Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing

Validity and reliability of the 6-min stepper test in hypertensive individuals

BACKGROUND

Hypertension is a common public health problem characterized by high blood pressure (BP) and associated with complications such as coronary artery disease, stroke, and renal failure. Physical activity and exercise regulate BP, and assessment of exercise capacity is a cornerstone of exercise training.

OBJECTIVE

The aims of this study were to evaluate the validity and reliability of the 6-min stepper test (6MST) in hypertensive individuals and compare their physiological responses during the 6MST and 6-min walk test (6MWT).

METHODS

Forty individuals with hypertension were included. Participants performed the 6MWT and 6MST in separate morning and afternoon sessions. In each session, the test was repeated twice with a 30-min rest interval. Heart rate (HR), BP, perceived dyspnea, general fatigue, and leg fatigue were measured pre and posttest. Intraclass correlation coefficient (ICC), Bland-Altman plots, and standard error of measurement (SEM) were used to assess reliability. Pearson correlation analysis was used for convergent validity.

RESULTS

There was a strong and significant correlation between 6MWT distance and 6MST score ( r  = 0.689, P  < 0.001). Physiological responses during the 6MST had ICC values ranging from 0.70 to 0.89, suggesting good to excellent test-retest reliability. The SEM and minimum detectable difference (MDD) indicated the 6MST had low measurement error and high sensitivity.

CONCLUSION

The 6MST is a valid and reliable tool for assessing exercise capacity in people with HTN. Its practicality and ease of use make it a suitable alternative to the 6MWT for this population.

Multiethnic norms for blood pressure response to submaximal exercise testing in young-to-middle adulthood and associations with hypertension: The NHANES dataset

The blood pressure (BP) response during exercise testing is a robust correlate of hypertension in middle-to-older White people, but whether this extends to a healthy, young-to-middle-aged multiethnic population is unknown. Moreover, it is unclear what constitutes an exaggerated BP to submaximal exercise, which is a more reliable and stronger correlate of hypertension than maximal testing. The NHANES dataset was used to interrogate the association of submaximal exercise BP with current hypertension and to provide multiethnic norms for BP responses in young-to-middle-aged adults. The analyses combined NHANES cycles wherein treadmill exercise testing was conducted with an analytic sample of 2544 participants aged 12-49 years (Female: White = 467; Black = 324; Hispanic = 439; Male: White = 493, Black = 351; Hispanic = 470). Weighted logistic models were fitted to test associations between exercise BP and hypertension. Age, sex, and race-specific percentiles were estimated. Exaggerated systolic BP (SBP) responses to exercise testing were defined as readings ≥90th percentile, and ≥ROC-derived cutoff. Regardless of race, sex, exercise workload, clinical and socioeconomic characteristics, a 5-mmHg increase in SBP and diastolic BP during stage 1 of exercise testing was associated with a 15% (aOR: 1.15, 95% CI: 1.08-1.21), and 31% (aOR: 1.31, 95% CI: 1.22-1.40) higher odds for hypertension, respectively. Black males had the highest proportion of exaggerated SBP responses (44%, 95% CI: 36-53%) when defined only via ROC-derived cutoffs. BP responses during submaximal exercise were associated with hypertension, irrespective of race in young-to-middle adulthood. Still, the exaggerated SBP response to exercise of Black males suggests uncontrolled high BP not detected at rest.

Patterns of systolic blood pressure response at the end of exercise and mortality and morbidity in patients referred for exercise testing

OBJECTIVES

Peak exercise systolic blood pressure (SBP) is associated with future cardiovascular disease (CVD) and mortality. We aimed to evaluate the predictive value of different SBP patterns at the end of exercise with these outcomes.

METHODS

We studied 6329 adults (45% women) referred for exercise testing, with test duration of 6-14 min, maximal effort and valid SBP measurements at the end of exercise. The two last SBPs were indexed to work rate (mmHg/Watt), defining responses as: drop (negative change), plateau (no change), slow (lower tertile of increase), intermediate (middle tertile) and steep (upper tertile). Data were cross-linked with nationwide disease and mortality registries. Associations with all-cause mortality and incident CVD were analysed using Cox proportional hazards regression (hazard ratio (HR), 95% confidence interval), using slow SBP increase as reference, adjusted for sex, age, body mass index, baseline CVD (mortality analysis only), beta-blockers and exercise capacity (peak Watt).

