The beneficial effect of regular endurance exercise training on blood pressure and quality of life in patients with hypertension

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.

Relationship between depression, anxiety, stress, and health-related quality of life in adults with and without chronic diseases: A cross-sectional study

Health-related quality of life (HRQoL) in patients with chronic diseases is an important tool to measure patient-reported health outcomes and evaluate the usefulness of treatment, management, and rehabilitation programs. Patients with chronic diseases are more likely than those without to experience psychological problems such as depression, anxiety, and stress, all of which can affect HRQoL. This study evaluated the impact of psychological problems such as depression, anxiety, and stress on HRQoL in people with and without chronic diseases in South Korea. The study's descriptive survey included 501 participants (191 with and 310 without chronic diseases). Data were collected using structured questionnaires between April and May 2021. The general characteristics, DASS-21, and HRQOL of this study were analyzed using descriptive statistics. Differences in DASS-21 and HRQoL based on general characteristics were analyzed using t tests and ANOVA. The study analyzed the factors influencing the participants' HRQoL using stepwise multiple regression analysis with SPSS Win 27.0. HRQoL was generally lower for patients with chronic diseases than for patients without. In patients with chronic diseases, the major variables affecting HRQoL were depression (β = -0.244, t = -3.582, P < .001), exercise (β = 0.201, t = 2.927, P = .004), and economic status (β = -0.150, t = -2.184, P = .030), of which depression was the most influential. These variables explained 12.5% of the variance in the regression model for total HRQoL. These results emphasize the need to explore intervention measures that can reduce depression in patients with chronic diseases and anxiety in patients without chronic diseases to improve their HRQoL. In addition, national efforts are needed to provide economic support, as economic status is an influential factor in HRQoL regardless of the presence of chronic disease. The study's limitations include the fact that neither did it consider disease severity among chronically ill patients nor did it examine all the variables affecting HRQoL.

Effects of different types of exercise on hypertension in middle-aged and older adults: a network meta-analysis

Objective

This study mainly used network meta-analysis to explore the effect of different types of exercise on hypertension in middle-aged and older adults.

Methods

Several databases (e.g., PubMed, Embase, and the Cochrane Library) were used to search for randomized controlled trials on the effects of different types of exercise on hypertension in middle-aged and older adults.

Results

A total of 19 articles and 2,385 participants were included in the analysis. Aerobic exercise interventions [MD = -9.254, P < 0.05, 95% CI (-14.810, -3.698)] and static exercise interventions [MD = -10.465, P < 0.05, 95% CI (-18.135, -2.794)] had a significant effect on the improvement in systolic blood pressure (SBP). For diastolic blood pressure (DBP), aerobic exercise interventions [MD = -1.4096; P > 0.05, 95% CI (-8.2395, 5.4201)] and static exercise interventions [MD = -4.5206, P > 0.05, 95% CI (-14.0436, 5.0023)] were not statistically significant. The results of the surface under the cumulative ranking curve (SUCRA) showed that static exercise improved hypertension better than aerobic exercise.

Conclusion

Aerobic exercise and static exercise have been shown to have a good effect on the improvement of hypertension, but the effect on DBP is not significant.

Protocol: Implementation evaluation of a combination intervention for sustainable blood pressure control in rural KwaZulu-Natal, South Africa (IMPACT BP): A three-arm, unblinded, parallel group individually randomized clinical trial

BACKGROUND

Hypertension is the primary risk factor for stroke and heart disease, which are leading causes of death in South Africa. Despite the availability of treatments, there is an implementation gap in how best to deliver hypertension care in this resource-limited region.

METHODS

We describe a three-arm parallel group individually randomized control trial to evaluate the effectiveness and implementation of a technology-supported, community-based intervention to improve blood pressure control among people with hypertension in rural KwaZulu-Natal. The study will compare three strategies: 1) standard of care (SOC arm) clinic-based management, 2) home-based blood pressure management supported by community blood pressure monitors (CBPM arm) and a mobile health application to record blood pressure readings and enable clinic-based nurses to remotely manage care, and 3) an identical strategy to the CBPM arm, except that participants will use a cellular blood pressure cuff, which automatically transmits completed readings over cellular networks directly to clinic-based nurses (eCBPM+ arm). The primary effectiveness outcome is change in blood pressure from enrollment to 6 months. The secondary effectiveness outcome is the proportion of participants with blood pressure control at 6 months. Acceptability, fidelity, sustainability, and cost-effectiveness of the interventions will also be assessed.

CONCLUSIONS

In this protocol, we report the development of interventions in partnership with the South Africa Department of Health, a description of the technology-enhanced interventions, and details of the study design so that our intervention and evaluation can inform similar efforts in rural, resource-limited settings.

PROTOCOL

Version 3 November 9th, 2022.

CLINICALTRIALS

gov Trial Registration: NCT05492955 SAHPRA Trial Number: N20211201. SANCTR Number: DOH-27-112,022-4895.

Differences in Health-Related Quality of Life and Physical Condition of Two Community-Based Exercise Programs in Subjects with Cardiovascular Risk Factors: A Prospective Observational Cohort Study

We compared the effect of two community-based physical activity (PA) programs on health-related quality of life (HRQL) and physical condition in people with cardiovascular risk factors. Fifty-one subjects participated in the “ACTIVA Murcia” AM3 program characterized by non-individualized training loads for 3 months, and forty-two participated in the AM6 program characterized by individualized progressive training loads for 6 months. Both programs included a 6-month follow-up period without PA. HRQL was assessed with the Short Form 36 Health Survey (SF-36) and physical condition by VO2 max, strength, flexibility, and balance. Participants in the AM6 program as compared with those in the AM3 program showed significantly higher scores in the subscales of physical functioning, mental health, energy/vitality, and general health. Mental health and general health at 6 months of follow-up were also scored significantly higher by AM6 participants. VO2 max and flexibility improved more in the AM6 group, whereas strength was better in the AM3 group. Half of the participants in the AM6 program expressed a strong willingness to continue exercising vs. 38% in the AM3 program. In this study, a community-based PA program with individualized progressive training loads of 6-month duration showed a more favorable impact on HRQL than a 3-month non-individualized PA program.

Effects of Aerobic Training Progression on Blood Pressure in Individuals With Hypertension: A Systematic Review With Meta-Analysis and Meta-Regression

INTRODUCTION

Aerobic training of moderate intensity is the primary modality recommended in the management of hypertension. The manipulation of training variables can be an important strategy for the continuity of health benefits; however, little is known about the effects of the progression of aerobic training variables in the adaptations of blood pressure in hypertensive adults.

OBJECTIVE

To analyze, through a systematic review with meta-analysis, the effects of aerobic training with and without progression on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in hypertensive adults.

METHOD

The search for the studies was carried out in the PubMed, Cochrane Central, SPORTDiscus and LILACS databases. Clinical trials that analyzed the effect of aerobic training, lasting at least six weeks, on blood pressure in hypertensive individuals comparing with a control group without intervention were selected. The selection of studies and data extraction were carried out independently by two pairs of researchers. The results are presented as mean difference and 95% confidence interval. Statistical significance was considered with p < 0.05.

