Blood pressure lowering effect of low intensity aerobic training in elderly hypertensive patients

Effects of the different Tai Chi exercise cycles on patients with essential hypertension: A systematic review and meta-analysis

Objective

The main treatment for essential hypertension at this stage is pharmacotherapy. Long-term pharmacotherapy is costly with some side effects. Tai Chi, a bright star in traditional Chinese arts, relaxes both mind and body and has been shown to relax blood vessels and lower blood pressure. This study aimed to systematically review the therapeutic effectiveness of the Tai Chi exercise cycle on blood pressure and cardiovascular risk factors of patients with essential hypertension.

Methods

Searching CNKI, VIP, CBM, PubMed, EBSCO, Embase, Cochrane Library, and Web of Science to collect randomized controlled trials about Tai Chi exercise in the treatment of patients with essential hypertension according to the inclusion and exclusion criteria. The search time ranged from the date of database construction to December 2022. The Cochrane risk-of-bias tool was used to evaluate the included trials. The meta-analysis was performed with RevMan5.3 and Stata12.0 software.

Results

According to the meta-analysis, compared with the controls, Tai Chi exercise with a cycle of more than 12 weeks may be better for the reduction of systolic blood pressure (SBP) [MD = -11.72, 95% CI (-15.52, -7.91)] and diastolic blood pressure (DBP) [MD = -4.68, 95% CI (-7.23, -2.12)], as well as increasing the content of nitric oxide (NO) [MD = 0.99, 95% CI (0.69, 1.28)]. The blood lipid metabolism ability may also be improved after more than 12 weeks of Tai Chi exercise, total cholesterol (TC) [SMD = -0.68, 95% CI (-0.89, -0.46), triglyceride (TG) [SMD = -0.84, 95% CI (-1.25, -0.43)], low-density lipoprotein cholesterol (LDL-C) [SMD = -1.58, 95% CI (-2.29, -0.86)]. However, the improvement of high-density lipoprotein cholesterol (HDL-C) [SMD = 0.54, 95% CI (0.28, 0.79)] was better with a less than 12 weeks exercise cycle. A subgroup analysis for exercise frequency and time showed that the exercise frequency should preferably be more than or equal to 5 times per week for patients with hypertension, and for patients with hypertension plus hyperlipidemia, the exercise frequency less than 5 times per week with exercise time less than 60 min each day may be more beneficial.

Conclusion

The meta-analysis indicated that a more than 12 weeks Tai Chi exercise cycle with less than 60 min each time and more than 5 times per week may be more beneficial in blood pressure reduction, NO level increasing and blood lipid metabolism improving in the comparison with the other exercise cycles. For patients with hypertension plus hyperlipidemia, exercise frequency of less than 5 times per week may be better.

Systematic Review Registration

[http://www.crd.york.ac.uk/prospero], identifier [CRD42022352035].

Effects of Long-Term Regular Continuous and Intermittent Walking on Oxidative Stress, Metabolic Profile, Heart Rate Variability, and Blood Pressure in Older Adults with Hypertension

It is documented that regular exercise is beneficial for improving the antioxidant system, metabolic system, cardiac autonomic function, and blood pressure in those with hypertension. In this regard, low-intensity exercise is recommended for older adults, particularly those with chronic diseases. This study aimed to compare the effects of long-term regular continuous walking with intermittent walking on oxidative stress, metabolic profile, heart rate variability, and blood pressure in older adults with hypertension. Forty-three participants with hypertension aged 60–80 years were randomly divided into the continuous or intermittent walking (CON or INT) groups. Participants in the CON group walked for 30 min, 3 days/week for 12 weeks. Participants in the INT group split 30 min walking into 3 identical sessions punctuated by a 1 min rest after each session, 3 days/week for 12 weeks. Antioxidant and oxidative stress markers, metabolic markers, heart rate variability, and blood pressure were evaluated before and after the exercise program. Glutathione (GSH), GSH to GSH disulfide (GSSG) ratio, and total GSH increased significantly, and GSSG and malondialdehyde decreased significantly in both groups ( $p<0.05$ ) without significant differences between groups. Triglycerides, ratio of total cholesterol to high-density lipoprotein cholesterol, and atherosclerogenic index were significantly lower in the CON group than those in the INT group ( $p<0.05$ ). The standard deviation of the NN intervals and root mean square of the successive differences were significantly higher, and low-frequency power was significantly lower in the INT group than that in the CON group ( $p<0.05$ ). No significant changes in blood pressure were noted in both groups, and nor were there any significant differences between groups. Long-term regular continuous and intermittent walking may comparably increase antioxidants, reduce oxidative stress, and be beneficial for improving important blood pressure-related outcomes, including metabolic profile or cardiac autonomic function in older adults with hypertension.

