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.

Short-Term Effect of Self-Selected Training Intensity on Ambulatory Blood Pressure in Hypertensive Older Women: A Randomized Controlled Trial

PURPOSE

To investigate the short-term effect of self-selected training intensity (SSTI) on ambulatory blood pressure (BP) in hypertensive older women.

PARTICIPANTS AND METHODS

This is a randomized, single-blind, two-arm, parallel-group controlled trial that included 40 medicated hypertensive older women (64.4±3.6 years; resting systolic 118±19 and diastolic BP 68±9 mmHg). SSTI intervention was performed three times per week, 30-50 minutes per session (n=20). The control group participated in health education meetings once per week (n=20). Ambulatory BP (primary outcome) and six-minute walking test performance (secondary outcome) were assessed at baseline and following 8 weeks of intervention. Heart rate (HR), rating of perceived exertion (RPE, 6-20), and affective valence (ie, feeling scale, -5/+5) were recorded during all SSTI sessions. Intention-to-treat and per-protocol analyses were used for data analyses.

RESULTS

Fifteen participants from the SSTI group and 17 from the control group completed the study. No differences in ambulatory BP (24-h, awake, and asleep) were observed between SSTI and control groups (intention-to-treat and per-protocol analyses; p>0.05). The SSTI group showed a greater six-minute walking test performance than the control group in the intention-to-treat and per-protocol analyses (p<0.05). The participants exercised at 52±10% of HR reserve reported an RPE of 11±1 and an affective valence of 3.4±1.1 over the 8-week period.

CONCLUSION

SSTI is a feasible approach to induce a more active lifestyle and increase health-related fitness in hypertensive older women, although it does not improve BP control over a short-term period.

[Blood flow restriction training for people with cardiovascular disease: An exploratory review]

OBJECTIVE

To analyse the evidence on the effects of blood flow restriction training in people with cardiovascular disease.

MATERIALS AND METHODS

We searched MEDLINE, EMBASE, SPORTDiscus, CINAHL, LILACS, SCOPUS and Wiley databases. Experimental and non-experimental studies investigating the effects of blood flow restriction in participants with cardiovascular disease were included.

RESULTS

Six clinical trials and three non-experimental studies met the inclusion criteria. The experimental studies were conducted in participants with hypertension and ischaemic heart disease. Non-experimental studies described hemodynamic adaptations and potential adverse effects of therapy. The risk of bias of the included clinical trials was moderate to high. Exercise-induced hemodynamic stress increased significantly during training with blood flow restriction compared with traditional training. The small number of available studies have focused mostly on acute effects, but chronic effects are unknown.

CONCLUSION

There is currently no evidence to recommend the use of blood flow restriction in people with cardiovascular disease.

A Systematically Assembled Signature of Genes to be Deep-Sequenced for Their Associations with the Blood Pressure Response to Exercise

: Background: Exercise is one of the best nonpharmacologic therapies to treat hypertension. The blood pressure (BP) response to exercise is heritable. Yet, the genetic basis for the antihypertensive effects of exercise remains elusive. Methods: To assemble a prioritized gene signature, we performed a systematic review with a series of Boolean searches in PubMed (including Medline) from earliest coverage. The inclusion criteria were human genes in major BP regulatory pathways reported to be associated with: (1) the BP response to exercise; (2) hypertension in genome-wide association studies (GWAS); (3) the BP response to pharmacotherapy; (4a) physical activity and/or obesity in GWAS; and (4b) BP, physical activity, and/or obesity in non-GWAS. Included GWAS reports disclosed the statistically significant thresholds used for multiple testing. Results: The search yielded 1422 reports. Of these, 57 trials qualified from which we extracted 11 genes under criteria 1, 18 genes under criteria 2, 28 genes under criteria 3, 27 genes under criteria 4a, and 29 genes under criteria 4b. We also included 41 genes identified from our previous work. Conclusions: Deep-sequencing the exons of this systematically assembled signature of genes represents a cost and time efficient approach to investigate the genomic basis for the antihypertensive effects of exercise.

Heart Rate Variability following Combined Aerobic and Resistance Training in Sedentary Hypertensive Women: A Randomised Control Trial

Objective

To investigate the effect of combined aerobic and resistance training (CART) on heart rate variability in sedentary, hypertensive women.

Participants

A total of twenty-eight hypertensive (Stage 1 and 2) sedentary women (Age 40.54 ± 4.2 yrs; Height 155.14 ± 5.4 cm; Weight 70.96 ± 10.2 kg; BMI 29.6 ± 4.4; Duration of HTN: 6.43 ± 2.5 yrs) were recruited for the study.

Methods

Participants were randomly assigned to either the CART group that performed combined aerobic and resistance exercise of moderate intensity [aerobic exercise 50–80% of HR_max (maximum heart rate) and resistance exercises at 50–80% of 1 Repetition Maximum (RM)], 5 times/week for 4 weeks, or to the control group that followed conventional treatment without any supervised exercise intervention.

Main outcome measures

Resting blood pressure was measured and standard heart rate variability (HRV) indices were calculated using time domain (SDNN, pNN50, RMSSD) and frequency domain (LFnu, HFnu, LF/HF and TP) analysis.

Results

CART group demonstrated an increase in HFnu, TP, SDNN, and RMSSD, (p < 0.05) along with a significant decrease in LFnu, LF/HF ratio, systolic blood pressure, and diastolic blood pressure (p < 0.05).

Conclusion

CART showed significant improvement in HRV parameters indicating vagal dominance in middle-aged hypertensive women. Therefore, exercise training in combined form (aerobic and resistance) may be incorporated in the management programs of the patients suffering from hypertension in order to augment improvement in their cardiac autonomic control.

Self-Help, Mutual Aid and Chronic Patients' Clubs in Croatia, Yugoslavia: Discussion Paper

This paper describes the clubs for patients with hypertension which have operated effectively in parts of Croatia and Slovenia (Yugoslavia) for more than 15 years, with many thousands of patients enrolling voluntarily. Based on the principle of self-help, yet involving the regular participation of members of a patient's own primary health team, they increase compliance with long-term treatment regimens and improve the quality of life.