RESULTS

Of the 13,028 studies found, 24 were selected and included in this review, 12 with progression of training variables and 12 without progression, with a total of 1,207 participants analyzed. There was a reduction in SBP after aerobic training with progression (-10.67 mmHg; 95% CI -15.421, -5.926; p < 0.001) and without progression (-10.17 mmHg; CI -12.213, -8.120; p < 0.001). DBP also decreased after aerobic training with progression (-5.49 mmHg; 95% CI -8.663, -2.310; p < 0.001) and without progression (-6.51 mmHg; 95% CI -9.147, -3.868; p < 0.001). According to the results of the meta-regression analyses, only age showed an association with the reduction of SBP (β: -0.323; CI -0.339, -0.307; p < 0.001).

CONCLUSION

Aerobic training promotes a reduction in the SBP and DBP levels of adults with hypertension, regardless of whether or not the training variables progression.

The impact of antihypertensive treatment initiation on health-related quality of life and cardiovascular risk factor levels: a prospective, interventional study

Background

Effective prevention and treatment of hypertension is one of the most potential interventions in terms of preventing cardiovascular deaths and disabilities. However, the treatment control is often poor. This may be partly explained by the impact of hypertension diagnoses and treatment on health-related quality of life. Quality of life is also an important outcome for a hypertensive patient. Most of the previous studies on health-related quality of life in hypertension have concentrated on patients with treated hypertension and less is known about the initiation of medication and the first treatment year.

Methods

In this interventional study, we followed 111 primary care patients with newly diagnosed hypertension in real world primary care setting in Finland for 12 months.

Results

We found significant decrease in both systolic and diastolic blood pressure levels, as well as modest decrease in cholesterol levels and alcohol consumption. However, the health-related quality of life also slightly deteriorated during the first treatment year.

Conclusions

Our study shows that the initiation of hypertension treatment results in cardiovascular risk decrease among newly diagnosed Finnish hypertensive patients, but it is accompanied by small negative impact on health-related quality of life. However, the deterioration in health-related quality of life is of small magnitude and earlier research demonstrates several measures to enhance treatment and avoid impairment in health-related quality of life.

Trial registration ClinicalTrials NCT02377960 (Date of registration: 04/03/2015).

Sport and Recreational Physical Activities Attenuate the Predictive Association of Multimorbidity With Increased Geriatric Depressive Symptoms: A 14-Year Follow-Up Study of Community-Dwelling Older Adults

Multimorbidity is associated with increased depression risks. Little research examines how physical exercise moderates this association. From an existing cohort of community-dwelling older adults in Hong Kong recruited in 2001-2003, the authors included participants who were successfully interviewed after 14 years (2015-2017). Geriatric depressive symptoms were used as the primary outcome and measured by the 15-item Geriatric Depression Scale, while multimorbidity was operationalized using a list of 19 conditions. Subscores of the Physical Activity Scale for the Elderly measuring light, moderate, and strenuous sport/recreational activities were included as moderators. In total, 1,056 participants were included, of whom 50.7% were multimorbid. Multimorbidity was associated with 12% more geriatric depressive symptoms, but strenuous physical activities were associated with a smaller risk elevation only among multimorbid patients (adjusted relative risk = 0.99, 95% confidence interval [0.98, 0.99]; p = .001). In conclusion, strenuous sport and recreational activities may attenuate the association between multimorbidity and geriatric depressive symptoms.

Running to Lower Resting Blood Pressure: A Systematic Review and Meta-analysis

BACKGROUND

According to previous epidemiological studies, there are pros and cons for the relationship between running regularly and changes in resting blood pressure (RBP), and the changes may depend on the form of exercise.

OBJECTIVE

The aims of the current systematic review were to summarize the effects of running regularly on RBP and to investigate the most efficacious form of running in reducing RBP for this purpose.

METHODS

The inclusion criteria were: randomized controlled trials, involving healthy adults or adults with hypertension, the exercise group only performed regular running and the control group did not exercise, and the study reported the mean resting systolic blood pressure (RSBP) and/or diastolic blood pressure (RDBP). The mean difference (MD) in RBP in each trial was defined as follows: (mean value at post-intervention in the exercise group - mean value at baseline in the exercise group) - (mean value at post-intervention in the control group - mean value at baseline in the control group) and was calculated. The weighted MD (WMD) was defined as the synthesis of all MD. A linear meta-regression analysis, exercise intensity [the percentage of maximum heart rate] (%) and total exercise time throughout the intervention (hours) were selected as explanatory variables and the MD in RBP served as the objective variable.

RESULTS

Twenty-two trials (736 subjects) were analyzed. When trials were limited to those involving healthy subjects, the WMD in RBP decreased significantly [RSBP: - 4.2 mmHg (95% confidence intervals (95% CI) - 5.9 to - 2.4); RDBP: - 2.7 mmHg (95% CI - 4.2 to - 1.1)] and did not contain significant heterogeneity (RSBP: P = 0.67, I² = 0.0%; DBP: P = 0.38, I² = 7.2%). When trials were limited to those involving subjects with hypertension, the WMD in RBP decreased significantly [RSBP: - 5.6 mmHg (95% CI - 9.1 to - 2.1); RDBP: - 5.2 mmHg (95% CI - 9.0 to - 1.4)] but contained significant heterogeneity (RSBP: P = 0.01, I² = 62.2%; DBP: P < 0.01, I² = 87.7) and a meta-regression analysis showed that the percentage of maximum heart rate was significantly associated with the WMD in RSBP [slope: 0.56 (95% CI 0.21 to 0.92), intercept: - 48.76 (95% CI - 76.30 to - 21.22), R² = 0.88] and RDBP [slope: 0.45 (95% CI 0.01 to 0.87), intercept: - 38.06 (95% CI - 72.30 to - 4.08), R² = 0.41]. When trials were limited to those involving subjects with hypertension and a mean age ≥ 40 years, a meta-regression analysis showed that total exercise time throughout the intervention was significantly associated with the WMD in RDBP [slope: 0.82 (95% CI 0.54 to 1.09), intercept: - 22.90 (95% CI - 29.04 to - 16.77), R² = 0.99].

CONCLUSIONS

Running regularly decreases RBP, but the changes in subjects with hypertension may differ depending on exercise intensity or total exercise time. Therefore, running regularly at moderate intensity and at a restrained volume is recommended to lower RBP in subjects with hypertension.

Impact on Health-Related Quality of Life after Different Aerobic Exercise Programs in Physically Inactive Adults with Overweight/Obesity and Primary Hypertension: Data from the EXERDIET-HTA Study

Primary hypertension (HTN) and obesity are associated with a worse health-related quality of life (QoL). This research was carried out to analyze the health-related QoL measurements in a physically inactive and obese population with HTN (n = 253) in comparison to a HEALTHY sample (n = 30), to determine the HTN sample changes in QoL following different (high-volume moderate-intensity continuous training, high-volume high-intensity interval training (HIIT), low-volume HIIT) 16-week supervised aerobic exercise training (ExT) programs compared to attention control, and to assess the differences in QoL variables between the different ExT programs. The SF-36 questionnaire was used to assess health-related QoL. At baseline, HTN showed lower scores (p < 0.05) in physical function (88.6 vs. 99.2), general health (63.3 vs. 82.4), vitality (58.2 vs. 68.7), social functioning (88.5 vs. 95.2), and mental health (76.1 vs. 81.8) compared to HEALTHY. Following intervention, all HTN subgroups showed higher (p < 0.05) vitality, but physical functioning and general health significantly improved only in the ExT groups, with even better values in general health for both HIIT subgroups. Only the low-volume HIIT showed positive changes (p < 0.05) in social functioning (∆ = 6.9%) and mental health (∆ = 6.4%) domains after the intervention. These results highlight the important role of supervised exercise in improving physical and psychological health.