RESULTS

The prevalence of SBP responses at the end of exercise were drop (1.1%), plateau (15.0%), slow (30.4%), intermediate (25.2%) and steep increase (28.3%). Follow-up was 8.8±3.4 years. Compared with a slow increase, the adjusted all-cause mortality risks were not statistically different for a drop (HR 1.16 (0.50-2.65)), plateau (HR 1.19 (0.85-1.66)), intermediate (HR 1.24 (0.93-1.66)) or steep SBP increase (HR 1.16 (0.89-1.52)). CVD risk was increased in those with a SBP drop (HR 3.10 (1.85-5.19), but not significantly for plateau (HR 1.17 (0.92-1.48)), intermediate or steep SBP increases (HRs 0.99-1.00).

CONCLUSION

Subjects with a slow SBP increase at the end of exercise tended to have the lowest mortality risk, although no SBP response pattern predicted all-cause mortality independently. CVD risk was strongly increased in patients with a drop in SBP and tended to be increased (non-significantly) also in patients with a plateau in SBP at the end of exercise, in comparison with increasing SBP.

Tailored Exercise Intervention in Metabolic Syndrome: Cardiometabolic Improvements Beyond Weight Loss and Diet-A Prospective Observational Study

Background: Metabolic syndrome (MS) is a cluster of cardiovascular and metabolic risk factors that increase the likelihood of both acute events and chronic conditions. While exercise has been shown to improve individual risk factors associated with MS; research on its effects on MS as an integrated condition remains limited. This study aims to evaluate the effectiveness of a 6-month Adapted Personalized Motor Activity (AMPA) program for improving the health outcomes of individuals with MS. Methods: Seventy-one sedentary participants with MS (mean age: 63 ± 9.4 years, 46.5% female) completed a 6-month intervention, incorporating moderate-intensity aerobic and resistance training. Each participant received a personalized exercise plan prescribed by a sports medicine physician. The training was monitored via telemetry to ensure safety. No dietary recommendations were provided during the intervention. Baseline and post-intervention assessments included Cardiopulmonary Exercise Testing (CPET), anthropometric measurements, blood pressure, heart rate, lipid profile (total cholesterol, HDL, LDL, and triglycerides), fasting glucose, and HbA1c. Results: Significant improvements were observed in fasting glucose (-10.6%, p < 0.001), HbA1c (-3.88%, p < 0.001), HDL cholesterol (+20.8%, p < 0.001), LDL cholesterol (-25.1%, p < 0.001), and VO2max (+8.6%, p < 0.001). Systolic and diastolic blood pressure also decreased significantly, with reductions of -12% (p < 0.001) and -5.9% (p < 0.001), respectively. Reductions in weight and waist circumference were statistically significant but modest and clinically irrelevant, showing no correlation with improvements in cardio-metabolic parameters. Logistic regression and correlation matrix analyses were performed to identify key predictors of changes in individual risk factors. Conclusions: While personalized exercise alone may not fully control individual risk factors of metabolic syndrome, its overall effect is comparable to low-intensity pharmacological polytherapy with minimal adverse effects. These benefits appear to be independent of dietary habits, gender, and both baseline and post-intervention physical performance and anthropometric measures.

Prospective association of estimated cardiorespiratory fitness and risk of chronic kidney diseases

Previous studies have reported that cardiorespiratory fitness (CRF) was associated with decreased risk of chronic kidney disease (CKD) in westerner. The aim of present study was to investigate the potential association between estimated eCRF (eCRF) and CKD risk in Chinese general population. A total of 5,199 participants from the China Health and Retirement Longitudinal Study were including in analysis. The sex-specific models including age, physical activity, resting heart rate, and waist circumference were used to calculate eCRF. Participants were divided into three subgroups according to age and sex-specific tertiles of eCRF. Cox proportional hazards regression models were used to examine the associations between eCRF and CKD. During 9 years of follow-up, a total of 511 respondents experienced CKD. After adjustment for potential variables, the hazard ratio (95% confidence intervals) for the tertile 2 and tertile 3 of eCRF- WC was 0.80 (0.66-0.96) and 0.74 (0.60-0.92), respectively, compared with the lowest tertiles. Moreover, each 1-SD increase of eCRF- WC was associated with 6% (95%CIs, 1-11%) decreased risk of CKD. Similar associations were also found in both male and female subgroups. When the current study calculated eCRF using body mass index instead of waist circumference, the highest tertiles of eCRF- BMI was significantly associated with decreased risk of CKD in overall and female participants. A higher eCRF was associated with a decreased risk of CKD in general Chinese population. Future well-designed prospective clinical studies are needed to verify our findings and to assess the effect of eCRF interventions in CKD prevention.

