Vascular Remodeling in Response to 12 wk

of Upper Arm Unilateral Resistance Training

ROBERT F. ZOELLER1, THEODORE J. ANGELOPOULOS2, BENJAMIN C. THOMPSON3,
MARLENE R. WENTA3, THOMAS B. PRICE4, PAUL D. THOMPSON5, NIALL M. MOYNA6,
RICHARD L. SEIP5, PRISCILLA M. CLARKSON7, PAUL M. GORDON8, LINDA S. PESCATELLO9,
JOSEPH M. DEVANEY10, HEATHER GORDISH-DRESSMAN10, ERIC P. HOFFMAN10, and PAUL S. VISICH3
1
Florida Atlantic University, Davie, FL; 2University of Central Florida, Orlando, FL; 3Central Michigan University, Mt.
Pleasant, MI; 4Connecticut State University, Hartford, CT; 5Hartford Hospital, Hartford, CT; 6Dublin City University,
Dublin, IRELAND; 7University of Massachusetts, Amherst, MA; 8West Virginia University, Morgantown, WV; 9University of
Connecticut, Storrs, CT; and 10Children’s National Medical Center, Washington, DC

ABSTRACT

BASIC SCIENCES
ZOELLER, R. F., T. J. ANGELOPOULOS, B. THOMPSON, M. WENTA, T. B. PRICE, P. D. THOMPSON, N. M. MOYNA,
R. L. SEIP, P. CLARKSON, P. M. GORDON, L. S. PESCATELLO, J. DEVANEY, H. GORDISH-DRESSMAN, E. P.
HOFFMAN, and P. S. VISICH. Vascular Remodeling in Response to 12 wk of Upper Arm Unilateral Resistance Training.
Med. Sci. Sports Exerc., Vol. 41, No. 11, pp. 2003–2008, 2009. Participation in regular aerobic exercise has been shown to
increase arterial size and that exercise-induced vascular remodeling may be regional rather than systemic. However, these issues
have been minimally investigated concerning resistance training. Purposes: To determine whether 1) resistance training of the
nondominant arm elicits an increase in diameter of the brachial artery and 2) unilateral training induces arterial remodeling in the
contralateral arm. Methods: Twenty-four previously untrained participants, consisting of 18 females (aged 22.3 T 5.1 yr) and 6 males
(aged 21.7 T 1.8 yr), participated in unilateral strength training of the biceps and triceps for 12 wk using their nondominant arm.
Isotonic (one-repetition maximum, 1RM) and isometric (ISO) strength of the biceps were assessed before and after training on both
arms. Brachial artery diameter and biceps muscle cross-sectional area (CSA) of both arms were also measured before and after training
using magnetic resonance imaging (MRI). Results: Brachial artery diameter increased 5.47% (P G 0.05) in the nondominant trained arm
with no change observed in the dominant untrained arm. Biceps CSA increased 18.3% (P G 0.05) in the trained arm with no change
(P 9 0.05) in the untrained limb. Nondominant 1RM and ISO strength increased by 35.1% and 16.8%, respectively (P G 0.05 for both),
although there were no significant changes (P 9 0.05) in the contralateral arm. A modest correlation was found between the increases in
CSA and in brachial artery diameter (r2 = 0.19, P = 0.039). Conclusions: These results indicate that upper arm vascular remodeling,
manifesting as increased brachial artery diameter, can result from resistance training and that these changes are localized to the trained
limb and associated with increases in CSA. Key Words: BRACHIAL ARTERY, MAGNETIC RESONANCE IMAGING (MRI),
ARTERIAL DIAMETER, CROSS-SECTIONAL AREA (CSA)

