Exercise and hypertension

Prevalence and associated factors of hypertension among adult patients attending the outpatient department at the primary hospitals of Wolkait tegedie zone, Northwest Ethiopia

Introduction

Hypertension, often known as increased blood pressure, is a worldwide public health concern. Globally, ~1 billion people have hypertension and 7.1 million die from this disease. It is disproportionately more prevalent in resource-poor nations, with inadequate health systems like Ethiopia. Moreover, information on the burden of disease from hypertension in the specific area, especially in the newly organized Wolkait Tegedie zone, is essential to develop effective prevention and control strategies. Therefore, this study aimed to assess the prevalence of hypertension and associated factors among adult patients evaluated at the outpatient department of the two district hospitals in the Wolkait Tegedie zone, Northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted from September to October 2021. A systematic random sampling technique was used to select a total of 449 participants. The data were collected and then entered using EPI-INFO version 7 and exported to STATA 14 for analysis. Bivariable and multivariable binary logistic regression analyses were performed. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used as a measure of association. Variables having a p-value < 0.05 from the multivariable analysis were considered to have a significant association with the outcome.

Results

The prevalence of hypertension among adult patients in this study was 44.91% [95% CI: 40.26%, 49.65%], of which 63.92% were new diagnoses. Being >60 years [AOR = 1.81; 95% CI: 1.11, 3.20], having poor physical exercise [AOR = 1.74; 95% CI: 1.01, 3.15], consuming cruddy oil [AOR = 15.22; 95% CI: 3.86, 60.12], having a family history of hypertension [AOR = 13.02; 95% CI: 3.75, 45.16], and having a history of diabetes mellitus (DM) [AOR = 8.05; 95% CI: 1.24, 51.49] had a statistically significant association with having hypertension.

Conclusion

There is a relatively high prevalence of hypertension among adult patients in the outpatient department of the two primary hospitals, Northwest Ethiopia. Factors such as being of older age, having poor physical exercise behavior, cruddy oil consumption, and family history of DM and hypertension had a positive significant statistical association with being hypertensive. Community-based screening programs for hypertension should be designed and implemented to prevent this silent killer disease. Health education and promotion that focus on healthy nutrition and physical exercise should be delivered.

Dipeptide IF and Exercise Training Attenuate Hypertension in SHR Rats by Inhibiting Fibrosis and Hypertrophy and Activating AMPKα1, SIRT1, and PGC1α

Bioactive peptides are physiologically active peptides produced from proteins by gastrointestinal digestion, fermentation, or hydrolysis by proteolytic enzymes. Bioactive peptides are resorbed in their whole form and have a preventive effect against various disease conditions, including hypertension, dyslipidemia, inflammation, and oxidative stress. In recent years, there has been a growing body of evidence showing that physiologically active peptides may have a function in sports nutrition. The present study aimed to evaluate the synergistic effect of dipeptide (IF) from alcalase potato protein hydrolysates and exercise training in hypertensive (SHR) rats. Animals were divided into five groups. Bioactive peptide IF and swimming exercise training normalized the blood pressure and decreased the heart weight. Cardiac, hepatic, and renal functional markers also normalized in SHR rats. The combined administration of IF peptide and exercise offer better protection in SHR rats by downregulating proteins associated with myocardial fibrosis, hypertrophy, and inflammation. Remarkably, peptide treatment alongside exercise activates the PI3K/AKT cell survival pathway in the myocardial tissue of SHR animals. Further, the mitochondrial biogenesis pathway (AMPKα1, SIRT1, and PGC1α) was synergistically activated by the combinatorial treatment of IF and exercise. Exercise training along with IF administration could be a possible approach to alleviating hypertension.

Aqua walking as an alternative exercise modality during cardiac rehabilitation for coronary artery disease in older patients with lower extremity osteoarthritis

Background

The purpose of this study was to examine the effects of aqua walking (AW) on coronary artery disease (CAD) and cardiorespiratory fitness in older adults with osteoarthritis in the lower extremity and compare it with that of traditional over-ground walking.

Methods

Sixty consecutive eligible patients who had undergone percutaneous coronary intervention for CAD with limited ambulation due to lower extremity osteoarthritis were recruited. They were randomly assigned to the AW program group, treadmill/track walking (TW) program group, or non-exercise control group (CON). Assessments were performed before and after 24 weeks of medically supervised exercise training.

Results

Significant differences were observed in the change in %body fat (TW: −2.7%, AW: −2.8%, CON: −0.4%), total cholesterol level (TW: −23.6 mg/dL, AW: −27.2 mg/dL, CON: 15.8 mg/dL), resting heart rate (TW: −6.3 bpm, AW: −6.9 bpm, CON: 1.3 bpm), and cardiorespiratory fitness expressed as VO₂ peak (TW: 2.3 mL/kg·min⁻¹, AW: 2.0 mL/kg·min⁻¹, CON: −2.5 mL/kg·min⁻¹) over 24 weeks among the groups. However, no significant differences in the change in these measures were found between the TW and AW groups.

Conclusion

AW appears to be a feasible alternative exercise modality to over-ground walking for cardiac rehabilitation and can be recommended for older adults with CAD and osteoarthritis.

The impact of 12 weeks walking football on health and fitness in males over 50 years of age

Aim

To describe and characterise anthropometrical and fitness changes following a 12-week walking football programme in individuals over the age of 50 years.