Habitual preexercise caffeine supplementation prevents exercise training-induced attenuation of exercising systolic blood pressure and double product

We examined the effect of habitual preexercise caffeine supplementation on training-induced adaptations to exercising systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), heart rate (HR), and double product (DP). Young women (means ± SD; 24 ± 7 yr) were randomized to a caffeine (120 mg) supplement (CAF; n = 17) or placebo (PLA; n = 16) group, completed 6 wk of high-intensity exercise training on three nonconsecutive days per week, and supplemented with CAF or PLA 30-60 min before exercise or else upon waking. Before (PRE) and after (POST) the intervention, SBP, DBP, and HR were measured and PP and DP were calculated, at rest and during fixed-power exercise at 50 and 75 W. Statistical analyses included three-way mixed-factorial ANOVAs with post hoc comparisons as necessary. Group × intensity × time interactions were observed for SBP (P = 0.0105) and DP (P = 0.003). SBP and DP increased with increasing exercise intensity at PRE and POST in both groups. However, although SBP and DP decreased PRE to POST at 50 and 75 W in PLA, SBP and DP did not change at any intensity from PRE to POST in CAF. An intensity × time interaction was observed for DBP (P = 0.006) indicating no change in resting DBP, but reductions from PRE to POST at 50 and 75 W that were independent of group. Main effects of intensity (P < 0.0001) and time (P = 0.03) were observed for HR, and a main effect of intensity was observed for PP (P < 0.0001). Habitual caffeine supplementation blunted training-induced reductions in exercising SBP and DP. Individuals may wish to avoid preexercise supplementation if seeking to maximize the BP-lowering benefits of exercise.NEW & NOTEWORTHY Habitual preexercise caffeine consumption prevented reductions in exercising systolic blood pressure and double product induced by 6 wk of high-intensity exercise in women. Therefore, our findings indicate that habitual preexercise caffeine supplementation may impede beneficial hemodynamic adaptations of exercise training in healthy, young women.

The Role of Exercise Blood Pressure in Hypertension: Measurement, Mechanisms, and Management

ABSTRACT

Hypertension affects one in three adults globally and is the leading modifiable risk factor for cardiovascular disease. Although blood pressure measurements at rest are fundamental to the detection and management of hypertension, abnormal blood pressure responses to exercise, namely, an exaggerated exercise blood pressure (EEBP), can provide additional independent information about current and future hypertension risk. This paper summarizes a symposium entitled, "The Role of Exercise Blood Pressure in Hypertension: Measurement, Mechanisms and Management" included at the 2023 American College of Sports Medicine annual meeting, which presented a timely discussion about the clinical utility of EEBP. Here we will summarize the evidence presented by the speakers including considerations for blood pressure measurement during exercise, an overview of EEBP thresholds and discussion about the value of EEBP during submaximal exercise for the identification and management of hypertension, a summary of the potential physiological mechanisms underpinning an EEBP, and a review of exercise prescription guidelines based on new and emerging evidence as they relate to the American College of Sports Medicine's exercise recommendations for hypertension. We conclude by highlighting areas for future research with the overarching goal of improving the measurement and management of hypertension.

Blood pressure response to graded bicycle exercise in males and females across the age and fitness spectrum

AIMS

Blood pressure (BP) responses to exercise are frequently measured, with the concern that greater increases are a marker of disease. We sought to characterize the normal exercise BP response in healthy adults and its relationships with age, sex, and fitness.

