Refining the exercise prescription for hypertension

Mixed comparison of different exercise interventions on physical functioning in adult patients with morbid obesity following bariatric surgery: a systematic review and network meta-analysis

Introduction

People who are overweight following bariatric surgery (BS) often need physical exercise to help with body function. However, it is not known which exercise interventions are more effective in improving physical function.

Methods

PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for randomized controlled trials evaluating the effects of different exercise interventions on physical function in patients with excessive obesity following bariatric surgery. Outcome measures included effect sizes for physical function (PF), expressed as the number of stand-sit passes or the maximum distance walked within a time limit, body mass index (BMI), and blood pressure (BP). A systematic review was conducted to screen and synthesize the included studies, followed by a network meta-analysis for quantitative data analysis.

Results

A total of 15 studies involving 1011 patients were included. For PF, telehealth core exercise had the highest probability (0.46) of being the most effective intervention. For BMI, nutritional behavior and guided exercise, intervention had the highest probability (0.27) of being the most effective. Regarding BP, exercise prescription had the highest probability (0.47) for improving systolic blood pressure, while aerobic and strength and flexibility training had the highest probability (0.6) for improving diastolic blood pressure.

Discussion

Telehealth core exercise may be the most effective intervention for enhancing PF in overweight patients after bariatric surgery. Changes in BMI and BP with different postoperative exercise interventions may depend more on the surgery itself than the exercise modality. More specifically designed RCTs are needed for reliable conclusions.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42024507209.

Effect of High-Intensity interval training versus moderate continuous training on 24-h blood pressure profile and insulin resistance in patients with chronic heart failure

In patients with chronic heart failure (CHF) blood pressure (BP) control, represents a relevant target of management. This study evaluated the effect of different intensities exercise training on 24-h ambulatory BP profile and insulin resistance in patients with CHF. Thirty-six CHF patients with left ventricular ejection fraction <40%, were randomized to high-intensity interval training (HIT) or moderate continuous training (MIT) for 12 weeks. HIT consisted in treadmill exercise at ~75-80% of heart rate reserve (HRR), alternated with active pauses at 45-50% of HRR. MIT consisted in continuous treadmill at ~45-60% of HRR. Peak VO2 and anaerobic threshold increased significantly with both HIT and MIT, without significant differences between the two training programs. 24-h, systolic and diastolic BP decreased with both HIT and MIT. The same occurred for day-time and night-time systolic and diastolic BP. The decrease in day-time diastolic BP was slightly but significantly greater in HIT. Both HIT and MIT induced a significant decrease in fasting glucose and insulin, whereas HOMA-IR decreased significantly only after HIT. In patients with CHF exercise training reduces BP throughout the day, without substantial differences between moderate and more vigorous exercise intensity, with a small exception for day-time diastolic BP. HIT was more effective in improving insulin resistance.

Prescribing exercise for women

One- half of women in the United States do not meet the weekly dose of physical activity recommended by the Centers for Disease Control. Many women could benefit tremendously if they were to adopt a more active lifestyle. Health benefits from exercise include lowering the risk for cardiovascular disease, slowing the rate of bone loss in osteoporosis, and improving mood during pregnancy. In this article, we review the health benefits that women may gain from physical activity and the recommendations for physical activity for adults in the United States. We offer evidence supporting use of the exercise prescription, discuss how to write an exercise prescription, and how to tailor the exercise prescription for women with particular medical problems.

Perceived barriers to walking in the neighbourhood environment and change in physical activity levels over 12 months

OBJECTIVES

To investigate whether, and to what extent, perceived barriers to neighbourhood walking (BTNW) may be associated with physical activity levels.

DESIGN

Prospective survey with 12-month follow-up.

SUBJECTS AND METHODS

750 people attending walking schemes throughout England and Scotland; 551 completed the follow-up. independent variables were demographic characteristics, examples of possible "external" barriers to walking-for example, "worries about personal safety", and one item concerning ill health. The main outcome measures were "metabolic equivalent" (MET) hours' walking and overall physical activity in the preceding week.

RESULTS

Baseline and follow-up demographic characteristics were similar and physical activity levels generally high. Leisure walking changed little over 12 months, while total physical activity levels reduced significantly from a mean (SD) of 71.26 (78.14) MET hours per week at baseline to 59.57 (181.40) at the 12-month follow-up (p<0.001). External BTNW cited between baseline and 12 months increased significantly from a mean (SD) of 1.24 (1.61) at baseline to 1.43 (1.72) at the 12-month follow-up (p<0.001); only "worries about personal safety" reduced. A significant association was found between citing a health-related BTNW and the total number of external BTNW that were reported at baseline. The strength of this association increased over 12 months. Neither changes in reporting external BTNW that occurred over 12 months (increased vs decreased, vs unchanged) nor changes in the presence of a health-related BTNW were significantly related to levels of leisure walking and overall physical activity (MET hours in the preceding week) over the same period.

CONCLUSION

Among older people who attended walking schemes, having a health problem that restricted walking had a detrimental influence on people's perceptions about external BTNW, which increased over time. Actual levels of walking and overall physical activity levels did not appear to be significantly affected by this.