Methods

Following ethical approval, 10 male participants (mean (SD): age 66 (7) years) with a range of comorbidities completed a 12-week walking football programme, consisting of a single 2 h training session each week. Body mass, fat mass, fat free mass, maximal oxygen consumption, maximal heart rate, exercise time to exhaustion and isometric hand-grip strength, were assessed at baseline and immediately following the intervention. Week-0–12 intervention differences were determined using means (95% CIs) and t tests; effect sizes were calculated using Cohen's d (0.2 small, 0.5 medium, 0.8 large).

Results

12 weeks walking football significantly reduced body fat mass (week 0, 27.4 (9.0) kg versus week 12, 24.4 (8.9) kg, p=<0.05, d=1.0) and reduced percentage body fat (week 0, 30.3 (8.2) % versus week 12, 27.5 (8.5) %, p=<0.05, d=1.0). A significant increase in time to volitional exhaustion during increamental exercise (week 0, 545 (102) s versus week 12, 603 (102) s, p=<0.05, d=0.7) was observed without any change in peak blood lactate. Non-significant differences with medium effect sizes were seen for a reduction whole body mass, increase in lean body mass and a reduction in body mass index.

Conclusions

This investigation suggests the potential efficacy of walking football as a public health intervention, even in populations presenting a range of comorbidities, with future research investigating its move to scale.

Drug therapy for the patient with resistant hypertension

ABSTRACT 

Resistant hypertension is associated with high morbidity and mortality. Resistant hypertension is defined as blood pressure above targets despite treatment with at least three antihypertensive drugs in adequate dose and combination. Nonadherence is a frequent cause of uncontrolled hypertension and can be improved by providing fixed dose (of two or three agents) single pill combination. Triple combination of the most widely used antihypertensive agents (renin–angiotensin–aldosterone system antagonists, calcium channel blockers and diuretics) is a safe and effective therapy. Fourth line therapy is the use of an aldosterone antagonist. Renal denervation and baroreceptor stimulation can be considered in patients who remained uncontrolled despite optimal medical therapy.

Efeitos de um programa de exercicios fisicos sobre a pressao arterial e medidas antropometricas

INTRODUÇÃO: O número de pessoas com sobrepeso ou obesidade tem alcançado índices alarmantes no Brasil. Condutas não-medicamentosas devem ser a estratégia inicial para o tratamento de indivíduos com sobrepeso e hipertensão leve a moderada. OBJETIVO: Analisar os efeitos de um programa de condicionamento físico realizado por um período de 24 meses sobre pressão arterial e composição corporal em indivíduos normotensos e pré-hipertensos. MÉTODOS: Participaram do estudo 35 indivíduos randomizados como: (GI) normotensos (n = 16), 51 ± 1 anos, pressão arterial sistólica (PAS) < 120 e diastólica (PAD) < 80 mmHg; e (GII) pré-hipertensos (n = 19), 54 ± 1 anos, PAS de 139 e PAD de 89 mmHg. RESULTADOS: Após 24 meses de programa de condicionamento físico, os indivíduos do GII apresentaram redução na PAS (-3,6 ± 0,94 e -10 ± 0,94 mmHg, p < 0,05, respectivamente) e PAD (-6,5 ± 1 e -7,1 ± 0,9 mmHg, p < 0,05). Em ambos os grupos houve redução do perímetro de cintura (-1,74 ± 3,5 e -1,91 ± 4 cm, p < 0,05) e índice de adiposidade (-1,21 ± 2,6 e -1,35 ± 3,1%, p < 0,05), aumento da massa corporal (+1,27 ± 3 e +1,32 ± 3,8 kg, p < 0,05), IMC (+0,72 ± 0,4 e +0,54 ± 0,60 kg/m2, p < 0,05) e massa corporal isenta de gordura (+0,91 ± 0,5 e +0,77 ± 4,8 kg p < 0,05). CONCLUSÃO: Este programa reduziu PA, o perímetro de cintura e o índice de adiposidade em indivíduos pré-hipertensos, constituindo-se, portanto, numa estratégia segura e de baixo custo na prevenção de doenças cardiovasculares e melhoria da condição de saúde da população.

Effects of combined traditional Chinese exercises on blood pressure and arterial function of adult female hypertensive patients

This study examined the effects of combined traditional Chinese physical and mental exercises on the blood pressure of adult female hypertensive patients. Twenty female hypertensive patients aged between 50 and 60 years voluntarily participated in the study. The participants performed the combined exercises for 24 weeks, twice a week, and 60 min each time in low-to-moderate intensity. After the 24-week training, the participants showed significant decreases in systolic blood pressure (p = 0.000), diastolic blood pressure (p = 0.006), pulse pressure (p = 0.001), and right ankle brachial pressure index (p = 0.041). The combined Chinese traditional physical and mental exercises were found to have beneficial effects on adult female hypertensive patients.

