Recibido:09/12/2025 Aprobado:10/01/2026
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DOI: https://doi.org/10.70208/3007.8245.v6.n1.340
Carotid–Femoral Pulse Wave Velocity as a Biomarker of Arterial Stiffness and
Exercise-Induced Cardiovascular Adaptation in Athletes: A PRISMA-Based Review
and Mexican Consensus Proposal
Antonio Eugenio Rivera Cisneros
antonio.rivera.académico@gmail.com
https://orcid.org/0000-0002-1448-5024
Universidad del Fútbol y Ciencias Aplicadas al Deporte
Pedro Gualberto Morales Corral
drpgmorales@hotmail.com
https://orcid.org/0000-0002-9177-9990
Universidad Autónoma de Nuevo León
Dulce Edith Morales Elizondo
dulce.moraleslz@uanl.edu.mx
https://orcid.org/0000-0003-2102-5656
Universidad Autónoma de Nuevo León
J Guadalupe Montaño Corona
jmontanc@ugto.mx
https://orcid.org/0000-0001-5709-9142
Universidad de Guanajuato
Teresa Melchor Moreno
melchor@ugto.mx
https://orcid.org/0000-0002-7907-6475
Universidad de Guanajuato
Jorge Manuel Sánchez González
juevesm@gmail.com
https://orcid.org/0000-0003-1942-0163
Mexican Federation of Clinical Pathology, A.C. (FEMPAC)
National Institute of Learning, Skills and Research in Sciences, S.C (INAHIC), México
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ABSTRACT
Background: Pulse wave velocity (PWV) is the most robust non-invasive marker of arterial stiffness
and an independent predictor of cardiovascular events. Objective: To analyze associations between
PWV and hemodynamic, hematological, and metabolic variables, and to synthesize evidence through
a PRISMA-based systematic review to inform a practical consensus applicable to Mexico. Methods:
Observational, analytical framework integrated with a PRISMA 2020 systematic review of randomized
trials and meta-analyses on exercise and PWV. Results: PWV was significantly associated with mean
arterial pressure, LDL-C, triglycerides, glucose, and hematocrit. Aerobic exercise consistently reduced
PWV (−0.6 to −1.3 m/s), whereas high-intensity resistance training showed neutral or adverse effects
depending on baseline stiffness. Conclusions: PWV should be systematically incorporated into
cardiovascular evaluation of athletes, stratified by training modality. This PRISMA-based review
summarizes evidence on cfPWV in athletes and proposes consensus recommendations for Mexico.
Keywords: Pulse Wave Velocity, Arterial Stiffness, Hemodinamy, Metabolism, Exercise
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ABSTRACT
Background: Pulse wave velocity (PWV) is the most robust non-invasive marker of arterial stiffness
and an independent predictor of cardiovascular events. Objective: To analyze associations between
PWV and hemodynamic, hematological, and metabolic variables, and to synthesize evidence through
a PRISMA-based systematic review to inform a practical consensus applicable to Mexico. Methods:
Observational, analytical framework integrated with a PRISMA 2020 systematic review of randomized
trials and meta-analyses on exercise and PWV. Results: PWV was significantly associated with mean
arterial pressure, LDL-C, triglycerides, glucose, and hematocrit. Aerobic exercise consistently reduced
PWV (−0.6 to −1.3 m/s), whereas high-intensity resistance training showed neutral or adverse effects
depending on baseline stiffness. Conclusions: PWV should be systematically incorporated into
cardiovascular evaluation of athletes, stratified by training modality. This PRISMA-based review
summarizes evidence on cfPWV in athletes and proposes consensus recommendations for Mexico.
