Influence of population and exercise protocol characteristics on hemodynamic determinants of post-aerobic exercise hypotension

Acute effects of bolus water intake on post-exercise orthostatic hypotension and cardiovascular hemodynamics

INTRODUCTION

Water intake is known to be effective in preventing orthostatic hypotension (OH). However, it is unknown whether water intake would be effective in acutely preventing exercise-induced OH.

METHODS

Fourteen adults (men/women: 7/7, age: 20 ± 8 years) were recruited. Each subject underwent two protocols with and without 500 ml water intake using a randomized crossover design (Water vs. Control). Participants underwent 30 min of cycle ergometry at the 60-70% predicted VO2 max. OH and hemodynamics were assessed before and after exercise, and immediately (Water 1) and 20 min (Water 2) after the water intake. OH was evaluated with a 1-min standing test as the criteria for systolic blood pressure (SBP) < 90 mmHg. A cross-spectral analysis for RR and SBP variability was used to evaluate the cardiac autonomic activity and baroreflex sensitivity.

RESULTS

In both protocols, the incidence of OH increased after the exercise. The incidence of OH was lower in Water than in Control at Water 1 (OR: 0.093, 95% CI: 0.015-0.591). Heart rate was lower and SBP was higher in Water than in Control at Water 1 and 2 (P < 0.05). High-frequency power of RR variability and transfer function gains in Water were normalized and higher than in Control at Water 1 and 2 (P < 0.05). The ratio of low- to high-frequency power of RR variability in Water was normalized and lower in Water than in Control at Water 1 (P < 0.05).

CONCLUSION

Our findings indicate that water intake may prevent acute exercise-induced OH, accompanied by normalized cardiac autonomic activity and baroreflex sensitivity.

Post-Exercise Hypotension after Exercising in Hypoxia with and Without Tart Cherry Supplementation

Horiuchi, Masahiro, and Samuel J. Oliver. Post-exercise hypotension after exercising in hypoxia with and without tart cherry supplementation. High Alt Med Biol. 26:63-69, 2025. Background: This study investigated the effects of hypoxic exercise with and without tart cherry (TC) supplementation on post-exercise hypotension (PEH). Method: In a randomized order, 12 healthy young adults (9 men and 3 women) completed cycle exercise to exhaustion (1) in normoxia without any supplementation (Norm), (2) in hypoxia (13% O2) with placebo (Hypo), and (3) in hypoxia with TC supplementation (Hypo + TC). Supplements were supplied for 5 days pre-trial (TC was 200 mg anthocyanin per day for 4 days and 100 mg on day 5). Results: Cycle exercise total energy expenditure was greater in Norm than Hypo and Hypo + TC (p < 0.001) with no difference between Hypo and Hypo + TC (p = 0.41). Mean arterial pressure (MAP) decreased during recovery in all trials (main effect of time, p < 0.001), with no difference in PEH between the trials (p > 0.05, change [Δ] in MAP from pre-exercise at 60 minutes recovery, mean difference, Norm Δ-4.4 mmHg, Hypo Δ-6.1 mmHg, and Hypo + TC Δ-5.2 mmHg). Cardiac baroreflex sensitivity decreased during recovery in all trials (p < 0.001) and was lower in Hypo than Norm and Hypo + TC (main effect of trial, p = 0.02). Conclusion: PEH was not increased after exercise in hypoxia, with or without TC supplementation, compared with exercise in normoxia.

Interactive effects of exercise intensity and recovery posture on postexercise hypotension

Postexercise reduction in blood pressure, termed postexercise hypotension (PEH), is relevant for both acute and chronic health reasons and potentially for peripheral cardiovascular adaptations. We investigated the interactive effects of exercise intensity and recovery postures (seated, supine, and standing) on PEH. Thirteen normotensive men underwent a V̇o2max test on a cycle ergometer and five exhaustive constant load trials to determine critical power (CP) and the gas exchange threshold (GET). Subsequently, work-matched exercise trials were performed at two discrete exercise intensities (10% > CP and 10% < GET), with 1 h of recovery in each of the three postures. For both exercise intensities, standing posture resulted in a more substantial PEH (all P < 0.01). For both standing and seated recovery postures, the higher exercise intensity led to larger reductions in systolic [standing: -33 (11) vs. -21 (8) mmHg; seated: -34 (32) vs. -17 (37) mmHg, P < 0.01], diastolic [standing: -18 (7) vs. -8 (5) mmHg; seated: -10 (10) vs. -1 (4) mmHg, P < 0.01], and mean arterial pressures [-13 (8) vs. -2 (4) mmHg, P < 0.01], whereas in the supine recovery posture, the reduction in diastolic [-9 (9) vs. -4 (3) mmHg, P = 0.08) and mean arterial pressures [-7 (5) vs. -3 (4) mmHg, P = 0.06] was not consistently affected by prior exercise intensity. PEH is more pronounced during recovery from exercise performed above CP versus below GET. However, the effect of exercise intensity on PEH is largely abolished when recovery is performed in the supine posture.NEW & NOTEWORTHY The magnitude of postexercise hypotension is greater following the intensity above the critical power in a standing position.

Central and peripheral mechanisms underlying postexercise hypotension: a scoping review

Blood pressure (BP) reduction occurs after a single bout of exercise, referred to as postexercise hypotension (PEH). The clinical importance of PEH has been advocated owing to its potential contribution to chronic BP lowering, and as a predictor of responders to exercise training as an antihypertensive therapy. However, the mechanisms underlying PEH have not been well defined. This study undertook a scoping review of research on PEH mechanisms, as disclosed in literature reviews. We searched the PubMed, Web of Science, Scopus, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Sport Discus databases until January 2023 to locate 21 reviews - 13 narrative, four systematic with 102 primary trials, and four meta-analyses with 75 primary trials involving 1566 participants. We classified PEH mechanisms according to major physiological systems, as central (autonomic nervous system, baroreflex, cardiac) or peripheral (vascular, hemodynamic, humoral, and renal). In general, PEH has been related to changes in autonomic control leading to reduced cardiac output and/or sustained vasodilation. However, the role of autonomic control in eliciting PEH has been challenged in favor of local vasodilator factors. The contribution of secondary physiological outcomes to changes in cardiac output and/or vascular resistance during PEH remains unclear, especially by exercise modality and population (normal vs. elevated BP, young vs. older adults). Further research adopting integrated approaches to investigate the potential mechanisms of PEH is warranted, particularly when the magnitude and duration of BP reductions are clinically relevant. (PROSPERO CRD42021256569).

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

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

Effects of dietary inorganic nitrate on blood pressure during and post-exercise recovery: A systematic review and meta-analysis of randomized placebo-controlled trials

OBJECTIVES

A systematic review with meta-analysis was completed to study the effects of dietary inorganic nitrate (NO3-) oral ingestion from vegetables and salts on blood pressure responses during and following exercise.

BACKGROUND

NO3- is a hypotensive agent with the potential to reduce blood pressure peaks during exercise and amplify exercise-induced hypotensive effects. Several randomized and controlled trials have investigated the effects of NO3- on hemodynamic responses to physical exercise, however this still has yet to be studied systematically.

METHODS

The searches were conducted on EMBASE, Medline, and SPORTSDiscus databases. The study included masked randomized controlled trials (RCTs) with participants ≥18 years old. The NO3-intervention group received at least 50 mg NO3-/day with similar sources amid NO3- and placebo conditions. Included studies reported systolic blood pressure (SBP) or diastolic blood pressure (DBP) values during or following exercise performance.

RESULTS

1903 studies were identified, and twenty-six achieved the inclusion criteria. NO3- daily dosages ranged from 90 to 800 mg/day. Throughout exercise, SBP had smaller increases in the NO3- group (-2.81 mmHg (95%CI: -5.20 to -0.41), p=0.02. DBP demonstrated lower values in the NO3- group (-2.41 mmHg (95%CI: -4.02 to -0.79), p=0.003. In the post-exercise group, the NO3- group presented lower SBP values (-3.53 mmHg (95%CI: -5.65 to 1.41), p=0.001, while no changes were identified in DBP values between NO3- and placebo groups (p=0.31). Subgroup meta-analysis revealed that SBP baseline values, exercise type, duration of NO3- ingestion, and its dosages mediated blood pressure responses during and following exercise.

