1
|
Craighead DH, Freeberg KA, McCarty NP, Rossman MJ, Moreau KL, You Z, Chonchol M, Seals DR. Inspiratory muscle strength training for lowering blood pressure and improving endothelial function in postmenopausal women: comparison with “standard of care” aerobic exercise. Front Physiol 2022; 13:967478. [PMID: 36105300 PMCID: PMC9465043 DOI: 10.3389/fphys.2022.967478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background: High blood pressure (BP), particularly systolic BP (SBP), is the major modifiable risk factor for cardiovascular diseases and related disorders of aging. SBP increases markedly with aging in women such that the prevalence of above-normal SBP (i.e., ≥120 mmHg) in postmenopausal women exceeds rates in age-matched men. This increase in SBP is associated with vascular endothelial dysfunction, mediated by excessive reactive oxygen species-induced oxidative stress and consequent reductions in nitric oxide bioavailability. Moderate-intensity aerobic exercise is a recommended lifestyle strategy for reducing SBP. However, adherence to aerobic exercise guidelines among postmenopausal women is low (<30%) and aerobic exercise does not consistently enhance endothelial function in estrogen-deficient postmenopausal women. High-resistance inspiratory muscle strength training (IMST) is a time-efficient, adherable lifestyle intervention that involves inhaling against resistance through a handheld device (30 breaths/day). Here, we present the protocol for a randomized controlled trial investigating the efficacy of 3 months of high-resistance IMST compared to guideline-based, “standard-of-care” aerobic exercise training for decreasing SBP and improving endothelial function in estrogen-deficient postmenopausal women with above-normal SBP (120–159 mmHg) at baseline (ClinicalTrials.gov Identifier: NCT05000515). Methods: A randomized, single-blind, parallel-group design clinical trial will be conducted in 72 (36/group) estrogen-deficient postmenopausal women with above-normal SBP. Participants will complete baseline testing and then be randomized to either 3 months of high-resistance IMST (30 breaths/day, 6 days/week, 75% maximal inspiratory pressure) or moderate-intensity aerobic exercise training (brisk walking 25 min/day, 6 days/week, 40–60% heart rate reserve). Outcome measures will be assessed after 3 months of either intervention. Following end-intervention testing, participants will abstain from their assigned intervention for 6 weeks, after which BP and endothelial function will be assessed to evaluate the potential persistent effects of the intervention on the primary and secondary outcomes. Discussion: This study is designed to compare the effectiveness of time-efficient, high-resistance IMST to guideline-based aerobic exercise training for lowering SBP and improving endothelial function, and interrogating potential mechanisms of action, in estrogen-deficient postmenopausal women. Clinical Trial Registration:ClinicalTrials.gov, Identifier: NCT05000515.
Collapse
Affiliation(s)
- Daniel H. Craighead
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Kaitlin A. Freeberg
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Narissa P. McCarty
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Matthew J. Rossman
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Kerrie L. Moreau
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Veterans Affairs Eastern Colorado Geriatric Research, Educational and Clinical Center, Denver, CO, United States
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Douglas R. Seals
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
- *Correspondence: Douglas R. Seals,
| |
Collapse
|
2
|
Abstract
BACKGROUND Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings. OBJECTIVES To determine the effect of walking as a physical activity intervention on blood pressure and heart rate. SEARCH METHODS We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings. MAIN RESULTS A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times. AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.
Collapse
Affiliation(s)
- Ling-Ling Lee
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien City, Hualien County, Taiwan
| | | | | | | | - Michael C Watson
- School of Health Sciences, The University of Nottingham, Nottingham, UK
| | - Hui-Hsin Lin
- Medical Affairs Division, Hualien Armed Forces General Hospital, Hualien, Taiwan
| |
Collapse
|
3
|
Gunnarsson TP, Ehlers TS, Fiorenza M, Nyberg M, Bangsbo J. Essential hypertension is associated with blunted smooth muscle cell vasodilator responsiveness and is reversed by 10-20-30 training in men. Am J Physiol Cell Physiol 2020; 318:C1252-C1263. [DOI: 10.1152/ajpcell.00047.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Essential hypertension is associated with impairments in vascular function and sympathetic nerve hyperactivity; however, the extent to which the lower limbs are affected remains unclear. We examined the leg vascular responsiveness to infusion of acetylcholine (ACh), sodium nitroprusside (SNP), and phenylephrine (PEP) in 10 hypertensive men [HYP: age 59.5 ± 9.7 (means ± SD) yr; clinical and nighttime blood pressure: 142 ± 10/86 ± 10 and 141 ± 11/83 ± 6 mmHg, respectively; and body mass index (BMI): 29.2 ± 4.0 kg/m2] and 8 age-matched normotensive counterparts (NORM: age 57.9 ± 10.8 yr; clinical and nighttime blood pressure: 128 ± 9/78 ± 7 and 116 ± 3/69 ± 3 mmHg, respectively; and BMI: 26.3 ± 3.1 kg/m2). The vascular responsiveness was evaluated before and after 6 wk of 10-20-30 training, consisting of 3 × 5 × 10-s sprint followed by 30 and 20 s of low- to moderate-intensity cycling, respectively, interspersed by 3 min of rest. Before training, the vascular responsiveness to infusion of SNP was lower ( P < 0.05) in HYP compared with NORM, with no difference in the responsiveness to infusion of ACh and PEP. The vascular responsiveness to infusion of SNP and ACh improved ( P < 0.05) with training in HYP, with no change in NORM. With training, intra-arterial systolic blood pressure decreased ( P < 0.05) by 9 mmHg in both HYP and NORM whereas diastolic blood pressure decreased (5 mmHg; P < 0.05) in HYP only. We provide here the first line of evidence in humans that smooth muscle cell vasodilator responsiveness is blunted in the lower limbs of hypertensive men. This impairment can be reversed by 10-20-30 training, which is an effective intervention to improve the responsiveness of smooth muscle cells in men with essential hypertension.
Collapse
Affiliation(s)
- Thomas P. Gunnarsson
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Thomas S. Ehlers
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Matteo Fiorenza
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Michael Nyberg
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bangsbo
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Tanaka H, Tarumi T, Rittweger J. Aging and Physiological Lessons from Master Athletes. Compr Physiol 2019; 10:261-296. [PMID: 31853968 DOI: 10.1002/cphy.c180041] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sedentary aging is often characterized by physical dysfunction and chronic degenerative diseases. In contrast, masters athletes demonstrate markedly greater physiological function and more favorable levels of risk factors for cardiovascular disease, osteoporosis, frailty, and cognitive dysfunction than their sedentary counterparts. In many cases, age-related deteriorations of physiological functions as well as elevations in risk factors that are typically observed in sedentary adults are substantially attenuated or even absent in masters athletes. Older masters athletes possess greater functional capacity at any given age than their sedentary peers. Impressive profiles of older athletes provide insight into what is possible in human aging and place aging back into the domain of "physiology" rather than under the jurisdiction of "clinical medicine." In addition, these exceptional aging athletes can serve as a role model for the promotion of physical activity at all ages. The study of masters athletes has provided useful insight into the positive example of successful aging. To further establish and propagate masters athletics as a role model for our aging society, future research and action are needed. © 2020 American Physiological Society. Compr Physiol 10:261-296, 2020.