E
xercise-induced vascular remodeling, as manifested ther, the reduction in vessel diameter was shown to be
in an increased arterial diameter, is generally ac- endothelium-dependent. Other studies have found that in-
cepted as an adaptive response to mediate the in- creases in arterial diameter in response to increased blood
creases in transmural pressure and vessel wall stress flow are induced by an increased expression of endothe-
associated with exercise training (14,20). As early as 1893, lial nitric oxide synthase secondary to greater shear stress
Thoma (27) observed a relationship between blood flow and (8,10,14,23,30,31). More simply stated, it seems that the
vessel caliber. A classic study by Langille and O’Donnell exercise training-induced enlargement of conduit vessels,
(13) demonstrated that a chronic reduction in blood flow i.e., arteries, is a chronic adaptation stimulated by nitric oxide
resulted in a significant reduction in vessel diameter. Fur- release from the endothelium in response to increased shear
stress. It is thought that this adaptive response serves to me-
diate the increases in transmural pressure and wall stress as-
Address for correspondence: Paul S. Visich, Ph.D., Human Performance sociated with regular exercise training and to restore shear
Laboratory, School of Health Sciences, 1179 Health Professions Bldg, Cen-
tral Michigan University, Mt Pleasant, MI 48858; E-mail: Paul.Visich@ stress values to baseline (8,14,30).
cmich.edu. Cross-sectional studies of endurance athletes have shown
Submitted for publication January 2009. an association between aerobic exercise training and im-
Accepted for publication March 2009. proved vascular function as measured by flow-mediated
0195-9131/09/4111-2003/0 dilation (FMD) (11,19,26) and/or an increased arterial diam-
MEDICINE & SCIENCE IN SPORTS & EXERCISEÒ eter when compared with sedentary controls (6,9,12,22,
Copyright Ó 2009 by the American College of Sports Medicine 24,32). Increased FMD in response to training is less
DOI: 10.1249/MSS.0b013e3181a70707 frequently reported in apparently healthy individuals, and

2003

Copyright @ 2009 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 there is some evidence that increases in FMD and arterial carotid luminal diameter (17). In contrast, 12 wk of whole-
diameter may represent a continuum with arterial remodeling body resistance training of 28 previously untrained young
superseding FMD as the terminal adaptation (29). The as- men (aged 23 T 3.9 yr) resulted in a significant 5% in-
sumption is that the increase in FMD dilation serves as a crease in brachial artery diameter. Interestingly, this in-
short-term adaptation to normalize shear stress levels until crease was observed at week 6 with no further changes
arterial remodeling affects a more permanent return to base- after training (week 13) (21).
line levels (29). On the basis of these collective data, we hypothesized
Athletes such as distance runners and cyclists, whose that resistance training would induce vascular remodeling,
training primarily involves the large muscles of the legs, as manifested in an increased arterial diameter, and that this
have more consistently demonstrated an increased arterial increase would only be observed in the trained arm and not
diameter in the femoral as opposed to the carotid, aortic, the control/untrained arm. Therefore, the purposes of this
subclavian, or brachial arteries (5–7,9,12,24). Interventional study were to 1) determine whether brachial artery diameter
studies using dynamic aerobic exercise support these find- increases in response to 12 wk of supervised unilateral re-
ings with significant increases in arterial diameter associated sistance training of the nondominant arm and 2) compare
with training (4,6,15,16). The outcomes of these studies also the changes in brachial artery diameters between the trained
suggest that increases in arterial diameter are more likely nondominant arm and the untrained dominant arm.
to be regional rather than systemic (6,16). For example,
BASIC SCIENCES