Exercício físico controla pressão arterial e melhora qualidade de vida

INTRODUÇÃO: Para o tratamento correto da hipertensão arterial, é plausível a hipótese de que diante da prática regular de exercícios físicos estes pacientes não necessitariam de fármacos anti-hipertensivos. OBJETIVO: Avaliar o efeito do tratamento exclusivo com exercício físico na pressão arterial (PA) e qualidade de vida (QV) de hipertensos. MÉTODO: Ensaio clínico com 32 hipertensos sedentários, 55±9 anos, que estavam sob tratamento farmacológico (TF) aleatoriamente alocados em Grupo Exercício (GE) e Grupo Controle (GC). No GE, 18 indivíduos (50% mulheres) após pelo menos dez dias de interrupção do TF iniciaram programa de exercício de dez semanas, 3x/semana, 30 minutos de exercício aeróbio seguidos por exercícios resistidos, enquanto 14 do GC (57% mulheres) se mantiveram sob TF. Foi verificada PA sistólica (PAS) e diastólica (PAD) no início e final do estudo pelo método auscultatório clássico e QV pelo questionário MINICHAL. Os dados foram expressos por M±DP, usou-se teste t de Student, U de Mann-Whitney e Wilcoxon, considerando-se p < 0,05 significativo. RESULTADOS: No início e final da pesquisa, não foram observadas diferenças na PA entre os grupos. Intragrupos, a PA no GE manteve-se semelhante aos valores antes da retirada dos fármacos (PAS 132,2 ± 13,3 x 134,4 ± 10 mmHg; PAD 85,0 ± 9 x 85,3 ± 10 mmHg p = ns), assim como no GC (PAS 127,2 ± 19 x 130,2 ± 16 mmHg; PAD 82,1 ± 16 x 85,3 ± 12 mmHg p = ns). Para a QV, entregrupos não foi observada diferença dos escores no início e final, intragrupos melhora significativa no aspecto emocional do GE (p = 0,02). CONCLUSÃO: A terapêutica anti-hipertensiva, exclusivamente por meio do exercício físico na comparação com tratamento farmacológico convencional, possibilitou idêntico controle da PA e melhor percepção de QV.

The effects of physical exercise on the serum iron profile in spontaneously hypertensive rats

The purpose of this study was to evaluate the profile of serum iron in spontaneously hypertensive rats after an aerobic physical exercise. To accomplish this, 12 normotensive Wistar rats and 12 spontaneously hypertensive rats were distributed into "physical exercise" and "no physical exercise" groups. The animals in the physical exercise group underwent to an aerobic exercise for a total of 4 weeks. Blood was collected for the analysis of iron. Our results indicate that rats of the physical exercise group had significantly lower serum iron levels after the aerobic exercise protocol compared to the spontaneously hypertensive rats no physical exercise group (F ((3,16)) = 4.4915, p < 0.01). No significant difference was found between no physical exercise groups. The results indicated that the difference in iron may be due to an increased demand for iron, prompted by chronic physical exercise. In addition, erythrocytosis has been associated with increased blood pressure in spontaneously hypertensive rats, suggesting that iron reduction may be related to decreased blood pressure in these animals.

Validation of questionnaires to estimate adherence to the Mediterranean diet and life habits in older individuals in Southern Spain

OBJECTIVE

The aim of the present study was to determine the nutritional behaviour of an elderly urban population in Southern Spain, estimating their degree of adherence to the Mediterranean. DIET DESIGN: A population-based cross-sectional nutritional survey, recruiting a representative sample of elderly inhabitants. The study sample comprised 260 people. The mean age was 73.60 yrs for the men and 72.25 yrs for the women. Around 70% lived with their family.

RESULTS

The questionnaires used were first validated by using the Bland-Altman plot and the Wilcoxon test for paired samples. The degree of adherence to the Mediterranean Diet was around 50%, similar to findings in other Mediterranean populations. We highlight the mean consumption of milk and milk products (300-317 g/day) and of fruit/vegetables (250 g/day), which are slightly below recommendations. Our study subjects were all autonomous in their movements and were physically independent: 80% reported that they performed some type of physical activity.

CONCLUSION

In this study, both adherence to the Mediterranean Diet and physical activity were considered as components of a healthy life. In summary, a majority of this elderly population was slightly overweight, considered themselves to be in good health.

Influência da cafeína na resposta pressórica ao exercício aeróbio em sujeitos hipertensos

A redução da pressão arterial (PA) promovida pelo exercício físico é evidente segundo a literatura atual. Mecanismos neuro-humorais explicam essa resposta hipotensora, em que a diminuição da atividade simpática apresenta-se como um dos principais mecanismos. Porém, a ingestão de alimentos ricos em cafeína (CA) pode suprimir esta atenuação simpática. O objetivo desse estudo foi elucidar o impacto da ingestão de CA na resposta pressórica ao exercício em pessoas hipertensas. Sete hipertensos (52,3 ± 3,3 anos), sendo cinco mulheres, realizaram duas sessões de caminhada com 40 minutos de duração, em dois dias de treinamento, tendo previamente ingerido CA (4mg/kg de peso corporal) ou placebo (PL). A PA e a frequência cardíaca foram verificadas anteriormente a ingestão, após 15, 30, 45, 60 minutos da ingestão em estado de repouso e com 10, 20 e 30 minutos após o exercício. Os dados foram tratados por meio de estatística descritiva, e pelo teste não paramétrico de Wilcoxon (p < 0,05). A média da PA aumentou de 124,9/80,9mmHg antes da ingestão de CA para 129,4/84,3mmHg 60 minutos após, ainda no repouso (p < 0,05). Trinta minutos após o exercício observou-se resposta hipotensora no procedimento PL (queda da PA de 122,6/79,4mmHg para 115,7/78,6mmHg), enquanto que no procedimento com CA, a PA mostrou-se significativamente mais alta em relação aos valores de repouso (aumento de 124,9/80,9mmHg para 136,9/90,9mmHg, p < 0,05). Conclui-se que a ingestão de CA não só suprime a resposta hipotensora do exercício, como provoca uma hipertensão pós-exercício.

Exercise therapy in polycystic ovary syndrome: a systematic review

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common endocrine disorder, affecting 8-12% of women. Lifestyle modification, including increased physical activity, is the first-line approach in managing PCOS. A systematic review was performed to identify and describe the effect of exercise as an independent intervention on clinical outcomes in PCOS.

