A Mixed Comparisons of Aerobic Training With Different Volumes and Intensities of Physical Exercise in Patients With Hypertension: A Systematic Review and Network Meta-Analysis

Exercise Training Modalities in Young and Middle-Aged Adults With Prehypertension or Hypertension: A Systematic Review and Network Meta-Analysis

Aims

The question of how to choose the right type of exercise to lower blood pressure and cardiovascular risk factors in people worldwide with high blood pressure is not yet fully understood. Thus, the aim of this study was to investigate the effects of various exercise training on blood pressure and cardiovascular risk factors among young and middle-aged adults with prehypertension or hypertension.

Design

Systematic review and network meta-analysis.

Methods

We searched five electronic databases to identify randomized controlled trials that compare exercise training versus a sedentary or sham control group in young and middle-aged adults with prehypertension or hypertension. Review Manager 5.3, Stata15.0, and R4.2.1 software estimated the efficacy of exercise training modalities.

Results

We included 19 eligible articles with 1590 participants to assess five exercise trainings. Our findings indicated that low-middle intensity aerobic exercise (mean difference (MD) = -8.08, 95% confidence interval (CI) = -13.58, -2.58) was superior to all exercise strategies (high-intensity aerobic exercise: MD = -6.53, 95% CI = -12.51, -0.56; high-intensity resistance exercise: MD = -4.95, 95% CI = -11.07, 1.17; low-middle-intensity resistance exercise: MD = -3.49, 95% CI = -12.36, 5.39) compared with control group in lowering systolic blood pressure. Compared with the control strategy, high-intensity resistance exercise (MD = -4.75, 95% CI = -8.00, -1.50), high-intensity aerobic exercise (MD = -4.27, 95% CI = -7.08, -1.45) could lower diastolic blood pressure. The effects of different exercise patterns on cardiovascular risk factors, the results indicated that only low-middle-intensity aerobic exercise significantly improved body mass index (MD = -0.55, 95% CI = -7.08, -1.45), total cholesterol (MD = -19.07, 95% CI = -36.42, -1.72), triglycerides (MD = -14.32, 95% CI = -23.16, -5.48), high-density lipoprotein (MD = 2.29, 95% CI = 0.85, 3.73), and low-density lipoprotein (MD = -13.90, 95% CI = -22.18, -5.63). In addition, no intervention affects heart rate.

Conclusion

Compared with other types of exercise, aerobic exercise can significantly improve systolic blood pressure, while high-intensity resistance or aerobic exercise may significantly improve diastolic blood pressure. In addition, AE-LM is effective in the reduction of risk factors that are contributors to the development of cardiovascular disease. Therefore, this study provides strong evidence to support the selection of appropriate exercise modalities for hypertensive patients.

Digital phenotyping from heart rate dynamics: Identification of zero-poles models with data-driven evolutionary learning

Heart rate response to physical activity is widely investigated in clinical and training practice, as it provides information on a person's physical state. For emerging digital phenotyping approaches, there is a need for individualized model estimation. In this study, we propose a zero-poles model and a data-driven evolutionary learning method for identification. We also perform a comparison with existing first and second order models and gradient descent identification methods. The proposed model is based on a five-phase description of heart rate dynamics. Data was collected from 30 healthy participants using a treadmill and a thoracic sensor in two protocols (static and dynamic), for increasing and decreasing activity. Results show that the zero-poles model is a good fit for heart rate response to exercise (Pearson's coefficient ρ>.95), while first and second order models are also suitable (ρ>.92). The evolutionary learning method shows excellent results for fast model identification, in comparison with least-squares methods (p<.03). We surmise that the parameters of investigated linear dynamic models make good candidates for digital biomarkers and continuous monitoring.

The effectiveness of functional inspiratory muscle training on exercise capacity and peripheral muscle strength in patients with essential hypertension: a three-arm randomized controlled trial

BACKGROUND

The effect of inspiratory muscle training (IMT) applied along with function in Hypertension (HT) patients is uncertain. In this study, it was to determine the effectiveness of functional IMT (F-IMT) on functional lower and upper exercise capacity, mobility, peripheral and respiratory muscle strength, blood pressure, fatigue, physical activity, and quality of life (HRQoL) in HT patients.

METHODS

Prospective, randomized controlled, assessor-blinded, parallel three-armed trial. Forty-five patients with HT were divided into F-IMT group (IMT with 50% maximal inspiratory pressure (MIP)/4 weeks + exercise and IMT with 50% MIP/4 weeks, n = 15), IMT group (MIP 50%, n = 15) and control group (CG, breathing exercises, n = 15). 6-min walking test (6-MWT), 6-min pegboard ring test (6PBRT), 1-min sit to stand test (1STS), mobility, peripheral muscle strength, MIP, maximal expiratory pressure (MEP), systolic& diastolic blood pressure (SBP, DBP), fatigue, physical activity, and HRQoL were evaluated before and after 8 weeks of training.

