Effect of cervical manipulation on blood pressure and heart rate variability responses in adults: A scoping review

This study aimed to review the blood pressure and heart rate variability responses after different cervical manipulation. A comprehensive literature search was conducted across CINAHL, Cochrane Library, PubMed®, and SciELO databases on December 26, 2024. From an initial pool of 84,625 studies, five met the inclusion criteria for this review. The findings suggest that cervical manipulation may induce a hypotensive response in systolic blood pressure while promoting an overall enhancement in cardiovascular regulation, particularly through an increase in parasympathetic activity. Specifically, 80 % of the reviewed studies reported a reduction in systolic blood pressure following cervical manipulation, highlighting its potential as a therapeutic strategy for blood pressure management. Additionally, 66 % of the included studies demonstrated improvements in sympathetic-vagal balance regulation. Other findings pointed to reductions in both blood pressure and plasma norepinephrine levels, which could indirectly support autonomic and hemodynamic stability. Although these results reinforce the potential benefits of cervical manipulation as a complementary approach for managing blood pressure and autonomic function, the limited number of available studies (n = 5) and their methodological variability (ranging from moderate to high quality) warrant caution in extrapolating these findings to broader clinical populations.

Stretching, isometrics, and aerobic exercise for decreasing blood pressure post-exercise: a randomized crossover study

We compared stretching, isometrics, and aerobic exercise for effectiveness in decreasing blood pressure post-exercise. Using a randomized crossover design, 5 males and 4 females (21.3 years; normotensive) participated in four 30 min sessions on separate days: static stretching (30 s stretches, major muscle groups), isometric exercise, aerobic cycling (75% VO2peak), and control (rest), with blood pressure and heart rate measured before exercise (or rest) and for 60 min post-exercise (or rest). Aerobic exercise and stretching decreased post-exercise systolic blood pressure (∼10 mmHg each) (p < 0.05), whereas isometric exercise and the control condition did not significantly decrease post-exercise blood pressure. Stretching is similar to aerobic exercise for reducing blood pressure post-exercise. ClinicalTrials.gov Identifier: NCT06628635.

Muscular Performance and Blood Pressure After Different Pre-Strength Training Strategies in Recreationally Strength-Trained Women: Cross-Over Trial

BACKGROUND

This study aimed to investigate the acute effects of different pre-ST strategies on muscular performance and blood pressure (BP) responses in recreationally strength-trained women.

METHODS

Twelve overweight women with normal BP were recruited and performed six experimental protocols in a randomized order: (1) control protocol (CC), where BP was assessed without exercises performed; (2) ST; (3) foam rolling warm-up followed by ST (FR + ST); (4) specific warm-up followed by ST (SW + ST); (5) aerobic exercise followed by ST (AE + ST); and (6) stretching exercises followed by ST (SE + ST). ST consisted of three sets at 80% of 10 repetition maximum with a self-suggested rest interval between sets for bench press, back squat, bench press 45°, front squat, lat pull-down, leg press, shoulder press, and leg extension.

RESULTS

All experimental protocol had a lower total training volume, fatigue index, and repetitions performance in relation to ST (p < 0.05). No significant reduction was observed in systolic and diastolic BP for any protocol or exercise, although the effect size magnitudes ranged from trivial to large. Decreases in maximum repetitions, resistance to fatigue, and total training volume were performed before ST as warm-up strategies. However, these strategies indicated a clinical reduction in BP with a large and meaningful magnitude (effect size) in recreationally strength-trained women with normal to elevated BP.

CONCLUSIONS

The results of this investigation may help to influence decision-making by practitioners who desire to elicit a post-exercise hypotension response in both subjects with normal BP and hypertension.