Nonpharmacologic Interventions for Reducing Blood Pressure in Adults With Prehypertension to Established Hypertension

Background

Nonpharmacologic interventions that modify lifestyle can lower blood pressure (BP) and have been assessed in numerous randomized controlled trials and pairwise meta‐analyses. It is still unclear which intervention would be most efficacious.

Methods and Results

Bayesian network meta‐analyses were performed to estimate the comparative effectiveness of different interventions for lowering BP. From 60 166 potentially relevant articles, 120 eligible articles (14 923 participants) with a median follow‐up of 12 weeks, assessing 22 nonpharmacologic interventions, were included. According to the surface under the cumulative ranking probabilities and Grading of Recommendations Assessment, Development and Evaluation (GRADE) quality of evidence, for adults with prehypertension to established hypertension, high‐quality evidence indicated that the Dietary Approach to Stop Hypertension (DASH) was superior to usual care and all other nonpharmacologic interventions in lowering systolic BP (weighted mean difference, 6.97 mm Hg; 95% credible interval, 4.50–9.47) and diastolic BP (weighted mean difference, 3.54 mm Hg; 95% credible interval, 1.80–5.28). Compared with usual care, moderate‐ to high‐quality evidence indicated that aerobic exercise, isometric training, low‐sodium and high‐potassium salt, comprehensive lifestyle modification, breathing‐control, and meditation could lower systolic BP and diastolic BP. For patients with hypertension, moderate‐ to high‐quality evidence suggested that the interventions listed (except comprehensive lifestyle modification) were associated with greater systolic BP and diastolic BP reduction than usual care; salt restriction was also effective in lowering both systolic BP and diastolic BP. Among overweight and obese participants, low‐calorie diet and low‐calorie diet plus exercise could lower more BP than exercise.

Conclusions

DASH might be the most effective intervention in lowering BP for adults with prehypertension to established hypertension. Aerobic exercise, isometric training, low‐sodium and high‐potassium salt, comprehensive lifestyle modification, salt restriction, breathing‐control, meditation and low‐calorie diet also have obvious effects on BP reduction.

The effect of exercise training on blood pressure in African and Asian populations: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Exercise is key in the primary prevention and management of hypertension. Yet, current exercise recommendations are predominantly based on meta-analyses involving populations of European descent. Since blood pressure (BP) responses to pharmaceutical interventions are known to differ among ethnic groups, we aimed to investigate the BP responses to exercise training in non-European descendants.

PURPOSE

The aim of this study was to systematically summarize the available literature on the efficacy of exercise on BP in healthy adults (age ≥18 years) of African or Asian origin.

METHODS

We searched the MEDLINE database for randomized controlled trials that evaluated the effect of exercise training on BP in healthy African and Asian adults with optimal BP, elevated BP or hypertension and published in a peer-reviewed journal up to May 2019. Random effect models were fitted to estimate the effect sizes.

RESULTS

We identified 22 trials involving individuals of Asian origin (n = 931; mean age: 44 years; 41% male) and four trials involving individuals of African origin (n = 510; mean age: 56.7 years; 80% male). Aerobic exercise training significantly (p < 0.001) reduced systolic and diastolic BP in each ethnic group. Resistance training did not affect the BP of Asian participants with optimal BP. The effect of resistance training in Asians with elevated BP or hypertension and Africans could not be determined due to lack of data. Sub-analyses suggested somewhat larger reductions in systolic BP following aerobic training in hypertensive Africans compared with hypertensive Asians.

CONCLUSIONS

We found favorable effects of aerobic exercise training on BP in the African and the Asian populations. However, the overall low number of studies and especially the lack of data on resistance training and combined training in African and Asian populations warrant more research to improve the quality of evidence.

The effectiveness of aerobic exercise for hypertensive population: A systematic review and meta-analysis

The study aims to evaluate the effectiveness of different durations of aerobic exercise on hypertensive patients. Four electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched from their inception until July 2018. English publications and randomized controlled trials involving aerobic exercise treatment for hypertensive population were included. Two reviewers independently extracted the data. The Cochrane's Risk of Bias tool was used to assess the quality of included studies. In this systematic review, a total of 14 articles were included, involving 860 participants. The quality of the included studies ranged from moderate to high. The results of the meta-analysis showed that compared with the control group, significant effects of aerobic exercise were observed on reducing systolic blood pressure (SBP) (mean difference [MD] = -12.26 mm Hg, 95% confidence interval [CI] = -15.17 to -9.34, P < 0.05), diastolic blood pressure (DBP; MD = -6.12 mm Hg, 95% CI = -7.76 to -4.48, P < 0.05), and heart rate (MD = -4.96 bpm, 95% CI = -6.46 to -3.43, P < 0.05). In addition, significant reductions were observed in ambulatory DBP (MD = -4.90 mm Hg, 95% CI = -8.55 to -1.25, P < 0.05) and ambulatory SBP (MD = -8.77mm Hg, 95% CI = -13.97 to -3.57, P < 0.05). Therefore, aerobic exercise might be an effective treatment for blood pressure improvement in hypertensive patients. However, the effectiveness between the duration of different treatment needs to be well-designed and rigorous studies will be required to verify the dataset.

Self-management and blood pressure control in China: a community-based multicentre cross-sectional study

OBJECTIVES

This study explored the relationship between self-management and blood pressure (BP) control in China.

DESIGN

A cross-sectional study.

SETTING

Eight community health centres from four cities in the Northeast (Shenyang), Northwest (Xi'an), Southwest (Chengdu) and South (Changsha) of China.

PARTICIPANTS

A total of 873 adults with hypertension, including 360 men and 513 women. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg.

OUTCOME MEASUREMENTS

BP control was the primary outcome variable. This was categorised as good control if individuals with hypertension reduced their BP to <140/90 mm Hg, otherwise, it was categorised as poor control. Secondary outcomes included self-management, defined as: (1) context or condition-specific factors or physical/social environments (eg, age, sex, marital status, education, personal income and health insurance) and (2) process or knowledge/beliefs, self-regulation skills/abilities and social facilitation (eg, treatment, diet, exercise and risk factor management). Data were analysed using logistic regression models using SPSS V.20.

RESULTS

A total of 67.1% (n=586) participants had poor BP control. Limited outpatient care benefits in mainly rural residents (OR 2.26, 95% CI 1.06 to 4.81) and longer disease duration (OR 1.03, 95% CI 1.01 to 1.04) were associated with poor BP control. Self-management practices reduced the odds of having poor BP control (OR 0.98, 95% CI 0.97 to 0.99).

