Reduced central blood pressure in older adults following progressive resistance training

Arterial Stiffness Response to Acute Combined Training with Different Volumes in Coronary Artery Disease and Heart Failure Patients

Resistance training has been shown to acutely increase arterial stiffness (AS), while endurance training appears to decrease AS. However, the findings are from studies in apparently healthy subjects and have limited applicability to patients at low and high cardiovascular risk, for whom combined exercise is recommended. We compared the time course of changes in local and regional indices of AS in response to high-volume combined endurance training (CET) and high-volume combined resistance training (CRT) in patients with coronary artery disease (CAD) and heart failure (HF). We studied 20 men with CAD and HF (10 each) aged 68.3 ± 9.6 years. AS was measured by pulse wave velocity (PWV), and brachial and central blood pressure (BP) were determined after 15 min of rest and 5 and 15 min after the exercise session. All patients completed two sessions on nonconsecutive days. A protocol by time interaction effect was observed for carotid (η² = 0.21, p = 0.02), aortic (η² = 0.60, p < 0.001), and femoral (η² = 0.46, p = 0.01) PWV after CET and CRT, suggesting that PWV decreased after CET and increased after CRT. Decreases in the brachial and central variables of BP across time points were observed in both protocols. CET decreased whereas CRT increased carotid, aortic, and femoral PWV at 15 min after exercise in patients with CAD and HF.

Longitudinal Impact of Physical Activity on Brain Pulsatility Index and Cognition in Older Adults with Cardiovascular Risk Factors: A NIRS Study

Recent studies have shown that optical indices of cerebral pulsatility, including cerebral pulse amplitude, are linked to cerebrovascular health. A chronically higher cerebral pulsatility is associated with cognitive decline. Although it is widely known that regular physical activity improves cognitive functions, little is known about the association between physical activity and the optical index of cerebral pulsatility. This study assessed the impact of 12 months of regular physical activity on the changes in the optical index of cerebral pulsatility and explored its association with cognition. A total of 19 older adults (aged 59-79 years) with cardiovascular risk factors (CVRF) completed the study. Low-intensity, short-duration walking as a brief cardiovascular challenge was used to study the impact of regular physical activity on post-walking changes in cerebral pulsatility index. The participants walked on a gym track while a near-infrared spectroscopy (NIRS) device recorded hemodynamics data from the frontal and motor cortex subregions. Our data indicated that 12 months of physical activity was associated with lower global cerebral pulse amplitude, which was associated with higher cognitive scores in executive functions. Further, the global cerebral pulsatility index was reduced after short-duration walking, and this reduction was greater after 12 months of regular physical activity compared with the baseline. This may be an indication of improvement in cerebrovascular response to the cardiovascular challenge after regular physical activity. This study suggests that 12 months of physical activity may support cognitive functions through improving cerebral pulsatility in older adults with CVRF.

Reshaping the path of vascular cognitive impairment with resistance training: a study protocol for a randomized controlled trial

Background

Subcortical ischemic vascular cognitive impairment (SIVCI) is the most common form of vascular cognitive impairment. Importantly, SIVCI is considered the most treatable form of cognitive impairment in older adults, due to its modifiable risk factors such as hypertension, diabetes mellitus, and hypercholesterolemia. Exercise training is a promising intervention to delay the progression of SIVCI, as it actively targets these cardiometabolic risk factors. Despite the demonstrated benefits of resistance training on cognitive function and emerging evidence suggesting resistance training may reduce the progression of white matter hyperintensities (WMHs), research on SIVCI has predominantly focused on the use of aerobic exercise. Thus, the primary aim of this proof-of-concept randomized controlled trial is to investigate the efficacy of a 12-month, twice-weekly progressive resistance training program on cognitive function and WMH progression in adults with SIVCI. We will also assess the efficiency of the intervention.

Methods

Eighty-eight community-dwelling adults, aged > 55 years, with SIVCI from metropolitan Vancouver will be recruited to participate in this study. SIVCI will be determined by the presence of cognitive impairment (Montreal Cognitive Assessment < 26) and cerebral small vessel disease using computed tomography or magnetic resonance imaging. Participants will be randomly allocated to a twice-weekly exercise program of (1) progressive resistance training or (2) balance and tone training (i.e., active control). The primary outcomes are cognitive function measured by the Alzheimer’s Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-13 with additional cognitive tests) and WMH progression.

Discussion

The burden of SIVCI is immense, and to our knowledge, this will be the first study to quantify the effect of progressive resistance training on cognitive function and WMH progression among adults with SIVCI. Slowing the rate of cognitive decline and WMH progression could preserve functional independence and quality of life. This could lead to reduced health care costs and avoidance of early institutional care.

Trial registration

ClinicalTrials.gov NCT02669394. Registered on February 1, 2016

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05156-1.

Saffron (Crocus sativus L.) in combination with resistance training reduced blood pressure in the elderly hypertensive men: A randomized controlled trial

AIMS

We aimed to determine the independent and combined effects of saffron and resistance training on blood pressure (BP) and some chemical biomarkers in the elderly with hypertension.

METHODS

The present study was a randomized clinical trial on hypertensive men aged 60-70 years who were assigned to a control group (CO) and 3 experimental groups; resistance training (RT); saffron (S); and resistance training + saffron (RTS) for 12 weeks. Dynamic resistance training was applied with moderate intensity. Patients in S and RTS received 1 tablet containing 200 mg of saffron daily. BP variables, chemical biomarkers and anthropometric indicators were measured at weeks 0, 6, 12 and 18. Data were analysed by repeated measurements ANOVA with 95% confidence interval (CI).