Collapse
Affiliation(s)
- Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Takashi Tarumi
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Jörn Rittweger
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| |
Collapse
|
5
|
Environmental Factors Associated with Older Adult’s Walking Behaviors: A Systematic Review of Quantitative Studies. SUSTAINABILITY 2019. [DOI: 10.3390/su11123253] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this study is to systematically review the relationship between neighborhood environments and all types of walking behaviors among older adults. Seventy peer-reviewed journal articles which met the selection criteria were examined. Research designs were summarized by geographical location and the associations of environmental characteristics and walking were calculated. Interactions between moderators and environmental characteristics for all types of walking were also categorized. Results have shown that transport walking is the most supported by neighborhood environmental characteristics. The positively related environmental characteristics are walkability, urbanization, land use mix-diversity and accessibility, walking amenities, and bicycle lanes. Total walking was positively associated with walkability and urbanization. Recreational walking was associated with neighborhood employment/income level, nearness to public transport/bus stops, and social cohesion. The most commonly used moderators were age and gender, but inconsistent moderating effects between neighborhood environments and walking were also found. In densely populated environments such as Hong Kong, older adults walked mostly for both transport and recreation. In contrast, American older adults in low density areas walked less for transport and more for recreation. Findings support a strong relationship between neighborhood environments and older adults’ walking. Future research should focus on longitudinal studies and comparison studies by geographic location.
Collapse
|
6
|
Reimers AK, Knapp G, Reimers CD. Effects of Exercise on the Resting Heart Rate: A Systematic Review and Meta-Analysis of Interventional Studies. J Clin Med 2018; 7:E503. [PMID: 30513777 PMCID: PMC6306777 DOI: 10.3390/jcm7120503] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/23/2018] [Accepted: 11/27/2018] [Indexed: 12/17/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Anne Kerstin Reimers
- Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Technical University of Chemnitz, Straße der Nationen 62, D-09111 Chemnitz, Germany.
| | - Guido Knapp
- Department of Statistics, TU Dortmund University, Vogelpothsweg 87, D-44227 Dortmund, Germany.
| | | |
Collapse
|
7
|
Evidence of a metabolic reserve in the skeletal muscle of elderly people. Aging (Albany NY) 2017; 9:52-67. [PMID: 27824313 PMCID: PMC5310656 DOI: 10.18632/aging.101079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/20/2016] [Indexed: 11/25/2022]
Abstract
The purpose of the present study was to determine whether mitochondrial function is limited by O2 availability or the intrinsic capacity of mitochondria to synthesize ATP in elderly individuals. To this aim, we examined, in comparison to free-flow conditions (FF), the effect of superimposing reactive hyperemia (RH), induced by a period of brief ischemia during the last min of exercise, on O2 availability and mitochondrial function in the calf muscle. 12 healthy, untrained, elderly subjects performed dynamic plantar flexion exercise and phosphorus magnetic resonance spectroscopy (31P-MRS), near-infrared spectroscopy (NIRS), and Doppler ultrasound were used to assess muscle metabolism and peripheral hemodynamics. Limb blood flow [area under the curve (AUC), FF: 1.5±0.5L; RH: 3.2±1.1L, P<0.01] and convective O2 delivery (AUC, FF: 0.30±0.13L; RH: 0.64±0.29L, P<0.01) were significantly increased in RH in comparison to FF. RH was also associated with significantly higher capillary blood flow (P<0.05) and this resulted in a 33% increase in estimated peak mitochondrial ATP synthesis rate (FF: 24±11 mM.min−1; RH: 31±7 mM.min−1, P<0.05). These results document a hemodynamic reserve in the contracting calf muscle of the elderly accessible by superimposing reactive hyperemia. Furthermore, this increase in O2 availability enhanced mitochondrial function thus indicating a skeletal muscle metabolic reserve despite advancing age and low level of physical activity.
Collapse
|
8
|
Huang G, Wang R, Chen P, Huang SC, Donnelly JE, Mehlferber JP. Dose-response relationship of cardiorespiratory fitness adaptation to controlled endurance training in sedentary older adults. Eur J Prev Cardiol 2015; 23:518-29. [PMID: 25901000 DOI: 10.1177/2047487315582322] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this investigation was to identify a quantitative dose-response relationship for enhancing maximal oxygen consumption (VO2max) in healthy sedentary older adults after controlled endurance training. METHODS AND RESULTS This meta-analysis of controlled clinical trials included 1257 exercisers and 845 controls with a mean age of 67.45 ± 5.25 years. Effect sizes were calculated for training-induced VO2max changes. Different training regimens were analyzed and compared. The weighted net change of the mean VO2max values showed a significant increase of 3.78 ml/kg per min (95% confidence interval = 3.29 to 4.27; p < 0.0001) in response to aerobic training. Interstudy differences in VO2max changes were significantly related to exercise intensity, and explained approximately 11% of the variance of the VO2max responses. VO2max improved significantly at 35%-50% heart rate reserve (HRR) and continued improving at a greater rate with increasing "dose". The largest VO2max-improvement adaptation was achieved with a mean intensity of 66%-73% HRR. The magnitudes of the VO2max adaptation are identical to exercise at 57%-65% HRR and at 75%-80% HRR. Higher intensity doses more than 75-80% HRR did not lead to greater enhancement of VO2max improvements but, conversely, resulted in large declines. CONCLUSIONS Our data provide quantitative insight into the magnitude of VO2max alterations as affected by exercise intensity, duration, frequency, and program length. The shapes of the dose-response curves are not simply linear, but with many similar trends and noteworthy characteristics. Aerobic training at a mean intensity of 66%-73% HRR with 40-50 min per session for 3-4 day/week for 30-40 weeks appears to be effective and optimal for maximum cardiorespiratory benefits in healthy sedentary older adults.
