Effects of aerobic exercise on blood pressure and lipids in overweight hypertensive postmenopausal women

Influence of different exercise types on vascular endothelial function in middle-aged and older adults - A systematic review and network meta-analysis

STUDY OBJECTIVES

Against the current backdrop of population ageing, the correlation between cardiovascular diseases and endothelial dysfunction is increasingly important. Exercise, a simple and accessible method of preventing and ameliorating numerous diseases, has been demonstrated to significantly enhance endothelial function. This study aimed to assess the effects of aerobic exercise (AE), resistance exercise (RE), combined exercise (CE) and high-intensity interval training (HIIT) on vascular endothelial function in middle-aged and older adults. Flow-mediated dilation (FMD) is a non-invasive ultrasound technique used to measure endothelial function. Direct and indirect comparisons were used to determine which exercise modality most effectively improved vascular endothelial function in this demographic.

METHODS

This comprehensive systematic review and network meta-analysis examined randomised controlled trials (RCTs) comparing the effects of four different exercise interventions (AE, RE, CE and HIIT) to a control intervention on FMD in middle-aged and older adults.

RESULTS

The analysis included 20 RCTs involving 1,123 participants. The surface under the cumulative ranking curve (SUCRA) analysis indicated that AE was the most effective in improving FMD (SUCRA = 68.9 %), followed by HIIT (SUCRA = 62.5 %), RE (SUCRA = 58.8 %), CE (SUCRA = 54.9 %) and CON (SUCRA = 4.9 %).

CONCLUSIONS

This network meta-analysis of various interventions for FMD in middle-aged and older adults found that AE was the most effective in improving FMD (SUCRA = 68.9 %). These findings suggest that AE could be a valuable intervention in clinical practice for enhancing vascular health in this population.

Effects of aerobic exercise on blood pressure in patients with hypertension: a systematic review and dose-response meta-analysis of randomized trials

We aimed to evaluate the dose-dependent effects of aerobic exercise on systolic (SBP) and diastolic blood pressure (DBP) and haemodynamic factors in adults with hypertension. PubMed, Scopus, and Web of Science were searched to April 2022 for randomized trials of aerobic exercise in adults with hypertension. We conducted a random-effects meta-analysis to estimate mean differences (MDs) and 95%CIs for each 30 min/week increase in aerobic exercise. The certainty of evidence was rated using the GRADE approach. The analysis of 34 trials with 1787 participants indicated that each 30 min/week aerobic exercise reduced SBP by 1.78 mmHg (95%CI: -2.22 to -1.33; n = 34, GRADE=low), DBP by 1.23 mmHg (95%CI: -1.53 to -0.93; n = 34, GRADE=moderate), resting heart rate (MD = -1.08 bpm, 95%CI: -1.46 to -0.71; n = 23, GRADE=low), and mean arterial pressure (MD = -1.37 mmHg, 95%CI: -1.80 to -0.93; n = 9, GRADE = low). A nonlinear dose-dependent decrement was seen on SBP and DBP, with the greatest decrement at 150 min/week (MD150 min/week = -7.23 mmHg, 95%CI: -9.08 to -5.39 for SBP and -5.58 mmHg, 95%CI: -6.90 to -4.27 for DBP). Aerobic exercise can lead to a large and clinically important reduction in blood pressure in a dose-dependent manner, with the greatest reduction at 150 min/week. The dose-dependent effects of aerobic exercise on systolic and diastolic blood pressure and haemodynamic factors in adults with hypertension.

Effect of Exercise Training on Blood Pressure in Healthy Postmenopausal Females: A Systematic Review with Meta-analysis

INTRODUCTION

The prevalence of hypertension is greater in postmenopausal females compared with males of similar age. Previous meta-analyses of normotensive and hypertensive adults have shown that aerobic exercise training reduces systolic blood pressure (SBP) and/or diastolic blood pressure (DBP). However, the effect of aerobic exercise training on blood pressure specifically within healthy postmenopausal females remains unclear. This systematic review with meta-analysis quantified the effect of aerobic exercise training on resting SBP and DBP in healthy postmenopausal females.