Such programmes are capable of reducing the amount of time devoted by a medical practitioner while increasing the effectiveness of treatments. If they are to succeed, it is essential to ensure regular club meetings, social activities and encouragement to each individual member to find a role and to continue attending for as long as possible. A new life style and consequent benefits to health are obtained only through long membership.

Adherence to physical activity recommendations and physical and mental health risk in people with severe mental illness in Uganda

This study investigated cardio-metabolic risk factors among patients with severe mental illness who do or do not meet the recommendations of 150min per week of physical activity. A secondary aim was to assess whether those that do meet the recommendations report lower levels of mental health symptoms. 107 (60♀) Ugandan in- and outpatients (mean age=34.4 ± 9.7 years) with severe mental illness (depression=7, bipolar disorder=55, schizophrenia=45) completed the Physical Activity Vital Sign (PAVS) method and Brief Symptoms Inventory -18. Participants were also screened for abdominal obesity (waist circumference>90cm), overweight (body mass index≥25) and hypertension (systolic pressure≥140mmHg and/or diastolic pressure≥90mmHg).48.6% (n = 52) of patients met the physical activity recommendations as assessed by the PAVS method. 41.1% (n = 44) were overweight, 40.2% (n = 43) had abdominal obesity and 23.4% (n = 25) had hypertension. Those who did not meet the physical activity recommendations were significantly older, had a higher BSI-18 somatisation score, and had a higher risk of overweight [relative risk (RR) = 2.88, 95% confidence interval (CI) = 1.59-4.99], abdominal obesity (RR = 1.82, 95%CI = 1.13-2.93), and hypertension (RR = 2.16, 95%CI = 0.99-4.73). The PAVS is a feasible method of assessing physical activity among patients with severe mental illness in a low resource setting. The PAVS may have clinical utility for physical and mental health risk stratification.

Exercise training in patients with pulmonary and systemic hypertension: A unique therapy for two different diseases

Pulmonary hypertension is a potentially life-threatening condition. Given its evolving definition, the incidence and prevalence of the disease is difficult to define, but registries suggest an increased global awareness. The management of patients with pulmonary arterial hypertension is highly specialised and requires multi-disciplinary input from a range of healthcare professionals, including cardiologists, respiratory physicians, rheumatologists, rehabilitation physicians and cardio-pulmonary physiotherapists. Historically, exercise training in pulmonary hypertension has not been recommended because of safety concerns. However, an increasing number of studies have demonstrated the benefit of exercise training on exercise capacity, peak oxygen consumption and quality of life. Systemic hypertension is one of the most important risk factors for cardiovascular disease, and has been ranked as the leading cause for death and disability worldwide: therefore, adequate control of blood pressure is important for public health. Lowering of blood pressure and prevention of hypertension is in first instance preferable by lifestyle changes. These include weight loss, moderation of alcohol intake, a diet with increased fresh fruit and vegetables, reduced saturated fat, reduced salt intake, reduced stress, and, finally, increased physical activity. With regard to the latter, former guidelines predominantly recommended aerobic exercises such as walking, jogging, and cycling for lowering blood pressure. The main focus of this narrative overview paper is to briefly examine and summarize the benefit of exercise training in patients with pulmonary and systemic hypertension, suggest mechanisms by which exercise may improve symptoms and function and provide evidence-based recommendations regarding the frequency and intensity of exercise in these patients.

[Cardiorehabilitation of hypertonic disease]

OBJECTIVE

Introduction: Considering the great medical, social and economic significance of the problem of treatment of hypertension, cardiological rehabilitation is of great importance in restorative treatment of patients. The aim: To analyze the scientific literature on the necessity of different methods of cardiorehabilitation, which proved their effectiveness and shown for use in the complex regenerative treatment of patients with hypertonic disease.

PATIENTS AND METHODS

Materials and methods: Analysis and generalization of scientific and methodical literature on modern directions and methods of cardiorehabilitation at hypertonic disease.

CONCLUSION

Conclusions: The effectiveness of hypertonic disease treatment depends on the complex combination of a wide range of rehabilitation products, such as medical therapy, physical exercises, physiotherapy, ergotherapy, psychological correction; application of them depending on the current tasks of a certain restorative stage of treatment, which allows to achieve optimal physical rehabilitation.

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation

BACKGROUND

The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients.

OBJECTIVE

To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease.

METHODS

A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach's alpha and the construct validity by the exploratory factorial analysis.

RESULTS

The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach's correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension.

CONCLUSION

The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Combined aerobic and resistance training: are there additional benefits for older hypertensive adults?

OBJECTIVES:

The objective of this study was to compare the effects of a combination of aerobic and resistance training to those of isolated aerobic training on blood pressure, body composition, and insulin sensitivity in hypertensive older adults.

METHOD:

Forty-four patients were randomly assigned to the aerobic group, resistance and aerobic group, and control group. Before and after 10 weeks, the following data were obtained: 24-hour ambulatory blood pressure data, abdominal circumference, waist circumference, body mass index, lean mass, fat mass, and insulin sensitivity. The study was conducted with 3 training sessions per week.

RESULTS:

Comparison revealed significant reductions in the body mass index, abdominal and waist circumferences, and ambulatory blood pressure (24-hour, wakefulness and sleep systolic/diastolic blood pressures) in both the aerobic group and the resistance and aerobic (combined) group. The fat mass only changed in the combined group. There was no difference in the insulin sensitivity in any group.

CONCLUSIONS:

The combined treatment and aerobic treatment alone were equally effective in reducing the blood pressure, body mass index, and abdominal and waist circumferences, although the addition of the resistance component also helped reduce the fat mass.