Collapse
Affiliation(s)
- Guoyuan Huang
- Pott College of Science, Engineering & Education, University of Southern Indiana, Evansville, USA College of Exercise Science, Shanghai University of Sport, China
| | - Ru Wang
- College of Exercise Science, Shanghai University of Sport, China
| | - Peijie Chen
- College of Exercise Science, Shanghai University of Sport, China
| | - Sunny C Huang
- Pott College of Science, Engineering & Education, University of Southern Indiana, Evansville, USA Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Joseph E Donnelly
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Jon P Mehlferber
- College of Arts & Letters, University of North Georgia, Dahlonega, USA
| |
Collapse
|
9
|
Ohta Y, Kawano Y, Minami J, Iwashima Y, Hayashi S, Yoshihara F, Nakamura S. Effects of daily walking on office, home and 24-h blood pressure in hypertensive patients. Clin Exp Hypertens 2015; 37:433-7. [PMID: 25815710 DOI: 10.3109/10641963.2015.1013115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aerobic exercise has been recommended in the management of hypertension. However, few studies have examined the effect of walking on ambulatory blood pressure (BP), and no studies have employed home BP monitoring. We investigated the effects of daily walking on office, home, and 24-h ambulatory BP in hypertensive patients. Sixty-five treated or untreated patients with essential hypertension (39 women and 26 men, 60 ± 9 years) were examined in a randomized cross-over design. The patients were asked to take a daily walk of 30-60 min to achieve 10 000 steps/d for 4 weeks, and to maintain usual activities for another 4 weeks. The number of steps taken and home BP were recorded everyday. Measurement of office and ambulatory BP, and sampling of blood and urine were performed at the end of each period. The average number of steps were 5349 ± 2267/d and 10 049 ± 3403/d in the control and walking period, respectively. Body weight and urinary sodium excretion did not change. Office, home, and 24-h BP in the walking period were lower compared to the control period by 2.6 ± 9.4/1.3 ± 4.9 mmHg (p < 0.05), 1.6 ± 6.8/1.5 ± 3.7 mmHg (p < 0.01), and 2.4 ± 7.6/1.8 ± 5.3 mmHg (p < 0.01), respectively. Average 24-h heart rate and serum triglyceride also decreased significantly. The changes in 24-h BP with walking significantly correlated with the average 24-h BP in the control period. In conclusion, daily walking lowered office, home, and 24-h BP, and improved 24-h heart rate and lipid metabolism in hypertensive patients. However, the small changes in BP may limit the value of walking as a non-pharmacologic therapy for hypertension.
Collapse
Affiliation(s)
- Yuko Ohta
- Division of Internal Medicine, Japan Seafarers Relief Association, Moji Ekisaikai Hospital , Kitakyushu, Fukuoka , Japan
| | | | | | | | | | | | | |
Collapse
|
10
|
Montero D. The association of cardiorespiratory fitness with endothelial or smooth muscle vasodilator function. Eur J Prev Cardiol 2014; 22:1200-11. [PMID: 25301872 DOI: 10.1177/2047487314553780] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/11/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Maximal oxygen consumption (VO2max) is strongly associated with peripheral vasodilator function as determined by exercise-induced vasodilation. However, findings with regard to its relation with non-exercise-stimulated vasodilation are unclear. The purpose of this study was to systematically review published literature reporting associations between VO2max and endothelial function (EF) or smooth muscle function (SMF). DESIGN AND METHODS We conducted a systematic search of MEDLINE, Cochrane and Web of Science, since their inceptions until April 2014 for articles reporting the association between (a) VO2max during incremental exercise and (b) endothelium-dependent or -independent vasodilator function, by means of correlation and/or regression analysis. RESULTS Fifty-six articles exploring 88 associations between VO2max and vascular EF or SMF were included, involving a total of 4159 healthy and diseased subjects. VO2max was determined by incremental cycle ergometer (64%), treadmill (33%) and cycle ergometer/treadmill (3%) exercise. Vasodilator function variables were assessed in the upper limb (86%), lower limb (10%) and both upper and lower limbs (3%). Most of the evaluated bivariate associations involved EF stimuli such as flow-mediated dilation (FMD) (n = 29) or blood flow occlusion (BFO) (n = 18). VO2max was significantly associated with FMD and BFO in 59% and 67% of bivariate associations and 46% and 33% of age-independent associations, respectively. Explored bivariate associations regarding SMF involved sodium nitroprusside (SNP) iontophoresis (n = 7) and nitrate-mediated dilation (NMD) (n = 4). VO2max was associated with NMD in 50% of bivariate associations and 50% of age-independent associations. VO2max was not associated with SNP iontophoresis. Results were similar for associations including only healthy subjects. CONCLUSIONS The association between VO2max and EF or SMF is moderately frequent and independent of health status, despite very few studies having assessed vasodilator function in the lower limb.
Collapse
Affiliation(s)
- David Montero
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC), the Netherlands Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| |
Collapse
|
11
|
Barnes JN, Nualnim N, Dhindsa M, Renzi CP, Tanaka H. Macro- and microvascular function in habitually exercising systemic lupus erythematosus patients. Scand J Rheumatol 2014; 43:209-16. [DOI: 10.3109/03009742.2013.846408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
12
|
Huang G, Shi X, Gibson CA, Huang SC, Coudret NA, Ehlman MC. Controlled aerobic exercise training reduces resting blood pressure in sedentary older adults. Blood Press 2013; 22:386-94. [PMID: 23550511 DOI: 10.3109/08037051.2013.778003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The results of existing controlled clinical trials were synthesized to determine effects of aerobic exercise training on resting systolic (SBP) and diastolic blood pressure (DBP) among previously sedentary older adults, to quantify the magnitude of observed changes, and to examine the influence of the associated interventional variables on these changes. Studies were identified via a systematic computer database search, hand searching, and cross-referencing of previously located articles. All potentially eligible articles were carefully reviewed and examined with the established inclusion criteria. Twenty-three studies, representing a total of 1226 older subjects, were included in the final analysis. Robust statistically significant effects were found in terms of the pooled standardized effect size of - 0.33 ± 0.06 (p < 0.0001) in SBP and - 0.39 ± 0.09 (p < 0.0001) in DBP. When compared with the control group, net decreases in both SBP (- 5.39 ± 1.21 mmHg, p < 0.0001) and DBP (-3.68 ± 0.83 mmHg, p < 0.0001) were observed in older exercisers, representing a 3.9% and a 4.5% reduction, respectively. This meta-analytic study provides robust quantitative data to support the efficacy and effectiveness of controlled endurance exercise training in decreasing resting SBP and DBP among previously sedentary older adults.
Collapse
|
13
|
Goldberg MJ, Boutcher SH, Boutcher YN. The effect of 4 weeks of aerobic exercise on vascular and baroreflex function of young men with a family history of hypertension. J Hum Hypertens 2011; 26:644-9. [PMID: 22048712 DOI: 10.1038/jhh.2011.95] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The effect of short-term aerobic exercise on vascular function of young individuals with a family history of hypertension was investigated. Thirty young men with a family history of hypertension were randomly assigned to either an exercise (n=15) or control (n=15) group. Exercise subjects performed 30 min of supervised cycle training at 65% of their maximal oxygen uptake (VO(2max)), three times per week for 4 weeks. Control subjects were asked to maintain their normal levels of physical activity. Peak leg and forearm blood flow were assessed using plethysmography and was determined as the highest blood flow following 5 min of reactive hyperemia. Cardiopulmonary baroreceptor (CPBR) sensitivity was measured using lower body negative pressure (LBNP) for 5 min at -20 mm Hg. CPBR was determined by calculating change of stroke volume and forearm vascular resistance at baseline and during LBNP. Carotid baroreceptor (CBR) sensitivity was assessed using neck suction at -20, -40, -60 and -80 mm Hg pressures, and was determined from RR interval divided by systolic blood pressure. Augmentation index (AIx), a measure of arterial stiffness, was assessed using applanation tonometry and was calculated as the ratio of augmented pressure and pulse pressure. The major findings were that the exercise group showed increase in leg vasodilation, reduction in AIx and increase in VO(2max) compared with the control group (P<0.05). However, there was no significant change for CPBR and CBR. A short-term moderate-intensity aerobic exercise intervention in young men with a family history of hypertension significantly reduced arterial stiffness and increased aerobic fitness.
