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Arterial Blood Velocity Measurement by Portable Wireless System for Healthcare Evaluation:

The related effects and signicant reference data 413


ArteriaI BIood VeIocity Measurement by
PortabIe WireIess System for HeaIthcare
EvaIuation: The reIated effects and significant
reference data

Azran Azhin
and Yohsuke Kinouchi

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Tnc Unitcrsi|q cf Tc|usnima

1. Introduction
ArleriaI henodynanic funclion is changed vilh aging, gender and reguIar exercise. Age-
reIaled decreases in cardiovascuIar funclion are evidenl. The haIInarks of cardiovascuIar
aging are decreased for naxinun hearl rale, ejeclion fraclion, naxinaI oxygen inlake,
naxinun cardiac oulpul and arlery conpIiance (Lakalla, 2OO2, Tanaka el aI., 2OOO). On lhe
olher hand, ve have found lhal exercise couId inprove lhe age-reIaled delerioralion in
connon carolid lIood veIocily (Azhin el aI., 2OO7).
Cender-reIaled differences in arleriaI henodynanic funclions such as sysloIic lIood
pressure (SI) are denonslraled in sone previous sludies (London el aI., 1995, MilcheII el
aI., 2OO4). Il is suggesled lhal younger vonen have Iover lrachiaI and ankIe sysloIic lIood
pressure (SI) and a Iover ankIe-arn pressure index lhan age-nalched nen (London el aI.,
1995). Il has leen reporled lhal lhe incidence of cardiovascuIar conpIicalions increases vilh
SI (KanneI and Slokes, 1985) and lhal an increases in lhe puIsaliIe conponenls of lIood
pressure is associaled vilh higher cardiovascuIar risk in poslnenopausaI vonen (Darne, el
aI., 1989). Hovever, lhere are a fev sludies in lIood fIov and veIocily. In lhis chapler, ve
presenl lhe inpacl of gender on lIood veIocily vaveforn in connon carolid arlery (CCA).
Il vas found lhal lhere is significanl gender difference in sone veIocily vaveforns in CCA
(Azhin el aI., 2OO7).
The aliIily lo neasure and inlerprel varialions of pressure and fIov in hunans depends on
an underslanding of physioIogic principIes and is lased on a herilage veII over 1OO years
oId. Sludies of pressure preceded lhose of fIov, since reIialIe looIs vere avaiIalIe for
pressure neasurenenl aInosl 1OO years ago lul for fIov onIy 5O years ago (NichoIs and
ORourke, 2OO5).
There are lvo kinds of noninvasive lechnique lo neasure lIood fIov for porlalIe vireIess
appIicalions, one is a DoppIer uIlrasound nelhod and lhe olher is an oplicaI one. The
DoppIer uIlrasound vas videIy used lo neasure henodynanic in lIood vesseIs as carolid
Recent Advances in Biomedical Engineering 414

arleries lhal exisl in lhe deep pIace fron lhe hunan lissue (Irichard el aI., 1979, askell el aI.,
1977, CosIing, 1977, He el aI., 1992).
We have deveIoped lhe leIenelry neasurenenl syslen in our Ialoralory vhich is capalIe
lo neasure lIood fIov veIocily in lolh aeriaI and aqualic environnenls. The device has
enough perfornance for lhe neasurenenl during physicaI exercise slress as veII as al resl
poslure (Azhin el aI., 2OO7, He el aI., 1996, }iang el aI., 1994, }iang el aI., 1995). The
neasurenenl syslen vilh synchronized neasurenenl of eIeclrocardiogran and lIood
pressure viII conlrilule lo lhe exlenl of underslandings in exercise physioIogy as veII as
furlher knovIedge of arleriaI henodynanic funclions. We have shovn lhal exercise has
significanl change lo enveIope vaveforn of CCA lIood veIocily in henodynanic funclions
as evaIualed fron cross-seclionaI and inlervenlion invesligalions (Azhin el aI. 2OO7a).
Various leIenelric lechniques have leen deveIoped for anluIalory and noninvasive
delerninalion of lioeIeclricaI and physioIogicaI signaIs in hunan suljecls. ionedicaI
leIenelry appIicalions has lroughl nunerous advanlages such as conforl and porlaliIily,
providing lhe crilicaI infornalion on inprovenenls in quaIily of heaIlh care, efficiency in
hospilaI adninislralion capaliIilies and finaIIy reduclion al overaII nedicaI cosl. ionedicaI
leIenelry is a reIialIe looI for dala galhering since lhe invenlion of inlegraled circuil (IC)
lechnoIogy vhich has enornous inpacls on lhe conlrilulions of nicroeIeclronics lo
lionedicine and heaIlh care appIicalions (Azhin el aI., 2OO9).
In lhe chapler, lhe usefuIness of CCA veIocilies and lhe vaveforn indices afler laking inlo
accounl aII reIevanl effecls as reference vaIue for cIinicaI and heaIlhcare appIicalions are
presenled. In seclion 2, syslen is descriled lhe deveIoped porlalIe neasurenenl syslen.
ReaI-line nonilor and dala anaIysis are descriled in seclion 3. In seclion 4, dala
neasurenenls and coIIeclions in lhe seIecled 2O2 heaIlhy voIunleers lelveen lhe ages of 2O
and 69 years are presenled as a resuIl ly lhe foIIoving: Anlhroponelric dala for lhe seIecled
suljecls, reference dala for nornaI veIocilies in CCA and indices lelveen lhe lhird lo
sevenlh decades afler conlroIIing for lhe effecls of exercise lraining and gender, generaI age-
reIaled decrease in fIov veIocilies and change in lhe veIocily vaveforn, reguIar exercise
lraining inproved lIood veIocily vaveforns vhich narkedIy differenl in reguIarIy
exercise-lrained niddIe-aged and oIder age-groups conpared lo lhe sedenlary age peers,
and gender-reIaled difference in veIocily and ils indices. In Iasl seclion, il can le concIuded
lhal nornaI CCA lIood veIocily paranelers vhich are delernined in a lolaI of 2O2 heaIlhy
voIunleers lelveen lhe lhird and sevenlh age decade afler adjuslnenl for gender and
exercise effecls nay conlrilule lo inproved neans of heaIlhcare noniloring and cIinicaI

