The anti-hypertensive effects of exercise: integrating acute and chronic mechanisms

Joint Association of Physical Activity and Sleep Quality With Blood Pressure Control in Patients With Hypertension in Douala, Cameroon

INTRODUCTION

Blood pressure (BP) control is necessary to prevent fatal events in patients with hypertension. Although physical activity (PA) and sleep quality (SQ) are known to reduce BP, their joint association is yet to be demonstrated. This study aimed to assess the joint association of PA and SQ on BP control among patients with hypertension in Cameroon.

METHODS

This was a hospital-based cross-sectional study carried out among outpatients attending Douala General Hospital in Cameroon diagnosed with hypertension. BP was considered to be controlled if it was lower than 140/90 mm Hg. PA and SQ have been assessed using the International Physical Activity Questionnaire and the Pittsburg Sleep Quality Index. Odds ratio and 95% CI have been calculated, and differences were considered significant at P < .05.

RESULTS

A total of 415 participants were recruited, the mean age was 61 (11) years, and 67% were women. Around 66.3% of participants had their BP uncontrolled. Patients with uncontrolled BP had a significantly higher proportion of overweight/obesity (87.3% vs 73.6, P = .001), sedentary time ≥ 2 hours per day (37.1% vs 27.1, P = .043), and low leisure-time PA level (39.6% vs 52.9%, P = .014). After adjustment for confounders, a poor SQ associated with a low PA level significantly increased the odds of having an uncontrolled BP (odds ratio: 2.66; 95% CI, 1.13-6.24; P = .025).

CONCLUSION

Cameroonian patients with hypertension exhibit a high rate of poor BP control which is significantly associated with poor SQ and low PA level. These 2 parameters should be considered simultaneously for a better prevention of cardiovascular complications.

Interindividual Variability Response to Resistance and High-Intensity Interval Training on Blood Pressure Reduction in Hypertensive Older Adults

BACKGROUND

This study evaluated the effects of resistance training (RT) and high-intensity interval training (HIIT) on systolic (SBP) and diastolic blood pressure (DBP) in hypertensive older adults undergoing pharmacological therapy over four and eight weeks. We compared the efficacy of RT and HIIT in reducing non-responders (NRs) between weeks 4 and 8 and analyzed time-course adaptations in NRs and responders (Rs).

METHODS

Thirty-nine participants were randomized into RT-G (n = 13), HIIT-G (n = 13), or control (CG, n = 13) groups. RT utilized elastic bands, and HIIT involved cycle ergometers, with three weekly 30 min sessions for 8 weeks. SBP and DBP were measured before intervention and at weeks 4 and 8, respectively. Individual responses were classified as NRs or Rs using the Hopkins method (SDIR = √[SDExp2-SDCon2]). Time-course adaptations were evaluated.

RESULTS

Both the RT-G and HIIT-G reduced SBP at 8 weeks (RT-G: -13 mmHg; [ES: 1.12]; HIIT-G: -12 mmHg [ES: 0.8]; both p < 0.05). The proportion of NRs for SBP decreased from 46% to 38% in RT-G and 69% to 46% in HIIT-G. Rs showed a peak SBP reduction at 4 weeks (-14.7 and -25.5 mmHg), stabilizing by week 8 (-22.8 and -19.6 mmHg) in RT-G and HIIT-G, respectively.

CONCLUSION

Eight weeks of RT and HIIT effectively reduced SBP and NR prevalence, with time-course adaptations favoring Rs.

Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).

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 aerobic combined with resistance exercise on cardiorespiratory fitness and cardiometabolic health in breast cancer survivors: A Systematic Review, meta-analysis and meta-regression

Background

Cardiotoxicity from chemotherapy is a serious risk to the quality of survival of breast cancer survivors (BCS), and aerobic combined with resistance exercise (CE) has the potential to combat this cardiac damage. However, there is a lack of high-quality studies to assess the specific effects of CE. This study aimed to investigate the effects of CE on cardiopulmonary function (CRF) and cardiometabolic health in BCS.

Methods

A comprehensively searched of the 4 databases (PubMed, Embase, Web of Science, Cochrane Library) from the database construction until March 1, 2023. The included studies were randomized controlled trials (RCTs) reporting the effects of CE on CRF and cardiometabolic health in BCS. The quality of the literature was assessed by two independent reviewers using the Cochrane Collaboration Risk of Bias Tool. Weight means difference (WMD), or standardized mean difference (SMD), were combined using random or fixed effects models. Subgroup and meta-regression explored heterogeneity as well as covariate effects.

Results

40 studies were included in the meta-analysis, with 2849 participants. Results showed that CE significantly increased maximal oxygen uptake (VO2max) (WMD:4.55; 95% CI:2.84, 6.26; I2 = 91.90%, P < 0.001) and reduced body weight (BW) (WMD: 1.61; 95% CI: 2.44, -0.78; I2 = 38.60%, P = 0.032) and body mass index (BMI) (WMD: 0.86; 95% CI: 1.43, -0.29; I2 = 70.50%, P < 0.001) in BCS. Subgroup analysis showed that BMI (WMD: 1.15; 95% CI: 1.89, -0.41; I2 = 76.90%, P < 0.001) and VO2max (WMD:4.21; 95% CI:2.40, 6.02; I2 = 96.4%, P < 0.001) were more effective with supervision. Meta-regression analysis showed that sample size had a significant moderating effect on BW (Coeff: 0.03, 95% CI: 0.00, 0.06).

Conclusions

CE significantly increases CRF in BCS and improves most cardiometabolic health-related outcomes. In addition, there will be a need for many larger RCTs to explore the effects of CE on inflammatory biomarkers in BCS.

Effect of exercise training on the renin-angiotensin-aldosterone system: a meta-analysis

Blood pressure (BP) management reduces the risk of cardiovascular disease (CVD). The renin-angiotensin-aldosterone system (RAAS) plays an important role in regulating and maintaining blood volume and pressure. This analysis aimed to investigate the effect of exercise training on plasma renin, angiotensin-II and aldosterone, epinephrine, norepinephrine, urinary sodium and potassium, BP and heart rate (HR). We systematically searched PubMed, Web of Science, and the Cochrane Library of Controlled Trials until 30 November 2022. The search strategy included RAAS key words in combination with exercise training terms and medical subject headings. Manual searching of reference lists from systematic reviews and eligible studies completed the search. A random effects meta-analysis model was used. Eighteen trials with a total of 803 participants were included. After exercise training, plasma angiotensin-II (SMD -0.71; 95% CI -1.24, -0.19; p = 0.008; n = 9 trials), aldosterone (SMD -0.37; 95% CI -0.65, -0.09; p = 0.009; n = 8 trials) and norepinephrine (SMD -0.82; 95% CI -1.18, -0.46; p < 0.001; n = 8 trials) were reduced. However, plasma renin activity, epinephrine, and 24-h urinary sodium and potassium excretion remained unchanged with exercise training. Systolic BP was reduced (MD -6.2 mmHg; 95% CI -9.9, -2.6; p = 0.001) as was diastolic BP (MD -4.5 mmHg; 95% CI -6.9, -2.1; p < 0.001) but not HR (MD -3.0 bpm; 95% CI -6.0, 0.4; p = 0.053). Exercise training may reduce some aspects of RAAS and sympathetic nervous system activity, and this explains some of the anti-hypertensive response.