RESULTS

In comparison to the CO (153.3 ± 1.18, CI = 10.9-20.2, P < .001) and S (143.3 ± 1.18, CI = 0.97-10.2, P = .01), RTS (137.7 ± 1.18) reduced systolic BP with the effect size partial η² of 0.68. Nitric oxide increased in the RTS compared to the CO group (CI = 0.13-0.62, P = .001). There was a significant increase and decrease in adiponectin and endothelin-1 in the S (CI = 0.03-1.20, P = .012; CI = 4.30-17.3, P < .001) and RT (CI = 0.36-1.60, P < .001; CI = 2.26-15.3, P = .003) compared to the CO, respectively. The partial η² for nitric oxide, adiponectin and ET-1 were 0.35, 0.35 and 0.38, respectively. There was no significant difference between the groups for atrial natriuretic peptide.

CONCLUSIONS

Resistance training and consumption of saffron can improve BP in the elderly with hypertension by affecting the factors involved in altering vascular endothelial resistance. The present study was approved by the Ethics Committee of Iran's sports science research institution (IR.SSRC.REC.1398.020) and registered at the Iranian Registry of Clinical Trials (IRCT20190731044398N1).

Chronic Fish Oil Consumption with Resistance Training Improves Grip Strength, Physical Function, and Blood Pressure in Community-Dwelling Older Adults

Fish oil (FO) has received great attention for its health-enhancing properties. However, its potential synergistic effects with resistance training (RT) are not well established. The purpose of this study was to investigate the effects of FO supplementation during 12-weeks of RT on handgrip strength, physical function, and blood pressure (BP) in community-dwelling older adults. Twenty-eight healthy older adults (10 males, 18 females; 66.5 ± 5.0 years) were randomly assigned to three groups: Control (CON), resistance training (RT), resistance training with FO (RTFO). Handgrip strength, physical function [five times sit-to-stand (5T-STS), timed up and go (TUG), 6-m walk (6MW), 30-s sit-to-stand (30S-STS)], and BP were measured pre- and post-intervention. ANOVA was used with significance set at P ≤ 0.05. Handgrip strength significantly increased in RT (+5.3%) and RTFO (+9.4%) but decreased in CON (−3.9%). All physical function outcomes increased in RT and RTFO. CON exhibited significantly decreased TUG and 30S-STS with no change in 5T-STS and 6MW. BP substantially decreased only in RTFO, systolic blood pressure (−7.8 mmHg), diastolic blood pressure (−4.5 mmHg), mean arterial pressure (−5.6 mmHg), while no change was found in CON and RT. Chronic RT enhanced strength and physical function, while FO consumption combined with RT improved BP in community-dwelling older adults.

Active body, healthy brain: Exercise for healthy cognitive aging

The world's population is aging and promoting healthy cognitive aging is a public health priority and challenge. Physical activity is a modifiable lifestyle factor that has been identified as positively impacting the cognitive health of older adults with and without cognitive impairment. This chapter current evidence from epidemiological and intervention studies (i.e., randomized controlled trials) on the role of physical activity and exercise in promoting cognitive health in older adults both with and without cognitive impairment. Biological sex as a potential moderator of exercise efficacy is also discussed. We conclude with future directions for this rapidly expanding line of research.

Exercise and the Aging Brain: Considerations for Sex Differences

Engaging in targeted exercise interventions is a promising, non-pharmacological strategy to mitigate the deleterious effects of aging and disease on brain health. However, despite its therapeutic potential, a large amount of variation exists in exercise efficacy in older adults aged 55 and older. In this review, we present the argument that biological sex may be an important moderator of the relationship between physical activity and cognition. Sex differences exist in dementia as well as in several associated risk factors, including genetics, cardiovascular factors, inflammation, hormones and social and psychological factors. Different exercise interventions, such as aerobic training and resistance training, influence cognition and brain health in older adults and these effects may be sex-dependent. The biological mechanisms underlying the beneficial effects of exercise on the brain may be different in males and females. Specifically, we examine sex differences in neuroplasticity, neurotrophic factors and physiological effects of exercise to highlight the possible mediators of sex differences in exercise efficacy on cognition. Future studies should address the potential sex difference in exercise efficacy if we are to develop effective, evidence-based exercise interventions to promote healthy brain aging for all individuals.

Physical activity for brain health in older adults

Physical activity is a promising strategy for dementia prevention and disease modification. Here, we provide a narrative review of the current evidence from epidemiological and intervention studies on the role of physical activity and exercise in promoting cognitive health in older adults both without and with cognitive impairment. We highlight some of the potential underlying mechanisms and discuss biological sex as a potential moderating factor. We conclude with limitations and future directions for this rapidly expanding line of research.

Effects of exercise modalities on central hemodynamics, arterial stiffness and cardiac function in cardiovascular disease: Systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Exercise is accepted as an important contribution to the rehabilitation of patients with cardiovascular disease (CVD). This study aims to better understand the possible causes for lack of consensus and reviews the effects of three exercise modalities (aerobic, resistance and combined exercise) on central hemodynamics, arterial stiffness and cardiac function for better rehabilitation strategies in CVD.

METHODS

The electronic data sources, Cochrane Library, MEDLINE, Web of Science, EBSCO (CINAHL), and ScienceDirect from inception to July 2017 were searched for randomized controlled trials (RCTs) investigating the effect of exercise modalities in adult patients with CVD. The effect size was estimated as mean differences (MD) with 95% confidence intervals (CI). Subgroup analysis and meta-regression were used to study potential moderating factors.