CONCLUSIONS

NO3- ingestion prior to exercise attenuated the increases in SBP and DBP during exercise, and increased the decline in SBP after exercise. These results are dependent on factors that moderate the blood pressure responses (e.g., health status, type of exercise, resting blood pressure values).

Reliability and Time Course of Postexercise Hypotension during Exercise Training among Adults with Hypertension

Postexercise hypotension (PEH), or the immediate decrease in blood pressure (BP) lasting for 24 h following an exercise bout, is well-established; however, the influence of exercise training on PEH dynamics is unknown. This study investigated the reliability and time course of change of PEH during exercise training among adults with hypertension. PEH responders (n = 10) underwent 12 weeks of aerobic exercise training, 40 min/session at moderate-to-vigorous intensity for 3 d/weeks. Self-measured BP was used to calculate PEH before and for 10 min after each session. The intraclass correlation coefficient (ICC) and Akaike Information Criterion (AIC) determined PEH reliability and goodness-of-fit for each week, respectively. Participants were obese (30.6 ± 4.3 kg∙m-2), middle-aged (57.2 ± 10.5 years), and mostly men (60%) with stage I hypertension (136.5 ± 12.1/83.4 ± 6.7 mmHg). Exercise training adherence was 90.6 ± 11.8% with 32.6 ± 4.2 sessions completed. PEH occurred in 89.7 ± 8.3% of these sessions with BP reductions of 9.3 ± 13.1/3.2 ± 6.8 mmHg. PEH reliability was moderate (ICC ~0.6). AIC analysis revealed a stabilization of maximal systolic and diastolic BP reductions at 3 weeks and 10 weeks, respectively. PEH persisted throughout exercise training at clinically meaningful levels, suggesting that the antihypertensive effects of exercise training may be largely due to PEH. Further studies in larger samples and under ambulatory conditions are needed to confirm these novel findings.

Can postexercise hypotension also be observed in African and Asian populations: a systematic review and meta-analysis of randomized controlled trials

Worldwide, raised blood pressure (BP) or hypertension is the global leading risk factor for the development of cardiovascular diseases and all-cause mortality, with the highest prevalence found in Asian and African origin populations. Post-exercise hypotension (PEH), defined as a sustained reduction in BP after a single bout of exercise is an important physiological phenomenon in BP management. However, little is known about the hypotensive effect of a single bout of exercise in non-Caucasian populations. We systematically summarized the acute effects of a single bout of aerobic exercise on BP in a population of African or Asian origin. We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations with optimal BP, high normal BP or hypertension published in a peer reviewed journal up to August 2021. A subsequent meta-analysis was performed using random-effect models fitted to estimate effect sizes. We identified 10 aerobic exercise trials performed in individuals of Asian origin (n = 136; mean age: 29.51 (21.2-69) years: 78% male; baseline systolic BP/diastolic BP: 118.9 ± 9.64/68.9 ± 2.69 mmHg) and 11 aerobic exercise trials involving individuals of African origin (n = 157; mean age: 41.05 (29.9-49) years; 59% male; baseline systolic BP/diastolic BP: 134.5 ± 8.65 mmHg/82.2 ± 3.24 mmHg). Non-significant reductions in office systolic BP and diastolic BP at 30 min post exercise (-2.25 [-6.38, 1.88] mmHg, p = 0.28/-1.02 [-2.51, 0.47] mmHg, p = 0.18) and 60 min post exercise (-2.80 [-7.90, 2.28], p = 0.27/-1.95, [-5.66, 1.75], p = 0.3) were observed compared to the control intervention. No statistically significant differences were found between both ethnic groups (p > 0.05). Ambulatory BP was reported only in a few African groups. No effect was found on 24h-systolic BP post exercise, but 24h-diastolic BP was statistically significantly reduced (-1.89 [-3.47, -0.31] mmHg, p < 0.01) after a bout of aerobic exercise compared to the control intervention. The available evidence is insufficient to recommend a single session of aerobic exercise as an efficient tool to lower BP in African and Asian populations. Though, the paucity of data in non-Caucasian populations underscores the need for additional efforts to establish the efficacy of single bouts of exercise, including isometric and dynamic resistance exercise, as a potential non-pharmacological adjunct to help lowering BP in the daily life of descendants of Asian or African origin.

Greater post-exercise hypotension in healthy young untrained men after exercising in a hot compared to a temperate environment

This research examined the effects of exercising in a hot compared to a temperate environment on post-exercise hemodynamics in untrained men. We hypothesized exercise in a hot compared to a temperate environment would elicit greater post-exercise hypotension, and this would be attributable to higher cutaneous vascular conductance and sweat loss, and lower heart rate variability (HRV) and cardiac baroreflex sensitivity (cBRS). In a randomized counterbalanced order, 12 untrained healthy men completed two trials involving 40-min leg-cycling exercise at either 23 °C (CON) or 35 °C (HOT). Post-exercise participants rested supine for 60 min at 23 °C whilst hemodynamic and thermoregulatory measurements were assessed. Post-exercise hypotension was greater after exercising in a hot than a temperate environment as indicated by a lower mean arterial pressure at 60 min recovery (CON 83 ± 5 mmHg, HOT 78 ± 5 mmHg, Mean difference [95% confidence interval], -5 [-8, -3] mmHg). Throughout recovery, cutaneous vascular conductance was higher, and cBRS and HRV were lower after exercising in a hot than in a temperate environment (P < 0.05). Sweat loss was greater on HOT than on CON (P < 0.001). Post-exercise hypotension after exercising in the hot environment was associated with sweat loss (r = 0.66, P = 0.02), and changes in cutaneous vascular conductance (r = 0.64, P = 0.03), and HRV (Root mean square of the successive difference in R-R interval [RMSSD]) r=0.75, P = 0.01 and and log high frequency [HF] r=0.66, P = 0.02), but not cBRS (all, r ≤ 0.2, P > 0.05). Post-exercise hypotension was greater after exercise in a hot compared to a temperate environment and may be partially explained by greater sweat loss and cutaneous vascular conductance, and lower HRV.

Comparing Post-Exercise Hypotension after Different Sprint Interval Training Protocols in a Matched Sample of Younger and Older Adults

This study assessed the post-exercise hypotension (PEH) effect in a sample of matched young and older adults after different sprint interval training (SIT) protocols. From forty-three participants enrolled in this study, twelve younger (24 ± 3 years) and 12 older (50 ± 7 years) participants, matched for the body mass index, systolic blood pressure, and VO₂max-percentiles, were selected. The participants completed two SIT protocols consisting of 4 × 30 s exercise bouts interspersed by either one (SIT1) or three minutes (SIT3) of active rest. The peripheral systolic (pSBP) and diastolic (pDBP) blood pressure, central systolic (cSBP) and diastolic (cDBP) blood pressure, pulse wave velocity (PWV), and heart rate (HR) were obtained before and at different measurement time points (t5, t15, t30, t45) after the exercise. No significant time × group interactions were detected in pSBP (p = 0.242, η² = 0.060), pDBP (p = 0.379, η² = 0.046), cSBP (p = 0.091, η² = 0.861), cDBP (p = 0.625, η² = 0.033), PWV (p = 0.133, η² = 0.076), and HR (p = 0.190, η² = 0.123) after SIT1. For SIT3 no significant time × group interactions could be detected for pSBP (p = 0.773, η² = 0.020), pDBP (p = 0.972, η² = 0.006), cSBP (p = 0.239, η² = 0.060), cDBP (p = 0.535, η² = 0.036), PWV (p = 0.402, η² = 0.044), and HR (p = 0.933, η² = 0.009). Matched samples of young and older adults reveal similar PEH effects after HIIT. Accordingly, age does not seem to affect PEH after SIT. These results show that rest interval length and age modulate the PEH effect after SIT.

Similar Postexercise Hypotension After MICT, HIIT, and SIT Exercises in Middle-Age Adults

INTRODUCTION

Acute bouts of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) transiently lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the hours after termed postexercise hypotension (PEH); however, the effects of sprint interval training (SIT) exercise have yet to be explored in middle-age adults. Although previous work has found no effect of exercise intensity on PEH, no study has compared submaximal, near maximal, and supramaximal intensities, specifically in middle-age adults where blood pressure (BP) management strategies may be of greater importance.

