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Mendes BF, Improta-Caria AC, Diniz E Magalhães CO, Peixoto MFD, Cassilhas RC, de Oliveira EM, De Sousa RAL. Resistance Training Reduces Blood Pressure: Putative Molecular Mechanisms. Curr Hypertens Rev 2024; 20:52-56. [PMID: 38258772 DOI: 10.2174/0115734021277791240102041632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
Arterial hypertension is a multifactorial clinical condition characterized by higher blood pressure levels. The main treatment for controlling high blood pressure consists of drug therapy, but the scientific literature has been pointing to the efficiency of aerobic and resistance exercises acting in a therapeutic and/or preventive way to reduce and control the blood pressure levels. Resistance training is characterized by sets and repetitions on a given muscle segment that uses overload, such as machine weights, bars, and dumbbells. As it successfully affects a number of variables associated to practitioners' functional and physiological features as well as emotional and social variables, resistance training has been a crucial part of physical exercise programs. Several reports highlight the various adaptive responses it provides, with a focus on the improvement in strength, balance, and muscular endurance that enables a more active and healthy lifestyle. Resistance training programs that are acute, sub-chronic, or chronic can help people with varying ages, conditions, and pathologies reduce their arterial hypertension. However, molecular mechanisms associated with resistance training to reduce blood pressure still need to be better understood. Thus, we aimed to understand the main effects of resistance training on blood pressure as well as the associated molecular mechanisms.
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Affiliation(s)
- Bruno Ferreira Mendes
- Multicenter Post Graduation Program in Physiological Sciences, Brazilian Society of Physiology, Federal University of the Valleys of Jequitinhonha and Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Alex Cleber Improta-Caria
- Laboratory of Biochemistry and Molecular Biology of the Exercise, University of Sao Paulo (USP), São Paulo-SP, Brazil
| | - Caique Olegário Diniz E Magalhães
- Multicenter Post Graduation Program in Physiological Sciences, Brazilian Society of Physiology, Federal University of the Valleys of Jequitinhonha and Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Marco Fabricio Dias Peixoto
- Multicenter Post Graduation Program in Physiological Sciences, Brazilian Society of Physiology, Federal University of the Valleys of Jequitinhonha and Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Ricardo Cardoso Cassilhas
- Multicenter Post Graduation Program in Physiological Sciences, Brazilian Society of Physiology, Federal University of the Valleys of Jequitinhonha and Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Edilamar Menezes de Oliveira
- Laboratory of Biochemistry and Molecular Biology of the Exercise, University of Sao Paulo (USP), São Paulo-SP, Brazil
| | - Ricardo Augusto Leoni De Sousa
- Multicenter Post Graduation Program in Physiological Sciences, Brazilian Society of Physiology, Federal University of the Valleys of Jequitinhonha and Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
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Ambelu T, Teferi G. The impact of exercise modalities on blood glucose, blood pressure and body composition in patients with type 2 diabetes mellitus. BMC Sports Sci Med Rehabil 2023; 15:153. [PMID: 37964349 PMCID: PMC10644520 DOI: 10.1186/s13102-023-00762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Physical activity has been recommended as an important non-pharmacological therapeutic strategy for the management of type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the effects of 12 weeks of strength, aerobic, and a combination of aerobic and resistance training on blood glucose level, blood pressure, and body composition in patients with T2DM. METHODS From Debremarkos referral hospital, 40 subjects with T2DM (mean age 42.45 years, 29 men, 11 women) were randomly assigned to one of three intervention groups or the control group. The following variables were measured: body mass index (BMI), fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body fat percentage (BFP). Paired sample T-test and one-way ANCOVA were applied whilst controlling for diet, gender, and age. RESULTS All intervention groups showed improvement in a mean difference of FBG - 13.03 (t =-5.55, df = 39, p < 0.001), SBP - 21.63 mmHg - 17.6 mmHg (t =-6.51, df = 39, p < 0.001), DBP - 11.86 mmHg (t = -5.47, df = 39, p < 0.001) and BFP - 9.14 (t = -7.49, df = 39, p < 0.001). There was a significant difference in mean BMI reduction when diet, gender, and age were controlled in a one-way ANCOVA (F (3, 33) = 11.79, p < 0.001), SBP (F (3, 33) = 13.383, p < 0.001), DBP (F (3, 33) = 7.830, p < 0.001), FBG (F (3, 33) = 6.337, p < 0.001), BFP (F (3, 33) = 24.29, p < 0.001) between the exercise intervention groups and control group. Additionally, the estimated marginal means indicate that the combined strength and aerobic exercise intervention group experienced the greatest improvements. CONCLUSION Body composition, blood pressure, and fasting blood glucose were significantly lower in the combined (aerobic plus strength) treatment than in the individual treatment, indicating that the combined exercise intervention was more successful in altering these parameters.