2. Measurement System
The Iasl lhree decades has shovn rapid increase in lhe use of DoppIer uIlrasound devices
for noniloring cardiovascuIar funclions. DeveIopnenls in DoppIer lechnoIogy have Ied lo a
vasl increase in lhe nunler of non-invasive lIood veIocily invesligalions carried oul in
nany areas of nedicine. As vilh nany rapidIy expanding lechnoIogies lhere have leen a
consideralIe nunler of lypes of inslrunenl deveIoped and used in lheir inslilulions of
origin, vhereas onIy a fev are in videspread porlalIe device for exercise use.
We have deveIoped a porlalIe vireIess syslen for neasurenenl of lIood veIocily speclra in
CCA vilh synchronized neasurenenls of LCC and I as shovn in Iig. 1. In our previous
Arterial Blood Velocity Measurement by Portable Wireless System for Healthcare Evaluation:
The related effects and signicant reference data 415

sludies, ve have presenled lhal lhe leIenelry syslen has enough perfornance lo gel
accurale dala for eslinalion of lIood circuIalion during physicaI exercise slress in lolh aeriaI
and aqualic environnenls (Azhin el aI., 2OO7a, Azhin el aI., 2OO8, He el aI., 1996, }iang el aI.,
1994, }iang el aI., 1995). Measurenenls of lIood veIocily vere noninvasiveIy delecled ly
using DoppIer uIlrasound nelhod. The neasurenenl syslen vas consisls of an uIlrasound
prole, a DoppIer signaI discrininalor (DSD), an anaIog-digilaI (A/D) converler loard and a
Iaplop personaI conpuler (IC), a vireIess lransniller and a receiver as shovn in Iig. 1. Dala
vere lransnilled using 315 MHz IM/ISK lransniller vhich has 28.8 klps and ~O.5 nV/n
(feelIe vave) for lransnission speed and oulpul, respecliveIy.

Iig. 1. IorlalIe neasurenenl syslen of lIood fIov veIocily vilh synchronized
neasurenenls of eIeclrocardiogran and lIood pressure

Measurenenls of lIood circuIalion during exercise slress or posluraI change vas difficuIl. Il
provided high IeveI arlifacls caused ly reIalive dispIacenenl of lhe uIlrasound and arlery
and vilralion of lissue, parlicuIarIy neasurenenl of lIood fIov in fenoraI arlery (Dahnoun
el aI. 199O). Considering lhal ve seIecled senicircuIar lransducers lo provide lhe vider and
uniforn lransnilling uIlrasonic lean (Zhang el aI. 2OO2). Considering lhe deplh of lhe
arleries and lhe size of lransducers, 2.O MHz vas chosen as lhe lransnilling uIlrasonic
frequency. The prole vas designed vilh a snaII size (W34H2OD42 nn
, approxinaleIy
veighing 2O g) using lvo piezoeIeclric zirconale lilanale lransducers (IZT) vilh a dianeler
of 15 nn, vhere one vas for lransnilling uIlrasound and lhe olher vas for receiving lhe
DoppIer echoes using conlinuous-vave uIlrasound as shovn in Iig. 2A. To nake lhe
enilling and receiving leans face lo lhe largel of lIood vesseIs, a snaII angIe of 184 degrees
vere sel lelveen lhe pair lransducers for lhe carolid arlery (Iig. 2). The uIlrasonic prole
vas allached lo lhe Iefl side of neck vilh 5O degrees of lhe DoppIer angIe of insonalion as
Recent Advances in Biomedical Engineering 416

shovn in Iig. 2C and vas fixed il vilh land vound around lhe neck. An exacl allachnenl
posilion in neasuring lIood fIov veIocily in CCA is lelveen lhe slernocIeidonasloid
nuscIe and lhe lhroal al a IeveI lelveen lhe fourlh and fiflh cervicaI verlelrae.
A lransniller lransducer chosen for cIinicaI use had an inlensily oulpul of 8 nW/cn

spaliaI peak-lenporaI average (SITA) as neasured ly a O.4 nn dianeler needIe
hydrophone (ONDA, nodeI HNV-O4OO). The uIlrasonic oulpul inlensily vas safe for lhe
hunan lissue.



Iig. 2. (A) Dinension of uIlrasound prole, () The design prole for vider lransnilling
uIlrasonic lean, and (C) DoppIer insonalion angIe

Ior lhe purpose use of heaIlhcare appIicalion, lhe syslen vas inproved ly ninialurizing
lhe DSD, upgrading lhe prole vilh leller allachnenl on lhe skin and deveIoping lhe sland-
aIone reaI-line soflvare package for neasurenenl of lIood fIov veIocily speclra vilh
synchronized nonilor of eIeclrocardiogran (LCC) and lIood pressure (I). The DSD vas
ninialurized using nounl-surface lechnique, and lhe dovnsized sulslrale size vas 6748
as shovn in Iig. 1. The sulslrale size of lransniller and receiver noduIes is 18.518.5
and 2824.5 nn
, respecliveIy. The pover consunplion of lhe DSD and lransniller
noduIes vas reduced lo 2.1 W, lherefore il vas enalIed lallery inslaIIed in lhe porlalIe
syslen lo le used approxinaleIy 1O hours.

Arterial Blood Velocity Measurement by Portable Wireless System for Healthcare Evaluation:
The related effects and signicant reference data 417

Iig. 3. Iock diagran of lhe deveIoped DSD

As iIIuslraled in Iig. 3, square vave signaI of 2 MHz vas osciIIaled al cryslaI osciIIalor. The
signaI vas converled lo sinusoidaI signaI al LC circuil vhich consisls of an induclor and a
capacilor. Then, il vas luffered al operalionaI anpIifier (OIA) lefore 2 MHz of uIlrasound
vas enilled al lhe lransnilling lransducer. The enilled sinusoidaI signaI vas sel aloul 6.O
. The delecled signaIs al receiving lransducer vere incIuding of DoppIer shifled
frequencies fron lhe novenenl of lIood fIov (red lIood ceIIs), and vilralion of lissues.
Afler lesling severaI kinds of circuils, ve used lhe alove DSD configuralion lo neasure
lIood veIocily for lhe purpose of leIenelry (Azhin el aI. 2OO7a).
A receiving DoppIer signaIs vere a fev hundreds nanovoIls vhich very snaII and veak
signaIs. We used connerciaI avaiIalIe very-Iov-noise OIA (OI621, urr rovn, US) lo
anpIify lhe signaIs lo lens of niIivoIls. Afler leing anpIified, lhe signaIs (
) vere
synchronousIy delecled vilh 2.O MHz sinusoidaI signaIs (
) ly connerciaI nuIlipIier IC
(AD835, AnaIog device, US). TypicaI oulpuls of nuIlipIier generaled lhe frequencies of sun
) and difference (
), respecliveIy. ConsequenlIy, DoppIer signaI couId le derived
fron lhe oulpul of difference frequencies, and lhe olher unnecessary signaIs vere fiIlered ly
land-pass fiIler (UAI4, urr rovn, US). Considering of lIood fIov frequencies in
parlicuIarIy CCA, lhe cul-frequency (fc) of fiIler vas sel fron 1OO lo 48OO Hz.

