[Hypertension and exercise]

Exploring the Molecular Adaptations, Benefits, and Future Direction of Exercise Training: Updated Insights into Cardiovascular Health

This review emphasizes the globally accepted physical activity guidelines and explores the various molecular adaptations that occur with continuous exercise. It is essential to highlight the critical roles of cardiorespiratory fitness, muscular strength, and muscle mass in reducing mortality and enhancing quality of life. It has been shown in various studies that there are certainly substantial reductions in cardiovascular and all-cause mortality among individuals with high cardiorespiratory fitness levels. Resistance training is also examined, which, likewise, reveals significant mortality benefits, even with minimal weekly engagement. When delving into the molecular mechanisms, it is apparent that exercise training favorably influences certain cardiovascular conditions, mostly owing to its effect on enhanced lipid metabolism, improvement in glucose regulation, ability to modulate inflammation and oxidative processes, and induction of other cardioprotective effects like improved sympathetic tone and left ventricular remodeling. Cardiovascular diseases and malignancy also share the same risk factors, which explains why exercise can also mitigate the risk of developing many types of cancers. But despite these advancements in research, cardiovascular diseases continue to be prevalent, which may suggest the need to devise other means of promoting physical activity involvement. These approaches may include a greater emphasis on the societal benefits of increased exercise adherence, facilitated by community involvement and technological advancements in fitness tracking devices. We conclude that the future directions for exercise research should emphasize the need for personalized or tailored exercise programs to make it more engaging, accessible, and inclusive for a diverse set of people.

Effects of aerobic exercise on blood pressure in patients with hypertension: a systematic review and dose-response meta-analysis of randomized trials

We aimed to evaluate the dose-dependent effects of aerobic exercise on systolic (SBP) and diastolic blood pressure (DBP) and haemodynamic factors in adults with hypertension. PubMed, Scopus, and Web of Science were searched to April 2022 for randomized trials of aerobic exercise in adults with hypertension. We conducted a random-effects meta-analysis to estimate mean differences (MDs) and 95%CIs for each 30 min/week increase in aerobic exercise. The certainty of evidence was rated using the GRADE approach. The analysis of 34 trials with 1787 participants indicated that each 30 min/week aerobic exercise reduced SBP by 1.78 mmHg (95%CI: -2.22 to -1.33; n = 34, GRADE=low), DBP by 1.23 mmHg (95%CI: -1.53 to -0.93; n = 34, GRADE=moderate), resting heart rate (MD = -1.08 bpm, 95%CI: -1.46 to -0.71; n = 23, GRADE=low), and mean arterial pressure (MD = -1.37 mmHg, 95%CI: -1.80 to -0.93; n = 9, GRADE = low). A nonlinear dose-dependent decrement was seen on SBP and DBP, with the greatest decrement at 150 min/week (MD150 min/week = -7.23 mmHg, 95%CI: -9.08 to -5.39 for SBP and -5.58 mmHg, 95%CI: -6.90 to -4.27 for DBP). Aerobic exercise can lead to a large and clinically important reduction in blood pressure in a dose-dependent manner, with the greatest reduction at 150 min/week. The dose-dependent effects of aerobic exercise on systolic and diastolic blood pressure and haemodynamic factors in adults with hypertension.

Effect of Resistance Training on Skeletal Muscle Mass and Brown Adipose Tissue Activity

Brown adipose tissue (BAT) may be effective in preventing obesity and type II diabetes; however, there are no established reports on exercise-induced changes in BAT. This study focused on BAT variability in women undergoing resistance training (RT) interventions twice weekly for 10 weeks in cold environments. Fifteen participants were recruited: seven were randomly assigned to an RT group and eight to a control (CT) group. To evaluate BAT density (BAT-d), total haemoglobin concentration was measured using near-infrared time-resolved spectroscopy before and after the intervention. There was no significant difference in BAT-d between the CT and RT groups after the intervention (p = 0.921). There was a positive correlation between Δskeletal muscle (SM) mass and ΔBAT-d in the RT group (r = 0.615, p = 0.142). Supraclavicular region-specific thermogenesis (SST) had a significant positive correlation with BAT-d in the RT group (r = 0.889, p = 0.007). These results suggest that RT may be involved in BAT variability, owing to the trend of increased BAT-d with increased ΔSM mass and SST, although there was no significant increase in BAT-d after the RT intervention.