Secreted Protein Acidic and Rich in Cysteine (Sparc) KO Leads to an Accelerated Ageing Phenotype Which Is Improved by Exercise Whereas SPARC Overexpression Mimics Exercise Effects in Mice

Secreted protein acidic and rich in cysteine (SPARC) is a matricellular glycoprotein implicated in various functions, including metabolism, tissue regeneration, and functional homeostasis. SPARC/Sparc declines with ageing but increases with exercise. We aim to verify two hypotheses: (1) SPARC deficiency leads to an ageing-like phenotype (metabolic decline, muscle loss, etc.), and (2) SPARC overexpression would mimic exercise, counteract ageing, and improve age-related changes. Our mice experiments are divided into two parts. First, we explore the consequences of Sparc knockout (KO) and compare them to the ageing effects. We also observe the effects of exercise. In the second part, we study the effects of SPARC overexpression and compare them to the exercise benefits. At the end, we make an analysis of the results to point out the analogies between Sparc KO and the ageing-like phenotype on the one hand and make comparisons between SPARC overexpression and exercise in the context of exercise counteracting ageing. The measurements were mainly related to tissue weights, adiposity, metabolism, and muscle strength. The main findings are that Sparc KO reduced glucose tolerance, muscle glucose transporter expression, and abdominal adipose tissue weight but increased glycogen content in the muscle. SPARC overexpression increased muscle strength, muscle mass, and expressions of the muscle glucose transporter and mitochondrial oxidative phosphorylation but lowered the glycemia and the adiposity, especially in males. Collectively, these findings, and the data we have previously reported, show that Sparc KO mice manifest an ageing-like phenotype, whereas SPARC overexpression and exercise generate similar benefits. The benefits are towards counteracting both the SPARC deficiency-induced ageing-like phenotype as well as reversing the age-related changes. The potential applications of these findings are to build/optimize Sparc KO-based animal models of various health conditions and, on the other hand, to develop therapies based on introducing SPARC or targeting SPARC-related pathways to mimic exercise against age-related and metabolic disorders.

Walking for hypertension

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.

Physical Activity: A Viable Way to Reduce the Risks of Mild Cognitive Impairment, Alzheimer's Disease, and Vascular Dementia in Older Adults

A recent alarming rise of neurodegenerative diseases in the developed world is one of the major medical issues affecting older adults. In this review, we provide information about the associations of physical activity (PA) with major age-related neurodegenerative diseases and syndromes, including Alzheimer's disease, vascular dementia, and mild cognitive impairment. We also provide evidence of PA's role in reducing the risks of these diseases and helping to improve cognitive outcomes in older adults. Finally, we describe some potential mechanisms by which this protective effect occurs, providing guidelines for future research.

Exercise performed around MLSS decreases systolic blood pressure and increases aerobic fitness in hypertensive rats

Background

Exercise is a non-pharmacologic agent widely used for hypertension control, where low intensity is often associated with blood pressure reduction. Maximal lactate steady state (MLSS) was recently identified in spontaneously hypertensive rats (SHRs) as an important step in establishing secure intensities for prescribing exercise for hypertensive phenotypes. Here we verified the effects of training around MLSS, 20% below MLSS, and 15% above MLSS on aerobic fitness and blood pressure status of SHR. Eighteen-week-old SHRs (n = 5, ~ 172.4 ± 8.1 mm Hg systolic blood pressure) were trained on a treadmill for 4 weeks for 30 min/day, 5 days/week at a velocity of 20 m.min⁻¹. After training, a novel MLSS and incremental test was performed to evaluate the animals’ aerobic fitness. Furthermore, ~ 22-week-old SHRs (n = 12, ~169.8 ± 13.8 mm Hg systolic blood pressure) were divided into non-exercised (CG, n = 4), low intensity (LIG, n = 4) and high intensity (HIG, n = 4) groups, where rats were trained at 16 m.min⁻¹ and 23 m.min⁻¹ respectively for 30 min/day, 5 days/week for 4 weeks.

Results

Exercise performed at MLSS enhanced aerobic fitness, leading to a novel MLSS, identified around 30 m.min⁻¹. Low and high intensity training reduced systolic blood pressure and only high intensity training led to improved aerobic fitness (28.1%, p < 0.01).

