Acute and chronic cardiovascular response to 16 weeks of combined eccentric or traditional resistance and aerobic training in elderly hypertensive women: a randomized controlled trial

Exercise interventions to improve physical frailty and physical frailty components in older adults with hypertension: A systematic review

Physical frailty and hypertension are both highly prevalent among older adults. Furthermore, physical frailty may impact the risk-benefit ratio of pharmacological hypertension treatment. Thus, it may be prudent to focus on physical activity and exercise interventions to achieve better patient outcomes that addresses both conditions. This systematic review aimed to investigate the effects of exercise interventions on physical frailty components and hypertension-related outcomes in older adults with hypertension. PubMed/Medline, Embase, Cochrane Library, Cinahl and PEDro were searched for exercise trials in older adults with hypertension, measuring physical frailty or physical frailty components. Preferred Reporting Items for Systematic Review and Meta-Analysis protocol (PRISMA-P) and Physiotherapy Evidence Database (PEDro) scale were used for internal validity. The searches retrieved 4965 titles without duplicates. Ninety-four potential full texts were evaluated, and 30 original studies were included in the review. Mean methodological quality of the included studies was 5.7 out of 10. Only one study measured frailty (using a cumulative deficit model) in older adults with hypertension. Different types of exercise training demonstrated improvements in components of physical frailty. This systematic review shows that there is no evidence whether exercise ameliorates the effects of physical frailty and hypertension and there is a need for more data to be generated.

Moderate intensity continuous training, combined moderate-intensity continuous training vs combined high-intensity interval training in adults with hypertension: Randomized controlled trial

BACKGROUND AND PURPOSE

Despite all efforts to treat hypertension, it is still responsible for 10.8 million deaths annually. The aim of this study was to compare the effects of continuous moderate-intensity training, strength training combined with continuous moderate-intensity training and strength training combined with high-intensity interval training in adults with high blood pressure.

METHODS

A 12-week randomized control trial was performed. A total of 100 volunteers, 51 women and 49 men with hypertension participated. The sample was randomly assigned into three intervention groups and one control group.

RESULTS

All intervention groups significantly improved their hemodynamic parameters, body composition, lipid profile, glucose, and physical fitness as compared to the control group. Both combined training groups showed greater improvements than the moderate-intensity continuous training group. However, the strength group combined with the moderate-intensity continuous group showed the greatest benefits in systolic, diastolic and mean arterial pressure, of -13.4 mmHg, -6.8 mmHg and -8.9 mmHg respectively, abdominal circumference, upper and lower limb strength and VO₂peak, versus the continuous moderate-intensity group; it also achieved greater reductions in systolic and mean blood pressure, up to -6.8 mmHg and 4.3 mmHg respectively, than the strength group combined with the high intensity interval group.

CONCLUSION

Performing a strength training program combined with continuous moderate intensity training, 2 days per week for 12 weeks, produces significant improvements in cardiometabolic biomarkers, body composition, and physical condition of adults with hypertension, with these adaptations being superior to those produced by continuous moderate-intensity training and strength training combined with high-intensity intervallic training.

Post-exercise hypotension after different volumes of combined calisthenic and walking exercises in older adults with hypertension: a randomized controlled trial

This study aimed to analyze the acute effects of combined calisthenic and walking exercises using different volumes on blood pressure (BP) in aging adults with primary hypertension. A total of 48 participants with primary hypertension aged 50-80 years were randomly assigned into two groups that performed two experimental sessions each: a non-exercising CONTROL session and a LOW (group 1) or HIGH (group 2) volume exercise session. The order of these sessions was randomized. The exercise protocols lasted 30 min (LOW) or 60 min (HIGH) and consisted of calisthenic exercises combined with continuous walking or jogging. Exercise intensity was controlled using a rating of perceived exertion (RPE) scale. BP was measured at baseline and after each session for 60 min. Results showed that systolic BP was lower after the HIGH session at post 30' (p = 0.03), post 40' (p = 0.03), post 50' (p = 0.04), and post 60' (p < 0.02), and after the LOW session at post 30' (p = 0.02), post 40' (p < 0.01), post 50' (p < 0.01), and post 60' (p < 0.01) when compared to the corresponding CONTROL at the same time point. There were no significant differences in systolic and diastolic BP between the HIGH and LOW sessions. In conclusion, a pragmatic combined training session using different volumes acutely reduces BP in older adults with primary hypertension.

Walking training decreases cardiovascular load after walking to maximal intermittent claudication in patients with peripheral artery disease

PURPOSE

This study investigated whether: 1) walking training (WT) changes cardiovascular load after walking until maximal intermittent claudication (IC) in patients with peripheral artery disease (PAD); and 2) acute and chronic cardiovascular responses to walking were related to each other.

METHODS

A randomized, controlled, parallel-group design was employed. Thirty-two men with PAD and IC were randomly assigned to one of two groups: WT (n=16) or control (CO, n=16) twice a week for 12 weeks. The WT group completed 15, 2-min bouts of walking at moderate intensity interspersed with 2-min upright resting intervals per session. The CO group completed 30 minutes of stretching per session. At Baseline and after 12 weeks, both groups underwent a progressive walking session to maximal IC (3.2 km/h, 2% increase in grade every 2 min). Systolic blood pressure (BP), diastolic BP, heart rate (HR), and rate pressure product (RPP) were measured pre- and post-walking. Data were analyzed by three-way mixed ANOVAs. Pearson correlations were used to explore the association between the acute and chronic responses.

RESULTS

WT significantly reduced pre- and post-walking systolic BP (p<0.001), diastolic BP (p<0.001), and RPP (p<0.001). No significant correlations were found between the acute and chronic changes observed for all variables (all p>0.05).

CONCLUSION

In patients with PAD, WT decreased cardiovascular load assessed before and after walking to maximal IC. Furthermore, the acute and chronic cardiovascular responses to walking were not associated. Thus, WT may reduce the risk of immediate post-walking cardiac events in susceptible patients.

Physiological characteristics of blood pressure responses after combined exercise in elderly hypertensive patients: a systematic review and meta-analysis

Objective

The aim of this investigation is to explore the efficacy of combined exercise in elderly patients with hypertension. Moreover, we aim to delve into the underlying mechanisms governing blood pressure regulation, with the objective of promoting the adoption of this exercise regimen among elderly hypertensive individuals.

Methods

In our study, we conducted a thorough search across multiple databases, including PubMed, Web of Science, Cochrane Library, Embase, and Scopus. This extensive search resulted in the preliminary screening of 2,347 articles. Among these, 9 studies were carefully selected for an in-depth analysis. For our meta-analysis, we employed Review Manager 5.3 and Stata 15.0, enabling us to perform detailed subgroup analyses and assess the possibility of publication bias.

Results

In comparison to the control group (n = 194), individuals enrolled in the combined exercise group (n = 200) exhibited a notable decrease in both resting systolic blood pressure (SBP) [weighted mean difference (WMD) = -11.17 mm Hg, 95% confidence interval (CI) (-17.13, -5.22), Z = 3.68, P < 0.05] and diastolic blood pressure (DBP) [WMD = -5.93 mm Hg, 95% CI (-9.24, -2.61), Z = 3.51, P < 0.05]. Nonetheless, no statistically significant alteration was observed in pulse pressure (PP) [WMD = -9.05 mm Hg, 95% CI (-22.65, 4.55), Z = 1.3, P = 0.192]. Further subgroup analyses elucidated that combined exercise regimens, characterized by aerobic training intensities below 85% of HRmax, durations of up to 12 weeks, weekly frequencies of either ≥3 or <3 sessions, total session times under 60 min, and a sequence of aerobic exercise followed by resistance training (AE-RT), were particularly effective in enhancing SBP and DBP among elderly patients with hypertension. Additionally, regular engagement in combined exercise led to significant improvements in SBP and DBP across individuals aged 60-70, those older than 70 years, and regardless of whether participants were using antihypertensive medications or not.