CONCLUSIONS

The individual and family self-management theory can serve as an effective theory for understanding the key contexts, processes and outcomes essential for BP control in China. Future research should evaluate the effect of a self-management intervention (eg, self-monitoring, medication adherence, regular and routine doctor visits, and social supports) for BP control in China using a multisite cluster randomised controlled trial. Sex and gender difference, cost and patient-reported outcomes should also be examined.

Effects of Exercise on the Resting Heart Rate: A Systematic Review and Meta-Analysis of Interventional Studies

Resting heart rate (RHR) is positively related with mortality. Regular exercise causes a reduction in RHR. The aim of the systematic review was to assess whether regular exercise or sports have an impact on the RHR in healthy subjects by taking different types of sports into account. A systematic literature research was conducted in six databases for the identification of controlled trials dealing with the effects of exercise or sports on the RHR in healthy subjects was performed. The studies were summarized by meta-analyses. The literature search analyzed 191 studies presenting 215 samples fitting the eligibility criteria. 121 trials examined the effects of endurance training, 43 strength training, 15 combined endurance and strength training, 5 additional school sport programs. 21 yoga, 5 tai chi, 3 qigong, and 2 unspecified types of sports. All types of sports decreased the RHR. However, only endurance training and yoga significantly decreased the RHR in both sexes. The exercise-induced decreases of RHR were positively related with the pre-interventional RHR and negatively with the average age of the participants. From this, we can conclude that exercise-especially endurance training and yoga-decreases RHR. This effect may contribute to a reduction in all-cause mortality due to regular exercise or sports.

Physical activity, cardiovascular health, quality of life and blood pressure control in hypertensive subjects: randomized clinical trial

BACKGROUND

Physical activity (PA) promotes cardiovascular health and health related quality of life (HRQoL), although the effect of that on blood pressure (BP) control has rarely been studied in hypertensive subjects. Our aim was to evaluate the effectiveness of a PA intervention programme on cardiovascular disease (CVD) risk, HRQoL and BP control in hypertensive subjects.

METHODS

A randomized clinical trial, with a PA intervention programme of 9 months duration, comprising a walking group of 120 min/week, supervised, and with socio-cultural activities. Participants were 207 hypertensive subjects (68.2 years, 76.8% women). PA (IPAQ-s), diet, CVD risk, BP, BMI, smoking, and HRQoL (SF-36) were assessed at baseline and at the end of the intervention. Changes in CVD risk and in HRQoL during the intervention was calculated (end-baseline score). Multivariate models were applied.

RESULTS

In multivariate models, the PA intervention programme, with no modification of the diet, decreased CVD risk (- 1.19 points) and the systolic BP (- 8.68 mmHg), and increased some areas of HRQoL (4.45 to 14.62 points). An increase in the percentage of subjects with controlled BP was observed by the PA programme itself (OR 5.395 to 5.785 according to multivariate models), and by the changes during the intervention in the decrease in CVD risk (OR 0.609) and in the increase in the HRQoL in physical component summary (OR 1.041), role physical (OR 1.010), and bodily pain (OR 1.014), independently of controlled BP at baseline.

CONCLUSIONS

This PA intervention programme improved cardiovascular health and HRQoL, and favoured BP control in primary care users with hypertension.

TRIAL REGISTRATION

Clinicaltrials.gov ID NCT02767739 ; Trial registered on May 5th, 2016. Retrospectively registered.

Regular aerobic exercise and blood pressure in East Asians: A meta-analysis of randomized controlled trials

The aim of this meta-analysis was to evaluate the effects of regular aerobic exercise on blood pressure in East Asians. The inclusion criteria of the randomized controlled trials were healthy East Asian adults, exercise group performing regular aerobic exercise and control group not exercising, and a description of the mean systolic blood pressure or diastolic blood pressure at rest. This study included 31 study groups and 1994 subjects. Pooled changes in blood pressure showed significant reductions (systolic blood pressure: -4.7 mmHg; diastolic blood pressure: -3.2 mmHg). In subgroup analyses, the change in systolic blood pressure for randomized controlled trials meeting the America Heart Association and American College of Sports Medicine guidelines for physical activity to maintain health was significantly larger than in randomized controlled trials not meeting the guidelines. In addition, meta-regression indicated that the change in systolic blood pressure was significantly related to "exercise time × exercise frequency." The ideal volume of exercise is that for a long time at a high frequency, such as the volume recommended in the America Heart Association and American College of Sports Medicine guidelines: moderate intensity and >150 min per week. List of abbreviations: BP: blood pressure; BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; RCT: randomized controlled trial; AHA: America Heart Association; ACSM: America College of Sports Medicine; SD: standard deviation; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; TC: total cholesterol; TG: triglycerides; PEDro: Physiotherapy Evidence Database; CI: confidence intervals; %HR_max: percentage of maximal heart rate.

Effect of Tai Chi Chuan on degeneration of lumbar vertebrae and lumbar discs in middle-aged and aged people: a cross-sectional study based on magnetic resonance images

Objective Exercise has a positive effect on physical fitness. Tai Chi Chuan is a traditional Chinese aerobic exercise. We assessed the effect of Tai Chi on the degeneration of lumbar vertebrae and lumbar discs with magnetic resonance images. Methods This retrospective cohort study involved 2 groups of participants: 27 Tai Chi practitioners with more than 4 years of experience with regular Tai Chi exercise and 24 sex- and age-matched participants without Tai Chi experience. The lumbar magnetic resonance images of all participants were collected. The numbers of degenerated lumbar vertebrae and lumbar discs were evaluated by the same radiologist, who was blind to the grouping. Results The Tai Chi practitioners had significantly fewer degenerated lumbar vertebrae (1.9) and lumbar discs (2.3) than the control group (2.6 and 2.9, respectively). The most severely affected lumbar vertebrae and discs were L5 and L4/L5, respectively. Conclusion Regular performance of the simplified Tai Chi 24 form could possibly retard the degeneration of lumbar vertebrae and lumbar discs in middle-aged and aged people.

Joint predictability of physical activity and body weight status on health-related quality of life of patients with hypertension

This study investigated the predictability of physical activity (PA) and body weight status (BWS) on health-related quality of life (HRQoL) of patients with hypertension. A cross-sectional study involved 250 patients with hypertension (≥140/90≤179/109 mmHg) selected from government hospitals in Osun State, Nigeria. Purposive sampling technique was used to select participants. Socio-demographic characteristics and cardiovascular parameters were recorded. PA and HRQoL were assessed using the International Physical Activity Questionnaire and Short Form health survey questionnaire respectively. Sufficient PA equals ≥150 min/wk while BWS was defined using body mass index classification. Data were analyzed using descriptive and inferential statistics. Alpha level was set at P<0.05. Of all participants, 63.6% reported sufficient PA and 78.4% was either overweight or obese. The HRQoL of participants become poorer in all domains with higher body weight. The HRQoL including role limitation due to physical health (RLdPhp) and emotional problems (RLdEmp) had worst scores. Participants in the categories of normal and overweight/obese with sufficient PA demonstrated higher (better) HRQoL in all domains than those with insufficient PA (P<0.05). When adjusted for body weight, significant differences were found in all domains of HRQoL except in RLdPhp, RldEmp, and bodily pain (P>0.05). There were significant correlations between PA and all domains of HRQoL except in RldEmp, emotional well-being and bodily pain (P>0.05). Regression models established PA as a significant predictor of HRQoL. Sufficient PA is a better predictor of HRQoL among patients with hypertension irrespective of BWS. Regular PA is recommended for improving HRQoL among patients with hypertension.