The effects of aerobic exercise on cardiometabolic health in postmenopausal females: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

After menopause, reductions in ovarian hormones increase the risk of cardiovascular disease. Aerobic exercise training has been shown to reduce cardiovascular risk in older adults, but its effectiveness in postmenopausal females is less definitive.

OBJECTIVES

The objectives of this study were to examine the: (1) effects of aerobic training, and (2) association between aerobic training intensity and cardiometabolic health outcomes in postmenopausal females.

DESIGN

Systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES AND METHODS

Six electronic databases were searched from inception to July 21, 2023 for aerobic training interventions reporting cardiometabolic outcomes in postmenopausal females. Data were synthesized qualitatively and random-effects meta-analyses and subgroup analyses (light, moderate, and vigorous intensity) were performed. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the certainty of evidence.

RESULTS

Fifty-nine studies (n = 4,225; 45-78 years old) were identified, 53 (n = 3,821) were included in the quantitative analyses. Aerobic training interventions varied in frequency (3-21×/week), intensity, type, time (8-60 min/session), and duration (3-52 weeks). Aerobic training improved systolic blood pressure (mean difference (MD) = -4.41 mmHg, 95% confidence interval (95%CI) [-7.29, -1.52], p = 0.01), resting heart rate (MD = -3.08 bpm, 95%CI [-5.11, -1.05], p < 0.01), body mass index (BMI, MD = -0.65 kg/m2, 95%CI [-0.99, -0.31], p < 0.01), waist circumference (MD = -2.03 cm, 95%CI [-2.65, -1.41], p < 0.01), body fat (MD = -2.57 kg, 95%CI [-3.65, -1.49], p < 0.01), low-density lipoprotein cholesterol (MD = -10.46 mg/dL, 95%CI [-16.31, -4.61], p < 0.01), high-density lipoprotein cholesterol (MD = 3.28 mg/dL, 95%CI [0.20, 6.36], p = 0.04) and cardiorespiratory fitness (standardized MD = 1.38, 95%CI [1.13, 1.64], p < 0.01). There was a very low certainty of evidence for all outcomes. In subgroup analyses, light- and vigorous intensities were beneficial for BMI with no effect for moderate-intensity exercise (p < 0.01). Light intensity showed a beneficial effect (p = 0.02) for glucose levels (p < 0.01) and triglycerides; there was no effect with moderate or vigorous intensities.

CONCLUSION

Aerobic training may improve cardiometabolic health outcomes in postmenopausal females. There may be differential effects of exercise intensity on BMI, blood triglycerides, and blood glucose; however, this warrants further investigation.

REGISTRATION

PROSPERO-CRD42022313350.

Exercise may not just be good for sleep; It can also help lower cardiovascular event risk

Cardiovascular diseases (CVD) stand at the forefront of global mortality, presenting an immense and urgent public health challenge on a global scale. Effectively addressing the associated risk factors is pivotal in not only preventing but also stabilizing and potentially reversing the progression of these conditions. Emerging research illuminates a compelling correlation between sleep disorders and CVD. Clinically, individuals afflicted with existing CVD or those possessing risk factors frequently grapple with sleep disturbances, exacerbating their conditions, particularly in severe cases where disease progression is accelerated. Even among ostensibly healthy individuals, chronic sleep deprivation exacts a toll on cardiovascular function. The strategic implementation of exercise interventions emerges as a potent tool in enhancing sleep quality, surpassing the efficacy of pharmaceutical treatments. Furthermore, the maintenance of optimal sleep patterns significantly contributes to lowering the risk of cardiovascular diseases. This comprehensive review delves deeply into the intricate relationship between exercise and the amelioration of cardiovascular disease risk associated with sleep. Moreover, it meticulously elucidates the complex mechanisms through which exercise operates, effectively reducing cardiovascular disease risk from the unique perspective of sleep science.

Effect of leisure-time physical activity on blood pressure in people with hypertension: a systematic review and meta-analysis

High blood pressure is a major risk factor for premature death. Leisure-time physical activities have been recommended to control hypertension. Studies examining how leisure-time physical activity affects blood pressure have found mixed results. We aimed to conduct a systematic review examining the effect of leisure-time physical activity (LTPA) on lowering blood pressure among adults living with hypertension. We searched studies in Embase, Medline/PubMed, Web of Science, Physical Education Index, Scopus and CENTRAL (the Cochrane Library). The primary outcome variables were systolic blood pressure (SBP) and diastolic blood pressure (DBP). This systematic review is registered on PROSPERO (CRD42021260751). We included 17 studies out of 12,046 screened articles in this review. Moderate-intensity LTPA (all types) reduced SBP compared to the non-intervention control group (MD -5.35 mm Hg, 95% CI -8.06 to -2.65, nine trials, n = 531, low certainty of the evidence). Mean DBP was reduced by -4.76 mm Hg (95% CI -8.35 to -1.17, nine trials, n = 531, low certainty of the evidence) in all types of LTPA (moderate intensity) group compared to the non-intervention control group. Leisure-time walking reduced mean SBP by -8.36 mmHg, 95% CI -13.39 to -3.32, three trials, n = 128, low certainty of the evidence). Walking during leisure time reduced -5.03 mmHg mean DBP, 95% CI -8.23 to -1.84, three trials, n = 128, low certainty of the evidence). Performing physical activity during free time probably reduces SBP and DBP (low certainty of the evidence) among adults with hypertension.