Collapse
Affiliation(s)
- M J Goldberg
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | |
Collapse
|
14
|
Lu Z. Investigating Walking Environments in and around Assisted Living Facilities: A Facility Visit Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2010; 3:58-74. [DOI: 10.1177/193758671000300406] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study explores assisted living residents' walking behaviors, locations where residents prefer to walk, and walking environments in and around assisted living facilities. Background: Regular walking is beneficial to older adults' physical and psychological health. Yet frail older residents in assisted living are usually too sedentary to achieve these benefits. The physical environment plays an important role in promoting physical activity. However, there is little research exploring this relationship in assisted living settings. Methods: The researcher visited 34 assisted living facilities in a major Texas city. Methods included walk-through observation with the Assisted Living Facility Walking Environment Checklist, and interviews with administrators by open- and close-ended questions. The data from 26 facilities were analyzed using descriptive statistics (for quantitative data) and content analysis (for qualitative data). Results: The results indicate that (a) residents were walking both indoors and outdoors for exercise or other purposes (e.g., going to destinations); (b) assisted living facility planning and design details—such as neighborhood sidewalk conditions, facility site selection, availability of seating, walking path configuration (e.g., looped/nonlooped path), amount of shading along the path, presence of handrails, existence of signage, etc.—may influence residents' walking behaviors; and (c) current assisted living facilities need improvement in all aspects to make their environments more walkable for residents. Conclusion: Findings of the study provide recommendations for assisted living facilities to improve the walkability of environments and to create environmental interventions to promote regular walking among their residents. This study also implies several directions for future research.
Collapse
|
15
|
Abstract
Swimming is an exercise modality that is highly suitable for health promotion and disease prevention, and is one of the most popular, most practiced and most recommended forms of physical activity. Yet little information is available concerning the influence of regular swimming on coronary heart disease (CHD). Exercise recommendations involving swimming have been generated primarily from unjustified extrapolation of the data from other modes of exercise (e.g. walking and cycling). Available evidence indicates that, similarly to other physically active adults, the CHD risk profile is more favourable in swimmers than in sedentary counterparts and that swim training results in the lowering of some CHD risk factors. However, the beneficial impact of regular swimming may be smaller than land-based exercises. In some cases, regular swimming does not appear to confer beneficial effects on some CHD risk factors. Moreover, swimming has not been associated with the reduced risks of developing CHD. Thus, extrapolation of research findings using land-based exercises into swimming cannot be justified, based on the available research. Clearly, more research is required to properly assess the effects of regular swimming on CHD risks in humans.
Collapse
Affiliation(s)
- Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas 78712, USA.
| |
Collapse
|
16
|
De Rosa ML, Chiariello M. Candesartan improves maximal exercise capacity in hypertensives: results of a randomized placebo-controlled crossover trial. J Clin Hypertens (Greenwich) 2009; 11:192-200. [PMID: 19614803 PMCID: PMC8673411 DOI: 10.1111/j.1751-7176.2009.00095.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 02/02/2009] [Accepted: 02/02/2009] [Indexed: 11/30/2022]
Abstract
Cardiac hypertrophy and remodelling in hypertension has been associated with impaired exercise capacity. The authors tested whether an angiotensin receptor blocker, candesartan, improved exercise peak oxygen volume (VO2) in this population. A total of 154 untreated hypertensive patients, aged 40 to 66 years, with World Health Organization stage I or II hypertension and left ventricular hypertrophy, were randomized to receive placebo, candesartan (32 mg), each of these plus aspirin (300 mg/d), or the same preparations in a reverse order, for 3 weeks, with a 3-week washout period between treatments. The authors measured maximal workload and oxygen reserve with an exercise test, 24 hour-ambulatory blood pressure, and echocardiography at the end of each treatment. Hypertensive patients did not achieve the maximal workload (116 [99-133] W vs 132 (AMA style = no period on vs) [116-149] W; P=.01). This impaired exercise capacity was in a multiple regression analysis related to lower oxygen reserve (r=0.49, P<.001), and the lower oxygen reserve to higher left ventricular hypertrophy by echocardiography (beta=-0.34), respectively. The use of candesartan alone or with aspirin resulted in an improvement of peak VO2 and exercise tolerance, when compared with controls. Patients with hypertension and cardiac hypertrophy cannot achieve a predicted maximal workload. The use of an angiotensin receptor blocker in therapy may represent a useful treatment in these patients for its effect on exercise peak VO2 and exercise tolerance. The use of aspirin did not affect outcome.
Collapse
Affiliation(s)
- Maria Leonarda De Rosa
- Department of Internal Medicine, Cardiology Unit, Faculty of Medicine, University of Naples "Federico II" DD, Via Caravaggio, Naples, Italy.
| | | |
Collapse
|
17
|
Manfredini F, Malagoni AM, Mandini S, Boari B, Felisatti M, Zamboni P, Manfredini R. Sport therapy for hypertension: why, how, and how much? Angiology 2008; 60:207-16. [PMID: 18796453 DOI: 10.1177/0003319708316012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Fabio Manfredini
- Vascular Diseases Center, University of Ferrara, S. Anna Hospital, Ferrara, Italy.
| | | | | | | | | | | | | |
Collapse
|
18
|
Huang G, Gibson CA, Tran ZV, Osness WH. Controlled Endurance Exercise Training and VO
2max
Changes in Older Adults: A Meta‐Analysis. ACTA ACUST UNITED AC 2007; 8:217-25. [PMID: 16230876 DOI: 10.1111/j.0197-3118.2005.04324.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This meta-analysis of controlled clinical trials quantifies the effect of aerobic exercise on VO2max (aerobic fitness) among sedentary older adults and examines the associations of such magnitude with variables of intervention. Forty-one trials including 2102 older subjects (within-group mean age of 60 years and older) were identified by searches of databases, hand searching, and cross-referencing. Outcomes were homogeneous. The pooled standardized effect size by a fixed-effect model showed a higher moderate effect (mean +/- SEM) of 0.64+/-0.05; 95% confidence interval, 0.56-0.73; p<0.001, representing a net increase in VO2max (mean +/- SEM) of 3.78+/-0.28 mL.kg-1.min-1; 95% confidence interval, 3.24-4.33; or a 16.3% improvement, compared with control groups. Greater improvement in VO2max was associated with training length more than 20 weeks and training intensity of approximately 60% but less than 70% of VO2max. Endurance training improves aerobic fitness in older adults, thus providing protective benefits for cardiovascular aging and quality of later life.