[THE EFFICIENCY OF SCHOOL OF COMBINED PATHOLOGY IN THE REHABILITATION OF PATIENTS WITH PEPTIC DUODENAL ULCER ASSOCIATED WITH ARTERIAL HYPERTENSON AFTER ACUTE GASTROINTESTINAL BLEEDING]

Objectives of the investigation was to examine the dynamics of emotional and autonomic disorders in patients with peptic duodenal ulcer (DU) associated with arterial hypertension after acute gastrointestinal bleeding during training at School of Combined Pathology (SCP). Main group included 25 patients. The comparison group consisted of 26 patients with the matched pathology, sex and age, but not trained at SCP. Results. Both groups of patients demonstrated improvement in emotional sphere and autonomic regulation. However, in patients who had training at the SCP the indicators of emotional status improved earlier and got a greater extent. Optimization of autonomic regulation was identified in 3 months, not six months, like in untrained patients. Conclusion. Training hypertensive patients with peptic DU at the SCP improves the efficiency of emotional state and autonomic regulation.

[THE PROGRAM OF PHYSICAL REHABILITATION FOR PATIENTS WITH CORONARY HEART DISEASE AND HYPERTENSIVE DISEASE]

The authors demonstrate the importance of individual criteria for the choice of dosed physical load for the patients with cardiological problems during hospitalization. The analysis of the functional state and hemodynamic parameters included 68 patients with various cardiovascular diseases before and after performance of the special program of physical rehabilitation. The results suggest high efficiency of the proposed treatment and good prospects for further studies in this field.

Effects of endurance, circuit, and relaxing training on cardiovascular risk factors in hypertensive elderly patients

Recommendations for prevention of cardiovascular diseases (CVDs) risk factors among older adults highlighted the importance of exercise-based interventions, including endurance training (ET). However, the evidence of efficacy of other interventions based on short-bouts of exercise (circuit training, CT), and the practice of breath-control and meditation (relaxing training, RT) is growing. The aim of this study was to elucidate if CT or RT are equally effective in CVD risk factors reduction compared to ET. To this purpose, in 40 elderly participants, with clinically diagnosed grade 1 hypertension, resting blood pressure, blood glucose, and cholesterol levels, peak oxygen uptake ([Formula: see text]), mechanical efficiency and quality of life were evaluated before and after 12 weeks of ET, CT, and RT treatments. Resting blood pressure reduced significantly in all groups by ∼11 %. In ET, blood cholesterol levels (-18 %), [Formula: see text] (+8 %), mechanical efficiency (+9 %), and quality of life scores (+36 %) ameliorated. In CT blood glucose levels (-11 %), [Formula: see text] (+7 %) and quality of life scores (+35 %) were bettered. Conversely, in RT, the lower blood pressure went along only with an improvement in the mental component of quality of life (+42 %). ET and CT were both appropriate interventions to reduce CVDs risk factors, because blood pressure reduction was accompanied by decreases in blood glucose and cholesterol levels, increases in [Formula: see text], mechanical efficiency, and quality of life. Although RT influenced only blood pressure and quality of life, this approach would be an attractive alternative for old individuals unable or reluctant to carry out ET or CT.

[New approaches to the diagnosis, treatment and rehabilitation of military personnel, military pensioners and their family members with arterial hypertension]

The article considers new approaches to diagnosis, treatment and rehabilitation of patients with arterial hypertension (AH) applied to the Ministry of Defence contingent. For the medical service of the Armed Forces the problem is relevant because of the significant labor losses, high level of dismission, morbidity and mortality of this disease. In the assessment of the patients limitation of life should be considered a variant AH, the stage, availability and seventy of the organ damage, severity and reversibility of complications, the incidence and severity of hypertensive crises, the effectiveness of treatment, comorbidity, education, occupation, the presence of contra-types and conditions of military service or labor. Military medical expertise of soldiers with AH uses the classification of degrees of arterial hypertension of 2010 and a three-stage-classification hypertonic disease created by the World Health Organization, 1996.

Chronic resistance training does not affect post-exercise blood pressure in normotensive older women: a randomized controlled trial

Resistance training has been recommended for maintenance or improvement of the functional health of older adults, but its effect on acute cardiovascular responses remains unclear. Thus, the purpose of this study was to analyze the effect of 12 weeks of resistance training on post-exercise blood pressure (BP) in normotensive older women. Twenty-eight normotensive and physically inactive women (≥ 60 years) were randomly assigned to a training group (TG) or a control group (CG). The TG underwent a resistance training program (12 weeks, 8 exercises, 2 sets, 10-15 repetitions, 3 days/week), while the CG performed stretching exercises (12 weeks, 2 sets, 20 s each, 2 days/week). At baseline and after the intervention, participants were randomly submitted to two experimental sessions: a resistance exercise session (7 exercises, 2 sets, 10-15 repetitions) and a control session. BP was obtained pre- and post-sessions (90 min), through auscultation. Post-exercise hypotension was observed for systolic, diastolic, and mean BP in the TG (-6.1, -3.4, and -4.3 mmHg, respectively; P < 0.05) and in the CG (-4.1, -0.7, and -1.8 mmHg, respectively; P < 0.05). After the intervention period, the magnitude and pattern of this phenomenon for systolic, diastolic, and mean BP were similar between groups (TG -8.8, -4.1, and -5.7 mmHg, respectively; P < 0.05 vs CG -11.1, -5.8, and -7.6 mmHg, respectively; P < 0.05). These results indicate that a single session of resistance exercise promotes reduction in post-exercise BP and 12 weeks of resistance training program do not change the occurrence or magnitude of this hypotension. (ClinicalTrial.gov: NCT02346981).

[Analysis of Efficiency of the Standard of Sanatorium Care of Patients With Arterial Hypertension]

Analysis of efficiency of the standard of sanatorium care of patients with arterial hypertension is presented. Rates of arbitrary use of methods of care and their use in accordance with requirements of the standard were compared in patients with diferent results of treatment. It was found that existing standard was insufficiently adequate for application in the work of attending physician. Observance of requirements of the standard was associated with 93 ± 0.8% achievement of positive results. Rates of use of methods of care in groups of patients with positive and negative result of sanatorium stay were significantly different.

Assessment of the effects of rehabilitation after cerebrovascular accident in patients with diabetes mellitus and hypertension as risk factors

Aim:

The aim of this study is to evaluate the results of rehabilitation, to determine the prevalence of major risk factors in cerebrovascular accident and their consequences, as well as to propose measures and procedures that will affect the better rehabilitation.