Conclusions

Therefore, our data indicate a decrease in blood pressure due to low and high exercise intensity, and an increase in aerobic fitness provided by high-intensity exercise in SHRs.

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.

Controlled aerobic exercise training reduces resting blood pressure in sedentary older adults

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.

Physical activity, health benefits, and mortality risk

A plethora of epidemiologic evidence from large studies supports unequivocally an inverse, independent, and graded association between volume of physical activity, health, and cardiovascular and overall mortality. This association is evident in apparently healthy individuals, patients with hypertension, type 2 diabetes mellitus, and cardiovascular disease, regardless of body weight. Moreover, the degree of risk associated with physical inactivity is similar to, and in some cases even stronger than, the more traditional cardiovascular risk factors. The exercise-induced health benefits are in part related to favorable modulations of cardiovascular risk factors observed by increased physical activity or structured exercise programs. Although the independent contribution of the exercise components, intensity, duration, and frequency to the reduction of mortality risk is not clear, it is well accepted that an exercise volume threshold defined at caloric expenditure of approximately 1,000 Kcal per week appears to be necessary for significant reduction in mortality risk. Further reductions in risk are observed with higher volumes of energy expenditure. Physical exertion is also associated with a relatively low and transient increase in risk for cardiac events. This risk is significantly higher for older and sedentary individuals. Therefore, such individuals should consult their physician prior to engaging in exercise.

“Walking is man’s best medicine”

Hippocrates

Effect of low-intensity aerobic exercise on insulin-like growth factor-I and insulin-like growth factor-binding proteins in healthy men

Increased concentrations of circulating insulin-like growth factor-I (IGF-I) or IGF-I relative to IGF-binding proteins (IGFBPs) are associated with increased risk of developing several forms of cancer. Conversely, exercise is linked with reduced risk. This study aims to investigate the effect of a low-intensity exercise program on circulating levels of IGF-I, IGFBP-1, and IGFBP-3, in previously sedentary males. Fourteen healthy men participated in cycle ergometer training at lactate threshold intensity for 60 min/day, 5 days/week for 6 weeks. After aerobic training, insulin sensitivity improved by 20%, while fasting insulin levels decreased by 13%. Simultaneously, low-intensity aerobic training decreased the circulating levels of IGF-I by 9%, while IGFBP-1 levels increased by 16%. An interesting finding was that higher pretraining level of IGF-I was associated with greater decline in IGF-I with training. Insulin-sensitizing low-intensity aerobic exercise is thus considered to be an effective method for downregulating IGF-I and upregulating IGFBP-1 levels.

Beneficial effects of physical exercise on hypertension and cardiovascular adverse remodeling of diet-induced obese rats

BACKGROUND AND AIMS

Obesity is present among all age groups and in all socioeconomic groups. This study on obese rats aims to quantify the beneficial effects of physical exercise on blood pressure (BP), the heart, the elasticity and resistance of arteries.

METHODS AND RESULTS

Obese male Wistar rats, (obesity due to a high fat diet with 30% fat), and non-obese rats, were assigned to four groups (n=5): sedentary obese; exercise-practice obese; sedentary control; and exercise-practice control (motor treadmill for 13 weeks). Their organs were studied through light microscopy and stereology. The diet-induced obesity caused mild hypertension with adverse cardiovascular changes. Physical exercise diminished the alterations associated with BP elevation and obesity. The pressure-lowering effect observed in obese rats submitted to physical exercise improved the myocardial vascularization and the aortic and the carotid wall structure by reducing the thickness and normalizing both the elastic lamellae and the smooth muscle cells. The adaptive response of the gluteus superficialis muscle to physical exercise also improved the peripheral resistance arteries of obese rats.

CONCLUSION

Current research supports the notion of physical exercise as a potential non-pharmacological antihypertensive treatment for diet-induced obesity hypertension.

Blood pressure and ageing

Isolated systolic hypertension, an elevation in systolic but not diastolic pressure, is the most prevalent type of hypertension in those aged 50 or over, occurring either de novo or as a development after a long period of systolic-diastolic hypertension with or without treatment. The increase in blood pressure with age is mostly associated with structural changes in the arteries and especially with large artery stiffness. It is known from various studies that rising blood pressure is associated with increased cardiovascular risk. In the elderly, the most powerful predictor of risk is increased pulse pressure due to decreased diastolic and increased systolic blood pressure. All evidence indicates that treating the elderly hypertensive patient will reduce the risk of cardiovascular events. However, there is no evidence yet for the very elderly. This population is particularly susceptible to side effects of treatments and the reduction of blood pressure, although reducing the risk of cardiovascular events such as stroke, may result in increased mortality.