Collapse
Affiliation(s)
- Guoyuan Huang
- University of Southern Indiana, 8600 University Boulevard, Evansville, IN 47712, USA.
| | | | | | | |
Collapse
|
19
|
Anton MM, Cortez-Cooper MY, DeVan AE, Neidre DB, Cook JN, Tanaka H. Resistance training increases basal limb blood flow and vascular conductance in aging humans. J Appl Physiol (1985) 2006; 101:1351-5. [PMID: 16840576 DOI: 10.1152/japplphysiol.00497.2006] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Age-related reductions in basal limb blood flow and vascular conductance are associated with the metabolic syndrome, functional impairments, and osteoporosis. We tested the hypothesis that a strength training program would increase basal femoral blood flow in aging adults. Twenty-six sedentary but healthy middle-aged and older subjects were randomly assigned to either a whole body strength training intervention group (52 +/- 2 yr, 3 men, 10 women) who underwent three supervised resistance training sessions per week for 13 wk or a control group (53 +/- 2 yr, 4 men, 9 women) who participated in a supervised stretching program. At baseline, there were no significant differences in blood pressure, cardiac output, basal femoral blood flow (via Doppler ultrasound), vascular conductance, and vascular resistance between the two groups. The strength training group increased maximal strength in all the major muscle groups tested (P < 0.05). Whole body lean body mass increased (P < 0.05) with strength training, but leg fat-free mass did not. Basal femoral blood flow and vascular conductance increased by 55-60% after strength training (both P < 0.05). No such changes were observed in the control group. In both groups, there were no significant changes in brachial blood pressure, plasma endothelin-1 and angiotensin II concentrations, femoral artery wall thickness, cardiac output, and systemic vascular resistance. Our results indicate that short-term strength training increases basal femoral blood flow and vascular conductance in healthy middle-aged and older adults.
Collapse
Affiliation(s)
- Maria M Anton
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
Pet ownership among older adults was investigated to determine whether dog owners were more likely to engage in physical activity than non-dog-pet or non–pet owners. The relationship between pet ownership and physical activity was examined using data from the Health ABC study. After age, race, education level, number of assets, family income, and site were adjusted for dog owners were more likely than non–pet owners to have engaged in non-exercise-related walking in the preceding week but did not differ from non–pet owners in walking for exercise or any physical activity. In contrast, non-dog-pet owners did not differ from non–pet owners in non-exercise-related walking in the preceding week and were less likely than non–pet owners to have engaged in walking for exercise or any physical activity in the preceding week. The activity-related benefits of pet ownership in older adults were limited to dog owners, who engaged in greater overall physical activity—non-exercise-related walking, in particular. Whether pet-related physical activity is sufficient to provide health benefits requires longitudinal investigation.
Collapse
|
21
|
Ridout SJ, Parker BA, Proctor DN. Age and regional specificity of peak limb vascular conductance in women. J Appl Physiol (1985) 2005; 99:2067-74. [PMID: 16109827 DOI: 10.1152/japplphysiol.00825.2005] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The influence of age on limb vasodilator capacity in women is unclear. The objectives of this study were to characterize and compare age-associated changes in forearm and calf peak vascular conductance (VC(peak); a functional index of arterial structure) in women and to identify physiological characteristics predictive of variation in limb-specific VC(peak). Peak conductance (plethysmographic flow/mean arterial pressure), VC(peak) of the forearm (forearm VC(peak)), and calf (calf VC(peak)) after 10 min of arterial occlusion were measured in 58 healthy, normally active women aged 21-79 yr. Aerobic capacity (cycle peak oxygen uptake), arterial health (pulse-wave velocity, ankle-brachial index), total cholesterol, limb-specific tissue composition (dual-energy X-ray absorptiometry), and isometric strength (handgrip, plantar flexion) were also assessed. The relative decline in calf VC(peak) with age (-6.8% per decade, P < 0.001) was greater than the forearm (-4.4% per decade, P = 0.004), in contrast to results previously reported for men (forearm decline > calf decline). Limb VC(peak) per kilogram muscle declined with age in the calf (-6.0% per decade; P = 0.002), but not the forearm (P = 0.12). Age, cholesterol, and regional tissue composition were significant predictors of peak conductance in both limbs; however, age was a stronger predictor of peak conductance in the calf. These results suggest that healthy aging is associated with a linear decline in limb vasodilator capacity in women, but the magnitude of this effect is region specific. Further research will be required to determine whether the decline in lower extremity vasodilator capacity with age explains diminished exercising leg vasodilation in older women.
Collapse
Affiliation(s)
- Samuel J Ridout
- Noll Laboratory, The Pennsylvania State University, University Park, PA 16802-6900, USA
| | | | | |
Collapse
|
22
|
Huang G, Shi X, Davis-Brezette JA, Osness WH. Resting Heart Rate Changes after Endurance Training in Older Adults: A Meta-Analysis. Med Sci Sports Exerc 2005; 37:1381-6. [PMID: 16118586 DOI: 10.1249/01.mss.0000174899.35392.0c] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Question remains regarding endurance training and changes in resting heart rate (HR) among older individuals. The objective of this meta-analysis was to determine the effects of controlled aerobic training on resting HR among sedentary older adults. METHODS Studies were identified by a systematic computer database search, hand article search, and cross-reference. The inclusion criteria were (i) controlled clinical trials, (ii) endurance exercise as the only intervention, (iii) a nonexercise control group, (iv) within-group mean ages of subjects > or = 60 yr, (v) a measure of changes in resting HR, (vi) studies published in English journals. RESULTS Outcome was derived from 13 studies with a total of 651 individuals in 14 control (N = 241) and 16 exercise groups (N = 410). The pooled standardized effect size by a fixed-effect model showed an upper moderate effect of -0.58 +/- 0.08 (mean +/- SEM, 95% CI = -0.74 to -0.42). This homogeneity effect was statistically significant (P = 0.001). The magnitude of net change averaged -6 bpm (-2 to -12 bpm), representing an 8.4% reduction. Greater and statistically significant decrease of resting HR among the elderly was found in the studies with training length more than 30 wk. CONCLUSIONS This meta-analytic investigation supports the efficacy of endurance exercise training in decreasing HR at rest in older adults. This training induced adaptation may have protective benefits for cardiovascular aging. A longer exercise training length, probably more than 30 wk, may be needed for older individuals to be more effective in terms of resting HR reduction.
Collapse
Affiliation(s)
- Guoyuan Huang
- Department of Physical Education, University of Southern Indiana, Evansville, IN 47712, USA.
| | | | | | | |
Collapse
|
23
|
Abstract
Currently, modern chronic diseases, including cardiovascular diseases, Type 2 diabetes, metabolic syndrome, and cancer, are the leading killers in Westernized society and are increasing rampantly in developing nations. In fact, obesity, diabetes, and hypertension are now even commonplace in children. Clearly, however, there is a solution to this epidemic of metabolic disease that is inundating today's societies worldwide: exercise and diet. Overwhelming evidence from a variety of sources, including epidemiological, prospective cohort, and intervention studies, links most chronic diseases seen in the world today to physical inactivity and inappropriate diet consumption. The purpose of this review is to 1) discuss the effects of exercise and diet in the prevention of chronic disease, 2) highlight the effects of lifestyle modification for both mitigating disease progression and reversing existing disease, and 3) suggest potential mechanisms for beneficial effects.