Miyachi et al. (16) showed that one-legged cycle training

resulted in a significant increase (P G 0.05) in femoral artery
METHODS
diameter in the trained but not the untrained leg in 10 pre-
viously untrained young men. The data for this project were derived from a subset of
Resistance/strength training is an increasingly popular participants from the Functional SNPs Associated with
form of regular exercise, either alone or as an adjunct to an Muscle Size and Strength (FAMuSS) study (28). The
aerobic exercise program. It is well recognized that an ap- FAMuSS Study is a multisite controlled unilateral biceps
propriate resistance training program provides additive resistance exercise study assessing four specific variables:
health and fitness benefits by increasing bone density and 1) baseline biceps muscle strength, 2) baseline biceps mus-
improving muscle tone and strength (1,2). However, its cle cross-sectional area (CSA), 3) posttraining biceps muscle
ability to promote vascular remodeling is not clear. Whereas strength, and 4) posttraining muscle CSA. The goal of the
resistance exercise increases transmural pressure and shear study is to search for relationships between these mus-
stress, it is associated with intermittent, postcontraction in- cle traits and specific genetic markers (single nucleotide
creases in blood flow, under high pressure compared with polymorphisms or SNP). The well-controlled design of the
the continuous increase in blood flow under relatively low FAMuSS study also provided a unique opportunity to deter-
pressure seen with aerobic exercise. As such, resistance train- mine whether 12 wk of unilateral resistance training of the
ing may or may not produce the same vascular stimulus. nondominant arm induces vascular remodeling and, if so,
The few investigations of the effects of dynamic resis- whether remodeling is confined to the trained limb or is also
tance training on vascular adaptations in apparently healthy evident in the untrained limb, suggesting a systemic adap-
populations have been equivocal. Cross-sectional studies tation. The methods for the FAMuSS project have been de-
comparing strength-trained individuals with sedentary con- tailed previously by Thompson et al. (28). However, a brief
trols have provided conflicting results. Bertovic et al. (3) description is presented below:
found no group difference in transverse aortic diameter be- Participants. Participants were apparently healthy adult
tween untrained and strength-trained young men. In con- males (n = 6) and females (n = 18). Baseline characteristics
trast, Miyachi et al. (18) measured femoral artery diameter of the participants are presented in Table 1. Participants were
in young and middle-aged men who were classified as excluded if they were G18 or 940 yr old; used medications
either sedentary or resistance-trained. Compared with young known to affect skeletal muscle such as corticosteroids; had
and middle-aged sedentary men, femoral artery diameter any restriction of activity; had chronic medical conditions
was significantly greater in both age groups of resistance- such as diabetes; had metal implants in arms, eyes, head,
trained men. Consistent with aerobic training studies, these brain, neck, or heart that would prohibit magnetic resonance
limited data suggest that vascular remodeling in response to imaging (MRI) testing; had performed strength training or
chronic resistance exercise may be localized to the limbs or employment requiring repetitive use of the arms within the
muscles involved. prior 12 months; consumed on average more than two alco-
Interventional studies exploring the ability of resistance holic drinks daily; or had used dietary supplements reported
training to induce vascular remodeling are also limited and to build muscle size/strength or to cause weight gain such
equivocal. Four months of supervised whole-body resis- as protein supplements, creatine, or androgenic precursors.
tance training of 14 young men (aged 20–38 yr) signifi- Before initiating the study, all participants were informed of
cantly increased 1RM for all of the muscle groups tested, all procedures and risks associated with the study and signed
ranging from 20% to 47%, but did not increase brachial or an informed consent in accordance with the Institutional

2004 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org

Copyright @ 2009 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
TABLE 1. Descriptive characteristics for all subjects (n = 24) before and after training. move through a full range or motion starting at 180- to full
Baseline After Training flexion. Care was taken to ensure that the subject completed
Age (yr) 22.2 T 4.83 22.5 T 5.16 the full range of motion. After the warm-up, subjects were
Body weight (kg) 71.12 T 15.68 71.30 T 14.86
Height (cm) 167.51 T 7.14 167.49 T 7.11
instructed to attempt one full contraction at a higher weight.
Brachial artery diameter measured If the attempt was successful, the subject rested for 3 min and
axially (cm) then performed another attempt at a higher weight (incre-
Untrained (DOM) arm 0.400 T 0.088 0.402 T 0.087
Trained (ND) arm 0.402 T 0.078 0.424 T 0.077*‡ ments of 0.5–1.0 kg). This process was continued (usually
Brachial artery diameter measured three to five attempts) until they were unable to perform a
coronally (cm)
Untrained (DOM) arm 0.396 T 0.094 0.397 T 0.095 full contraction. If the initial attempt was not successful, the
Trained (ND) arm 0.404 T 0.083 0.425 T 0.087*‡ weight was decreased and the same pattern was used. The
Biceps CSA (cm2)
Untrained (DOM) arm 15.05 T 4.04 14.91 T 4.12
test was terminated when the subject completed a full con-
Trained (ND) arm 14.81 T 3.95 17.64 T 5.63*‡ traction with a given weight and failed at the next attempt.
Isometric strength (kg) Exercise training. Subjects underwent a gradually pro-
Untrained (DOM) arm 31.81 T 13.08 32.58 T 13.88
Trained (ND) arm 29.76 T 13.57 34.76 T 13.52*
gressive, supervised strength training of their nondominant
Isotonic strength (1RM; kg) arm, as follows:
Untrained (DOM) arm 9.76 T 4.15 10.37 T 4.43
Trained (ND) arm 9.67 T 4.30 13.05 T 4.41* Weeks 1–4: three sets, 12 reps at 65%–75% of 1RM
Values are means T SD. Weeks 5–8: three sets, 8 reps at 76%–82% of 1RM