PURPOSE

This study examined the effects of MICT, HIIT, and SIT exercises on PEH in the immediate (≤2 h) and 24 h after exercise specifically in middle-age adults.

METHODS

Fourteen participants (10 female; age, 46 ± 9 yr; SBP, 116 ± 11 mm Hg; DBP, 67 ± 6 mm Hg; one hypertensive, four prehypertensive, nine normotensive) had their BP measured before, immediately (15, 30, 60, 120 min), and over 24 h after four experimental sessions: 1) 30-min MICT exercise (65% maximal oxygen consumption), 2) 20-min HIIT exercise (10 × 1 min at 90% maximum heart rate with 1-min rest), 3) 16-min SIT exercise (8 × 15 s all-out sprints with 2-min rest), and 4) no-exercise control. Postexercise BP was compared with no-exercise control.

RESULTS

PEH was similar for all exercise sessions for SBP ( P = 0.388, = 0.075) and DBP ( P = 0.206, = 0.108). Twenty-four-hour average SBP was similar for all sessions P = 0.453, = 0.069), and DBP was similar over 24 h except after MICT exercise compared with HIIT exercise ( P = 0.018, d = 1.04).

CONCLUSIONS

In middle-age adults, MICT, HIIT, and SIT exercises are effective at reducing SBP; however, the effects on DBP are smaller, and neither reductions are sustained over 24 h.

Minimal Dose of Resistance Exercise Required to Induce Immediate Hypotension Effect in Older Adults with Hypertension: Randomized Cross-Over Controlled Trial

To determine the optimal exercise volume to generate a hypotension response after the execution of a single strength exercise in elderly subjects with hypertension (HT), a randomized crossover design was performed. A total of 19 elderly subjects with HT performed one control session and three experimental sessions of resistance training with different volumes in a randomized order: three, six, and nine sets of 20 repetitions maximum (RM) of a single elbow flexion exercise with elastic bands. The systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean heart rate (MHR) were tested at the beginning and immediately afterwards, at 30 and 60 min, and at 4, 5, and 6 h after the resistance exercise. The results show that the volumes of six and nine sets of 20 RM obtained statistically significant differences in the SBP at 30 and 60 min post-exercise (p < 0.05); in the DBP at 30 min after exercise (p < 0.05); and in the MHR immediately after exercise at 30 and 60 min (p < 0.05), compared to a control session. A single resistance exercise with a minimum volume of six sets of 20 RM generated an acute post-exercise antihypertensive response that was maintained for 60 min in elderly people with controlled HT.

Effects of exercise modalities on decreased blood pressure in patients with hypertension

This study aimed to evaluate the acute effects of aerobic and resistance exercises on blood pressure and endothelial blood markers. We also correlated post-exercise blood pressure response with baseline cardiovascular parameters in middle-aged patients with hypertension. This cross-sectional study randomized 54 volunteers into the aerobic exercise group (AG, n = 27; 45.6 ± 7.7 years) or dynamic resistance exercise group (RG, n = 27; 45.8 ± 8.4 years). Blood marker evaluation, cardiopulmonary exercise tests, resting blood pressure monitoring, ambulatory blood pressure monitoring (ABPM), flow-mediated dilatation monitoring, and body composition evaluation were carried out. Exercise sessions were performed to evaluate post-exercise hypotension (PEH) and endothelial marker responses, in addition to post-exercise ABPM (ABPMex). This study is an arm of the study which was approved by the local ethics committee (No. 69373217.3.0000.5347) in accordance with the Helsinki Declaration and was registered at ClinicalTrials.gov (NCT03282942). The AG performed walking/running at 60% of the reserve heart rate, while the RG performed 10 exercises with two sets of 15-20 repetitions. The mean 24 h ABPM and ABPMex values showed no significant statistical differences. Systolic and diastolic blood pressure hypotension after aerobic and dynamic resistance were -10.59 ± 5.24/-6.15 ± 6.41 mmHg and -5.56 ± 7.61/-6.20 ± 8.25 mmHg, respectively. For an up-to-7 h assessment of resting pressure, there was a positive effect in the aerobic group. The concentrations of nitrites/nitrates (NOx) and endothelin-1 (ET-1) did not change during hypotension. Moreover, PEH and ABPMex were significantly correlated with baseline health variables. Thus, when middle-aged patients with hypertension perform aerobic or resistance exercise, the NOx/ET-1 pathway does not provide the best explanation for PEH. Finally, we found associations between baseline cardiovascular variables and endothelial vasoconstrictors with PEH.

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

Cardiovascular Autonomic Responses to Aerobic, Resistance and Combined Exercises in Resistance Hypertensive Patients

Here, we report the acute effects of aerobic (AER), resistance (RES), and combined (COM) exercises on blood pressure, central blood pressure and augmentation index, hemodynamic parameters, and autonomic modulation of resistant (RH) and nonresistant hypertensive (NON-RH) subjects. Twenty participants (10 RH and 10 NON-RH) performed three exercise sessions (i.e., AER, RES, and COM) and a control session. Hemodynamic (Finometer®, Beatscope), office blood pressure (BP), and autonomic variables (accessed through spectral analysis of the pulse-to-pulse BP signal, in the time and frequency domain-Fast Fourrier Transform) were assessed before (T0), one-hour (T1), and twenty-four (T2) hours after each experimental session. There were no changes in office BP, pulse wave behavior, and hemodynamic parameters after (T0 and T1) exercise sessions. However, AER and COM exercises significantly reduced sympathetic modulation in RH patients. It is worth mentioning that more significant changes in sympathetic modulation were observed after AER as compared to COM exercise. These findings suggest that office blood pressure, arterial stiffness, and hemodynamic parameters returned to baseline levels in the first hour and remained stable in the 24 hours after the all-exercise sessions. Notably, our findings bring new light to the effects of exercise on RH, indicating that RH patients show different autonomic responses to exercise compared to NON-RH patients. This trial is registered with trial registration number NCT02987452.

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.

Serum and Urinary Neutrophil Gelatinase-Associated Lipocalin Are Not Associated With Serum Redox Parameters in Amateur Athletes After an Ultramarathon

Objective

To evaluate the relationship between oxidative stress and NGAL levels in blood and urine of amateur athletes after participating in a 100 km ultramarathon.

Methodology

The sample was composed of seven athletes, submitted to anthropometric assessment, cardiopulmonary exercise test, collection of urine and blood, measurement of body weight. The rate of perceived exertion (RPE), competition duration, heart rate (HR), energy expenditure and oxygen consumption (V'O2") were also measured during the event. The energy consumption during the race was verified at its end. The analyses were based on the means (M) and respective standard deviations (SD), with statistical significance set at 5% (p < 0.05). Paired t-test was used for comparison between the periods before and after the competition, and Pearson's correlation coefficient was used to measure the linear correlation between quantitative variables.

Results

Body mass index (BMI) of the sample was 25.75 kg/m2 ± 3.20, body fat percentage 18.54% ± 4.35% and V'O2"max 48.87% ± 4.78. Glucose, cortisol, and neutrophil gelatinase-associated lipocalin (NGAL) (p < 0.01) as well as glutathione peroxidase (GPx) active were higher after the race when compared to basal values. Moreover, lactate, creatinine, microalbuminuria, and glomerular filtration rate (GFR) (p < 0.001) were also higher after the race. After the competition, there was a significant correlation only between serum NGAL and creatinine, which was classified as strong and positive (r: 0.77; p < 0.05). There was a significant reduction (p < 0.05) of body weight after the event (72.40 kg ± 9.78) compared to before it (73.98 kg ± 10.25). In addition, we found an increase of RPE (p < 0.001) after the race. The competition lasted 820.60 min (±117.00), with a 127.85 bpm (±12.02) HR, a 2209.72 kcal ± 951.97 energy consumption, 7837.16 kcal ± 195.71 energy expenditure, and 28.78 ml/kg/min-1 (±4.66) relative V'O2"max.