Blood Pressure Responses after a Session of Functional Training in Young Adults and the Elderly: A Pilot Study

Purpose. The potential of functional training (FT) to improve health is evident. However, regarding post-exercise hypotension (PEH) in older adults, there are few data. The study aimed to determine the cardiometabolic demand imposed by an FT session and evaluate PEH, comparing it with exercise sessions with aerobic and resistance exercises in physically active practitioners.

Methods. Fourteen young (23.3 ± 2 years) and 15 older (68 ± 4 years) adults underwent a control session and FT session randomly determined. Blood pressure, heart rate, and double product were recorded at rest, during exercise, and in every 10 minutes over 60 minutes of recovery. Additionally, we measured the rate of perceived exertion (RPE).

Results. The FT protocol promoted systolic PEH in both groups in the last half of recovery, reaching a reduction of 10.4 ± 4.9 mm Hg in young and 13.4 ± 3.8 mm Hg in older adults (p < 0.05). No differences were observed between the groups (p > 0.05). There were no differences between the groups with reference to RPE at any time (p > 0.05).

Conclusions. A single FT session is able to promote PEH in normotensive young and borderline hypertensive older adults but without changing the RPE in comparison over the time, owing to a great similarity of FT practices in the groups.

Physical activity and exercise lower blood pressure in individuals with hypertension: narrative review of 27 RCTs

Regular physical activity (PA) reduces the blood pressure (BP) of individuals with hypertension. The present review analysed the scientific evidence for the BP lowering effect of aerobic PA in 27 randomised controlled studies on individuals with hypertension, and shows that regular medium-to-high-intensity aerobic activity reduces the BP by a mean of 11/5 mm Hg (level of evidence, 3+). In addition, three randomised controlled trials (RCTs) on isometric (static) activity showed a BP reduction of similar magnitude in hypertensives; dynamic resistance training may show less effect, as shown in five available RCTs (level of evidence 2+). As both the prevalence of hypertension and physical inactivity are high and increasing in today's society, PA has a great role to play as a single (when indicated) or additive treatment for hypertension. Furthermore, as competitive athletes are getting older, it can be expected that more athletes at different competitive levels will have hypertension. Certain considerations must be applied regarding evaluation and treatment of hypertension in athletes. Eligibility for competitive sports may be affected if target organ damage (TOD) is present; however, an athlete with well-controlled BP, having no additional risk factors or TOD, is eligible for all sports.

Resistance training attenuates the effects of aging in the aorta of Wistar rats

Abstract The objective of the present study was to follow the structural modifications of the aortic wall in middle-aged rats submitted to a resistance training protocol for a period of four months. Three groups of 8 animals per group were considered: middle-aged group (MA), old control group (OC) and old trained group (OT). Training consisted in to climb a 1.1-m vertical (80° incline) ladder with weights tied to their tail. Aortic wall structural modifications were studied through light and electron microscopy and morphometry. The mean arterial blood pressure at rest was similar in the three experimental groups (p = .07). At the beginning of the experiment, the OC and OT groups had similar repetition maximums, ranging from 1.6-fold to 1.9-fold the body weight. At the end of the experiment, the repetition maximum of the OT group was 5-fold greater than the body weight (p = .03). The LV weight was 15% larger in the OT group than in the MA group and 12% larger than in the OC group (p = .02). The LV wall thickness of the OT group was significantly larger than that of both, the MA group and the OC group (p = .03). The LV internal diameter in the OT group was significantly smaller than that observed in the MA and OC groups (p = .02). Resistance training diminished the alterations associated with aging improving aortic wall structure by reducing the thickness, normalising the elastic material, the collagen and the smooth muscle cells. Resistance training seems to be a potential treatment for reducing the deleterious effects of aging on the aortic wall.

African drumming: a holistic approach to reducing stress and improving health?

AIMS

Very little data are available on the physical requirements for drumming and the potential health benefits of particularly djembe drumming. We hypothesized that djembe drumming constitutes low-to-moderate intensity exercise, and that drumming would simultaneously reduce stress and anxiety levels and benefit cardiovascular health.

METHODS

Two study populations, middle-aged experienced drummers and a younger novice group participated in 40-min djembe drumming sessions. Measurements of blood pressure, blood lactate and stress and anxiety levels were taken before and after sessions. Also, heart rate was monitored at 5-s intervals throughout each session.

RESULTS

Participation in drumming significantly decreased the Stress Anxiety Index scores acutely, both in a middle-aged (P < 0.01) and younger population (P < 0.001). SBP was significantly decreased in the older population postdrumming (141 ± 24 vs. 153 ± 26  mmHg; P < 0.01). Blood lactate levels remained below 4  mmol/l in all individuals and together with heart rate suggest that drumming may be categorized as low-to-moderate intensity exercise.

CONCLUSION

Djembe drumming may improve cardiovascular health, without the cardiovascular risks to unhealthy or older populations that are associated with higher intensity exercise, and at the same time may decrease stress and anxiety levels. Furthermore, participation in drumming did not result in acute hypotension in normotensive individuals.

Description and implementation of U-Turn Medical, a comprehensive lifestyle intervention programme for chronic disease in the sport and exercise medicine setting: pre-post observations in 210 consecutive patients

BACKGROUND

Non-communicable disease (NCD) is increasing, but management remains mostly curative, disease-centred and focused on single interventions. We describe the development and implementation of a patient-centred, comprehensive, multidisciplinary lifestyle intervention programme (LIP) for patients with NCD in the sport and exercise medicine (SEM) setting (part 1) and present preliminary observational data (part 2).

METHODS

Part 1 is a description of the programme development and implementation. In part 2, 210 participants with NCD underwent a 12-week LIP (U-Turn Medical). Physiological, functional and metabolic outcomes were assessed at baseline and at completion.

RESULTS

84% of patients had two or more comorbidities, requiring additional considerations for exercise rehabilitation. On completion, there were decreases in % body fat (29.8±6.7% vs 28.5±6.6%), waist (100.2±16.2 vs 97.3±14.8 cm) and hip circumference (105.4±13 vs 104±12 cm), resting heart rate (74.2±13.4 vs 71.4±11.9 bpm), resting systolic blood pressure (125.7±16.1 vs 120.1±13 mm Hg) and cholesterol (4.7±1.2 vs 4.3±0.9 mmol/L), low-density lipoprotein (3±0.9 vs 2.7±0.8 mmol/L) and triglyceride (1.4±0.7 vs 1.3±0.6 mmol/L), and increases in flexibility (12.1±11.6 vs 16.1±10.8 cm) and 6 min walk distance (559.4±156.6 vs 652.3±193.6 m; all p<0.05).