Postexercise Hypotension Is Delayed in Men With Obesity and Hypertension

Background

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

Purpose

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

Methods

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

Results

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

Conclusion

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

HIIE Protocols Promote Better Acute Effects on Blood Glucose and Pressure Control in People with Type 2 Diabetes than Continuous Exercise

This study compared the acute effects of a session of different high-intensity interval exercise (HIIE) protocols and a session of moderate-intensity continuous exercise (MICE) on blood glucose, blood pressure (BP), and heart rate (HR) in people with Type 2 Diabetes Mellitus (DM2). The trial included 44 participants (age: 55.91 ± 1.25 years; BMI: 28.95 ± 0.67 kg/m²; Hb1Ac: 9.1 ± 2.3%; 76 mmol/mol) randomized into three exercise protocols based on the velocity at which maximum oxygen consumption was obtained (vVO2 max): long HIIE (2 min at 100% vV̇o2peak + 2 min of passive rest); short HIIE (30 s at 100% vV̇o2peak + 30 s of passive rest); or MICE (14 min at 70% vV̇o2peak) on a treadmill. Capillary blood glucose, BP, and HR measurements were taken at rest, during peak exercise, immediately after the end of exercise, and 10 min after exercise. Long and short HIIE protocols reduced capillary blood glucose by 32.14 mg/dL and 31.40 mg/dL, respectively, and reduced systolic BP by 12.43 mmHg and 8.73 mmHg, respectively. No significant changes were observed for MICE. HIIE was found to promote more acute effects than MICE on glycemia and BP in people with DM2.

Effects of Aquatic Exercise in Post-exercise Hypotension: A Systematic Review and Meta-Analysis

Background

Post-exercise hypotension (PEH) can be an important non-pharmacological strategy in the treatment of arterial hypertension. Both aerobic and resistance exercises produce PEH, but it is not clear if the exercise environment can lead to a higher PEH.

Objective

This meta-analysis investigated whether a session of aquatic exercise (AE) induces PEH in comparison with control conditions such as land exercise (LE) or rest in hypertensive subjects.

Methods

The present systematic review and meta-analysis was conducted using the following electronic databases: PubMed, Google Scholar, and EMBASE. Ambulatory blood pressure measurements made in randomized clinical trials were pooled to compare PEH induced by AE with LE and rest conditions in hypertensive subjects.

Results

Data from four trials were included, which comprised 127 participants (94 women and 33 men). A 24-h analysis did not detect significant differences between AE and LE or rest for either systolic blood pressure (SBP) or diastolic blood pressure (DBP). Monitoring during the night showed that AE induced significant PEH in comparison with LE for SBP [−8.6 (−15.0 to −1.5) mmHg (p = 0.01)]. For DBP, the AE had pronounced PEH during the night in comparison with LE [−3.7 (−4.7 to −2.8) mmHg, p = 0.000] and rest [−1.7 (−1.9 to −0.8) mmHg, p = 0.000]. There were no differences in daytime values.

Conclusion

AE showed a higher PEH effect than LE sessions and rest conditions. PEH was observed in both SBP and DBP during the night. The number of studies was low, but all studies included in this meta-analysis used 24-h monitoring. The understanding of clinical relevance of AE, inducing a higher PEH, depends on a standardization of exercise protocols plus a rigorous monitoring of blood pressure.

Systematic Review Registration

PROSPERO registration: CRD42021271928.

Enhancing oxygenation of patients with coronavirus disease 2019: Effects on immunity and other health-related conditions

Coronavirus disease 2019 (COVID-19) distresses the pulmonary system causing acute respiratory distress syndrome, which might lead to death. There is no cure for COVID-19 infection. COVID-19 is a self-limited infection, and the methods that can enhance immunity are strongly required. Enhancing oxygenation is one safe and effective intervention to enhance immunity and pulmonary functions. This review deliberates the probable influences of enhancing oxygenation on immunity and other health-connected conditions in patients with COVID-19. An extensive search was conducted through Web of Science, Scopus, Medline databases, and EBSCO for the influence of enhancing oxygenation on immunity, pulmonary functions, psycho-immune hormones, and COVID-19 risk factors. This search included clinical trials and literature and systematic reviews. This search revealed that enhancing oxygenation has a strong effect on improving immunity and pulmonary functions and psycho-immune hormones. Also, enhancing oxygenation has a self-protective role counter to COVID-19 risk factors. Lastly, this search revealed the recommended safe and effective exercise protocol to enhance oxygenation in patients with COVID-19. Enhancing oxygenation should be involved in managing patients with COVID-19 because of its significant effects on immunity, pulmonary functions, and COVID-19 risk factors. A mild to moderate cycling or walking with 60%-80% Vo2max for 20-60 min performed 2-3 times per week could be a safe and effective aerobic exercise program in patients with COVID-19 to enhance their immunity and pulmonary functions.

Glutathione S-transferase M1 and T1 genes deletion polymorphisms and blood pressure control among treated essential hypertensive patients in Burkina Faso

OBJECTIVE

Glutathione S-transferases have been associated with experimental resistance to some drugs. The present study investigated the factors associated with blood pressure control in patients with essential hypertension, especially the role of GSTT1 and GSTM1 genes polymorphisms. This cross-sectional study in Burkina Faso consisted of 200 patients with essential hypertension and under treatment.

RESULTS

In the present study, 57.5% (115/200) of patients had their hypertension under control. No statistically significant difference was found between controlled and uncontrolled groups for anthropometric and biochemical parameters as well as for GSTT1 or GSTM1 gene polymorphisms (all p > 0.05). Current alcohol consumption (OR = 3.04; CI 1.88-6.13; p < 0.001), Physical inactivity (OR = 3.07; CI 1.71-5.49; p < 0.001), severe hypertension before any treatment (Grade III [OR = 3.79; CI 2.00-7.17; p < 0.001]) and heart damage (OR = 3, 14; CI 1.59-6.02; p < 0.001) were statistically more frequent in uncontrolled essential hypertensive patients than controlled hypertensive patients.

Effects of combined training performed two or four times per week on 24-h blood pressure, glycosylated hemoglobin and other health-related outcomes in aging individuals with hypertension: Rationale and study protocol of a randomized clinical trial

BACKGROUND

Acute blood pressure lowering after exercise seems to predict the extent of blood pressure reduction after chronic exercise training interventions. Based on that, the same weekly amount of exercise performed more frequently could be more beneficial for controlling blood pressure.

PURPOSE

To compare the effects of a combined training program (resistance plus aerobic exercise) performed four or two times per week on 24-h ambulatory blood pressure and other health-related outcomes in middle-aged and older individuals with hypertension.

