDIX III. Previous literatures
Page 425 and 426:
Gupta et al (2004)Misra et al (2005
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Azizi et al (2003)Iran (Tehran,urba
Page 429 and 430:
Bataille et al.(2006)France50-59 10
Page 431 and 432:
803 African-Caribbeans(57% male)ATP
Page 433:
Lanz et al (2006)BrazilAdults Going
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