METHODS

The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines and was registered in PROSPERO (CRD42020198171). The literature search was done in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL Plus, and SPORTDiscus. Randomized controlled trials involving healthy postmenopausal females with normal or high normal blood pressure and undergoing ≥4 wk of aerobic exercise training were included. The total weighted mean change in SBP and DBP was compared between the exercise and the control interventions. A random-effects model was used to calculate the overall effect sizes of the weighted mean differences and the 95% confidence interval (CI).

RESULTS

Twelve studies were included in the meta-analysis (exercise interventions: n = 357, age = 60 ± 4 yr, baseline SBP/DBP = 128 ± 13/79 ± 8 mm Hg; control interventions: n = 330, age = 60 ± 4 yr, baseline SBP/DBP = 126 ± 11/77 ± 6 mm Hg). Compared with the change observed in response to the control interventions, exercise training significantly reduced SBP (-0.43 mm Hg, 95% CI = -0.78 to -0.09, P = 0.02) and DBP (-0.39 mm Hg, 95% CI = -0.73 to -0.05, P = 0.05).

CONCLUSIONS

Aerobic exercise training significantly reduces resting SBP and DBP in healthy postmenopausal females with normal or high normal blood pressure. However, this reduction is small and of uncertain clinical significance.

Comparison of Blood Pressure and Vascular Health in Physically Active Late Pre- and Early Postmenopausal Females

PURPOSE

The benefits of exercise on vascular health are inconsistent in postmenopausal females. We investigated if blood pressure and markers of vascular function differ between physically active early post- and late premenopausal females.

METHODS

We performed a cross-sectional comparison of 24-h blood pressure, brachial artery flow-mediated dilation, microvascular reactivity (reactive hyperemia), carotid-femoral pulse wave velocity, and cardiac baroreflex sensitivity between physically active late premenopausal (n = 16, 48 ± 2 yr) and early postmenopausal (n = 14, 53 ± 2 yr) females.

RESULTS

Physical activity level was similar between premenopausal (490 ± 214 min·wk-1) and postmenopausal (550 ± 303 min·wk-1) females (P = 0.868). Brachial artery flow-mediated dilation (pre, 4.6 ± 3.9, vs post, 4.7% ± 2.2%; P = 0.724), 24-h systolic (+5 mm Hg, 95% confidence interval [CI] = -1 to +10, P = 0.972) and diastolic (+4 mm Hg, 95% CI = -1 to +9, P = 0.655) blood pressures, total reactive hyperemia (pre, 1.2 ± 0.5, vs post, 1.0 ± 0.5 mL·mm Hg-1; P = 0.479), carotid-femoral pulse wave velocity (pre, 7.9 ± 1.7, vs post, 8.1 ± 1.8 m·s-1; P = 0.477), and cardiac baroreflex sensitivity (-8 ms·mm Hg-1, 95% CI = -20.55 to 4.62, P = 0.249) did not differ between groups. By contrast, peak reactive hyperemia (-0.36 mL·min-1⋅mm Hg-1, 95% CI = -0.87 to +0.15, P = 0.009) was lower in postmenopausal females.

CONCLUSIONS

These results suggest that blood pressure and markers of vascular function do not differ between physically active late pre- and early postmenopausal females.

Effect of combined aerobic and resistance exercise on blood pressure in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The purpose of this study is to evaluate the effects of combined aerobic and resistance exercise on blood pressure (BP) in postmenopausal women. The results of this study will provide an effective means for postmenopausal women to control BP and reduce the morbidity and mortality of cardiovascular disease (CVD).

METHODS

Eligible studies were searched in five electronic databases until November 2020, and 11 randomized controlled trials that met the inclusion criteria were included in this systematic review and meta-analysis. The random-effects model was used to calculate overall effect sizes of weighted mean differences (WMD) and 95% confidence interval (CI). This study was registered in PROSPERO with the registration number: CRD42021225546.