Conclusion

Combined exercise serves as an efficacious adjunctive therapy for reducing blood pressure among elderly individuals with hypertension, exerting beneficial influences on multiple physiological mechanisms pertinent to blood pressure regulation. Moreover, the integration of aerobic exercise with resistance training presents a more varied training program, thereby eliciting wider-ranging positive effects on both the physical and mental well-being of elderly patients afflicted with hypertension.

Post-exercise hypotension and recreational futsal: Effects of a 3-month intervention and association with resting blood pressure adaptations

To investigate i) if a recreational futsal (RF) training session elicits post-exercise hypotension (PEH), ii) the impact of a 3-month RF intervention on PEH, and iii) the association between PEH in the early phase of the intervention with resting blood pressure (BP) chronic adaptions in men with treated hypertension. BP was measured before and after a RF training session every 5-min (total of 30-min) in the early (weeks 1-2) and the final phases (weeks 11-12) of a 3-month RF intervention, comprising 3 weekly one-hour sessions. Thirty-three men (48 ± 7 years; mean arterial pressure [MAP]: 96 ± 8 mmHg; BMI: 32.2 ± 4.9 kg/m2) participated. In the intervention early phase, systolic BP ([SBP]; -15.4 mmHg; 95% CI: -10.9, -16.8), diastolic BP ([DBP]; -5.4 mmHg; 95% CI: -7.8, -3.0), and MAP (-8.8 mmHg; 95% CI: -11.2, -6.4) significantly decreased 30-min post- compared to pre-training session (n = 33). In the intervention final phase (n = 24), SBP (-8.1 mmHg; 95% CI: -12.0, -3.9) and MAP (-3.0 mmHg; 95% CI: -5.4, -0.7) significantly decreased 30-min post- compared to pre-training session, but not DBP (-0.5 mmHg; 95% CI: -3.7, 2.7). PEH in the final phase was significantly inferior compared to the early phase. PEH in the early phase of the intervention was not consistently associated with chronic BP changes.

Short-duration dynamic power training with elastic bands combined with endurance training: a promising approach to hypertension management in older adults

Previous studies have investigated the effects of different combined training programs involving traditional resistance training and aerobic exercise on hemodynamic parameters and arterial stiffness in older adults. However, little is known about the impact of power training combined with endurance training on these variables in hypertensive older adults. Therefore, this study aimed to investigate the effects of dynamic power training with elastic bands combined with endurance training on arterial stiffness and hemodynamic parameters in hypertensive older adults. Twenty-six participants were randomly assigned to the control group (CG; n = 13) and the intervention group (n = 13). IG participants performed power training with elastic bands combined with endurance training twice a week for 8 weeks. Pulse pressure, central pulse pressure, pulse wave velocity, SBP, DBP, central SBP, and central DBP were assessed before and after 8 weeks using the triple pulse wave velocity method. Pulse pressure, central pulse pressure, pulse wave velocity, SBP, DBP, central SBP, and central DBP significantly improved after 8 weeks of intervention (P < 0.05). These findings indicate that power training with elastic bands combined with endurance training reduces arterial stiffness and significantly improves hemodynamic parameters in older adults diagnosed with grade 1 hypertension. In addition, underscores the potential of this approach as a promising strategy for the management of hypertension in older adults.

Taoist way of a balanced exercise training cocktail for the management of primary hypertension in older persons

High blood pressure is the world's leading risk factor for mortality, affecting nearly half of the global population aged 50-79 years. Physical inactivity is one factor contributing to the prevalence of hypertension. This paper discusses a new concept for the management of hypertension in older persons. We are inclined to fade the current guidelines used in China, the United States, and Europe. Although demonstrating irrefutable benefits for blood pressure regulation, the guidelines fail to address the need to incorporate balance exercises, which are crucial for mitigating the risk of falling. We address three pressing questions regarding the efficacy of various combinations of exercise modes for blood pressure regulation, alongside providing an overview of balance exercises. At the core of our concept, we explicate the challenges inherent in addressing the global pandemic of physical inactivity and hypertension in regular socioeconomic people. No guidelines could change the state of inactivity by jumping between zero and all things, where "zero" symbolizes conditions such as physical inactivity and hypertension, and the concept of "all things" encompasses the ideals of an active lifestyle and healthy aging. We advocate a Taoist way, "zero-one-all things," where "one" in this context refers to an inclusive and culturally diverse exercise training cocktail. The Tao guides us to illuminate an ancient way of overcoming physical inactivity-associated diseases in the present day.

Effects of combined muscle power and endurance training with different volumes on functional and hemodynamic parameters in previously trained older adults

BACKGROUND

To promote optimal neuromuscular and cardiovascular gains in older adults, it seems crucial to investigate the effects of different combined training volumes in this population. Thus, the present study aimed to compare the effects of combined muscle power training (MPT) and endurance training (ET) with different volumes on functional and hemodynamic parameters in previously trained older adults.

METHODS

Twenty-five older adults were randomly assigned to either the lower-volume group (LVG; n = 13) or the higher-volume group (HVG; n = 12). In the LVG, participants performed 1 set of 6 repetitions for each exercise, followed by 10 min of walking exercise. In the HVG, participants performed 2 sets of 6 repetitions for each exercise, followed by 20 min of walking exercise. Lift from the ventral decubitus position (LPDV), timed up-and-go (TUG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed before and after 8 weeks.

RESULTS

Significant increases in LPDV test occurred in both groups after 8 weeks (p < 0.05). Additionally, significant improvements in TUG performance occurred in both groups from week 0 to week 8 (p < 0.05). However, no significant changes were observed between groups in functional parameters (p > 0.05). SBP and DBP remain unchanged (p > 0.05) in both groups over the experimental period.

CONCLUSIONS

These findings indicate that lower-volume and higher-volume of combined MPT and ET promoted improvements in functional parameters. This study has an important practical application, as it indicates that regardless of the volume (lower or higher), comparable improvements are observed in functional parameters in previously trained older adults.

Effects of different types of exercise on hypertension in middle-aged and older adults: a network meta-analysis

Objective

This study mainly used network meta-analysis to explore the effect of different types of exercise on hypertension in middle-aged and older adults.

Methods

Several databases (e.g., PubMed, Embase, and the Cochrane Library) were used to search for randomized controlled trials on the effects of different types of exercise on hypertension in middle-aged and older adults.

Results

A total of 19 articles and 2,385 participants were included in the analysis. Aerobic exercise interventions [MD = -9.254, P < 0.05, 95% CI (-14.810, -3.698)] and static exercise interventions [MD = -10.465, P < 0.05, 95% CI (-18.135, -2.794)] had a significant effect on the improvement in systolic blood pressure (SBP). For diastolic blood pressure (DBP), aerobic exercise interventions [MD = -1.4096; P > 0.05, 95% CI (-8.2395, 5.4201)] and static exercise interventions [MD = -4.5206, P > 0.05, 95% CI (-14.0436, 5.0023)] were not statistically significant. The results of the surface under the cumulative ranking curve (SUCRA) showed that static exercise improved hypertension better than aerobic exercise.

Conclusion

Aerobic exercise and static exercise have been shown to have a good effect on the improvement of hypertension, but the effect on DBP is not significant.