METHODS AND RESULTS

Five hundred and eighty-nine participants [median age 46 (interquartile range 24-56) years, 81% male] underwent cardiopulmonary exercise testing with repeated, automated BP measures. An exaggerated maximal systolic BP (SBPmax) was defined from current guidelines as ≥210 mmHg in males and ≥190 mmHg in females. Individual linear regression analyses defined the relationship between BP and workload (W; SBP/W-slope and DBP/W-slope). Participants with or without an exaggerated SBPmax and above- or below-median SBP/W-slope were compared. An exaggerated SBPmax was found in 51% of males and 64% of females and was more prevalent in endurance-trained athletes (males 58%, females 72%, P < 0.001). The mean SBP/W-slope was lower in males (0.24 ± 0.10 mmHg/W) than females (0.27 ± 0.12 mmHg/W, P = 0.031). In both sexes, peak oxygen uptake (VO2peak) was inversely correlated with SBP/W-slope (P < 0.01). Those with an exaggerated SBPmax and below-median SBP/W-slope were 10 years younger and had a 20% higher VO2peak, on average (P < 0.001). A non-exaggerated SBPmax and above-median SBP/W-slope was observed in older individuals with the lowest VO2peak.

CONCLUSION

In a large cohort of healthy individuals, an exaggerated SBPmax was common and associated with higher fitness. In contrast, higher SBP indexed to W was associated with older age, lower fitness, and female sex. Thus, sex, age, and fitness should be considered when evaluating BP response to exercise.

REGISTRATION

Pro@Heart: NCT05164328, ACTRN12618000716268; ProAFHeart: ACTRN12618000711213; Master@Heart: NCT03711539.

Construction of neural network model for exercise load monitoring based on yoga training data and rehabilitation therapy

The Internet of Things is based on the traditional Internet and its purpose is to achieve information exchange between users and devices, as well as between devices. The rapid development of sensor technology, communication network technology, and computer technology has enriched the coverage of the Internet of Things, including a wide range of intelligent applications such as healthcare, smart cities, and smart homes. The development of high-performance computing and machine learning technologies has promoted the wide application of intelligent auxiliary systems in sports medicine. With the rapid development of yoga in the field of sports, athletes can play the various functions of yoga, improve their physical strength and quality, and improve their strength, flexibility, etc., cultivate positive, optimistic, and healthy emotions, and these are conducive to rehabilitation treatment after sports injuries. Therefore, it is feasible and feasible to introduce yoga training into the monitoring of the exercise load of athletes. In this paper, neural network technology was used to break the traditional training method based on experience. Based on yoga training data, through experimental exercise research, it could explore a new effective way to monitor exercise load and rehabilitation treatment, and build an exercise load monitoring model of the Ant Colony Optimization (ACO) neural network. By sorting out the data, statistics and analysis of the data, this article confirmed the effect of yoga training on reducing fatigue after exercise. The experimental results showed that the prediction value obtained by the ACO neural network model was 9.106, and the error was only -0.003 compared to the actual detection value of 9.109. This result showed that the ACO neural network model can perfectly fit the functional relationship between yoga training level and exercise load and has high prediction accuracy. This also marked that the development of high-performance computing systems has entered a new journey in the field of sports and health.

Exercise blood pressure, cardiorespiratory fitness, fatness and cardiovascular risk in children and adolescents

Cardiovascular disease remains the leading cause of mortality on a global scale. Individuals who possess risk factors for cardiovascular disease, such as high blood pressure (BP) and obesity, face an elevated risk of experiencing organ-specific pathophysiological changes. This damage includes pathophysiological changes in the heart and peripheral vascular systems, such as ventricular hypertrophy, arterial stiffening, and vascular narrowing and stenosis. Consequently, these damages are associated with an increased risk of developing severe cardiovascular outcomes including stroke, myocardial infarction, heart failure, and coronary heart disease. Among all the risk factors associated with cardiovascular disease, high blood pressure emerges as the most prominent. However, conventional resting BP measurement methods such as auscultatory or oscillometric methods may fail to identify many individuals with asymptomatic high BP. Recently, exercise BP has emerged as a valuable diagnostic tool for identifying real (high) blood pressure levels and assessing underlying cardiovascular risk, in addition to resting BP measurements in adults. Furthermore, numerous established factors, such as low cardiorespiratory fitness and high body fatness, have been confirmed to contribute to exercise BP and the associated cardiovascular risk. Modifying these factors may help reduce high exercise BP and, consequently, alleviate the burden of cardiovascular disease. A significant body of evidence has demonstrated cardiovascular disease in later life have their origins in early life. Children and adolescents with these cardiovascular risk factors also possess a greater propensity to develop cardiovascular diseases later in life. Nevertheless, the majority of previous studies on the clinical utility of exercise BP have been conducted in middle-to-older aged populations, often with pre-existing clinical conditions. Therefore, there is a need to investigate further of the factors influencing exercise BP in adolescence and its association with cardiovascular risk in early life. Our previously published work showed that exercise BP is a potential useful method to detect adolescents with increased cardiovascular risk. Children and adolescents with cardiovascular risk factors are more likely to develop cardiovascular diseases later in life. However, previous studies on the clinical utility of exercise BP have largely focused on middle-to-older aged populations with pre-existing clinical conditions. Therefore, there is a need to investigate further the factors influencing exercise BP in adolescence and its association with future cardiovascular risk. Our previous studies, which focused on exercise BP measured at submaximal intensity, have shown that exercise BP is a potentially useful method for identifying adolescents at increased cardiovascular risk. Our previous findings suggest that improving cardio-respiratory fitness and reducing body fatness may help to reduce the risk of developing cardiovascular disease and improve overall cardiovascular health. These findings have important implications for the development of effective prevention and early detection strategies, which can contribute to improved public health outcomes.

