Tuesday, October 3, 2023

Training for first marathon reduces heart ageing by 4 years

Age-Related Aortic Stiffening, which is an independent predictor for blood pressure, heart disease, and stroke, can be lowered by exercise.

Executive Summary

Our blood arteries including the Aorta, the largest artery that supplies blood to the body, get stiffer due to ageing. This hardening is correlated with many diseases such as high BP, heart disease, stroke, and type 2 diabetes.

Training for your first marathon was found to reduce aortic stiffness equivalent of 4 years of ageing. In other words, your arterial hardening–related disease chances reduce as if you were 4 years younger. This benefit is more prominently seen in older and slower men marathoners.

As we age, our heart arteries lose their flexibility. The arterial stiffening makes even healthy individuals susceptible to heart disease and its risky outcomes. A marathon training program can reverse this hardening.

Organ ageing

Ageing is a very complicated topic. However, one way is to consider ageing in terms of organ ageing.

Various organs in the body age at different rates. For example, if one is an alcoholic, the liver will get damaged much faster than in a normal individual. Thus, a 50–year old alcoholic may have a 50–year old’s eyesight but a 75–year old’s liver.

In a body, different organs will age at different rates depending on the abuse they face and one’s genetic makeup. Often, it may be the weakest link —the ‘oldest’ organ—that may decide the quality of life, or the lifespan, of the individual.

Cardiovascular ageing

Our heart pumps blood in noticeable pulses. These happens because our heart beats 40–200 times a minute. The blood is pushed out to the body that many times.

As the blood flow pulses through arteries, the corresponding increase and decrease in blood pressure is counteracted by the flexibility of arteries.

When the arteries are supple, as in young age, they expand and release pressure whenever there is an increase in blood pressure.

However, as we age, the arteries supplying blood to various parts of our body stiffen slowly. As the arteries harden, various organs in the body start feeling this blood pressure change. Over years, such organs can get damaged. Also, various problems related to heart disease start showing up.

Reasons for vascular hardening

With age, various degenerative changes take place in the walls of arteries.

The arterial walls have fibers of elastin protein, which can stretch to 1.5 times their original size and snap back. With repeated cycles of mechanical stress such as rise and fall in blood pressure, their closely packed structure starts fraying.

The walls also have collagen protein, which confer rigidity, or compressive strength, to the arteries. To compensate for loss of elastin, the collagen content of the arteries increases. Excess collagen also gets deposited in the walls through a process called Fibrosis, or formation of excess fibrous connective tissue.

When proteins or fats are exposed to sugar—such as that in our blood—over the years, they get glycated. The Advanced Glycation Endproducts (AGEs) crosslink the adjacent collagen fibers in the arteries, hardening them.

Aortic stiffness

Cardiovascular magnetic resonance distensibility test measures aortic stiffness. Using years of medical research data, we know the ‘chronological age’–’aortic stiffness’ relationship. That is, we know how the aortic stiffness changes with age. Knowing this, we can calculate biological ‘aortic age’ of one’s aorta—the main artery in the body.

Aortic stiffness is a very well researched subject. This article in the journal Integrated Blood Pressure Control explains aortic stiffness and its clinical significance.

An article in the journal Hypertension explains that aortic stiffness is an independent predictor of development of high blood pressure problem in normal people.

Another article in the journal Stroke claims that aortic stiffness is an independent predictor of fatal stroke in high BP patients.

Another paper in the journal Cardiovascular Diabetology showed that in type 2 diabetics, aortic stiffness is independently associated with poor blood sugar control and adverse cardiovascular events such as heart attacks.

A paper in the journal PLOS ONE showed that obesity is a strong predictor of aortic stiffness.

An article published in Nov 2019 in the journal International Journal of Obesity showed that exercise improved many health parameters in obese children but it did not improve aortic stiffness.

All in all, increased aortic stiffness is not a good sign, though it is inevitable with ageing. And lowering aortic stiffness is not an easy task.

New Study

Researchers took 139 healthy untrained people between age 21 to 69 years, 51% of which were women. These runners trained (ran) about 10 to 20 km/week for 6 months before completing their first marathon: London Marathon.

Their aortic stiffness was measured at three locations along the aorta, before starting the training and after completing the marathon. Their systolic (SBP) and diastolic (DBP) central (aortic) blood pressures were also measured.


Training decreased their SBP by 4 mm Hg and DBP by 3 mm Hg. The distensibility (or flexibility, in layman’s language) of the descending aorta reduced by 9% to 16% during the training. This was equivalent of a reduction in ‘aortic age’ by 3.9 to 4.0 years.

This benefit was even more significant in older, male participants with slower running times.

These results were published in the Journal of the American College of Cardiology in Jan 2020: Training for a First-Time Marathon Reverses Age-Related Aortic Stiffening.


Undertaking training for a first–time marathon sounds like an extreme step to improve cardiovascular age. And it is.

However, one must note that poor fitness is an independent marker for early death. Read two articles on this website to judge how serious a risk you carry as a result of your fitness:
1. This simple fitness test can predict if you will die early.
2. A simple treadmill test to measure the risk of dying.

In other words, do pay proper attention to your fitness, especially as you age beyond 35–40 years.

Actionable tips

  1. Incorporate fitness activities in your daily regimen.
    Check with your doctor first, if you are carrying any medical condition.
  2. Understand that ageing is inevitable; but ageing slowly is optional.
    Accept ageing as a natural outcome. But don’t accept ageing at a normal pace as natural. Fight it through proper exercise, adequate sleep, reduced stress, mindfulness, healthy diet and proper dietary supplementation.

First published on: 18th January 2020

Image by Skeeze from Pixabay


  1. Thank you, Madhur. The statement, “This benefit is more prominently seen in older and slower men marathoners” is indeed *heart*ening. I began running recently, and have been at it for 5 months or so, barring a 9-month break for family reasons. Your article encourages me to continue, and increase my distance over time.


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