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Training type and vascular health in young male athletes: A comparison of brachial and central blood pressure and pulse wave velocity

This study of 532 young male athletes reveals that while broad sport categories show limited differences in most vascular metrics, power and mixed-sport disciplines exhibit higher central systolic and diastolic blood pressures, and cluster analysis uncovers distinct sport-specific vascular profiles that transcend traditional classifications.

Original authors: Lisa Baumgartner, Jonas Haferanke, Maximilian Dettenhofer, Tobias Engl, Sebastian Freilinger, Stefanie Huber, Frauke Mühlbauer, Renate Oberhoffer, Thorsten Schulz

Published 2026-09-29

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Lisa Baumgartner, Jonas Haferanke, Maximilian Dettenhofer, Tobias Engl, Sebastian Freilinger, Stefanie Huber, Frauke Mühlbauer, Renate Oberhoffer, Thorsten Schulz

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

The heart and blood vessels are not static pipes; they are living tissues that respond to the demands placed upon them. When a person exercises, the heart pumps harder and faster, sending a surge of blood through the arteries. Over time, regular physical activity generally strengthens this system, making the vessels more flexible and efficient. However, not all exercise is the same. Some sports, like long-distance running or swimming, rely on steady, rhythmic movements that keep blood flowing smoothly. Others, like weightlifting or wrestling, involve short, explosive bursts of effort where muscles squeeze tight, sometimes holding their breath to generate maximum force. These different types of exertion create different pressures inside the body. While doctors have long measured blood pressure at the upper arm to check a person's health, this measurement only captures the pressure in the peripheral arteries. It does not tell the whole story of what is happening closer to the heart, where the main aorta carries blood to the rest of the body. Understanding how different sports affect this central pressure is crucial for young athletes, whose bodies are still growing and developing.

Researchers at the Technical University of Munich set out to investigate exactly how these different training styles shape the vascular health of young boys. They gathered data from 532 boys between the ages of 8 and 17, a group that included competitive athletes training at least three hours a week and a smaller group of boys who exercised less than three hours a week. The athletes were sorted into three main categories based on their primary sport: endurance sports like cross-country skiing, power sports like wrestling, and mixed sports like soccer. The team used a specialized, non-invasive device to measure blood pressure at the upper arm and then calculated the pressure closer to the heart, known as central blood pressure. They also measured pulse wave velocity, which is a way of assessing how stiff the arteries are by timing how fast a pressure wave travels through them. To ensure a fair comparison, the researchers carefully adjusted their results to account for the boys' ages, body sizes, and the total amount of training they did.

The study revealed a clear distinction between the different types of athletes, but not in the way one might initially expect. When the researchers looked at the standard blood pressure reading taken at the arm, the differences between the groups were small and largely disappeared once they accounted for body size and training volume. Similarly, the measure of arterial stiffness did not show a significant difference between the endurance, power, and mixed-sport groups after these adjustments. However, a different picture emerged when they examined the central blood pressure. The boys who participated in power sports, such as wrestling and rowing, had significantly higher central systolic blood pressure than the endurance athletes, the mixed-sport athletes, and the less active control group. This difference remained even after the researchers adjusted for age, body surface area, and training load. The power athletes also showed higher diastolic blood pressure at the arm compared to the endurance athletes and controls.

These findings suggest that the type of sport a young person plays influences the pressure their heart and main arteries experience, even if the standard arm measurement looks similar across groups. The higher central pressure in power athletes likely stems from the nature of their training, which involves brief, intense bursts of force that can cause temporary spikes in blood pressure. Repeated exposure to these spikes may lead to a resting state where the pressure closer to the heart remains slightly elevated. Yet, the researchers were careful to note that this does not mean the arteries of these athletes are permanently damaged or stiffer. The study found no evidence that the power athletes had greater arterial stiffness than the others. Instead, the higher pressure appears to be a specific hemodynamic response to their training style, a physiological adaptation rather than a sign of disease.

To dig deeper, the researchers used a statistical method to group the sports based on their overall vascular profiles rather than just their traditional labels. This analysis showed that the simple categories of endurance, power, and mixed did not perfectly predict the vascular outcomes. Instead, the sports naturally fell into three distinct clusters. One group, including swimming and cross-country skiing, showed the lowest values across all pressure and stiffness measures. Another group, featuring sports like wrestling, rowing, and field hockey, displayed the highest values. A third group, including soccer and basketball, sat in the middle. This indicates that the cardiovascular demands of a sport are complex and cannot be fully understood by looking at a single characteristic like whether it is mostly aerobic or anaerobic.

The authors conclude that while power-oriented sports are associated with higher central blood pressure in young male athletes, this does not equate to unhealthy stiffening of the arteries. The findings highlight that central blood pressure provides a more sensitive view of the heart's workload than standard arm measurements, particularly for athletes in high-force sports. However, the study is a snapshot in time, and the researchers emphasize that long-term follow-up is needed to see if these differences persist as the athletes grow or if they lead to any future health issues. For now, the results suggest that while different sports create different vascular signatures, these variations are part of the normal spectrum of athletic adaptation rather than a cause for alarm.

