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Testosterone or exercise – which boosts vascular function more?


Anastasia Tsirtsakis


25/02/2021 3:53:34 PM

New research, focusing on middle-aged and older men, has found one to be more effective than the other.

Middle-aged man exercising in the gym.
An exercise program involving stationary bikes and resistance training machines has been shown to have the biggest impact on artery function.

The answer is exercise, according to a new study led by researchers at the University of Western Australia.
 
As men get older, both their testosterone levels and physical activity tend to decrease, coinciding with a heightened risk of developing cardiovascular disease.
 
As a result, researchers set out to examine the effect of a 12-week exercise program, using stationary bikes and resistance training machines, and testosterone treatment on artery function – a determinant of future cardiovascular risk.
 
Seventy-eight men aged 50–70 with low-to-medium testosterone levels, no history of cardiovascular disease and a waist measurement of 95 centimetres or more, were randomly assigned to four groups:

  • 21 who received a testosterone cream that was applied to the skin daily, along with aerobic and strength training two to three times a week
  • 18 who received testosterone cream with no exercise training
  • 19 who received a placebo with exercise training
  • 20 who received a placebo and no exercise training.
Participants had ultrasound scans at the beginning and end of the trial, along with a series of other testing to monitor the artery diameter responses to changes in blood flow.
 
The findings showed artery function improved most – by 28% – for the cohort that undertook exercise training alone, followed by the group that followed a combined protocol of exercise and testosterone (19%).
 
However, no improvement in artery function was observed in the group that received testosterone therapy alone.
 
While there is evidence that testosterone therapy can help men build muscle mass and strength, the study found exercise was also more effective at reducing body fat and developing lean body mass than the hormone treatment.
 
GP Dr Jennifer Graham-Taylor, Chair of the RACGP Specific Interests Sport and Exercise network, told newsGP the findings are ‘important’, and provide further support for current practice.
 
‘In older patients with low normal testosterone levels the risk of hormone replacement may outweigh potential benefits,’ she said.
 
‘However, the multiple benefits of exercise in all aspects of health, including vascular health, are well established.’
 
Despite controversy over testosterone supplementation and cardiovascular risk, globally sales increased 12-fold from 2000–2011. To curb the concerning trend, the Federal Government introduced new criteria in 2015, requiring GPs to consult with a relevant specialist or registered member of the Australasian Chapter of Sexual Health Medicine for any new prescriptions.
 
Co-author of the study, Endocrinologist Professor Bu Yeap urged any GPs and other specialists prescribing the treatment to do so cautiously.
 
‘Apply caution when prescribing testosterone if the aim is to improve artery function and health,’ he said.
 
‘[There is an] unproven belief that testosterone therapy [is] rejuvenating and might have anti-ageing effects.’
 
Despite the study using a relatively small sample, Adjunct Professor Trevor Shilton, Director of Active Living at the Heart Foundation, says the findings are ‘very promising’.
 
‘Physical activity is such a powerful tonic, if you like, for preventing and managing chronic conditions, including heart disease, but also diabetes and cancers,’ he told newsGP.
 
'There’s also evidence on arterial health combined with what we know about weight gain, blood pressure and cholesterol.
 
‘All of this collectively, in terms of the impact, explains why people who meet physical activity guidelines have approximately 35% reduced risk of cardiovascular disease compared to people who are sedentary.’
 
The Australian Physical Activity and Sedentary Behaviour Guidelines recommend adults be active most days, with at least 150 minutes of moderate physical activity or 75 minutes of vigorous activity per week, coupled with strength training at least twice a week.
 
Recent findings from the Australian Institute of Health and Welfare show one in two Australian adults do not meet these guidelines, with 50% of men insufficiently active and a higher prevalence among those aged older than 65.  
 
Adjunct Professor Shilton says the study’s findings are particularly important for GPs, who regularly manage chronic disease and undertake health checks and risk assessments.
 
‘[As well as] weight gain, blood pressure and cholesterol, there is a mounting evidence around physical activity and both the prevention and management of mental health issues, depression in particular, and the prevention of cognitive decline and Alzheimer's,’ he said.
 
‘These are many of the biggest issues that we face as a nation in health and that GPs see every day unmitigated by encouraging people to do simple everyday activity.
 
‘This is something that GPs can talk to patients about who might harbour a concern that “I used to play football [or] I used to play netball [and] I haven’t been active for 20 years – maybe it’s too late for me”.
 
‘It’s very important to understand that in in terms of your cardiovascular risk, it’s never too late to start. You can start by walking up to 30 minutes a day and get most of these benefits.’
 
Dr Graham-Taylor agrees.
 
‘GPs are experts in behaviour change,’ she said.
 
‘And are well-placed to encourage patients to engage safely in regular, progressive and preferably supervised exercise.’
 
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