Acute and chronic cardiovascular responses to concentric and eccentric exercise in older adults with knee osteoarthritis

PURPOSE

Muscle contraction type in resistance exercise training may confer benefits besides strength in individuals with osteoarthritis and cardiovascular disease (CVD) risks. The purpose of the study was to explore whether Eccentric-resistance training (RT) improved hemodynamic responses to acute walking exercise stress compared to Concentric-RT among individuals with knee OA over four months.

METHODS

This was a secondary analysis from a randomized, controlled, single-blinded study. Participants (N = 88; 68.3 ± 6.4 yrs; 67.4% female) were randomized to one of two work-matched resistance training (RT) programs against a non-RT control group. Pre-training and month four, participants completed a self-paced Six-Minute Walk Test (6MWT) and progressive treadmill exercise test. Heart rates, blood pressures and mean arterial pressures (MAP) were captured during each test. Antihypertensive medications use was documented at each time point.

RESULTS

Leg strength improved in both training groups by month four (p < .05). Changes in 6MWT distance and progressive treadmill test time were not different across groups over four months. Neither Concentric or Eccentric RT produced different hemodyamic responses during the 6MWT compared to the control group post-training. However, Concentric RT was associated with 6.0%-7.4% reductions in systolic blood pressure during the graded treadmill walking test at 50%, 75% and 100% of the test time compared to Eccentric RT and the controls (p = .045). MAP values were lower at 75% and 100% of the treadmill test after Concentric RT (5.7%-6.0% reductions) compared to Eccentric RT (1.0%-2.4% reductions) and controls (1.5% and 4.0% elevations) post-training (p = .024). Antihypertensive medication use did not change in any group.

CONCLUSIONS

The repeated, progressive exposures of Concentric RT-induced blunted the hypertensive responses to acute exercise compared to Eccentric-RT. Among people with knee OA, Concentric-RT may confer strength benefits to manage OA and possibly reduce cardiovascular stress during exercise.

Multicomponent Training and Optimal Dosing Strategies for Adults with Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

(1) Background: Non-pharmacological interventions have demonstrated efficacy in the prevention, management, and control of hypertension. Multicomponent training confers a host of benefits to the general populace. The aim of this research was to assess the impact of multicomponent training on the blood pressure of adults with hypertension and ascertain the nature of the dose-response relationship. (2) Methods: This systematic review adhered to the PRISMA guidelines and was registered in PROSPERO. Eight studies were included, following a literature search across PubMed, Web of Science, Cochrane, and EBSCO. Randomized controlled trials implementing multicomponent training interventions on adults with hypertension were considered for inclusion. A quality assessment was performed using the PEDro scale, with a random-effects model utilized for all analyses. (3) Results: Multicomponent training yielded a significant reduction in systolic (MD = -10.40, p < 0.001) and diastolic (MD = -5.97, p < 0.001) blood pressure relative to the control group. Interventions lasting over 14 weeks with a minimum frequency of three sessions per week, each lasting 60 min, were deemed most effective. (4) Conclusion: An optimal training intensity was achieved with 30 min of aerobic exercise at 75% of the heart rate reserve, whereas sets of 10 repetitions at 75% of one repetition maximum produced the best outcomes in strength training.

Benefits of Eccentric Training with Emphasis on Demands of Daily Living Activities and Feasibility in Older Adults: A Literature Review

Aging is associated with a decline in physical capabilities and several other health-related conditions. One of the most common age-related processes is sarcopenia. Sarcopenia is usually accompanied with a decline in skeletal muscle mass and physical functioning. A decrease in these markers usually impacts basic daily living activities (DLAs), which become somewhat harder to accomplish for older individuals. Several research studies have examined the demands of DLA in older individuals with results indicating that activities such as walking, sitting, standing, stair climbing, stair descending, and running generate high demands on older adults. The forces that act on individuals are in most cases equal or multiple times higher relative to their body mass. For instance, it was reported that the GRF (ground reaction force) during stair descent ranged from 1.43 to 1.50 of BW (body weight) in an older population. Even higher demands were recorded during other related activities. These demands of DLA raise the question of appropriate rehabilitative or training management procedures. During the past decades, an eccentric form of resistance training gained popularity due to its effectiveness and lower metabolic demands, which seems to be an appropriate method to develop and maintain a basic level of strength capabilities in higher age. Multiple factors of eccentric training have been examined including modality of exercise, intensity, frequency, and safety of the elderly. Several modalities of eccentric exercise have been shown to be effective including traditional methods, as well as machine-based ones, with or without using some equipment. The studies included in this review varied in intensity from low to high; however, the most frequently used intensity was ≥50% of the maximal eccentric strength during two or three eccentric sessions per week. Importantly, the prevalence of injury of older adults appears to have been low to none, highlighting the safety of this approach. In summary, eccentric training prescriptions for older adults should consider the demands of DLA and the characteristics of the elderly for appropriate management of training recommendations.

Strength training for arterial hypertension treatment: a systematic review and meta-analysis of randomized clinical trials

Cardiovascular diseases are the leading cause of death in the world and arterial hypertension (AH) accounts for 13.8% of deaths caused by cardiovascular diseases. Strength training interventions could be an important alternative tool for blood pressure control, however, consistent evidence and the most effective training protocol for this purpose are yet to be established. The current study used the Cochrane methodology to systematically review randomized controlled trials (RCTs) that investigated the effect of strength training on blood pressure in hypertensive patients. A systematic search was conducted in the PubMed, EMBASE, Scopus, Cochrane Library, and World Health Organization databases. This review included controlled trials that evaluated the effect of strength training for 8 weeks or more in adults with arterial hypertension, published up to December 2020. Data are described and reported as the weighted mean difference of systolic and diastolic pressure and a 95% confidence interval. Protocol registration: PROSPERO registration number CRD42020151269. A total of 14 studies were identified, including a combined total of 253 participants with hypertension. The meta-analysis showed that mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased significantly after strength training interventions. The strongest effect of strength training on decreasing blood pressure was observed in protocols with a moderate to vigorous load intensity (> 60% of one-repetition maximum-1RM), a frequency of at least 2 times per week, and a minimum duration of 8 weeks. We concluded that strength training interventions can be used as a non-drug treatment for arterial hypertension, as they promote significant decreases in blood pressure.

Acute effects of mixed circuit training on hemodynamic and cardiac autonomic control in chronic hemiparetic stroke patients: A randomized controlled crossover trial

Objectives: To investigate whether a single bout of mixed circuit training (MCT) can elicit acute blood pressure (BP) reduction in chronic hemiparetic stroke patients, a phenomenon also known as post-exercise hypotension (PEH).

Methods: Seven participants (58 ± 12 years) performed a non-exercise control session (CTL) and a single bout of MCT on separate days and in a randomized counterbalanced order. The MCT included 10 exercises with 3 sets of 15-repetition maximum per exercise, with each set interspersed with 45 s of walking. Systolic (SBP) and diastolic (DBP) blood pressure, mean arterial pressure (MAP), cardiac output (Q), systemic vascular resistance (SVR), baroreflex sensitivity (BRS), and heart rate variability (HRV) were assessed 10 min before and 40 min after CTL and MCT. BP and HRV were also measured during an ambulatory 24-h recovery period.