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Affiliation(s)
- Tensay Ambelu
- Department of Sport Science, Debre Markos University, Debremarkos, Ethiopia
| | - Getu Teferi
- Department of Sport Science, Debre Markos University, Debremarkos, Ethiopia.
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Ribeiro F, Teixeira M, Alves AJ, Sherwood A, Blumenthal JA. Lifestyle Medicine as a Treatment for Resistant Hypertension. Curr Hypertens Rep 2023; 25:313-328. [PMID: 37470944 DOI: 10.1007/s11906-023-01253-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW Approximately 10% of the adults with hypertension fail to achieve the recommended blood pressure treatment targets on 3 antihypertensive medications or require ≥ 4 medications to achieve goal. These patients with 'resistant hypertension' have an increased risk of target organ damage, adverse clinical events, and all-cause mortality. Although lifestyle modification is widely recommended as a first-line approach for the management of high blood pressure, the effects of lifestyle modifications in patients with resistant hypertension has not been widely studied. This review aims to provide an overview of the emerging evidence on the benefits of lifestyle modifications in patients with resistant hypertension, reviews potential mechanisms by which lifestyles may reduce blood pressure, and discusses the clinical implications of the recent findings in this field. RECENT FINDINGS Evidence from single-component randomized clinical trials demonstrated that aerobic exercise, weight loss and dietary modification can reduce clinic and ambulatory blood pressure in patients with resistant hypertension. Moreover, evidence from multi-component trials involving exercise and dietary modification and weight management can facilitate lifestyle change, reduce clinic and ambulatory blood pressure, and improve biomarkers of cardiovascular risk. This new evidence supports the efficacy of lifestyle modifications added to optimized medical therapy in reducing blood pressure and improving cardiovascular risk biomarkers in patients with resistant hypertension. These findings need to be confirmed in larger studies, and the persistence of benefit over extended follow-up needs further study.
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Affiliation(s)
- Fernando Ribeiro
- Institute of Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Manuel Teixeira
- Institute of Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Alberto J Alves
- University of Maia, Research Center in Sports Sciences, Health Sciences and Human Development, Castêlo da Maia, Portugal
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.
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Saco-Ledo G, Valenzuela PL, Ruilope LM, Lucia A. Physical Exercise in Resistant Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Cardiovasc Med 2022; 9:893811. [PMID: 35665271 PMCID: PMC9161026 DOI: 10.3389/fcvm.2022.893811] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/22/2022] [Indexed: 11/27/2022] Open
Abstract
Physical exercise reduces blood pressure (BP) in patients with hypertension in general but more evidence is needed specifically for a high-risk phenotype associated with intensive medication, resistant hypertension (RH). In this systematic review and meta-analysis, we aimed to summarize current evidence of the exercise effects on BP in patients with RH. A systematic search was conducted in PubMed, Web of Science and Cochrane Library (from inception to 3rd November, 2021). A random effects meta-analysis was performed when at least two trials assessed the effect of either acute or regular exercise (vs. a control condition) on the same outcome. Ten studies (N = 380 participants; 51% female; mean age 52 to 67 years) were included in the review, of which four (N = 58) and six (N = 322) assessed the effects of acute and regular exercise, respectively. Evidence overall suggests that a single bout of acute exercise results in a short-term (≤ 24 h) reduction of BP, although no meta-analysis could be performed. As for regular exercise, three randomized controlled trials (N = 144, 50% female) could be meta-analyzed, which showed that exercise training intervention (8–12 weeks, 3 sessions/week) significantly reduces 24-h (−9.9 mmHg, 95% confidence interval −15.4−4.4 for systolic BP; and −5 mmHg, −7.0−3.0 for diastolic BP) and daytime ambulatory BP (−11.7 mmHg, −17.8−5.7; and −7.4 mmHg, −11.9−2.9). In summary, physical exercise appears as an effective option to reduce BP in patients with RH, although more research is needed to confirm these findings as well as to determine the most effective exercise characteristics.