Methods:

The survey analyzed: age, sex, duration of rehabilitation, activities in daily life through the Barthel index at admission and at discharge, presence of risk factors HTA and DM. The study included a total of 116 patients, the majority of patients are older than 61 years. We had 49% of male patients and 51% of female patients and they spent 31-40 days at the rehabilitation.

Results:

The most common risk factor is HTA (83%) and diabetes (33%). Most of the patients at admission had a BI from 0 to 4 (32.7%), and at discharge BI in the range 17-20 (36.2%). Statistical analysis shows that there is a statistically significant correlation between the BI at admission, BI at discharge and risk factors of HTA and diabetes mellitus.

Conclusions:

the rehabilitation results in most patients is good results of rehabilitation. The most important risk factors in patients are HTA, DM and directly affect on results of rehabilitation. For the better results we should have energetic fight against risk factors for HTA and DM through primary and secondary prevention and patient education about early detection and treatment of these risk factors.

[The clinical and functional rationale for the application of the baths containing the Siberian Stag velvet antler extracts in the rehabilitative treatment of the patients presenting with arterial hypertension and concomitant chronic psychoemothional overtension]

We have developed the method for the treatment of the patients presenting with arterial hypertension and concomitant chronic psychoemothional overtension. The method consists of the application of the baths containing the Siberian Stag velvet antler extracts in combination with exercise therapy and massage. A total of 35 patients with arterial hypertension and concomitant chronic psychoemothional overtension were enrolled in the study. It was shown that inclusion of the baths containing the Siberian Stag velvet antler extracts in the combined treatment of arterial hypertension and concomitant chronic psychoemothional overtension has positive effect on the parameters of the main homeostatic systems, enhances the working capacity of the patients, promotes their psychological stability, and increases the adaptive potential of the organism.

[Effect of sanatorium treatment on endothelial function in children with primary arterial hypertension]

To study the effect of sanatorium treatment (ST) using sodium chloride baths and metabolic drug mildronat on the dynamics of the ambulatory blood pressure monitoring (ABPM), markers of endothelial function in children with primary arterial hypertension (PAH). ABPM and held defined level of asymmetric dimethylarginine (ADMA), endothelin-1 (ET-1) and nitric oxide (NO) in the serum of 114 children with PAH aged 12-17. The positive dynamics of ABPM in all groups, but significantly (P < 0.05) decrease in mean BP was noted in the group with combined ST using sodium chloride baths. When analyzing the level of NO a positive trend (P < 0.01) in the group was using metabolic therapy, but significantly (P < 0.001) pronounced effect was observed when it is combined balneotherapy and metabolic therapy. Analysis of ET-1 and ADMA at ST in conjunction with therapy and metabolic rate of sodium chloride baths there was a significant (P < 0.01) decrease in these parameters in comparison with those before treatment. In children with PAH have been identified violations of the functional activity of the endothelium, which is reflected in increased levels of ET-1, ADMA and reducing NO. Conducting rehabilitation inclusion complex balneotherapy and metabolic therapy helps to reduce average daily blood pressure, normalization of functional activity of the endothelium as a normalization of the synthesis of NO (P < 0.,001), a significant decrease of ET-1 (P < 0.01) and ADMA (P < 0.01).

[Modern combined technologies for the rehabilitation of the patients presenting with arterial hypertension and its prevention]

The present review describes the modern methods for the combined treatment and rehabilitation of the patients presenting with arterial hypertension and their influence on the key pathogenetic components of this condition in accordance with the currently accepted theories of its origin and evolution. The discovery of specific molecular and cellular mechanisms of the therapeutic action of certain factors that reflect peculiar and unique character of their inherent physical energy provided a basis for the development of highly effective methods for the treatment and prevention of arterial hypertension and rehabilitation of the patients suffering this disease. The most comprehensive clinical effect is produced by the application of scientifically sound therapeutic systems; exclusion of certain therapeutic physical factors from these modalities results in s significant reduction of their curative effectiveness.

[The influence of carbon dioxide baths differing in the total mineralization levels on the functional state of the cardiovascular system of the patients presenting with hypertensive disease associated with coronary heart disease]

The results of the study on the influence of carbon dioxide baths differing in the total mineralization levels on the clinical course of hypertensive disease associated with coronary heart disease and on various functional systems of the body. The data obtained provide an insight into the role of salt concentrations (10 and 20 g/l) in carbon dioxide bath water (1.2 g/l) applied for the traditional treatment of the patients with hypertensive disease associated with concomitant coronary heart disease and musculoskeletal pathology. Highly mineralized bath water has a greater influence on the functional state of the cardiovascular system by causing a more pronounced decrease in peripheral vascular resistance and hypotensive effect. Baths with a salt concentration of 20 g/l markedly reduced pain and had anti-inflammatory effect in the patients with pathology of support and locomotor organs.

[The application of the non-invasive lung ventilation technique (CPAP therapy) for the early comprehensive rehabilitation of the patients with metabolic syndrome and "night-piker" arterial hypertension]

The treatment of patients presenting with metabolic syndrome and "night-piker" arterial hypertension is a most difficult task facing modern therapy. It was shown that metabolic disorders and night-time elevation of arterial pressure in such patients are attributable to obstructive sleep apnea syndrome (OSAS). The present study included 32 patients suffering moderately severe or severe OSAS in conjunction with metabolic syndrome, and "night-piker" arterial hypertension. We tried to elucidate the role of CPAP therapy in the treatment and early rehabilitation of such patients. The study group included 17 patients and the control group was comprised of 15 subjects. The quality of sleep significantly improved in all the patients (100%) during 4 weeks of CPAP therapy; simultaneously, normalization of hemodynamics (the absence of the morning rise in AP) was documented. The morning rise in AP (up to 140/80 mmHg at awakening) persisted in 9 (60%) control patients. The mean cholesterol level decreased by 28.65% and 25.89% in the study and control groups respectively (p>0.1). (all patients in both groups were treated with statins). The level of C-reactive protein decreased more significantly in the study group compared with the control one (38.22% and 15.32% respectively; p<0.05). It is concluded that CPAP therapy produces beneficial effect in the patients with OSAS suffering hypertension during the night or early in the morning. CPAP therapy during 1 month did not have an appreciable effect on metabolic parameters. At the same time, long-term CPAP therapy promoted the reduction in the level of C-reactive protein known to be a predictor of cardiac complications.