RESULTS

Increases in 6-MWT were higher in F-IMT (p < 0.001). 6PBRT, 1STS, quadriceps femoris strength were improved and SBP reduced in F-IMT and IMT than CG (p < 0.001). Mobility, handgrip, HRQoL, and physical activity level increased within groups (p < 0.05). MIP increased within F-IMT and IMT; MEP, fatigue, DBP improved only within F-IMT (p < 0.05).

CONCLUSIONS

F-IMT is more effective in enhancing exercise capacity, reducing fatigue and DBP, and improving MEP. Both IMT and F-IMT show similar benefits for upper extremity exercise capacity, quadriceps femoris strength, SBP, and MIP. Mobility, HRQoL, and physical activity levels are increased with F-IMT, IMT, and breathing exercises.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT06343246 (03/29/2024).

Cross-evaluation of wearable data for use in Parkinson's disease research: a free-living observational study on Empatica E4, Fitbit Sense, and Oura

BACKGROUND

Established assessment scales used for Parkinson's disease (PD) have several limitations in tracking symptom progression and fluctuation. Both research and commercial-grade wearables show potential in improving these assessments. However, it is not known whether pervasive and affordable devices can deliver reliable data, suitable for designing open-source unobtrusive around-the-clock assessments. Our aim is to investigate the usefulness of the research-grade wristband Empatica E4, commercial-grade smartwatch Fitbit Sense, and the Oura ring, for PD research.

METHOD

The study included participants with PD (N = 15) and neurologically healthy controls (N = 16). Data were collected using established assessment scales (Movement Disorders Society Unified Parkinson's Disease Rating Scale, Montreal Cognitive Assessment, REM Sleep Behavior Disorder Screening Questionnaire, Hoehn and Yahr Stage), self-reported diary (activities, symptoms, sleep, medication times), and 2-week digital data from the three devices collected simultaneously. The analyses comprised three steps: preparation (device characteristics assessment, data extraction and preprocessing), processing (data structuring and visualization, cross-correlation analysis, diary comparison, uptime calculation), and evaluation (usability, availability, statistical analyses).

RESULTS

We found large variation in data characteristics and unsatisfactory cross-correlation. Due to output incongruences, only heart rate and movement could be assessed across devices. Empatica E4 and Fitbit Sense outperformed Oura in reflecting self-reported activities. Results show a weak output correlation and significant differences. The uptime was good, but Oura did not record heart rate and movement concomitantly. We also found variation in terms of access to raw data, sampling rate and level of device-native processing, ease of use, retrieval of data, and design. We graded the system usability of Fitbit Sense as good, Empatica E4 as poor, with Oura in the middle.

CONCLUSIONS

In this study we identified a set of characteristics necessary for PD research: ease of handling, cleaning, data retrieval, access to raw data, score calculation transparency, long battery life, sufficient storage, higher sampling frequencies, software and hardware reliability, transparency. The three analyzed devices are not interchangeable and, based on data features, none were deemed optimal for PD research, but they all have the potential to provide suitable specifications in future iterations.

The physical and psychological effects of dance therapy on middle-aged and older adult with arterial hypertension: A systematic review

Objective

To systematically review the intervention effect of dance therapy on the physical and psychological health level of middle-aged and older adult with arterial hypertension.

Methods

The databases including the Cochrane Library, PubMed, Web of Science, EBSCO, CNKI, VIP, WANFANG DATA, and Bailianyun Library, which were searched for the randomized controlled trials for identifying the effect of dance intervention on the blood pressure. The literature published from the establishment of the database to May 10, 2023, was collected for analysis. The quality of the literature was evaluated by the Cochrane bias risk assessment tool.

Results

The blood pressure in the dance intervention group were significantly improved than those of patients in the control group. However, among the mediating variables that influence the effects of dance intervention, its intensity and frequency based on the improvement of aerobic capacity were found high and low respectively, while the research on dance intervention aimed at muscle strength, endurance, and flexibility remains lacking. The movement selection and arrangement of dance therapy could integrate the physical activities with local traditional cultural characteristics.

Conclusions

It is worth noting that in the selection and arrangement of movements, dance therapy can skillfully integrate physical activities with local cultural characteristics. This unique combination not only enriches the content of dance therapy but also deepens people's understanding and recognition of traditional culture. Through this comprehensive dance intervention approach, we hope to comprehensively improve participants' physical and mental health, and promote the inheritance and development of culture.

