Low-dose estrogen therapy does not change postexercise hypotension, sympathetic nerve activity reduction, and vasodilation in healthy postmenopausal women

Effect of exercise modalities on postexercise hypotension in pre- and postmenopausal women: a systematic review and meta-analysis

Hormonal changes associated with menopause increase the risk of hypertension. Postexercise hypotension (PEH) is an important tool in the prevention and management of hypertension; however, menopause may alter this response. The aim of this systematic review and meta-analysis [International Prospective Registered of Systematic Review (PROSPERO): CRD42023297557] was to evaluate the effect of exercise modalities (aerobic, AE; resistance, RE; and combined exercise, CE: AE + RE) on PEH in women, according to their menopausal status (premenopausal or postmenopausal). We searched controlled trials in PubMed, Web of Science, EBSCO, and Science Direct published between 1990 and March 2023. Inclusion criteria were normotensive, pre- and hypertensive, pre- and postmenopausal women who performed an exercise session compared with a control session and reported systolic blood pressure (SBP) and diastolic blood pressure (DBP) for at least 30 min after the sessions. Methodological quality was assessed using the PEDro scale. Standardized mean differences (Hedge's g) and their 95% confidence intervals (CIs) were calculated, and Q-test and Z-test were conducted to assess differences between moderators. Forty-one trials with 718 women (474 menopausal) were included. Overall, we found with moderate evidence that SBP and DBP decreased significantly after exercise session (SBP: g = -0.69, 95% CI -0.87 to -0.51; DBP: g = -0.31, 95% CI -0.47 to -0.14), with no difference between premenopausal and postmenopausal women. Regarding exercise modalities, RE is more effective than AE and CE in lowering blood pressure (BP) in women regardless of menopausal status. In conclusion, women's menopausal status does not influence the magnitude of PEH, and the best modality to reduce BP in women seems to be RE.NEW & NOTEWORTHY This meta-analysis has demonstrated that a single bout of exercise induces postexercise hypotension (PEH) in women and that the hormonal shift occurring with menopause does not influence the magnitude of PEH. However, we have shown with moderate evidence that the effectiveness of exercise modalities differs between pre- and postmenopausal women. Resistance and combined exercises are the best modalities to induce PEH in premenopausal women, whereas resistance and aerobic exercises are more effective in postmenopausal women.

Post-exercise hypotension of normotensive young men through track running sessions

INTRODUCTION: After a single session of physical exercise the blood pressure is reduced (post-exercise hypotension, PHE) and it has been considered as a non-pharmacological mechanism to control the blood pressure. When the exercise is performed since youth it can prevent or avoid hypertension. However, it is important to consider studies with clear practical applications to optimize its reproducibility on a daily basis. OBJECTIVE: Analyze the PEH of normotensive and physically active young men after two track running sessions (maximum and submaximal). METHODS: Participated in this study 62 physically active young men (23.3 ± 4.2 years old; 75.5 ± 9.8 kg; 177.7 ± 5.5 cm; 12.0 ± 4.6% body fatF; 52.4 ± 4.0 mL.kg-1.min-1oxygen uptake), which performed a maximum laboratory exercise test for determination of maximal oxygen uptake (VO2max - aerobic power) and subsequently three randomly running sessions (maximum - T1600; submaximal - T20; control - CON), with 48h interval between themselves. Blood pressure (BP) was measured each 15min during a 60 min period after sessions. RESULTS: Both the maximum and the submaximal exercise lead to PEH. The post-exercise values of systolic blood pressure and diastolic blood pressure differed from resting value in session T20 (p<0.05). The same pattern occurred after T1600 (p<0.05), evidenced from 30th minute post-exercise. The CON did not result in PEH. The magnitude of decay for the mean BP at the 45th after maximum exercise was higher than the other sessions (p<0.05). CONCLUSION: We concluded that both maximum and submaximal exercises, performed on a track running condition, caused PEH in young normotensive and physically active men.

Effects of estrogen therapy and aerobic training on sympathetic activity and hemodynamics in healthy postmenopausal women: a double-blind randomized trial

OBJECTIVE

The aim of this study was to evaluate the isolated and associated effects of aerobic training and estrogen therapy on sympathetic nerve activity and hemodynamics in healthy postmenopausal women.

METHODS

Forty-five postmenopausal women (mean [SD] age, 51 [3] y) were randomly divided into four groups: sedentary-placebo (SED-PLA; n = 11), sedentary-estrogen therapy (SED-ET; n = 14), aerobic training-placebo (AT-PLA; n = 12), and aerobic training-estrogen therapy (AT-ET; n = 8). The ET groups received oral estradiol valerate (1 mg/d), whereas the PLA groups received placebo. The AT groups performed aerobic exercise three times a week on a cycle ergometer for 50 minutes, whereas the SED groups remained sedentary. All participants were evaluated before and after 6 months. Muscle sympathetic nerve activity (MSNA; microneurography), forearm blood flow (plethysmography), blood pressure (oscillometry), and heart rate (HR) were measured at rest for 10 minutes. Data were analyzed by three-way analysis of variance.

RESULTS

Estrogen administration itself did not change any of the studied parameters. AT improved forearm blood flow (AT-PLA, 2.02 [0.85] vs 2.92 [1.65] mL min(-1) 100 mL(-1), P = 0.03; AT-ET, 1.68 [1.11] vs 2.27 [0.76] mL min(-1) 100 mL(-1), P = 0.03), reduced MSNA in the AT-PLA group (39 [6] vs 34 [5] bursts/min(-1), P = 0.01), and decreased HR in the AT-ET group (65 [8] vs 62 [7] beats/min, P = 0.01).