Collapse
Affiliation(s)
- Christian K Roberts
- Dept. of Physiological Science, University of California-Los Angeles, 4101 Life Sciences Bldg., 621 Charles E. Young Dr. South, Los Angeles, CA 90095-1606, USA.
| | | |
Collapse
|
24
|
Polichnowski AJ, Heyer EK, Ng AV. Effect of active muscle mass during ischemic exercise on peak lower leg vascular conductance. J Appl Physiol (1985) 2005; 98:765-71. [PMID: 15501921 DOI: 10.1152/japplphysiol.00468.2004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Uncertainty exists as to whether a period of passive arterial occlusion (PAO) or ischemic exercise (IE) results in peak lower leg vascular conductance (LVC). This uncertainty is due to the different body positions, active muscle mass, and occlusion times used for PAO or IE. The purpose of this study was to examine whether 10 min of PAO elicits a similar LVC compared with ischemic dorsiflexion (IDF), ischemic plantar flexion (IPF), and ischemic plantar-dorsiflexion (IPDF). Ten subjects (5 women, 27 ± 9 yr, 68 ± 3 kg) were studied on 3 days over 1 wk in a semireclined position with the right foot attached to an isokinetic dynamometer. Mean arterial pressure (Finapres) and lower leg blood flow (LBF, venous occlusion plethysmography) were measured at rest and after PAO and IE. PAO was administered randomly on 1 of the 3 days and before IE. IE protocols consisted of maximal isokinetic dorsiflexion and/or plantar flexion at 120 and 60°/s, respectively. In a second experiment, an additional eight subjects (4 women, 29 ± 12 yr, 77 ± 12 kg) were studied to examine the effect of isokinetic speed during IDF on peak LBF and LVC. Peak LVC (ml·min−1·100 ml−1·mmHg−1) was similar among IPF (0.590 ± 0.16), IPDF (0.532 ± 0.17), and PAO (0.511 ± 0.18), and significantly lower after IDF (0.334 ± 0.15). No differences in peak LBF and LVC were observed after IDF using different isokinetic speeds. We conclude that 10 min of PAO, IPF, and IPDF performed in a similar posture are adequate stimuli to elicit peak LVC.
Collapse
Affiliation(s)
- Aaron J Polichnowski
- Exercise Science Program, Physical Therapy Department, Marquette University, Milwaukee, WI 53201-1881, USA
| | | | | |
Collapse
|
25
|
Kurbel S, Sindić A, Marić S. Can arteries of skeletal muscles act as a circulatory bottleneck during heavy exercise? Med Hypotheses 2005; 64:367-74. [PMID: 15675082 DOI: 10.1016/j.mehy.2004.02.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It is generally assumed that almost no pressure gradient exists in the aorta and large arteries. This holds truth in rest, but during heavy exercise, when the resistance of arterioles in active skeletal muscles is diminished, the remaining resistance of large and small arteries might become significant and limit the maximal perfusion rate. To describe this idea better, a simplified model of vasculature based on the textbook data on circulation are described. The model suggests that the mean arterial pressure (MAP) acts as a hydrostatic pressure reserve that backups sudden changes in the local flow demands. During exercise, reduced resistance in arterioles changes the pressure profile along the arterial tree, making the pressure gradient along arteries more important and arteries become the circulatory bottleneck. Adequately high MAP and the shear stress arterial dilatation are both needed to allow sufficient flow through them. For a normal adult person, the model predicts that a hydrostatic pressure reserve allows almost sixfold increase in arterial flow before it is exhausted. A reduced resistance in arteries (shorter, more elastic arteries) can be expected in a young person, while in an atherosclerotic hypertensive person, reduced hydrostatic pressure reserve and the shear stress responsiveness would compromise the skeletal muscle performance during exercise.
Collapse
Affiliation(s)
- Sven Kurbel
- Department of physiology, Osijek Medical Faculty, Croatia.
| | | | | |
Collapse
|
26
|
Proctor DN, Le KU, Ridout SJ. Age and regional specificity of peak limb vascular conductance in men. J Appl Physiol (1985) 2004; 98:193-202. [PMID: 15347629 DOI: 10.1152/japplphysiol.00704.2004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Because of methodological variation in previous studies, age-associated changes in peak limb vascular conductance (VC(peak); a functional index of arterial structure) and its determinants remain poorly defined. The objectives of this study were to describe and compare age-associated changes in peak forearm and calf conductance across a broad age range and to identify physiological characteristics that are predictive of variation in limb-specific VC(peak). Peak conductance (plethysmographic flow/brachial mean arterial pressure) of the forearm (forearm VC(peak)) and calf (calf VC(peak)) after 10 min of arterial occlusion was measured twice in 68 healthy, normally active men aged 20-79 yr. Aerobic capacity (cycle peak oxygen consumption), arterial health (ankle-brachial index, pulse wave velocity), and limb-specific measures of muscle mass (dual-energy X-ray absorptiometry) and isometric strength (grip, plantar flexion) were also assessed. The relative decline in forearm VC(peak) with age (-6.6% per decade; P < 0.001) was greater than the decline in calf VC(peak) (-3.4% per decade; P = 0.004). Limb VC(peak) per kilogram of muscle declined with age in the forearm (-3.8% per decade; P = 0.004) but not in the calf (P = 0.35). Age, Vo(2 peak), and regional muscle mass were significant predictors of peak conductance in both limbs; however, these predictors explained considerably less variance in the calf than in the forearm. These results suggest that healthy aging is associated with a linear decline in limb vasodilator capacity in men, but the magnitude of this effect is reduced in the calf relative to the forearm. This could reflect regional differences in habitual muscle use with aging in normally active men.
Collapse
Affiliation(s)
- David N Proctor
- Noll Physiological Research Center, The Pennsylvania State University, University Park, PA 16802-6900, USA.
| | | | | |
Collapse
|
27
|
Sin MK, Sanderson B, Weaver M, Giger J, Pemberton J, Klapow J. Personal characteristics, health status, physical activity, and quality of life in cardiac rehabilitation participants. Int J Nurs Stud 2004; 41:173-81. [PMID: 14725781 DOI: 10.1016/s0020-7489(03)00127-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The purpose of this study was to examine the relationships between personal factors, health status, and adherence to physical activity behavior, and quality of life in cardiac rehabilitation participants. The record of 146 subjects, who met inclusion criteria were obtained from the University Cardiac Rehabilitation Database. Change scores in physical activity were used as a proxy for adherence. Participants who were categorized as not working, female gender, and at high-risk health status had lower means and lower improvement scores from repeated measures analysis of variance. This study found that some personal factors and health status are significant factors influencing the participant's adherence to physical activity recommendations and quality of life in this cardiac rehabilitation program.
Collapse
Affiliation(s)
- Mo-Kyung Sin
- School of Nursing, University of Washington, Box 357266, Seattle, WA 98195-7266, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Proctor DN, Koch DW, Newcomer SC, Le KU, Leuenberger UA. Impaired leg vasodilation during dynamic exercise in healthy older women. J Appl Physiol (1985) 2003; 95:1963-70. [PMID: 12882993 DOI: 10.1152/japplphysiol.00472.2003] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of the present study was to test the hypothesis that leg blood flow responses during leg cycle ergometry are reduced with age in healthy non-estrogen-replaced women. Thirteen younger (20-27 yr) and thirteen older (61-71 yr) normotensive, non-endurance-trained women performed both graded and constant-load bouts of leg cycling at the same absolute exercise intensities. Leg blood flow (femoral vein thermodilution), mean arterial pressure (MAP; radial artery), mean femoral venous pressure, cardiac output (acetylene rebreathing), and blood O2 contents were measured. Leg blood flow responses at light workloads (20-40 W) were similar in younger and older women. However, at moderate workloads (50-60 W), leg blood flow responses were significantly attenuated in older women. MAP was 20-25 mmHg higher (P < 0.01) in the older women across all work intensities, and calculated leg vascular conductance (leg blood flow/estimated leg perfusion pressure) was lower (P < 0.05). Exercise-induced increases in leg arteriovenous O2 difference and O2 extraction were identical between groups (P > 0.6). Leg O2 uptake was tightly correlated with leg blood flow across all workloads in both subject groups (r2 = 0.80). These results suggest the ability of healthy older women to undergo limb vasodilation in response to submaximal exercise is impaired and that the legs are a potentially important contributor to the augmented systemic vascular resistance seen during dynamic exercise in older women.