Enhance range-of-motion and hypotensive effect in elderly submitted to three manual therapy techniques: Cross-over study

The present study has two objectives: 1) to verify the effect of Maitland mobilization, manual massage (MM), and static stretching (SS) on the acute range-of-motion (ROM) responses, over 30 min, in the elderly; 2) to verify the effect of Maitland's mobilization, MM, and SS on blood pressure (BP) responses, over 60 min, in the elderly. Sixteen inactive elderly men were recruited. After familiarization, all subjects performed the experimental conditions throughout four remaining sessions. Each session included two baselines ROM measures in randomized order. After baseline, participants completed the control group, Maitland, MM, and SS conditions and retesting immediately (Post-0) e again throughout 30-min following intervention. All conditions increased ankle, hip, and shoulder ROM for at least 10-min post-intervention. Systolic BP hypotensive effects were found for all experimental protocols when compared to baseline values. In conclusion, it was observed that Maitland, MM, and SS conditions enhance ROM and promote hypotensive effect post-intervention. These results have a practical prescription and rehabilitation implications and may be used in the elderly population, since a movement limitation can be treated by global interventions in a non-limited, as well as promoting cardiovascular protection through the hypotensive effects in the same experimental session.

Changes in Heart Rate Variability and Post‐Exercise Blood Pressure from Manipulating Rest Intervals Between Sets of Resistance Training

The purpose of this study was to compare blood pressure and heart rate variability responses in physically active men after performing resistance training sessions with rest intervals of 1 min, 2 min and 3 min. Eighteen men (age, 21.6±1.1 years; body mass, 74.1±8.1 kg; body height, 175.3±7.1 cm) who performed 180min of physical activity per week participated in this study. After determining the 15RM loads for the squat, bench press, bent-over row and deadlift, participants performed a resistance training session. Participants performed three resistance training protocols in randomized counterbalanced order. Each experimental protocol comprised different rest intervals between sets of resistance training exercises (1min, 2min or 3min). During each experimental session, participants performed three sets with a 15RM load. Blood pressure and heart rate variability were measured before and for 2h after each session. The results demonstrated a greater blood pressure (p<0.05) reduction with a longer rest interval. There was no statistically significant difference in heart rate variability changes between groups. These results indicate that 2min and 3min rest intervals while using a 15RM load provide the best stimulus for a blood pressure reduction response after a resistance training session. Our findings suggest that strength and conditioning professionals should prescribe 2min or 3min rest intervals when resistance training is performed with a 15RM load if the aim is to obtain an acute reduction in blood pressure after a resistance training session.

Effects of Manual Therapies and Resistance Exercise on Postexercise Hypotension in Women With Normal Blood Pressure

ABSTRACT

Monteiro, ER, Pescatello, LS, Winchester, JB, Corrêa Neto, VG, Brown, AF, Budde, H, Marchetti, PH, Silva, JG, Vianna, JM, and Novaes, JdS. Effects of manual therapies and resistance exercise on postexercise hypotension in women with normal blood pressure. J Strength Cond Res 36(4): 948-954, 2022-The purpose of this investigation was to examine the acute effects of resistance exercise (RE) and different manual therapies (static stretching and manual massage [MM]) performed separately or combined on blood pressure (BP) responses during recovery in women with normal BP. Sixteen recreationally strength-trained women (age: 25.1 ± 2.9 years; height: 158.9 ± 4.1 cm; body mass: 59.5 ± 4.9 kg; body mass index: 23.5 ± 1.9 kg·m-2; baseline systolic BP median: 128 mm Hg; and baseline diastolic BP median: 78 mm Hg) were recruited. All subjects performed 6 experiments in a randomized order: (a) rest control (CON), (b) RE only (RE), (c) static-stretching exercise only (SS), (d) MM only, (e) RE immediately followed by SS (RE + SS), and (f) RE immediately followed by MM (RE + MM). RE consisted of 3 sets of bilateral bench press, back squat, front pull-down, and leg press exercises at 80% of 10RM. Static stretching and MM were applied unilaterally in 2 sets of 120 seconds to each of the quadriceps, hamstring, and calf regions. Systolic (SBP) and diastolic BP were measured before (rest) and every 10 minutes for 60 minutes following (Post 10-60) each intervention. There were significant intragroup differences for RE in Post-50 (p = 0.038; d = -2.24; ∆ = -4.0 mm Hg). Similarly, SBP intragroup differences were found for the SS protocol in Post-50 (p = 0.021; d = -2.67; ∆ = -5.0 mm Hg) and Post-60 (p = 0.008; d = -2.88; ∆ = -5.0 mm Hg). Still, SBP intragroup differences were found for the MM protocol in Post-50 (p = 0.011; d = -2.61; ∆ = -4.0 mm Hg) and Post-60 (p = 0.011; d = -2.74; ∆ = -4.0 mm Hg). Finally, a single SBP intragroup difference was found for the RE + SS protocol in Post-60 (p = 0.024; d = -3.12; ∆ = -5.0 mm Hg). Practitioners should be aware that SS and MM have the potential to influence BP responses in addition to RE or by themselves and therefore should be taken into consideration for persons who are hypertensive or hypotensive.