Exercise testing unmasks exaggerated blood pressure independent of fibrinolytic response in Black but not White postmenopausal females

Exercise testing unmasks more exaggerated systolic blood pressure responses (SBP) in Black compared with White male adults. Such responses, if translatable to females, may detect racial disparities particularly relevant during menopause. Given the endothelial involvement in BP regulation and as a source of fibrinolytic markers, it follows that fibrinolytic and BP response to exercise could be linked. Thus, we examined BP and fibrinolytic responses to exercise testing in Black and White postmenopausal females. Postmenopausal females (Black = 40; White = 41; 51-70 yr) performed maximal treadmill exercise. BP and blood draws were conducted before and immediately after exercise. Plasma samples, using minimal stasis, were analyzed for tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) activity and antigen, respectively. Resting SBP and fibrinolytic potential were similar between races. Black females exhibited greater increases in SBP during exercise [change (d)=75, 95% CI: 64-86 mmHg, P < 0.001] than White females (d = 60, 95% CI: 48-71 mmHg, P < 0.001). Black compared with White females had smaller changes in tPA (d = 3.27, 95% CI: 2.28-4.27 IU/mL, P < 0.001 vs. d = 5.55, 95% CI: 4.58-6.53, P < 0.001) and PAI-1 (d = -2.89, 95% CI: -4.39 to -1.40 IU/mL, P < 0.001 vs. d = -5.08, 95% CI: -6.59 to -3.61, P < 0.001) activities after exercise. SBP exercise-induced changes were not associated with tPA (r = -0.10, P = 0.42) or PAI-1 (r = 0.13, P = 0.30), without any influence of race (P > 0.05). Our findings show that maximal exercise unmasks risk factors for cardiovascular disease in Black postmenopausal females.NEW & NOTEWORTHY Exaggerated SBP responses to exercise testing are more frequent in Black than in White male adults. Such responses, if translatable to females, may detect early racial disparities arriving during menopause. Because the endothelium regulates BP and fibrinolytic responses, these could be linked during exercise. At peak exercise, Black but not White postmenopausal females had more exaggerated SPB responses regardless of reduced fibrinolytic potential. Maximal exercise unmasked risk factors for cardiovascular disease in Black postmenopausal females.

Exploring the direct and indirect effects of cardiovascular disease risk factors on exercise blood pressure

OBJECTIVE

Exaggerated exercise blood pressure (BP) is independently associated with cardiovascular disease (CVD) outcomes. However, it is unknown how individual CVD risk factors may interact with one another to influence exercise BP. The aim of this study was to quantify direct and indirect associations between CVD risk factors and exercise BP, to determine what CVD risk factor/s most-strongly relate to exercise BP.

METHODS

In a cross-sectional design, 660 participants (44 ± 2.6 years, 54% male) from the population-based Childhood Determinants of Adult Health Study had BP measured during low-intensity fixed-workload cycling. CVD risk factors were measured, including body composition, clinic (rest) BP, blood biomarkers, and cardiorespiratory fitness. Associations between CVD risk factors and exercise BP were assessed using linear regression, with direct and indirect pathways of association assessed via structural equation model.

RESULTS

Sex, waist-to-hip ratio, fitness, and clinic BP were independently associated with exercise systolic BP (SBP), and along with age, had direct associations with exercise SBP (p < 0.05 all). Most CVD risk factors were indirectly associated with exercise SBP via a relation with clinic BP (p < 0.05 all). Clinic BP, waist-to-hip ratio, and fitness were most-strongly associated (direct and indirect association) with exercise SBP (β[95% CI]: 9.35 [8.04, 10.67], 4.91 [2.56, 7.26], and -2.88 [-4.25, -1.51] mm Hg/SD, respectively).