RESULTS

Compared with the control group, the aerobic combined resistance exercise significantly decreased the systolic blood pressure (SBP) and diastolic blood pressure (DBP) by 0.81 mmHg (95% CI, -1.34 to -0.28) and 0.62 mmHg (95% CI, -1.11 to -0.14), respectively. The results of the meta-analysis also indicated that a significant reduction in brachial-to-ankle pulse wave velocity (baPWV) of - 1.18 m/s (95% CI, -1.81 to -0.56) and heart rate (HR) of -0.22 beats/min (95% CI: -0.42 to -0.02) after combined aerobic and resistance exercise intervention. Subgroup analysis showed that postmenopausal women ≥60 years of age who were overweight or had a normal baseline BP were more sensitive to the combined aerobic and resistance exercise. When combined aerobic and resistance exercise frequency < 3 times/week, weekly exercise time ≥ 150 min, or the duration of exercise lasted for 12 weeks, the SBP and DBP of postmenopausal women could be reduced more effectively.

CONCLUSIONS

The present study indicates that combined aerobic and resistance exercise can significantly reduce BP in postmenopausal women. Accordingly, combined aerobic and resistance exercise may be an effective way to prevent and manage hypertension in postmenopausal women.

Menopausal Women: Recognition, Exercise Benefits, Considerations, and Programming Needs

Recognition of the physiological and psychological concerns associated with menopausal women is described. A review of the current literature regarding these conditions (vasomotor responses, insomnia, sarcopenia, osteoporosis, obesity, cardiovascular conditions, metabolic concerns, and psychological concerns) and how exercise impacts the conditions are discussed. Considerations of exercise for menopausal women are presented. General exercise programming and exercise adherence preferences are reviewed with recommendations for a variety of exercise types, exercise progressions, and exercise programming to meet the needs of the menopausal woman to improve overall health and well-being.

Do the combined blood pressure effects of exercise and antihypertensive medications add up to the sum of their parts? A systematic meta-review

Objective

To compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension.

Data sources

PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library.

Eligibility criteria

Randomised controlled trails (RCTs) or meta-analyses (MAs) of controlled trials that: (1) involved healthy adults>18 year with hypertension; (2) investigated exercise and BP; (3) reported preintervention and postintervention BP and (4) were published in English. RCTs had an EX+MEDScombined arm; and an EXalone arm and/or an MEDSalone arm; and MAs performed moderator analyses.

Design

A systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system.

Outcome

The BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other.

Results

Twelve RCTs qualified with 342 subjects (60% women) who were mostly physically inactive, middle-aged to older adults. There were 13 qualifying MAs with 28 468 participants (~50% women) who were mostly Caucasian or Asian. Most RCTs were aerobic (83.3%), while the MAs involved traditional (46%) and alternative (54%) exercise types. Strong evidence demonstrates EXalone, MEDSalone and EX+MEDScombined reduce BP and EX+MEDScombined elicit BP reductions less than the sum of their parts. Strong evidence indicates EX+MEDScombined potentiate the BP effects of MEDSalone. Although the evidence is stronger for alternative than traditional types of exercise, EXaloneelicits greater BP reductions than MEDSalone.

Conclusions

The combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone.

PROSPERO registration number

The protocol is registered at PROSPERO CRD42020181754.

Effects of regular dance therapy intervention on blood pressure in hypertension individuals: a systematic review and meta-analysis

INTRODUCTION

Dance therapy is a non-conventional aerobic exercise in cardiovascular rehabilitation. This meta-analysis aimed to update and assess evidence from randomized controlled trials of dance therapy on patients with hypertension.