METHODS

This study will be a randomized, parallel group, two-arm, superiority trial. Ninety-eight participants aged 50-80 years with a previous physician diagnosis of hypertension will be randomized to perform two or four sessions per week of combined training using the same total weekly overload. Primary outcomes will be 24-h ambulatory blood pressure and glycosylated hemoglobin; secondary outcomes will be endothelial function, physical fitness and quality of life. The outcomes will be assessed at baseline and at the end of 12 weeks period.

RESULTS

Our conceptual hypothesis is that a combined exercise program performed four or two times per week with equalized weekly volume/overload will improve all outcomes in comparison to the baseline values, and that reductions in 24-h blood pressure and glycosylated hemoglobin will be more pronounced in the group that trained four times a week than twice. The results of this trial are expected to provide evidences to support that higher weekly frequency of combined training should be emphasized in aging adults with hypertension.

The effect of remote ischaemic conditioning on blood pressure response: A systematic review and meta-analysis

BACKGROUND

Previous work has evaluated the effect of remote ischaemic conditioning (RIC) in a number of clinical conditions (e.g. cardiac surgery and acute kidney injury), but only one analysis has examined blood pressure (BP) changes. While individual studies have reported the effects of acute bouts and repeated RIC exposure on resting BP, efficacy is equivocal. We conducted a systematic review and meta-analysis to evaluate the effects of acute and repeat RIC on BP.

METHODS

A systematic search was performed using PubMed, Web of Science, EMBASE, and Cochrane Library of Controlled Trials up until October 31, 2020. Additionally, manual searches of reference lists were performed. Studies that compared BP responses after exposing participants to either an acute bout or repeated cycles of RIC with a minimum one-week intervention period were considered.

RESULTS

Eighteen studies were included in this systematic review, ten examined acute effects while eight investigated repeat effects of RIC. Mean differences (MD) for outcome measures from acute RIC studies were: systolic BP 0.18 mmHg (95%CI -0.95, 1.31; p = 0.76), diastolic BP -0.43 mmHg (95%CI -2.36, 1.50; p = 0.66), MAP -1.73 mmHg (95%CI -3.11, -0.34; p = 0.01) and HR -1.15 bpm (95%CI -2.92, 0.62; p = 0.20). Only MAP was significantly reduced. Repeat RIC exposure showed non-significant change in systolic BP -3.23 mmHg (95%CI -6.57, 0.11; p = 0.06) and HR -0.16 bpm (95%CI -7.08, 6.77; p = 0.96) while diastolic BP -2.94 mmHg (95%CI -4.08, -1.79; p < 0.00001) and MAP -3.21 mmHg (95%CI -4.82, -1.61; p < 0.0001) were significantly reduced.

CONCLUSIONS

Our data suggests repeated, but not acute, RIC produced clinically meaningful reductions in diastolic BP and MAP.

The Burden of Hypertension and Associated Factors Among Adults Visiting the Adult Outpatient Department at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2016

Background

Hypertension is a global health concern that can lead to cardiovascular disease and death. In Ethiopia, the risks for cardiovascular disease have been increasing dramatically. But due to the high burden of communicable diseases, less emphasis is given to non-communicable diseases like hypertension. This study aimed to fill the information gap by determining the prevalence and the key determinants of hypertension in the study area.

Methods

Institution-based cross-sectional study was conducted in Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia from September to October 2016. A total of 414 adults visiting medical OPDs were selected using systematic random sampling. Data were collected by blood pressure measurements and a pre-tested structured questionnaire. Descriptive statistics were computed. Multivariable logistic regression analysis was used to determine the adjusted odds ratio with a 95% confidence interval. The goodness of fit of the model was also checked by Hosmer and Lemeshow test.

Results

The overall prevalence of hypertension in the study area was 38.9% (95% CI: 34.1-43.7). Age above 55 years (AOR = 3.33, 95% CI: 1.88-5.90), family history of hypertension (AOR = 2.71, 95% CI: 1.37-5.36), diabetes (AOR = 4.15, 95% CI 1.77-9.72), obesity (AOR = 5.50, 95% CI: 2.07-14.62), knee arthritis (AOR = 1.71, 95% CI: 1.24, 2.36), and not walking at least for 10 minutes continuously on daily basis (AOR = 2.86, 95% CI: 1.15 -7.12) were found to be independent predictors of hypertension.

Conclusion

Prevalence of hypertension was high in the study area, and a large proportion of them were also newly diagnosed. Factors like age, family history of hypertension, diabetes, obesity, knee arthritis, and exercise were found to be independent predictors of hypertension. Therefore, we recommend people who have these risk factors to have screening for hypertension.

ENDOTHELIAL NITRIC OXIDE CONCENTRATIONS IN THE SALIVA OF JIU-JITSU ATHLETES

ABSTRACT Introduction This article discusses the production of nitric oxide under the influence of sport-specific physical training, measured by the salivary nitrite of Jiu-Jitsu athletes. Objectives To verify the potential of the sport to produce optimal levels of nitric oxide stimulated by exertion, and to quantify training-related nitric oxide concentrations. Method The study participants were 14 volunteer athletes from the Tatame project (extension project), who were monitored for nine months in their training routine, providing samples of unstimulated saliva. Samples were collected each month, in three periods of the day: in the morning upon waking, immediately before training, and immediately after training. Salivary nitrite was quantified by the colorimetric Griess assay. Training heart rates were also monitored in order to establish training intensity. Results Mean monthly salivary nitrite levels showed a significant correlation with mean monthly heart rates, suggesting that salivary nitrite responds to training. However, salivary nitrite concentrations measured immediately after training were always lower than in the pre-training period. Conclusion The post-training reduction in concentrations was due to the nature of the sport studied, since because it involves a fight, the intense sympathetic stimulation inhibited salivary gland activity and irrigation, preventing salivary nitrite from producing an increase in circulating nitric oxide. Level of evidence IV; Case series.

Role of increasing the aerobic capacity on improving the function of immune and respiratory systems in patients with coronavirus (COVID-19): A review

BACKGROUND AND AIMS

COVID-19 is a public world crisis, however, it is a self-limited infection. In COVID-19, the strength of immune and respiratory systems is a critical element. Thus, this review was conducted to demonstrate the short and long term effects of increasing the aerobic capacity on increasing the function and strength of immune and respiratory systems, particularly those essential for overcoming COVID-19 infections and associated disorders.

METHODS

This review was carried out by searching in Web of Science, Scopus, EBSCO, Medline databases. The search was conducted over clinical trials and literature and systematic reviews on the effects of increasing the aerobic capacity on the function and strength of specific immune and respiratory elements essential for overcoming COVID-19 infections.