A Cross-Sectional Study on the Associations between Depression and Anxiety, Medication Use for These Diseases and Physical Activity Level in Spanish People with Hypertension

Hypertension (HTN) has a high prevalence in the overall population, affecting people's mental health. Physical Activity (PA) has proven to be an effective tool to improve mental health. This study analyzed the associations between Depression and Anxiety prevalence, medication use for these disorders (antidepressants and anxiolytics) and Physical Activity Level (PAL) in people with HTN. A cross-sectional study was conducted with data from the Spanish National Health Survey 2017 (ENSE2017) with a final sample of 3228 individuals over 15 years of age with HTN who resided in Spain. Data normality was assessed through the Kolmogorov-Smirnov test. Associations between Depression and Anxiety prevalence, antidepressant and anxiolytic use and PAL were studied using a chi-square test. Possible differences between Depression and Anxiety prevalence and medication use according to the PAL were analyzed with a z-test for independent proportions. Depression or Anxiety and antidepressant and anxiolytic use odds ratios (OR) were calculated for every PAL group, taking the "Very Active" group as a reference. Risk factors were evaluated using multiple binary logistic regression. Dependency relationships were found between Depression and Anxiety prevalence, antidepressant and anxiolytic use and PAL (p < 0.001). The Inactive group displayed the highest prevalence and medication use according to their PAL (p < 0.05). Higher ORs for Depression or Anxiety and pharmacological treatments used were also found in the Inactive group compared to the other PAL groups.

Microbiota-derived tryptophan metabolites in vascular inflammation and cardiovascular disease

The essential amino acid tryptophan (Trp) is metabolized by gut commensals, yielding in compounds that affect innate immune cell functions directly, but also acting on the aryl hydrocarbon receptor (AHR), thus regulating the maintenance of group 3 innate lymphoid cells (ILCs), promoting T helper 17 (TH17) cell differentiation, and interleukin-22 production. In addition, microbiota-derived Trp metabolites have direct effects on the vascular endothelium, thus influencing the development of vascular inflammatory phenotypes. Indoxyl sulfate was demonstrated to promote vascular inflammation, whereas indole-3-propionic acid and indole-3-aldehyde had protective roles. Furthermore, there is increasing evidence for a contributory role of microbiota-derived indole-derivatives in blood pressure regulation and hypertension. Interestingly, there are indications for a role of the kynurenine pathway in atherosclerotic lesion development. Here, we provide an overview on the emerging role of gut commensals in the modulation of Trp metabolism and its influence in cardiovascular disease development.

The Effects of 10-Week Strength Training in the Winter on Brown-like Adipose Tissue Vascular Density

There is no evidence of the effect of exercise training on human brown-like adipose tissue vascular density (BAT-d). Here, we report whether whole-body strength training (ST) in a cold environment increased BAT-d. The participants were 18 men aged 20-31 years. They were randomly assigned to two groups: one that performed ST twice a week at 75% intensity of one-repetition maximum for 10 weeks during winter (EX; n = 9) and a control group that did not perform ST (CT; n = 9). The total hemoglobin concentration in the supraclavicular region determined by time-resolved near-infrared spectroscopy was used as a parameter of BAT-d. ST volume (T_vol) was defined as the mean of the weight × repetition × sets of seven training movements. The number of occasions where the room temperature was lower than the median (NR_cold) was counted as an index of potential cold exposure during ST. There was no significant between-group difference in BAT-d. Multiple regression analysis using body mass index, body fat percentage, NR_cold, and T_vol as independent variables revealed that NR_cold and T_vol were determined as predictive of changes in BAT-d. An appropriate combination of ST with cold environments could be an effective strategy for modulating BAT.

Isometric handgrip exercise training reduces resting systolic blood pressure but does not interfere with diastolic blood pressure and heart rate variability in hypertensive subjects: a systematic review and meta-analysis of randomized clinical trials

To evaluate the effects of isometric handgrip exercise training (IHET) on blood pressure and heart rate variability in hypertensive subjects. Five databases were searched for randomized clinical trials in English, Spanish, or Portuguese evaluating the effect of IHET vs. no exercise on blood pressure (systolic and/or diastolic) and/or heart rate variability (low frequency [LF], high frequency [HF], and/or LF/HF ratio) through December 2020. Random-effects meta-analyses of mean differences (MDs) and/or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were performed. Five trials were selected (n = 324 hypertensive subjects), whose durations ranged from 8 to 10 weeks. Compared to no exercise, IHET reduced systolic blood pressure (MD -8.11 mmHg, 95% CI -11.7 to -4.53, p < 0.001) but did not affect diastolic blood pressure (MD -2.75 mmHg, 95% CI -9.47-3.96, p = 0.42), LF (SMD -0.14, 95% CI -0.65-0.37, p = 0.59), HF (SMD 0.38, 95% CI -0.14-0.89, p = 0.15), or the LF/HF ratio (SMD -0.22, 95% CI -0.95-0.52, p = 0.57). IHET performed for 8-10 weeks had a positive effect on resting systolic blood pressure but did not interfere with diastolic blood pressure or heart rate variability in hypertensive subjects. These data should be interpreted with caution since all volunteers included in the studies were clinically medicated and their blood pressure was controlled.