Collapse
Affiliation(s)
- David N Proctor
- Noll Physiological Research Center, The Pennsylvania State University, University Park 16802-6900, USA.
| | | | | | | | | |
Collapse
|
29
|
Koch DW, Leuenberger UA, Proctor DN. Augmented leg vasoconstriction in dynamically exercising older men during acute sympathetic stimulation. J Physiol 2003; 551:337-44. [PMID: 12824451 PMCID: PMC2343147 DOI: 10.1113/jphysiol.2003.042747] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2003] [Accepted: 05/12/2003] [Indexed: 11/08/2022] Open
Abstract
Vasoconstrictor responsiveness to acute sympathetic stimulation declines with advancing age in resting skeletal muscle. The purpose of the present study was to determine if age-related reductions in sympathetic vasoconstrictor responsiveness also occur in exercising skeletal muscle. Thirteen younger (20-30 years) and seven older (62-74 years) healthy non-endurance-trained men performed cycle ergometer exercise at ~60 % of peak oxygen uptake while leg blood flow (femoral vein thermodilution), mean arterial blood pressure (radial artery catheter), and plasma adrenaline and noradrenaline concentrations were measured. After steady state was reached (i.e. ~4 min), acute sympathetic stimulation was achieved by immersing a hand in ice water for 2-4 min (cold pressor test, CPT). CPT tended to cause a larger increase in mean arterial blood pressure in older men (older (O): 16 +/- 3 mmHg; younger (Y): 10 +/- 2 mmHg) during exercise, but increases in arterial noradrenaline were similar (O: 2.56 +/- 0.96 nM; Y: 1.98 +/- 0.40 nM). However, the older men demonstrated a larger percentage reduction in exercising leg vascular conductance (leg blood flow/mean arterial pressure) during CPT compared to younger men (O: -13.6 +/- 3.1 %; Y: -1.5 +/- 4.3 %; P = 0.04). Leg blood flow tended to increase in the younger men, but not in the older men (P = 0.10). These results suggest, in contrast to what has been observed in resting skeletal muscle, that vasoconstrictor responsiveness to sympathetic stimulation is not reduced, but may be augmented in exercising muscle of healthy older humans. This could reflect a reduced ability of local substances (e.g. nitric oxide) to impair vasoconstriction in response to sympathetic stimulation during exercise in older humans.
Collapse
Affiliation(s)
- Dennis W Koch
- Noll Physiological Research Center, The Pennsylvania State University, University Park, PA 16801-6900, USA
| | | | | |
Collapse
|
30
|
Proctor DN, Newcomer SC, Koch DW, Le KU, MacLean DA, Leuenberger UA. Leg blood flow during submaximal cycle ergometry is not reduced in healthy older normally active men. J Appl Physiol (1985) 2003; 94:1859-69. [PMID: 12547841 DOI: 10.1152/japplphysiol.00898.2002] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The purpose of the present study was to test the hypothesis that leg blood flow responses during submaximal cycle ergometry are reduced with age in healthy normally active men. Eleven younger (20-25 yr) and eight older (62-73 yr) normotensive, nonendurance-trained men performed both graded and constant-load bouts of leg cycling at the same absolute and relative [% of peak O(2) consumption (Vo(2 peak))] exercise intensities while leg blood flow (femoral vein thermodilution), mean arterial pressure (MAP; radial artery), cardiac output (acetylene rebreathing), blood O(2) content, and plasma catecholamines were measured. Leg blood flow responses at the same absolute submaximal power outputs (20-100 W) and at a fixed systemic O(2) demand (1.1 l/min) did not differ between groups (P = 0.14-0.19), despite lower absolute levels of cardiac output in the older men (P < 0.05). MAP at the same absolute power outputs was 8-12 mmHg higher (P < 0.05) in the older men, but calculated leg vascular conductance responses (leg blood flow/MAP) were identical in the two groups (P > 0.9). At the same relative intensity (60% Vo(2 peak)), leg norepinephrine spillover rates were approximately twofold higher in the older men (P = 0.38). Exercise-induced increases in leg arterial-venous O(2) difference were identical between groups (P > 0.9) because both arterial and venous O(2) contents were lower in the older vs. younger men. These results suggest that the ability to augment active limb blood flow and O(2) extraction during submaximal large muscle mass exercise is not impaired but is well preserved with age in healthy men who are normally active.
Collapse
Affiliation(s)
- David N Proctor
- Noll Physiological Research Center, Department of Kinesiology, The Pennsylvania State University, University Park, 16802-6900, USA.
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
More than one third of all Americans have high or high-normal blood pressure and are at risk for stroke, cardiovascular disease, kidney disease, and heart failure. Many of these are not diagnosed or are inadequately treated. The large number of untreated individuals at risk for the complications of hypertension, or who have not achieved goal pressures on therapy, require a concerted effort by health care professionals to screen and treat this condition. Aggressive identification and treatment of even high-normal hypertension can reduce adverse outcomes. The importance of aggressive management is outlined in this article.
Collapse
|
32
|
Houde SC, Melillo KD. Cardiovascular health and physical activity in older adults: an integrative review of research methodology and results. J Adv Nurs 2002; 38:219-34. [PMID: 11972658 DOI: 10.1046/j.1365-2648.2002.02172.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED PURPOSE OF THE PAPER: The purpose of this article is to review the literature on physical activity and its relationship to cardiovascular risk factors and mortality in older adults, in an effort to clarify the specific benefits and optimal level of physical activity for cardiovascular health in the older adult population. BACKGROUND/RATIONALE Despite physical activity being recognized as an important factor in the quality of life of older adults, there is a lack of clarity about the optimal level of physical activity that results in positive cardiovascular health benefits. DESIGN/METHODS An integrative review of the literature using the MEDLINE and CINAHL databases from 1990 through August 2000 was conducted identifying articles related to physical activity and cardiac risk factors, cardiovascular health, or mortality in the older adult. RESULTS/FINDINGS Forty-four research articles were reviewed. The intervention studies generally provided support for positive cardiovascular changes with exercise, but the results were inconsistent, sample sizes were small, and the outcomes, interventions, and measures of physical activity differed between studies. There was wide variation in the method of measurement of physical activity in the studies. Studies showed an increase in mortality in those who had a sedentary lifestyle compared to those who were more physically active. Results were mixed related to plasma lipids levels. Three studies showed a positive effect of physical activity on blood pressure (BP), while three studies showed no relationship. Each of the studies that evaluated the relationship between physical activity and pulse rate showed a decreased rate with increased physical activity. CONCLUSIONS The quantity and type of physical activity that should be recommended to bring about positive effects on cardiovascular health and mortality is unclear. There is support, however, that an active lifestyle decreases mortality. There is conflicting evidence to support positive effects of physical activity on cardiac risk factors. Further research is needed with larger sample sizes, better control of extraneous variables, and using measurements of physical activity that have undergone adequate psychometric testing.