RESULTS

This review found that increasing the aerobic capacity could produce short-term safe improvements in the function of immune and respiratory systems, particularly those specific for COVID-19 infections. This could be mainly produced through three mechanisms. Firstly, it could improve immunity by increasing the level and function of immune cells and immunoglobulins, regulating CRP levels, and decreasing anxiety and depression. Secondly, it could improve respiratory system functions by acting as an antibiotic, antioxidant, and antimycotic, restoring normal lung tissue elasticity and strength. Lastly, it could act as a protective barrier to decrease COVID-19 risk factors, which helps to decrease the incidence and progression of COVID-19.

CONCLUSION

This review summarizes that increasing the aerobic capacity is recommended because it has potential of improving immune and respiratory functions which would help counter COVID-19.

Carotid baroreflex control of central and peripheral hemodynamics during recovery after moderate leg cycling exercise

This study aimed to examine the carotid baroreflex (CBR) control of the central and peripheral hemodynamics after exercise using the neck pressure (NP) and neck suction (NS) technique. Sixteen healthy young male participants (age: 27 ± 1.5 yr) were in a supine position for 30 min preexercise, followed by 60 min of cycling exercise, and then returned to a supine position for an additional 60 min postexercise. Both pre- and postexercise, the CBR-mediated responses of the central and peripheral hemodynamics were evaluated using 5-s periods of NP and NS (-60, -40, or +40 mmHg). As the central hemodynamics measurements, heart rate (HR), mean arterial pressure (MAP), cardiac output, and total vascular conductance were assessed. To determine peripheral circulation, vascular conductance in active and inactive limbs was measured. Eight participants [responder (RE) group] showed substantial postexercise hypotension (PEH) during recovery from exercise (Δ MAP: approximately -5 ± 0.9 mmHg, P < 0.05). The other eight participants did not display a reduction in MAP after exercise (non-RE group). In the non-RE group, the responsiveness of CBR-mediated changes in HR, MAP, and vascular conductance increased, particularly in response to -40 mmHg NS during postexercise compared with preexercise. However, in the RE group, any alterations in responsiveness to NP and NS were unchanged during PEH compared with preexercise. In conclusion, some normotensive individuals do not show PEH because the responsiveness of the CBR in central and peripheral hemodynamics following exercise is augmented, particularly to high blood pressure.NEW & NOTEWORTHY The carotid baroreflex (CBR) control of central and peripheral hemodynamics was investigated after exercise in both the presence and absence of postexercise hypotension (PEH). In individuals with no PEH, the responsiveness of CBR-mediated changes in all hemodynamics was augmented after exercise, particularly to high blood pressure; conversely, the CBR responsiveness remained unchanged in individuals with PEH. These findings provide insight into the mechanism of CBR control after exercise.

The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis

Cardiovascular disease (CVD) morbidity and mortality is highly prevalent in patients with rheumatoid arthritis (RA) with debilitating effects for the individual as well as significant healthcare impact. Current evidence demonstrates that engaging in aerobic and resistance exercise (i.e. structured physical activity) can significantly improve patient-reported and clinical index-assessed outcomes in RA. In addition to this, engagement in exercise programmes improves, in a dose-dependent manner, the risk of developing CVD as well as CVD symptoms and outcomes. The present narrative review uses evidence from systematic reviews and meta-analyses as well as controlled trials, to synthesize the current state-of-the-art on the potential effects of aerobic and resistance exercise on CVD risk factors as well as on cardiac and vascular function and structure in people with RA. Where there is a lack of evidence in RA to explain potential mechanisms, relevant studies from the general population are also discussed and linked to RA.

Exercise Prevents Hypertension and Disrupts the Correlation Between Vascular Sympathetic Activity and Age-Related Increase in Blood Pressure in SHRs

BACKGROUND

Hypertension usually accompanies the elevated sympathetic activity and sleep interruption. Few researches explored the dynamic changes and possible correlations in cardiovascular functions and sleep patterns during the development of hypertension. In contrast, exercise training provides several benefits on cardiovascular and sleep function in hypertensive subjects. However, controlling various factors during a long period of exercise training is difficult in hypertensive subjects, an animal model may be essential. This study aimed to explore dynamic changes in cardiovascular functions and sleep patterns during the development period of hypertension (10-20 weeks old) in spontaneously hypertensive rats (SHRs) and effects of exercise intervention.

METHODS

We used the treadmill exercise model for 8 weeks and started when SHRs were 12 weeks old. Electroencephalogram, electromyogram, electrocardiogram, and blood pressure (BP) were recorded simultaneously for 24 hours once a week over 11 weeks.

RESULTS

Untrained SHRs revealed the age-related increments in BP, and the significant increasing slopes of differences on BP and vascular sympathetic activity were observed during the development period of hypertension. Compared with untrained rats, age-related increases in BP and vascular sympathetic activity were significantly suppressed in trained SHRs. Nevertheless, trained SHRs showed more quiet sleep time at partial weeks. The positive correlation between the differences from 10 weeks of vascular sympathetic activity and BP was disappeared in trained SHRs.

CONCLUSIONS

There existed the significant correlation between the dynamic changes of vascular sympathetic activity and age-related elevation of BP during the development period of hypertension; however, exercise prevented hypertension and disrupted this correlation.

Role of Nutrition and Exercise Programs in Reducing Blood Pressure: A Systematic Review

The combined effect of diet and strength training (ST) on blood pressure (BP) seems to be very important for the treatment of prehypertension and hypertension (HT). Therefore, the aim of this study was to determine whether ST alone or combined with nutrition or supplementation has an impact on the arterial pressure reduction in normotensive and hypertensive populations. A systematic computerized literature search was performed according to the PRISMA guidelines using PubMed, Scopus and Google Scholar; only English language studies published from 1999 until 2018 were included. This systematic search identified the results of 303 individuals from nine studies. The ST program alone had a similar effectiveness as the nutrition program (NP) alone; however, their combination did not result in increased effectiveness in terms of a high BP reduction. The consumption of L-citrulline had a similar effect as ST on lowering BP; on the other hand, caffeine led to an increase in BP during the ST session. Our data suggest that a combination of ST 2-3 times a week at moderate intensity and a NP seems to be equally effective in terms of lowering BP (systolic and diastolic) as ST and NP alone.