3. ReaI-time Monitor and Data AnaIysis
Afler processing lhe DoppIer signaI al DSD, lhe signaIs vere sanpIed lo digilaI signaI ly
A/D converler and fed lo lhe conpuler for nonilor and dala anaIysis. We deveIoped lhe
sland-aIone soflvare lo nonilor lIood speclraI veIocily vilh reaI-line as descriled leIov.

3.1 ReaI-time Monitor
In lhe reaI-line processing nonilor inpIenenlalion, lvo nain specificalions had leen laken
in accounl. Iirsl, lhe execulion line of signaI processing nusl le Iov, lo avoid overIoading
lhe avaiIalIe syslen resources. Second, lhe oulpul Ialency line had kepl as shorl as possilIe
(Iess lhan 1OO ns) lo synchronize lhe sound vilh anolher oulpul dispIay (corresponding
reaI-line speclrogran).
Recent Advances in Biomedical Engineering 418

The signaI processing had leen inpIenenled lhrough a progran vrillen in VisuaI C++
for a sland-aIone Windovs appIicalion as shovn in Iig. 4. The reaI-line speclrogran
nonilor vas inpIenenled ly using Ioop liner nelhod. Tiner vas sel as 5O ns
corresponding lo lhe sanpIing dala of 5OO poinls. Hovever, dala vere anaIyzed ly using
fasl Iourier lransforns (IIT) vilh nuIlipIes of 256 poinls of Hanning vindov. The
speclrogran vas processed using decinalion in frequency (DII) radix-2 IIT aIgorilhn,
vhich had snaIIer lhe discrele Iourier lransforn (DIT) conpulalions in order lo reduce lhe
conpulalion line. To increase lhe efficiency, deconposed of DIT vas oplinized ly
processing lhe reaI signaI as caIIed reaI-onIy IIT conpulalion.
The average of CIU Ioad, nenory uliIizalion, and conpulalion line vere neasured in lvo
Iaplop ICs of differenl perfornance as reporled in previous sludy (Azhin el aI. 2OO7a).
ecause of using sel liner nelhod, oulpul Ialency vas depended lo liner rale, 5O ns. If lhe
signaI processing line vas Iess lhan sel liner rale, Ialency line vas conslanlIy nainlained.
The conpulalion line vas Iover lhan 1 ns vhen lesled in lhe recenl Iaplop IC. Hovever,
lhe conpulalion line vas quile Iarger, aloul 16 ns in lhe quile olsoIele Iaplop IC, so lhal
Ialency line lo rendering speclrogran vas sliII nainlained al rale of 5O ns.
Iood fIov veIocily speclra vere neasured for 1 ninule in lhe reIaxed silling poslure. Dala
coIIeclions vere perforned vilh synchronized noniloring of LCC and I using a
deveIoped reaI-line processing nonilor.
SysloIic (SI) and diasloIic lIood pressure (DI) vas coIIecled al lhe Iefl lrachiaI arlery ly
using lhe aulonalic lIood pressure nonilor (Tango, SunTech MedicaI, USA). Mean (MI)
and puIse lIood pressure (II) vere caIcuIaled fron DI+ (SI-DI)/3 and SI-DI,

Iig. 4. The deveIoped sland aIone diaIog soflvare for reaI line noniloring of lIood veIocily
speclra and LCC

Arterial Blood Velocity Measurement by Portable Wireless System for Healthcare Evaluation:
The related effects and signicant reference data 419

3.2 Data AnaIysis
The neasured signaIs vhich incIuded a Iov-frequency noise and a harnonics noise vere
fiIlered ly land-pass fiIler of O.1 lo 4.8 kHz in lhe DSD as shovn in Iig. 3. Iron lhe
frequency range, veIocily speclra couId le laken oul ly IIT anaIysis as nonilored reaI-line
in lhe deveIoped diaIog soflvare (see Iig. 4). Lslinalion of fIov veIocily speclra (V
) vas
perforned fron lhe delecled DoppIer shifled frequency (f
) lhal vas given ly lhe cIassic
equalion: V
cos, vhere, c=154O n/s, sound speed in hunan lissue, f

an irradialed
uIlrasound frequency and =5O degrees, lhe angIe insonalion.
The signaIs vere acquired al 1O kHz of fs lhrough a 16 lil-A/D converler (CI-36O116TR,
Inlerface }AIAN). Il vas repealedIy anaIyzed ly using IIT vilh successive 25.6 ns, vhich
vere given ly shifling 12.8 ns in lurn. Therefore, an inslanlaneous spaliaI speclraI
frequency vas caIcuIaled al 12.8 ns inlervaIs vilh 39 Hz per poinl of frequency resoIulion.
Using a lhreshoId nelhod, fIov veIocily enveIope (Vp) vas exlracled fron il speclra as
shovn in Iig. 5. Iood fIov veIocilies in CCA vere characlerize lo 5 fealure poinls of
vaveforn, peak sysloIic (S1), second sysloIic (S2), insicura lelveen sysloIe and diasloIe (I),
peak diasloIic (D) and end-diasloIic nininun (d) veIocilies (Azhin el aI., 2OO7a). An
ensenlIe-averaging nelhod vas used lo characlerize and caIcuIale lIood veIocilies and ils
indices (Azhin el aI., 2OO7a). We seIecled 3O conseculive cardiac cycIes of lhose lo
characlerize lhe fealure poinls as represenled in Iig. 6. Iron lhese, veIocily indices vere
caIcuIaled fron 1-d/S1, S2/S1-1 and 1-I/D as resislive (RI), veIocily refIeclion (VRI) and
vascuIar eIaslicily indices (VLI), respecliveIy (Azhin el aI., 2OO7l).

Iig. 5. Synchronizalion neasurenenl of eIeclrocardiogran (LCC) and lIood veIocily
enveIope (Vp).