RESULTS

Thirty-eight articles describing RCTs with a total of 2089 patients with CVD were included. The pooling revealed that aerobic exercise [MD(95%CI) = -5.87 (-8.85, -2.88), P = 0.0001] and resistance exercise [MD(95%CI) = -7.62 (-10.69, -4.54), P<0.00001] significantly decreased aortic systolic pressure (ASP). Resistance exercise significantly decreased aortic diastolic pressure [MD(95%CI) = -4(-5.63, -2.37), P<0.00001]. Aerobic exercise significantly decreased augmentation index (AIx) based on 24-week exercise duration and patients aged 50-60 years. Meanwhile, aerobic exercise significantly improved carotid-femoral pulse wave velocity (cf-PWV) [MD(95%CI) = -0.42 (-0.83, -0.01), P = 0.04], cardiac output (CO) [MD(95% CI) = 0.36(0.08, 0.64), P = 0.01] and left ventricular ejection fraction (LVEF) [MD(95%CI) = 3.02 (2.11, 3.93), P<0.00001]. Combined exercise significantly improved cf-PWV [MD(95%CI) = -1.15 (-1.95, -0.36), P = 0.004] and CO [MD(95% CI) = 0.9 (0.39, 1.41), P = 0.0006].

CONCLUSIONS

Aerobic and resistance exercise significantly decreased ASP, and long-term aerobic exercise reduced AIx. Meanwhile, aerobic and combined exercise significantly improved central arterial stiffness and cardiac function in patients with CVD. These findings suggest that a well-planned regime could optimize the beneficial effects of exercise and can provide some evidence-based guidance for those involved in cardiovascular rehabilitation of patients with CVD.

Effects of circuit exercise training on vascular health and blood pressure

As the global burden of cardiovascular disease (CVD) rises, public health-related interventions aimed at prevention of heart disease have gained medical attention. Clinical research reports that exercise is a protective risk factor associated with CVD and that clinicians need to provide exercise recommendations to patients. Nevertheless, physical inactivity remains a public health problem. In certain populations, like firefighters (FF), increased risk of CVD is especially concerning. The workload FF face is extreme, 50% of line-of-duty deaths (LODD) in FF are cardiac-related, and research on the volunteer FF population is scarce. Government regulations do not require volunteer FF companies to have fitness testing or programming, so exercise intervention studies are necessary to improve the burden of CVD risk in this population. Therefore, this study examined the effects of a 4-week exercise circuit training (CT) intervention on vascular health and fitness in volunteer FF (N = 27) from the Philadelphia PA area compared to a control group of Non-FF (N = 25). Carotid artery intima-media thickness (IMT), brachial artery flow-mediated dilation (FMD), augmentation index, and pulse pressure (PP), brachial and central blood pressure (BP) and fitness were measured pre- and post- intervention. Overall, volunteer FF had more significant improvements (p < 0.05) in vascular health measures (FMD, IMT, and PP). In both groups, we also found that brachial and central BP decreased with exercise. We show that a 4 week CT program can improve vascular structure and function in the volunteer FF population, suggesting that clinicians may be able to reduce or prevent cardiac LODD by exercise.

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Short term circuit training improves vascular health in volunteer firefighters.

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Core blood pressure and clinic blood pressure are reduced with 4 weeks of training.

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Implementing functional exercise programs in firehouses would improve overall health.

Effects of acute and chronic exercise in patients with essential hypertension: benefits and risks

The importance of regular physical activity in essential hypertension has been extensively investigated over the last decades and has emerged as a major modifiable factor contributing to optimal blood pressure control. Aerobic exercise exerts its beneficial effects on the cardiovascular system by promoting traditional cardiovascular risk factor regulation, as well as by favorably regulating sympathetic nervous system (SNS) activity, molecular effects, cardiac, and vascular function. Benefits of resistance exercise need further validation. On the other hand, acute exercise is now an established trigger of acute cardiac events. A number of possible pathophysiological links have been proposed, including SNS, vascular function, coagulation, fibrinolysis, and platelet function. In order to fully interpret this knowledge into clinical practice, we need to better understand the role of exercise intensity and duration in this pathophysiological cascade and in special populations. Further studies in hypertensive patients are also warranted in order to clarify the possibly favorable effect of antihypertensive treatment on exercise-induced effects.

Effect of combined aerobic and resistance training versus aerobic training on arterial stiffness

BACKGROUND

While aerobic exercise training may decrease arterial stiffness, the impact of combined aerobic and resistance training is unclear. Therefore, the aim of this study was to systematically review and quantify the effect of combined aerobic and resistance training on arterial stiffness, as determined by arterial pulse wave velocity (PWV), and compare it with aerobic training.

METHODS

MEDLINE, EMBASE and Web of Science were searched through November 2013 for randomized controlled trials evaluating the effect of aerobic or combined aerobic and resistance training on PWV. A meta-analysis was performed to determine the standardized mean difference (SMD) in PWV between exercise and control groups. Subgroup analyses were used to study potential moderating factors.

RESULTS

Twenty-one randomized controlled trials comparing exercise and control groups (overall n=752), met the inclusion criteria. After data pooling, PWV was decreased in aerobic trained groups compared with controls (10 trials, SMD=-0.52, 95% CI= -0.76, -0.27; P<0.0001) but did not reach statistical significance in combined trained groups compared with controls (11 trials, SMD=-0.23, 95% CI=-0.50, 0.04; P=0.10). The effect in aerobic trained groups did not differ compared with combined trained groups (P=0.12). In addition, aerobic training resulted in significantly lower SMD in PWV compared with combined training in interventions including a higher volume of aerobic training or assessing carotid-femoral PWV.