Conclusion

The lack of correlation between oxidative stress biomarkers and serum and urine NGAL suggests that NGAL is more sensitive to inflammatory processes than to ROS levels.

Skeletal Muscle Hyperemia: A Potential Bridge Between Post-exercise Hypotension and Glucose Regulation

For both healthy individuals and patients with type 2 diabetes (T2D), the hemodynamic response to regular physical activity is important for regulating blood glucose, protecting vascular function, and reducing the risk of cardiovascular disease. In addition to these benefits of regular physical activity, evidence suggests even a single bout of dynamic exercise promotes increased insulin-mediated glucose uptake and insulin sensitivity during the acute recovery period. Importantly, post-exercise hypotension (PEH), which is defined as a sustained reduction in arterial pressure following a single bout of exercise, appears to be blunted in those with T2D compared to their non-diabetic counterparts. In this short review, we describe research that suggests the sustained post-exercise vasodilation often observed in PEH may sub-serve glycemic regulation following exercise in both healthy individuals and those with T2D. Furthermore, we discuss the interplay of enhanced perfusion, both macrovascular and microvascular, and glucose flux following exercise. Finally, we propose future research directions to enhance our understanding of the relationship between post-exercise hemodynamics and glucose regulation in healthy individuals and in those with T2D.

Postexercise hypotension in men with parental history of hypertension: effects of mode and intensity

BACKGROUND

A family history of arterial hypertension is a significant risk factor for the development of hypertension in youngsters. Thus, primary prevention has been emphasized in those subjects with a genetic predisposition.

METHODS

This randomized clustered trial aimed to compare the effects of four modalities of aerobic training in postexercise hypotension. The primary outcomes were systolic blood pressure (SBP) and diastolic blood pressure (DBP). Secondly, peak oxygen uptake, heart rate, and subjective perceived exertion were analyzed. Nine normotensive men were randomized in four isocaloric sessions (200 kcal): high-intensity continuous training (HICT), moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), and moderate-intensity interval training (MIIT).

RESULTS

The area under the curve (AUC) showed a difference between sessions for SBP (F(3;8)=3.2; P=0.04), with MICT promoting a higher reduction than MIIT (P<0.05). In DBP there was also a difference (F(3;8)=15.3; P<0.001), with HICT reducing more than HIIT (P<0.05) and MIIT (P<0.05). Moderate-intensity protocols provided clinically relevant changes (CRC) in 11.1% of the individuals, and high-intensity protocols presented CRC in 50% of them (χ²=6.41; P=0.011) for SBP. For DBP, there was CRC in 27.8% of continuous conditions and none in the intervals (χ²=5.81; P=0.016).

CONCLUSIONS

All training sessions promoted postexercise hypotension for DBP, and HICT provided higher reductions in the AUC. CRC for SBP were observed according to the intensity, while CRC for DBP were associated with modality.

Central Hemodynamic Adjustments during Post-Exercise Hypotension in Hypertensive Patients with Ischemic Heart Disease: Concurrent Circuit Exercise versus High-Intensity Interval Exercise. A Preliminary Study

Concurrent aerobic plus resistance exercise (RAE) and high-intensity interval exercise (HIIE) are both effective at inducing post-exercise hypotension (PEH) in patients with hypertension. However, central hemodynamic changes associated with PEH in hypertensive subjects with underlying ischemic heart disease (IHD) have been poorly investigated. The study aim was to compare the acute effects produced by these two exercise modalities on left ventricular diastolic function and left atrial function. Twenty untrained male patients with a history of hypertension and IHD under stable pharmacological therapy were enrolled. Each patient underwent three exercise sessions: RAE, HIIE and a control session without exercise, each lasting 45 min. An echocardiography examination was performed before and between 30 min and 40 min from the end of the exercise sessions. Following the exercise sessions, BP values decreased in a similar way in RAE and HIIE and were unchanged after the control session. Compared to pre-session, the ratio between early filling velocity (E) and mitral annulus early diastolic velocity (E’). E/E’ increased after HIIE and remained unchanged after both RAE and control sessions (between-sessions p 0.002). Peak atrial longitudinal strain (PALS) increased slightly after RAE (+1.4 ± 1.1%), decreased after HIIE (−4.6 ± 2.4%) and was unchanged after the control session (between-sessions p 0.03). Peak atrial contraction strain (PACS) was mildly increased after RAE, was reduced after HIIE and was unchanged after the control session. Atrial volume was unchanged after both exercise sessions. Left ventricular and left atrial stiffness increased significantly after HIIE, but remained unchanged after the RAE and control sessions. Stroke volume and cardiac output increased after RAE, decreased after HIIE, and were unchanged after the control session. In conclusion, single session of RAE and HIIE brought about similar PEH in hypertensive subjects with IHD, while they evoked different central hemodynamic adjustments. Given its neutral effects on diastolic and atrial functions, RAE seems more suitable for reducing blood pressure in hypertensive patients with IHD.

Consistency of hemodynamic and autonomic mechanisms underlying post-exercise hypotension

Post-exercise hypotension (PEH) is a clinically relevant phenomenon, but its mechanisms vary between different studies and between the participants within each study. Additionally, it is possible that PEH mechanisms are not consistent in each individual (i.e. within-individual variation), which has not been investigated yet. Thus, the aim of the current study was to assess the within-individual consistency of PEH hemodynamic and autonomic mechanisms. For that, 30 subjects performed 4 sessions divided in 2 blocks (test and retest). In each block, an exercise (cycling, 45 min, 50%VO₂peak) and a control (seated rest, 45 min) session was randomly conducted. Blood pressure (BP) and its mechanisms were evaluated pre- and post-interventions. In each block, individual responses were calculated as post-exercise minus post-control, and a response was considered present when its magnitude reached the typical error of the measurement. Consistencies were evaluated by comparing test and retest responses through kappa coefficient (k). PEH consistency was calculated using role sample, while mechanisms consistency was evaluated in those with consistent PEH. Twenty-one (70%) participants showed consistent PEH, 5 (17%) presented PEH in only test or retest and 4 (13%) had absent PEH response, characterising a good consistency (k = 0.510). Regarding mechanisms' responses, good consistency was found for heart rate (k = 0.456), sympathovagal balance (k = 0.438), and baroreflex sensitivity (k = 0.458); while systemic vascular resistance (k = 0.152), cardiac output (k = -0.400), stroke volume (k = -0.055), and sympathetic vasomotor modulation (k = -0.096) presented marginal consistencies. Thus, PEH is a highly consistent physiological phenomenon, although its mechanisms present variable consistencies.

Sex Differences in Post-exercise Hypotension, Ambulatory Blood Pressure Variability, and Endothelial Function After a Power Training Session in Older Adults

Background: The efficacy of power training (PT) to acutely reduce blood pressure (BP) in participants with hypertension is controversial, and no studies have assessed the influence of sex on post-exercise hypotension and its mechanisms in older adults.

Purpose: The aims of this secondary, exploratory analysis were to compare the effects of a single bout of PT on post-exercise hypotension, BP variability, and endothelial function between older men and women with hypertension.

Methods: Twenty-four participants with hypertension (12 men and 12 women aged to >60 years old) took part in this crossover study and randomly performed two experimental sessions: power exercise training (PT) and non-exercising control session (Con). The PT protocol was composed of 3 sets of 8–10 repetitions of five exercises performed in the following order: leg press, bench press, knee extension, upright row, and knee flexion, using an intensity corresponding to 50% of one repetition maximal test (1RM) and 2-min intervals between sets and exercises. The concentric phase of exercises during each repetition was performed “as fast as possible,” while the eccentric phase lasted 1 to 2 s. During Con, the participants remained at seated rest on the same exercise machines, but without any exercise. Each protocol lasted 40 min. Office BP, flow-mediated dilatation (FMD), 24-h ambulatory BP, and the average real variability (ARV) of systolic and diastolic BP were assessed before and after experimental sessions.

