Combined resistance and endurance exercise training improves arterial stiffness, blood pressure, and muscle strength in postmenopausal women

The offsetting relationship between hand grip strength and hypertension: A cross-sectional study from physically disabled over 50 years old in China

OBJECTIVES

To explore the relationship between hand grip strength (HGS) and blood pressure in physically disabled individuals over 50 years old.

METHODS

The research adopts a cross-sectional survey, and the data comes from the "2022-2023 Physical Health Monitoring and Scientific and Technological Services for Physical Disabilities" jointly carried out by Beijing Sport University and China Disabled Sports Management Center. Select physically disabled individuals over 50 years old and collect physical fitness measurement data. HGS was measured and adjusted based on body weight and waist circumference, with standard normal conversion. The relationship between HGS and blood pressure was analyzed using multiple linear regression, and further logistic regression was used to analyze the relationship between standard HGS and the risk of abnormal blood pressure.

RESULTS

695 disabled individuals participated in the experiment, including 402 males (57.84%) and 293 females (42.16%). Multiple linear regression analysis found that for each standard deviation increase in the standardized Z-value of relative HGS, the systolic and diastolic blood pressure of male individuals decreased by 2.391 mmHg (P = 0.008) and 1.229 mmHg (P = 0.025); decreased by 2.336 mmHg (P = 0.026) and 1.585 mmHg (P = 0.008), respectively, for female. The increase in HGS reduced the risk of hypertension in physical disabilities in males [OR = 0.820 95%CIs (0.670, 0.952)] (P = 0.003) and females [OR = 0.735 95%CIs (0.472, 0.986)] (P = 0.007).

CONCLUSION

The HGS of middle-aged and elderly physically disabled individuals negatively correlates with blood pressure, indicating the importance of increasing muscle strength (HGS) in preventing blood pressure.

Short-duration dynamic power training with elastic bands combined with endurance training: a promising approach to hypertension management in older adults

Previous studies have investigated the effects of different combined training programs involving traditional resistance training and aerobic exercise on hemodynamic parameters and arterial stiffness in older adults. However, little is known about the impact of power training combined with endurance training on these variables in hypertensive older adults. Therefore, this study aimed to investigate the effects of dynamic power training with elastic bands combined with endurance training on arterial stiffness and hemodynamic parameters in hypertensive older adults. Twenty-six participants were randomly assigned to the control group (CG; n = 13) and the intervention group (n = 13). IG participants performed power training with elastic bands combined with endurance training twice a week for 8 weeks. Pulse pressure, central pulse pressure, pulse wave velocity, SBP, DBP, central SBP, and central DBP were assessed before and after 8 weeks using the triple pulse wave velocity method. Pulse pressure, central pulse pressure, pulse wave velocity, SBP, DBP, central SBP, and central DBP significantly improved after 8 weeks of intervention (P < 0.05). These findings indicate that power training with elastic bands combined with endurance training reduces arterial stiffness and significantly improves hemodynamic parameters in older adults diagnosed with grade 1 hypertension. In addition, underscores the potential of this approach as a promising strategy for the management of hypertension in older adults.

Effects of exercise programs on cardiorespiratory fitness and arterial stiffness on postmenopausal women: A systematic review study

BACKGROUND

Arterial stiffness is an important marker of cardiovascular disease, with a considerable increase in menopause. The impact of exercise, as a preventive measure, on controlling the progression of cardiovascular disease and arterial dysfunction in middle age remains under investigation.

OBJECTIVE

This systematic review aims to present the results of studies that examined the effects of different exercise programs (isolated, aerobic, and resistance or combined) on arterial stiffness and cardiorespiratory fitness in postmenopausal women.

METHODS

Based on PRISMA guidelines, B-On, BioMed, EBSCOhost, MEDLINE, ScienceOpen, PubMed, Science Direct, Scopus, Web of Science, Cochrane library and LILACS databases were searched using specific keywords.