Statistical Analysis of the Consistency of HRV Analysis Using BCG or Pulse Wave Signals

Ballistocardiography (BCG) is considered a good alternative to HRV analysis with its non-contact and unobtrusive acquisition characteristics. However, consensus about its validity has not yet been established. In this study, 50 healthy subjects (26.2 ± 5.5 years old, 22 females, 28 males) were invited. Comprehensive statistical analysis, including Coefficients of Variation (CV), Lin’s Concordance Correlation Coefficient (LCCC), and Bland-Altman analysis (BA ratio), were utilized to analyze the consistency of BCG and ECG signals in HRV analysis. If the methods gave different answers, the worst case was taken as the result. Measures of consistency such as Mean, SDNN, LF gave good agreement (the absolute value of CV difference < 2%, LCCC > 0.99, BA ratio < 0.1) between J-J (BCG) and R-R intervals (ECG). pNN50 showed moderate agreement (the absolute value of CV difference < 5%, LCCC > 0.95, BA ratio < 0.2), while RMSSD, HF, LF/HF indicated poor agreement (the absolute value of CV difference ≥ 5% or LCCC ≤ 0.95 or BA ratio ≥ 0.2). Additionally, the R-R intervals were compared with P-P intervals extracted from the pulse wave (PW). Except for pNN50, which exhibited poor agreement in this comparison, the performances of the HRV indices estimated from the PW and the BCG signals were similar.

Effects of progressive muscular relaxation and stretching exercises combination on blood pressure among farmers in rural areas of Indonesia: a randomized study†

Objective

Maintaining blood pressure (BP) could improve the quality of life among farmers in agricultural health. The study aims to evaluate the effects of progressive muscular relaxation and stretching exercises (SEs) for BP in farmer subjects in rural areas.

Methods

A randomized controlled design was applied for this study. We performed a method, which is the combination of progressive muscle relaxation (PMR) and SEs for participants (30 in the control group and 60 in the intervention group). The intervention group self-practiced PMR and SEs through a video that providing instructions for 15 min. PMR practiced before going to sleeping in the night, and SEs practiced before going to farms in the morning per day for 3-months. Wilcoxon signed-rank test was performed to measure the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP) as one pre- and post-test comparison of baseline and 3 months data in control and intervention groups.

Results

There were no significant differences between SBP and DBP pre- and post-test in control group (P > 0.050). Meanwhile, there were significant differences in reducing SBP (M = 126.67; SD = 18.07; 95% CI = 120–147.5 mmHg) and DBP (M = 80.67; SD = 6.91; 95% CI = 80–90 mmHg) pre- and post-test combination of PMR and SEs in intervention group (P < 0.001). After 3-months of follow-up data, number type SBP and DBP still remained at the same levels of baseline and 3-month data in control group. While, there was an increased number of normal and prehypertension for SBP and DBP (10% vs. 10% and 20% vs. 31.6%) and reduced of hypertension stage I for SBP and DBP (30% vs. 41.6%).

Conclusions

This pilot study demonstrated effectively to reduce SBP and DBP among farmers using the combination of PMR and SEs in the agricultural health setting.