Results: Comparing PT with Con, a reduced office BP after exercise was found in men (systolic BP—average post 1 h: −14 mmHg, p < 0.001; diastolic BP—average post 1 h: −8 mmHg, p < 0.001) and only a reduced systolic BP in women (average post 1 h: −7 mmHg, p = 0.04). Comparing men and women, a reduced systolic BP (post 60': −15 mmHg, p = 0.048; average post 1 h: −7 mmHg, p = 0.046) and diastolic BP (post 60': −9 mmHg, p = 0.049) after the first hour were found in men. In relation to 24-h ambulatory BP, ARV, and FMD, no statistically significant differences were found between men and women.

Conclusion: In older adults with hypertension, the office BP response after the experimental sessions was different in men and women, showing that the PT protocol is more effective to acutely reduce BP in men. Additionally, the mechanisms behind this reduction remain unclear. This finding suggests that sex cannot be combined to analyze post-exercise hypotension.

Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT03615625.

The Effects of Acute Aerobic Exercise on Blood Pressure, Arterial Function, and Heart Rate Variability in Men Living With HIV

PURPOSE

This study aims to investigate the effects of acute cycling on blood pressure (BP), arterial function, and heart rate variability (HRV) in men living with HIV (MLHIV) using combined antiretroviral therapy (cART).

METHODS

Twelve MLHIV (48.7 ± 9.2 years; 25.2 ± 2.8 kg m-2) and 13 healthy controls (41.2 ± 9.9 years; 26.3 ± 2.9 kg m-2) performed a cycling bout (ES) (intensity: 50% oxygen uptake reserve; duration: time to achieve 150 kcal-MLHIV: 24.1 ± 5.5 vs. controls: 23.1 ± 3.0 min; p = 0.45), and a 20-min non-exercise session (NES).

RESULTS

At rest (p < 0.05), MLHIV presented higher brachial systolic/diastolic BP (SBP/DBP: 123.2 ± 14.2/76.8 ± 6.3 vs. 114.3 ± 5.1/71.6 ± 2.6 mmHg) and central BP (cSBP/cDBP: 108.3 ± 9.3/76.5 ± 6.5 vs. 101.6 ± 4.9/71.3 ± 4.4 mmHg) vs. controls but lower absolute maximal oxygen uptake (2.1 ± 0.5 vs. 2.5 ± 0.3 L min-1) and HRV indices reflecting overall/vagal modulation (SDNN: 24.8 ± 7.1 vs. 42.9 ± 21.3 ms; rMSSD: 20.5 ± 8.5 vs. 38.1 ± 22.8 ms; pNN50: 3.6 ± 4.2 vs. 13.6 ± 11.3%). DBP postexercise lowered in controls vs. MLHIV (∼4 mmHg, p < 0.001; ES: 0.6). Moreover, controls vs. MLHIV had greater reductions (p < 0.05) in augmentation index (-13.6 ± 13.7 vs. -3.1 ± 7.2% min-1; ES: 2.4), and HRV indices up to 5 min (rMSSD: -111.8 ± 32.1 vs. -75.9 ± 22.2 ms min-1; ES: 3.8; pNN50: -76.3 ± 28.3 vs. -19.0 ± 13.7% min-1; ES: 4.4). Within-group (ES vs. NES; p < 0.05) reductions occurred in controls for SBP (∼10 mmHg, 2 h), DBP (∼6 mmHg, 20, 30, and 70 min), cSBP (∼9 mmHg, 30 min), cDBP (∼7 mmHg, 30 and 70 min), augmentation index (∼10%, 30 min), and pNN50 (∼20%; up to 2 h), while in MLHIV only cSBP (∼6 mmHg, 70 min) and cDBP (∼4 mmHg, 30 min) decreased. Similar increases (up to 5 min) in heart rate (∼22 bpm) and decreases in SDNN (∼18 ms) and rMSSD (∼20 ms) occurred in both groups.

CONCLUSION

MLHIV under cART exhibited attenuated postexercise hypotension vs. healthy controls, which seemed to relate with impairments in vascular function.

Central and Peripheral Postexercise Blood Pressure and Vascular Responses in Young Adults with Obesity

INTRODUCTION

Adults with obesity are at an increased risk of incident hypertension. Regular aerobic exercise is recommended for the prevention and treatment of hypertension, but whether young adults with obesity exhibit impaired postexercise blood pressure (BP) and vascular responses remains unclear.

PURPOSE

We tested the hypothesis that young adults with obesity exhibit attenuated postexercise hypotension (PEH) and postexercise peripheral vasodilation compared with young adults without obesity.

METHODS

Thirty-six normotensive adults without and with obesity (11 men and 7 women per group) underwent measurements of brachial and central BP, and leg blood flow (Doppler ultrasound) at baseline and at 30, 60, and 90 min after acute 1-h moderate-intensity cycling. Leg vascular conductance (LVC) was calculated as flow/mean arterial pressure.

RESULTS

Both groups exhibited similar brachial and central PEH (peak change from baseline, -2 and -4 mm Hg for brachial and central systolic BPs, respectively, for both groups; time effect, P < 0.05). Both groups also exhibited postexercise peripheral vasodilation, assessed via LVC (time effect, P < 0.05), but its overall magnitude was smaller in young adults with obesity (LVC change from baseline, +47% ± 37%, +29% ± 36%, and +20% ± 29%) compared with young adults without obesity (LVC change from baseline, +88% ± 58%, +59% ± 54%, and +42% ± 51%; group effect, P < 0.05).

CONCLUSIONS

Although obesity did not impair PEH after acute moderate-intensity exercise, young adults with obesity exhibited smaller postexercise peripheral vasodilation compared with young adults without obesity. Collectively, these findings have identified evidence for obesity-induced alterations in the peripheral vasculature after exercise.

Cardiovascular and Autonomic Responses after a Single Bout of Resistance Exercise in Men with Untreated Stage 2 Hypertension

The aim of this paper is to assess the integrated responses of ambulatory blood pressure (BP), cardiac autonomic modulation, spontaneous baroreflex sensitivity (BRS), and vascular reactivity after a single bout of resistance exercise (RE) in men with stage 2 hypertension who have never been treated before. Ten hypertensive men were subjected to a RE session of three sets of 20 repetitions and an intensity of 40% of the 1-repetition maximum (RM) test in seven different exercises. For the control (CTR) session, the volunteers were positioned on the exercise machines but did not perform any exercise. Forearm blood flow was measured by venous occlusion plethysmography. We also analyzed the heart rate variability (HRV), ambulatory BP, blood pressure variability (BPV), and BRS. All measurements were performed at different timepoints: baseline, 20 min, 80 min, and 24 h after both RE and CTR sessions. There were no differences in ambulatory BP over the 24 h between the RE and CTR sessions. However, the area under the curve of diastolic BP decreased after the RE session. Heart rate (HR) and cardiac output increased for up to 80 and 20 min after RE, respectively. Similarly, forearm blood flow, conductance, and vascular reactivity increased 20 min after RE (p < 0.05). In contrast, HRV and BRS decreased immediately after exercise and remained lower for 20 min after RE. We conclude that a single bout of RE induced an increase in vascular reactivity and reduced the pressure load by attenuating AUC of DBP in hypertensive individuals who had never been treated with antihypertensive medications.

Obesity does not Impair Ambulatory Cardiovascular and Autonomic Responses Post-exercise

This study aimed to assess whether obesity and/or maximal exercise can change 24 h cardiac autonomic modulation and blood pressure in young men. Thirty-nine men (n: 20; 21.9±1.8 kg·m^-2, and n: 19; 32.9±2.4 kg·m^-2) were randomly assigned to perform a control (non-exercise) and an experimental day exercise (after maximal incremental test). Cardiac autonomic modulation was evaluated through frequency domain heart rate variability (HRV). Obesity did not impair the ambulatory HRV (p>0.05), however higher diastolic blood pressure during asleep time (p=0.02; group main effect) was observed. The 24 h and awake heart rate was higher on the experimental day (p<0.05; day main effect), regardless of obesity. Hypotension on the experimental day, compared to control day, was observed (p<0.05). Obesity indicators were significantly correlated with heart rate during asleep time (Rho=0.34 to 0.36) and with ambulatory blood pressure(r/Rho=0.32 to 0.53). Furthermore, the HRV threshold workload was significantly correlated with ambulatory heart rate (r/Rho=- 0.38 to-0.52). Finally, ambulatory HRV in obese young men was preserved; however, diastolic blood pressure was increased during asleep time. Maximal exercise caused heart rate increase and 24h hypotension, with decreased cardiac autonomic modulation in the first hour, regardless of obesity.