Collapse
Affiliation(s)
- Susan Crocker Houde
- Department of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts 01854, USA.
| | | |
Collapse
|
33
|
Moreau KL, Degarmo R, Langley J, McMahon C, Howley ET, Bassett DR, Thompson DL. Increasing daily walking lowers blood pressure in postmenopausal women. Med Sci Sports Exerc 2001; 33:1825-31. [PMID: 11689731 DOI: 10.1097/00005768-200111000-00005] [Citation(s) in RCA: 212] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The American College of Sports Medicine and the Centers for Disease Control and Prevention (ACSM-CDC) recommend 30 min of daily moderate-intensity physical activity for health; however, the effectiveness of this recommendation in lowering blood pressure (BP) in hypertensives is unclear. The present study tested the hypothesis that walking activity following the ACSM-CDC physical activity recommendation would lower BP in postmenopausal women with high BP. METHODS Resting BP was measured in 24 postmenopausal women with borderline to stage 1 hypertension at baseline, 12 wk, and 24 wk. Fifteen women in the exercise (EX) group walked 3 km.d-1 above their daily lifestyle walking, whereas 9 women in the control (CON) group did not change their activity. Walking activity was self-measured with a pedometer in both groups. RESULTS Resting systolic BP was reduced in the EX group after 12 wk by 6 mm Hg (P < 0.005) and was further reduced by 5 mm Hg at the end of 24 wk (P < 0.005). There was no change in diastolic BP with walking. The CON group experienced no change in BP at either 12 or 24 wk. Body mass was modestly reduced by 1.3 kg in the EX group after 24 wk (P < 0.05); however, it was not correlated with the change in BP. There were no changes in selected variables known to impact BP including percent body fat, fasting plasma insulin, or dietary intake. CONCLUSION In conclusion, a 24-wk walking program meeting the ACSM-CDC physical activity recommendation is effective in lowering systolic BP in postmenopausal women with borderline to stage 1 hypertension.
Collapse
Affiliation(s)
- K L Moreau
- Department of Exercise Science and Sport Management, University of Tennessee, Knoxville, TN 37996, USA.
| | | | | | | | | | | | | |
Collapse
|
34
|
Pickering TG. In praise of walking: an antidote to increasing health care costs in the elderly? J Clin Hypertens (Greenwich) 2001; 3:380-2. [PMID: 11723361 PMCID: PMC8099236 DOI: 10.1111/j.1524-6175.2001.00676.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T G Pickering
- Integrative and Behavioral Cardiovascular Health Program, Zena and Michael Wiener Cardiovascular Institute, Mt. Sinai School of Medicine, New York, NY 10029, USA
| |
Collapse
|
35
|
Abstract
Epidemiologic studies have consistently revealed inverse associations between physical activity (or fitness) and hypertension. There are hypotensive benefits to exercise training found across a number of aerobic and progressive resistance training modalities. Optimal exercise prescriptions remain unclear, but hypotensive benefits have been noted for mild to vigorous ranges of exercise intensity, for as few as three exercise sessions per week and durations as short as 20 minutes. Hypertensive subjects appear to experience greater reductions than normotensive subjects. Exercise interventions may be safely and effectively used with mild to moderate as well as severe levels of hypertension. The incorporation of physical activity with other lifestyle interventions provides multiple benefits to hypertensive patients that extend beyond a reduction in blood pressure.
Collapse
Affiliation(s)
- K T Lesniak
- G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi 39216, USA
| | | |
Collapse
|
36
|
George BJ, Goldberg N. The benefits of exercise in geriatric women. THE AMERICAN JOURNAL OF GERIATRIC CARDIOLOGY 2001; 10:260-3. [PMID: 11528284 DOI: 10.1111/j.1076-7460.2001.00804.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Women 65 years of age and older are the fastest growing segment of the population. As women age, physical inactivity is the leading cause of morbidity and mortality due to coronary heart disease, diabetes mellitus, and hypertension. There is also a loss of both physiologic and psychological capabilities that contributes to an overall reduction in function and independent living. Regular physical activity in geriatric women has been shown to reduce cardiovascular morbidity and all-cause mortality. Further research needs to be done to evaluate the role of regular physical activity in the management of diabetes and hyperlipidemia.
Collapse
Affiliation(s)
- B J George
- Women's Heart Program, Lenox Hill Hospital, 178 East 85th Street, New York, NY 10028, USA
| | | |
Collapse
|
37
|
Rankinen T, Rice T, Pérusse L, Chagnon YC, Gagnon J, Leon AS, Skinner JS, Wilmore JH, Rao DC, Bouchard C. NOS3 Glu298Asp genotype and blood pressure response to endurance training: the HERITAGE family study. Hypertension 2000; 36:885-9. [PMID: 11082161 DOI: 10.1161/01.hyp.36.5.885] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endothelium-dependent vasodilation is a mechanism that may affect blood pressure response to endurance training. Because NO plays a central role in this process, the endothelial NO synthase gene is a good candidate for the regulation of exercise blood pressure. We investigated the associations between an endothelial NO synthase gene polymorphism (Glu298Asp) and endurance training-induced changes in resting and submaximal exercise blood pressure in 471 white subjects of the HERITAGE Family Study. Two submaximal exercise tests at 50 W were conducted both before and after a 20-week endurance training program. Steady-state exercise blood pressure was measured twice in each test with an automated unit. The Glu298Asp polymorphism was typed with a PCR-based method and digestion with BAN:II. Both systolic and diastolic blood pressure at 50 W decreased in response to the training program, whereas resting blood pressure remained unchanged. The decrease in diastolic blood pressure at 50 W was greater (P=0.0005, adjusted for age, gender, baseline body mass index, and baseline diastolic blood pressure at 50 W) in the Glu/Glu homozygotes (4.4 [SEM 0.4] mm Hg, n=187) than in the heterozygotes (3.1 [0.4] mm Hg, n=213) and the Asp/Asp homozygotes (1.3 [0.7] mm Hg, n=71). The genotype accounted for 2.3% of the variance in diastolic blood pressure at 50 W training response. Both the Glu298 homozygotes and the heterozygotes had a greater (P=0.013) training-induced reduction in rate-pressure product at 50 W than the Asp298 homozygotes. These data suggest that DNA sequence variation in the endothelial NO synthase gene locus is associated with the endurance training-induced decreases in submaximal exercise diastolic blood pressure and rate-pressure product in sedentary normotensive white subjects.
Collapse
Affiliation(s)
- T Rankinen
- Pennington Biomedical Research Center, Human Genomics Laboratory, Baton Rouge, LA, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|