EVIDENCE ACQUISITION

PubMed, web of science, EBSCO, EMBESE, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure databases in English or Chinese were searched and randomized controlled trials were conducted for this meta-analysis to investigate the effects of dance therapy on blood pressure in hypertension patients. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed by I² test.

EVIDENCE SYNTHESIS

Five studies were included according to the eligibility criteria. Dance therapy could significantly reduce the systolic/diastolic pressure of hypertension individuals (SBP:WMD -11.07mmHg; 95%CI, -14.3 to -8.12mmHg, P<0.00001;DBP:WMD-4.16mmHg;95% CI, -6.44to-1.88mmHg, P=0.0004) when compared with the control group. low heterogeneity was observed in this research (P=0.65; I²=0% to SBP; P=0.57; I² =0% to DBP). Subgroup analysis results showed that the subgroup of less than 12 weeks intervention group reduce the blood pressure more than those of 12 weeks intervention. Dance therapies reduce the SPB of hypertension individuals in African region better than Europe and America hypertension population.

CONCLUSIONS

Despite the limited number of studies and people involved, the meta-analysis further demonstrated that dance therapy could reduce SBP and DBP in patients with hypertension. The effect of dance therapy intervention on hypertension might be related to duration of intervention and population gene.

Habitual Combined Exercise Protects against Age-Associated Decline in Vascular Function and Lipid Profiles in Elderly Postmenopausal Women

Postmenopausal status is associated with increased risks for cardiovascular diseases (CVD). This study investigated differences in vascular function, lipids, body composition, and physical fitness in elderly postmenopausal women active in combined resistance and aerobic exercise (CRAE) training for 1 year versus a sedentary cohort of similar-in-age counterparts. Elderly postmenopausal women performing habitual CRAE training for 1 year (age ~75 year; CRAE, n = 57) and elderly sedentary postmenopausal women (age ~78 year; SED, n = 44) were recruited. Arterial stiffness (brachial-to-ankle pulse-wave velocity, baPWV), blood pressure, blood lipids, anthropometrics, 2-min walking distance, and muscular strength were assessed for both groups. There were significant differences for baPWV, systolic blood pressure, low-density lipoprotein, and body fat percentage, which were significantly lower (p < 0.05) in CRAE vs. SED, and both 2 min walking distance and muscular strength were significantly greater (p < 0.05) in CRAE vs. SED. These results indicate that elderly postmenopausal women participating in habitual CRAE training may have better protection against risks for CVD and have better physical fitness compared to SED counterparts.

Physiological response and cardiorespiratory adaptation after a 6-week Nordic Walking training targeted at lipid oxidation in a group of post-menopausal women

This study examined the effects of a 6-week Nordic Walking (NW) training, at the intensity corresponding to the dominance of lipid metabolism, on the levels of selected physiological indices, the haemodynamic indices of the cardiovascular system and physical fitness in sedentary women older than 55 years of age. In addition, the physiological response of the female body to the walking effort on treadmill with poles (NW) and without poles (W) was compared and the influence of training on this response was determined. A single group study with a pre-test/post-test study design was conducted. Eighteen women performed NW controlled intensity training 3 times a week for 6 weeks. Body composition, resting blood pressure (BP), heart rate (HR), maximum oxygen uptake (VO₂max) as well as circulatory and respiratory indices in two graded walking efforts on mechanical treadmill NW and W were measured before and after training period. The intensity of workouts, which considered the dominance of lipid metabolism, was determined individually, based on the dynamics of changes in the level of physiological indices during the graded intensity NW. After the course of training, body mass, fat mass, resting BP and HR decreased significantly (p < 0.05). HR and respiratory exchange ratio recorded during NW and W at 1.75 m^.s^-1 walking speed decreased, while the oxygen pulse increased (p < 0.05). VO₂max increased significantly (p < 0.05). Before and after the training period HR, oxygen uptake per minute, and energy expenditure during NW were significantly higher than in W (p < 0.05). The study showed that 6-week NW training at the intensity corresponding to the dominance of lipid metabolism can provide improvement in body composition, cardiovascular function and physical performance in previously sedentary women. NW compared to the regular walk with the same speed revealed higher energy expenditure.