CONCLUSIONS

These data suggest that combined aerobic and resistance training interventions may have reduced beneficial effects on arterial stiffness compared with control interventions, but do not appear to differ significantly with aerobic training alone.

Effects of hypocaloric diet, low-intensity resistance exercise with slow movement, or both on aortic hemodynamics and muscle mass in obese postmenopausal women

OBJECTIVE

This study aims to examine the independent and combined impact of hypocaloric diet and low-intensity resistance exercise training (LIRET) on aortic hemodynamics and appendicular skeletal muscle mass (ASM) in obese postmenopausal women.

METHODS

Forty-one obese postmenopausal women (mean [SD] age, 54 [1] y) were randomly assigned to LIRET (n = 13), diet (n = 14), or diet + LIRET (n = 14). Body weight, waist circumference, aortic systolic blood pressure, aortic pulse pressure, augmentation index, subendocardial viability ratio (SEVR; myocardial perfusion), and heart rate (HR) were measured before and after 12 weeks. ASM was assessed by dual-energy x-ray absorptiometry.

RESULTS

Body weight (P < 0.001) and waist circumference (P < 0.01) decreased similarly after diet and diet + LIRET compared with no changes after LIRET. ASM did not change after diet + LIRET, and the decrease observed after diet (P < 0.001) was significant compared with LIRET. Aortic systolic blood pressure decreased similarly after LIRET (P < 0.05), diet (P < 0.01), and diet + LIRET (P < 0.01). Aortic pulse pressure (P < 0.05) decreased similarly after diet and diet + LIRET, but not after LIRET. SEVR (P < 0.01) increased similarly in both diet groups, whereas HR (P < 0.01) decreased only after diet. Changes in SEVR (P < 0.05) and HR (P< 0.01) with diet were different compared with LIRET. The augmentation index did not change in any group.

CONCLUSIONS

Our findings suggest that diet-induced weight loss may reduce cardiovascular risk by improving SEVR via HR and aortic pulse pressure reductions in obese postmenopausal women. LIRET prevents ASM loss associated with hypocaloric diet but has no additive effects on aortic hemodynamics.

Análise metodológica do treinamento de força como estratégia de controle da pressão arterial em idosos: uma revisão

OBJETIVO: Realizar uma revisão sobre quais variáveis do programa de treinamento resistido estariam mais associadas com a maior redução da pressão arterial de repouso em idosos. MÉTODOS: Foi realizado um levantamento bibliográfico nas bases de dados MEDLINE, SciELO e LILACS, compreendendo o período entre os anos 1990 e 2010, utilizando os descritores: envelhecimento, idosos, pressão arterial, exercício resistido e treinamento de força. Seguindo os procedimentos estabelecidos para o estudo, foram selecionados 16 artigos para esta revisão. RESULTADOS: O treinamento resistido regular promove redução da pressão arterial de repouso em indivíduos idosos. A magnitude e a duração do efeito hipotensor variou entre os estudos, de modo que o efeito benéfico do treinamento resistido se mostrou mais evidente quando realizado com: intensidade moderada, maior número de repetições e, pelo menos, 16 semanas de duração. CONCLUSÃO: O treinamento resistido promove redução da pressão arterial, mas as características do protocolo de treinamento influenciam nesta resposta. Além disso, ainda existem controvérsias na pesquisa, e são necessárias investigações futuras.

Eight weeks of stretching training reduces aortic wave reflection magnitude and blood pressure in obese postmenopausal women

The augmentation index (AIx, a marker of wave reflection) is reduced and peripheral artery vasodilation increased following acute stretching exercise. We examined the effects of stretching training (ST) on arterial function, blood pressure (BP) and sympathetic vasomotor modulation. Twenty-eight obese postmenopausal women (57±1 years) were randomized to a ST (n=14) or no-exercise control (CON) group ( n=14). ST included stretching exercises 3 days week(-1) for 8 weeks. Brachial (b) and aortic (a) systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), heart rate (HR), brachial-ankle pulse wave velocity (baPWV), carotid-femoral PWV (aPWV), femoral-ankle PWV (faPWV), AIx, low-frequency component of SBP (LFSBP) and sit/reach score (SRS) were measured before and after interventions. There were significant decreases in bSBP (P<0.05), aSBP (P<0.01), aDBP (P<0.05), aMAP (P<0.01), aAIx (P<0.05) and LFSBP (P<0.05) after ST compared with CON. SRS significantly (P<0.01) increased after ST but not after CON. There were no significant effects (P>0.05) on HR, baPWV, aPWV and faPWV after ST or CON. Eight weeks of ST decreases BP, AIx and LFSBP in obese postmenopausal women. Our findings show that ST reduces peripheral and central BP, wave reflection magnitude and vascular sympathetic activity in obese postmenopausal women with prehypertension and hypertension.

A multicentre year-long randomised controlled trial of exercise training targeting physical functioning in men with prostate cancer previously treated with androgen suppression and radiation from TROG 03.04 RADAR

BACKGROUND

Long-term prostate cancer (PCa) survivors are at increased risk for comorbidities and physical deconditioning.

OBJECTIVE

To determine the effectiveness of a year-long randomised controlled trial of exercise training in PCa survivors >5 yr postdiagnosis on physical functioning.