As shovn in Iig. 6, lhe veIocily indices vere caIcuIaled fron lhe fealure poinls of lIood
fIov veIocily. These indices vere dinension-Iess and independenl of lhe angIe insonalion.
The RI vas used as a lypicaI peripheraI vascuIar resislance index lhal can le caIcuIaled fron
vaveforns as 1-d/S1, vhich lhe snaIIer RI lhe Iover resislance and vice versa. The index
vas firslIy used ly IourceIol on fIov veIocily vaveforn in CCA (IIanioI el aI., 1973,
IourceIol, 1976). CosIing el aI. vas firslIy used veIocily index of S1/S2 (as caIIed A/ ralio)
in CCA and superorlilaI arleries for delecling occIusive disease in lhe inlernaI carolid arlery
(CosIing, 1977). The VRI vas used in a nanner siniIar lo evaIuale refIecled vave veIocily in
second sysloIic veIocily in CCA. In lhe previous sludy, lhe index of D/I vas proposed and
nay le provided lo evaIuale lhe nagnilude of vascuIar eIaslic recoiI during cardiac diasloIe
lhal is exerled ly ils snoolh nuscIe ceIIs (Azhin el aI., 2OO7a). The VLI vas used in lhe
sludy lo define lhe nagnilude of vascuIar eIaslicily in a siniIar vay. The veIocily indices in
Recent Advances in Biomedical Engineering 420

CCA vere found lhal changed ly aging, reguIar exercise effecl and gender difference
(Azhin el aI., 2OO7a, Azhin el aI. 2OO7l).

Iig. 6. Characlerislic fealures on vaveforn: LnsenlIe-average veIocilies of 3O conseculive
cardiac cycIes in a young suljecl (21 years oId, naIe). S1: lhe firsl peak sysloIic veIocily
vave (peak veIocily), S2: lhe second sysloIic veIocily vave, I: incisura lelveen sysloIe and
diasloIe, D: lhe peak diasloIic veIocily vave, and d: lhe end-diasloIic nininun veIocily.

3.3 StatisticaI AnaIysis
Dala vere expressed as nean slandard error (SL). Ior overaII viev, Iearsons correIalion
anaIysis vas perforned lo confirn lhe reIalionship lelveen aII oulcone varialIes and lhe
faclors. As previous sludies, ve have reporled lhal lIood veIocily vaveforns in CCA had
infIuenced ly aging and reguIar exercise (Azhin el aI., 2OO7a) and had significanlIy
difference in gender (Azhin el aI., 2OO7l). Hence, nuIlivariale ANOVA lesl vas used lo
delernine lhe oulcone varialIes (veIocily dala) lhal infIuenced ly lhe nuIlipIe effecls. The
designed age-groups of significanl pairvise differences vere delernined using Tukeys
posl-hoc lesl. Afler conlroIIed for lhe effecls of exercise and gender, correIalion coefficienl, R
of aII varialIes vilh age vas delernined (TalIe 2). The effecls of exercise lraining are
conpared ly ANOVA, vhich provides I vaIues. The I vaIue represenls lhe effecls of
exercise lraining on lhe enlire group, conlining lhe cIassified decade-group as a singIe
group. Cender difference vas delernined afler adjuslnenl for aging and exercise effecls ly
Ieasl significanl difference nelhod, and as a calegoricaI varialIe gender vas coded as 1 for
nen and 2 for vonen (TalIe 3). The significance IeveI, I vas sel al O.O5. SlalislicaI anaIysis
vas perforned using slalislicaI package for lhe sociaI sciences (SISS).

4. Measurement Data
Using lhe deveIoped porlalIe neasurenenl syslen as descriled alove, dala vere coIIecled
in lhe sludy. Sludy vas perforned in a lolaI of 286 pulaliveIy heaIlhy suljecls. We sludied
lhe seIecled 2O2 suljecls lelveen lhe ages of 2O and 69 years, fron a cohorl vhich
nornolensive (sysloIic lIood pressure14OnnHg), nornaI lody nass index (leIov 3O
), vilhoul any drug inlake, and free of overl chronic diseases (incIuding
Arterial Blood Velocity Measurement by Portable Wireless System for Healthcare Evaluation:
The related effects and signicant reference data 421

hyperIipidenia, dialeles, arrylhnia) as assessed ly nedicaI hislory. There vere 5 cIassified
groups fron 2O-year-oId lo 69-year-oId in 1O-year-oId inlervaIs as shovn in TalIe 2. Suljecls
vere cIassified as exercised vho perforned reguIar aerolic exercise lraining nore lhan 3
lines per veek.

4.1 Anthropometric data for seIected subjects
TalIe 1 shovs lhe characlerislics of seIecled 2O2 suljecls lelveen lhe ages of 2O and 69
years. Anlhroponelric dala for heighl, veighl, lody nass index, sysloIic, diasloIic, nean,
and puIse lIood pressure are represenled in nean, slandard error, nininun and naxinun

Mean SL Min Max
Heighl (cn) 165 O.7 148 184
Weighl (kg) 59 O.9 39 93
MI (kg/cn
) 22 O.2 16 29
SI (nnHg) 119 O.9 83 14O
DI (nnHg) 74 O.7 5O 96
MI (nnHg) 89 O.9 62 11O
II (nnHg) 45 O.7 17 7O
Hearl rale (leals /nin) 73 O.8 48 1OO
TalIe 1. Anlhroponelric dala of lhe seIecled suljecls. Dala are nean, slandard error (SL),
nininun (Min) and naxinun (Max). MI, lody nass index, SI, sysloIic, DI, diasloIic,
MI, nean, II, puIse lIood pressure.

4.2 Reference data for normaI veIocities and the waveform indices
TalIe 2 represenls lhe reference dala for nornaI CCA veIocilies and lhe indices lelveen lhe
lhird lo sevenlh decades. CorreIalion coefficienls of aII varialIes vilh age vere delernined
afler conlroIIing for lhe effecls of exercise and gender. The veIocilies in d and I vaves vere
nol changed vilh age (I=NS). There vere significanl negalive correIalions in S1 and D
veIocilies vilh age (R=-O.615, I<O.OO1 and R=-O.248, I<O.OO1, respecliveIy). Hovever, S2
veIocily significanlIy posiliveIy correIaled vilh age (R=O.279, I<O.OO1). Ior veIocily indices
of RI and VLI, lhere vere significanl negalive reIalion vilh age (R=-O.6O6 I<O.OO1 and R=-
O.479, I<O.OO1, respecliveIy), vhereas lhere vere significanl posilive reIalion vilh age for
VRI (R=O.798, I<O.OO1). Iron lhe dala, il cIearIy shovn lhal veIocily conlinuousIy changed
vilh advancing age as conpared lo lhird decade-group. The S1 and D veIocilies in sevenlh
decade-group decreased 65 and 83, respecliveIy conpared lo lhird decade-group. The S2
increased 16 in fiflh decade-group and 13 in sevenlh decade-group conpared lo lhird
decade one. The indices of RI and VLI decreased 89 and 67 in sevenlh decade-group.
Due lo narkedIy decreased in S1, lhe VRI increased 34 in sevenlh decade-group.