Exercise Training and Cardiac Rehabilitation in COVID-19 Patients with Cardiovascular Complications: State of Art

Recent scientific literature has investigated the cardiovascular implications of COVID-19. The mechanisms of cardiovascular damage seem to involve the protein angiotensin-converting enzyme 2 (ACE2), to which severe acute respiratory syndrome (SARS) coronavirus-2 (CoV-2) binds to penetrate cells and other mechanisms, most of which are still under study. Cardiovascular sequelae of COVID-19 include heart failure, cardiomyopathy, acute coronary syndrome, arrhythmias, and venous thromboembolism. This article aims to collect scientific evidence by exploiting PubMed, Scopus, and Pedro databases to highlight the cardiovascular complications of COVID-19 and to define the physiotherapy treatment recommended for these patients. Exercise training (ET), an important part of cardiac rehabilitation, is a powerful tool in physiotherapy, capable of inducing significant changes in the cardiovascular system and functional in the recovery of endothelial dysfunction and for the containment of thromboembolic complications. In conclusion, due to the wide variety of possible exercise programs that can be obtained by combining intensity, duration, and speed in various ways, and by adjusting the program based on continuous patient monitoring, exercise training is well suited to the treatment of post-COVID patients with an impaired cardiovascular system of various degrees.

Hemodynamics of post-exercise vs. post hot water immersion recovery

This study sought to compare the hemodynamics of the recovery periods following exercise versus hot water immersion. Twelve subjects (6 F, 22.7 ± 0.8 y; BMI: 21.8 ± 2.1 kg·m-2) exercised for 60 minutes at 60% VO2peak or were immersed in 40.5oC water for 60 minutes on separate days, in random order. Measurements were made before, during, and for 60-minutes post-intervention (i.e., recovery) and included heart rate, arterial pressure, core temperature, and subjective measures. Brachial and superficial femoral artery blood flows were assessed using Doppler ultrasonography and cardiac output was measured using the acetylene wash-in method. Internal temperature increased to a similar extent during exercise and hot water immersion. Cardiac outputand mean arterial pressure were greater during exercise than during hot water immersion (both p<0.01). Sustained reductions in mean arterial pressure compared to baseline were observed in both conditions during recovery (p<0.001 vs before each intervention). Cardiac output was similar during recovery between the interventions. Stroke volume was reduced throughout recovery following exercise, but not following hot water immersion (p<0.01). Brachial artery retrograde shear was reduced following hot water immersion, but not following exercise (Interaction; p=0.035). Antegrade shear in the superficial femoral artery was elevated compared to baseline (p=0.027) for 60 minutes following exercise, whereas it returned near baseline values (p=0.564) by 40 minutes following hot water immersion. Many of the changes observed during the post-exercise recovery period that are thought to contribute to long-term beneficial cardiovascular adaptations were also observed during the post-hot water immersion recovery period.

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.

Caffeine ingestion alters central hemodynamics following aerobic exercise in middle-aged men

PURPOSE

To examine the acute influence of caffeine on post-exercise central blood pressures, arterial stiffness, and wave reflection properties.

METHODS

In a double-blind randomized placebo-controlled crossover study design, ten middle-aged males (55 ± 5 year) completed two exercise trials after ingestion of caffeine (400 mg) or placebo. Measurements were taken before and 30 min post-ingestion via cuff-based pulse wave analysis (PWA) and carotid-femoral pulse wave velocity (PWV). Participants performed a 40-min cycling bout at 70% HRmax with matched workloads between trials. PWA and PWV were reassessed 30 min post-exercise.

RESULTS

Prior to exercise, compared to placebo, caffeine increased brachial systolic blood pressure (bSBP) (+ 12.3 ± 2.4 mmHg; p = 0.004), brachial diastolic blood pressure (bDBP) (+ 7.7 ± 0.9 mmHg; p = 0.011), central systolic blood pressure (cSBP) (+ 11.1 ± 2.1 mmHg; p = 0.005) and central diastolic blood pressure (cDBP) (+ 7.6 ± 1.0 mmHg; p = 0.012). PWV was higher 30 min after pill ingestion (p = 0.021 for time) with a trend for a greater increase in caffeine (p = 0.074 for interaction). bSBP (p = 0.036) and cSBP (p = 0.007) were lower after exercise but remained higher (both p < 0.001) in caffeine compared to placebo. PWV remained higher (p = 0.023) after exercise in caffeine compared to placebo but was not influenced by exercise. At rest, augmentation pressure (AP) and index (AIx) were not influenced by caffeine ingestion. Conversely, AIx was lower (p = 0.009) after exercise in placebo only.

CONCLUSION

In healthy and active middle-aged men, pre-exercise caffeine ingestion led to higher central and peripheral systolic blood pressures, PWV and AIx at 30 min post-exercise, indicating an increased left ventricular workload which may have implications for cardiovascular event risk.

The acute and chronic effects of high-intensity exercise in hypoxia on blood pressure and post-exercise hypotension: A randomized cross-over trial

BACKGROUND

Acute exercise leads to an immediate drop in blood pressure (BP), also called post-exercise hypotension (PEH). Exercise in hypoxia is related to additional vasodilation, potentially contributing to more profound PEH. Therefore, we investigated the impact of hypoxia versus normoxia on the magnitude of PEH. Second, we examined whether these changes in PEH relate to the BP-lowering effects of 12-week exercise training under hypoxia.

METHODS

In this prospective study, 21 healthy individuals (age 22.2 ± 3.0 years, 14 male) performed a 45-minute high-intensity running exercise on 2 different days in a random order, under hypoxia (fraction of inspired oxygen 14.5%) and normoxia (fraction of inspired oxygen 20.9%). BP was examined pre-exercise (t = 0) and at t = 15, t = 30, t = 45, and t = 60 minutes post-exercise. Afterward, subjects took part in a 12-week hypoxic running exercise training program. Resting BP was measured before and after the 12-week training program.

RESULTS

Acute exercise induced a significant decrease in systolic BP (systolic blood pressure [SBP], P = .001), but not in diastolic BP (diastolic blood pressure [DBP], P = .113). No significant differences were observed in post-exercise BP between hypoxic and normoxic conditions (SBP, P = .324 and DBP, P = .204). Post-exercise changes in SBP, DBP, and mean arterial pressure significantly correlated to the 12-week exercise training-induced changes in SBP (r = 0.557, P = .001), DBP (r = 0.615, P < .001), and mean arterial pressure (r = 0.458, P = .011).

CONCLUSION

Our findings show that hypoxia does not alter the magnitude of PEH in healthy individuals, whilst PEH relates to the BP-lowering effects of exercise. These data highlight the strong link between acute and chronic changes in BP.

Post-Exercise Hypotension and Reduced Cardiac Baroreflex after Half-Marathon Run: In Men, but Not in Women

We examined whether trained women exhibit similar cardiovascular and cardiac baroreflex alterations after a half-marathon compared to men. Thirteen women (39.1 ± 9.3 years; 165 ± 6 cm; 58.2 ± 7.5 kg; maximal aerobic speed (MAS): 13.7 ± 2.2 km·h^-1) and 12 men (45.7 ± 10.5 years; 178 ± 7 cm; 75.0 ± 8.3 kg; MAS: 15.8 ± 2.2 km·h^-1) ran an official half-marathon. Before and 60-min after, cardiovascular variables, parasympathetic (heart rate variability analysis) modulation and cardiac baroreflex function (transfer function and sequence analyses) were assessed during supine rest and a squat-stand test. Running performance was slower in women than in men (120 ± 19 vs. 104 ± 14 min for women and men, respectively). However, when expressed as a percentage of MAS, it was similar (78.1 ± 4.6% and 78.2 ± 5.4% of MAS for women and men, respectively). Before the run, women exhibited lower mean blood pressure (BP), cardiac output (CO) and stroke volume (SV) compared to men, together with higher parasympathetic indexes. After the race, parasympathetic indexes decreased in both sexes, but remained higher in women. Reduced SV, systolic BP and cardiac baroreflex were observed in men but not in women. Contrary to men, a competitive half-marathon did not trigger post-exercise hypotension and a reduced cardiac baroreflex in women.