High intensity exercise enhances platelet reactivity to shear stress and coagulation during and after exercise

Platelets play a crucial role in the pathogenesis of acute cardiac events, such as angina, myocardial infarction and sudden death. It is believed that regular low-intensity exercise can reduce, while high-intensity exercise may provoke acute cardiac events. The aim of the present study was to investigate the effect of acute exercise both at low and high intensities on the ventilatory threshold (VT), platelet reactivity and coagulation before and after exercise. Platelet reactivity and coagulation were measured under flow condition, using native blood, by hemostatometry. Seven healthy young men (age: 20-29 years) performed bicycle ergometer exercise for 30 min at intensities of 90% (Ex-VT90% or approximately 55% VO(2max)) and 130% (Ex-VT130% or 80% VO(2max)) of individual VT. Blood cell counts, hematocrit, blood lactic acid and plasma catecholamine levels were slightly but significantly increased after Ex-VT90% and markedly after Ex-VT130% after 30 min exercise. Subsequent to the exercise, the elevated blood cell counts decreased to the resting levels both at Ex-VT90% and at Ex-VT130%. Platelet reactivity to shear stress and dynamic coagulation were significantly enhanced immediately and 30 min after Ex-130%VT. In contrast, no significant changes occurred in those of Ex-90%VT. The present study suggests that high-intensity exercise-induced platelet hyperreactivity and hypercoagulable state may pose an increased risk for acute, sometimes fatal cardiac event. On the other hand, our findings support the view that low-intensity exercise does not present a risk of thrombosis.

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

Regular aerobic exercise can reduce blood pressure and is recommended as part of the lifestyle modification to reduce high blood pressure and cardiovascular risk. Hypertension itself, or/and pharmacological treatment for hypertension is associated with adverse effects on some aspects of quality of life. This study was performed to evaluate the effects of regular endurance exercise training on quality of life and blood pressure. Patients with mild to moderate hypertension (systolic blood pressure 140-180 or diastolic blood pressure 90-110 mm Hg) were randomized to a moderate-intensity aerobic exercise group training for 3 sessions/week over 10 weeks or to a non-exercising control group. Health-related quality of life was assessed with the Short Form 36-item Health Survey (SF-36) at baseline and after 6 and 10 weeks. In the 102 subjects (47 male, mean age 47 years) who completed the study, reductions in blood pressure in the exercise group at 10 weeks (-13.1/-6.3 mm Hg) were significant (P < 0.001) compared to baseline and to the control group (-1.5/+6.0 mm Hg). Unlike the control group, the exercise group showed an increase in exercise capacity from 8.2 +/- 1.6 to 10.8 +/- 2.2 METS (P < 0.01) and showed higher scores on 7 out of 8 subscales (P < 0.05) of the SF-36. Improvement in bodily pain and general health sub-scores correlated with reduction in systolic blood pressure. Regular endurance training improves both blood pressure and quality of life in hypertensive patients and should be encouraged more widely.

Supervised versus recommended physical exercise in hypertensive women. Is its recommendation enough?

OBJECTIVE

The aim of this study is to evaluate, in women with grade 1 essential hypertension, the response of cardio-respiratory and blood pressure (BP) after 6 weeks of supervised physical exercise (PE) vs only recommended exercise.

METHODS

Eighteen consecutive hypertensive women whose BP control was stable were assigned randomly into two exercise groups. Group A including nine patients in an aerobic PE programme supervised by a physiotherapist, aged (mean +/- SD) 35.5 +/- 5.5 years old. Group B, nine patients aged 37.7 +/- 7.2 years old, received only oral and written instructions about the benefits of aerobic PE for controlling BP. We used a treadmill for walking to observe the cardio-respiratory and BP response at the beginning and at the end of the period of exercise training, and the response in all the patients, and to test whether there were any differences between the two groups.