Recent Advances in Biomedical Engineering 422

Decade (years
(2O~29) 4
(3O~39) 5
(4O~49) 6
(5O~59) 7
R, I
d O.O84, NS 2O.38rO.49 21.23rO.8O 23.O4r1.O6 21.23rO.8O 2O.O7r1.32
S1 -O.615, <O.OO1 1O8.6r1.87 1O2.Or3.O5 84.18r4.O2 76.Or3.O48 7O.54r5.OO
S2 O.279, <O.OO1 52.42r1.27 59.21r2.O6 61.Or2.72 59.96r2.O6 59.44r3.38
I O.O97, NS 29.31rO.76 31.55r1.23 35.14r1.63 3O.64r1.23 28.2Or2.O2
D -O.248, <O.OO1 43.57rO.78 42.29r1.26 42.54r1.66 39.41r1.26 36.38r2.O7
The indices ()
RI -O.6O6, <O.OO1 8O.8rO.5 78.6rO.8 72.4r1.1 72.OrO.8 72.2r1.3
VRI O.798, <O.OO1 -51.OrO.1 -41.Or1.7 -27.4r2.3 -21.5r1.7 -17.1r2.9
VLI -O.479, <O.OO1 33.1r1.O 26.2r1.6 O.18.Or2.1 21.8r1.6 22.2r2.7
TalIe 2. The reference dala indicaled veIocily and lhe indices lelveen lhe lhird lo lhe
sevenlh age decades. The vaIues indicaled nean and slandard error. R indicales lhe vaIues
of parliaI correIalion coefficienl lelveen varialIes and age afler conlroIIing for lhe effecls of
gender and exercise. I<O.OO1 and NS indicaled significanl IeveI and nol significanl,
respecliveIy. RI, resislive index, VRI, veIocily refIeclion index, VLI, vascuIar eIaslicily.

To our knovIedge, lhere vere onIy lhree anaIogous sludies for age-reIaled decIine in lIood
fIov veIocily and for reference dala of nornaI veIocilies in CCA lelveen nuIlipIe age-
groups. In a firsl paper, Cregova el aI. reporled lhe peak sysloIic and end-diasloIic veIocilies
of CCA in 199 suljecls vhich in lhe age range of 2O-92 years. They suggesled peak sysloIic
veIocily in CCA decreased vilh aging as lhe foIIoving yearIy rale: in lhe righl 6.44
nn/s/year and Iefl 7.39 nn/s/year. The yearIy decrease of end-diasloIic veIocily on lhe
lolh sides vas in range lelveen 1.72 and 2.28 nn/s (Cregova el aI., 2OO4). In a second one,
ScheeI el aI. presenled lhe reference dala of fIov veIocilies in CCA and ils index vhich
perforned in 78 heaIlhy aduIls fron 2O lo 85 years oId. They suggesled lhal peak sysloIic
veIocily and end-diasloIic nininun veIocily decrease vilh age as foIIoving rale: 1O122
cn/s and 255 cn/s for age-group of 2O-39 years, 8917 cn/s and 265 cn/s for age-group
of 4O-59 years, and 8121 cn/s and 2O7 cn/s for age-group of 6O-85 years, respecliveIy. In
a lhird one, Iujishiro el aI. neasured lIood veIocily in lhe righl connon carolid arlery in
14O nornaI heaIlhy individuaIs in lheir leens lo sevenlies using an uIlrasonic quanlilalive
fIov neasurenenl syslen (Iujishiro el aI., 1982). As a resuIl, lhey presenled lhal S1 and d
veIocilies narkedIy decreased vilh age, in vhich lhe vaIues in lhe 7Os vere aloul 1/2 and
2/3 as snaII as lhal in lhe 2Os, respecliveIy (Iujishiro el aI., 1982). These findings vere
consislenl vilh age-reIaled decrease in lIood fIov veIocilies in CCA (Tanaka el aI., 2OOO,
Cregova el aI., 2OO4, Azhin el aI., 2OO7a, Naganolo el aI., 1992, Iujishiro and Yoshinura,
Mosl of olher sludies vere nol laken inlo accounl for lhe nuIlipIe effecls on fIov veIocilies
in CCA. In lhe sludy, ve denonslraled lhal lhere are nuIlipIe effecls lhal prolalIy aIler
lIood veIocily vaveforns in CCA (Azhin el aI., 2OO7a, Azhin el aI., 2OO7l). We aIso found
lhal lIood veIocily dala are nore sensilive conpared lo I dala. In lhe sludy, ve found lhal
Arterial Blood Velocity Measurement by Portable Wireless System for Healthcare Evaluation:
The related effects and signicant reference data 423

nol onIy S1 and d veIocilies, lul aIso D veIocily significanlIy decreased vilh age, vhereas S2
veIocily increased vilh age.

4.3 Age-associated changes in fIow veIocity waveforms
Iig. 8 represenls lhe average vaIues of five decade-groups as age-associaled change lIood
veIocily in CCA and lhe veIocily indices. *Significanl pairvise differences lelveen lhird
decade-group and lhe olher designed decade-groups vere delernined using Tukeys posl
hoc lesl. The peak sysloIic and peak diasloIic veIocilies vere Iover in lhe suljecls over 4O
years oId

(I<O.OOO1 and I<O.OOO1, respecliveIy). The fourlh decade-group had significanl
higher in S2 veIocily conpared lo lhird decade-group. The d veIocily had no significanl
differenl lelveen lhe designed decade-groups. The fourlh and over decade-groups had
significanl Iover in lhe veIocily indices of RI and VLI (I<O.OOO1 and I<O.OOO1, respecliveIy).
The VRI vas higher in lhe decade-groups of lhird and over (I<O.OOO1).


Iig. 8. Age-associaled change in lhe fealure poinls of veIocily in CCA (A) and in ils veIocily
indices (). Dala vere nean and SL. *Significanl pairvise differences versus lhird decade-
group vere delernined ly Tukeys posl-hoc lesl.