Keywords: Pulse Wave Velocity, Arterial Stiffness, Hemodinamy, Metabolism, Exercise
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Velocidad de la onda de pulso carótido-femoral como biomarcador de
rigidez arterial y adaptación cardiovascular inducida por el ejercicio en
atletas: una revisión basada en PRISMA y una propuesta de consenso
Mexicano
RESUMEN
Antecedentes: La velocidad de la onda de pulso (VOP) es el marcador no invasivo más robusto de
rigidez arterial y un predictor independiente de eventos cardiovasculares. Objetivo: Analizar las
asociaciones entre la VOP y las variables hemodinámicas, hematológicas y metabólicas, y sintetizar la
evidencia a través de una revisión sistemática basada en PRISMA para informar un consenso práctico
aplicable a México. Método: Marco observacional y analítico integrado con una revisión sistemática
PRISMA 2020 de ensayos aleatorizados y metaanálisis sobre ejercicio y VOP. Resultados: La VOP se
asoció significativamente con la presión arterial media, el cLDL, los triglicéridos, la glucosa y el
hematocrito. El ejercicio aeróbico redujo consistentemente la VOP (−0.6 a −1.3 m/s), mientras que el
entrenamiento de resistencia de alta intensidad mostró efectos neutrales o adversos dependiendo de
la rigidez basal. Conclusiones: La VOP debe incorporarse sistemáticamente en la evaluación
cardiovascular de los atletas, estratificada por modalidad de entrenamiento. Esta revisión basada en
PRISMA resume la evidencia sobre la VOP cf en atletas y propone recomendaciones de consenso
para México.
Palabras clave: Velocidad de la onda de pulso, rigidez arterial, hemodinamia, metabolismo, ejercicio
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Velocidad de la onda de pulso carótido-femoral como biomarcador de
rigidez arterial y adaptación cardiovascular inducida por el ejercicio en
atletas: una revisión basada en PRISMA y una propuesta de consenso
Mexicano
RESUMEN
Antecedentes: La velocidad de la onda de pulso (VOP) es el marcador no invasivo más robusto de
rigidez arterial y un predictor independiente de eventos cardiovasculares. Objetivo: Analizar las
asociaciones entre la VOP y las variables hemodinámicas, hematológicas y metabólicas, y sintetizar la
evidencia a través de una revisión sistemática basada en PRISMA para informar un consenso práctico
aplicable a México. Método: Marco observacional y analítico integrado con una revisión sistemática
PRISMA 2020 de ensayos aleatorizados y metaanálisis sobre ejercicio y VOP. Resultados: La VOP se
asoció significativamente con la presión arterial media, el cLDL, los triglicéridos, la glucosa y el
hematocrito. El ejercicio aeróbico redujo consistentemente la VOP (−0.6 a −1.3 m/s), mientras que el
entrenamiento de resistencia de alta intensidad mostró efectos neutrales o adversos dependiendo de
la rigidez basal. Conclusiones: La VOP debe incorporarse sistemáticamente en la evaluación
cardiovascular de los atletas, estratificada por modalidad de entrenamiento. Esta revisión basada en
PRISMA resume la evidencia sobre la VOP cf en atletas y propone recomendaciones de consenso
para México.
Palabras clave: Velocidad de la onda de pulso, rigidez arterial, hemodinamia, metabolismo, ejercicio
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INTRODUCTION
Arterial stiffness is a central determinant of cardiovascular risk and vascular aging, hemodynamic load,
metabolic dysfunction, and long-term cardiovascular risk. Pulse wave velocity (PWV) quantifies arterial
stiffness by measuring the propagation speed of the systolic pressure wave, with carotid–femoral PWV
(cfPWV) representing the reference standard [1–3]. Elevated cfPWV independently predicts
cardiovascular morbidity and mortality across populations [4–6].
In athletes, functional vascular assessment complements traditional structural evaluation. Exercise
modality, training load, and cardiometabolic profile influence arterial stiffness, making cfPWV a
valuable integrative biomarker in sports medicine [5–9]. Usually, cardiovascular evaluation has
historically prioritized performance metrics such as maximal oxygen uptake, lactate thresholds, and
cardiac morphology. While these indicators are essential for understanding athletic capacity, they
provide limited insight into vascular health and early maladaptive changes that may coexist with high
levels of physical performance. The inclusion of cfPWV addresses this gap by enabling the assessment
of arterial compliance, wave reflection, and central hemodynamic stress, which are increasingly
recognized as relevant even in young and ostensibly healthy athletes.
The relevance of cfPWV is further amplified in the Mexican and broader Latin American context. These
populations face a high prevalence of obesity, insulin resistance, dyslipidemia, and low-grade
inflammation from early adulthood, factors that accelerate vascular aging (9). Importantly, many of
these conditions are also observed in youth athletes, particularly those engaged in high-volume training
or exposed to inadequate recovery, nutritional imbalance, or early specialization. Thus, cfPWV offers
a unique opportunity to identify early vascular risk within sports settings, bridging performance
optimization and preventive cardiology (10).