RESULTS

There were significant differences in cardio-respiratory parameters in group A, in basal VO2/kg post- vs pre-rehabilitation 27.6 +/- 5.1 vs 23.1 +/- 4.6, change 4.4 +/- 2; O2 pulse 10.9 +/- 0.9 vs 10.4 +/- 1.6, varied 0.5 +/- 0.1; furthermore we observed heart rate 73.3 +/- 12.37 vs 86.6 +/- 12.8, change -13.4 +/- 12.1 and metabolic equivalents of oxygen 9 +/- 1.2 vs 6.6 +/- 2.7, change 2.5 +/- 1.6, while in BP in group A, the differences were 153.1 +/- 7.1 vs 148.8 +/- 13.6, change -6.3 +/- 0.7 mm/g, p < 0.01 between pre- and post-rehabilitation. There were also significant differences between pre- and post-rehabilitation in group A in systolic BP 153 +/- 7.3 vs 135.1 +/- 16, change -18.1 +/- 4.1, p < 0.001 and diastolic BP 92.6 +/- 10.1 vs 83.5 +/- 9.1, change -9 +/- 4, p < 0.05; no change in group B. Finally, an improvement was observed in pulse pressure post-rehabilitation in group A 61.4 +/- 15.2 vs 51.6 +/- 11.4, change -9.8 +/- 3.9 vs group B 59.4 +/- 11.2 vs 59.3 +/- 10.6, only -0.1 +/- 0.8, p < 0.001.

CONCLUSIONS

These results suggest that supervised PE in hypertensive women significantly improves cardio-respiratory and BP values, as well as vascular adaptability.

Daily exercise lowers blood pressure and reduces visceral adipose tissue areas in overweight Japanese men

OBJECTIVE

To investigate the link between a reduction in blood pressure (BP) and daily exercise.

DESIGN

Cross-sectional and longitudinal clinical intervention study with exercise education.

SUBJECTS

43 overweight Japanese men aged 32-59 years (BMI, 29.0+/-2.3 kg/m2) at baseline. Among the participants, a randomly selected 23 overweight men (BMI, 28.5+/-1.7) were further enrolled into the 10 months exercise program.

MEASUREMENTS

BP was measured every week and steps per day were also recorded every day throughout the observation period. Fat distribution was evaluated by visceral fat (V) and subcutaneous fat (S) areas measured with computed tomography (CT) scanning at umbilical level, at before, 5 months and after intervention. Anthropometric parameters were also measured at same point. Aerobic exercise level, muscle strength, flexibility and calorie intake and insulin resistance (HOMA index) were investigated at before and after the study.

RESULTS

In a cross sectional analysis, systolic BP (SBP) and diastolic BP (DBP) were significantly correlated with body composition. In a second longitudinal analysis, SBP was significantly reduced at 2 months and DBP was also reduced at 3 months, and almost maintained until the end of the observation period. Increasing daily walking was observed in 3 months and maintained until 10 months. Body composition, aerobic exercise level, muscle strength, flexibility and insulin resistance were significantly improved. There was positive correlation between DeltaDBP and Deltavisceral fat area (1-5, 5-10, 1-10 months). By stepwise multiple regression analysis, only Deltavisceral fat area was independently related to DeltaDBP at a significant level (1-10 months: DeltaDBP=-0.608+0.105Deltavisceral fat area, r2=0.227, P=0.0334).

CONCLUSION

The present study indicated daily exercise lowers BP and visceral fat area is the critical factor for BP change.

Exercise as hypertension therapy

In conclusion, the findings of most recent studies show that moderate-intensity aerobic exercise training can lower BP in patients with stage 1 and 2 essential hypertension. The average reduction in BP is 10.5 mm Hg for systolic and 7.6 mm Hg for diastolic BP. The reductions do not appear to be gender- or age-specific. Significant reductions in BP and LVH regression in patients with stage 3 hypertension have also been reported following aerobic exercise training. Resistance training exercise has not consistently shown to significantly lower BP and is not recommended as the only form of exercise for hypertensive patients. The exercise training program for optimal benefits should consist of 3 to 5 times per week, 30 to 60 minutes per session, at 50% to 80% of PMHR. However, exercise programs should be individualized to meet the patient's needs and abilities. Exercise intensity and duration should be manipulated to promote a safe and effective antihypertensive program. Initially, the exercise intensity should be low and the duration short. Both intensity and duration should progressive increase over a period of weeks until the desired goal, is achieved. The rate of progression must be tailored to meet individual patient needs and abilities. The exercise program for overweight or obese hypertensive patients should aim to promote a caloric expenditure of 300 to 500 Kcal per day and 1000 to 2000 Kcal per week. Such an approach, combined with a prudent diet, is likely to reduce body weight. The mechanisms mediating exercise-induced BP reduction are poorly understood. BP reductions appear to be independent of changes in body weight or body composition. There are also no indications of age- or gender-related differences in BP response to exercise. The use of ambulatory blood pressure measuring devices in exercise studies is not extensive. The few studies available indicate a more moderate reduction in BP than that reported by casual observations.