As ve found lhal fIov veIocilies in CCA decreased vilh age, olher groups had reporled lhal
a conparalIe decrease in fIov veIocilies vilh age (Salonura, 1959, Naganolo el aI., 1992,
Iujishiro el aI., 1982). Mosl of lheir sludies onIy focused veIocily vaveforns, i.e. on lhe S1
and d veIocilies, and denonslraled lhal il decreased vilh age (Salonura, 1959, Naganolo el
aI., 1992, Iujishiro el aI., 1982).
In our sludy, ve found lhal S1 and D veIocilies decreased conlinuousIy vilh age (ly 9.67
and 1.55 nn/s/year, respecliveIy), and S2 veIocily increased significanlIy vil h age (ly 1.93
nn/s/year). In henodynanic sludies, characlerislic lIood fIov veIocilies in S1, S2, and d
vere nore focused on lheir reIalionship eilher lelveen aging and carolid diseases
(Naganolo el aI., 1992, Iujishiro and Yoshinura, 1982, Cregova, 2OO4, Schnidl-Truchsass el
aI., 1999, }ohannes el aI., 2OO1, ScheeI el aI., 2OOO). Our resuIls suggesl lhal nol onIy S1 and D
veIocilies (R=-O.612, I<O.OO1 and R=-O.248, I<O.OO1, respecliveIy), lul aIso ils indices of RI,
VRI and VLI decreased conlinuousIy vilh age (R=-O.6O6, I<O.OO1, R=-O.798, I<O.OO1, R=-
O.478, I<O.OO1, respecliveIy afler adjuslnenl for gender and exercise effecls). AIlhough lhe
Recent Advances in Biomedical Engineering 424

Ialler veIocilies and lhe ralio couId le neasured easiIy using ensenlIe-average enveIope
veIocilies, onIy very fev sludies look lhis paranelers inlo consideralions vilh lhe inlenlion
of characlerizing ils associalions vilh disease (Kaneko el aI., 1978, Rulherford el aI., 1977),
aging and exercise lraining.
In lhe sludy, ve aIso found lhal lhe decreases of D veIocilies and D/I paraneler, vhich
vere depended on arleriaI eIaslic recoiI, vere lhe inporlanl delerninanl as prediclor of age.
The decrease nay le honeoslalicaIIy reIaled lo lhe reduclion of arleriaI conpIiance and
eIaslicily vilh age (Schnidl-Trucksass el aI., 1999, Lakalla, 2OO2, Tanaka el aI., 2OOO). Age-
associaled aIleralions in arleriaI properlies conprised of slrucluraI, e.g. inlina-nedia
lhickness (IMT), and funclionaI, e.g. arleriaI eIaslicily, vere reIaled lo changes of
henodynanic paranelers parlicuIarIy in peak lIood fIov veIocily (Schnidl-Trucksass el aI.,
1999). Age vas lhe slrongesl prediclor in lhe decrease of S1, vhich nay le a suilalIe
paraneler lo evaIuale lhe infIuence of aging or alheroscIerolic risk faclor on arleriaI
slruclure and funclion (Schnidl-Trucksass el aI., 1999).
Changes in lhe shape of veIocily vaveforn nay le quanlified using RI as lhe nosl popuIar
index. The index vas originaIIy used ly IourceIol on vaveforns fron CCA, as an indicalor
of peripheraI vascuIar resislance leyond lhe neasurenenl poinl (IIanioI el aI., 1973,
IourceIol, 1976), vhich lhe snaIIer RI lhe Iover resislance and vice versa. Il is dinension-
Iess and independenl of lhe angIe insonalion. Il has consequenlIy leen videIy used for lhe
variely sludy of palhophysioIogicaI condilions incIuding inlernaI carolid slenosis (IourceIol,
1976) and for lhe sludy of cerelraI haenodynanics in neolanaI and felaI (IernaI, 1985,
Donofrio el aI., 2OO3). In lhe presenl sludy, ve found lhal RI has significanlIy changed vilh
age (see lalIe 2).
The veIocily ralio of S1/S2 is knovn lhal aIlers vilh aging and ICA disease (askell el aI.,
1977, CosIing, 1977, Irichard el aI., 1979). CosIing denonslraled lhal S1/S2 ralio in
sonograns fron lhe CCA decreased vilh aging (CosIing, 1977). askell el aI. used lhe ralio
for screening and diagnosis of carolid junclion disease (askell el aI., 1977). They suggesled
lhal S1/S2 ralio Iess lhan 1.O5 lhere is an 88 prolaliIily of disease al carolid junclion
(askell el aI., 1977). We found lhal lhe index of S1/S2 has sane lendency lhal significanlIy
decrease conlinuousIy vilh age (R=-O.7O2, I<O.OO1). In lhe sludy, veIocily refIeclion index,
as caIcuIaled fron S2/S1-1, increased conlinuousIy vilh aging (R=O.781, I<O.OO1). This
index seens lo have leen inproved in aII age-groups ly lhe lraining (see delaiIs in seclion
4.4). Il is expecled lhal decreased of peak sysloIic veIocily S1 is associaled vilh increased of
second sysloIic veIocily S2 vilh advancing age. The increasing of S2 nay le reIaled lo lhe
increased of vave refIeclion properlies cause an increase in augnenlalion index (AI) and
vasled venlricuIar energy (see delaiIs in seclion 4.5).
We couId nol delernine lhe henodynanic varialIes for veIocily dala in lhe sevenlies and
over lecause of lhere are no heaIlhy voIunleers lhal parlicipaled in lhis invesligalion. Thus,
furlher sludies are needed.

4.4 Effect of exercise on the entire groups
Iig. 9 shovs lhe effecl of exercise lraining on peak sysloIic veIocily and lhe veIocily indices
(I ly ANOVA). As anlicipaled resuIls, HR is Iover in exercise-lrained lhan in sedenlary
(I<O.OOO1). The S1 veIocilies are significanlIy higher in exercise-lrained lhan in sedenlary
(I=O.OO9). The olhers (S2, D, d) have no significanl differences for lhe exercise effecl (I=NS).
Due lo lhe significanl increase in S1, il is reasonalIe lhal lhe RI and VRI in lhe exercise-
Arterial Blood Velocity Measurement by Portable Wireless System for Healthcare Evaluation:
The related effects and signicant reference data 425

lrained are significanlIy higher (I<O.OO8) and Iover (I=O.OOO8), respecliveIy. The VLI vas
nol found significanl difference lelveen lvo groups (I=O.O93).