Acute Hemodynamic Responses to Three Types of Hamstrings Stretching in Senior Athletes

Although stretching is recommended for fitness and health, there is little research on the effects of different stretching routines on hemodynamic responses of senior adults. It is not clear whether stretching can be considered an aerobic exercise stimulus or may be contraindicated for the elderly. The purpose of this study was to compare the effect of three stretching techniques; contract/relax proprioceptive neuromuscular facilitation (PNF), passive straight-leg raise (SLR), and static sit-and-reach (SR) on heart rate (HR) and blood pressure (BP) in senior athletes (119 participants: 65.6 ± 7.6 yrs.). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and HR measurements were taken at baseline (after 5-minutes in a supine position), 45 and 90-seconds, during the stretch, and 2-minutes after stretching. Within each stretching group, (SLR, PNF, and SR) DBP, MAP and HR at pre-test and 2-min post-stretch were lower than at 45-s and 90-s during the stretch. SLR induced smaller increases in DBP and MAP than PNF and SR, whereas PNF elicited lower HR responses than SR. In conclusion, trained senior adult athletes experienced small to moderate magnitude increases of hemodynamic responses with SLR, SR and PNF stretching, which recovered to baseline values within 2-min after stretching. Furthermore, the passive SLR induced smaller increases in BP than PNF and SR, while PNF elicited lower HR responses than SR. These increases in hemodynamic responses (HR and BP) were not of a magnitude to be clinically significant, provide an aerobic exercise stimulus or warrant concerns for most senior athletes.

Postexercise hypotension due to resistance exercise is not mediated by autonomic control: A systematic review and meta-analysis

Changes in autonomic control have been suggested to mediate postexercise hypotension (PEH). We investigated through meta-analysis the after-effects of acute resistance exercise (RE) on blood pressure (BP) and autonomic activity in individuals with normal and elevated BP. Electronic databases were searched for trials including: adults; exclusive RE interventions; and BP and autonomic outcomes measured pre- and postintervention for at least 30 min. Analyses incorporated random-effects assumptions. Thirty trials yielded 62 interventions (N = 480). Subjects were young (33.6 ± 15.6 yr), with systolic BP (SBP)/diastolic BP (DBP) of 124.2 ± 8.9/71.5 ± 6.6 mm Hg. Overall, RE moderately reduced SBP (normal BP: ~1 to 4 mm Hg, p < 0.01; elevated BP: ~1 to 12 mm Hg, p < 0.01) and DBP (normal BP: ~1 to 4 mm Hg, p < 0.03; elevated BP: ~0.5 to 7 mm Hg, p < 0.01), which was in general parallel to sympathetic increase (normal BP: g = 0.49 to 0.51, p < 0.01; elevated BP: g = 0.41 to 0.63, p < 0.01) and parasympathetic decrease (normal BP: g = -0.52 to -0.53, p < 0.01; elevated BP: g = -0.46 to -0.71, p < 0.01). The meta-regression showed inverse associations between the effect sizes of BP vs. sympathetic (SBP: slope - 0.19 to -3.45, p < 0.01; DBP: slope - 0.30 to -1.60, p < 0.01), and direct associations vs. parasympathetic outcomes (SBP: slope 0.17 to 2.59, p < 0.01; DBP: slope 0.21 to 1.38, p < 0.01). In conclusion, changes in BP were concomitant to sympathetic increase and parasympathetic decrease, which questions the role of autonomic fluctuations as potential mechanisms of PEH after RE.

Beliefs, perceptions and practices of chiropractors and patients about mitigation strategies for benign adverse events after spinal manipulation therapy

BACKGROUND

Approximately 50% of patients who receive spinal manipulative therapy (SMT) experience some kind of adverse event (AE), typically benign and transient in nature. Regardless of their severity, mitigating benign AEs is important to improve patient experience and quality of care. The aim of this study was to identify beliefs, perceptions and practices of chiropractors and patients regarding benign AEs post-SMT and potential strategies to mitigate them.