CONCLUSIONS

AT reduces sympathetic nerve activity and improves muscle blood flow in healthy hysterectomized postmenopausal women. Moreover, AT decreases HR when combined with ET. However, ET abolishes the reducing effect of AT on MSNA.

Influence of resistance training on blood pressure in patients with metabolic syndrome and menopause

This study investigated the chronic and acute influence of resistance exercise on blood pressure in women with metabolic syndrome before and after climacteric. Twenty sedentary women, nine non-menopausal (RNM) and 11 menopausal (RM), performed training for 12 weeks. Meanwhile, 23 controls, 11 not menopausal (CNM) and 12 menopausal (CM), remained sedentary. Blood pressure was measured before and after the training period in conditions of rest and after a session of exercise. Training promoted variations in blood pressure at rest from 116±13 to 118±10 mmHg (p=0.73) and from 128±12 mmHg to 120±11mmHg (p=0.12) in RNM and RM, respectively. CNM and CM varied from 115±11 to 116±12 mmHg (p=0.9) and from 115±14 mmHg to 116±13 mmHg (p=0.74). Blood pressure values in one acute session did not differ between groups (p>0.05). Resistance training did not improve blood pressure in women with metabolic syndrome, regardless of climacteric.

Oral estrogen therapy may mitigate the effects of aerobic training on cardiorespiratory fitness in postmenopausal women: a double-blind, randomized clinical pilot study

OBJECTIVE

The aim of this study was to evaluate the isolated and associated effects of oral estrogen therapy and aerobic training on cardiorespiratory fitness in postmenopausal women.

METHODS

Forty-two hysterectomized healthy postmenopausal women were randomly divided (in a double-blind manner) into four groups: placebo-control (n = 9), estrogen therapy-control (n = 12), placebo-aerobic training (PLA-AT; n = 11), and estrogen therapy-aerobic training (ET-AT; n = 10). The estrogen therapy groups received estradiol valerate (1 mg/day) and the aerobic training groups trained on a cycle ergometer three times per week at moderate intensity. Before and 6 months after the interventions, all women underwent a maximal cardiopulmonary exercise test on a cycle ergometer.

RESULTS

Regardless of hormone therapy, aerobic training increased oxygen uptake at anaerobic threshold (P = 0.001), oxygen uptake at respiratory compensation point (P = 0.043), and oxygen uptake at peak exercise (P = 0.020). The increases at respiratory compensation point and peak exercise were significantly greater in the groups receiving placebo than in the groups receiving estrogen (oxygen uptake at respiratory compensation point: PLA-AT +5.3 [2.8] vs ET-AT +3.0 [2.5] mL kg(-1) min(-1), P = 0.04; oxygen uptake at peak exercise: PLA-AT +5.8 [3.4] vs ET-AT +2.8 [1.4] mL kg(-1) min(-1), P = 0.02).

CONCLUSIONS

Oral estrogen therapy may mitigate the cardiorespiratory fitness increase induced by aerobic training in hysterectomized healthy postmenopausal women.

Microneurographic research in women

This article reviews microneurographic research on sympathetic neural control in women under both physiological and pathophysiological conditions across the lifespan. Specifically, the effects of sex, age, race, the menstrual cycle, oral contraceptives, estrogen replacement therapy, and normal pregnancy on neural control of blood pressure in healthy women are reviewed. In addition, sympathetic neural activity during neurally mediated (pre)syncope, the Postural Orthostatic Tachycardia Syndrome (POTS), obesity, the Polycystic Ovary Syndrome (PCOS), gestational hypertension, and preeclampsia, chronic essential hypertension, heart failure, and myocardial infarction in women are also reviewed briefly. It is suggested that microneurographic studies provide valuable information regarding autonomic circulatory control in women of different ages and in most cases, excessive sympathetic activation is associated with specific medical conditions regardless of age and sex. In some situations, sympathetic inhibition or withdrawal may be the underlying mechanism. Information gained from previous and recent microneurographic studies has significant clinical implications in women's health, and in some cases could be used to guide therapy if more widely available.

Dental pulp blood flow and its oscillations in women with different estrogen status

INTRODUCTION

The skin microcirculation is significantly affected by serum estrogen levels. The objective of this study was to investigate the effects of estrogen serum level changes associated with the menstrual cycle and postmenopause on dental pulp blood flow (PBF) as well as its dynamics.

METHODS

Young women at the menstrual phase (low serum estrogen levels) and in the mid-cycle phase of the menstrual cycle (high serum estrogen levels) and postmenopausal women were enrolled in the study. PBF and its oscillations were measured by laser Doppler flowmetry and analyzed by using wavelet transform. Serum levels of estradiol-17β were measured by immunoassay.

RESULTS

PBFs of young women in the menstrual phase and postmenopausal women were mutually similar and significantly lower than those of young women in the mid-cycle period. With respect to the mid-cycle phase, relative amplitude and power were significantly increased in the interval 0.0095-0.02 Hz and decreased in the intervals 0.02-0.06 and 0.06-0.2 Hz in the menstrual phase. A significant decrease in 0.0095-0.02 Hz and increase in 0.02-0.06, 0.06-0.2, 0.2-0.6, and 0.6-1.6 Hz intervals were observed in postmenopause.

CONCLUSIONS

The study has shown that the menstrual phase of the menstrual cycle and postmenopause have similar PBF decrease, but PBF oscillations are differently affected in the mid-cycle phase.