METHODS

Five databases were searched with no time limit. A pre-specified definition of PCOS was not used. Studies were included if exercise therapy (aerobic and/or resistance) could be evaluated as an independent treatment against a comparison group. Outcomes measured included cardiovascular risk factors [insulin resistance (IR), lipid profiles, blood pressure and weight] and reproductive measures (ovulation, menstrual regularity and fertility outcomes). Quality analysis was performed based on the Cochrane Handbook of Systematic Reviews and the Quality of Reporting of Meta-Analyses checklist.

RESULTS

Eight manuscripts were identified (five randomized controlled trials and three cohort studies). All studies involved moderate intensity physical activity and most were of either 12 or 24 weeks duration with frequency and duration of exercise sessions ranging between studies. The most consistent improvements included improved ovulation, reduced IR (9-30%) and weight loss (4.5-10%). Improvements were not dependant on the type of exercise, frequency or length of exercise sessions.

CONCLUSIONS

Exercise-specific interventions in PCOS are limited. Studies vary considerably in design, intensity and outcome measures; therefore conclusive results remain elusive. Larger, optimally designed studies are needed to both gain insights into the mechanisms of exercise action and to evaluate the public health impact of exercise of PCOS.

Interaction between exercise and hypertension in spontaneously hypertensive rats: a meta-analysis of experimental studies

The effect of exercise on the progression of hypertension and development of heart failure has been extensively studied in spontaneously hypertensive rats (SHRs), but results published thus far have not revealed a clear picture. Studies differ with respect to the age and sex of rats, duration of exercise and exercise protocols. This study was aimed to examine the influence of age at the start of exercise and the effect of the duration of exercise on blood pressure and hypertrophy, which has not been previously investigated. We identified 18 reports in the literature (with a total of about 410 rats) that investigated the effect of exercise on SHR. A reduction in blood pressure was observed in rats that started exercise protocols in the pre-hypertensive or very early hypertensive state, but not in older rats. Exercise lowered the heart weight-to-body weight ratio in rats starting exercise at a very early age, but not in rats at an advanced age. A reduction in blood pressure was observed in animals that had a short period of training, but the effect was lost when the duration of exercise was prolonged. Exercise reduced resting heart rates in all groups and increased the heart weight-to-body weight ratio in groups that were exposed to free running wheels, but not in rats that performed treadmill exercise. In conclusion, exercise per se does not reduce blood pressure in SHR with established hypertension and may increase the incidence of myocardial hypertrophy, depending on the form of exercise.

Screening and evaluation of the cardiovascular and pulmonary systems in patients presenting with upper extremity impairments

NARRATIVE REVIEW: Given the prevalence of cardiovascular and pulmonary (CV-P) disease, it is likely that a substantial portion of patients seeking services from hand therapists have diagnosed or yet to be diagnosed disease in one or both of these systems. Pain originating from these systems is more common in the chest, shoulder, and scapular regions, but both systems can refer pain into the medial aspect of the forearm and hand. Pancoast's tumors of the lung, myocardial ischemia, and myocardial infarction are examples of specific pathologies capable of referring pain into these upper extremity regions. Another concern for the hand therapist is that upper extremity exercise is more stressful on the cardiovascular system than lower extremity exercise. Because of this, hand therapists need to be able to recognize when to discontinue or modify exercise interventions based on inappropriate cardiovascular system responses. Thus, the purpose of this review is to present 1) screening for potential pathology in the CV-P systems, 2) methods typically available to hand therapists for monitoring these systems, 3) criteria that indicate the need for therapy modification or medical referral, and 4) symptomatology of some common cardiac and pulmonary pathologic conditions the hand therapist may encounter.

LEVEL OF EVIDENCE

5.

Leisure activities and mortality: does gender matter?

OBJECTIVES

This study examines the association between participation in leisure activities and mortality risk among older men and women.

METHODS

A representative sample of 1,246 men and women ages 65 to 95, interviewed in 1991-1992, were followed for 12 years. Cox regressions analyzed mortality risk.

RESULTS

Participating in only a few activities doubled mortality risk compared to those with the highest participation levels, even after controlling for age, education, walking ability, and other health indicators. Women had a dose-response relationship between overall participation and survival. Strong associations with survival were found for engagement in organizational activities and study circles among women and hobby activities and gardening among men.

DISCUSSION

Results suggest gender differences in the association between leisure activities and mortality. Women display a decreasing mortality risk for each additional activity. Social activities have the strongest effects on survival among women, whereas men seem to benefit from solitary activities.

Relationship of health behavior theories with self-efficacy among insufficiently active hypertensive African-American women

OBJECTIVE

While self-efficacy plays an important role in physical activity, relatively little research has examined this construct in minorities. This study identified theoretical correlates associated with self-efficacy among insufficiently active, hypertensive Black women.

METHODS

Correlates of self-efficacy to: (1) overcoming barriers to physical activity; (2) making time for activity; and (3) "sticking with" physical activity were studied.

RESULTS

Sixty-one women (M=50.48+/-4.2 years) participated. We accounted for 32% of the variance in confidence in overcoming barriers. Women confident in overcoming barriers reported less worry about physical activity. The TTM processes of change were also in the model: consciousness raising, environmental reevaluation, counter conditioning, and self-liberation. We accounted for 16% of the variance in "making time" self-efficacy. An aversiveness barrier (e.g., physical activity is boring, physical activity is hard work) was the dominant variable in the model. Confidence to 'stick with' physical activity was associated with self-reevaluation (i.e., reflection on how personal values correspond to behavior). Social support and competing demands were not associated with self-efficacy.