METHODS

Clinicians and patients from two chiropractic teaching clinics were invited to respond to an 11-question survey exploring their beliefs, perceptions and practices regarding benign AEs post-SMT and strategies to mitigate them. Responses were analyzed using descriptive statistics.

RESULTS

A total of 39 clinicians (67% response rate) and 203 patients (82.9% response rate) completed the survey. Most clinicians (97%) believed benign AEs occur, and 82% reported their own patients have experienced one. For patients, 55% reported experiencing benign AEs post-SMT, with the most common symptoms being pain/soreness, headache and stiffness. While most clinicians (61.5%) reported trying a mitigation strategy with their patients, only 21.2% of patients perceived their clinicians had tried any mitigation strategy. Clinicians perceived that patient education is most likely to mitigate benign AEs, followed by soft tissue therapy and/or icing after SMT. Patients perceived stretching was most likely to mitigate benign AEs, followed by education and/or massage.

CONCLUSIONS

This is the first study comparing beliefs, perceptions and practices from clinicians and patients regarding benign AEs post-SMT and strategies to mitigate them. This study provides an important step towards identifying the best strategies to improve patient safety and improve quality of care.

Genome-Protecting Compounds as Potential Geroprotectors

Throughout life, organisms are exposed to various exogenous and endogenous factors that cause DNA damages and somatic mutations provoking genomic instability. At a young age, compensatory mechanisms of genome protection are activated to prevent phenotypic and functional changes. However, the increasing stress and age-related deterioration in the functioning of these mechanisms result in damage accumulation, overcoming the functional threshold. This leads to aging and the development of age-related diseases. There are several ways to counteract these changes: 1) prevention of DNA damage through stimulation of antioxidant and detoxification systems, as well as transition metal chelation; 2) regulation of DNA methylation, chromatin structure, non-coding RNA activity and prevention of nuclear architecture alterations; 3) improving DNA damage response and repair; 4) selective removal of damaged non-functional and senescent cells. In the article, we have reviewed data about the effects of various trace elements, vitamins, polyphenols, terpenes, and other phytochemicals, as well as a number of synthetic pharmacological substances in these ways. Most of the compounds demonstrate the geroprotective potential and increase the lifespan in model organisms. However, their genome-protecting effects are non-selective and often are conditioned by hormesis. Consequently, the development of selective drugs targeting genome protection is an advanced direction.

Does the combination of resistance training and stretching increase cardiac overload?

OBJECTIVES

To compare the effects of combinations of resistance training (RT) and static stretching (SS) on heart rate (HR), systolic pressure (SBP), diastolic pressure (DBP), rate pressure product (RPP), oxygen saturation (SpO2), rating of perceived effort (RPE), and heart rate variability (HRV) in men.

METHODS

Twelve normotensive healthy men participated in four protocols: a) SS+RT, b) RT+SS, c) RT, and d) SS. Variables were measured before, immediately after, and 15, 30, and 45 min after the sessions.

RESULTS

The combination of SS and RT increased (p<0.001) HR when compared to the effects of the noncombined protocols (from 2.38 to 11.02%), and this result indicated metabolic compensation. Regarding DBP, there were differences (p<0.001) between the RT and SS groups (53.93±8.59 vs. 67.00±7.01 mmHg). SS has been shown to be able to reduce (p<0.001) SpO2 (4.67%) due to the occlusion caused by a reduction in the caliber of the blood vessels during SS compared to during rest. The increase in RPP (6.88% between RT and SS+RT) along with the HR results indicated higher metabolic stress than that reflected by the RPE (combined protocols increased RPE from 21.63 to 43.25%). The HRV analysis confirmed these results, showing increases (p<0.01) in the LF index between the combined and noncombined protocols. Compared to the effect of RT, the combination of SS and RT promoted a vagal suppression root mean square of the successive differences (RMSSD) index (from 9.51 to 21.52%) between the RT and SS+RT groups (p<0.01) and between the RT and RT+SS groups (p<0.001).

CONCLUSION

Static stretching increases cardiac overload and RPE, reducing oxygen supply, especially when performed in combination with RT.