Iig. 9. Ieak sysloIic veIocily and lhe veIocily indices in exercise-lrained and sedenlary
suljecls. *I<O.O5 significance lelveen exercise-lrained and sedenlary peers.

One of nosl pronounced cardiovascuIar adaplalion lo aerolic exercise lraining is a Iovered
HR in lhe resling (Chen el aI., 1997, CoIdsnilh el aI., 2OOO). Ior inslance, il has leen reporled
lhal lrained runners oflen possess resling HR Iover lhan 5O lpn (CosliII, 1986). SiniIarIy,
Iover resling HR have leen shovn lo occur in sedenlary individuaIs afler lhey have leen
exposed lo effeclive aerolic exercise lraining (MacieI el aI., 1985). In our cross-seclionaI
sludy, HR are Iover in reguIar exercise lrained lhan in lhe sedenlary peers. As anlicipaled,
lhe resling HR decreased in previousIy sedenlary young suljecls afler exercise inlervenlion.
As shovn in Iig. 1O, lhere are lypicaI lIood veIocily vaveforns in lhree age-groups. Ieak
sysloIic veIocilies are seen exlreneIy sharper and higher in lhird decade-group, exercise-
lrained sixlh decade- and sevenlh decade-persons. AII lIood fIov veIocily vaveforns are
nol significanlIy changed in vho reguIarIy perforned aerolic exercise lraining in lhree age-
groups. The veIocilies are sharper and higher lhan lhose of sedenlary peers in lhe especiaIIy,
eIderIy age. The adaplalions of lIood fIov lo reguIar exercise are siniIarIy changed vilh
aging (I=NS ly ANOVA). The pallerns of lIood fIov vaveforns are no significance
difference lelveen young and oIder exercise-lrained. As ve reporled in previous sludy,
lhere vere no differenliaI exercise effecls in lhe designed age-groups (Azhin el aI., 2OO7).
S1 veIocilies have a significanl difference lelveen exercise-lrained and sedenlary aduIls.
Due lo lhe increased of S1 veIocilies, lhe VLI and RI indicale a siniIar lendency change vilh
lhe lraining. Thus, lraining exercise is a prediclor of increasing S1 veIocilies as a suilalIe
paraneler lo evaIuale lhe effecl of lraining exercise. The decreased of resling HR is
associaled vilh lhe increased of S1 veIocilies and RI and lhe decreased of VRI vilh lraining.
We can onIy specuIale on one of lhe adaplalion of cardiovascuIar syslens lo reguIar aerolic
exercise lraining inproved arleriaI conpIiance and increased slroke voIune in lhe presenl
sludy. The increased of S1 veIocilies seen lo refIecl lhe changes of severaI slrucluraI and
funclionaI paranelers incIuding IMT and arleriaI conpIiance reIaled lo snoolh nuscIe
lehavior in a siniIar vay (Schnidl-Trucksass el aI., 1999). ReguIar exercise lraining exerled
a decreased HR vilh lhe associalion of increased lIood veIocily vaveforns in CCA.
Recent Advances in Biomedical Engineering 426

We aIso found lhal lhe aliIily of reguIar aerolic exercise lo inprove fIov veIocily vaveforn
in parlicuIarIy oIder popuIalion vas nol reIaled on lIood pressure. This vas lhe firsl finding
in age-associaled delerioralion in lIood veIocily vaveforns of CCA couId le nodified
favoralIy ly reguIar exercise aerolic exercise (Azhin el aI., 2OO7a).

Iig. 1O. Conparisons of lypicaI lIood fIov veIocily vaveforns for reguIar aerolic exercise-
lrained (soIid Iine) and sedenlary aduIls (dashed Iine) in lhe lhird (A), sixlh (), and sevenlh
(C) decade-groups. ReguIar exercise nay relard age-associaled dininishing in lIood fIov
veIocily vaveforns in hunan.

4.5 Gender difference in the veIocities and waveform indices
TalIe 3 represenls lhe gender difference in lhe oulcone henodynanic varialIes and
anlhroponelric dala. CeneraIIy nen had Iarger lody slalure and nass. As shovn in lhe
resuIl, heighl, veighl and MI are significanlIy higher in nen (I<O.OO1). Men had Iarger
SI and II conpared lo vonen (I<O.O5). Hovever, ve couId nol found lhe gender
difference in DI and MI (I=NS). There vas renarkalIe gender difference in fIov
veIocilies, expecled for S1 veIocily as shovn in TalIe 3. Il is shovn lhal aII veIocily indices
vere significanl differenl lelveen nen and vonen (I<O.OO1). There vas no gender
difference in hearl rale (I=NS).
The findings presenl lhe effecl of gender in lhe roIe lody heighl and veighl on arleriaI
henodynanics in carolid lIood fIov veIocily vaveforns. As ve found in lhe sludy, lhe
vonen had a Iover lrachiaI sysloIic pressure and carolid sysloIic veIocily, vhereas had
higher end-diasloIic and second sysloIic veIocilies. Therefore, lhe veIocily indices in
vascuIar resislive and eIaslic recoiI vere Iover in vonen. Hovever, vave refIeclion index
vas higher in vonen lhan in nen.
The augnenled secondary peak in lhe carolid sysloIic pressure vaveforn vas allriluled lo
vave refIeclion (Murgo el aI., 198O). A najor delerninanl of inlensily of vave refIeclion vas
lhe dislance lo refIecling siles. Irevious invesligalors suggesled lody heighl vas a
significance inverse delerninanl of augnenlalion due lo earIier vave refIeclion (London el
aI., 1995). Sone reporls presenled lhal lhe grealer of vave refIeclion in vonen vas
associaled vilh shorler lody heighl, due lo shorler dislance lo refIecling siles (MilcheII el aI.,
2OO4). They reporled lhal augnenlalion vave pressure refIeclion vas usefuI for assessnenls
of cardiovascuIar risk and cIinicaI polenliaI (Marchais el aI., 1993, MilcheII el aI., 2OO4,
NichoIs el aI., 2OO5). Hovever, lhe inporlance of refIecled fIov vaves vas nol enphasized

Arterial Blood Velocity Measurement by Portable Wireless System for Healthcare Evaluation:
The related effects and signicant reference data 427

unliI reIaliveIy recenlIy (NichoIs el aI., 2OO5). In lhe sludy, augnenlalion of refIecled fIov
vave had highIy correIaled vilh lhal of refIecled pressure vave. Il vas polenliaI lo
delernine vave refIeclion fron ils fIov veIocily conponenls. VeIocily vave refIeclions
vere highIy correIaled lo ils pressure conponenls (R
= O.836) (Azhin el aI., 2OO7c).