Dose effect of cardiorespiratory exercise on metabolic syndrome in postmenopausal women

As an ancillary report to a large National Institutes of Health (NIH)-funded trial, we examined the effects of 6 months of exercise training at 50%, 100%, and 150% of the NIH Consensus Recommendations for physical activity (i.e., 4, 8, and 12 kcal/kg of energy expenditure/wk [KKW]) versus a nonexercise control group on the metabolic syndrome (MS) in sedentary, overweight, moderately hypertensive, postmenopausal women. We examined the clinically defined National Cholesterol Education Program MS, individual components scores, and summed z-scores, expressed as a continuous variable (zMS), using chi-square and general linear models to assess the clinical and progressive nature of MS, respectively. Our results showed significant improvements in zMS for all exercise groups and MS for the 8- and 12 KKW groups only (all, p for trend = 0.02). Post hoc analyses showed that 12 KKW for zMS and 8 and 12 KKW for MS was significant versus the control group (all, p <0.05). When examining the composite scores, we observed significant trends for improvement in waist circumference (p for trend = 0.001), fasting glucose (p for trend = 0.01), and systolic blood pressure (p for trend = 0.02), which appeared to be dose dependent, given the additive nature for incorporating the within-group improvements in waist circumference (4, 8, and 12 KKW), fasting glucose (8 and 12 KKW), and systolic blood pressure (12 KKW). Our results suggest that low-to-moderate intensity cardiorespiratory exercise appears to improve components of the MS in postmenopausal women at levels at or greater than NIH recommendations and that zMS improves at half the NIH recommendations. Greater levels of energy expenditure appear to enhance this effect by incorporating a greater number of requisite MS composite scores.

Randomised controlled trial: effects of aerobic exercise training programme on indices of adiposity and metabolic markers in hypertension

OBJECTIVE

To investigate the effects of interval training programme on blood pressure, maximal oxygen consumption, indices of adiposity and metabolic markers in black African men with essential hypertension.

METHODS

The study was conducted at Murtala Muhammed Specialist Hospital, Kano, Nigeria, from October 24, 2007 to February 24, 2009. It comprised 245 male patients with mild to moderate (systolic blood pressure 140-179 and diastolic blood pressure 90-109 mmHg) essential hypertension who were age-matched and grouped into experimental and control groups. The experimental group was involved in an 8-week training programme of between 45 and 60 minutes, while the controls remained sedentary during the period. Cardiovascular parameters, maximal oxygen consumption, per cent body fat, waist-to-hip ratio, body mass index, fasting blood sugar, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein and artherogenic index were assessed. Analysis of co-variance and Pearson correlation tests were used in data analysis which was done using SPSS 16.

RESULTS

The study had 140 (57.1%) cases with a mean age of 58.90+/-7.35 years, and 105 (42.9%) controls with a mean age of 58.27+/-6.24 years. It revealed significant increased effect of interval training programme on maximal oxygen consumption and high-density lipoprotein. There was significant reduction in on all the other controls. Changes in maximal oxygen consumption as a result of interval training significantly and negatively correlated with the other variables except high-density lipoprotein.

CONCLUSIONS

The therapeutic role of interval exercise training on blood pressure reduction may be mediated through elevation of high-density lipoprotein, reduction of other markers of metabolism, and reduction in bodyweight and fatness.

Translating basic behavioral and social science research to clinical application: the EVOLVE mixed methods approach

OBJECTIVE

To describe a mixed-methods approach to develop and test a basic behavioral science-informed intervention to motivate behavior change in 3 high-risk clinical populations. Our theoretically derived intervention comprised a combination of positive affect and self-affirmation (PA/SA), which we applied to 3 clinical chronic disease populations.

METHOD

We employed a sequential mixed methods model (EVOLVE) to design and test the PA/SA intervention in order to increase physical activity in people with coronary artery disease (post-percutaneous coronary intervention [PCI]) or asthma (ASM) and to improve medication adherence in African Americans with hypertension (HTN). In an initial qualitative phase, we explored participant values and beliefs. We next pilot tested and refined the intervention and then conducted 3 randomized controlled trials with parallel study design. Participants were randomized to combined PA/SA versus an informational control and were followed bimonthly for 12 months, assessing for health behaviors and interval medical events.

RESULTS

Over 4.5 years, we enrolled 1,056 participants. Changes were sequentially made to the intervention during the qualitative and pilot phases. The 3 randomized controlled trials enrolled 242 participants who had undergone PCI, 258 with ASM, and 256 with HTN (n = 756). Overall, 45.1% of PA/SA participants versus 33.6% of informational control participants achieved successful behavior change (p = .001). In multivariate analysis, PA/SA intervention remained a significant predictor of achieving behavior change (p < .002, odds ratio = 1.66), 95% CI [1.22, 2.27], controlling for baseline negative affect, comorbidity, gender, race/ethnicity, medical events, smoking, and age.

CONCLUSIONS

The EVOLVE method is a means by which basic behavioral science research can be translated into efficacious interventions for chronic disease populations.

[Linguistic image of the disease as exemplified by essential hypertension: the main semantic clusters of adjectives]

The authors present the results of the study on the semantic structure of adjectives in the framework of the linguistic image for the case of essential hypertension based on the corpus analysis of the co-occurrence range in the free textual descriptions of the clinical conditions by the patients. The data obtained can be used to more adequately interpret the patients' complaints for the better organization of psychological aid in the framework of medical rehabilitation of the patients included in the present study.

