Acute changes in arterial stiffness following exercise in people with metabolic syndrome

Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial

BACKGROUND

The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with "adherence" playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension.

OBJECTIVE

The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence.

METHODS

A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant.

RESULTS

The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (-7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes.

CONCLUSIONS

The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/46883.

Effects of Acute Aquatic High-Intensity Intermittent Exercise on Blood Pressure and Arterial Stiffness in Postmenopausal Women with Different ACE Genotypes

The present study investigated the effects of acute aquatic high-intensity intermittent jumping (HIIJ) on blood pressure (BP) and arterial stiffness in postmenopausal women with different angiotensin-converting enzyme genotypes (ACE). We recruited 12 postmenopausal women carrying the ACE deletion/deletion (DD) genotype and 61 carrying the insertion/insertion or insertion/deletion (II/ID) genotype. The participants performed 12 trials of 30 s, 75% heart rate reserve (HRR) jumping, and 60 s, 50% HRR recovery, and 3 trials of 40 s upper limb resistance exercises were performed as fast as possible. The heart rate (HR) and BP were measured before exercise, immediately, 10 min, and 45 min after exercise. The brachial-ankle pulse wave velocity (baPWV) was measured before and after exercise. The systolic blood pressure (SBP) of the DD genotype increased more significantly than those with the II/ID genotype post-exercise (30.8 ± 4.48 vs. 20.4 ± 2.00 mmHg, p = 0.038). The left and right sides of baPWV increased significantly after exercise (1444.8 ± 29.54 vs. 1473.4 ± 32.36 cm/s, p = 0.020; 1442.1 ± 30.34 vs. 1472.0 ± 33.09, p = 0.011), and there was no significant difference between the two groups. The HIIJ increased baPWV. The postmenopausal women with the DD genotype have a higher SBP increased post-exercise than those with II/ID genotype. These findings suggest that the aquatic exercise program has better effects in decreasing blood pressure in postmenopausal women with the II/ID genotype. Those with the DD genotype should pay attention to the risk of increasing blood pressure after aquatic HIIJ exercise.

Impaired subendocardial perfusion in patients with metabolic syndrome

BACKGROUND

Metabolic Syndrome (MS) is associated to vascular damage, increased arterial stiffness, and impaired myocardial perfusion. Subendocardial viability ratio (SEVR) is a noninvasive estimation of myocardial workload, oxygen supply, and perfusion. The aim of the study was to describe the relation between arterial stiffness, SEVR, and cardio-metabolic risk factors.

METHODS

A cohort of 55 patients, aged 59.9 ± 10.8 years, was studied; 28 subjects (50.9%) had metabolic syndrome. All patients underwent a clinical evaluation and blood venous sampling, to assess glico-lipid profile. Applanation tonometry was performed, to obtain pulse wave analysis and SEVR values.

RESULTS

In the overall study population, SEVR showed negative associations with mean (r = -0.301; p = 0.026) and systolic (borderline relation, r = -0.257; p = 0.058) arterial pressure. Metabolic syndrome patients presented lower level of SEVR (p = 0.012), even after adjusting for age, sex, and mean arterial pressure (p = 0.040). Subdividing the study population by the number of metabolic syndrome components, SEVR significantly decreased as the number of Metabolic Syndrome components increased (p for trend 0.005). In a logistic backward regression analysis, both metabolic syndrome and mean arterial pressure resulted significant predictors of SEVR, accounting for 18% of variance.

CONCLUSION

The reduced SEVR in metabolic syndrome patients could be an important pathophysiological determinant of the increased cardiovascular risk.

Prolonged Elevation of Arterial Stiffness Following Peak Aerobic Exercise in Individuals With Chronic Stroke

Background

Stroke is a highly disabling condition and is the second leading cause of death globally. Engaging in aerobic exercise is important for the prevention of a recurrent stroke through improving markers of cardiovascular health such as blood pressure and arterial stiffness. While higher intensities of aerobic exercise generally elicit greater cardioprotective effects, little is known about the acute cardiovascular effects of a single session of high intensity aerobic exercise in people with stroke. The objective of this study was to model the recovery of arterial stiffness (carotid-femoral pulse wave velocity, cfPWV), heart rate and blood pressure following peak intensity aerobic exercise in individuals with chronic stroke.