Effects of Physical Training on the Myocardium of Oxariectomized LDLr Knockout Mice: MMP 2/9, Collagen I/III, Inflammation and Oxidative Stress

BACKGROUND

The emergence of coronary heart disease is increased with menopause, physical inactivity and with dyslipidemia. Physical training is known to promote the improvement of cardiovascular functions.

OBJECTIVE

To investigate the effects of aerobic physical training on the left ventricle in ovariectomized LDL knockout mice.

METHODS

Thirty animals were divided into 6 groups (n = 5): Sedentary non-ovariectomized control; Sedentary ovariectomized control; Trained ovariectomized control; Sedentary non-ovariectomized LDL-knockout, sedentary ovariectomized LDL-knockout and trained ovariectomized LDL-knockout. We analyzed the average parameters of apparent density of collagen fibers types I and III, and metalloproteinase type 2 and type 9, were considered significant p < 0.05.

RESULTS

The results showed that the proposed exercise protocol altered the volume of type I collagen fibers, altered collagen remodeling parameters (MMP-2), and also reduced the 8-hydroxy-2'-deoxyguanosine (8OHdG) oxidative stress parameter.

CONCLUSION

Moderate intensity aerobic training acts on collagen fiber volume, on collagen remodeling with the reduction of oxidative stress in the left ventricles of ovariectomized LDL-knockout mice.

Cardiovascular Benefits of Exercise Training in Postmenopausal Hypertension

Exercise training is often considered the cornerstone of nonpharmacological therapy for postmenopausal hypertension while aerobic exercise is the mainstay of life style modification for antihypertension. Moderate-intensity aerobic exercise is well tolerated on most days of the week by most people with postmenopausal hypertension and is not suspected to detract from exercise adherence. That being said, moderate aerobic exercise may be superior for eliciting cardiovascular benefits in hypertensive postmenopausal women and resistance exercise may offer desirable benefits. The beneficial outcomes of exercise training for hypertensive postmenopausal women include improvements in blood pressure, autonomic tone, baroreflex sensitivity, oxidative stress, nitric oxide (NO), bioavailability, and lipid profiles, as well as cardiovascular function and cardiorespiratory fitness. This partly explains the fact that exercise training programs have a positive effect for cardiovascular disease in hypertensive postmenopausal women. This review is to collect and present the literature of exercise training in postmenopausal hypertension. Our review may provide the current understanding of beneficial effects and mechanisms of exercise intervention for prevention and treatment of stage 1 to 2 hypertensive postmenopausal women.

Effectiveness of combined and conventional exercise trainings on the biochemical responses of stroke patients

Stroke is the topmost cause of mortality and disability in Ghana. Conventional exercise is mostly used aside pharmacological management technique but the complimentary effects of combined exercise training (CET) have not been reported. This study investigated the effectiveness of combined and conventional exercise trainings on lipid-cardiovascular profiles and body composition among stroke patients in Kumasi. Thirteen stroke survivors between ages 35–68 years (mean±standard deviation: age, 59.88±10.88 years; duration of illness, 18.11±7.72 years) participated in the study. Participants were randomly assigned to CET and conventional exercise group. The CET had 10 weeks of 3 types of exercise trainings, 3 days/wk; conventional exercise group monitored for daily conventional activities during the same period. Post weight (P= 0.003), body mass index (P=0.004), systolic blood pressure (P=0.022), diastolic blood pressure (P=0.004), heart rate (P=0.003), and total cholesterol (P=0.044) of the CET were significantly improved. CET significantly improved total cholesterol (P=0.005) and low-density lipoprotein (P=0.006) better than the conventional exercises. Effectiveness of CET to positively enhance biochemical responses in the management of strove patients was established.