DESIGN, SETTING, AND PARTICIPANTS

Between 2010 and 2011, 100 long-term PCa survivors from Trans-Tasman Radiation Oncology Group 03.04 Randomised Androgen Deprivation and Radiotherapy previously treated with androgen-deprivation therapy and radiation therapy were randomly assigned to 6 mo of supervised exercise followed by 6 mo of a home-based maintenance programme (n=50) or printed educational material about physical activity (n=50) for 12 mo across 13 university-affiliated exercise clinics in Australia and New Zealand.

INTERVENTION

Supervised resistance and aerobic exercise or printed educational material about physical activity.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The primary end point was a 400-m walk as a measure of cardiovascular fitness. Secondary end points were physical function, patient-reported outcomes, muscle strength, body composition, and biomarkers. Analysis of covariance was used to compare outcomes for groups at 6 and 12 mo adjusted for baseline values.

RESULTS AND LIMITATIONS

Participants undergoing supervised exercise showed improvement in cardiorespiratory fitness performance at 6 mo (-19 s [p=0.029]) and 12 mo (-13 s [p=0.028]) and better lower-body physical function across the 12-mo period (p<0.01). Supervised exercise also improved self-reported physical functioning at 6 (p=.006) and 12 mo (p=0.002), appendicular skeletal muscle at 6 mo (p=0.019), and objective measures of muscle strength at 6 and 12 mo (p<0.050). Limitations included the restricted number of participants undertaking body composition assessment, no blinding to group assignment for physical functioning measures, and inclusion of well-functioning individuals.

CONCLUSIONS

Supervised exercise training in long-term PCa survivors is more effective than physical activity educational material for increasing cardiorespiratory fitness, physical function, muscle strength, and self-reported physical functioning at 6 mo. Importantly, these benefits were maintained in the long term with a home-based programme with follow-up at 12 mo.

CLINICAL TRIAL REGISTRY

The effect of an exercise intervention on cardiovascular and metabolic risk factors in prostate cancer patients from the RADAR study, ACTRN: ACTRN12609000729224.

Effects of resistance training on central blood pressure in obese young men

Central blood pressure is a predictor of the risk of cardiovascular disease (CVD), and the effects of resistance training (RT) on central blood pressure are largely unknown. This study explored the effects of high-intensity RT on central blood pressure, indices of arterial stiffness and wave reflection and inflammatory/atherogenic markers in overweight or obese, sedentary young men. Thirty-six participants were randomized to RT (12 weeks of training, 3/wk, n=28) or control groups (C, 12 weeks of no training, n=8) and assessed for changes in central and brachial blood pressures, augmentation index (AIx), carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), body composition, lipids and inflammatory/atherogenic markers. High-intensity RT resulted in decreased central and brachial systolic/diastolic blood pressures (all P0.03), despite not altering AIx (P=0.34) or cfPWV (P=0.43). The vascular endothelial growth factor increased (P=0.03) after RT, without any change in cIMT, C-reactive protein, oxidized LDL (oxLDL) or other inflammatory markers (all P0.1). Changes in the central systolic blood pressure (cSBP) were positively correlated with changes in oxLDL (r=0.42, P=0.03) and soluble E-selectin (r=0.41, P=0.04). In overweight/obese young men, high-intensity RT decreases cSBP, independently of weight loss and changes in arterial stiffness. The cardioprotective effects of RT may be related to effects on central blood pressure.

Promoção da saúde e prevenção de incapacidades funcionais dos idosos na estratégia de saúde da família: a contribuição da fisioterapia

A procura de idosos por serviços de saúde costuma ocorrer quando estes são acometidos por limitações importantes e/ou necessitam de assistência devido à redução da força muscular e a incapacidades funcionais. Tal momento é fundamental para que profissionais da saúde, particularmente fisioterapeutas, amenizem o enfraquecimento muscular e reduzam as incapacidades e dependências. O presente artigo expõe ações de promoção da saúde e prevenção das incapacidades funcionais na terceira idade para que as equipes de saúde da família possam estimular os idosos a mudarem seus hábitos e viverem suas vidas com melhor qualidade. Espera contribuir para a incorporação das práticas fisioterapêuticas entre as equipes de saúde.

Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension

We examined changes in central blood pressure (BP) following resistance exercise training (RET) in men and women with prehypertension and never-treated hypertension. Both Windkessel theory and wave theory were used to provide a comprehensive examination of hemodynamic modulation with RET. Twenty-one participants (age 61±1 years, n=6 male; average systolic blood pressure (SBP)/diastolic blood pressure (DBP)=138/84 mm Hg) were randomized to either 12 weeks of RET (n=11) or an inactive control group. Central BP and augmentation index (AIx) were derived from radial pressure waveforms using tonometry and a generalized transfer function. A novel reservoir-wave separation technique was used to derive excess wave pressure (related to forward and backward traveling waves) and reservoir pressure (related to the capacitance/Windkessel properties of the arterial tree). Wave separation using traditional impedance analysis and aortic flow triangulation was also applied to derive forward wave pressure (Pf) and backward wave pressure (Pb). There was a group-by-time interaction (P<0.05) for central BP as there was a significant ~6 mm Hg reduction in SBP and ~7 mm Hg reduction in DBP following RET with no change in the control condition. There were also group-by-time interactions (P<0.05) for Pf, excess wave pressure and reservoir pressure attributable to reductions in these parameters in the RET group concomitant with slight increases in the control group. There was no change in AIx or Pb (P>0.05). RET may reduce central BP in older adults with hypertension and prehypertension by lowering Pf and reservoir pressure without affecting pressure from wave reflections.