BASIC SCIENCES
* Significant (P G 0.05) difference between pre- and posttraining values.
‡Significant (P e 0.05) difference between trained and untrained arms at same time Weeks 9–12: three sets, 6 reps at 83%–90% of 1RM
point.
DOM, dominant; ND, nondominant. The 1RM measured during pretraining testing was used
to estimate the weight that could be lifted for 12, 8, and
6 repetitions using standard formulas (2). This protocol
Review Board for Human Subjects Experimentation at was designed to increase both muscle size using high repe-
Central Michigan University. titions, low intensity early in training, and strength using
Isometric biceps strength testing. Isometric strength low repetitions, high intensity as training progressed (25).
of the biceps brachii of each arm was determined before The primary interest was to train the elbow flexors, but the
and after 12 wk of strength training using a specially con- elbow extensors were trained as well to balance muscle
structed, modified preacher bench and strain gauge (Model strength across the joint.
32628CTL; Lafayette Instrument Company, Lafayette, IN). All exercises were performed with the nondominant
Baseline measures of isometric strength were assessed on arm only. The exercises consisted of the biceps preacher
three separate days, spaced no more than 2 d apart to control curl, biceps concentration curl, standing biceps curl, over-
for learning effect. Posttraining measures of isometric head triceps extension, and triceps kickback. All exercises
strength were assessed immediately before the last training were performed with dumbbells (Powerblocks, Intellbell,
session and 48 h after the last training session. On each of the Inc., Owatonna, MN), and some exercises used a preacher
testing days, three maximal contractions were performed curl bench (Yukon International, Inc., Cleveland, OH). All
with each arm. To obtain three consistent peak force values, training sessions were supervised and lasted approximately
up to two more contractions were performed if a peak value 45–60 min.
deviated by more than 2.25 kg from the other two peak Arterial size: measurement of cross-sectional
values. The average of the results obtained on the second and area. MRI (GE Signa 1.5T; GE Medical Systems, General
third pretraining testing days were used as the baseline cri- Electric Company) was performed before and after training
terion measurement, and the results obtained 48 h after the to assess brachial artery diameter and biceps CSA. Subjects
last training session were used for the posttraining criterion were positioned in the magnet in the supine position with
measurement. hands supinated. A phased array torso coil (GE Medical
One-repetition maximum biceps strength testing. Systems, General Electric Company) was positioned so that
Isotonic muscle strength of the elbow flexors of each arm it completely covered the antecubital fossa of the arm being
was assessed before and after training by determining the scanned. A finger pulse probe was used for cardiac gating
one-repetition maximum (1RM) on a standard preacher purposes.
bench. Baseline 1RM testing was performed during either An axial two-dimensional vascular time of flight was
the second or third strength testing visits. Posttraining 1RM used to obtain the long axis of the brachial artery. This im-
was measured 48–72 h after the final training session (either age allowed the technician to locate a point 1 cm above the
48 h before or immediately after the MRI measurement to bifurcation of the brachial artery. This was the landmark
avoid the effect of prior testing on muscle size). that was used for all subjects. Once the bifurcation was
The 1RM test protocol was modified from Baechle (2). visualized, a sequential fast image slice acquisition time
Briefly, each subject performed two warm-up sets with in- (ISAT) pulse that was spoiled gradient (SPGR) gated was
creasing weight, with 3 min of rest between each set. During used to obtain an image of the brachial artery echo time
the warm-up and the test itself, each subject was instructed to (TE) = minimum, repetition time (TR) = minimum, 60- flip

RESISTANCE TRAINING AND BRACHIAL ARTERY DIAMETER Medicine & Science in Sports & Exercised 2005