CONCLUSION

Many CVD risk factors are associated with exercise BP, mostly with indirect effects via clinic BP. Clinic BP, body composition, and fitness were most-strongly associated with exercise BP. These results may elucidate how lifestyle modification could be a primary strategy to decrease exaggerated exercise BP-related CVD risk.

Improved Maximal Workload and Systolic Blood Pressure After Cardiac Rehabilitation Following Thoracic Aortic Repair: A SYSTEMATIC REVIEW AND META-ANALYSIS

PURPOSE

It is of clinical importance to gain more knowledge about the risks and benefits of exercise in patients recovering from thoracic aortic repair. Therefore, the aim of this review was to perform a meta-analysis on changes in cardiorespiratory fitness, blood pressure, and the incidence of adverse events during cardiac rehabilitation (CR) in patients recovering from thoracic aortic repair.

REVIEW METHODS

We performed a systematic review and random-effects meta-analysis of outcomes before versus after outpatient CR in patients recovering from thoracic aortic repair. The study protocol was registered (PROSPERO CRD42022301204) and published. MEDLINE, EMBASE, and CINAHL were systematically searched for eligible studies. Overall certainty of evidence was scored with Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

SUMMARY

We included five studies with data from in total 241 patients. Data from one study could not be used in our meta-analysis because they were provided in a different unit of measure. Four studies with data of 146 patients were included in the meta-analysis. The mean maximal workload increased with 28.7 W (95% CI: 21.8-35.6 W, n = 146, low certainty of evidence). The mean systolic blood pressure during exercise testing increased with 25.4 mm Hg (95% CI: 16.6-34.3, n = 133, low certainty of evidence). No exercise-induced adverse events were reported. These outcomes indicate that CR seems beneficial and safe to improve exercise tolerance in patients recovering from thoracic aortic repair, although outcomes were based on data from a small, heterogeneous group of patients.

Microbial bowel infections-induced biochemical and biological abnormalities and their effects on young Egyptian swimmers

Swimmers' personal hygiene affects the spread of microbes in pools. The present study aimed to determine the incidence of microbial infections among young Egyptian swimmers and its impact on swimmers' scores. From January 2020 to June 2021, 528 public club swimmers were examined cross-sectionally. Swimmers were divided into two groups according to their star tests and their scores in the competition (group 1 with a high score and group 2 with a low score). Stool samples, biochemical and biological parameters were assessed. Microbial infections were 54% for intestinal parasitosis and 2.8% for Helicobacter pylori. The rate of intestinal parasitosis was higher among Gp2 as compared to Gp1. The results also revealed higher prevalence of Cryptosporidium spp., Giardia lamblia, Entameba histolytica, and Cyclospora among Gp2 than Gp1. Swimming frequency, and duration influenced the infectious status that induced anemia, abnormal blood pressure, and heart rate. Infected swimmers with cryptosporidiosis had higher alanine transaminase levels, white blood cells, and differential cells but lower aspartate transaminase levels. Giardiasis showed higher reduction in the biochemical markers including ferritin, lactoferrin, iron, and transferrin among Gp 2, compared to Gp 1 and thus affected the swimmers' scores. Thus, raising swimmers' hygiene awareness and targeting health education is obliged.

Type-2 Diabetes and the Clinical Importance of Exaggerated Exercise Blood Pressure

BACKGROUND

Exaggerated exercise blood pressure (EEBP) during clinical exercise testing is associated with poor blood pressure (BP) control and cardiovascular disease (CVD). Type-2 diabetes (T2DM) is thought to be associated with increased prevalence of EEBP, but this has never been definitively determined and was the aim of this study.

METHODS

Clinical exercise test records were analyzed from 13 268 people (aged 53±13 years, 59% male) who completed the Bruce treadmill protocol (stages 1-4, and peak) at 4 Australian public hospitals. Records (including BP) were linked to administrative health datasets (hospital and emergency admissions) to define clinical characteristics and classify T2DM (n=1199) versus no T2DM (n=12 069). EEBP was defined as systolic BP ≥90th percentile at each test stage. Exercise BP was regressed on T2DM history and adjusted for CVD and risk factors.