Intensidades de treinamento resistido e pressão arterial de idosas hipertensas - um estudo piloto

INTRODUÇÃO: Observa-se que a literatura apresenta uma lacuna acerca da intensidade ideal de treinamento resistido para idosos hipertensos, os poucos estudos existentes utilizam treinamentos com diferentes intensidades. OBJETIVO: Verificar o efeito de duas intensidades de treinamento resistido sobre a pressão arterial de idosas hipertensas controladas. Métodos: Dezesseis idosas hipertensas, controladas por medicação anti-hipertensiva, foram divididas em dois grupos através de sorteio. Nove pacientes foram submetidas a treinamento resistido moderado (G1) e sete, a treinamento resistido leve (G2). As pacientes realizaram oito semanas de treinamento resistido, com frequência de três vezes por semana em dias alternados, no período vespertino. Os exercícios realizados foram respectivamente: leg press, supino reto, extensão de joelhos, puxada frontal, flexão de joelhos, abdução de ombro, abdução unilateral de quadril com cross over e rosca direta com barra. RESULTADOS: As pacientes do G1 apresentaram redução tanto nos valores de repouso da pressão arterial diastólica (PAD) p < 0,03, como da pressão arterial média (PAM) p < 0,03. O G2, por sua vez, apresentou redução nos valores de repouso da PAM (p < 0,03) e uma tendência à redução na PAD (p < 0,06). A magnitude de queda em ambos os grupos foi superior aos valores apresentados na literatura. CONCLUSÂO: Tanto o treinamento resistido moderado quanto o leve, mesmo quando iniciados na terceira idade, promoveram benefícios cardiovasculares. Ambos podem ser indicados como tratamento coadjuvante para idosas hipertensas controladas por medicação.

Progressive resistance training might improve vascular function in older women but not in older men

OBJECTIVES

Resistance exercise training increases strength and muscle mass in older adults however there is no consensus for its effect on arterial health. The aim of this study was to determine the effect of community based resistance training versus flexibility training on indicators of arterial stiffness and central blood pressure in healthy older adults and to test whether the effects of training are gender specific.

DESIGN

A randomised crossover intervention study.

METHODS

Forty-nine healthy elderly participants (23 males) aged 66.7±4.3 years (mean±SD) participated in this study which involved undertaking 16 weeks of resistance training and 16 weeks of flexibility training in a random order separated by a four week washout period of usual activity. Prior to and following each training protocol period, participants underwent testing of arterial stiffness as augmentation index; and central blood pressure.

RESULTS

When all participants were compared no changes in any measure of arterial stiffness or central blood pressure following resistance training compared to flexibility training were found. When male and female participants were analysed separately, a statistically significant decrease in augmentation index was observed in females (-5.28%; 95% CI: -10.29 to -0.26; p=0.04) but not males (+1.72%; 95% CI: -3.04 to 6.48; p=0.48).

CONCLUSIONS

Community based resistance exercise training does not adversely affect vascular function in apparently healthy older adults and may actually improve arterial function in females.

Cardiac autonomic modulation during progressive upper limb exercise by patients with coronary artery disease

The purpose of this study was to investigate the behavior of heart rate (HR) and HR variability (HRV) during different loads of resistance exercise (incline bench press) in patients with coronary artery disease (CAD) and healthy sedentary controls. Ten healthy men (65 ± 1.2 years, control group, CG) and 10 men with clinically stable CAD (66 ± 2.4 years, CADG) were recruited. A discontinuous progressive protocol was applied with an initial load of 10% of the maximum load achieved in the 1RM (1 repetition maximum) with increases of 10% until 30% 1RM was reached, which was followed by subsequent increases of 5% 1RM until exhaustion. HRV was analyzed by linear and non-linear methods. There was a significant reduction in rMSSD (CG: 20 ± 2 to 11 ± 3 ms; CADG: 19 ± 3 to 9 ± 1 ms) and SD1 indexes (CG: 14 ± 2 to 8 ± 1 ms; CADG: 14 ± 2 to 7 ± 1 ms). An increase in HR (CG: 69 ± 5 to 90 ± 5 bpm; CADG: 62 ± 4 to 75 ± 4 bpm) and in systolic blood pressure (CG: 124 ± 3 to 138 ± 3 mmHg; CADG: 122 ± 6 to 126 ± 9 bpm) were observed (P < 0.05) when comparing pre-effort rest and 40% 1RM in both groups. Furthermore, an increase in RMSM index was also observed (CG: 28 ± 3 to 45 ± 9 ms; CADG: 22 ± 2 to 79 ± 33 ms), with higher values in CADG. We conclude that loads up to 30% 1RM during incline bench press result in depressed vagal modulation in both groups, although only stable CAD patients presented sympathetic overactivity at 20% 1RM upper limb exercise.