Copyright @ 2009 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 angle, 2 mm by 0 skip, 256  224 matrix resolution, phase Windows-based personal computer platform. This software
field of view 0.75, inversion number of excitation (INEX). enables the user to assign regions of interest (ROI) in an
MR images were then transferred to a compact disc for image set by tracing region borders with a mouse. The
offline analysis. muscle is easily identifiable on MR images, and its CSA is
Muscle size: measurement of CSA. MRI mea- measured using this computerized planimetry technique.
surements were performed before and after exercise training Once the ROI was defined, the program reported the
to assess changes in the biceps brachialis CSA as previously number of pixels contained in the selected ROI. Based on
described (28). Because of the concern that postexertion the MR acquisition data (i.e., field of view and matrix
swelling can spuriously increase MRI measurements, pre- resolution), the CSA (cm2) of the defined ROI was then
training and posttraining MRI were performed before or 24 calculated. When the pretraining CSA was subtracted from
and 48 h after the isometric or 1RM tests, respectively, and the posttraining CSA, the training effect could be compared
posttraining MRI was performed 48–96 h after the final between subjects. To optimize the accuracy of the muscle
training session. This ensured that temporary exercise effects, size calculation, a subset of data was analyzed by
such as water shifts, were avoided while avoiding any reduc- volumetric analysis. By analyzing the 15 successive slices
tion of muscle size from detraining. Pre- and posttraining throughout the scanned length of the upper arm each CSA
MR images were obtained separately from both the dominant was multiplied by the known slice thickness (1.6 cm) to
(untrained) and nondominant (trained) arms. yield a slice volume (cm3). Slice volumes were then
BASIC SCIENCES

Because MR images were collected before and after train- summed over the length of the anatomical structure of
ing, it was important that each subject’s positioning within interest.
the MR magnet be reliably reproduced to avoid coregistration Statistical analyses. To examine pre- and posttrain-
errors. To accomplish this, the maximum circumference of ing differences, two-tailed, paired t-tests were used to test
the upper arm (i.e., the belly of the muscle) was measured with for significance. In addition, Pearson correlations were used
a vinyl, nonstretchable tape measure. The arm was abducted to determine significant relationships between variables
90- at the shoulder, flexed 90- at the elbow, and the biceps of interest. Statistical significance for all tests was set at
maximally contracted for this measurement. The location of P G 0.05.
the maximum circumference, or the point of measure (POM),
was then marked on the subject’s skin using a radiographic RESULTS
bead (Beekley Spots; Beekley Corp., Bristol, CT). The ra-
The descriptive characteristics for all participants, before
diographic bead was also used to standardize MRI mea-
and after training, are presented in Table 1. Briefly, in the
surements by comparing its measured CSA with that of the
trained arm, 12 wk of progressive resistance training sig-
MRI-determined CSA.
nificantly increased (P G 0.05) the diameter of the brachial
Subjects had both arms scanned in the supine position
artery, CSA of the biceps brachii, and both ISO and 1RM
with the arm of interest at their side and the center of the
strength by 5.5% (axial plane), 18.3%, 16.8%, and 35.1%,
arm as close to the magnetic isocenter of the scanner as
respectively. There were no significant changes in these
possible, palms facing up. The hand was supinated and
variables for the untrained arm or in any other variables
taped in place on the scanner bed surface, and the POM
including body weight.
centered to the alignment light of the MRI. A coronal scout
In the ND-trained arm, correlations were found between
image (six to nine slices) was obtained to locate the long
pretraining brachial artery diameter and baseline measures
axis of the humerus, followed by a sagittal scout image (six
of muscle CSA, as well as ISO and 1RM (r 2 = 0.20, P =
to nine slices) to align the eighth slice of the axial/oblique
0.027; r 2 = 0.21, P = 0.023; and r 2 = 0.19, P = 0.042,
image with the POM. Fifteen serial fast-spoiled gradient
respectively). In addition, the training-induced increase in
images of each arm was then obtained (TE = 1.9 s, TR =
CSA was correlated with the increase in brachial artery
200 ms, flow artifact suppression, 30- flip angle) using the
diameter (r 2 = 0.19, P = 0.039). In the dominant untrained
POM as the centermost point. These axial/oblique image
arm, only baseline ISO strength was correlated with
slices (i.e., perpendicular to the humerus) began at the top
brachial artery diameter (r 2 = 0.20, P = 0.030).
of the arm and proceeded toward the elbow such that the
belly of the muscle occurred at slices 8 and 9. Individual
DISCUSSION
image slices were 16 mm thick with a 0-mm interslice gap,
256  192 matrix resolution, 22 cm  22 cm field of view, This is the first study to examine the effects of a super-
number of excitations (NEX)  6. This method images a vised program of unilateral upper arm resistance training on
24-cm length of each arm. MR images were transferred to the diameter of the brachial artery. The most salient finding
the central MRI facility at Yale University via either was that 12 wk of unilateral biceps resistance training pro-
magneto-optical disk or compact disc read-only memory. duced a significant increase in the diameter of the brachial
Images were analyzed using a custom-design interactive artery in the trained arm. In addition, the increase in brachial
processing and visualization program that operates in artery diameter was modestly associated with the increase
Matlab (The Math Works, Inc., Natick, MA) running on a in muscle CSA. These results demonstrate that resistance