CONCLUSIONS

Consistent with Social Cognitive Theory, results suggest that self-efficacy is behavior specific and each measure likely provides unique information.

PRACTICE IMPLICATIONS

Interventions should be tailored to address specific self-efficacy types.

Population strategies to treat hypertension

The risks of cardiovascular disease, cerebrovascular disease, peripheral artery disease, and end-stage renal disease are linearly related to systolic blood pressure. As the population ages and the prevalence of high blood pressure increases, the implementation of population-based strategies will be essential to reduce the burden of hypertension-related diseases. Reduction and control of elevated blood pressure can effectively slow the progression of end-stage renal disease, cerebrovascular disease, peripheral vascular disease, and cardiovascular disease. The strategies for population-based hypertension control are implemented through an increased awareness of the newest guidelines. In the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the strategies include lifestyle modification and antihypertensive medication. Although specific blood pressure levels determine antihypertensive medications, lifestyle modifications are advised for all segments of the population and for all blood pressure levels. In particular, lifestyle modification is the recommended intervention for the "prehypertension" category and is encouraged for individuals with normal blood pressure. Also, strategies for lifestyle modifications are part of the treatment strategies for stage 1 and stage 2 hypertension categories in conjunction with antihypertensive medications. The major lifestyle modifications to reduce and manage blood pressure include weight management, incorporation of specific diet plans, dietary sodium reduction, physical activity, and moderation of alcoholic consumption. The implementation and commitment to these strategies can effectively and significantly reduce blood pressure levels, and subsequent hypertension-related disease risks in the population.

Voluntary exercise training enhances glucose transport but not insulin signaling capacity in muscle of hypertensive TG(mREN2)27 rats

Male heterozygous TG(mREN2)27 rats (TGR) overexpress a murine renin transgene, display marked hypertension, and have insulin resistance of skeletal muscle glucose transport and insulin signaling. We have shown previously that voluntary exercise training by TGR improves insulin-mediated skeletal muscle glucose transport (Kinnick TR, Youngblood EB, O’Keefe MP, Saengsirisuwan V, Teachey MK, and Henriksen EJ. J Appl Physiol 93: 805–812, 2002). The present study evaluated whether this training-induced enhancement of muscle glucose transport is associated with upregulation of critical insulin signaling elements, including insulin receptor substrate-1 (IRS-1), phosphatidylinositol 3-kinase, Akt, and glycogen synthase kinase-3. TGR remained sedentary or ran spontaneously in activity wheels for 6 wk, averaging 7.1 ± 0.8 km/day by the end of week 3 and 4.3 ± 0.5 km/day over the final week of training. Exercise training reduced total abdominal fat by 20% ( P < 0.05) in TGR runners (2.64 ± 0.01% of body weight) compared with sedentary TGR controls (3.28 ± 0.01%). Insulin-stimulated (2 mU/ml) glucose transport activity in soleus muscle was 36% greater in TGR runners compared with sedentary TGR controls. However, the protein expression and functionality of tyrosine phosphorylation of insulin receptor and IRS-1, IRS-1 associated with the p85 regulatory subunit of phosphatidylinositol 3-kinase, and Ser473 phosphorylation of Akt were not altered by exercise training. Only insulin-stimulated glycogen synthase kinase-3β Ser9 phosphorylation was increased (22%) by exercise training. These results indicate that voluntary exercise training in TGR can enhance insulin-mediated glucose transport in skeletal muscle, as well as reduce total abdominal fat mass. However, this adaptive response in muscle occurs independently of modifications in the proximal elements of the insulin signaling cascade.

Risk Factors of Stroke Mortality: A 40-Year Follow-Up of the Corfu Cohort from the Seven-Countries Study

The present work evaluates several risk factors for stroke mortality based on a 40-year follow-up of the Corfu cohort from the Seven-Countries Study. The population studied in this analysis consisted of 529 rural men (49.7 +/- 5.7 years old) enrolled at 1961. The death rate at the end of follow-up was 87.1% (i.e. 461 deaths out of 529 participants). Of 529 cardiovascular-disease-free men at entry, 74 (14%) died because of hemorrhagic or thrombotic stroke. Age (HR=1.11/year, p<0.001), pulse pressure (HR=1.16/5 mm Hg, p<0.001), total serum cholesterol levels (HR=0.81/10 mg/dl, p<0.01) and presence of physical activity (HR=0.59, p<0.05), showed a statistically significant association with fatal stroke events. In conclusion, age, pulse pressure levels, physical activity (protective) and total serum cholesterol levels (protective) were significantly related with 40-year stroke mortality.

Effect of isometric handgrip exercise training on resting hemodynamics: a pilot study

OBJECTIVE

The purpose of the present study was to examine 1) whether Isometric Handgrip (IHG) training lowers arterial pressure at rest and 2) whether possible reductions in arterial pressure are associated with reductions in the heart rate variability (HRV).

METHODS

This case series consisted of 2 hypertensive female subjects who were trained with four 3-minute bouts of IHG) exercise at 30% maximal voluntary contraction (MVC) separated by 5-minute rest periods. Training was performed 4 times per week for 4 weeks. Subjects' resting arterial pressure were measured before and after training each day for 4 consecutive days, with HRV recorded on the third day each week.