RESULTS

Prevalence of EEBP (age, sex, preexercise BP, hypertension history, CVD history and aerobic capacity adjusted) was 12% to 51% greater in T2DM versus no T2DM (prevalence ratio [95% CI], stage 1, 1.12 [1.02-1.24]; stage 2, 1.51 [1.41-1.61]; stage 3, 1.25 [1.10-1.42]; peak, 1.18 [1.09-1.29]). At stages 1 to 3, 8.6% to 15.8% (4.8%-9.7% T2DM versus 3.5% to 6.1% no-T2DM) of people with 'normal' preexercise BP (<140/90 mm Hg) were identified with EEBP. Exercise systolic BP relative to aerobic capacity (stages 1-4 and peak) was higher in T2DM with adjustment for all CVD risk factors.

CONCLUSIONS

People with T2DM have higher prevalence of EEBP and exercise systolic BP independent of CVD and many of its known risk factors. Clinicians supervising exercise testing should be alerted to increased likelihood of EEBP and thus poor BP control warranting follow-up care in people with T2DM.

Antihypertensive treatment effect on exercise blood pressure and exercise capacity in older adults

BACKGROUND

An exaggerated blood pressure (BP) response to exercise and low exercise capacity are risk factors for cardiovascular disease (CVD). The effect of pharmacological antihypertensive treatment on exercise BP in older adults is largely unknown. This study investigates these effects accounting for differences in exercise capacity.

METHODS

Participants enrolled in the Southall and Brent Revisited (SABRE) study undertook a 6-min stepper test with expired gas analysis and BP measured throughout exercise. Participants were stratified by antihypertensive treatment status and resting BP control. Exercise systolic and diastolic BP (exSBP and exDBP) were compared between groups using potential outcome means [95% confidence intervals (CIs)] adjusted for exercise capacity. Exercise capacity was also compared by group.

RESULTS

In total, 659 participants were included (mean age ± SD: 73 ± 6.6 years, 57% male). 31% of normotensive and 23% of hypertensive older adults with controlled resting BP had an exaggerated exercise BP. ExSBP was similar between normotensive and treated/controlled individuals [mean (95%CI): 180 (176 184) mmHg vs. 177 (173 181) mmHg, respectively] but was higher in treated/uncontrolled and untreated/uncontrolled individuals [mean (95% CI): 194 (190 197) mmHg, P  < 0.001 and 199 (194 204) mmHg, P  < 0.001, respectively]; these differences persisted after adjustment for exercise capacity and other confounders. Exercise capacity was lower in treated vs. normotensive individuals [mean (95% CI) normotensive: 16.7 (16.0,17.4) ml/kg/min]; treated/controlled: 15.5 (14.8,16.1) ml/kg/min, P  = 0.009; treated/uncontrolled: [15.1 (14.5,15.7) ml/kg per min, P  = 0.001] but was not reduced in untreated/uncontrolled individuals [mean (95% CI): 17.0 (16.1,17.8) ml/kg per min, P  = 0.621].

CONCLUSION

Irrespective of resting BP control and despite performing less exercise, antihypertensive treatment does not fully mitigate an exaggerated BP response to exercise suggesting residual CVD risk in older adults.

The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance

High blood pressure (BP) is a leading risk factor for cardiovascular disease (CVD). The identification of high BP is conventionally based on in-clinic (resting) BP measures, performed within primary health care settings. However, many cases of high BP go unrecognised or remain inadequately controlled. Thus, there is a need for complementary settings and methods for BP assessment to identify and control high BP more effectively. Exaggerated exercise BP is associated with increased CVD risk and may be a medium to improve identification and control of high BP because it is suggestive of high BP gone undetected on the basis of standard in-clinic BP measures at rest. This paper provides the evidence to support a pathway to aid identification and control of high BP in clinical exercise settings via the measurement of exercise BP. It is recommended that exercise professionals conducting exercise testing should measure BP at a fixed submaximal exercise workload at moderate intensity (e.g., ~70% age-predicted heart rate maximum, stage 1-2 of a standard Bruce treadmill protocol). If exercise systolic BP is raised (≥170 mmHg), uncontrolled high BP should be assumed and should trigger correspondence with a primary care physician to encourage follow-up care to ascertain true BP control (i.e., home, or ambulatory BP) alongside a hypertension-guided exercise and lifestyle intervention to lower CVD risk related to high BP.