2006 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org

Copyright @ 2009 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
training can elicit vascular adaptations that were previously and arterial diameter is documented, with cross-sectional
found primarily through aerobic exercise. These data also sug- studies demonstrating 7% to 21% greater diameter of the
gest that the vascular remodeling that occurs with resistance femoral artery in endurance-trained athletes compared with
training is specific to the limbs and/or muscles that are trained sedentary controls (6,9,24). These studies, however, did not
and associated with changes in muscle CSA. observe between-group differences in the brachial (6), aortic
Resistance training and arterial diameter. Twelve (9), subclavian (9), or common carotid (24) arteries. Because
weeks of progressive unilateral resistance training of the most athletes in these studies were distance runners and
biceps produced a 5.47% increase in the diameter of the cyclists, vascular remodeling may be primarily regional.
brachial artery in the trained but not in the untrained arm. Tinken et al. (29) have recently suggested that the lack of
Miyachi et al. (18) reported that, compared with young and evidence for generalized remodeling may be related to the
middle-aged sedentary men, femoral artery diameter was method used to assess arterial remodeling. They suggest, for
significantly greater in both age groups of resistance-trained example, that simple resting measures may be influenced by
men. Specifically, the femoral artery diameter of strength- changes or variations in vasoconstrictor tone. They further
trained young men was 3.3% greater than that of sedentary recommend that inducing maximal/peak diameter change as-
age-matched controls. Of equal if not greater interest, the sociated with reactive hyperemia is a better index of arterial
femoral artery diameter of middle-aged resistance-trained remodeling because it is not influenced by this and other
men was greater than both sedentary young and middle- potential confounds.

BASIC SCIENCES
aged men (7.8% and 9.0%, respectively; P G 0.05). In Interventional studies have demonstrated that aerobic ex-
contrast, Bertovic et al. (3) found no group difference in ercise training may induce vascular remodeling and increases
transverse aortic diameter between untrained and strength- in arterial diameter. Miyachi et al. (15) measured CSA of
trained young men. These very limited data suggest that both the ascending and abdominal aorta before and after
vascular remodeling associated with resistance training, 8 wk of vigorous exercise training. The exercise training
such as aerobic exercise training, may be more regional than group showed increases of approximately 20% for both the
systemic. ascending and abdominal aorta. Three months of aerobic leg
Interventional studies using resistance training are not only training, primarily walking, resulted in a 6.7% increase in
few in number but also equivocal. Miyachi et al. (17) reported V̇O2max and a 9% increase in femoral artery diameter in a
no change in carotid luminal diameter after 4 months of group of 22 previously untrained middle-aged men with no
a typical supervised whole-body resistance training of 14 change in brachial artery diameter (6).
young males (aged 20–38 yr) despite significantly increased Collectively, these data not only support the hypothesis
1RM for all of the muscle groups tested, ranging from 20% that regular aerobic exercise induces vascular remodeling
to 47%. In another study using a whole-body resistance but also this adaptation seems to be largely regional and
training program, 28 previously untrained young men (aged specific to the conduit vessels in the exercising limbs and/or
23 T 3.9 yr) performed 12 wk of resistance training 5 dIwkj1 muscles. This was most clearly demonstrated by Miyachi
using a repeating split-body 3-d cycle (21). Resting brachial et al. (16) who used unilateral cycling exercise to examine
artery diameter was measured at baseline, week 6 of train- changes in femoral artery diameter in both the trained and
ing, and again at week 13. At week 6, mean brachial artery untrained legs. Six weeks of one-legged cycle training re-
diameter increased È5% but did not demonstrate further sulted in a 16% increase in femoral artery CSA but no
changes after that point. changes in the control leg.
A modest association (P G 0.05) was demonstrated be- Limitations and future directions. This study only
tween the increases in muscle CSA and brachial artery di- examined the gross change in brachial artery diameter in
ameter in the trained arm. Although muscular strength (ISO response to resistance training. Changes in brachial artery
and 1RM) was correlated with brachial artery diameter at structure such as intimal medial thickness as well as hemo-
baseline, the changes in strength did not show an association dynamic responses such as FMD were not examined. As
with the increase in brachial artery diameter. These data sug- such, we do not know if the increase in brachial artery di-
gest that training and/or adaptations that induce muscular ameter was due to changes in arterial structural, vascular
hypertrophy, but not necessarily strength, may also serve to tone, or both.
increase brachial artery diameter. It is generally accepted that The duration of the present study was only 12 wk. Al-
training volume, more so than the intensity of the training though a previous work (21) suggests that vascular remodel-
per se, is more conducive to muscle hypertrophy. It is also ing with a whole-body resistance training protocol occurs
possible that resistance training that emphasizes volume and within the first 6 wk of training, with no further changes at
more muscle contractions may also be more likely to induce 12 wk, it is possible for further adaptive responses to occur
vascular remodeling. However, more work is needed in this with further training.
area before definitive statements can made about the nature In summary, 12 wk of supervised unilateral biceps resis-
of the training stimulus and arterial remodeling. tance training significantly increased brachial artery diameter
Aerobic exercise training and arterial diameter. by È5.5% in the trained arm with no change in the con-
The positive association between aerobic exercise training tralateral arm. Muscular strength and CSA also increased