Strength and power training did not modify cardiovascular responses to aerobic exercise in elderly subjects

Resistance training increases muscle strength in older adults, decreasing the effort necessary for executing physical tasks, and reducing cardiovascular load during exercise. This hypothesis has been confirmed during strength-based activities, but not during aerobic-based activities. This study determined whether different resistance training regimens, strength training (ST, constant movement velocity) or power training (PT, concentric phase performed as fast as possible) can blunt the increase in cardiovascular load during an aerobic stimulus. Older adults (63.9 ± 0.7 years) were randomly allocated to: control (N = 11), ST (N = 13, twice a week, 70-90% 1-RM) and PT (N = 15, twice a week, 30-50% 1-RM) groups. Before and after 16 weeks, oxygen uptake (VO(2)), systolic blood pressure (SBP), heart rate (HR), and rate pressure product (RPP) were measured during a maximal treadmill test. Resting SBP and RPP were similarly reduced in all groups (combined data = -5.7 ± 1.2 and -5.0 ± 1.7%, respectively, P < 0.05). Maximal SBP, HR and RPP did not change. The increase in measured VO(2), HR and RPP for the increment in estimated VO(2) (absolute load) decreased similarly in all groups (combined data = -9.1 ± 2.6, -14.1 ± 3.9, -14.2 ± 3.0%, respectively, P < 0.05), while the increments in the cardiovascular variables for the increase in measured VO(2) did not change. In elderly subjects, ST and PT did not blunt submaximal or maximal HR, SBP and RPP increases during the maximal exercise test, showing that they did not reduce cardiovascular stress during aerobic tasks.

Influência do treinamento resistido realizado em intensidades diferentes e mesmo volume de trabalho sobre a pressão arterial de idosas hipertensas

A hipertensão arterial sistêmica (HAS) é uma doença de natureza multifatorial com alta prevalência na população idosa, sendo o exercício resistido (ER) preconizado para aquela moléstia. No entanto, a literatura carece de trabalhos que evidenciem o efeito hipotensor agudo do ER em idosos hipertensos. O objetivo do presente estudo foi comparar o efeito da hipotensão pós-exercício (HPE) durante 60 minutos entre duas sessões de exercícios resistidos realizados com intensidades diferentes, mas com igual relação carga-repetição em idosas hipertensas. A amostra foi composta de 32 mulheres, divididas aleatoriamente em dois grupos, contendo 16 pacientes no grupo com carga de leve intensidade (G1) e 16 pacientes no grupo com carga de alta intensidade (G2), porém, ambos com mesmo volume de treinamento. Após duas semanas de adaptação, as idosas realizaram três sessões de exercício resistido e logo em seguida foram aferidas as pressões arteriais sistólica e diastólica durante uma hora, a cada 10 minutos. Para a análise estatística, utilizaram-se os testes t de Student para amostras independentes, exato de Fischer e a análise de variância (ANOVA) com uma entrada. Considerou-se significativo p < 0,05. Não houve diferença significativa das pressões arteriais sistólica e diastólica pós-exercício entre os indivíduos dos grupos G1 e G2, bem como intragrupo. No entanto, observou-se tendência à redução pressórica no grupo G1 quando comparado ao grupo G2. Nossos dados sugerem que a sequência de exercícios resistidos com duração de três sessões não resultou em HPE em idosas hipertensas, não havendo diferenças significativas quanto às pressões sistólica e diastólica entre os grupos com intensidades leve e alta.

Resistance exercise training does not affect postexercise hypotension and wave reflection in women with fibromyalgia

The purpose of this study was to assess the effects of resistance exercise training (RET) on aortic wave reflection and hemodynamics during recovery from acute resistance exercise in women with fibromyalgia (FM) and healthy women (HW). Nine women with FM (aged 42 ± 5 years; mean ± SD) and 14 HW (aged 45 ± 5 years) completed testing at baseline and after 12 weeks of whole-body RET that consisted of 3 sets of 5 exercises. Heart rate (HR), digital blood pressure (BP, plethysmography), aortic BP, and wave reflection (radial tonometry) were assessed before and 20 min after acute leg resistance exercise. Aortic and digital diastolic blood pressure (DBP) were significantly decreased (p < 0.05) and aortic and digital pulse pressures (PP) were significantly increased (p < 0.05) after acute exercise before RET. Acute resistance exercise had no effect on HR, wave reflection (augmentation index and reflection time), digital, or aortic systolic BP. RET improved muscle strength without affecting acute DBP and PP responses. Acute resistance exercise produces postexercise diastolic hypotension without affecting systolic blood pressure, HR, and wave reflection responses in women with and without FM. RET does not alter resting and postexercise hemodynamics and aortic wave reflection in premenopausal women.

Heart-rate variability and blood-lactate threshold interaction during progressive resistance exercise in healthy older men

The objective of this study was to (a) evaluate the impact of the leg press, at variable percentages of 1 repetition maximum (1RM), on heart rate variability (HRV) and blood lactate and (b) determine the relationship between HRV with blood lactate in a healthy elderly cohort. Ten healthy men (64 +/- 4 years) participated in a progressive leg-press protocol to maximal exertion. Initially, 1RM for the leg press was determined for all subjects. The protocol then began at 10% of 1RM, with subsequent increases of 10% until 30% of 1RM, followed by incremental adjustments of 5% until exhaustion. The measurement of instantaneous R-R interval variability from Poincare plots (SD1 and SD2) and time domain indexes (RMSSD and RMSM), blood pressure, and blood lactate were obtained at rest and all leg-press loads. Significant alterations of HRV and blood lactate were observed from 30% of 1RM leg press (p < 0.05). Additionally, significant correlations were found between the lactate threshold (LT) and the RMSSD threshold (r = 0.78; p < 0.01), and between the LT and SD1 threshold (r = 0.81, p < 0.01). We conclude that metabolic and cardiovascular alterations are apparent during relatively low resistance exercise (RE) loads in apparently healthy subjects. In addition, HRV indexes were associated with blood-lactate levels during RE. The practical applications is the possibility of using HRV as a noninvasive measure obtained at a relatively low cost may be used to identify neural and metabolic alterations during RE in older subjects.