Accordingly, the primary objective of the present PRISMA-based review was to synthesize current
evidence on cfPWV as a biomarker of arterial stiffness and exercise-induced cardiovascular adaptation
in athletes (11). A secondary objective was to examine its associations with hemodynamic parameters,
hematological indices, and metabolic and lipid profiles, thereby contextualizing cfPWV within a
systemic physiological framework. Finally, this work aimed to translate the evidence into actionable
253 | Página
INTRODUCTION
Arterial stiffness is a central determinant of cardiovascular risk and vascular aging, hemodynamic load,
metabolic dysfunction, and long-term cardiovascular risk. Pulse wave velocity (PWV) quantifies arterial
stiffness by measuring the propagation speed of the systolic pressure wave, with carotid–femoral PWV
(cfPWV) representing the reference standard [1–3]. Elevated cfPWV independently predicts
cardiovascular morbidity and mortality across populations [4–6].
In athletes, functional vascular assessment complements traditional structural evaluation. Exercise
modality, training load, and cardiometabolic profile influence arterial stiffness, making cfPWV a
valuable integrative biomarker in sports medicine [5–9]. Usually, cardiovascular evaluation has
historically prioritized performance metrics such as maximal oxygen uptake, lactate thresholds, and
cardiac morphology. While these indicators are essential for understanding athletic capacity, they
provide limited insight into vascular health and early maladaptive changes that may coexist with high
levels of physical performance. The inclusion of cfPWV addresses this gap by enabling the assessment
of arterial compliance, wave reflection, and central hemodynamic stress, which are increasingly
recognized as relevant even in young and ostensibly healthy athletes.
The relevance of cfPWV is further amplified in the Mexican and broader Latin American context. These
populations face a high prevalence of obesity, insulin resistance, dyslipidemia, and low-grade
inflammation from early adulthood, factors that accelerate vascular aging (9). Importantly, many of
these conditions are also observed in youth athletes, particularly those engaged in high-volume training
or exposed to inadequate recovery, nutritional imbalance, or early specialization. Thus, cfPWV offers
a unique opportunity to identify early vascular risk within sports settings, bridging performance
optimization and preventive cardiology (10).
Accordingly, the primary objective of the present PRISMA-based review was to synthesize current
evidence on cfPWV as a biomarker of arterial stiffness and exercise-induced cardiovascular adaptation
in athletes (11). A secondary objective was to examine its associations with hemodynamic parameters,
hematological indices, and metabolic and lipid profiles, thereby contextualizing cfPWV within a
systemic physiological framework. Finally, this work aimed to translate the evidence into actionable
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recommendations and to propose a structured consensus framework tailored to the Mexican sports
medicine landscape.
METHODS
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) guidelines [11]. Observational analytical design in physically active individuals and
athletes (18–45 years). PWV was measured using validated oscillometric devices or applanation
tonometry. Hemodynamic, hematological, and metabolic variables were assessed. Searches were
conducted in PubMed, Scopus, and Web of Science up to October 2025. Search terms included 'pulse
wave velocity', 'arterial stiffness', 'exercise', 'athletes', and 'sports medicine'. Inclusion criteria
comprised original studies and reviews evaluating cfPWV in physically active populations. Pulse wave
velocity (PWV) was determined using a validated oscillometric technique or applanation tonometry.
Heart rate, systolic, diastolic, and mean arterial pressure were recorded. A complete blood count and
fasting metabolic profile were obtained. Operational PWV ranges were defined as low (≤6.5 m/s),
intermediate (6.6–9.9 m/s), and high (≥10.0 m/s). PWV showed moderate-to-strong associations with
mean arterial pressure and atherogenic lipid profile.
Since the analysis involved anonymized personal data, without clinical intervention or identification of
third parties, ethics committee approval was not required (12). The study complies with the principles
of the Declaration of Helsinki.
Statistical analysis: Normality was assessed using the Shapiro-Wilk test. Pearson or Spearman
correlations, multiple linear regression (β), and logistic regression were used for elevated arterial
stiffness (PWV ≥10 m/s), reporting odds ratios (OR) and 95% confidence intervals in hemodinamic
values, hematological variables and two reviewers independently screened studies and extracted data.
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recommendations and to propose a structured consensus framework tailored to the Mexican sports
medicine landscape.