Methods

Ten participants with chronic stroke (mean ± SD age = 56.9 ± 11.8 years, median [IQR] years post-stroke = 2.9 [1.9]) performed a symptom-limited cardiopulmonary exercise test (CPET) on a recumbent stepper. Before the CPET, resting cfPWV, heart rate and blood pressure were measured. Immediately following the CPET, all outcomes were measured again continuously for 20 min to use all available observations (n = 245 observations) and capture any potential non-linear changes. Mixed model analyses were then applied to model post-exercise changes of cfPWV, heart rate and blood pressure.

Results

Carotid-femoral pulse wave velocity was increased from rest following the CPET (9.0 ± 0.53 to 9.9 ± 0.52 m/s, p < 0.001) and remained elevated for 20 min into post-exercise recovery, independent of heart rate (p = 0.001). Heart rate also increased from baseline (71.2 ± 3.2 to 77.4 ± 3.1 bpm, p < 0.001) and remained elevated for 10 min post-exercise (p < 0.001). Finger systolic blood pressure was reduced from rest (117.3 ± 4.7 to 111.8 ± 4.6 mmHg, p < 0.001) and remained reduced for 15 min after exercise (p < 0.001). There were no significant differences in finger diastolic or mean arterial pressures from rest.

Conclusion

This was the first study to capture continuous changes in cfPWV following peak aerobic exercise in any clinical population. The present study revealed that cfPWV is elevated for 20 min after peak aerobic exercise in individuals with stroke, which was independent of heart rate. These findings suggest there may be autonomic imbalances in large arteries following peak intensity aerobic exercise in individuals with stroke.

Effects of cycling bouts performed with different intensities and amounts of energy expended on central pressure and pulse wave reflection in normotensive and hypertensive men

OBJECTIVE

This study investigated pulse wave analysis in normotensive and hypertensive men after cycling bouts with different intensities and amounts of energy expended.

METHODS

Twenty-four men were assigned into normotensive (n = 14; age: 40.7 ± 2.8 years; 24-h ambulatory SBP/DBP:121 ± 2/74 ± 1 mmHg) and hypertensive (n = 10; age: 39.2 ± 2.3 years; 24-h ambulatory SBP/DBP:139 ± 3/86 ± 2 mmHg) groups. Participants undertook a maximal cardiopulmonary exercise test, a nonexercise control session (CTL) and three cycling bouts [two prolonged bouts expending 300 kcal at 50% (i.e. P-MOD) and 70% (i.e. P-VIG) oxygen uptake reserve (VO2R) and one short bout expending 150 kcal at 50% VO2R (i.e. S-MOD)] performed in a randomized order. Central SBP (cSBP), pulse pressure (cPP), augmentation pressure, augmentation index (AIx), heart rate (HR) and AIx adjusted for HR (AIx@75) were determined 10 min before, and 30- and 70-min postintervention.

RESULTS

Compared to CTL, only the P-VIG changed the cSBP [70-min (Δ -11.7 mmHg)], cPP [70-min (Δ:-7.4 mmHg)], augmentation pressure [30-min (Δ:-5.7 mmHg); 70-min (Δ:-7.3 mmHg)], AIx [30-min (Δ:-15.3 %); 70-min (Δ:-16.4 %)], AIx@75 [30-min (Δ:-12.8 %); 70-min (Δ:-13.9 %)] and HR [70-min (Δ: 9.9 bpm)] in the hypertensive group. However, all exercise bouts mitigated the increased cSBP responses post-CTL in the hypertensive group.

CONCLUSION

The present study provides evidence that vigorous-intensity aerobic exercise reduces acute central pressure and pulse wave reflection in hypertensive men.