RESISTANCE TRAINING AND BRACHIAL ARTERY DIAMETER Medicine & Science in Sports & Exercised 2007

Copyright @ 2009 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 significantly in the trained, but not the untrained, arm. A nature and specific to the conduit vessels in the limb and/or
modest but significant correlation was found between the muscles involved. Finally, the increase in brachial artery
changes in muscle CSA and brachial artery diameter. These diameter was associated with the increase in muscle CSA.
data suggest that resistance training of the elbow flexors
not only increases muscle size and strength but may also
induce vascular remodeling resulting in greater arterial di- This study was funded by the National Institutes of Health grant
ameter. These findings are also consistent with previous NIH-IDS RO1 NS40606-02.
cross-sectional and interventional studies suggesting that The authors thank the subjects for their participation in this study.
In addition, the hard work of MRI technologists at Central Michigan
vascular remodeling associated with exercise training, in Community Hospital is greatly appreciated. Lastly, the results of the
general, and resistance training, in particular, is regional in present study do not constitute endorsement by ACSM.

REFERENCES
1. American College of Sports Medicine. Guidelines for Exercise 17. Miyachi M, Kawano H, Sugawara J, et al. Unfavorable effects of
Testing and Prescription. 7th ed. Philadelphia (PA): Lippincott, resistance training on central arterial compliance. Circulation.
Williams, and Wilkins; 2006. 154 p. 2004;110:2858–63.
2. Baechle TR. Essentials of Strength Training and Conditioning. 18. Miyachi M, Tanaka H, Kawano H, Okajima M, Tabata I. Lack of
3rd ed. Champaign (IL): Human Kinetics; 2008. p. 395–423. age-related decreases in basal whole leg blood flow in resistance-
BASIC SCIENCES