The Western and Chinese exercise training for blood pressure reduction among hypertensive patients: An overview of systematic reviews

Hypertension remains the world's leading cause of premature death. Interventions such as exercise, diet modification, and pharmacological therapy remain the mainstay of hypertension treatment. Numerous systematic reviews and meta-analyses demonstrated the effectiveness of western exercises, such as aerobic exercise and resistance exercise, in reducing blood pressure in hypertensive patients. There is recently emerging evidence of blood pressure reduction with Chinese exercises, such as Tai Chi, Baduanjin, and Qigong. The current overview of systematic reviews aims to evaluate the quality and descriptively summarize the evidence for the effectiveness of western and Chinese exercises for hypertension management. Thirty-nine systematic reviews were included in this overview, with 15 of those being on Chinese exercise. Evidence suggests that exercise training, regardless of Western or Chinese exercise, generally reduced both systolic and diastolic blood pressure. High-intensity intermittent training did not further reduce blood pressure when compared to moderate-intensity continuous training. Conflicting results on the effectiveness of blood pressure reduction when comparing Chinese and Western exercise training were observed. This suggests the comparable effectiveness of Chinese exercise training, in particularly Tai Chi, to general or aerobic exercise training in terms of blood pressure reduction. The Chinese exercise modality and intensity may be more suitable for the middle-aged and elderly population.

Updates in the management of hypertension

Hypertension is the leading cause of cardiovascular diseases and nephropathies. Its treatment and management require long-term follow-up which can be facilitated by the emergence of device-based therapies. Novel recommendations have been well described in the latest ESH guidelines as well as new risk factors have been identified. The authors summarized the published evidence on hypertension management. The authors also cited in this review novel treatment approaches in different settings and the intervention of medication adherence in treatment success. Such non-communicable disease requires long-term follow-up and monitoring, which is quite facilitated in the era of digitalization by cuff-less devices based on prediction tools.

Physical activity and eating behaviors patterns associated with high blood pressure among Chinese children and adolescents

BACKGROUND

Physical activity and eating behavior are associated with hypertension in children and adolescents. Revealing the associations between physical activity patterns, eating behavior patterns and high blood pressure (HBP) could help improve the problem of hypertension from the actual children's physical activities and eating behaviors.

METHODS

A total of 687 students aged 8-15 years were selected from two nine-year primary and secondary schools using stratified cluster random sampling method. The students' body height, weight, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and their physical activity time and eating behaviors were surveyed by using CLASS questionnaire and self-made eating behavior questionnaire, respectively. Exploratory factor analysis (EFA) was used to extract moderate to vigorous physical activity factor (MVPAF), sedentary activity factor (SAF), healthy eating behavior factor (HEBF), unhealthy eating behavior factor (UHEBF). MVPAF ≥ SAF was defined as moderate to vigorous physical activity pattern (MVPAP), MVPAF < SAF was defined as sedentary activity pattern (SAP). HEBF ≥ UHEBF was defined as healthy eating behavior pattern (HEBP), while the opposite was defined as unhealthy eating behavior pattern (UHEBP). Lifestyles includes physical activity patterns and eating behavior patterns.

RESULTS

The overall prevalence of hypertension was 5.8% (40/687), and was 5.69% (21/369) in boys and 5.97% (19/318) in girls, respectively. The MVPAF and UHEBF in boys were significantly higher than those in girls (P < 0.01), while the SAF in girls was significantly higher than that in boys (P < 0.05). The SAF was positively correlated with SBP in girls (β(SE) = 0.14 (0.50), P = 0.016), and was positively correlated with SBP (β(SE) = 0.21 (1.22), P = 0.000 and DBP (β(SE) = 0.14 (0.49), P = 0.006) in boys. The MVPAF was negatively correlated with DBP (β(SE)=-0.11 (0.40), P = 0.022) in boys. In boys, the SAP increased the risks of HBP (OR (95% CI):3.34 (1.30-8.63)) and high DBP (OR (95% CI):3.08 (1.02-9.34)) compared with MVPAP.

CONCLUSION

Compared with the boys with MVPAP, boys with SAP may increase the risks of HBP and high DBP. The SAF may be positively associated with SBP in boys and girls, while the MVPAF may be negatively associated with DBP in boys.

Long-Term Physical Activity Effectively Reduces the Consumption of Antihypertensive Drugs: A Randomized Controlled Trial

BACKGROUND

Although physical activity (PA) has been shown to enhance hypertension control, the impact of exercise on the potential decrease of the use of antihypertensive medications remains inadequately researched.

AIM

The aim was to assess the impact of a two-year PA on the medication requirements of individuals with hypertension.