Technical Summary: Training Type and Vascular Health in Young Male Athletes

Problem Statement
While regular physical activity generally promotes cardiovascular health in youth, the specific vascular adaptations resulting from different training modalities remain unclear. Existing literature suggests that broad sport categories (e.g., endurance vs. power) may not adequately capture the heterogeneity of hemodynamic responses. Furthermore, brachial blood pressure (bBP), the clinical standard, may not fully reflect the pulsatile load on the central arterial system. This study addresses the gap in understanding how specific training demands influence central systolic blood pressure (cSBP) and aortic pulse wave velocity (PWV) in young male athletes, distinguishing between peripheral and central hemodynamic phenotypes.

Methodology
This cross-sectional analysis pooled data from three cohorts (MuCAYA, MuCAYAplus, and LICO) conducted at the Technical University of Munich between 2018 and 2024. The final sample included 532 boys aged 8–17 years, categorized as follows:

Competitive Athletes: Defined by ≥3 hours/week of training, further classified into Endurance ( $n=72$ ), Power ( $n=43$ ), and Mixed ( $n=389$ ) categories based on the European Society of Cardiology classification. The "Skill" category ( $n=5$ ) was excluded due to small sample size.
Controls: Recreational participants (<3 hours/week, $n=23$ ).

Measurements:

Vascular Parameters: Brachial systolic (bSBP) and diastolic blood pressure (bDBP), central systolic blood pressure (cSBP), and aortic PWV were assessed using a non-invasive oscillometric device (Mobil-O-Graph) with the ARCSolver algorithm.
Anthropometry: Height, weight, and body surface area (BSA) were measured; BMI and BSA were calculated.
Training Load: Quantified using a MET-hours index derived from self-reported duration and intensity.

Statistical Analysis:
Group differences were analyzed using Analysis of Covariance (ANCOVA), adjusting for age, BSA, and training load. Effect sizes were reported as partial eta squared ( $\eta^2_p$ ). Additionally, a hierarchical cluster analysis (Ward's method) was performed at the sport-discipline level to identify data-driven vascular profiles, utilizing z-standardized, adjusted means of the four vascular parameters.

Key Results

Adjusted Group Differences:
- cSBP: Significant group effects were observed ( $p=0.012$ ). Power athletes exhibited significantly higher adjusted cSBP compared to controls, endurance, and mixed-sport athletes.
- bDBP: Significant group effects were found ( $p<0.001$ ). Both power and mixed-sport athletes had higher adjusted bDBP than controls and endurance athletes.
- bSBP and PWV: No significant group effects were detected for brachial systolic pressure or PWV after covariate adjustment.
Standard Deviation Scores (SDS):
- The cohort was generally taller than reference populations. While age-adjusted PWV and cSBP SDS were positive, height-adjusted values were below the reference mean, suggesting stature influences these metrics.
- Power athletes showed the highest proportion of participants with values $\ge$ 95th percentile for height-adjusted PWV (25.6%) and cSBP (18.6%).
Cluster Analysis:
- Three distinct vascular profiles emerged that crossed conventional sport categories:
  - Cluster 1 (Intermediate): Soccer, basketball. Characterized by moderate values with relatively higher bDBP.
  - Cluster 2 (Low-Normal): Ice hockey, swimming, cross-country skiing, volleyball. Showed the lowest values across all parameters.
  - Cluster 3 (High-Normal): Field hockey, handball, rowing, wrestling. Exhibited the highest values for bSBP, cSBP, and PWV.

Key Contributions

Central vs. Peripheral Dissociation: The study demonstrates that in young male athletes, sport-specific training loads may manifest as differences in central hemodynamics (cSBP) and diastolic pressure (bDBP) without corresponding significant differences in brachial systolic pressure or estimated aortic stiffness (PWV) after adjusting for growth and training load.
Limitations of Broad Categories: The cluster analysis reveals that vascular phenotypes do not strictly align with broad endurance/power classifications. Disciplines with mixed physiological demands (e.g., rowing, wrestling) grouped with high-static load sports, while others (e.g., swimming) grouped with low-load sports, suggesting that single-component classifications obscure specific adaptation patterns.
Hemodynamic Phenotyping: The findings suggest that higher cSBP in power athletes may reflect altered ventricular-arterial coupling, wave reflection, or resting hemodynamic regulation rather than structural arterial stiffening, given the lack of significant PWV differences.

Significance and Claims
The paper claims that these findings support a "modest sport-associated central pressure phenotype" in power athletes but explicitly does not provide evidence of pathological arterial stiffening or adverse vascular remodeling. The authors emphasize that:

Higher cSBP should be interpreted as a hemodynamic phenotype related to the specific loading of power sports rather than a disease state.
Broad sport categories may obscure heterogeneity; data-driven clustering offers a more nuanced view of vascular adaptation.
Current findings are exploratory and cross-sectional. They do not justify restricting participation in power sports or using cSBP as a standalone diagnostic criterion for young athletes.
The study highlights the need for longitudinal research to determine if these profiles persist through puberty and whether they correlate with long-term cardiovascular outcomes, noting that pediatric thresholds for central hypertension remain undefined.

The authors conclude that while central blood pressure may complement brachial assessment by revealing hidden hemodynamic loads, its prognostic relevance in healthy youth requires further validation.

Technical Summary: Training Type and Vascular Health in Young Male Athletes

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