Cardiovascular Responses during and after Maximal Walking in Men and Women with Symptomatic Peripheral Artery Disease

BACKGROUND

Walking is recommended for patients with peripheral arterial disease (PAD). It has been shown that patients with PAD present sharper increases in blood pressure (BP) and heart rate (HR) during maximal walking when compared with healthy subjects. Additionally, women with PAD present a worse physiological profile, and it is possible that they may present higher cardiovascular load during and after a bout of maximal walking than men. Thus, the objective of this study was to compare cardiovascular and autonomic responses during and after maximal walking between men and women with PAD and intermittent claudication (IC).

METHODS

Forty patients with PAD and IC (20 men and 20 women) underwent, in random order, 2 sessions: control (standing on treadmill) and exercise (maximal treadmill walking test with Gardner's protocol). During the exercise, HR and BP were measured. Before and after the sessions, cardiovascular variables (BP HR, cardiac output, peripheral vascular resistance, and stroke volume) and autonomic modulation (HR and BP variabilities and baroreflex sensitivity) were assessed. In addition, an ambulatory BP monitoring was recorded after each session.

RESULTS

Men and women presented similar maximal walking capacity. During the walking test, HR and systolic BP increased similarly in men and women. After the maximal walking, cardiovascular and autonomic responses did not differ between the genders. In addition, postintervention ambulatory BP parameters were also similar in men and women. Therefore, in men and women, maximal walking similarly reduced clinic systolic BP and stroke volume, and increased HR and total power of HR variability during the recovery period.

CONCLUSIONS

Men and women with PAD and IC present similar cardiovascular and autonomic responses during and after maximal walking.

Acute Effect of Interval vs. Continuous Exercise on Blood Pressure: Systematic Review and Meta-Analysis

Fundamento

O exercício aeróbio contínuo (EC) é uma das principais recomendações não farmacológicas para prevenção e tratamento da hipertensão arterial sistêmica. O EC é seguro e eficaz para reduzir a pressão arterial cronicamente, assim como nas primeiras horas após sua realização, fenômeno conhecido por hipotensão pós-exercício (HPE). O exercício intervalado (EI) também gera HPE.

Objetivo

Essa revisão sistemática e metanálise buscou comparar a magnitude da HPE entre o EC e EI em adultos.

Métodos

Realizou-se uma revisão sistemática de estudos publicados em revistas indexadas nas bases PubMed, Web of Knowledge, Scopus e CENTRAL até março de 2020 que compararam a magnitude da HPE entre o EC versus EI. Foi definida HPE entre 45 e 60 minutos pós-exercício. As diferenças entre grupos sobre a pressão arterial foram analisadas por meio do modelo de efeito aleatório. Os dados foram reportados como diferença média ponderada (WMD) e 95% de intervalo de confiança (IC). Valor p menor que 0,05 foi considerado estatisticamente significativo. A escala TESTEX (0 a 15) foi usada para verificação da qualidade metodológica dos estudos.

Resultados

O EI apresentou HPE de maior magnitude sobre a pressão arterial sistólica (WMD: -2,93 mmHg [IC95%: -4,96, -0,90], p = 0,005, I² = 50%) e pressão arterial diastólica (WMD: -1,73 mmHg [IC95%: -2,94, -0,51], p = 0,005, I² = 0%) quando comparado ao EC (12 estudos; 196 participantes). A pontuação dos estudos na escala TEXTEX variou entre 10 e 11 pontos.

Conclusões

O EI gerou HPE de maior magnitude quando comparado ao EC entre 45 e 60 minutos pós-exercício. A ausência de dados sobre eventos adversos durante o EI e EC nos estudos impede comparações sobre a segurança dessas estratégias. (Arq Bras Cardiol. 2020; 115(1):5-14)

Postexercise Hypotension After Muscle Power Training Session in Older Adults With Hypertension

The aim of the present study was to determine the acute effects of a muscle power training (PT) session on arterial blood pressure (BP) in older adults with hypertension. Thirteen participants (64 ± 4 years) with essential hypertension were randomly assigned to a PT session and control session without exercise. During PT, the participants performed three sets of eight repetitions at 50% of the one-repetition maximum tests. The concentric phase during each repetition was performed as fast as possible. The systolic BP (post-15 min: -1.7 ± 1.8 mmHg [p = .048; d = 0.22]; post-30 min: -3.6 ± 1.7 mmHg [p = .010; d = 0.48]; post-45 min: -3.3 ± 1.3 mmHg [p = .002; d = 0.42]; post-60 min: -3.9 ± 1.7 mmHg [p = .003; d = 0.49]) and diastolic BP (post-15 min: -1.5 ± 1.5 mmHg [p = .053; d = 0.20]; post-30 min: -2.2 ± 1.7 mmHg [p = .001; d = 0.29]; post-45 min: -2.0 ± 2.0 mmHg [p = .001; d = 0.27]; post-60 min: -2.0 ± 1.3 mmHg [p < .001; d = 0.26]) reductions were observed at all times after the PT session, compared with the preexercise and control session. PT is an effective strategy to acutely reduce BP in older patients with essential hypertension.

Effects of ACEi and ARB on post-exercise hypotension induced by exercises conducted at different times of day in hypertensive men

BACKGROUND

Post-exercise hypotension (PEH) is greater after evening than morning exercise, but antihypertensive drugs may affect the evening potentiation of PEH. Objective: To compare morning and evening PEH in hypertensives receiving angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB).

METHODS

Hypertensive men receiving ACEi (n = 14) or ARB (n = 15) underwent, in a random order, two maximal exercise tests (cycle ergometer, 15 watts/min until exhaustion) with one conducted in the morning (7 and 9 a.m.) and the other in the evening (8 and 10 p.m.). Auscultatory blood pressure (BP) was assessed in triplicate before and 30 min after the exercises. Changes in BP (post-exercise - pre-exercise) were compared between the groups and the sessions using a two-way mixed ANOVA and considering P < .05 as significant.

RESULTS

In the ARB group, systolic BP decrease was greater after the evening than the morning exercise, while in the ACEi group, it was not different after the exercises conducted at the different times of the day. Additionally, after the evening exercise, systolic BP decrease was lower in the ACEi than the ARB group (ARB = -11 ± 8 vs -6 ± 6 and ACEi = -6 ± 7 vs. -8 ± 5 mmHg, evening vs. morning, respectively, P for interaction = 0.014).

CONCLUSIONS

ACEi, but not ARB use, blunts the greater PEH that occurs after exercise conducted in the evening than in the morning.

Hydration Does Not Change Postexercise Hypotension and Its Mechanisms

BACKGROUND

Drinking water is recommended before and after exercise to avoid dehydration. However, water ingestion may mitigate or prevent postexercise hypotension. This study investigated the effects of intentional hydration on postaerobic exercise hemodynamics and autonomic modulation.

METHODS

A total of 18 young men randomly underwent 4 experimental sessions as follows: (1) control with intentional hydration (1 L of water in the previous night, 500 mL 60 min before the intervention, and 1 mL for each 1 g of body mass lost immediately after the intervention); (2) control without intentional hydration (ad libitum water ingestion before the intervention); (3) exercise (cycle ergometer, 45 min, 50% of VO2peak) with intentional hydration; and (4) exercise without intentional hydration. Hemodynamic and autonomic parameters were measured before and after the interventions and were compared by 3-way analysis of variance.

RESULTS

Intentional hydration did not change any postexercise hemodynamic nor autonomic response. Exercise decreased systolic blood pressure and stroke volume (-4.1 [0.8] mm Hg and -4.9 [1.5] mL, P < .05), while increased cardiac sympathovagal balance (0.3 [0.3], P < .05) during the recovery. In addition, it abolished the increase in diastolic blood pressure and the decrease in heart rate observed in the control sessions.

CONCLUSION

Intentional hydration does not modify the hypotensive effect promoted by previous aerobic exercise and did not alter its hemodynamic and autonomic mechanisms.