CONCLUSIONS

A 12-week comprehensive, patient-centred LIP can be implemented successfully in the SEM setting in patients with NCDs with multiple comorbidities. Observed results show improvements in the majority of outcome variables.

Treinamento aerobio e resistido, qualidade de vida e capacidade funcional de hipertensas

INTRODUÇÃO: Pacientes hipertensos podem apresentar comprometimento da qualidade de vida (QV) e da qualidade de vida relacionada à saúde (QVRS), tanto pela hipertensão arterial (HA), quanto pelos eventuais efeitos adversos do tratamento. Exercícios físicos, aeróbios e resistidos, melhoram a performance cardiorrespiratória e neuromuscular, mas há poucas evidências sobre seus efeitos na QV, QVRS e capacidade funcional (CF) em mulheres hipertensas. OBJETIVO: Avaliar e comparar os efeitos dos treinamentos aeróbio e resistido sobre a QV, QVRS e a capacidade funcional em hipertensas. MÉTODOS: Ensaio clínico randomizado, cego, com total de 18 sessões de exercícios. Foram incluídas mulheres hipertensas sob tratamento medicamentoso, não participantes de programas de exercícios, com 50 anos de idade ou mais, que não apresentaram arritmias e/ou alterações isquêmicas em teste ergométrico (protocolo de Bruce). A amostra foi randomizada como segue: grupo aeróbio (GA) (n = 21) e grupo resistido (GR) (n = 20). Intensidade GA: leve a moderada (Escala de Borg adaptada); GR: até 50-65% de 1 RM. Duas séries com 12 a 15 repetições. Antes e após a intervenção foram aplicados os questionários WHOQOL-bref (QV) e SF-36 (QVRS) e realizado o teste de caminhada de 6 minutos (TC6`) para avaliar a CF. Estatística: testes Shapiro-Wilk, t de Student, Fisher, U de Mann-Whitney e Wilcoxon. Nível de significância: p < 0,05. RESULTADOS: Os grupos eram inicialmente homogêneos nos aspectos clínicos, antropométricos, funcionais e sociodemográficos (p > 0,05). Após a intervenção houve melhora significativa em todos os domínios do WHOQOL-bref no GA e no GR houve melhora no domínio aspectos físicos. No SF-36, constatou-se melhora significativa em sete de oito domínios tanto no GA quanto no GR. Capacidade funcional: verificou-se melhora nos dois grupos (p < 0,001). CONCLUSÃO: Os dois tipos de treinamento melhoraram a QV e a CF e, dependendo dos objetivos estabelecidos, ambos podem ser eficazes.

Relationship Between Physical Fitness, BMI, WHR and Hypertension in Elderly Men and Women

Aim: The aim of this study was to determine the structure, characteristics and significance of the relationship between physical fitness, BMI and WHR on one hand and hypertension of elderly men and women on the other.

Methods: The sample consisted of 1288 participants (594 men and 694 women) who live in their own households in the cities and villages of Central, Eastern and South Serbia. After the obtained classification of participants based on arterial blood pressure, 231 patients with hypertension aged 60-80 years were selected. The subsample consisted of 138 male participants, while the subsample of women was 93 participants. Predictor variables consisted of 6 variables for the evaluation of physical fitness, Body mass index (BMI) and Waist-to Hip Ratio index (WHR). Criterion variables consisted of systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Results: The results showed that there is a statistically significant correlation (p <0.05) between predictor variables and hypertension. Higher values of higher SBP in elderly men causes an increase in body weight due to increased body fat (BMI, WHR). In elderly women, these changes occur under the influence of increased body mass index and reduced CRF. Higher values of high DBP in elderly men cause more power and flexibility of the upper body and in elderly women greater strength in the arms and less strength in legs and CRF.

Conclusions: Being overweight in both subsamples could be considered as a factor that contributes to high blood pressure.

Effects of combined traditional Chinese exercises on blood pressure and arterial function of adult female hypertensive patients

This study examined the effects of combined traditional Chinese physical and mental exercises on the blood pressure of adult female hypertensive patients. Twenty female hypertensive patients aged between 50 and 60 years voluntarily participated in the study. The participants performed the combined exercises for 24 weeks, twice a week, and 60 min each time in low-to-moderate intensity. After the 24-week training, the participants showed significant decreases in systolic blood pressure (p = 0.000), diastolic blood pressure (p = 0.006), pulse pressure (p = 0.001), and right ankle brachial pressure index (p = 0.041). The combined Chinese traditional physical and mental exercises were found to have beneficial effects on adult female hypertensive patients.

Cardiac baroreflex function and dynamic cerebral autoregulation in elderly Masters athletes

Cerebral blood flow (CBF) is stably maintained through the combined effects of blood pressure (BP) regulation and cerebral autoregulation. Previous studies suggest that aerobic exercise training improves cardiac baroreflex function and beneficially affects BP regulation, but may negatively affect cerebral autoregulation. The purpose of this study was to reveal the impact of lifelong exercise on cardiac baroreflex function and dynamic cerebral autoregulation (CA) in older adults. Eleven Masters athletes (MA) (8 men, 3 women; mean age 73 ± 6 yr; aerobic training >15 yr) and 12 healthy sedentary elderly (SE) (7 men, 5 women; mean age 71 ± 6 yr) participated in this study. BP, CBF velocity (CBFV), and heart rate were measured during resting conditions and repeated sit-stand maneuvers to enhance BP variability. Baroreflex gain was assessed using transfer function analysis of spontaneous changes in systolic BP and R-R interval in the low frequency range (0.05–0.15 Hz). Dynamic CA was assessed during sit-stand–induced changes in mean BP and CBFV at 0.05 Hz (10 s sit, 10 s stand). Cardiac baroreflex gain was more than doubled in MA compared with SE (MA, 7.69 ± 7.95; SE, 3.18 ± 1.29 ms/mmHg; P = 0.018). However, dynamic CA was similar in the two groups (normalized gain: MA, 1.50 ± 0.56; SE, 1.56 ± 0.42% CBFV/mmHg; P = 0.792). These findings suggest that lifelong exercise improves cardiac baroreflex function, but does not alter dynamic CA. Thus, beneficial effects of exercise training on BP regulation can be achieved in older adults without compromising dynamic regulation of CBF.

Prevalence, awareness and control of hypertension in estate workers in Malaysia

Background:

Hypertension continues to be a major causative factor contributing to cardiovascular, cerebrovascular and renal morbidity and mortality.

Aim:

The objective of this study was to assess the prevalence, awareness and control of hypertension in the estate population in Johor, Malaysia.

Patients and Methods:

A mercury sphygmomanometer was used to record systolic and diastolic blood pressures. Cross sectional population survey was carried out in the study.

Results:

The overall prevalence of hypertension in 903 subjects studied was 26.91% (243). A higher prevalence 27.65 % (133) was found in males against 26.07% (110) in females. Awareness of the disease was present in only 39% (96) of which 86.45% (83) received treatment. Among those who received treatment, control of hypertension was present in 15.66% (13).

Conclusion:

The prevalence of hypertension among the estate population is lower than that of the general population of Malaysia, which can be attributed to their regular physical activity but the awareness, treatment, control and follow-up of patients is disappointingly low.