Results: Compared to CTL, SBP (∆-22%), DBP (∆-28%), SVR (∆-43%), BRS (∆-63%), and parasympathetic activity (HF; high-frequency component: ∆-63%) were reduced during 40 min post-MCT (p < 0.05), while Q (∆35%), sympathetic activity (LF; low-frequency component: ∆139%) and sympathovagal balance (LF:HF ratio: ∆145%) were higher (p < 0.001). In the first 10 h of ambulatory assessment, SBP (∆-7%), MAP (∆-6%), and HF (∆-26%) remained lowered, and LF (∆11%) and LF:HF ratio (∆13%) remained elevated post-MCT vs. CTL (p < 0.05).

Conclusion: A single bout of MCT elicited prolonged PEH in chronic hemiparetic stroke patients. This occurred concurrently with increased sympathovagal balance and lowered SVR, suggesting vasodilation capacity is a major determinant of PEH in these patients. This clinical trial was registered in the Brazilian Clinical Trials Registry (RBR-5dn5zd), available at https://ensaiosclinicos.gov.br/rg/RBR-5dn5zd.

Clinical Trial Registration:https://ensaiosclinicos.gov.br/rg/RBR-5dn5zd, identifier RBR-5dn5zd

Non-pharmacological interventions for older patients with hypertension: A systematic review and network meta-analysis

OBJECTIVE

To determine the most effective non-pharmacological interventions to control the blood pressure variation in older hypertensive patients.

METHODS

Primary endpoints were office systolic blood pressure (SBP) and diastolic blood pressure (DBP). The quality of evidence was assessed using the "risk of bias 2″ tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. We performed a Bayesian network meta-analysis using R-4.0.2 software to compare the efficacy of interventions.

RESULTS

36 eligible studies (3,531 patients) with a median follow-up of 12 weeks, assessing 18 non-pharmacological interventions, were included. The percentages of high, moderate, low, and very low certainty evidence were 16.7%, 38.9%, 33.3%, and 11.1%, respectively.

CONCLUSION

High certainty evidence suggests that self-management education is most effective in lowering SBP and DBP in older patients with hypertension, followed by moderate-intensity aerobic exercise. Moderate-intensity resistance training is the most effective exercise for lowering SBP.

REGISTRATION

PROSPERO, #CRD42020209850.

Chronobiology of Exercise: Evaluating the Best Time to Exercise for Greater Cardiovascular and Metabolic Benefits

Physiological function fluctuates across 24 h due to ongoing daily patterns of behaviors and environmental changes, including the sleep/wake, rest/activity, light/dark, and daily temperature cycles. The internal circadian system prepares the body for these anticipated behavioral and environmental changes, helping to orchestrate optimal cardiovascular and metabolic responses to these daily changes. In addition, circadian disruption, caused principally by exposure to artificial light at night (e.g., as occurs with night-shift work), increases the risk for both cardiovascular and metabolic morbidity and mortality. Regular exercise is a countermeasure against cardiovascular and metabolic risk, and recent findings suggest that the cardiovascular benefits on blood pressure and autonomic control are greater with evening exercise compared to morning exercise. Moreover, exercise can also reset the timing of the circadian system, which raises the possibility that appropriate timing of exercise could be used to counteract circadian disruption. This article introduces the overall functional relevance of the human circadian system and presents the evidence surrounding the concepts that the time of day that exercise is performed can modulate the cardiovascular and metabolic benefits. Further work is needed to establish exercise as a tool to appropriately reset the circadian system following circadian misalignment to preserve cardiovascular and metabolic health. © 2022 American Physiological Society. Compr Physiol 12:3621-3639, 2022.

The blood pressure response to acute exercise predicts the ambulatory blood pressure response to exercise training in patients with resistant hypertension: results from the EnRicH trial

Reports suggest that the blood pressure (BP) response to an acute bout of exercise is associated with the BP response to aerobic training in participants with elevated BP. These associations have not been tested among patients with resistant hypertension. This study aimed to determine whether the BP response to acute exercise predicts the 24-h ambulatory BP response to a 12-week exercise training program in patients with resistant hypertension (n = 26, aged 59.3 ± 8.2 years, 24-h ambulatory BP 127.4 ± 12.2/75.6 ± 7.8 mm Hg) who completed the exercise arm of the EnRicH trial. Ambulatory BP measurements were obtained before and after the exercise program to assess the chronic BP response. To assess acute BP changes, resting BP was measured before and 10 min after three exercise sessions in the third week of training and averaged. The resting systolic (9.4 ± 6.7, p < 0.001) and diastolic BP (1.9 ± 3.2, p = 0.005) were reduced after acute exercise. The 24-h systolic (6.2 ± 12.2, p = 0.015) and diastolic BP (4.4 ± 6.1, p = 0.001) were decreased after exercise training. The reductions in systolic BP after acute exercise were associated with the reductions in 24-h systolic BP after exercise training (ß = 0.538, adjusted r² = 0.260, P = 0.005). The reductions in diastolic BP after acute exercise (ß = 0.453, adjusted r² = 0.187) and baseline 24-h diastolic BP (ß = -0.459, adjusted r² = 0. 199) accounted for 38.6% (p = 0.008) of the 24-h diastolic BP response to exercise training. In conclusion, the magnitude of the BP response to acute exercise appears to predict the ambulatory BP response to exercise training among patients with resistant hypertension.

Postexercise Hypotension Is Delayed in Men With Obesity and Hypertension

Background

Postexercise hypotension (PEH) can play a major role in the daily blood pressure management among individuals with hypertension. However, there are limited data on PEH in persons with obesity and hypertension, and no PEH data in this population beyond 90 min postexercise.

Purpose

The purpose of this study was to determine if PEH could be elicited in men with obesity and hypertension during a 4-h postexercise measurement period.

Methods

Seven men [age = 28 ± 4 years; body mass index = 34.6 ± 4.8 kg/m²; brachial systolic blood pressure (SBP): 138 ± 4 mmHg; brachial diastolic BP (DBP): 80 ± 5 mmHg; central SBP: 125 ± 4 mmHg; central DBP: 81 ± 8 mmHg] performed two exercise sessions on a cycle ergometer, each on a separate day, for 45 min at ∼65% VO_2max. One exercise session was performed at a cadence of 45 RPM and one at 90 RPM. Blood pressure was monitored with a SunTech Oscar2 ambulatory blood pressure monitor for 4 h after both exercise sessions, and during a time-matched control condition.

Results

Both brachial and central SBP were not changed during the first h postexercise but were reduced by ∼5-11 mmHg between 2 and 4 h postexercise (p < 0.05) after both exercise sessions. Brachial and central DBP were elevated by ∼5 mmHg at 1 h postexercise (p < 0.05) but were ∼2-3 mmHg lower compared to control at 4 h postexercise, and ∼2-4 mmHg lower at 3 h postexercise compared to baseline. Mean arterial pressure (MAP) was elevated compared to control at 1 h postexercise after both exercise sessions, but was ∼2-3 mmHg lower compared to control at 2, 3, and 4 h postexercise, and ∼4-7 mmHg lower at 3 h postexercise compared to baseline.

Conclusion

Despite the small sample size and preliminary nature of our results, we conclude that PEH is delayed in men with obesity and hypertension, but the magnitude and duration of PEH up to 4 h postexercise is similar to that reported in the literature for men without obesity and hypertension. The PEH is most pronounced for brachial and central SBP and MAP. The virtually identical pattern of PEH after both exercise trials indicates that the delayed PEH is a reproducible finding in men with obesity and hypertension.

Rewinding sarcopenia: a narrative review on the renin-angiotensin system

BACKGROUND AND AIMS

The purpose of this review was two-fold. First, we aimed to provide an in-depth glance on the relationship between renin-angiotensin system (RAS) dysregulation and sarcopenia. Second, we aimed to touch upon potential treatments of sarcopenia (including RAS blockers, vitamin D, and exercise) in light of the pertinent literature.