The acute effects of vinyasa flow yoga on vascular function, lipid and glucose concentrations, and mood

While the chronic effects of certain styles of yoga on cardiometabolic factors have been investigated, little is known about the acute effects of a single yoga session on these outcomes. Moreover, vinyasa yoga's potential to modulate cardiometabolic outcomes has not been established. The purpose of this study is to determine the acute effects of a vinyasa yoga session on arterial stiffness, wave reflection, lipid and glucose concentrations, and mood in adults with prior yoga experience. Thirty yoga practitioners with a minimum of 3 months of practice experience were enrolled into the study. Carotid-femoral pulse wave velocity (cf-PWV), augmentation index (AIx), lipid profile, glucose concentrations, and mood (Positive and Negative Affect Scale) were assessed at baseline and immediately following a 1 -h vinyasa yoga session. After the yoga session, participants had significantly lower AIx (p < 0.001), non-HDL cholesterol (p < 0.05), and negative affect (p < 0.01) compared to baseline. These results highlight the efficacy of a single bout of yoga in altering wave reflection while improving mood and lipid concentrations in healthy adults with a history of yoga practice.

Evaluation of exercise capacity using two field tests in patients with metabolic syndrome

PURPOSE

Field tests are popular for assessing exercise capacity because they are practical and have established validity. The objective of this study was to compare physiological responses and exercise performance of patients with metabolic syndrome in two field tests of exercise capacity.

MATERIAL AND METHODS

Forty-seven patients diagnosed with metabolic syndrome participated in this cross-sectional study. Exercise capacity was assessed using incremental shuttle walk test and six-minute walk test. Factors determining exercise capacity and agreement between the two tests were also investigated.

RESULTS

Metabolic syndrome patients achieved a significantly greater percentage of predicted maximal heart rate, blood pressure, and longer distance in the incremental shuttle walk test than in the six-minute walk test (p < 0.001). Gender and body mass index explained 48.5% of the variance in six-minute walk test distance (R = 0.697, R² = 0.485, F_(2-46) = 20.737, p < 0.001). Body mass index and fat-free mass explained 55% of the variance in incremental shuttle walk test distance (R = 0.746, R²= 0.557, F_(2-46) = 27.623, p < 0.001).

CONCLUSIONS

Despite the agreement in the percentages of predicted maximal heart rate during these two field tests, the incremental shuttle walk test may be a better assessment tool than the six-minute walk test because it elicits more pronounced and definitive physiological responses to exercise tolerance in patients with metabolic syndrome.IMPLICATIONS FOR REHABILITATIONThe incremental shuttle walk test can be used to evaluate exercise capacity in metabolic syndrome.The incremental shuttle walk test elicits greater physiological responses than the six-minute walk test.The incremental shuttle walk test may be preferable over the six-minute walk test in investigating exercise capacity.Both tests can guide and assist in the evaluation of this patient population in clinical practice.Body mass index affected distance in both exercise tests.

Assessment of Arterial Stiffness in Metabolic Syndrome Related to Insulin Resistance in Apparently Healthy Men

BACKGROUND

Assessment of subclinical atherosclerosis in metabolic syndrome is one of the global health targets' priorities. This study aimed to evaluate the subclinical atherosclerosis in metabolic syndrome related to insulin resistance in healthy and physically active men.

METHODS

A consecutive group of 68 healthy men, 30-55 years of age, was studied. Anthropometric parameters, proinflammatory factors, and insulin level were measured, and pulse wave analysis (PWA) was performed by applanation tonometry and then processed with dedicated software (SphygmoCor^®). The metabolic syndrome was defined according to International Diabetes Federation (IDF) and metabolic health as ≤1 component of metabolic syndrome according to the Joint Interim Statement criteria.

RESULTS

The odds ratio of insulin resistance for metabolic syndrome was 5.16 (95% confidence interval: 1.44-18.5), P = 0.008. In PWA, metabolically healthy subjects had lower aortic systolic and diastolic, and cardiac end-systolic pressures (103.5 ± 9.9 vs. 108.8 ± 11.0), P = 0.03, (76.2 ± 8.8 vs. 80.6 ± 7.8), P = 0.04, and (96.5 ± 9.2 vs. 101 ± 10.1), P = 0.05, respectively. Furthermore, metabolic syndrome was accompanied by higher ejection duration% (38.8 ± 3.5 vs. 36.9 ± 2.8), P = 0.04, and lower subendocardial viability ratio (SEVR) (139.8 ± 17.7 vs. 150.9 ± 17.6), P = 0.05. Insulin resistance was associated with higher cardiac end-systolic pressure (103.0 ± 6.9 vs. 96.7 ± 10.4), P = 0.015.