Intervention with a combined physical exercise training to reduce oxidative stress of women over 40 years of age

Exercise training has been shown to be one of the most important lifestyle factor for improving functional performance and health status. Nevertheless, and although some evidence exists about the effects of aerobic training on oxidative stress, there is scarce information concerning the effects of combined exercise training (aerobic and strength training) in oxidative stress. Considering this, the aim of this study was to verify the effects of a combined exercise training in oxidative stress parameters of women over 40 years of age. At baseline, 67 women enrolled in the study and were divided into three groups: younger group (YG, n = 28: 40 to 49 years), middle-aged group (MAG, n = 21: 50 to 59 years) and oldest group (OG, n = 18: above 60 years). These women engaged in a combined exercise training program for 16 weeks, 3 sessions of 60 min per week. At the end of the program, only 31 women (YG: 15; MAG: 8 and OG: 8) were remained in the study and were considered for analysis. Physical assessments (weight, height, body mass index and waist circumference), health and functional parameters (systolic and diastolic blood pressure, fitness tests: supine, latissimus, squat jump, 8 foot up and go test, 30 second chair stand test, and 6 min walk test) and measures of DNA damage (DNA SBs, DNA netFPG), lipid peroxidation (MDA), total antioxidant capacity (TAC) and catalase activity (CAT) were performed before and after the 16-week intervention with combined exercise. The results showed an improvement of overall physical and functional performance as well as a significant decrease in waist perimeter and systolic blood pressure after the exercise program intervention. Regarding the biochemical measures, the exercise training induced a significant decrease in oxidative damage, and a significant increase in the TAC (p < 0.05). The results indicate that combined exercise training induces benefits in functional capacity and reduce damage caused by oxidative stress.

Postexercise Hypotension as a Predictor for Long-Term Training-Induced Blood Pressure Reduction: A Large-Scale Randomized Controlled Trial

OBJECTIVE

To investigate the correlation between acute exercise effects and chronic training effects on blood pressure (BP).

DESIGN

Randomized, controlled training study focusing on the optimization of preventive effects of physical training.

SETTING

The study was performed in a university department.

PARTICIPANTS

One hundred twenty-seven healthy, untrained subjects.

INTERVENTION

Subjects were divided into 4 groups: interval endurance training (IET) (n = 26, 4 × 4 min at 95% maximal heart rate), continuous endurance training (CET) (n = 23, 45 minutes at 60% heart rate reserve), strength endurance training (SET) (n = 40, 8 machine-based exercises, each 2 x 15 repetitions at the 20 repetition maximum), and control (CON) (n = 38). In the 3 training groups, subjects trained 3 times a week for 6 months, the CON group was asked to retain their sedentary lifestyle.

MAIN OUTCOME MEASURES

The acute exercise effect on BP was defined as the change of BP after an exhaustive stage test, compared with baseline. The chronic training effect on BP was determined as the change of resting BP after the 6-month training period.

RESULTS

For CET, a significant correlation between acute and chronic effects on systolic (r = 0.66, P = 0.001) and diastolic (r = 0.66, P = 0.001) BP was observed. For SET, a significant correlation (r = 0.45, P = 0.007) was found only for diastolic BP. No significant correlations were found for IET.

CONCLUSIONS

It can be assumed that postexercise hypotension is an easy-to-use predictor for the efficacy of CET to reduce BP, and may be a valuable tool for physicians to individualize prescribed training schedules for patients to reduce cardiovascular risk.

TRIAL REGISTRATION

www.clinicaltrials.gov; ID: NCT01263522.

The influence of physical training status on postexercise hypotension in patients with hypertension: a cross-sectional study

BACKGROUND

To date, few studies have analyzed postexercise hypotension (PEH) in hypertensive patients with different levels of physical fitness.

AIM

Therefore, this study aimed to compare PEH in trained and sedentary hypertensive individuals.

METHODS

Fifty-one well-controlled hypertensive patients of both sexes were assigned to a trained group [60.4±9.4 years; resting blood pressure (BP)=126.3±5.4/75.0±6.3 mmHg; VO2peak=27.3±4.6 ml kg/min] and 58 sedentary hypertensive patients of both sexes were assigned to a sedentary group (63.1±8.9 years; resting BP=134.1±4.2/82.9±5.8 mmHg; VO2peak=20.6±5.5 ml/kg/min). In a cross-sectional design, the individuals were randomized to perform an aerobic exercise session (treadmill; 40 min; 55% VO2peak) and a control session on two different days in the morning. After each session, participants wore an ambulatory BP device for 12 h.

RESULTS

Although no significant differences were identified in BP after the control session, after the experimental session, the trained participants presented lower values than the sedentary participants for systolic (124.1±6.3 vs. 133.4±5.2 mmHg, P<0.01) and diastolic BP (73.1±4.4 vs. 85.5±6.4 mmHg, P<0.01) over the course of 12 h monitoring. For the trained participants, significant correlations were also identified (P<0.05) between the VO2peak and systolic (R=-0.68) and diastolic BP (R=-0.61) 12 h monitoring.

CONCLUSION

In conclusion, the training level of hypertensive patients influences PEH.

A Single Session of Low-Volume High-Intensity Interval Exercise Reduces Ambulatory Blood Pressure in Normotensive Men

Dantas, TCB, Farias Junior, LF, Frazão, DT, Silva, PHM, Sousa Junior, AE, Costa, IBB, Ritti-Dias, RM, Forjaz, CLM, Duhamel, TA, and Costa, EC. A single session of low-volume high-intensity interval exercise reduces ambulatory blood pressure in normotensive men. J Strength Cond Res 31(8): 2263-2269, 2017-The magnitude and duration of postexercise hypotension (PEH) may provide valuable information on the efficacy of an exercise approach to blood pressure (BP) control. We investigated the acute effect of a time-efficient high-intensity interval exercise (HIIE) on ambulatory BP. Twenty-one normotensive men (23.6 ± 3.6 years) completed 2 experimental sessions in a randomized order: (a) control (no exercise) and (b) low-volume HIIE: 10 × 1 minute at 100% of maximal treadmill velocity interspersed with 1 minute of recovery. After each experimental session, an ambulatory BP monitoring was initiated. Paired sample t-test was used to compare BP averages for awake, asleep, and 20-hour periods between the control and the low-volume HIIE sessions. A 2-way repeated measures analysis of variance was used to analyze hourly BP after both experimental sessions. Blood pressure averages during the awake (systolic: 118 ± 6 vs. 122 ± 6 mm Hg; diastolic: 65 ± 7 vs. 67 ± 7 mm Hg) and 20-hour (systolic: 115 ± 7 vs. 118 ± 6 mm Hg; diastolic: 62 ± 7 vs. 64 ± 7 mm Hg) periods were lower after the low-volume HIIE compared with the control (p ≤ 0.05). Systolic and diastolic PEH presented medium (Cohen's d = 0.50-0.67) and small (Cohen's d = 0.29) effect sizes, respectively. Systolic PEH occurred in a greater magnitude during the first 5 hours (3-5 mm Hg). No changes were found in asleep BP (p > 0.05). In conclusion, a single session of low-volume HIIE reduced ambulatory BP in normotensive men. The PEH occurred mainly in systolic BP during the first 5 hours postexercise.