[Artificial silicious-carbon dioxide baths for the rehabilitation and secondary prophylaxis in the patients presenting with arterial hypertension associated with coronary heart disease]

The present paper is designed to report the results of a clinical study undertaken to estimate the efficacy of artificial silicious-carbon dioxide baths for the rehabilitation and secondary prophylaxis in the patients presenting with arterial hypertension associated with coronary heart disease. The study included 130 patients whose treatment outcome was compared with that in a group of patients treated with the use of ordinary silicious baths alone. It was shown that artificial silicious-carbon dioxide baths have an advantage over the ordinary silicious baths in that they produce a more pronounced therapeutic effect especially in the patients with the most severe forms of hypertension associated with cardiovascular disorders. This effect is due to the combined action of their constituent components, in the first place water soluble silicates and carbon dioxide. The simultaneous action of the water soluble silicon on the structure and permeability of cellular membranes coupled with the reduction of sensitivity of vascular beta-adrenorecepors to pressor agents and inhibition of aldosterone secretion from the adrenal glands under effect of carbon dioxide accounts for the more pronounced hypotensive, anti-ischemic, and antiarrhythmic effect of artificial silicious-carbon dioxide baths that is associated with the beneficial effect on the quality of life in the majority of the treated patients.

[Medical applications of ozone for the rehabilitation of the patients presenting with chronic bronchitis and arterial hypertension]

Of paramount importance at the stage of rehabilitative treatment of the patients presenting with combined cardiorespiratory pathology are therapeutic measures aimed at eliminating the principal components of pathogenesis of a given disease and correcting the concomitant immunometabolic disturbances. Our investigations have demonstrated that ozone therapy given to the patients with chronic bronchitis and hypertension produces lipid-lowering, hypoglycemic and fibrinolytic effects. Its combination with anti-hypoxic treatment helps to normalize the functioning capabilities of all organs and systems of the body. Immunomodulatory effects of ozone therapy is attributable to the disintoxicative and anti-hypoxic actions of medical ozone as well as activation of the "lipid peroxidation--antioxidant protection" system.

The effect of hemiplegia/hemiparesis, diabetes mellitus, and hypertension on hospital length of stay after stroke

OBJECTIVE

To determine and analyze the variables of age, hemiplegia/hemiparesis, diabetes mellitus (DM), and hypertension (HTN) on the hospital length of stay (LoS) in the stroke rehabilitation unit.

METHODS

We conducted a retrospective cross-sectional study of all patients who completed the stroke rehabilitation program at Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia between January 2007 and October 2010. Admission records of 687 patients were identified with the mean age of 61.7 ± 14.7 (mean ± SD) years, and were included in this study. The patients were divided into 5 groups based on their age (30-80 years). Patients aged ≤ 29 and ≥ 81 years were excluded due to small sample sizes. Mixed hemispheric patients were also excluded.

RESULTS

The frequency of the stroke occurrence was highest in the 61-70 age group, and lowest in the 30-40 age group. Compared with left hemiplegia/hemiparesis (43.5 days), patients with right hemiplegia/hemiparesis (47.3 days) had significantly higher LoS (p=0.042). Compared with stroke alone, in patients with stroke combined with DM and HTN the LoS was significantly higher in right (p=0.003) and left hemiplegia/hemiparesis (p=0.046) patients.

CONCLUSION

Right hemiplegia/hemiparesis and combined comorbidity (DM + HTN) has a significant effect on LoS stroke patients; age also had a similar effect.

Low-Intensity physical activity beneficially alters the ultrastructural renal morphology of spontaneously hypertensive rats

INTRODUCTION AND OBJECTIVE

Kidney disorders can cause essential hypertension, which can subsequently cause renal disease. High blood pressure is also common among those with chronic kidney disease; moreover, it is a well-known risk factor for a more rapid progression to kidney failure. Because hypertension and kidney function are closely linked, the present study aimed to observe the beneficial effects of low-intensity physical activity on structural and ultrastructural renal morphology and blood pressure in normotensive and spontaneously hypertensive rats.

METHOD

Male Wistar-Kyoto rats and spontaneously hypertensive rats were randomly allocated into four groups: sedentary or exercised Wistar-Kyoto and sedentary or exercised spontaneously hypertensive rats. The exercise lasted 20 weeks and consisted of treadmill training for 1 hour/day, 5 days/week.

RESULTS

The exercised, spontaneously hypertensive rats showed a significant blood pressure reduction of 26%. The body masses of the Wistar-Kyoto and spontaneously hypertensive strains were significantly different. There were improvements in some of the renal structures of the animals treated with physical activity: (i) the interdigitations of the proximal and distal convoluted tubules; (ii) the basal membrane of the proximal and distal convoluted tubules; and (iii) in the basal membrane, slit diaphragm and pedicels of the glomerular filtration barrier. The spontaneously hypertensive rats also showed a decreased expression of connexin-43.

CONCLUSION

Physical exercise could be a therapeutic tool for improving kidney ultrastructure and, consequently, renal function in hypertensive individuals.

[Combined application of magnetolaserotherapy and polyunsaturated fatty acids for the treatment of patients with hypertensive disease]

The authors report the results of combined treatment including application of magnetolaserotherapy and n-3 polyunsaturated fatty acids for the management of patients presenting with hypertensive disease. These data give evidence of the accumulation of atherogenic fractions of plasma lipids and pathological modification of the fatty acid composition in erythrocyte membranes. They suggest the appropriateness of lipid-correcting and membrane-protective treatment for patients presenting with hypertensive disease. It is concluded that the proposed combination of magnetolaserotherapy and polyunsaturated fatty acids may be instrumental in the normalization of the serum lipid profile and the correction of the cellular fatty acid composition.

Hypertension improvement through healthy lifestyle modifications

Hypertension is the major risk factor for the development of cardiovascular and renal disease. This disease has a disproportionate effect on African Americans when compared to other races. The purpose of this project was to examine the effectiveness of healthy lifestyle modifications on blood pressure control among hypertensive African American adults. Thirty-six individuals participated in the 12-week project, with a 67% retention rate. Weekly sessions included interactive educational and walking components. Initial and final BMI measurements were recorded. Participants completed health risk assessments; pre and post questionnaires; and, daily logs ofblood pressure measurement, dietary consumption, and physical activity levels. Data were collected from the logs, BMI measurements, and questionnaires. Overall, the results revealed that participants experienced an increase in healthy lifestyle modification adoption resulting in blood pressure control improvement. Implementation of healthy lifestyle modifications is crucial in providing quality patient care to hypertensive individuals.