Health status of older adults with Type 2 diabetes mellitus after aerobic or resistance training: a randomised trial

BACKGROUND

A prior study showed positive effects of resistance training on health status in individuals with diabetes compared to aerobic or no exercise, the exercise regimens were either different in volume, duration or rate of progression. We aimed to compare the effects of progressive resistance training (PRT) or aerobic training (AT) of similar volume over an 8-week period on health status (measured using the Short-form 36 Questionnaire) in middle aged adults with type 2 diabetes mellitus (T2DM).

FINDINGS

Sixty subjects aged 58 (7) years were randomised to PRT (n = 30) or AT (n = 30). General health and vitality were significantly improved in both groups (mean (SD) change scores for PRT were 12.2(11.5) and 10.5(18.2), and for AT, 13.3(19.6) and 10.0(13.1), respectively) and exceeded the minimally important difference of 5 points. The PRT group also had improved physical function and mental health status (mean (SD) change scores: 9.0(22.6), p < 0.05 and 5.3(12.3), p < 0.05, respectively), which was not observed in the AT group. However, the between group differences were not statistically significant.

CONCLUSIONS

Both exercise regimens have positive impact on health status that correlated well with clinical improvement in patients with T2DM. PRT may have some additional benefits as there were significant changes in more domains of the SF-36 than that observed for the AT group.

[Physical exercise in patients with high-blood pressure: a conceptual analysis]

In the treatment of arterial hypertension, physical exercises have been appointed as one of the main non-pharmacological measures. This study aims to analyze the concept of physical exercise in patients with hypertension and identify possible critical attributes and preceding and consequent factors. The study followed the conceptual analysis methodology and the integrative revision of scientific articles related to the topic. As to critical attributes, aspects related to time, frequency, duration and intensity of physical exercise were identified. The preceding factors found were: advice/education, motivation, goal development from Transtheoretical Model, self-efficacy and support groups. Regarding the consequent factors, general health benefits were evidenced as physiological, psychosocial, cognitive and behavioral benefits. The conceptual analysis supports quality assistance centered in the patient with hypertension, aiming the control of the disease and the prevention of complications.

Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients

AIMS

Exercise is recommended as prevention, management, and control of all stages of hypertension. There are still controversies about the optimal training dose, frequency, and intensity. We aimed to study the effect of aerobic interval training on blood pressure and myocardial function in hypertensive patients.

METHODS AND RESULTS

A total of 88 patients (52.0 ± 7.8 years, 39 women) with essential hypertension were randomized to aerobic interval training (AIT) (>90% of maximal heart rate, correlates to 85-90% of VO(2max)), isocaloric moderate intensity continuous training (MIT) (~70% of maximal heart rate, 60% of VO(2max)), or a control group. Exercise was performed on a treadmill, three times per week for 12 weeks. Ambulatory 24-hour blood pressure (ABP) was the primary endpoint. Secondary endpoints included maximal oxygen uptake (VO(2max)), mean heart rate/24 hour, flow mediated dilatation (FMD), total peripheral resistance (TPR), and myocardial systolic and diastolic function by echocardiography. Systolic ABP was reduced by 12 mmHg (p < 0.001) in AIT and 4.5 mmHg (p = 0.05) in MIT. Diastolic ABP was reduced by 8 mmHg (p < 0.001) in AIT and 3.5 mmHg (p = 0.02) in MIT. VO(2max) improved by 15% (p < 0.001) in AIT and 5% (p < 0.01) in MIT. Systolic myocardial function improved in both exercise groups, diastolic function in the AIT group only. TPR reduction and increased FMD were only observed in the AIT group.

CONCLUSIONS

This study indicates that the blood pressure reducing effect of exercise in essential hypertension is intensity dependent. Aerobic interval training is an effective method to lower blood pressure and improve other cardiovascular risk factors.

Exercise Prescription for the Prevention and Management of Hypertension

Regular physical activity is known to reduce blood pressure in 75% of individuals with hypertension and is a key component of lifestyle therapy for the prevention and management of hypertension. However, the frequency, intensity, duration, and mode of activity play a role in the magnitude and duration of blood pressure reduction. Aerobic activity is the preferred type of activity to lower blood pressure. Acute, moderate-intensity aerobic activity (40%-60% VO2max ) can decrease blood pressure by 5 to 7 mm Hg for up to 22 hours postexercise, so participation in aerobic activity is recommended on most, if not all, days of the week. The recommended duration for aerobic activity is 30 to 60 minutes of continuous or intermittent activity. Resistance activity results in a 3-mm Hg decrease in blood pressure and should supplement the aerobic activity. Low- to moderate-intensity resistance training (30%-40% of a 1—repetition maximum [1RM] for upper body exercises and 50%-60% 1RM for lower body exercises) is recommended 2 to 3 d/wk. The volume of resistance training for blood pressure reduction is 1 to 3 sets of 10 to 15 repetitions for 8 to 10 exercises that target large muscle groups (thighs, hips, back, chest, arms, and abdominals). When prescribing physical activity for the prevention or management of hypertension, it is important to know that certain populations respond differently to activity and that certain medications can inhibit physical performance.

A tailored target intervention on influence factors of quality of life in Chinese patients with hypertension

Studies suggested that hypertension was associated with impaired health-related quality of life and it is important to find a proper and feasible management of hypertension in the community. This study evaluates the effect of a tailored target intervention on influence factors of quality of life in Chinese patients with hypertension. A cross-sectional survey was carried out to investigate 644 patients with hypertension by using the Chinese version of the short form-36, and 195 patients were screened out to participate in the tailored target intervention. Multivariate linear regression analyses showed that age, gender, educational level, high intake of fried food, household income, attitude, knowledge, blood pressure, symptoms, serious events during the past year, duration of hypertension, and number of taking anti-hypertensive medicine were significantly correlated with quality of life. Grade-based management by community physicians and physical exercise had a positive effect on quality of life. After the 6-month intervention, the control rate of hypertension was increased from 32.0% to 39.4%, and the mean systolic and diastolic blood pressure values were significantly decreased to 137.2 and 85.7 mmHg vs. 140.9 and 87.6 mmHg at baseline, respectively. The intervention program resulted in overall improvement on total score of quality of life and mean scores of all the domains except social functioning in patients with hypertension. In view of the influence factors of quality of life, taking the tailored target intervention could not only improve the quality of life of hypertensive patients, but also effectively increase the control rate of hypertension.

Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial

OBJECTIVE

To assess the effectiveness of a primary care based programme of exercise on prescription among relatively inactive women over a two year period.

DESIGN

Randomised controlled trial.

SETTING

17 primary care practices in Wellington, New Zealand

PARTICIPANTS

1089 women aged 40-74 not undertaking 30 minutes of moderate intensity physical activity on at least five days of the week

INTERVENTION

Brief physical activity intervention led by nurse with six month follow-up visit and monthly telephone support over nine months.

MAIN OUTCOME MEASURE

Physical activity assessed at baseline and 12 and 24 months. Secondary outcomes were quality of life (SF-36), weight, waist circumference, blood pressure, concentrations of fasting serum lipids, glycated haemoglobin (HbA(1c)), glucose, insulin, and physical fitness.