RESULTS

In the first subject, resting diastolic pressure decreased from 120 to 90 mmHg and systolic arterial pressure decreased from 160 to 140 mmHg, whereas heart rate increased from 52 to 55 beats/min, and HRV did not change following training. The decrease in blood pressure was seen after 3 weeks of handgrip exercise. In the second subject, no trend of blood pressure reduction was seen but the systolic arterial pressure decreased before and after the handgrip exercise at 10 training days out of the 17 possible days. In the other 7 days, 6 days showed no blood pressure changes after handgrip exercise. The HRV in the LF, HF, VLF ranges did not change with training.

DISCUSSION

Handgrip exercise moderately reduced blood pressure in the 2 female hypertensive subjects. The reduction of blood pressure and response to HRV seemed to relate to subject's history of using hypertensive medication.

CONCLUSION

IHG training might be an effective nonpharmacological intervention in lowering arterial pressure. Further study is needed.

Gender differences on the risk evaluation of acute coronary syndromes: the CARDIO2000 study

Coronary heart disease (CHD) is more common in men than women. Gender differences in CHD risk may be explained by a different impact that coronary risk factors may have for men and women, in the development of CHD. Thus, the authors aimed to analyze the extent to which cardiovascular risk factors can explain the gender difference in CHD risk, at population level. During 2000-2001, 848 hospitalized patients with a first event of acute coronary syndrome and 1078 controls, paired by gender, age, and region with no evidence of overt CHD, were randomly selected from all Greek regions. Data revealed that women experiencing their first acute coronary syndrome were significantly older than men (65.3+/-8 vs. 59.7+/-10 years old; p<0.01), and that acute coronary syndrome occurred more frequently in men than women (frequency ratio 4:1, men:women). When adjusting for age, multivariate analysis revealed that both family history of premature CHD and hypercholesterolemia were associated with higher coronary risk in men than women (odds ratio [OR]=5.11 vs. 3.14; p<0.05 for family history and OR=3.77 vs. 2.19; p<0.05 for hypercholesterolemia). The presence of hypertension however, had a significantly greater effect in women than men (OR=4.86 vs. 1.66; p<0.01). Also, higher education level and the adoption of a Mediterranean diet had a more protective effect in women than men (OR=0.53 vs. 0.87; p<0.001; and OR=0.80 vs. 0.96; p<0.05, respectively). There was also evidence of a greater association between depression and higher coronary risk in women than men (OR=1.93 vs. 1.58; p<0.07). The impact of other factors (i.e., smoking, diabetes, body mass index, physical activity, alcohol consumption, and financial status), on the coronary risk difference between genders was similar for men and women. In conclusion, our findings suggest that the contribution of certain coronary risk factors to the risk for CHD is different for men and women.

Modulation of metabolic control by angiotensin converting enzyme (ACE) inhibition

Angiotensin converting enzyme (ACE) inhibitors are a widely used intervention for blood pressure control, and are particularly beneficial in hypertensive type 2 diabetic subjects with insulin resistance. The hemodynamic effects of ACE inhibitors are associated with enhanced levels of the vasodilator bradykinin and decreased production of the vasoconstrictor and growth factor angiotensin II (ATII). In insulin-resistant conditions, ACE inhibitors can also enhance whole-body glucose disposal and glucose transport activity in skeletal muscle. This review will focus on the metabolic consequences of ACE inhibition in insulin resistance. At the cellular level, ACE inhibitors acutely enhance glucose uptake in insulin-resistant skeletal muscle via two mechanisms. One mechanism involves the action of bradykinin, acting through bradykinin B(2) receptors, to increase nitric oxide (NO) production and ultimately enhance glucose transport. A second mechanism involves diminution of the inhibitory effects of ATII, acting through AT(1) receptors, on the skeletal muscle glucose transport system. The acute actions of ACE inhibitors on skeletal muscle glucose transport are associated with upregulation of insulin signaling, including enhanced IRS-1 tyrosine phosphorylation and phosphatidylinositol-3-kinase activity, and ultimately with increased cell-surface GLUT-4 glucose transporter protein. Chronic administration of ACE inhibitors or AT(1) antagonists to insulin-resistant rodents can increase protein expression of GLUT-4 in skeletal muscle and myocardium. These data support the concept that ACE inhibitors can beneficially modulate glucose control in insulin-resistant states, possibly through a NO-dependent effect of bradykinin and/or antagonism of ATII action on skeletal muscle.

The association between physical activity and the development of acute coronary syndromes in treated and untreated hypertensive subjects

The objective of this study was to evaluate the effect of physical activity on the risk of coronary events in different groups of hypertensive patients. During 2000-2001, 848 patients hospitalized for a first event of coronary heart disease and 1078 hospitalized controls without any suspicion of coronary heart disease, paired by sex and age, were randomly selected from all Greek regions. A total of 418 (49%) of the patients and 303 (28%) of the controls were classified as hypertensives, while 88 (21%) of the hypertensive patients and 88 (29%) of the hypertensive controls, reported regular leisure-time physical activity. Compared to physical inactivity, the analysis showed that light to moderate physical activity was associated with a reduction by 12% of the coronary risk in controlled hypertensive subjects (p=0.03), by 9% (p=0.04) in hypertensives who were untreated or unaware of their condition, and by 5% (p=0.087) in uncontrolled hypertensives. The practice of regular physical activity seems to be associated with lower coronary risk in various groups of hypertensives. However, these data cannot prove causality, and prospective studies will be necessary to confirm or refute the authors findings.