METHODS

A clinical trial was conducted, involving 130 participants with essential hypertension who took at least one antihypertensive medication. Participants were randomly assigned to either a control group (CG n = 65) or an experimental group (EG n = 65) that underwent a 24-month supervised PA program based on a combination of aerobic and resistance training. The antihypertensive drug load for each participant was determined by adding the ratios of the prescribed daily dose (PDD) to the defined daily dose (DDD) for all antihypertensive medications taken by the participants. The outcome measures were evaluated at 0, 6, 12, 18, and 24 months.

RESULTS

A total of 76 participants completed the 24-month assessment, and RM-ANOVA revealed a significantly lower antihypertensive drug load in the EG compared to the CG at 18 (p < 0.017) and 24 months (p < 0.003).

CONCLUSION

A long-term PA program can decrease the antihypertensive drug load in older adults with essential hypertension. The trend of improvement regarding the EG drug load intake and the trend of CG drug load increase, although not significant over time, results in a significant difference between the groups at 18 months and an even greater difference at 24 months. This trend certifies the protective value of PA against the aging process and its related health risk factors.

Feasibility and Efficacy of Low-to-Moderate Intensity Aerobic Exercise Training in Reducing Resting Blood Pressure in Sedentary Older Saudis with Hypertension Living in Social Home Care: A Pilot Randomized Controlled Trial

Background and Objectives: The effect of non-pharmacological aerobic exercise training on blood pressure in sedentary older individuals receiving social home care in Saudi Arabia has not been investigated. This study aimed to examine the effects of aerobic exercise on blood pressure in sedentary older Saudis with hypertension residing in these settings. Materials and Methods: A pilot randomized control trial was conducted with 27 sedentary individuals, aged 60-85, diagnosed with hypertension, and living in social home care in Makkah, Saudi Arabia. Recruitment took place between November 2020 and January 2021, and participants were randomly assigned to either the experimental or control group. The experimental group engaged in three 45 min sessions of low-to-moderate intensity aerobic activity per week for eight weeks. This trail was registered with the ISRCTN registry (ISRCTN50726324). Results: Following eight weeks of mild to moderate aerobic exercise training, the primary outcome of resting blood pressure showed a significant reduction in the experimental group (systolic blood pressure: mean difference [MD] = 2.91 mmHg, 95% confidence interval [CI] = 1.61, 4.21, p = 0.001; and diastolic blood pressure: MD = 1.33 mmHg, 95% CI = 1.16, 1.50, p = 0.001) compared to the control group. Within the experimental group, there was also a significant decrease in systolic blood pressure (MD = -2.75 mmHg, 95% CI = -7.73, 2.22, p = 0.005) and diastolic blood pressure (MD = -0.83 mmHg, 95% CI = -5.81, 4.14, p = 0.02). Conclusions: This trial demonstrates the feasibility and potential benefits of low-to-moderate intensity aerobic exercise training in reducing resting blood pressure among sedentary older Saudis with hypertension residing in this aged care setting.

Chinese Herbal Medicine Reduces the Risk of Heart Failure in Hypertensive Patients: A Nationwide, Retrospective, Cohort Study

Background

Hypertension (HTN) is the leading preventable risk factor for cardiovascular disease worldwide. Patients with HTN are at higher risk for heart failure (HF). The currently available therapeutic approaches for HTN do not always optimally control blood pressure or are not suitable for hypertensive patients who have a higher number of comorbidities. This study aimed to determine whether Chinese herbal medicine (CMH)-based interventions could reduce the risk of HF in hypertensive patients.

Methods

This retrospective study randomly selected 2 million enrollees from the National Health Insurance Research Database and identified 507,608 patients who were newly diagnosed with HTN in 2000–2017. After 1:1 frequency-matching by age, sex, index year, income, urbanization, duration of HTN, comorbidities and antihypertensive medications, we selected 8,912 eligible patients in each group. During 16 years of follow-up, 380 CHM users and 426 CHM non-users developed HF, representing incidence rates of 6.29 and 7.43 per 1,000 person-years, respectively.

Results

CHM users had significantly lower HF risk compared with CHM non-users (adjusted HR = 0.85, 95% CI 0.74–0.98). The markedly predominant effect was observed in those receiving CHM products for more than 180 days (adjusted HR = 0.65). The frequently prescribed formula, Jia-Wei-Xiao-Yao-San, and the single herbs Ge Gen, Huang Qi, Du Zhong, Huang Qin, and Chuan Xiong were significantly associated with lower risk of HF.

Conclusions

This population-based study revealed decreased HF risk in hypertensive patients with CHM use. These findings may provide a reference for HF prevention strategies and support the integration of CHM into clinical intervention programs that provide a favorable prognosis for hypertensive patients.