RESULTS

Mean age was 58.9 (SD 7) years. Trial retention rates were 93% and 89% at 12 and 24 months, respectively. At baseline, 10% of intervention participants and 11% of control participants were achieving 150 minutes of at least moderate intensity physical activity a week. At 12 months rates increased to 43% and 30% and at 24 months to 39.3% and 32.8% (P<0.001), respectively. SF-36 physical functioning (P=0.03) and mental health (P<0.05) scores improved more in intervention compared with control participants, but role physical scores were significantly lower (P<0.01). There were no significant differences in clinical outcomes. More falls (P<0.001) and injuries (P=0.03) were recorded in the intervention group.

CONCLUSIONS

This programme of exercise on prescription increased physical activity and quality of life over two years, although falls and injuries also increased. This finding supports the use of exercise on prescription programmes as part of population strategies to reduce physical inactivity.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ANZCTRN012605000490673.

Sport therapy for hypertension: why, how, and how much?

Exercise may prevent or reduce the effects of metabolic and cardiovascular diseases, including arterial hypertension. Both acute and chronic exercise, alone or combined with lifestyle modifications, decrease blood pressure and avoid or reduce the need for pharmacologic therapy in patients with hypertension. The hypotensive effect of exercise is observed in a large percentage of subjects, with differences due to age, sex, race, health conditions, parental history, and genetic factors. Exercise regulates autonomic nervous system activity, increases shear stress, improves nitric oxide production in endothelial cells and its bioavailability for vascular smooth muscle, up-regulates antioxidant enzymes. Endurance training is primarily effective, and resistance training can be combined with it. Low-to-moderate intensity training in sedentary patients with hypertension is necessary, and tailored programs make exercise safe and effective also in special populations. Supervised or home-based exercise programs allow a nonpharmacological reduction of hypertension and reduce risk factors, with possible beneficial effects on cardiovascular morbidity.

The Future of Antihypertensive Treatment

Despite progress in recent years in the prevention, detection, and treatment of high blood pressure (BP), hypertension remains an important public health challenge. Hypertension affects approximately 1 billion individuals worldwide. High BP is associated with an increased risk of mortality and morbidity from stroke, coronary heart disease, congestive heart failure, and end-stage renal disease; it also has a negative impact on the quality of life. Hypertension cannot be eliminated because there are no vaccines to prevent the development of hypertension, but, its incidence can be decreased by reducing the risk factors for its development, which include obesity, high dietary intake of fat and sodium and low intake of potassium, physical inactivity, smoking, and excessive alcohol intake. For established hypertension, efforts are to be directed to control BP by lifestyle modification (LSM). However, if BP cannot be adequately controlled with LSM, then pharmacotherapy can be instituted along with LSM. Normalization of BP reduces cardiovascular risk (for cardiovascular death, myocardial infarction, and cardiac arrest), provides renoprotection (prevention of the onset or slowing of proteinuria and progression of renal dysfunction to end-stage renal disease in patients with hypertension, diabetes mellitus types 1 and 2, and chronic renal disease), and decreases the risk of cerebrovascular events (stroke and cognition impairment), as has been amply demonstrated by a large number of randomized clinical trials. In spite of the availability of more than 75 antihypertensive agents in 9 classes, BP control in the general population is at best inadequate. Therefore, antihypertensive therapy in the future or near future should be directed toward improving BP control in treated hypertensive patients with the available drugs by using the right combinations at optimum doses, individually tailored gene-polymorphism directed therapy, or development of new modalities such as gene therapy and vaccines. Several studies have shown that BP can be reduced by lifestyle/behavior modification. Although, the reductions appear to be trivial, even small reductions in systolic BP (for example, 3-5 mm Hg) produce dramatic reduction in adverse cardiac events and stroke. On the basis of the results of clinical and clinical/observational studies, it has been recommended that more emphasis be placed on lifestyle/behavior modification (obesity, high dietary intake of fat and sodium, physical inactivity, smoking, excessive alcohol intake, low dietary potassium intake) to control BP and also to improve the efficacy of pharmacologic treatment of high BP. New classes of antihypertensive drugs and new compounds in the established drug classes are likely to widen the armamentarium available to combat hypertension. These include the aldosterone receptor blockers, vasodilator beta-blockers, renin inhibitors, endothelin receptor antagonists, and dual endopeptidase inhibitors. The use of fixed-dose combination drug therapy is likely to increase. There is a conceptual possibility that gene therapy may yield long-lasting antihypertensive effects by influencing the genes associated with hypertension. But, the treatment of human essential hypertension requires sustained over-expression of genes. Some of the challenging tasks for successful gene therapy that need to be mastered include identification of target genes, ideal gene transfer vector, precise delivery of genes into the required site (target), efficient transfer of genes into the cells of the target, and prompt assessment of gene expression over time. Targeting the RAS by antisense gene therapy appears to be a viable strategy for the long-term control of hypertension. Several problems that are encountered in the delivery of gene therapy include 1) low efficiency for gene transfer into vascular cells; 2) a lack of selectivity; 3) problem in determining how to prolong and control transgene expression or antisense inhibition; and 4) difficulty in minimizing the adverse effects of viral or nonviral vectors. In spite of the hurdles that face gene therapy administration in humans, studies in animals indicate that gene therapy may be feasible in treating human hypertension, albeit not in the near future. DNA testing for genetic polymorphism and determining the genotype of a patient may predict response to a certain class of antihypertensive agent and thus optimize therapy in individual patients. In this regard, there are some studies that report the effectiveness of antihypertensive therapy based upon the genotype of selected patients. Treatment of human hypertension with vaccines is feasible but is not likely to be available in the near future.

Evaluating a community-based walking intervention for hypertensive older people in Taiwan: a randomized controlled trial

OBJECTIVE

To study the effect of a community-based walking intervention on blood pressure among older people.

METHOD

The study design was a randomized controlled trial conducted in a rural area of Taiwan between October 2002 and June 2003. A total of 202 participants aged 60 years and over with mild to moderate hypertension was recruited. Participants randomized to the intervention group (n=102) received a six-month community-based walking intervention based on self-efficacy theory. A public health nurse provided both face-to-face and telephone support designed to assist participants to increase their walking. Control group participants (n=100) received usual primary health care. Primary outcome was change in systolic blood pressure and secondary outcomes were exercise self-efficacy, self-reported walking and diastolic blood pressure.

RESULTS

At six-month follow-up the mean change in systolic blood pressure was a decrease of 15.4 mmHg and 8.4 mmHg in the intervention and control group, respectively. The difference in mean change between the two groups was -7.0 mmHg (95% CI, -11.5 to -2.5 mmHg, p=0.002). Improvement in exercise self-efficacy scores was greater among intervention group participants (mean difference 1.23, 95% CI, 0.5 to 2.0, p=0.001). Intervention group participants were more likely to report walking more (p<0.0005) but no differences were observed in diastolic blood pressure (p=0.19).

CONCLUSIONS

Among hypertensive older people, a six-month community-based walking intervention was effective in increasing their exercise self-efficacy and reducing systolic blood pressure.