CONCLUSION

Metabolic risk factors had incremental correlations with central arterial pressures and cardiac end-systolic pressure. Furthermore, the composite of metabolic syndrome components imposed additional load on cardiac muscle by higher cardiac ejection duration and impairment in perfusion with lower Buckberg SEVR. Likewise, insulin resistance could be an early marker of arterial stiffness in healthy and active young to middle-age men.

Effects of exercise intensity and cardiorespiratory fitness on the acute response of arterial stiffness to exercise in older adults

PURPOSE

Increased arterial stiffness is observed with ageing and in individuals with low cardiorespiratory fitness ([Formula: see text]O_2peak), and associated with cardiovascular risk. Following an exercise bout, transient arterial stiffness reductions offer short-term benefit, but may depend on exercise intensity. This study assessed the effects of exercise intensity on post-exercise arterial stiffness in older adults with varying fitness levels.

METHODS

Fifty-one older adults (72 ± 5 years) were stratified into fitness tertiles ([Formula: see text]O_2peak: low-, 22.3 ± 3.1; mid-, 27.5 ± 2.4 and high-fit 36.3 ± 6.5 mL kg^-1 min^-1). In a randomised order, participants underwent control (no-exercise), moderate-intensity continuous exercise (40% of peak power output; PPO), and higher-intensity interval exercise (70% of PPO) protocols. Pulse wave velocity (PWV), augmentation index (AIx75) and reflection magnitude (RM) were assessed at rest and during 90 min of recovery following each protocol.

RESULTS

After control, delta PWV increased over time (P < 0.001) and delta RM was unchanged. After higher-intensity interval exercise, delta PWV (P < 0.001) and delta RM (P < 0.001) were lower to control in all fitness groups. After moderate-intensity continuous exercise, delta PWV was not different from control in low-fit adults (P = 0.057), but was lower in the mid- and higher-fit older adults. Post-exercise AIx75 was higher to control in all fitness groups (P = 0.001).

CONCLUSIONS

In older adults, PWV increases during seated rest and this response is attenuated after higher-intensity interval exercise, regardless of fitness level. This attenuation was also observed after moderate-intensity continuous exercise in adults with higher, but not lower fitness levels. Submaximal exercise reveals differences in the arterial stiffness responses between older adults with higher and lower cardiorespiratory fitness.

Aerobic Training Effect on Arterial Stiffness in Metabolic Syndrome

BACKGROUND

Metabolic syndrome, physical inactivity, and central obesity contribute to early vascular aging, which leads to increased risk of cardiovascular disease. This study aimed to assess the effect of heart rate (HR)-targeted aerobic exercise training on the indices of early vascular aging, in particular, arterial stiffness, and on anthropometric and clinical profile of metabolic syndrome subjects.

METHODS

There were 126 metabolic syndrome subjects randomly selected. Anthropometric parameters, blood pressure (BP), blood sample, and arterial wall functional and structural parameters were obtained prior to and after the 8-week (84 patients) supervised training program. The age- and sex-matched control group (42 patients) followed the same protocol, except for the HR-targeted training program.

RESULTS

In the study group, HR-targeted training was associated with decreased aortic pulse wave velocity (8.47 ± 1.40 vs 8.01 ± 1.06 m/s; P = .005), HR (P < .001), systolic (P < .015) and diastolic (P < .004) BP, waist circumference (P < .004), total and low-density-lipid cholesterol (respectively, 6.42 ± 1.41 vs 5.89 ± 1.32, P = .003 and 4.2 ± 1.18 vs 3.8 ± 1.21, P = .002), and an increase in aerobic capacity (P < .001). In the control group there were no statistically significant changes of arterial stiffness parameters. Multivariate analysis revealed that reduction of arterial stiffness was BP dependent.

CONCLUSIONS

In subjects with metabolic syndrome, HR-targeted exercise training is associated with BP-dependent decrease in aortic stiffness and improvement of metabolic and fitness parameters.