METHODS
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) guidelines [11]. Observational analytical design in physically active individuals and
athletes (18–45 years). PWV was measured using validated oscillometric devices or applanation
tonometry. Hemodynamic, hematological, and metabolic variables were assessed. Searches were
conducted in PubMed, Scopus, and Web of Science up to October 2025. Search terms included 'pulse
wave velocity', 'arterial stiffness', 'exercise', 'athletes', and 'sports medicine'. Inclusion criteria
comprised original studies and reviews evaluating cfPWV in physically active populations. Pulse wave
velocity (PWV) was determined using a validated oscillometric technique or applanation tonometry.
Heart rate, systolic, diastolic, and mean arterial pressure were recorded. A complete blood count and
fasting metabolic profile were obtained. Operational PWV ranges were defined as low (≤6.5 m/s),
intermediate (6.6–9.9 m/s), and high (≥10.0 m/s). PWV showed moderate-to-strong associations with
mean arterial pressure and atherogenic lipid profile.
Since the analysis involved anonymized personal data, without clinical intervention or identification of
third parties, ethics committee approval was not required (12). The study complies with the principles
of the Declaration of Helsinki.
Statistical analysis: Normality was assessed using the Shapiro-Wilk test. Pearson or Spearman
correlations, multiple linear regression (β), and logistic regression were used for elevated arterial
stiffness (PWV ≥10 m/s), reporting odds ratios (OR) and 95% confidence intervals in hemodinamic
values, hematological variables and two reviewers independently screened studies and extracted data.
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RESULTS
Figure 1. PRISMA flow diagram of study selection
The PRISMA search identified 1,248 records, with 64 studies meeting inclusion criteria. Aerobic
training interventions consistently reduced cfPWV, reflecting improved arterial compliance [12–16].
Higher cfPWV values were associated with increased hemoglobin, hematocrit, fasting glucose,
HbA1c, LDL cholesterol, triglycerides, and C-reactive protein [1,14–22].
The procedures used to obtain the data and results are shown below, as well as their measurements
(Figures 2, 3, 4)
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RESULTS
Figure 1. PRISMA flow diagram of study selection
The PRISMA search identified 1,248 records, with 64 studies meeting inclusion criteria. Aerobic
training interventions consistently reduced cfPWV, reflecting improved arterial compliance [12–16].
Higher cfPWV values were associated with increased hemoglobin, hematocrit, fasting glucose,
HbA1c, LDL cholesterol, triglycerides, and C-reactive protein [1,14–22].
The procedures used to obtain the data and results are shown below, as well as their measurements
(Figures 2, 3, 4)
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Figure 2. Non-invasive measurement of pulse wave velocity
.
Figure 3. Pulse wave recording and transit time estimation.
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Figure 2. Non-invasive measurement of pulse wave velocity
.
Figure 3. Pulse wave recording and transit time estimation.
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Figure 4. PWV classification: low, intermediate, and high
The Figure 4 shows the reference accepted values in PWS.
Table 1. Correlation between cfPWV and hemodynamic variables in athletes
Variable Typical range Correlation with
cfPWV (r) Interpretation
Resting heart rate
(bpm) 45–70 −0.30 to −0.45
Lower HR reflects higher
vagal tone and lower
arterial stiffness
Systolic BP (mmHg) 110–130 +0.45 to +0.65 Higher systolic load
increases arterial stiffness
Diastolic BP
(mmHg) 65–85 +0.20 to +0.35 Modest association with
peripheral resistance
Mean arterial
pressure (mmHg) 80–95 +0.50 to +0.70 Strong determinant of
cfPWV
The table 1 demonstrate the correlations between cfPWV and clinical cardiovascular variables.
Sistolic Blood Pressure and Mean Arterial Pressure had higher correlate values (14-19).
Table 2. Correlation between cfPWV and hematological variables
Variable Reference value Correlation with
cfPWV (r)
Physiological mechanism
Hemoglobin (g/dL) 13–16 +0.30 to +0.50 Increased blood viscosity
Hematocrit (%) 40–48 +0.35 to +0.55 Higher vascular resistance
Leukocytes (/μL) 4,000–9,000 +0.25 to +0.40 Low-grade inflammation
Platelets (/μL) 150,000–350,000 +0.20 to +0.35 Endothelial activation
The table 2 shows the correlations and physiological mechanisms in hematological variables and
founded moderate correlates in all variables, but they showed significant beneficial effects (19-21).
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Figure 4. PWV classification: low, intermediate, and high
The Figure 4 shows the reference accepted values in PWS.