METHODS

Currently available research regarding the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers on knee extensor strength, grip strength, chair stand test, gate speed together with the effects of exercise on muscle mass, strength, physical performance, blood pressure and cognitive tests (particularly in older adults) was reviewed.

RESULTS

Although some studies have shown favorable effects of ACEIs on muscle strength and/or physical function tests, some studies have reported no/negative association in between. The favorable impact of exercise on reducing blood pressure is shown, and exercise treatment is widely recommended in the relevant literature. Different types of exercises (aerobic, resistance, dancing, music movement, water-based, golf, knitting activities or multicomponent exercises) have shown improvement in cognitive functions as well.

CONCLUSION

Classical RAS activity results in deleterious effects not only on the cardiovascular but also on the neuromusculoskeletal system. Therefore, treatments targeting inhibition of the classical RAS activity seem to be important in the management of several age-related pathologies, including sarcopenia. As such, ACEIs, vitamin D, exercise, and healthy diet can have prominent effects not only on the modulation of RAS but also on physical and cognitive functions and sarcopenia as well.

Effects of DHA-Rich n-3 Fatty Acid Supplementation and/or Resistance Training on Body Composition and Cardiometabolic Biomarkers in Overweight and Obese Post-Menopausal Women

Resistance training (RT) and n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation have emerged as strategies to improve muscle function in older adults. Overweight/obese postmenopausal women (55–70 years) were randomly allocated to one of four experimental groups, receiving placebo (olive oil) or docosahexaenoic acid (DHA)-rich n-3 PUFA supplementation alone or in combination with a supervised RT-program for 16 weeks. At baseline and at end of the trial, body composition, anthropometrical measures, blood pressure and serum glucose and lipid biomarkers were analyzed. Oral glucose tolerance tests (OGTT) and strength tests were also performed. All groups exhibit a similar moderate reduction in body weight and fat mass, but the RT-groups maintained bone mineral content, increased upper limbs lean mass, decreased lower limbs fat mass, and increased muscle strength and quality compared to untrained-groups. The RT-program also improved glucose tolerance (lowering the OGTT incremental area under the curve). The DHA-rich supplementation lowered diastolic blood pressure and circulating triglycerides and increased muscle quality in lower limbs. In conclusion, 16-week RT-program improved segmented body composition, bone mineral content, and glucose tolerance, while the DHA-rich supplement had beneficial effects on cardiovascular health markers in overweight/obese postmenopausal women. No synergistic effects were observed for DHA supplementation and RT-program combination.

The effect of exercise training on blood pressure in menopause and postmenopausal women: A systematic review of randomized controlled trials

The prevalence of hypertension is higher in postmenopausal than in premenopausal women. Regular exercise training has been shown to be effective in addressing hypertension. The aim of this systematic review was to synthesize the effect of exercise training on systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in menopausal and postmenopausal women. This review was reported according to the PRISMA statement and registered in PROSPERO. The literature search was done in MEDLINE, Embase, Cochrane CENTRAL and ClinicalTrials. Randomized controlled trials involving menopausal and postmenopausal women undergoing exercise training were included. Two blinded reviewers assessed risk of bias in the included studies by using the Cochrane Risk of Bias tool. A random-effects model was used for all analyses. Significance was set at P < 0.05. Compared with the control group, exercise training resulted in clinically significant reductions on SBP (MD -3.43 mmHg; 95% CI, -5.16, -1.71; P < 0.0001), DBP (MD, -2.25 mmHg; 95% CI, -3.40, -1.11; P = 0.0001) and MAP (MD, -3.48 mmHg; 95% CI, -5.84, -1.11; P = 0.004). Aerobic training (AT) did not produce a significant reduction in SBP, DBP and MAP (P >0.05). Combined training (CT) generated larger reductions. Exercise training generated small but clinically relevant reductions in SBP, DBP and MAP in menopausal and postmenopausal women, younger or older than 65 years, with prehypertension or hypertension. AT did not lead to a clinically relevant improvement in blood pressure (BP) in this population. In addition, CT showed the largest reductions in SBP, DBP and MAP.

Advancements and critical steps for statistical analyses in blood pressure response to resistance training in hypertensive older women: a methodological approach

BACKGROUND

Repeated measures analysis of covariance and three-way analysis of variance with repeated measures are common statistical methods. For a valid interpretation of blood pressure (BP) response to exercise, a variety of additional statistical methods must be implemented. Four additional statistical methods are presented: technical error of measurement (SEM), smallest real difference (SRD), magnitude-based inference and mixed effect modeling technique (MEM). The aim of this perspective article is to demonstrate how to apply already known statistical analyses regarding BP responsiveness in order to improve interpretation and achieve higher reliability for future studies in exercise science.

METHODS

A total of 27 hypertensive older women (aged 68.37 ± 5.55 years) participated in the present study. A whole-body resistance training (RT) program was performed on two nonconsecutive days per week for 10 weeks. BP was monitored during the 10-week RT intervention and after 15 weeks of detraining. First, individuals were classified as high and low responders, then statistical methods to analyze data included the use of SEM, SRD, magnitude-based inference and MEM.

RESULTS

When magnitude-based inference was used to classify responsiveness, most participants displayed a trivial response. Decrements in SBP between 1 and 10 mmHg were not clinically meaningful but fell within the measurement error of the SBP measurements. Baseline SBP and time of training predicted post-SBP response.

CONCLUSION

Changes over time and declines in SBP might not be a SRD and fell in the SEM. Moreover, SBP responsiveness was the result of inappropriate control of covariates such as period of training.

Can Exercise-Induced Muscle Damage Be a Good Model for the Investigation of the Anti-Inflammatory Properties of Diet in Humans?

Subclinical, low-grade, inflammation is one of the main pathophysiological mechanisms underlying the majority of chronic and non-communicable diseases. Several methodological approaches have been applied for the assessment of the anti-inflammatory properties of nutrition, however, their impact in human body remains uncertain, because of the fact that the majority of the studies reporting anti-inflammatory effect of dietary patterns, have been performed under laboratory settings and/or in animal models. Thus, the extrapolation of these results to humans is risky. It is therefore obvious that the development of an inflammatory model in humans, by which we could induce inflammatory responses to humans in a regulated, specific, and non-harmful way, could greatly facilitate the estimation of the anti-inflammatory properties of diet in a more physiological way and mechanistically relevant way. We believe that exercise-induced muscle damage (EIMD) could serve as such a model, either in studies investigating the homeostatic responses of individuals under inflammatory stimuli or for the estimation of the anti-inflammatory or pro-inflammatory potential of dietary patterns, foods, supplements, nutrients, or phytochemicals. Thus, in this review we discuss the possibility of exercise-induced muscle damage being an inflammation model suitable for the assessment of the anti-inflammatory properties of diet in humans.

Hemodynamics and cardiac autonomic modulation after an acute concurrent exercise circuit in older individuals with pre- to established hypertension

OBJECTIVES

Few studies have investigated whether post-exercise hypotension (PEH) after concurrent exercise (CEX) is related to changes in cardiac output (Q) and systemic vascular resistance (SVR) in older individuals. We tested whether PEH after a single bout of CEX circuits performed in open-access facilities at the Third Age Academies (TAA) in Rio de Janeiro City (Brazil) would be concomitant with decreased Q and SVR in individuals aged ≥60 years with prehypertension. Moreover, we assessed autonomic modulation as a potential mechanism underlying PEH.