IMPACTO DO EXERCÍCIO CONTÍNUO E INTERVALADO NA RESPOSTA AUTONÔMICA E PRESSÓRICA EM 24 HORAS

RESUMO Introdução: Exercícios físicos aeróbicos contínuos são os mais relacionados com a hipotensão pós-exercício. No entanto, são escassas as informações sobre o impacto do exercício intervalado sobre a resposta pressórica de 24 horas. Objetivo: Comparar as respostas pressóricas subagudas e agudas em uma sessão de exercício aeróbico contínuo e intervalado e identificar possíveis modulações em indicadores de atividade autonômica em adultos normotensos. Métodos: Submeteram-se 25 adultos normotensos saudáveis a três sessões experimentais: controle (30 minutos em repouso), exercício contínuo (30 min. - 60%-70% da FCres) e exercício intervalado (6 sessões de 5 minutos com intervalos de 2 min. - 60-70% da FCres) e seus parâmetros cardiovasculares foram monitorados por 24 horas após as sessões. Para comparação dos dados, foi utilizada a ANOVA para medidas repetidas, seguida de suas hipóteses. Resultados: No acompanhamento subagudo foi identificada redução significativa (P < 0,05) da pressão arterial sistólica somente após a sessão de exercício contínuo em comparação com a sessão de repouso (115 ± 2 mmHg vs. 112 ± 2 mmHg) e à sessão controle (119 ± 2 mmHg vs. 112 ± 2 mmHg). Não se identificou redução da pressão arterial ambulatorial em nenhuma das sessões experimentais. Os indicadores autonômicos parassimpáticos (RMSSD e pNN50) permaneceram reduzidos após 30 minutos em ambas as sessões de exercício. Conclusão: Uma única sessão de exercício aeróbico contínuo causa redução subaguda da pressão arterial em adultos normotensos. A sessão única de exercício aeróbico contínuo e intervalado não promove redução da pressão arterial ambulatorial na média nos períodos intermediários de sono e vigília.

Effects of meal ingestion on blood pressure and regional hemodynamic responses after exercise

This study investigated the combined effects of consuming a meal during postexercise hypotension (PEH) on hemodynamics. Nine healthy young male subjects performed each of three trials in random order: 1) cycling at 50% of heart rate reserve for 60 min, 2) oral ingestion of a carbohydrate liquid meal (75 g glucose), or 3) carbohydrate ingestion at 40 min after cycling exercise. Blood pressure, heart rate, cardiac output, and blood flow in the superior mesenteric (SMA), brachial, and popliteal arteries were measured continuously before and after each trial. Regional vascular conductance (VC) was calculated as blood flow/mean arterial pressure. Blood pressure decreased relative to baseline values ( P < 0.05) after exercise cessation. Blood flow and VC in the calf and arm increased after exercise, whereas blood flow and VC in the SMA did not. Blood pressure did not change after meal ingestion; however, blood flow and VC significantly decreased in the brachial and popliteal arteries and increased in the SMA for 120 min after the meal ( P < 0.05). When the meal was ingested during PEH, blood pressure decreased below PEH levels and remained decreased for 40 min before returning to postexercise levels. The sustained increase in blood flow and VC in the limbs after exercise was reduced to baseline resting levels immediately after the meal, postprandial cardiac output was unchanged by the increased blood flow in the SMA, and total VC and SMA VC increased. Healthy young subjects can suppress severe hypotension by vasoconstriction of the limbs even when carbohydrate is ingested during PEH.

Acute Effects of Exercise on Blood Pressure: A Meta-Analytic Investigation

Hypertension affects 25% of the world's population and is considered a risk factor for cardiovascular disorders and other diseases. The aim of this study was to examine the evidence regarding the acute effect of exercise on blood pressure (BP) using meta-analytic measures. Sixty-five studies were compared using effect sizes (ES), and heterogeneity and Z tests to determine whether the ES were different from zero. The mean corrected global ES for exercise conditions were -0.56 (-4.80 mmHg) for systolic BP (sBP) and -0.44 (-3.19 mmHg) for diastolic BP (dBP; z ≠ 0 for all; p < 0.05). The reduction in BP was significant regardless of the participant's initial BP level, gender, physical activity level, antihypertensive drug intake, type of BP measurement, time of day in which the BP was measured, type of exercise performed, and exercise training program (p < 0.05 for all). ANOVA tests revealed that BP reductions were greater if participants were males, not receiving antihypertensive medication, physically active, and if the exercise performed was jogging. A significant inverse correlation was found between age and BP ES, body mass index (BMI) and sBP ES, duration of the exercise's session and sBP ES, and between the number of sets performed in the resistance exercise program and sBP ES (p < 0.05). Regardless of the characteristics of the participants and exercise, there was a reduction in BP in the hours following an exercise session. However, the hypotensive effect was greater when the exercise was performed as a preventive strategy in those physically active and without antihypertensive medication.

Influence of Physical Activity on Hypertension and Cardiac Structure and Function

The global burden of hypertension is rising and accounts for substantial morbidity and mortality. Lifestyle factors such as diet and physical inactivity contribute to this burden, further highlighting the need for prevention efforts to curb this public health epidemic. Regular physical activity is associated with lower blood pressure, reduced cardiovascular risk, and cardiac remodeling. While exercise and hypertension can both be associated with the development of left ventricular hypertrophy (LVH), the cardiac remodeling from hypertension is pathologic with an associated increase in myocyte hypertrophy, fibrosis, and risk of heart failure and mortality, whereas LVH in athletes is generally non-pathologic and lacks the fibrosis seen in hypertension. In hypertensive patients, physical activity has been associated with paradoxical regression or prevention of LVH, suggesting a mechanism by which exercise can benefit hypertensive patients. Further studies are needed to better understand the mechanisms underlying the benefits of physical activity in the hypertensive heart.