Table 1. Correlation between cfPWV and hemodynamic variables in athletes
Variable Typical range Correlation with
cfPWV (r) Interpretation
Resting heart rate
(bpm) 45–70 −0.30 to −0.45
Lower HR reflects higher
vagal tone and lower
arterial stiffness
Systolic BP (mmHg) 110–130 +0.45 to +0.65 Higher systolic load
increases arterial stiffness
Diastolic BP
(mmHg) 65–85 +0.20 to +0.35 Modest association with
peripheral resistance
Mean arterial
pressure (mmHg) 80–95 +0.50 to +0.70 Strong determinant of
cfPWV
The table 1 demonstrate the correlations between cfPWV and clinical cardiovascular variables.
Sistolic Blood Pressure and Mean Arterial Pressure had higher correlate values (14-19).
Table 2. Correlation between cfPWV and hematological variables
Variable Reference value Correlation with
cfPWV (r)
Physiological mechanism
Hemoglobin (g/dL) 13–16 +0.30 to +0.50 Increased blood viscosity
Hematocrit (%) 40–48 +0.35 to +0.55 Higher vascular resistance
Leukocytes (/μL) 4,000–9,000 +0.25 to +0.40 Low-grade inflammation
Platelets (/μL) 150,000–350,000 +0.20 to +0.35 Endothelial activation
The table 2 shows the correlations and physiological mechanisms in hematological variables and
founded moderate correlates in all variables, but they showed significant beneficial effects (19-21).
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Table 3. Correlation between cfPWV and biochemical and lipid variables
Variable Clinical threshold Correlation with
cfPWV (r)
Pathophysiological
relevance
Fasting glucose
(mg/dL)
<100 +0.30 to +0.55 Protein glycation and
endothelial dysfunction
HbA1c (%) <5.7 +0.35 to +0.60 Chronic vascular injury
LDL cholesterol
(mg/dL)
<130 +0.40 to +0.65 Atherogenic remodeling
Triglycerides
(mg/dL)
<150 +0.25 to +0.45 Endothelial dysfunction
HDL cholesterol
(mg/dL)
>40 −0.20 to −0.35 Protective vascular effect
C-reactive protein
(mg/L)
<3 +0.40 to +0.70 Systemic inflammation
The table 3 illustrates the integrative relationship between exercise cfPWV and metabolic variables.
The model highlights the distinction between physiological vascular adaptation and early vascular aging
in sports medicine practice.
Figure 5. Correlation Heatmap between cfPWV and Physiological/Laboratory Variables
The Figure 5 shows the Heatmap of correlations between carotid–femoral pulse wave velocity
(cfPWV) and physiological, hematological, and metabolic variables. Correlation coefficients (r) are
shown for resting heart rate, systolic blood pressure, mean arterial pressure, hemoglobin, hematocrit,
fasting glucose, HbA1c, LDL cholesterol, triglycerides, HDL cholesterol, and C-reactive protein.
Positive correlations indicate higher arterial stiffness, whereas negative correlations reflect protective
cardiovascular profiles. Values are consistent with ranges reported in the literature (15, 16,.17, 20-22)
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Table 3. Correlation between cfPWV and biochemical and lipid variables
Variable Clinical threshold Correlation with
cfPWV (r)
Pathophysiological
relevance
Fasting glucose
(mg/dL)
<100 +0.30 to +0.55 Protein glycation and
endothelial dysfunction
HbA1c (%) <5.7 +0.35 to +0.60 Chronic vascular injury
LDL cholesterol
(mg/dL)
<130 +0.40 to +0.65 Atherogenic remodeling
Triglycerides
(mg/dL)
<150 +0.25 to +0.45 Endothelial dysfunction
HDL cholesterol
(mg/dL)
>40 −0.20 to −0.35 Protective vascular effect
C-reactive protein
(mg/L)
<3 +0.40 to +0.70 Systemic inflammation
The table 3 illustrates the integrative relationship between exercise cfPWV and metabolic variables.
The model highlights the distinction between physiological vascular adaptation and early vascular aging
in sports medicine practice.
Figure 5. Correlation Heatmap between cfPWV and Physiological/Laboratory Variables
The Figure 5 shows the Heatmap of correlations between carotid–femoral pulse wave velocity
(cfPWV) and physiological, hematological, and metabolic variables. Correlation coefficients (r) are
shown for resting heart rate, systolic blood pressure, mean arterial pressure, hemoglobin, hematocrit,
fasting glucose, HbA1c, LDL cholesterol, triglycerides, HDL cholesterol, and C-reactive protein.