Modulation of insulin resistance and hypertension by voluntary exercise training in the TG(mREN2)27 rat

Hypertension is often accompanied by insulin resistance of skeletal muscle glucose transport. The male heterozygous TG(mREN2)27 rat, which harbors a mouse transgene for renin, displays local elevations in the renin-angiotensin system and exhibits markedly elevated systolic blood pressure (SBP). The present study was undertaken to characterize insulin-stimulated skeletal muscle glucose transport in male heterozygous TG(mREN2)27 rats and to evaluate the effect of voluntary exercise training on SBP and skeletal muscle glucose transport. Compared with normotensive Sprague-Dawley rats, TG(mREN2)27 rats displayed a 53% elevation (P < 0.05) in SBP, a twofold increase in plasma free fatty acid levels, and an exaggerated insulin response during an oral glucose tolerance test. Moreover, insulin-mediated glucose transport (2-deoxyglucose uptake) in isolated epitrochlearis and soleus muscles of TG(mREN2)27 animals was 33 and 43% less, respectively, than in Sprague-Dawley controls. TG(mREN2)27 rats ran voluntarily for 6 wk and achieved daily running distances of 6-7 km over the final 3 wk. Training caused a 36% increase in peak aerobic capacity and a 16% reduction in resting SBP. Fasting plasma insulin (21%) and free fatty acid (34%) levels were reduced in the trained TG(mREN2)27 rats. Whole body glucose tolerance was improved in the trained TG(mREN2)27 rats and was associated with increases of 39 and 50% in insulin-mediated glucose transport in epitrochlearis and soleus muscles, respectively. Whole muscle GLUT-4 protein was increased in the soleus (23%), but not in the epitrochlearis, of trained TG(mREN2)27 rats. These data indicate that the male heterozygous TG(mREN2)27 rat is a model of both hypertension and insulin resistance. Importantly, both of these defects can be beneficially modified by voluntary exercise training.

The effect of the combination of Mediterranean diet and leisure time physical activity on the risk of developing acute coronary syndromes, in hypertensive subjects

The World Health Organization reports that the number of hypertensives, worldwide, is estimated to be 600 million people. In addition a considerable proportion of hypertensive subjects remains untreated or uncontrolled. In this work we investigated the combined effect of physical activity and Mediterranean diet on coronary risk, in hypertensives. Thus we randomly selected, from all Greek regions, 848 hospitalised patients (695 males, 58 +/- 10 years old and 153 females, 65 +/- 9 years old) with a first event of coronary heart disease (CHD) and 1078 paired, by sex, age, region controls, without any suspicions for CHD. Physically active were those who reported non-occupational physical activity more than once per week. Subjects 'closer' to the Mediterranean diet were assessed through a special nutrient questionnaire. A total of 418 (49%) of the patients and 303 (28%) of the controls were hypertensive. Of these, 115 (27%) patients and 70 (23%) controls were untreated, 148 (35%)-111 (36%) were uncontrolled and 155 (38%)-122 (41%) were controlled (P-value <0.01). One hundred and sixty-two (19%) of the patients and 265 (25%) of the controls (P < 0.01) were 'closer' to the combination of Mediterranean type of diet and physical activity. The analysis showed that the previous combination is related to a 25% reduction of the coronary risk in controlled hypertensive subjects (OR = 0.75, P < 0.01), a 11% reduction in untreated (OR = 0.89, P < 0.05) and 17% reduction (OR = 0.83, P < 0.05) in uncontrolled, after adjusting for age, sex, educational and financial level and the conventional cardiovascular risk factors. Consequently, the adoption of Mediterranean diet by physically active subjects seems to reduce significantly the coronary risk and prevent, approximately, the one-third of acute CHD, in controlled hypertensive subjects.

Beneficial effects on blood pressure and lipid profile of programmed exercise training in subjects with white coat hypertension

BACKGROUND

Patients with white coat hypertension comprise a substantial portion of the hypertensive population. Previous reports have shown that moderate-intensity regular exercise training in patients with mild hypertension usually reduces blood pressure (BP), but there is a lack of data regarding individuals with white coat hypertension. This study was performed to evaluate whether programmed exercise was effective in reducing BP in patients with white coat hypertension and whether it also had beneficial effects on other biochemical parameters.

METHODS

A total of 42 patients (23 men and 19 women) with white coat hypertension (mean 24-h ambulatory BP 119.2 +/- 6.6/78.3 +/- 5.8 mm Hg) were divided randomly into two groups: control (n = 20) (no exercise), and moderate-intensity exercise (n = 22). The training group exercised three times per week at the prescribed exercise intensity using a treadmill exercise program. Blood pressure, heart rate, and biochemical parameters were monitored every 4 weeks for 12 weeks.

RESULTS

Significant reductions in clinic and ambulatory BPs were seen in the exercise group after only 4 weeks regular exercise training and these persisted over the 12-week study. The mean maximal reductions in clinic BP were 11 mm Hg for systolic and 5 mm Hg for diastolic pressure. Significant reductions were found in plasma total cholesterol (-6.1%), low-density lipoprotein cholesterol (LDL-C) (-14.1%), and triglyceride (-11.4%). Elevation of high-density lipoprotein cholesterol (HDL-C) (+11.2%) was also noted.

CONCLUSIONS

These data, which are clinically significant, suggest that 12 weeks of exercise training can result in successful reduction of BP and favorable changes in the lipid profile that would be beneficial to patients with white coat hypertension.