Influência da ordem de execução de exercícios resistidos na hipotensão pós-exercício em idosos hipertensos

Existem evidências de que exercícios resistidos contribuem para o controle de hipertensão arterial sistêmica, porém, são necessários estudos que indiquem a melhor forma de utilizá-los. O objetivo deste estudo foi analisar a influência da ordem de execução de exercícios resistidos na hipotensão pós-exercício em idosos com hipertensão arterial bem controlada. A amostra foi composta por oito idosos com hipertensão arterial sistêmica bem controlada (quatro homens e quatro mulheres). No protocolo 1 (P1) foram realizados inicialmente três exercícios para membros superiores e, posteriormente, três exercícios para membros inferiores. No protocolo 2 (P2) a sequência foi inversa. Já no protocolo 3 (P3) os exercícios foram realizados de forma alternada. Todos os exercícios foram realizados em três séries de 12 RM. Após cada protocolo a pressão arterial (PA) foi verificada em intervalos de 10 minutos, até 60 minutos pós-exercício. Os dados obtidos foram analisados através da ANOVA de fator duplo e fator único com post-hoc de Tukey e teste t de Student pareado com distribuição bicaudal (p < 0,05). Em relação ao repouso, as seis verificações de PA pós-exercício de P1 não apresentaram diferenças significativas; no P2 foram significantemente diferentes apenas as verificações de 20 e 40 minutos na PAS; no P3 foram observadas diferenças significativas em todas as seis verificações da PAS e nas de 10, 20, 30 e 60 minutos da PAD. A verificação de 20 minutos na PAD do P3 demonstrou-se significantemente diferente das de 20 minutos de P1 e P2. Conclui-se que a ordem de realização de exercícios resistidos em idosos com hipertensão arterial bem controlada influenciou na duração da resposta hipotensiva, mas não diretamente em sua magnitude.

Physical activity and prevalence of hypertension in a population-based sample of Brazilian adults and elderly

OBJECTIVES

a) To determine the prevalence of hypertension and its associated factors and b) to establish the impact of past (i.e. adolescence) and current physical activity on hypertension.

METHODS

A cross-sectional study of people aged 40 years or more living in the urban area of Pelotas - Brazil (2003). Hypertension was assessed by self-report of medical diagnosis. Individuals were considered active in adolescence if they reported regular physical activity practice between the ages 10 and 19 years. In adulthood, individuals who performed > or =150 min/week of leisure-time physical activities were considered active. Other variables studied included skin color, age, smoking, body mass index and socioeconomic status.

RESULTS

1696 individuals were interviewed (response rate >95%). Prevalence of hypertension was 34.4% (CI(95%) 32.1-36.7) and varied considerably among population subgroups. Current physical activity showed no association with hypertension. Physical activity in adolescence was associated with a decreased risk of adulthood hypertension in the crude analyses for women (p<0.001). However, after adjusting for potential confounders and mediators, this protection was no longer significant 1.20 (CI(95%) 0.93-1.55).

CONCLUSIONS

Prevalence of hypertension is high among Brazilians and markedly different among population subgroups. There was no robust evidence of association between adolescence physical activity practice and hypertension in later life.

A phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer

Background

Androgen deprivation therapy (ADT) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture, reduced lean mass and muscle strength, mood disturbance and increased fat mass compromising physical functioning, independence, and quality of life. The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects, and cardiovascular and diabetes risk factors in men receiving androgen deprivation for their prostate cancer. Specifically, we aim to investigate the effects of a 12-month exercise program designed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints: 1) bone mineral density; 2) cardiorespiratory function and maximal oxygen capacity; 3) body composition (lean mass and fat mass); 4) blood pressure and cardiovascular function; 5) lipids and glycemic control; and 6) quality of life and psychological distress.

Methods/Design

Multi-site randomized controlled trial of 195 men (65 subjects per arm) undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia. Participants will be randomized to (1) resistance/impact loading exercise, (2) resistance/cardiovascular exercise groups and (3) usual care/delayed exercise. Participants will then undergo progressive training for 12 months. Measurements for primary and secondary endpoints will take place at baseline, 6 and 12 months (end of the intervention).

Discussion

The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal, cardiovascular and insulin metabolism side effects of androgen deprivation in prostate cancer patients. As this project is much longer term than previous investigations in the area of exercise and cancer, we will gain knowledge as to the continuing effects of exercise in this patient population specifically targeting bone density, cardiovascular function, lean and fat mass, physical function and falls risk as primary study endpoints. In terms of advancement of prostate cancer care, we expect dissemination of the knowledge gained from this project to reduce fracture risk, improve physical and functional ability, quality of life and ultimately survival rate in this population.

Clinical Trial Registry

A Phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer; ACTRN12609000200280

Cardiovascular and metabolic complications during androgen deprivation: exercise as a potential countermeasure

Apart from the well-established adverse musculoskeletal and sexual health effects of androgen deprivation therapy (ADT), evidence is accumulating of substantial ADT-related cardiovascular and metabolic complications, which may impact quality of life and overall survival. In this brief review we discuss (1) the incidence of cardiovascular and metabolic complications during/following ADT from large cohort studies, (2) the increased risk factors for cardiovascular and metabolic disease from cross-sectional and prospective studies and (3) the use of physical exercise as a countermeasure in this new era of ADT-related toxicity. It is clear that exercise has the potential to provide a myriad of benefits to men undergoing ADT that may result in reduced morbidity and mortality, and subsequently improve quality of life.