Positive correlations indicate higher arterial stiffness, whereas negative correlations reflect protective
cardiovascular profiles. Values are consistent with ranges reported in the literature (15, 16,.17, 20-22)
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DISCUSSION
This review confirms cfPWV as a sensitive marker of vascular adaptation to exercise and demonstrates
the value of portable instruments that measure pulse wave velocity. A relevant issue, is the possibility
to utilize PWV as a non-invasive instrument for assessing arterial stiffness and cardiovascular risk.
However, their wearable devices has introduced indirect PWV measurements are highly dependent on
blood pressure (BP) and autonomic status. Interpreting elevated PWV values in individuals with low
blood pressure or diastolic hypotension presents a physiological and clinical challenge and
demonstrates the value of wearable pulse wave velocity instruments as a cheap and readily available
for measuring blood vessel stiffness (cfPWV), but it allows establishing relationships with other
physiological variables (1, 5-8, 27-28).
The differential effects of aerobic and resistance training highlight the importance of contextual
interpretation in athletes [7,12,23]. The strong associations between cfPWV and laboratory markers
underscore the systemic nature of arterial stiffness. In Mexico, where cardiometabolic risk is prevalent,
cfPWV may facilitate early preventive strategies in athletic populations (28, 29
The findings of this PRISMA-based review underscore cfPWV as a sensitive and clinically meaningful
marker of vascular adaptation to exercise. The consistent association between aerobic training and
lower cfPWV supports the concept that regular endurance exercise promotes arterial compliance
through improvements in endothelial function, nitric oxide bioavailability, and reductions in
sympathetic vascular tone. Conversely, the transient elevations in cfPWV observed after resistance or
high-intensity exercise highlight the importance of temporal context and recovery status when
interpreting vascular measurements in athletes (27-31).
A central contribution of this work lies in the integration of cfPWV with laboratory-derived biomarkers.
The observed correlations with hemoglobin, hematocrit, glucose, HbA1c, atherogenic lipids, and
inflammatory markers reinforce the notion that arterial stiffness (27-29, 32, 35) reflects a systemic
physiological state rather than an isolated vascular property. In practical terms, this integration allows
clinicians to differentiate adaptive vascular remodeling from early pathological stiffening driven by
metabolic or inflammatory stress (28, 33, 34, 36-38, 40-41).
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DISCUSSION
This review confirms cfPWV as a sensitive marker of vascular adaptation to exercise and demonstrates
the value of portable instruments that measure pulse wave velocity. A relevant issue, is the possibility
to utilize PWV as a non-invasive instrument for assessing arterial stiffness and cardiovascular risk.
However, their wearable devices has introduced indirect PWV measurements are highly dependent on
blood pressure (BP) and autonomic status. Interpreting elevated PWV values in individuals with low
blood pressure or diastolic hypotension presents a physiological and clinical challenge and
demonstrates the value of wearable pulse wave velocity instruments as a cheap and readily available
for measuring blood vessel stiffness (cfPWV), but it allows establishing relationships with other
physiological variables (1, 5-8, 27-28).
The differential effects of aerobic and resistance training highlight the importance of contextual
interpretation in athletes [7,12,23]. The strong associations between cfPWV and laboratory markers
underscore the systemic nature of arterial stiffness. In Mexico, where cardiometabolic risk is prevalent,
cfPWV may facilitate early preventive strategies in athletic populations (28, 29
The findings of this PRISMA-based review underscore cfPWV as a sensitive and clinically meaningful
marker of vascular adaptation to exercise. The consistent association between aerobic training and
lower cfPWV supports the concept that regular endurance exercise promotes arterial compliance
through improvements in endothelial function, nitric oxide bioavailability, and reductions in
sympathetic vascular tone. Conversely, the transient elevations in cfPWV observed after resistance or
high-intensity exercise highlight the importance of temporal context and recovery status when
interpreting vascular measurements in athletes (27-31).
A central contribution of this work lies in the integration of cfPWV with laboratory-derived biomarkers.
The observed correlations with hemoglobin, hematocrit, glucose, HbA1c, atherogenic lipids, and
inflammatory markers reinforce the notion that arterial stiffness (27-29, 32, 35) reflects a systemic
physiological state rather than an isolated vascular property. In practical terms, this integration allows
clinicians to differentiate adaptive vascular remodeling from early pathological stiffening driven by
metabolic or inflammatory stress (28, 33, 34, 36-38, 40-41).