Beneficial effect on blood pressure and lipid profile by programmed exercise training in Taiwanese patients with mild hypertension

Mild essential hypertensive patients comprise a large portion of the hypertensive population. Previous reports have shown that moderate-intensity regular exercise training in these patients usually reduces blood pressure. By designing programmed exercise to evaluate whether it is effective in reducing blood pressure in mild hypertensive patients and also has beneficial effects on other biochemical parameters. Twenty-three mild hypertensive Taiwanese patients (resting blood pressure 139.1 +/- 11.4/99.5 +/- 8.0 mmHg) were divided randomly into two groups: control (no exercise) and moderate-intensity exercise (average 6.4 +/- 0.7 METs). The training group exercised three times per week at the prescribed exercise intensity by using the Treadmill exercise test. Blood pressure, heart rate and other biochemical parameters were monitored regularly every 4 weeks for 12 weeks. After 12 weeks regular exercise training, the exercise group showed for significant resting blood pressure reduction. Mean maximal reduction of systolic pressure was 18 mmHg. Significant reduction of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglyceride were found; elevation of high-density lipoprotein cholesterol (HDL-C) was also noted. These data suggest that after 12 weeks of exercise training in mild hypertensive patients, successful reduction of blood pressure and favorable changes of lipid profile will be noted.

Quality of life with nonpharmacologic treatment of hypertension

Therapeutic treatment of hypertension has been achieved successfully with both pharmacologic and nonpharmacologic interventions. Clinical trials have shown that various approaches to treatment result in different levels of blood pressure reduction as well as varying effects on quality of life. Standardizing the approach to measuring quality of life would be beneficial to the assessment of treatment outcomes in hypertension trials. This article reviews some of the strengths and weaknesses of both pharmacologic and nonpharmacologic treatments of hypertension, with special emphasis placed on effects of quality of life.

Exercise and hypertension

Epidemiologic studies have consistently revealed inverse associations between physical activity (or fitness) and hypertension. There are hypotensive benefits to exercise training found across a number of aerobic and progressive resistance training modalities. Optimal exercise prescriptions remain unclear, but hypotensive benefits have been noted for mild to vigorous ranges of exercise intensity, for as few as three exercise sessions per week and durations as short as 20 minutes. Hypertensive subjects appear to experience greater reductions than normotensive subjects. Exercise interventions may be safely and effectively used with mild to moderate as well as severe levels of hypertension. The incorporation of physical activity with other lifestyle interventions provides multiple benefits to hypertensive patients that extend beyond a reduction in blood pressure.

Exercise as hypertension therapy

In conclusion, the findings of most recent studies show that moderate-intensity aerobic exercise training can lower BP in patients with stage 1 and 2 essential hypertension. The average reduction in BP is 10.5 mm Hg for systolic and 7.6 mm Hg for diastolic BP. The reductions do not appear to be gender- or age-specific. Significant reductions in BP and LVH regression in patients with stage 3 hypertension have also been reported following aerobic exercise training. Resistance training exercise has not consistently shown to significantly lower BP and is not recommended as the only form of exercise for hypertensive patients. The exercise training program for optimal benefits should consist of 3 to 5 times per week, 30 to 60 minutes per session, at 50% to 80% of PMHR. However, exercise programs should be individualized to meet the patient's needs and abilities. Exercise intensity and duration should be manipulated to promote a safe and effective antihypertensive program. Initially, the exercise intensity should be low and the duration short. Both intensity and duration should progressive increase over a period of weeks until the desired goal, is achieved. The rate of progression must be tailored to meet individual patient needs and abilities. The exercise program for overweight or obese hypertensive patients should aim to promote a caloric expenditure of 300 to 500 Kcal per day and 1000 to 2000 Kcal per week. Such an approach, combined with a prudent diet, is likely to reduce body weight. The mechanisms mediating exercise-induced BP reduction are poorly understood. BP reductions appear to be independent of changes in body weight or body composition. There are also no indications of age- or gender-related differences in BP response to exercise. The use of ambulatory blood pressure measuring devices in exercise studies is not extensive. The few studies available indicate a more moderate reduction in BP than that reported by casual observations.

Exercise training intervention after coronary angioplasty: the ETICA trial

OBJECTIVES

The goal of this study was to determine the effects of exercise training (ET) on functional capacity and quality of life (QOL) in patients who received percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting (CS), the effects on the restenosis rate and the outcome.

BACKGROUND

It is unknown whether ET induces beneficial effects after coronary angioplasty.

METHODS

We studied 118 consecutive patients with coronary artery disease (mean age 57+/-10 years) who underwent PTCA or CS on one (69%) or two (31%) native epicardial coronary arteries. Patients were randomized into two matched groups. Group T (n = 59) was exercised three times a week for six months at 60% of peak VO2. Group C (n = 59) was the control group.

RESULTS

Only trained patients had significant improvements in peak VO2 (26%, p < 0.001) and quality of life (26.8%, p = 0.001 vs. C). The angiographic restenosis rate was unaffected by ET (T: 29%; C: 33%, P = NS) and was not significantly different after PTCA or CS. However, residual diameter stenosis was lower in trained patients (-29.7%, p = 0.045). In patients with angiographic restenosis, thallium uptake improved only in group T (19%; p < 0.001). During the follow-up (33+/-7 months) trained patients had a significantly lower event rate than controls (11.9 vs. 32.2%, RR: 0.71, 95% confidence interval [CI]: 0.60 to 0.91, p = 0.008) and a lower rate of hospital readmission (18.6 vs. 46%, RR: 0.69, 95% CI: 0.55 to 0.93, p < 0.001).

CONCLUSIONS

Moderate ET improves functional capacity and QOL after PTCA or CS. During the follow-up, trained patients had fewer events and a lower hospital readmission rate than controls, despite an unchanged restenosis rate.