The effect of exercise training on blood pressure in menopause and postmenopausal women: A systematic review of randomized controlled trials

The prevalence of hypertension is higher in postmenopausal than in premenopausal women. Regular exercise training has been shown to be effective in addressing hypertension. The aim of this systematic review was to synthesize the effect of exercise training on systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in menopausal and postmenopausal women. This review was reported according to the PRISMA statement and registered in PROSPERO. The literature search was done in MEDLINE, Embase, Cochrane CENTRAL and ClinicalTrials. Randomized controlled trials involving menopausal and postmenopausal women undergoing exercise training were included. Two blinded reviewers assessed risk of bias in the included studies by using the Cochrane Risk of Bias tool. A random-effects model was used for all analyses. Significance was set at P < 0.05. Compared with the control group, exercise training resulted in clinically significant reductions on SBP (MD -3.43 mmHg; 95% CI, -5.16, -1.71; P < 0.0001), DBP (MD, -2.25 mmHg; 95% CI, -3.40, -1.11; P = 0.0001) and MAP (MD, -3.48 mmHg; 95% CI, -5.84, -1.11; P = 0.004). Aerobic training (AT) did not produce a significant reduction in SBP, DBP and MAP (P >0.05). Combined training (CT) generated larger reductions. Exercise training generated small but clinically relevant reductions in SBP, DBP and MAP in menopausal and postmenopausal women, younger or older than 65 years, with prehypertension or hypertension. AT did not lead to a clinically relevant improvement in blood pressure (BP) in this population. In addition, CT showed the largest reductions in SBP, DBP and MAP.

Associations between cardiac troponin I and cardiovascular parameters after 12-week endurance training in young moderately trained amateur athletes

Background

Previous studies were conducted only on elite athletes, and they investigate acute training responses of cardiac troponin I (CTnI). However, cardiac troponin was found to be elevated in young and inexperienced athletes than adults, and immature myocardium is more susceptible to injury, which needs further consideration.

Aim

Therefore, we aimed to observe the association between CTnI and cardiovascular parameters in response to chronic endurance training adaptation in young athletes.

Methods

Fifteen participants aged (19.5±1.3) years were selected and placed in endurance running at 70%–80% HRmax intensity for 35 min per training for the first week and additional 2 min each week from the second to the last week for 12 weeks. Serum cardiac troponin and cardiovascular parameters were assessed at pre-training and after 12 weeks of training.

Result

We find a significant CTnI level (p<0.05) and it is positively correlated with systolic blood pressure (BP) (r=0.425). Moreover, CTnI was statistically significant (p<0.01) and positively associated with mean arterial pressure (r=0.516) with a moderate correlation. Besides, CTnI showed a significant (p<0.001) and positive relationship with resting heart rate (r=0.605) and a moderate correlation. We did not find a significant relationship between CTnI and diastolic BP in response to endurance training adaptation.

Conclusion

In conclusion, serum CTnI was significantly and positively associated with cardiovascular parameters in young amateur athletes in response to 12-week endurance training adaptation.

Effects of arm swing exercise training on cardiac autonomic modulation, cardiovascular risk factors, and electrolytes in persons aged 60-80 years with prehypertension: A randomized controlled trial

Background/Objective

This study aimed to investigate the effect and carry-over effect of arm swing exercise (ASE) training on cardiac autonomic modulation, cardiovascular risk factors, and blood electrolytes in older persons with prehypertension.

Methods

Subjects were 50 individuals with prehypertension (aged 66.90 ± 5.50 yr, body mass index 23.84 ± 3.65 kg/m²). They were randomly assigned into ASE group and control group. Subjects in the ASE group underwent an ASE training program for 3 months at a frequency of 30 min/day, 3 days/week. Subjects in the control group maintained their daily routine activities minus regular exercise. Blood pressure, heart rate variability (HRV), cardiovascular risk factors including blood glucose, lipid profile, high-sensitive C-reactive protein (hsCRP), and electrolytes were evaluated on 3 occasions: before and after the 3-month intervention, and 1 month after intervention ended.