Postexercise hypotension and related hemodynamic responses to cycling under heat stress in untrained men with elevated blood pressure

PURPOSE

To investigate the effect of heat stress on postexercise hypotension.

METHODS

Seven untrained men, aged 21-33 years, performed two cycling bouts at 60% of oxygen uptake reserve expending 300 kcal in environmental temperatures of 21 °C (TEMP) and 35 °C (HOT) in a randomized, counter-balanced order. Physiological responses were monitored for 10-min before and 60-min after each exercise bout, and after a non-exercise control session (CON). Blood pressure (BP) also was measured during the subsequent 21-h recovery period.

RESULTS

Compared to CON, systolic, and diastolic BPs were significantly reduced in HOT (Δ = - 8.3 ± 1.6 and - 9.7 ± 1.4 mmHg, P < 0.01) and TEMP (Δ = - 4.9 ± 2.1 and - 4.5 ± 0.9 mmHg, P < 0.05) during the first 60 min of postexercise recovery. Compared to TEMP, rectal temperature was 0.6 °C higher (P = 0.001), mean skin temperature was 1.8 °C higher (P = 0.013), and plasma volume (PV) was 2.6 percentage points lower (P = 0.005) in HOT. During the subsequent 21-h recovery period systolic BP was 4.2 mmHg lower in HOT compared to CON (P = 0.016) and 2.5 mmHg lower in HOT compared to TEMP (P = 0.039).

CONCLUSION

Exercise in the heat increases the hypotensive effects of exercise for at least 22 h in untrained men with elevated blood pressure. Our findings indicate that augmented core and skin temperatures and decreased PV are the main hemodynamic mechanisms underlying a reduction in BP after exercise performed under heat stress.

200.000 IU of vitamin D does not reduce resting Blood Pressure and Inhibit Post-Exercise Hypotension in elderly women: a pilot study

Given the scarcity of studies with elderly and the existence of studies investigating the effect of vitamin D supplementation in PEH (post exercise hypotension), this study evaluated the effect of a single megadose of vitamin D on resting blood pressure (RBP) and post-exercise hypotension (PEH) in the elderly. 11 hypertensive elderly women (70.3 ± 1.7 years) received a single megadose of 200.000 IU of cholecalciferol or a placebo, orally, through capsules. On day 7, the subjects performed 30 minutes of aerobic exercise with blood pressure measurement before exercise and every 10 minutes after exercise during 60 minutes, besides cardiac autonomic modulation. RBP did not significantly change. Exercise promoted significant systolic PEH only in one moment post exercise in treated group and in the placebo group promoted significant systolic PEH at four moments. Significant diastolic PEH did not occur in any of the groups. Sympathovagal activity increased at post exercise balance in supplemented subjects at 20 min, 40 min, 50 min and 60 min when compared to rest; this increase was not observed in the placebo. A megadose of vitamin D did not reduce RBP, promoted partial inhibition of systolic PEH and increased sympathovagal balance.

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 Following Concurrent Exercise: Does Order of Exercise Modality Matter?

Cardiovascular (CV) and resistance training (RT) can moderate negative effects of aging, disease, and inactivity. Post-exercise hypotension (PEH) has been used as a non-pharmacological means to control and reduce BP. Few have evaluated PEH response following a bout of exercise combining CV and RT, whether or not there is an order effect, or if PEH continues when activities of daily living (ADLs) are resumed. Participants (N = 10) completed a non-exercise control, a graded exercise test (GXT), and two concurrent sessions (CVRT and RTCV). Each session was followed by a 60-minute laboratory and 3-hour ADLs PEH assessment, respectively. Two-way and Welch-one-way repeated measures ANOVAs were used to determine differences between among conditions in PEH. There was a significant interaction between BP and condition following the 60-minute laboratory measure (p = .030, ηp 2 = .166) and the ADLs BP assessments (p = .008, ηp 2 = .993), respectively. PEH occurred following concurrent exercise conditions at minute 45 for RTCV (118 ± 8, p = .041; 95% CI [0.223, 17.443]) and minutes 50 (117 ± 9; p = .036 95% CI [0.441, 21.097]) and 55 (118 + 8; p < .001; 95% CI [5.884, 14.731]) following CVRT. BP was elevated during ADLs following the control session compared to the GXT, RTCV, and CVRT. Regardless of the order, concurrent exercise is effective in potentiating PEH. Elevation in BP associated with ADLs can be mitigated if exercise is performed previously.

Post-exercise hypotension and its hemodynamic determinants depend on the calculation approach

Post-exercise hypotension (PEH) has been assessed by three calculation approaches: I = (post-exercise - pre-exercise), II = (post-exercise - post-control), and III = [(post-exercise - pre-exercise) - (post-control - pre-control)]. This study checked whether these calculation approaches influence PEH and its determinants. For that, 30 subjects underwent two exercise (cycling, 45 min, 50% VO₂ peak) and two control (seated rest, 45 min) sessions. Systolic (SBP) and diastolic (DBP) blood pressures, cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and stroke volume (SV) were measured pre- and post-interventions in each session. The mean value for each moment in each type of session was calculated, and responses to exercise were analyzed with each approach (I, II, and III) to evaluate the occurrence of PEH and its determinants. Systolic PEH was significant when calculated by all approaches (I = -5 ± 1, II = -11 ± 2, and III = -11 ± 2 mmHg, p < 0.05), while diastolic PEH was only significant when calculated by approaches II and III (-6 ± 1 and -6 ± 1 mmHg, respectively, p < 0.05). CO decreased significantly after the exercise when calculated by approach I, but remained unchanged with approaches II and III, while SVR increased significantly with approach I, but decreased significantly with approaches II and III. HR was unchanged after the exercise with approach I, but increased significantly with approaches II and III, while SV decreased significantly with all approaches. Thus, PEH and its hemodynamic determinants are influenced by the calculation approach, which should be considered when designing, analyzing, and comparing PEH studies.

Physical Exercise for Individuals with Hypertension: It Is Time to Emphasize its Benefits on the Brain and Cognition

Hypertension affects more than 40% of adults worldwide and is associated with stroke, myocardial infarction, heart failure, and other cardiovascular diseases. It has also been shown to cause severe functional and structural damage to the brain, leading to cognitive impairment and dementia. Furthermore, it is believed that these cognitive impairments affect the mental ability to maintain productivity at work, ultimately causing social and economic problems. Because hypertension is a chronic condition that requires clinical treatment, strategies with fewer side effects and less-invasive procedures are needed. Physical exercise (PE) has proven to be an efficient and complementary tool for hypertension management, and its peripheral benefits have been widely supported by related studies. However, few studies have specifically examined the potential positive effects of PE on the brain in hypertensive individuals. This narrative review discusses the pathophysiological mechanisms that hypertension promotes in the brain, and suggests PE as an important tool to prevent and reduce cognitive damage caused by hypertension. We also provide PE recommendations for hypertensive individuals, as well as suggestions for promoting PE as a method for increasing cognitive abilities in the brain, particularly for hypertensive individuals.

Cardiovascular responses to leg muscle loading during head-down tilt at rest and after dynamic exercises

The physiological processes underlying hemodynamic homeostasis can be modulated by muscle activity and gravitational loading. The effects of leg muscle activity on cardiovascular regulation have been observed during orthostatic stress. Here, we evaluated such effects during head-down tilt (HDT). In this posture, the gravitational gradient along the body is different than in upright position, leading to increased central blood volume and reduced venous pooling. We compared the cardiovascular signals obtained with and without leg muscle loading during HDT in healthy human subjects, both at rest and during recovery from leg-press exercises using a robotic device. Further, we compared such cardiovascular responses to those obtained during upright position. Loading leg muscles during HDT at rest led to significantly higher values of arterial blood pressure than without muscle loading, and restored systolic values to those observed during upright posture. Maintaining muscle loading post-exercise altered the short-term cardiovascular responses, but not the values of the signals five minutes after the exercise. These results suggest that leg muscle activity modulates cardiovascular regulation during HDT. This modulation should therefore be considered when interpreting cardiovascular responses to conditions that affect both gravity loading and muscle activity, for example bed rest or microgravity.