EFFECTS OF PHYSICAL TRAINING ON THE MYOCARDIUM OF FEMALE LDL KNOCKOUT OVARIECTOMIZED MICE

ABSTRACT Introduction: The emergence of coronary heart disease increases with menopause, physical inactivity and with dyslipidemia. It is known that physical training promotes the improvement of cardiovascular functions. Objective: The purpose of this study was to investigate the effects of aerobic physical training on the left ventricle in female LDL knockout ovariectomized mice. Methods: Thirty animals were divided into 6 groups (n=5), namely, sedentary non-ovariectomized control; sedentary ovariectomized control; trained ovariectomized control; sedentary non-ovariectomized; sedentary ovariectomized; and trained ovariectomized. We analyzed the mean nuclear volume parameters, the cross sectional area of the myocytes, the apparent density of the capillaries, interstitium, myocytes and collagen fibers. Results: The results show that for the density of the number of nuclei, the physical activity decreased to values close to the ovariectomized control group. Regarding the mean nuclear volume and the average area of myocytes, training and ovariectomy promoted the elevation of these values but hypercholesterolemia was lower. the volume density of myocytes, hypercholesterolemia showed an increase of these values as well as the training. There was no change in the volumetric density of the capillaries and the density of collagen fibers. The training caused the decrease in the density of the interstitial volume, and the hypercholesterolemia changed to a smaller one than the control group. Conclusion: We concluded that the moderate aerobic activity or the training time used in our study were not sufficient to generate significant alterations in the hypercholesterolemic group.

EXERCÍCIO FÍSICO COMO TRATAMENTO NÃO FARMACOLÓGICO PARA A MELHORA DA SAÚDE PÓS-MENOPAUSA

RESUMO O período da pós-menopausa é caracterizado por 12 meses consecutivos de amenorreia. Além de afetar o sistema reprodutivo e a produção de hormônios sexuais, principalmente o estrógeno, essas mulheres apresentam aumento da gordura corporal total, principalmente na região central, o que está relacionado com o desenvolvimento de diversas doenças crônicas, como dislipidemia, aterosclerose e resistência à insulina. Dessa forma, diferentes programas de exercício físico, aeróbico, resistido ou combinado (aeróbico e resistido em uma mesma sessão) podem ser uma forma interessante de tratamento não farmacológico para a prevenção e melhora dos desfechos. Entretanto, as adaptações promovidas pelos diferentes programas de exercício sobre a composição corporal, perfil lipídico e glicêmico não estão claras na literatura e precisam ser elucidadas. Assim sendo, esta revisão tem como objetivo discutir as diferentes adaptações do treinamento aeróbico, resistido e combinado na composição corporal, perfil lipídico e glicêmico de mulheres na pós-menopausa.

Coming of Age: Considerations in the Prescription of Exercise for Older Adults

Older adults represent the fastest-growing age demographic of the population. Physiological changes associated with primary aging and concurrent chronic disease adversely impact functional capacity, health outcomes, and quality of life. For these reasons, there is a national emphasis for healthcare providers to improve the health, function, and quality of life of older adults to preserve independent living and psychological well-being. The benefits of regular physical activity or exercise with regard to aging and disease are indisputable, yet many clinicians do not prescribe exercise to older adults. This reluctance may be attributable to a lack of knowledge regarding appropriate exercise prescription for older adults in light of the potential risks and benefits of various doses and types of exercise. In addition, clinicians and patients may have concerns about potential health considerations relevant to older adults such as comprehensive pre-exercise screening and exercise-drug interactions. In light of this, the following review presents (1) guidelines for exercise prescription in older adults and modification of these guidelines for patients with the most common age-associated comorbidities; (2) recommendations for pre-exercise screening prior to initiating an exercise program in older adults; (3) considerations for older adults on one or more medications; and (4) common barriers to adopting and maintaining exercise in an older population. Our goal is to provide a framework that clinicians can follow when prescribing exercise in older adults while considering the unique characteristics and concerns present in this population.