Men Wonen
Heighl (cn) 17OrO.6 157rO.8**
Weighl (kg) 64rO.9 51r1.1**
MI (kg/cn
) 22rO.3 2OrO.4**
SI (nnHg) 121r1.1 116r1.4*
DI (nnHg) 75rO.9 73r1.2
MI (nnHg) 9OrO.9 88r1.1
II (nnHg) 46rO.8 42r1.1*
Hearl rale (leals /nin) 73rO.8 73r1.3
Iood veIocily (cn/s)
d 18.8rO.5 23.OrO.6**
S1 98.8r1.9 99.4r2.4
S2 49.Or1.2 62.4r1.6**
I 27.OrO.7 34.OrO.9**
D 4O.OrO.7 44.9rO.9**
VeIocily indices ()
Resislive 8O.1rO.5 76.4rO.6**
RefIeclion -48.1r1.O -36.Or1.3**
VascuIar eIaslic recoiI 31.8rO.9 24.4r1.2**
TalIe 3. Cender difference in lhe oulcone varialIes and anlhroponelric dala. The vaIues
vere nean and SL afler adjuslnenl for lhe aging and exercise effecls. MI: lody nass
index, SI: sysloIic, DI: diasloIic, MI: nean, II: puIse lIood pressure. *I<O.O5, **I<O.OO1
indicaled lhe significanl IeveIs.

LpidenioIogicaI sludies lased on lrachiaI arlery pressure indicale lhal SI vere Iover in
young prenenopausaI vonen lhan in age-nalched nen (London el aI., 1995, KanneI el aI.,
1985). The resuIls vere consislenl finding lhal vonen had Iover lIood pressure in lrachiaI
arlery lhan in nen. CeneraIIy, SI and II increased as a puIse lraveIs fron aorla lovard lhe
peripheraI, lhe increase leing aII lhe nore pronounced as lhe dislance of puIse propagalion
(London el aI., 1995, Lalhan el aI., 1985). Wonen had Iarger refIecled vaves lhan nen, in
parl due lo shorler lody heighl and cIoser physicaI proxinily lelveen hearl and refIecling
siles. Hovever, lody heighl vas nol sufficienl lo fuIIy expIain higher refIecled vave fIov
and pressure in vonen. In lhe sludy ve indicaled lhal lhe refIecled vave had higher in
vonen and vas significanlIy correIaled lo lody heighl and veighl. AIlhough, pressure
vave refIeclion and propagalion are knovn recenlIy lo correIale vilh lody heighl (London
el aI., 1995, Lalhan el aI., 1985, MilcheII el aI., 2OO4), hovever, ve aIso found lhal increased
refIecled vave vas parliaIIy conlriluled ly decreased lody veighl and increased hearl rale
IeveI. The gender difference in arleriaI henodynanics in carolid lIood veIocily vaveforns
is prolalIy accounled for lody heighl and veighl.
Recent Advances in Biomedical Engineering 428

Il had leen reporled lhal vonen had Iover carolid arlery dislensiliIily conpared vilh nen
(YIilaIo el aI., 2OOO). Iron lhe findings of presenl sludy, ve agreed lhal vonen had Iover
arleriaI eIaslicily using lhe proposed veIocily indices. The difference in lhe veIocilies and ils
indices vere reIaled lo snaIIer lody size in vonen lhal IargeIy accounled for lhe gender
differences. Hovever, lhe difference in veIocily indices vas aIso infIuenced ly
concenlralions of eslrogen in hornone slalus of vonen (Krejza el aI., 2OO1).
The gender difference in veIocily vaveforns in CCA found in lhis popuIalion vas nol
depended on lIood pressure. Il vas denonslraled lhal lhe gender difference in lIood
veIocily vaveforns of CCA are nol direclIy Iinked lo il pressure vaveforns (Azhin el aI.,
AIlhough lhe finding in lhe effecl of increased vave refIeclion in arleriaI syslen on lody
heighl vas consislenl, lecause lhe reIalion of lody veighl and lody fal on lhe arlery
sliffness and fIov veIocilies vere IargeIy unknovn, furlher invesligalions are needed. The
DoppIer angIe of insonalion vas inporlanl lecause il nusl le laken inlo accounl vhen
caIcuIaling lIood fIov veIocily fron lhe DoppIer shifl frequency. Hovever, lhe veIocily
indices of vere independenl of lhe insonaling angIe so lhal lhe assessnenls of
henodynanics vere nore accurale and reIialIe.

Iig. 11. Conparison of lypicaI fIov veIocily vaveforns in CCA for gender difference of
nan (dashed Iine) and vonan (soIid Iine). Suljecls delaiIs vere 171 cn, 65 kg, MI: 22
, age: 23 years for nan and 154 cn, 48 kg, MI: 2O kg/n
, age: 25 years for vonan.

5. ConcIusion
In lhe chapler, ve have presenled firsl, lhe porlalIe neasurenenl syslen has deveIoped for
anluIalory and nonivansive delerninalion of lIood circuIalion vilh synchronized of lIood
pressure and LCC signaIs, vhich has polenliaI lo provide lhe crilicaI infornalion in cIinicaI
and heaIlhcare appIicalions. Second, lhere are nuIlipIe faclors vhich have effecls on lIood
veIocily vaveforns in CCA. ReguIar exercise lraining is alIe lo inprove age-associaled
decrease lIood veIocily in CCA vilh siniIar effecl lelveen young and oIder exercise-
lrained. The veIocily vaveforn pallerns have no significanlIy change vilh age in enlire
Arterial Blood Velocity Measurement by Portable Wireless System for Healthcare Evaluation:
The related effects and signicant reference data 429

groups vho reguIarIy perforned aerolic exercise. Cender-associaled difference in lhe
oulcone of veIocilies and lhe indices is aIso found in lhe sludy. Reference dala for nornaI
veIocilies and lhe indices in CCA are delernined afler adjuslnenl for lhe effecls of age,
gender, and exercise lraining. Reduclions in lIood fIov veIocilies are leIieved lo have
conlriluled significanlIy lo lhe palhophysioIogy of age-associaled increase in nol onIy
cardiovascuIar lul aIso cerelrovascuIar diseases. The findings have polenliaIIy inporlanl
cIinicaI and heaIlhcare requirenenls for prevenlion of cardiovascuIar diseases.

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