Ricerc@Sapienza

We welcome the paper by Bhuva et al. (1) who investigated whether real-world exercise training for a first-time marathon can reverse age-related aortic stiffening, concluding that training even at relatively low exercise intensity reduces central blood pressure and aortic stiffness, equivalent to a 4-year reduction in vascular age. Nonetheless, although we found these data particularly interesting and novel, the report raises additional issues that should be addressed by the authors. First, only marathon finishers were included in the study. This could represent an important bias because, as reported by Bhuva et al. (1), non-finishers could have had different vascular responsiveness. It is thus possible to speculate a different responsiveness in undertrained individuals not able to finish the marathon. Second, other behavioral factors may have affected the changes in aortic stiffness. Sport-targeted interventions, such as smoking cessation, dietary regimen, training induced weight and fat mass reduction, consumption of nutritional supplements, and/or any dietary supplement intended to provide nutrients that may otherwise not be consumed in sufficient quantities (e.g., inorganic nitrate supplementation or supplements able to elevate endogenous nitric oxide levels) may have substantially affected the results.