METHODS

Fourteen individuals (age, 65.8±0.9 y; systolic/diastolic blood pressure [SBP/DBP], 132.4±12.1/72.8±10.8 mmHg; with half of the patients taking antihypertensive medications) had their blood pressure (BP), heart rate (HR), Q, SVR, HR variability (HRV), and spontaneous baroreflex sensitivity (BRS) recorded before and 50 min after CEX (40-min circuit, including seven stations of alternate aerobic/resistance exercises at 60-70% HR reserve) and non-exercise control (CONT) sessions. The study protocol was registered in a World Health Organization-accredited office (Trial registration RBR-7BWVPJ).

RESULTS

SBP (Δ=-14.2±13.1 mmHg, p=0.0001), DBP (Δ=-5.2±8.2 mmHg, p= 0.04), Q (Δ=-2.2±1.5 L/min, p=0.0001), and BRS (Δ=-3.5±2.6 ms/mmHg; p=0.05) decreased after CEX as compared with the CONT session. By contrast, the HR increased (Δ=9.4±7.2 bpm, p<0.0001), and SVR remained stable throughout the postexercise period as compared with the CONT session (Δ=0.10±0.22 AU, p=0.14). We found no significant difference between the CEX and CONT with respect to the HRV indexes reflecting autonomic modulation.

CONCLUSION

CEX induced PEH in the older individuals with prehypertension status. At least in the first 50 min, PEH occurred parallel to the decreased Q and increased HR, while SVR was not different. The changes in autonomic outflow appeared to be unrelated to the acute cardiac and hemodynamic responses.

The promotion of physical activity for the prevention of Alzheimer's disease in adults with Down Syndrome: Rationale and design for a 12 Month randomized trial

Nearly all individuals with Down Syndrome (DS) display pathology associated with Alzheimer's disease (AD) beginning as early as age 30. Previous research in typically developed adults suggests that increased moderate-to-vigorous physical activity (MVPA) may improve cognitive function and protect against age-related structural and functional changes in the brain; however, the potential impact of increased MVPA on the development of AD in adults with DS has not been evaluated. Despite the potential positive impact of MVPA on cognition and AD risk, participation in MVPA among young adults with DS is low. The limited research evaluating strategies for increasing MVPA in adults with DS has been unsuccessful in increasing MVPA. Results from our preliminary investigation where we remotely delivered real-time MVPA, led by a trained health educator, to groups of adults with DS in their homes via video conferencing on a tablet computer demonstrated high attendance, increased MVPA during group sessions, and improvements in cognitive function. However, the sustainability, impact on total daily MVPA, optimal session frequency, and potential impacts on cognitive function and brain health of remotely delivered group MVPA sessions in adults with DS are unknown. Therefore, we will conduct a trial in 80 non-demented adults with DS to determine the feasibility and potential efficacy of remotely delivered group MVPA sessions to increase daily MVPA, relative to a usual care control. Secondarily we will assess the impact of MVPA on cardiovascular fitness, quality of life, cognitive function and brain parameters related to AD.

NCT REGISTRATION

NCT04048759.

ACUTE PHYSICAL EXERCISE AND HYPERTENSION IN THE ELDERLY: A SYSTEMATIC REVIEW

ABSTRACT As the population ages, health conditions, including hypertension (HT), which is one of the most prevalent diseases in the elderly population, increase. Regular physical exercise has been recommended for hypertensive individuals; however, due to the variety of factors involved in exercise, different acute responses can be achieved. Accordingly, the purpose of this study was to perform a systematic review of the acute effect of physical exercise on blood pressure (BP) in elderly hypertensive patients and of its applicability to the treatment of HT. The search was performed in electronic databases available at Pubmed/Medline, Scopus and Bireme from 2008 to 2018, using the terms “acute physical exercise and hypertension and elderly”. A total of 592 articles were found, and after applying the inclusion criteria, 9 articles were selected to form the analysis. All studies evaluated the acute effect of the exercise session and the acute effect of the session after a training period in male and female hypertensive individuals aged 60 years or over. The results indicate that in spite of the heterogeneity of training methods, all intervention protocols used in these studies were effective in promoting BP reduction post exercise when compared to the control group. However, there is still a gap in the reviewed literature regarding the maintenance time of post exercise hypotension (PEH) in the elderly. This information could suggest how long individuals undergoing physical exercise would be “protected” from high blood pressure values and their health risks, and help plan physical exercise sessions at the precise time the hypotensive effect ceases to be present. Level of evidence II; Therapeutic studies-Investigation of treatment results.

The Effects of Concurrent Training Combining Both Resistance Exercise and High-Intensity Interval Training or Moderate-Intensity Continuous Training on Metabolic Syndrome

To date, there are several knowledge gaps on how to properly prescribe concurrent training to achieve the best dose-response, especially regarding the optimal intensity or volume of the aerobic component. Thus, the objective of this study is to analyze the effects of different aerobic exercise modes and intensities [i.e. aerobic high-intensity interval training (HIIT) versus moderate-intensity continuous aerobic training (MICT) combined with a resistance training (RT) program] on metabolic outcomes in participants with metabolic syndrome (MetS). Thirty-nine men and women (67.0 ± 6.7 years) volunteered to a 12-weeks exercise intervention (3 week^–1, 50 min/session) and were randomly assigned to one of three groups: (a) RT plus MICT (RT+MICT) (2 males; 11 females); (b) RT plus HIIT (RT+HIIT) (4 males; 9 females); and (c) control group (CON) – without formal exercise (4 males; 9 females). Intensity was established between 60 and 70% of maximum heart rate (HRmax) in RT+MICT and ranged from 55–65% to 80–90% HRmax in the RT+HIIT group. Dependent outcomes included morphological, metabolic and hemodynamic variables. Both training groups improved waist circumference (RT+MICT: P = 0.019; RT+HIIT: P = 0.003), but not body weight, fat mass or fat-free mass (P ≥ 0.114). RT+HIIT group improved fasting glucose (P = 0.014), low density lipoprotein [LDL (P = 0.022)], insulin (P = 0.034) and homeostatic model assessment (P = 0.028). RT+MICT group reduced triglycerides (P = 0.053). Both exercise interventions did not change high sensitivity C-reactive protein, glycated hemoglobin, high density lipoprotein and total cholesterol, systolic, diastolic or mean arterial blood pressure (P ≥ 0.05). The CON group reduced the LDL (P = 0.031). This trial suggests that short-term exercise mode and intensity may differently impact the metabolic profile of individuals with MetS. Further, our data suggests that both concurrent trainings promote important cardiometabolic gains, particularly in the RT+HIIT. Nonetheless, due to the small-to-moderate effect size and the short-term intervention length, our data suggests that the intervention length also has an important modulating role in these benefits in older adults with MetS. Therefore, more research is needed to confirm our results using longer exercise interventions and larger groups.

Low Dose Resistance Exercise: A Pilot Study Examining Effects on Blood Pressure and Augmentation Index Between Intensities

INTRODUCTION

The effects of resistance exercise on vascular function are unclear.

AIM

To investigate the acute haemodynamic (blood pressure and augmentation index) and rate of perceived exertion (RPE) response to two types of resistance exercises of equal workload-a set of unilateral 35% of one repetition maximum (1RM) quadriceps extension and a set of unilateral 70% 1RM quadriceps extension.

METHODS

Twenty two young healthy males completed both exercises on separate days. Heart rate, central and peripheral systolic and diastolic blood pressure (BP), augmentation pressure, augmentation index (AIx), augmentation index at a heart rate of 75 beats per minute (AIx75), and RPE were measured using applanation tonometry before exercise, immediately after exercise, 5 min after exercise and 15 min after exercise.