Exercise training normalizes wall-to-lumen ratio of the gracilis muscle arterioles and reduces pressure in spontaneously hypertensive rats

OBJECTIVE

To investigate mechanisms underlying the training-induced blood pressure-lowering effect we analyzed the hemodynamic responses and morphometric changes of the skeletal muscle microcirculation of spontaneously hypertensive (SHR) and normotensive Wistar-Kyoto (WKY) rats during an exercise training program. DESIGN TRAINING: (50-60% VO2 max) was performed on a treadmill for 13 weeks and control groups were kept sedentary over the same period of time. Trained and sedentary rats were chronically instrumented for hindlimb flow and arterial pressure (AP) recordings under conscious unrestrained conditions. Gracilis and myocardial muscle samples were obtained for morphometric analysis after transcardiac perfusion of fixative.

RESULTS

SHR, when compared to WKY presented an elevated blood pressure, an increased relative hindlimb vascular resistance, capillary rarefaction in both gracilis and myocardium and an increased wall-to-lumen ratio of gracilis arterioles. Training increased significantly both capillary density and capillary/fiber ratio in the gracilis and myocardium of WKY and SHR groups, causing a complete reversal of capillary rarefaction in trained SHR. In SHR, training also reduced resting blood pressure and caused normalization of both relative hindlimb vascular resistance and gracilis arterioles wall-to-lumen ratio. Regression analysis revealed strong positive correlation between hindlimb vascular resistance and mean AP (MAP) and between arterioles wall-to-lumen ratio and MAP.

CONCLUSIONS

The results suggest that low-intensity training can significantly reduce pressure in SHR while normalizing both the arteriole morphology and the resistance of the skeletal muscle microcirculation.

The role of exercise training in the treatment of hypertension: an update

Hypertension is a very prevalent cardiovascular (CV) disease risk factor in developed countries. All current treatment guidelines emphasise the role of nonpharmacological interventions, including physical activity, in the treatment of hypertension. Since our most recent review of the effects of exercise training on patients with hypertension, 15 studies have been published in the English literature. These results continue to indicate that exercise training decreases blood pressure (BP) in approximately 75% of individuals with hypertension, with systolic and diastolic BP reductions averaging approximately 11 and 8mm Hg, respectively. Women may reduce BP more with exercise training than men, and middle-aged people with hypertension may obtain greater benefits than young or older people. Low to moderate intensity training appears to be as, if not more, beneficial as higher intensity training for reducing BP in individuals with hypertension. BP reductions are rapidly evident although, at least for systolic BP, there is a tendency for greater reductions with more prolonged training. However, sustained BP reductions are evident during the 24 hours following a single bout of exercise in patients with hypertension. Asian and Pacific Island patients with hypertension reduce BP, especially systolic BP, more and more consistently than Caucasian patients. The minimal data also indicate that African-American patients reduce BP with exercise training. Some evidence indicates that common genetic variations may identify individuals with hypertension likely to reduce BP with exercise training. Patients with hypertension also improve plasma lipoprotein-lipid profiles and improve insulin sensitivity to the same degree as normotensive individuals with exercise training. Some evidence also indicates that exercise training in hypertensive patients may result in regression of pathological left ventricular hypertrophy. These results continue to support the recommendation that exercise training is an important initial or adjunctive step that is highly efficacious in the treatment of individuals with mild to moderate elevations in BP.

The Evidence for Lifestyle Modification in Lowering Blood Pressure in the Elderly

Lifestyle modifications are a safe, effective treatment option for hypertension, yet are widely underutilized by clinicians, particularly in the elderly population. This review outlines the nonpharmacologic approaches to the treatment and prevention of hypertension, and discusses their applicability to the elderly population. Accepted recommendations include weight loss, regular exercise, decreased alcohol consumption, and dietary modifications. Each of these changes has been shown to independently reduce blood pressure in elderly individuals, as well as reduce the incidence and severity of comorbid conditions which potentiate cardiovascular risk. The safety of these recommendations equals or exceeds that of pharmacologic therapy, and few contraindications to their implementation exist. A simple, safe, and effective plan appropriate and acceptable to the geriatric patient is described, offering primary care physicians a guideline to follow when prescribing lifestyle modifications to the elderly hypertensive patient. (c) 2000 by CVRR, Inc.