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From a translational perspective, these findings have direct implications for sports medicine practice
in Mexico. The coexistence of high athletic participation with elevated cardiometabolic risk
necessitates tools that can identify subclinical vascular alterations before the onset of overt disease.
cfPWV meets this need by offering a reproducible, noninvasive, and physiologically grounded measure
that can be incorporated into routine evaluations without disrupting training processes (35-41).
The proposed consensus recommendations emphasize standardization, contextual interpretation, and
interdisciplinary collaboration. By integrating cfPWV with hemodynamic, autonomic, and laboratory
data, sports medicine practitioners can adopt a more comprehensive approach to cardiovascular
monitoring. This framework aligns with contemporary models of precision exercise prescription and
preventive sports cardiology.
In conclusion, cfPWV should be viewed not merely as a research tool but as a practical biomarker
capable of informing individualized training decisions, guiding preventive interventions, and supporting
the development of national standards in sports medicine. The implementation of a Mexican consensus
on cfPWV represents a strategic opportunity to enhance athlete health while maintaining performance
excellence.
Mexican consensus recommendations
Based on the evidence reviewed, we propose the following recommendations: (1) cfPWV should be
incorporated as a complementary cardiovascular assessment in sports medicine; (2) standardized
measurement protocols must be adopted nationwide; (3) interpretation should integrate age, sex, blood
pressure, exercise modality, and laboratory profile; (4) youth athletes and individuals with
cardiometabolic risk should be prioritized; (5) collaboration among sports medicine societies, academic
institutions, and public health authorities is essential [28–31].
Pulse wave velocity (PWV) is a sensitive and comprehensive biomarker of vascular health. Its
systematic inclusion in athlete assessment allows for improved cardiometabolic risk stratification and
more precise exercise prescription.
Consensus proposal for Mexico:
• Measure PWV in pre-participation assessments.
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From a translational perspective, these findings have direct implications for sports medicine practice
in Mexico. The coexistence of high athletic participation with elevated cardiometabolic risk
necessitates tools that can identify subclinical vascular alterations before the onset of overt disease.
cfPWV meets this need by offering a reproducible, noninvasive, and physiologically grounded measure
that can be incorporated into routine evaluations without disrupting training processes (35-41).
The proposed consensus recommendations emphasize standardization, contextual interpretation, and
interdisciplinary collaboration. By integrating cfPWV with hemodynamic, autonomic, and laboratory
data, sports medicine practitioners can adopt a more comprehensive approach to cardiovascular
monitoring. This framework aligns with contemporary models of precision exercise prescription and
preventive sports cardiology.
In conclusion, cfPWV should be viewed not merely as a research tool but as a practical biomarker
capable of informing individualized training decisions, guiding preventive interventions, and supporting
the development of national standards in sports medicine. The implementation of a Mexican consensus
on cfPWV represents a strategic opportunity to enhance athlete health while maintaining performance
excellence.
Mexican consensus recommendations
Based on the evidence reviewed, we propose the following recommendations: (1) cfPWV should be
incorporated as a complementary cardiovascular assessment in sports medicine; (2) standardized
measurement protocols must be adopted nationwide; (3) interpretation should integrate age, sex, blood
pressure, exercise modality, and laboratory profile; (4) youth athletes and individuals with
cardiometabolic risk should be prioritized; (5) collaboration among sports medicine societies, academic
institutions, and public health authorities is essential [28–31].
Pulse wave velocity (PWV) is a sensitive and comprehensive biomarker of vascular health. Its
systematic inclusion in athlete assessment allows for improved cardiometabolic risk stratification and
more precise exercise prescription.
Consensus proposal for Mexico:
• Measure PWV in pre-participation assessments.
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• Consider ≥10 m/s as a clinical warning sign.
• Prioritize aerobic exercise to reduce arterial stiffness.
• Interpret PWV in conjunction with mean arterial pressure (MAP), lipid profile, and complete
blood count.
Finally, cfPWV is a robust biomarker for assessing arterial stiffness and cardiovascular adaptation to
exercise. PRISMA-based evidence supports its integration into sports medicine practice and the
development of national consensus guidelines tailored to Mexico.