RESULTS

AIx75 was significantly lower 5 min after exercising at 35% of 1RM than 70% of 1RM. Systolic blood pressure was significantly lower at 5 min post exercise for both intensities. There was no significant difference in RPE between conditions or time points.

CONCLUSIONS

Results suggest that changes in blood pressure and augmentation index vary depending on the intensity of resistance exercise regardless of the volume of exercise carried out. Changes in AIx75 in response to resistance exercise may be independent of changes in BP.

Post-exercise hypotension in concurrent training: a systematic review

Abstract Physical exercise is capable to reduce blood pressure (BP) acutely in a phenomenon described as post-exercise hypotension (PEH). However, the acute effect of concurrent training on PEH needs clarification. The present review aimed to verify and summarize the acute effect of concurrent training on PEH in normotensive and hypertensive subjects. The search was carried out in the databases PubMed, Scielo, and Lilacs, and resulted in 3806 articles. Only 14 studies met the eligibility criteria and were selected. According to included studies, concurrent training can promote PEH regardless of the order, volume, and intensity prescribed, being an effective strategy in the control of arterial hypertension. There is no consensus in the literature regarding the best prescription strategy, as well as the order of execution of the types of exercise.

EFFECT OF THE AEROBIC COMPONENT OF COMBINED TRAINING ON THE BLOOD PRESSURE OF HYPERTENSIVE ELDERLY WOMEN

ABSTRACT Introduction Aerobic (AT), strength (ST) and combined (CT) training are already well referenced as a method for the treatment and control of arterial hypertension (AH) inducing positive changes in blood pressure (BP) reduction, a phenomenon known as post-exercise hypotension (PEH). However, the correct order of combined training to promote PEH is still unclear. Objective To verify the effect of the order of the aerobic component in combined training on PEH among hypertensive elderly women. Methods Randomized clinical trial of 24 elderly hypertensive women allocated to three training groups: Group 1 - Aerobic + Strength Training (AT + ST), Group 2 - Strength + Aerobic Training (ST + AT) and Group 3 - Aerobic + Strength + Aerobic Training (AT + ST + AT). Participants underwent AT at 60% heart rate reserve intensity for 30 minutes and ST with four exercises in three sets of 12 repetitions at 60% of one-repetition maximum (1RM) also for 30 minutes. The training involved 24 sessions (three times a week).Systolic (SBP) and diastolic blood pressure (DBP) were measured in all groups at time points before and after each session, and the mean BP (MBP) was calculated. Results The variables analyzed did not differ significantly between groups in either the pre- or post-training period. MBP showed a significant reduction only in G1. However, G3 had a greater effect on all the variables analyzed. Conclusion Combined training with an aerobic component (G3) generated a significant post-exercise hypotensive effect over 24 sessions, and is indicated for elderly hypertensive women. Level of evidence II; Therapeutic studies.

Influence of Acute Concurrent Exercise Performed in Public Fitness Facilities on Ambulatory Blood Pressure Among Older Adults in Rio de Janeiro City

Cordeiro, R, Monteiro, W, Cunha, F, Pescatello, LS, and Farinatti, P. Influence of acute concurrent exercise performed in public fitness facilities on ambulatory blood pressure among older adults in Rio de Janeiro city. J Strength Cond Res 32(10): 2962-2970, 2018-The project "Third-Age Academies'" (TAAs) is a public policy providing supervised physical activities to over 40,000 seniors at open-access facilities (squares etc.) in Rio de Janeiro, Brazil. We investigated whether TAA concurrent exercise circuit induced postexercise hypotension (PEH) in individuals older than 60 years. Blood pressure (BP) was measured by 24-hour ambulatory BP monitoring (ABPM) after counterbalanced CEX and nonexercise (CONT) sessions (n = 16; 66.8 ± 1.4 years; systolic/diastolic BP (SBP/DBP): 132.5 ± 4.3/78.0 ± 2.8 mm Hg). For statistical analyses purposes, groups were divided as exhibiting normal SBP (≤120 mm Hg) or high SBP (>120 mm Hg), based on 24-hour ABPM after CONT. The CEX included 2 aerobic and 9 resistance exercises performed alternately in circuit order (40 minutes at 60-70% heart rate reserve using body mass or fixed loads). 24-hour ambulatory BP monitoring lowered in individuals with high BP (n = 11; medicated = 5) (SBP: -6.5 ± 1.9 mm Hg; mean arterial pressure [MAP]: -4.3 ± 1.5 mm Hg; p < 0.015), particularly within the first 5-6 hours after exercise (SBP: -13.5 ± 2.6 mm Hg; DBP: -9.4 ± 2.2 mm Hg; and MAP: -11.4 ± 1.6 mm Hg, p < 0.05). Significant BP lowering was not detected among participants with normal BP (n = 5; medicated = 4). In conclusion, CEX provoked PEH in older adults with prehypertension to established hypertension. Because of the potential of TAAs to reach large numbers of older adults, our findings are encouraging and should be confirmed in subsequent studies.

Blood pressure response to resistance training in hypertensive and normotensive older women

PURPOSE

The purpose of the present study was to identify the variability of blood pressure response to a 10-week resistance training (RT) program in hypertensive and normotensive elderly women.

PARTICIPANTS AND METHODS

Twenty-seven untrained hypertensive and 12 normotensive elderly women participated in the present study. A whole-body RT program was performed on two nonconsecutive days per week for 10 weeks. The responsiveness of resting systolic blood pressure (SBP) was determined based on the percent decline between the pre- and post-training time points T1 and T4. The term responders were used to describe subjects who exhibited a percent SBP decline ≥-2.58% and the term nonresponders for subjects who exhibited a percent SBP decline <-2.58%, respectively.

RESULTS

Both the responders and nonresponders in the hypertensive group presented significant changes in SBP (-7.83 ± 5.70 mmHg vs 3.78 ± 7.42 mmHg), respectively. Moreover, the responders and nonresponders in the normotensive group presented significant changes in SBP as well (-8.58 ± 5.52 mmHg vs 5.71 ± 3.84 mmHg).

CONCLUSION

SBP presents a heterogeneous response to a controlled RT program in hypertensive and normotensive elderly women. A different modality of training and additional therapies should be used for nonresponders in order to decrease resting SBP.

Heart Rate Variability following Combined Aerobic and Resistance Training in Sedentary Hypertensive Women: A Randomised Control Trial

Objective

To investigate the effect of combined aerobic and resistance training (CART) on heart rate variability in sedentary, hypertensive women.

Participants

A total of twenty-eight hypertensive (Stage 1 and 2) sedentary women (Age 40.54 ± 4.2 yrs; Height 155.14 ± 5.4 cm; Weight 70.96 ± 10.2 kg; BMI 29.6 ± 4.4; Duration of HTN: 6.43 ± 2.5 yrs) were recruited for the study.

Methods

Participants were randomly assigned to either the CART group that performed combined aerobic and resistance exercise of moderate intensity [aerobic exercise 50–80% of HR_max (maximum heart rate) and resistance exercises at 50–80% of 1 Repetition Maximum (RM)], 5 times/week for 4 weeks, or to the control group that followed conventional treatment without any supervised exercise intervention.

Main outcome measures

Resting blood pressure was measured and standard heart rate variability (HRV) indices were calculated using time domain (SDNN, pNN50, RMSSD) and frequency domain (LFnu, HFnu, LF/HF and TP) analysis.