Results

Following the 3-month intervention, systolic blood pressure (SBP) and serum hsCRP concentration were significantly lower, while serum high-density lipoprotein (HDL)-cholesterol, potassium (K⁺), magnesium (Mg²⁺) concentrations, standard deviation of normal R-R intervals (RMSSD) and high frequency (HF) power values were higher in the ASE group when compared with the control group (p < 0.05). At the 1-month follow-up interval, SBP and serum hsCRP concentration remained lower while serum HDL-cholesterol and K⁺ concentrations remained higher in the ASE group as compared to the control group (p < 0.05).

Conclusion

ASE training decreased SBP and serum hsCRP concentration, increased serum HDL-cholesterol, K⁺, and Mg²⁺ concentrations and increased RMSSD and HF power values in older persons with prehypertension. In addition, there were carry-over effects of ASE training i.e. decreased SBP and serum hsCRP concentration as well as increased serum HDL-cholesterol and K⁺ concentrations.

Relationship between cardiorespiratory fitness and blood pressure in young adults: a mediation analysis of body composition

High blood pressure levels are among the most important cardiovascular disease risk factors and are influenced by physical fitness and body composition. However, the degree to which obesity may attenuate or modify the beneficial effects of physical fitness on blood pressure levels in young adults is uncertain. Thus, the aim of this study was to analyze whether body composition is a mediator between cardiorespiratory fitness (CRF) and blood pressure levels in young adults. This work was a cross-sectional study involving first-year college students (n=386) at the University Campus of Cuenca (Spain). We measured weight, height, waist circumference, fat mass percentage (by densitometry), systolic and diastolic blood pressure and CRF levels (by a 20 m shuttle run test). Partial correlation coefficients were estimated to examine the relationships among adiposity variables, CRF and blood pressure variables, controlling for age and sex. ANCOVA models were conducted to explore differences in blood pressure levels across adiposity and CRF categories. Hayes's PROCESS macro was used for the simple mediation analysis. The indirect effect and Sobel test were significant (P<0.001), confirming that all body composition variables mediate between CRF and all of the included blood pressure variables. All body composition variables acted as mediators between CRF and blood pressure. These results highlight the importance of maintaining a healthy body composition to prevent hypertension in young adults.

Cardiovascular Risk in Midlife African American Women Participating in a Lifestyle Physical Activity Program

BACKGROUND

Cardiovascular disease (CVD) is the largest contributor to disparate morbidity and mortality in African American women.

OBJECTIVE

The aims of this article are to describe in a cohort of sedentary, urban community-based midlife African American women eligible for a physical activity program their (1) CVD risk factors and (2) awareness, treatment, and control of hypertension and hypercholesterolemia.

METHODS

Cross-sectional baseline findings on 297 women were examined at baseline of a controlled physical activity clinical trial. Cardiovascular disease risks included hypertension, hypercholesterolemia, smoking, diabetes, and obesity. Among women with hypertension and hypercholesterolemia, rates of awareness, treatment, and control were calculated.

RESULTS

Our sample had significantly more hypertension and obesity than reported in other national samples of African American women. The women mirrored national samples of African American women: fewer than 60% had adequate control of hypertension. Versus national samples of African Americans (men/women combined), our study groups both showed significantly lower low-density-lipoprotein cholesterol level: treatment, 33% versus 63.8%, and control, 24.8% versus 45.3%.

CONCLUSIONS

Because national samples are more heterogeneous, our sample provides important information about CVD risks in inactive, urban community-dwelling, midlife African American women. Given the opportunity, many such women at elevated risk for CVD are willing to participate in a physical activity intervention. They must be identified and offered pharmacological and lifestyle interventions.