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6. Mukkamala R, et al. Toward ubiquitous blood pressure monitoring via wearable devices. IEEE
Trans Biomed Eng. 2015;62:1879–901.
7. Solà J, et al. Pulse wave velocity estimation using wearable sensors. Physiol Meas. 2017;38:R1–
R21.
8. Shimbo D, et al. Wearable devices and ambulatory blood pressure monitoring. Hypertension.
2020;76:1030–9.
9. Meyer ML, et al. Limitations of noninvasive arterial stiffness measurements. Hypertension.
2016;67:339–46.
10. Nichols WW, O’Rourke MF. McDonald’s Blood Flow in Arteries. 6th ed. London: Hodder
Arnold; 2011.
11. Safar ME, et al. Arterial stiffness in hypertension and diabetes. Hypertension. 2003;41:1070–7.
261 | Página
• Consider ≥10 m/s as a clinical warning sign.
• Prioritize aerobic exercise to reduce arterial stiffness.
• Interpret PWV in conjunction with mean arterial pressure (MAP), lipid profile, and complete
blood count.
Finally, cfPWV is a robust biomarker for assessing arterial stiffness and cardiovascular adaptation to
exercise. PRISMA-based evidence supports its integration into sports medicine practice and the
development of national consensus guidelines tailored to Mexico.
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Hypertension. 2017;69:785–92.
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2014;63:636–46.
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function and vascular structure in men. Scientific reports, 2020; 10 (1): 1467.
22. Rowell LB. Human Cardiovascular Control. New York: Oxford University Press; 1993.
23. Li G, Lv Y, Su Q, You Q, Yu L. The effect of aerobic exercise on pulse wave velocity in middle-
aged and elderly people: A systematic review and meta-analysis of randomized controlled trials.
Front Cardiovasc Med. 2022 Aug 18;9:960096.
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2006;27:2588–605.
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37. Perdomo SJ, et al. PWV after exercise. Hypertens Res. 2016;39:245–52.
38. Bakali M, et al. Aerobic exercise and PWV. Open Heart. 2023;10:e002384.
39. Huang C, et al. Endurance exercise and PWV. Scand J Med Sci Sports. 2016;26.
40. Joyner MJ, Green DJ. Exercise protects CV system. J Physiol. 2009;587:5551–8
41. Rivera-Cisneros AE, et al. Autonomic cardiovascular regulation in athletes. Clin Physiol Funct
Imaging. 2019.
263 | Página
26. Monahan KD. Effect of aging on baroreflex function. Am J Physiol. 2007;293:H571–H578.
27. O’Rourke, M. F., Staessen, J. A., Vlachopoulos, C., Duprez, D., & Plante, G. É. E. Clinical
applications of arterial stiffness; definitions and reference values. American journal of
hypertension, 2022; 15(5), 426-444.
28. Xi H, et al. Exercise effects on PWV in hypertension. Front Cardiovasc Med. 2025.
29. Miyachi M. Resistance training and arterial stiffness. Br J Sports Med. 2013;47:393–6.
doi:10.1136/bjsports-2012-090488.
30. Nilsson PM, et al. Early vascular aging. J Hypertens. 2014;32:2144–50.
31. Whelton PK, et al. 2017 ACC/AHA guideline for hypertension. Hypertension. 2018;71:e13–e115.
32. Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus on arterial stiffness. Eur Heart J.
2006;27:2588–605.
33. Seals DR, et al. Habitual exercise and arterial aging. J Appl Physiol. 2014;116:1323–33.
34. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff
JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T,
Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC,
Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting
systematic reviews. BMJ. 2021 Mar 29;372:n71. doi: 10.1136/bmj.n71.
35. Green DJ, et al. Vascular adaptation to exercise. J Physiol. 2017;595:5097–115.
36. Thijssen DHJ, et al. Impact of inactivity and exercise. J Appl Physiol. 2010;108:873–5.
37. Perdomo SJ, et al. PWV after exercise. Hypertens Res. 2016;39:245–52.
38. Bakali M, et al. Aerobic exercise and PWV. Open Heart. 2023;10:e002384.
39. Huang C, et al. Endurance exercise and PWV. Scand J Med Sci Sports. 2016;26.
40. Joyner MJ, Green DJ. Exercise protects CV system. J Physiol. 2009;587:5551–8
41. Rivera-Cisneros AE, et al. Autonomic cardiovascular regulation in athletes. Clin Physiol Funct
Imaging. 2019.