3. Bertovic DA, Waddell TK, Gatzka CD, Cameron JD, Dart AM, trained men. J Appl Physiol. 2005;99:1384–90.
Kingwell BA. Muscular strength training is associated with low 19. Palmieri EA, Palmieri V, Innelli P, et al. Aerobic exercise
arterial compliance and high pulse pressure. Hypertension. 1999; performance correlates with post-ischemic flow-mediated dilation
33:1385–91. of the brachial artery in young healthy men. Eur J Appl Physiol.
4. Brown MD. Exercise and coronary vascular remodeling in the 2005;94:113–7.
healthy heart. Exp Physiol. 2003;88:645–58. 20. Prior BM, Lloyd PG, Yang HT, Terjung RL. Exercise-induced
5. Currens JH, White PD. Half century of running: clinical, phys- vascular remodeling. Exerc Sport Sci Rev. 2003;31:26–33.
iological, and autopsy findings in the case of Clarence De Mar 21. Rakobowchuk M, McGowan CL, de Groot PC, Hartman JW,
FMr. Marathoner_. N Engl J Med. 1961;265:988–93. Phillips SM, MacDonald MJ. Endothelial function of young
6. Dinenno FA, Tanaka H, Monahan KD, et al. Regular endurance healthy males following whole-body resistance training. J Appl
exercise induces expansive arterial remodeling in the trained limbs Physiol. 2005;98:2185–90.
of healthy men. J Physiol. 2001;534:287–95. 22. Rognmo O, Bjornstad TH, Kahrs C, et al. Endothelial function in
7. Galanti G, Comeglio M, Toncelli L, Cappelli B, Amici E, highly endurance-trained men: Effects of acute exercise. J
Gambell G. The diameter of the common trunk of the left cor- Strength Cond Res. 2008;22:535–42.
onary artery and left ventricular mass in athletes. An echocardio- 23. Rudic RD, Shesely EG, Maeda N, Smithies O, Segal SS, Sessa
graphic study. Cardiologia. 1990;35:665–9. WC. Direct evidence for the importance of endothelium-
8. Green DJ, Maiorana A, O_Driscoll G, Taylor R. Effect of ex- derived nitric oxide in vascular remodeling. J Clin Invest. 1998;
ercise on endothelium-derived nitric oxide function in humans. 101:731–6.
J Physiol. 2004;561:1–25. 24. Schmidt-Trucksäss A, Schmid A, Brunner C, et al. Arterial
9. Huonker M, Schmid A, Schmidt-Trucksäb A, Grathwohl D, properties of the carotid and femoral artery in endurance-trained
Keul J. Size and blood flow of central and peripheral arteries in and paraplegic subjects. J Appl Physiol. 2000;89:1956–63.
highly trained able-bodied and disabled athletes. J Appl Physiol. 25. Stone MH, O_Bryant H, Garhammer J. A hypothetical model for
2003;95:685–91. strength training. J Sports Med Phys Fitness. 1981;4:342–51.
10. Kamiya A, Togawa T. Adaptive regulation of wall shear stress to 26. Tanriverdi H, Everengul H, Taniverdi S, et al. Improved
flow change in the canine carotid artery. Am J Physiol. 1980;239: endothelium dependent vasodilation in endurance athletes and its
14–21. relation with ACE I/D polymorphism. Circ J. 2005;69:1105–10.
11. Kasikcioglu E, Oflaz H, Kasikcioglu HA, Kayserilioglu A, 27. Thoma R. Investigation About the Histogenesis and histological
Umman S, Meric M. Endothelial flow-mediated dilatation and Mechanism of the Vascular System. Stuttgart (Germany): Enke
exercise capacity in highly trained endurance athletes. Tohoku J Verlag; 1893. 268 p.
Exp Med. 2005;205:45–51. 28. Thompson PD, Moyna NM, Seip R, et al. Functional poly-
12. Kool MJF, Stuijker-Boudier HA, Wijnen JA, Hoeks APG, van morphisms associated with human muscle size and strength. Med
Bortel LM. Effects of diurnal variability and exercise training on Sci Sports Exerc. 2004;36(7):1132–9.
properties of large arteries. J Hypertension. 1992;10:49–52. 29. Tinken TM, Thijssen DHJ, Black MA, Cable TN, Green DJ.
13. Langille BL, O’Donnell F. Reductions in arterial diameter Time course of change in vasodilator function and capacity in
produced by chronic decreases in blood flow are endothelium response to exercise training in humans. J Physiol. 2008;
dependent. Nature. 1986;231:405–7. 586(Pt 20):5003–12.
14. Lehoux S, Tronc F, Tedgui A. Mechanisms of blood-flow induced 30. Tronc F, Wassef M, Esposito B, Henrion D, Glagov S, Tedgui A.
vascular enlargement. Biorheology. 2002;39:319–24. Role of NO in flow-induced remodeling of the rabbit common
15. Miyachi M, Iemitsu M, Okutsu M, Onodera S. Effects of carotid artery. Atherosc Thromb Vasc Biol. 1986;16:1256–62.
endurance training on the size and blood flow of the arterial 31. Tuttle JL, Nachreiner RD, Bhuller AS, et al. Shear level
conductance vessels in humans. Acta Physiol Scand. 1998;163: influences resistance artery remodeling: wall dimensions, cell
13–6. density, and eNOS expression. Am J Physiol Heart Circ Physiol.
16. Miyachi M, Tanaka H, Yamamoto K, Yoshioka A, Takahashi K, 2001;281:H1380–9.
Onodera S. Effects of one-legged endurance training on femoral 32. Zeppilli P, Vannicelli R, Santini C, et al. Echocardiographic size
arterial and venous size in healthy humans. J Appl Physiol. 2001; of conductance vessels in athletes and sedentary people. Int J
90:2439–44. Sports Med. 1995;16:38–43.

2008 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org

Copyright @ 2009 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.