Correlation of Cardiac Markers and Biomarkers With Blood Pressure of Middle-Aged Marathon Runners

Runners with exercise-induced high blood pressure have recently been reported to exhibit higher levels of cardiac markers, vasoconstrictors, and inflammation. The authors attempted to identify correlations between exercise-related personal characteristics and the levels of biochemical/cardiac markers in marathon runners in this study. Forty healthy runners were enrolled. Blood samples were taken both before and after finishing a full marathon. The change in each cardiac/biochemical marker over the course of the marathon was determined. All markers were significantly (P<.001) increased immediately after the marathon (creatine kinase-MB [CK-MB]: 7.9 ± 2.7 ng/mL, cardiac troponin I (cTnI): 0.06 ± 0.10 ng/mL, N-terminal pro-B-type natriuretic peptide (NT-proBNP): 95.7 ± 76.4, endothelin-1: 2.7 ± 1.16, high-sensitivity C-reactive protein [hs-CRP]: 0.1 ± 0.09, creatine kinase [CK]: 315.7 ± 94.0, lactate dehydrogenase [LDH]: 552.8 ± 130.3) compared with their premarathon values (CK-MB: 4.3 ± 1.3, cTnI: 0.01 ± 0.003, NT-proBNP: 27.6 ± 31.1, endothelin-1: 1.11 ± 0.5, hs-CRP: 0.06 ± 0.07, CK: 149.2 ± 66.0, LDH: 399 ± 75.1). In middle-aged marathon runners, factors related to increased blood pressure were correlated with marathon-induced increases in cTnI, NT-proBNP, endothelin-1, and hs-CRP. These correlations were observed independent of running history, records of finishing, and peak oxygen uptake.

Physical activity is associated with decreased incidence of chronic kidney disease in type 2 diabetes patients: a retrospective cohort study in Taiwan

AIMS

To assess the effect of physical activity in patients with type 2 diabetes mellitus on prevention of diabetes with chronic kidney disease.

METHODS

This is a cohort study on stratified selected subjects in Taiwan from 2004/01/01 to 2005/12/31. Demographic data, lifestyle factors and clinical characteristics were analyzed for an association with the occurrence of chronic kidney disease. Applicable analysis weights, Stata 11.0, were applied to adjust the design variables for clustering and stratification.

RESULTS

During the two year study period, the univariate Cox proportional hazards model showed significant associations of age, physical activity, and the Charlson comorbidity index (CCI) with chronic kidney disease. Physical activity had a beneficial effect in diabetic subjects with chronic kidney disease (HR: 0.31, p<0.01). Older age and a CCI greater than 2 were both harmful in diabetic subjects with chronic kidney disease (1.06 and 3.44, respectively). The results of a multivariate Cox proportional hazards evaluation model were similar to those of a univariate evaluation model, except that CCI was not significantly different. Moreover, medications for hypertension of diabetic subjects created an increased risk of chronic kidney disease (HR: 5.85 and 3.74, respectively), indicating that the presence of hypertension is a strong risk factor for the progression of chronic kidney disease.

CONCLUSION

In this study, physical activity was not only a healthful lifestyle factor but also a treatment to decrease incidence of chronic kidney disease in diabetic patients.

Obesity indices and haemodynamic response to exercise in obese diabetic hypertensive patients: Randomized controlled trial

INTRODUCTION

Obesity, diabetes and hypertension are major worldwide interconnected problems. The aim of this study was to investigate body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressure (SBP and DPB) responses to circuit weight training (CWT) or aerobic exercise training (AET) in obese diabetic hypertensive patients (ODHP).

METHODS

Fifty-nine ODHP were randomly assigned into CWT, AET and control groups. Either CWT or AET was performed thrice weekly for 12 weeks. Variables were evaluated pre-training (evaluation-1), after 3 months (evaluation-2) and 1 month post-training cessation (evaluation-3).

RESULTS

At evaluation-2, BMI, WC, SBP, DBP mean values and percentages of decrease were 31.56±1.48 (9.23%), 104±5.97 (6.2%), 141±2.2 (3.09%), 91.2±1.24 (2.98%) and 32.09±1.21 (7.11%), 107.66±3.92 (3.07%), 138.3±1.17 (4.79%), 88.05±1.05 (6.02%) for CWT and AET groups respectively (P<0.05). At evaluation-3, mean values and percentage of decrease in BMI, WC, SBP, DBP were 31.88±1.54 (8.29%), 105±5.28 (5.26), 142.6±2.21 (1.99%), 92.7±0.86 (1.38%) and 33.26±1.22 (3.72%), 109.1±4.15 (1.77%), 140.35±1.23 (3.38%), 89.5±0.61 (4.47%) for CWT and AET groups respectively (P<0.05). There were also significant differences in BMI, WC, SBP, and DBP between groups at evaluation-2 and 3 (P<0.05).

CONCLUSIONS

While CWT is the intervention of choice to control obesity indices, AET is still the best intervention to lower blood pressure in ODHP, for a more extended period of time.