Results

CART group demonstrated an increase in HFnu, TP, SDNN, and RMSSD, (p < 0.05) along with a significant decrease in LFnu, LF/HF ratio, systolic blood pressure, and diastolic blood pressure (p < 0.05).

Conclusion

CART showed significant improvement in HRV parameters indicating vagal dominance in middle-aged hypertensive women. Therefore, exercise training in combined form (aerobic and resistance) may be incorporated in the management programs of the patients suffering from hypertension in order to augment improvement in their cardiac autonomic control.

Is Concurrent Training Efficacious Antihypertensive Therapy? A Meta-analysis

: Aerobic exercise training and, to a lesser degree, dynamic resistance training, are recommended to lower blood pressure (BP) among adults with hypertension. Yet the combined influence of these exercise modalities, termed concurrent exercise training (CET), on resting BP is unclear.

PURPOSE

This study aimed to meta-analyze the literature to determine the efficacy of CET as antihypertensive therapy.

METHODS

Electronic databases were searched for trials that included the following: adults (>19 yr), controlled CET interventions, and BP measured pre- and postintervention. Study quality was assessed with a modified Downs and Black Checklist. Analyses incorporated random-effects assumptions.

RESULTS

Sixty-eight trials yielded 76 interventions. Subjects (N = 4110) were middle- to older-age (55.8 ± 14.4 yr), were overweight (28.0 ± 3.6 kg·m), and had prehypertension (systolic BP [SBP]/diastolic BP [DBP] = 134.6 ± 10.9/80.7 ± 7.5 mm Hg). CET was performed at moderate intensity (aerobic = 55% maximal oxygen consumption, resistance = 60% one-repetition maximum), 2.9 ± 0.7 d·wk for 58.3 ± 20.1 min per session for 19.7 ± 17.8 wk. Studies were of moderate quality, satisfying 60.7% ± 9.4% of quality items. Overall, CET moderately reduced SBP (db = -0.32, 95% confidence interval [CI] = -0.44 to -0.20, -3.2 mm Hg) and DBP (db = -0.35, 95% CI = -0.47 to -0.22, -2.5 mm Hg) versus control (P < 0.01). However, greater SBP/DBP reductions were observed among samples with hypertension in trials of higher study quality that also examined BP as the primary outcome (-9.2 mm Hg [95% CI = -12.0 to -8.0]/-7.7 mm Hg [95% CI = -14.0 to -8.0]).

CONCLUSIONS

Among samples with hypertension in trials of higher study quality, CET rivals aerobic exercise training as antihypertensive therapy. Because of the moderate quality of this literature, additional randomized controlled CET trials that examine BP as a primary outcome among samples with hypertension are warranted to confirm our promising findings.

Blood pressure response to acute and chronic exercise in chronic kidney disease

AIM

The current study was designed to determine if a relationship exists between acute and chronic blood pressure responses to aerobic exercise in pre-dialysis patients.

METHODS

Pre-dialysis kidney patients attended four sessions before being randomized to the treatment (n = 25) or control group (n = 21). In session 1, resting blood pressure was recorded, and these measurements were repeated during the second visit when peak oxygen uptake (VO_2peak ) was assessed. In the third and fourth sessions, blood pressures were taken prior to a 40 min walk or period of seated rest. After the 40 min walk or seated rest, blood pressures were monitored for 60 min in the laboratory and for the subsequent 24 h. After session 4, subjects in the treatment group trained aerobically at a moderate intensity, three times per week for 16 weeks. Control subjects were asked to be sedentary. All measurements were repeated after 16 weeks of training or sedentary living.

RESULTS

Training increased VO_2peak (mL/kg per minute) in the treatment group (baseline 19.6 ± 6.7 vs 21.2 ± 7.7, P < 0.05), with no change in the control (18.0 ± 6.0 vs 17.5 ± 5.7) group. Post-exercise hypotension occurred at baseline prior to training but was unaffected by 16 weeks of training.

CONCLUSION

Post-exercise hypotension occurs in pre-dialysis patients following aerobic exercise, but short-term moderate-intensity continuous aerobic training has no effect upon this response. There seems to be no relationship between the acute and chronic blood pressure responses to exercise in pre-dialysis kidney patients.

Fractionated Concurrent Exercise throughout the Day Does Not Promote Acute Blood Pressure Benefits in Hypertensive Middle-aged Women

Hypertension is a chronic disease that affects about 30% of the world’s population, and the physical exercise plays an important role on its non-pharmacological treatment. Anywise, the dose–response of physical exercise fractionation throughout the day demands more investigation, allowing new exercise prescription possibilities. Therefore, this study aimed to analyze the acute blood pressure (BP) kinetics after 1 h of exercises and the BP reactivity after different concurrent exercise (CE) sessions and its fractioning of hypertensive middle-aged women. In this way, 11 hypertensive women voluntarily underwent three experimental sessions and one control day [control session (CS)]. In the morning session (MS) and night session (NS), the exercise was fully realized in the morning and evening, respectively. For the fractionized session (FS), 50% of the volume was applied in the morning and the remaining 50% during the evening. The MS provided the greatest moments (p ≤ 0.05) of post-exercise hypotension (PEH) for systolic BP (SBP) and highest reduction of BP reactivity for SBP (~44%) and diastolic BP (DBP) (~59%) compared to CS (p ≤ 0.05). The findings of the present study have shown that MS is effective for PEH to SBP, as well as it promotes high quality of attenuation for BP reactivity, greater than the other sessions.

Effect of Strength Training on Oxidative Stress and the Correlation of the Same with Forearm Vasodilatation and Blood Pressure of Hypertensive Elderly Women: A Randomized Clinical Trial

The aim of the study was to evaluate the effect of strength training on oxidative stress and the correlation of the same with forearm vasodilatation and mean blood pressure of hypertensive elderly women, at rest (basal) and during a static handgrip exercise. Insufficiently active hypertensive elderly women (N = 25; mean age = 66.1 years) were randomized into a 10 week strength training group (n = 13) or control (n = 12) group. Plasma malondialdehyde (MDA), total antioxidant capacity (TAC), plasma nitrite (NO2-), forearm blood flow (FBF), mean blood pressure (MBP) and vascular conductance ([FBF / MBP] x 100) were evaluated before and after the completion of the interventions. The strength training group increased the TAC (pre: Median = 39.0; Interquartile range = 34.0-41.5% vs post: Median = 44.0; Interquartile range = 38.0-51.5%; p = 0.006) and reduced the MDA (pre: 4.94 ± 1.10 μM vs post: 3.90 ± 1.35 μM; p = 0.025; CI-95%: -1.92 --0.16 μM). The strength training group increased basal vascular conductance (VC) (pre: 3.56 ±0.88 units vs post: 5.21 ±1.28 units; p = 0.001; CI-95%: 0.93-2.38 units) and decreased basal MBP (pre: 93.1 ±6.3 mmHg vs post: 88.9 ±5.4 mmHg; p = 0.035; CI-95%: -8.0 --0.4 mmHg). Such changes were also observed during static handgrip exercise. A moderate correlation was observed between changes in basal VC and MBP with changes in NO2- (ΔVC → r = -0.56, p = 0.047; ΔMBP → r = -0.41, p = 0.168) and MDA (ΔVC → r = 0.64, p = 0.019; ΔMBP → r = 0.31, p = 0.305). The strength training program reduced the oxidative stress of the hypertensive elderly women and this reduction was moderately correlated with their cardiovascular benefits.

TRIAL REGISTRATION

ensaiosclinicos.gov.br RBR-48c29w.