Effect of exercise training on the renin-angiotensin-aldosterone system in healthy individuals: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to evaluate the effect of exercise training on parameters of the renin-angiotensin-aldosterone system (RAAS) in healthy adults, and to investigate the relation with training induced changes in blood pressure. A systematic search was conducted and we included randomized controlled trials lasting ⩾4 weeks investigating the effects of exercise on parameters of the RAAS in healthy adults (age ⩾18 years) and published in a peer-reviewed journal up to December 2013. Fixed effects models were used and data are reported as weighted means and 95% confidence limits (CL). Eleven randomized controlled trials with a total of 375 individuals were included. Plasma renin activity was reduced after exercise training (n= 7 trials, standardized mean difference -0.25 (95% CL -0.5 to -0.001), P=0.049), whereas no effect was observed on serum aldosterone ((n= 3 trials; standardized mean difference -0.79 (-1.97 to +0.39)) or angiotensin II (n=3 trials; standardized mean difference -0.16 (-0.61 to +0.30). Significant reductions in systolic blood pressure -5.65 mm Hg (-8.12 to -3.17) and diastolic blood pressure -3.64 mm Hg (-5.4 to -1.91) following exercise training were observed. No relation was found between net changes in plasma renin activity and net changes in blood pressure (P>0.05). To conclude, although we observed a significant reduction in plasma renin activity following exercise training this was not related to the observed blood pressure reduction. Given the small number of studies and small sample sizes, larger well-controlled randomized studies are required to confirm our results and to investigate the potential role of the RAAS in the observed improvements in blood pressure following exercise training.

Recovery from exercise: vulnerable state, window of opportunity, or crystal ball?

Why should we study the recovery from exercise as a discrete phenomenon from exercise itself? We identify three distinct (but not mutually exclusive) rationales that drive the need to investigate the physiology of recovery from exercise. (1) Some individuals are at a heightened risk of clinical outcomes in the immediate post-exercise period; thus the potential negative outcomes of this “vulnerable state” must be weighed against the numerous benefits of exercise training, and may be mitigated to reduce risk. (2) Many of the signaling mechanisms responsible for the beneficial effects of exercise training remain amplified during the exercise recovery period, and may present a “window of opportunity” that can be exploited by interventions to enhance the beneficial adaptations to exercise training, especially in clinical populations. (3) On an individual level, exercise recovery responses may provide investigators with a “crystal ball” ability to predict future clinical outcomes even in apparently healthy individuals. In short, the physiology of recovery is a multi-faceted and complex process, likely involving systems and pathways that are distinct from the physiology of exercise itself. For these reasons, it merits ongoing study.

Assessing the Existing Professional Exercise Recommendations for Hypertension: A Review and Recommendations for Future Research Priorities

The Eighth Joint National Committee guideline on the management of adult hypertension was recently released. Rather than recommending specific lifestyle modifications as in the Seventh Joint National Committee guideline, the Eighth Joint National Committee endorsed the recommendations of the American Heart Association/American College of Cardiology 2013 Lifestyle Work Group. The Lifestyle Work Group report included systematic reviews and meta-analyses of randomized controlled trials or controlled clinical trials from 2001 through 2011 of "fair to good" quality. In total, 11 reviews qualified for inclusion in the report, 6 of which included blood pressure (BP) as the primary outcome. Three reviews did not find significant reductions in BP, and BP status was not reported in 5. When BP was reported, only 22% of the patients had hypertension. Yet, the group concluded with a strength of evidence categorized as "high" that aerobic exercise training reduces BP by 1 to 5 mm Hg in individuals with hypertension and that the most effective exercise interventions on average included aerobic physical activity of moderate to vigorous intensity for at least 12 weeks, 3 to 4 sessions per week lasting 40 minutes per session. The exercise prescription recommendations of the Lifestyle Work Group deviate from those of other professional organizations and committees including the Seventh Joint National Committee, another American Heart Association scientific statement, the American College of Sports Medicine, the European Society of Hypertension/European Society of Cardiology, and the Canadian Health Education Program. The purposes of this review are to present the existing exercise recommendations for hypertension, discuss reasons for differences in these recommendations, discuss gaps in the literature, and address critical future research needs regarding exercise prescription for hypertension.

Blood pressure responses to resistive exercise in trained female athletes: Influence of velocity of movement

The purpose of this study was to examine post-exercise hypotension (PEH) responses to three different resistance exercise velocities in female athletes. The 13 female subjects with experience of resistance training performed a series of resistance exercises with 80% of one repetition maximum for 3 sets with differing in velocity of movements: fast movement (FM; 1-second eccentric and 1-second concentric actions), moderate movement (MM; 1-second eccentric and 2-second concentric actions) and slow movement (SM; 2-second eccentric and 4-second concentric actions). After completing each training session, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were taken every 10 min for a period of 60 min of recovery. The results indicated significant increases in SBP at 10th min post-exercise in comparison to baseline. After 60-min recovery, all conditions showed statistically significant decreases in SBP when compared with pre-exercise. In all measured moments, there were no significant differences among experimental sessions in post-exercise levels of SBP and DBP. Therefore, resistance training with FM, MM, and SM can induce increases in SBP after exercise, whereas after 60-min recovery, can induce decreases in SBP or post-exercise hypotension.

Direct renin inhibitor therapy and swimming training: hemodynamic and cardiac effects in hypertensive and normotensive rats

PURPOSE

This study aimed to analyze the hemodynamic and cardiac effects of direct renin inhibitor (DRI) treatment and swimming training in hypertensive rats.

METHODS

Seventy-seven rats were divide into eight groups: sedentary normotensive (SN), trained normotensive (TN), sedentary normotensive treated with DRI (SN_DRI), trained normotensive treated with DRI (TN_DRI), sedentary hypertensive (SH), trained hypertensive (TH), sedentary hypertensive treated with DRI (SH_DRI), trained hypertensive treated with DRI (TH_DRI). Swimming training occurred for up to 60 min, five times a week for four weeks. The hypertensive animals were treated with 20 mg ċ kg(-1) ċ day(-1) L-NAME for four weeks. Groups treated with DRI received 10 mg ċ kg(-1) ċ day(-1) of aliskiren for four weeks. After the treatment period, all the animals underwent femoral artery catheterization surgery for direct measurement of cardiovascular variables.

RESULTS

The SH group presented hypertension (136.4 ± 5.0 mmHg) compared to the SN (107.1 ± 1.7 mmHg). The TH group showed lower mean arterial pressure (MAP) than the SH (121.1 ± 1.3 mmHg), but the treatment with DRI did not attenuate hypertension (128.2 ± 4.9 mmHg). The analysis of collagen areas demonstrated that treatment with DRI may attenuate cardiac remodeling in situations of hypertension, in the condition of treatment alone or combined with physical training.

CONCLUSION

Both interventions in combination may be more effective at reducing cardiovascular risk in hypertensive subjects.