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Affiliation(s)
- Gonzalo Saco-Ledo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Pedro L Valenzuela
- Research Institute of the Hospital Universitario 12 de Octubre ("Imas12"), Madrid, Spain
| | - Luis M Ruilope
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Research Institute of the Hospital Universitario 12 de Octubre ("Imas12"), Madrid, Spain
- Hypertension Unit and Cardiorenal Translational Laboratory, Hospital 12 de Octubre, Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Research Institute of the Hospital Universitario 12 de Octubre ("Imas12"), Madrid, Spain
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Dassanayake S, Sole G, Wilkins G, Gray E, Skinner M. Effectiveness of Physical Activity and Exercise on Ambulatory Blood Pressure in Adults with Resistant Hypertension: A Systematic Review and Meta-Analysis. High Blood Press Cardiovasc Prev 2022; 29:275-286. [PMID: 35366216 PMCID: PMC9050776 DOI: 10.1007/s40292-022-00517-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/14/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction Resistant hypertension (RHT) is a phenotype of hypertension that is challenging to manage by medications alone. While high grade evidence supports physical activity (PA) and exercise to reduce blood pressure (BP) in hypertension, it is unclear whether these are also effective for RHT. Aims To determine the quality of evidence for the effectiveness of PA and exercise and the change of magnitude of 24-hour ambulatory BP (24hABP) in adults with RHT. Methods Scopus, MEDLINE, CINHAL, Web of Science, Embase and SPORTDiscus databases were searched. Cochrane risk of bias tools, Review Manager and Grading of the Recommendation Assessment, Development and Evaluation were used to assess the methodological quality, the clinical heterogeneity and quality of the evidence. Results Four studies comprising 178 individuals in total were included. A meta-analysis with random effects showed decreased 24hABP. The experimental group demonstrated grater mean differences for 24hABP following the PA and exercise programmes (systolic − 9.88 mmHg, 95% CI: − 17.62, − 2.14, I2 = 72%, p = 0.01; diastolic − 6.24 mmHg, 95% CI: − 12.65, 0.17, I2 = 93%,p = 0.06); and aerobic exercise (systolic − 12.06 mmHg, 95% CI: − 21.14, − 2.96, I2 = 77%, p = 0.009, diastolic − 8.19 mmHg, 95% CI: − 14.83, − 1.55, I2 = 92% ,p = 0.02). In the included studies, indirectness and publication bias were ‘moderate’ while inconsistency and imprecision were rated as ‘low’. Thus, the overall quality of the evidence was considered to be ‘low’. Conclusions Low certainty evidence suggests that PA and aerobic exercise added to usual care may be more effective in 24hABP reduction in RHT than usual care alone. Registration PROSPERO—2019 CRD42019147284 (21.11.2019). Supplementary Information The online version contains supplementary material available at 10.1007/s40292-022-00517-6.
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Affiliation(s)
- Suranga Dassanayake
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research, University of Otago, Box 56, Dunedin, 9054, New Zealand.
| | - Gisela Sole
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research, University of Otago, Box 56, Dunedin, 9054, New Zealand
| | - Gerard Wilkins
- Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Emily Gray
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research, University of Otago, Box 56, Dunedin, 9054, New Zealand
| | - Margot Skinner
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research, University of Otago, Box 56, Dunedin, 9054, New Zealand
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Abstract
PURPOSE OF REVIEW In the United States (US), 46% of adults have hypertension (systolic blood pressure ≥ 130 mmHg, diastolic blood pressure ≥ 80 mmHg). Approximately, 16% of patients with hypertension have apparent treatment-resistant hypertension (aTRH) and the incidence of true resistant hypertension (RHT) is thought to be much lower (~ 2%). These patients with RHT are at a higher risk for adverse events and worse clinical outcomes. RECENT FINDINGS Although lifestyle interventions have proven to be effective as the first line of defense in treating hypertension, their role in the management of patients with RHT is not well established. Despite fewer in number, available studies examining lifestyle interventions in patients with RHT do indeed show promising results. In this review, we aim to discuss the role of common lifestyle interventions such as physical activity, exercise, weight loss, and dietary modifications on blood pressure control in patients with RHT.
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Analysis of Association of Occupational Physical Activity, Leisure-Time Physical Activity, and Sedentary Lifestyle with Hypertension according to the Adherence with Aerobic Activity in Women Using Korea National Health and Nutrition Examination Survey 2016-2017 Data. Int J Hypertens 2020; 2020:8943492. [PMID: 32110448 PMCID: PMC7042501 DOI: 10.1155/2020/8943492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/07/2019] [Accepted: 01/10/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose We investigated the association between occupational physical activity, leisure-time physical activity, and sedentary lifestyle with hypertension by adherence with aerobic exercise in middle-aged and elderly women. Methods A cross-sectional analysis was performed using Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative data between 2016 and 2017. A total of 4,241 women aged 40 years or older were included. Hypertension diagnosed by physician and exercise status was asked by questionnaires. Results Mean age of the participants was 58.4 (±11.4, range: 40∼80 years). There were 1,681 (39.6%) women in the aerobic activity adherence group. In the logistic regression analysis with adjustment for confounding factors, frequency of occupational physical activity (OPA) level (OR 1.931; p=0.048, in ≤4 per week group), walking frequency (OR 0.436; p=0.048, in ≤4 per week group), walking frequency (OR 0.436; p=0.048, in ≤4 per week group), walking frequency (OR 0.436; p=0.048, in ≤4 per week group), walking frequency (OR 0.436; Conclusions In the aerobic activity adherence group, further research is needed to identify the influence of occupational physical activity. In the aerobic activity nonadherence group, decreasing sitting hours and increasing endurance exercise may be helpful.
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Dassanayake S, Sole G, Wilkins G, Skinner M. Effect of exercise and physical activity on blood pressure in adults with resistant hypertension: a protocol for a systematic review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1728986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Suranga Dassanayake
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Gisela Sole
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Gerard Wilkins
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Margot Skinner
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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