Adherence to an exercise prescription scheme: The role of expectations, self-efficacy, stage of change and psychological well-being

OBJECTIVES

Poor rates of adherence to exercise prescription schemes present a potential barrier to the goal of increasing physical activity in patient samples. This study investigated the role of participant expectations, self-efficacy, stage of change and psychological well-being in adherence to a 12-week course of gym based exercise. It also aimed to assess the impact of failure to adhere on self-efficacy and psychological well-being.

METHOD

The 119 participants, referred by their medical practitioner for a course of exercise, completed questionnaires at the start of the course and 77 went on to complete second questionnaires. Objective measures included a range of physiological measures based on gym assessments.

RESULTS

Participants typically had high expectations of the scheme. Those who completed the course had more modest expectations of change and came closer to achieving these expected changes than those who dropped out. Initial stage of change and self-efficacy did not discriminate between the two groups. While self-efficacy improved over the scheme for completers, it tended to deteriorate for drop-outs. GHQ scores also failed to improve over time for drop-outs.

CONCLUSION

Overly optimistic expectations of inexperienced exercisers may lead to disappointment and attrition. Interventions to ensure realistic expectations might increase success and prevent potential negative effects of failure.

Exercise training enhances elastin, fibrillin and nitric oxide in the aorta wall of spontaneously hypertensive rats

This work aimed to analyze the effect of low-intensity exercise training on ultrastructural and molecular aortic remodeling. Male Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) were allocated into four groups: sedentary WKY (SED-WKY), exercised WKY (EX-WKY, 1 h/day, 5 days/week treadmill exercise training), sedentary SHR (SED-SHR), and exercised SHR (EX-SHR). EX-SHR showed blood pressure reduction of 26% in comparison to SED-SHR after 1 month of exercise (P<0.05). At the 20th week, BP level was not different between EX-SHRs and WKYs. Circumferential wall tension (CWT) was higher by 77% in SED-SHRs than in SED-WKYs (P<0.001). Exercise training reduced CWT by 30% in EX- vs. SED-SHR (P<0.001). In SED-SHRs, endothelial cells showed large and numerous cytoplasmatic vacuoles, fragmented inner elastic lamina and scarce elastin and fibrillin, while exercise training ameliorated it in EX-SHR group. The highest eNOS immunodensity was observed in EX-SHR, which was 50% higher than EX-WKY (P<0.01) and 120% higher than SED-SHR (P<0.0001). In conclusion, present findings indicate beneficial effects of exercise training in hypertensive rats since it increased elastin, fibrillin and eNOS content in the aortic wall.

[Predictive significance of initial morpho-functional characteristics for the evaluation of effectiveness of remedial correction of arterial hypertension]

Analysis of effectiveness of spa-and-resort treatment of 154 patients with arterial hypertension and metabolic disturbances has demonstrated predictive value of variations of biological characteristics which suggests their important contribution to beneficial outcome of rehabilitative therapy. Results of the study made it possible to distinguish the most essential aspects of metabolism and its regulation related to the success of spa-and-resort treatment.

[Hypobaric interval hypoxia as a tool for improving tolerance of harmful occupational factors]

The method of hypobaric interval hypoxia (HIH) has been developed and approved for application in aerospace, military, prophylactic and rehabilitative medicine. A course of H1H included 10 one-hour daily sessions of hypobaria and interval hypoxia simulating ascent to an altitude from 3 to 5 km a.s.l. Each session comprised a 7 minute exposure to hypoxia (breathing rarified air) alternating with a 3 minute exposure to hyperoxia (breathing oxygen) without a change of the altitude simulated in the low-pressure chamber. The first session included ascent to 3 km, in each of the following sessions (from 2nd to 4th) the altitude was successively increased by 500 m and reached 5 km in sessions 5-10. HIH was shown to be highly efficacious in improving the functional state of the organism and its resistance to unfavourable environmental conditions; also it can be used to correct changes of these parameters.

[Multidisciplinary collaboration in the introduction of home rehabilitation--a report on cases where patient's QOL was improved by the participation of pharmacists in care conferences]

Multidisciplinary collaboration is essential for home nursing care. The categories of problem solving in drug treatments that pharmacists are involved in go beyond prescription changes due to side effects. They have also been able to take actions such as offering proposals for dietary improvements to enhance dosage compliance, and for countermeasures against swelling during rehabilitation. This report presents cases where patient's QOL was improved by the participation of pharmacists in care conferences in which teams share problems. They propose actions in drug treatment and side-effect countermeasures, collaborating within multidisciplinary teams, including helpers and physiotherapists as well as doctors and care managers.

[Efficiency of normobaric hypoxytherapy in the combined rehabilitation of children and adolescents with arterial hypertension]

The present study included 166 children and adolescents presented with arterial hypertension. It has demonstrated high efficiency of normobaric hypoxytherapy of this condition. Its advantages over the standard electrotherapeutic sleep treatment is confirmed by the results of 24 hour arterial pressure monitoring. Criteria for the efficiency of combined rehabilitation have been developed including average day and night time arterial pressure, its maximum level, day and night hypertension time indices.

[Phytotherapy of arterial hypertension with concomitant obesity in sanatorium-resort conditions]

Efficiency of different phytotherapeutic modalities (per os, baths, inhalation) in patients with arterial hypertension was evaluated under conditions of balneologic treatment. Modes of their curative action and mechanisms of the disease are considered. Comparative analysis of non-medicamentous technologies used in balneologic practice is presented. It is shown that hormonal regulation of carbohydrate and lipid metabolism plays the key role in the realization of therapeutic effects of phytopreparations. The improvement of functional activity of the cardiovascular system turns out to correlate with reduced clinical manifestations of metabolic syndrome.

[Rehabilitative medical technology for the correction of microcirculatory disorders in patients with arterial hypertension]

The study with the use of laser Doppler flowmetry has revealed pathological changes in the microcirculatory system of patients with arterial hypertension. Their treatment with a low-frequency magnetic field showed that its effect on microcirculation depends on the regime and site of application of magnetotherapy as well as its combination with other physical factors. Frontal application of the magnetic field had the most pronounced beneficial effect on dynamic characteristics of microcirculation. Pulsed regime of magnetotherapy was more efficacious than conventional one. Amplipulse magnetotherapy produced better results than monotherapy.

Austrian Moderate Altitude Studies (AMAS): benefits of exposure to moderate altitudes (1,500-2,500 m)

OBJECTIVES

A considerable part of the millions of Alpine tourists suffer from pre-existing diseases (e.g., metabolic syndrome) and high daily stress levels. The main goal of the Austrian Moderate Altitude Study (AMAS) was to investigate (a) the consequences of an active vacation at moderate altitude on the key parameters of the metabolic syndrome (AMAS I) and (b) the effects of a short active vacation on adult progenitor cells, bio-psychological parameters, and heart rate variability (HRV).

METHODS

During the AMAS I pilot study (n = 22; 1,700 m a.s.l.) and AMAS I main study (n = 71; 1,700 m a.s.l. and 200 m a.s.l.), the volunteers simulated 3-week coached hiking vacations. For AMAS II, healthy volunteers (n = 13) participated in a 1-week active holiday at 1,700 m.

RESULTS

There were significant improvements of obesity, hypertension, dyslipidemia, and insulin resistance of AMAS I patients after the vacation. In AMAS II participants, we found an increase in circulating endothelial progenitor cells as well as improvements in bio-psychological and HRV parameters.

CONCLUSIONS

Active vacations at moderate altitude are associated with a variety of positive health effects in persons with metabolic syndrome and in healthy subjects.

Cardiac autonomic function and baroreflex changes following 4 weeks of resistance versus aerobic training in individuals with pre-hypertension

AIM

Cardiac autonomic modulation and baroreflex sensitivity (BRS) are altered in individuals with hypertension. Aerobic exercise (AE) training has been shown to improve both measures, yet little is known about the effects of resistance exercise (RE). The purpose of this study was to examine the heart rate variability (HRV) and BRS following 4 weeks of resistance or aerobic training in a population with borderline high blood pressure (BP).

METHODS

Twenty-nine mild hypertensives were recruited and randomly assigned to 4 weeks of RE or AE training. Before and after training, resting measures of HRV frequencies and BRS were obtained.

RESULTS

There was a significant decrease in resting systolic BP for both exercise training modes (RE 136 +/- 3.0 pre- to 132 +/- 3.4 post-training vs. AE 142 +/- 4.0 pre- to 137 +/- 3.6 mmHg post-training, P = 0.019). Diastolic BP decreased significantly following both exercise training modes (RE 78 +/- 1.31 pre to 74 +/- 1.1 post vs. AE 80 +/- 1.7 pre to 77 +/- 1.6 mmHg post, P = 0.002). A significant time by training mode interaction for low frequency : high frequency (HF) ratio (P = 0.017) with AE decreasing the ratio (275.21 +/- 67.28 to 161.26 +/- 61.49) and RE increasing this ratio (143.73 +/- 65.00 to 227.83 +/- 59.41). Natural log-transformed (ln) HRV values showed a time-by-training mode interaction for ln HF (P = 0.05) as ln HF increased (4.7 +/- 0.38 to 5.4 +/- 0.35 ms(2)) following AE and decreased (5.98 +/- 0.37 to 5.76 +/- 0.42 ms(2)) following RE. BRS increased following aerobic training and decreased after resistance training (6.74 +/- 1.2 to 7.94 +/- 1.3 and 10.44 +/- 1.2 to 9.1 +/- 1.2 ms mmHg(-1) respectively, P = 0.021).

CONCLUSIONS

Aerobic exercise improved the autonomic nervous system (increasing vagal tone, reducing sympathovagal balance while increasing BRS) while RE showed no improvements in cardiac autonomic tone and decreased BRS.

Implementation of MP3 player for music therapy on hypertension

Hypertension is a common clinical disease and a major risk to human health. Many clinical findings indicate that certain types of music can reduce blood pressure (BP), and music therapy is considered as an important part of anti-hypertension treatment. We integrate our former related research achievement into the new MP3 player, which can also detect the current BP value with a cuffless measurement method. According to the current BP value, the MP3 player selects certain types of music for playing in order to alleviate the hypertension of patients.

[Analysis of behavioural and emotional personality characteristics in patients with hypertensive disease and effect of therapeutic education on the quality of life]

The study was designed to assess selected behavioural and psychic personality characteristics in subjects with hypertensive disease engaged in strenuous labour activity and evaluate effect of their self-care education on quality of life. A total of 126 patients were involved in the study of whom 96 were treated and instructed in the framework of the "School of psychophysiological adaptation" program and 30 comprised the control group. They were followed up for 2 years. It was shown that emotional stress promoted formation of a complex of behavioural and psychic reactions resulting in reduced level of motivation and aspiration to achieve vocational rehabilitation and health resumption. The targeted system of education proved instrumental in raising the level of motivation to comply with medical recommendations and exercise self-control. Accomplishment of the program allowed to reduce effect of risk factors on the course of disease, improve performance efficiency and quality of life. It is concluded that introduction of education programs into clinical practice is an important line of further development of preventive medicine.

[Use of biomanagement methods to combined medical rehabilitation of patients with hypertensive disease]

The biomanagement technique finds wide application in practical medicine, e.g. in rehabilitation of patients with psychosomatic pathology. Results of combined rehabilitative treatment with the use of bioacoustic psychocorrection was assessed in patients with hypertensive disease. It was shown that normalization of CNS functional state by means of bioacoustic psychocorrection improves vegetative regulation of cardiovascular activity, corrects AP, reduces its variability and the degree of nocturnal fall, decreases peripheral vascular resistance, and increases efficiency of rehabilitative treatment.