RESULTS

A final total of 13 manuscripts were included in the qualitative synthesis, involving 700 participants. Four studies used only cardiorespiratory exercise, three only resistance, taekwondo class or flexibility exercise, and six combined exercise programs. Most interventions ranged from 3 to 5 days per week. Carotid-femoral pulse wave velocity showed improvements between 0.22 m/s and 1.56 m/s. In addition, one study showed an improvement of 4.4 ml/kg/min in maximal oxygen consumption. In 7 studies, participation in exercise programs improved arterial stiffness.

CONCLUSIONS

Combined exercise (aerobic and resistance exercise) and aerobic exercise alone (swimming) improve cardiorespiratory fitness and arterial stiffness in postmenopausal women, particularly pulse wave velocity. The combined exercise program is the most effective, promoting improvements of up to -2.6 m/s in pulse wave velocity in this climacteric phase.

Exercise training reduces arterial stiffness in women with high blood pressure: a systematic review and meta-analysis

The acute and long-term benefits of exercise on cardiovascular health are well established, yet the optimal mode of exercise training that improves arterial stiffness in women with high blood pressure remains unclear. The aim of this systematic review and meta-analysis was to assess the influence of aerobic and resistance training on arterial stiffness in women with high blood pressure. After an extensive search of four online databases, six randomized controlled trials met the inclusion criteria and were included in meta-analyses. Data were extracted from six studies examining the influence of exercise on arterial stiffness assessed by pulse wave velocity (PWV) and were expressed as standardized mean difference (SMD). Whereas aerobic exercise significantly reduced arterial PWV in women with high blood pressure after long-term training [SMD -1.87, 95% confidence interval (CI) -2.34 to -1.40], resistance training had a more modest effect that was borderline statistically significant (SMD -0.31, 95% CI -0.65 to 0.03). These findings suggest regular long-term aerobic exercise training (i.e. 12-20 week interventions) reduces arterial stiffness in women with high blood pressure. Although not statistically significant, the modest number of included trials and lack of publication bias encourages further assessments on the efficacy of resistance exercise for improving arterial stiffness in women with high blood pressure. Given the unique benefits of aerobic and resistance training, particularly for postmenopausal women (e.g. bone health and muscular strength), both modes of training should be encouraged for women with high blood pressure to enhance arterial function and support favorable cardiovascular outcomes.

Effects of Resistance Training on Spasticity in People with Stroke: A Systematic Review

Resistance training induces neuromuscular adaptations and its impact on spasticity remains inadequately researched. This systematic review (PROSPERO: CRD42022322164) aimed to analyze the effects of resistance training, compared with no treatment, conventional therapy, or other therapies, in people with stroke-related spasticity. A comprehensive search was conducted up to October 2023 in PubMed, PEDro, Cochrane, Web of Science, and Scopus databases. Selection criteria were randomized controlled trials involving participants with stroke-related spasticity intervened with resistance training. The PEDro scale was used to evaluate the methodological quality. From a total of 274 articles, 23 full-text articles were assessed for eligibility and nine articles were included in the systematic review, involving 225 participants (155 males, 70 females; mean age: 59.4 years). Benefits were found to spasticity after resistance training. Furthermore, studies measuring spasticity also reported benefits to function, strength, gait, and balance. In conclusion, resistance training was superior to, or at least equal to, conventional therapy, other therapies, or no intervention for improving spasticity, as well as function, strength, gait, and balance. However, the results should be taken with caution because of the heterogeneity of the protocols used. Further research is needed to explore the effects of resistance training programs on people with stroke.

Combined Aerobic and Strength Training Improves Dynamic Stability and can Prevent against Static Stability Decline in Postmenopausal Women: A Randomized Clinical Trial

OBJECTIVE

 To analyze the effect of combined training (CT) in postural control and gait parameters in postmenopausal women.

METHODS

 A parallel-group, randomized, control study was conducted with 16 weeks of combined training (n = 16) versus a non-training control group (n = 12) in postmenopausal women (aged 59.3 ± 8.0). Pre and postintervention assessments included postural control (using an AMTI force platform - Advanced Mechanical Technology, Inc., Watertown, MA, USA) and gait impairments (using baropodometry). In addition, the upper limb strength and abdominal tests, as well as aerobic capacity, assessed functional indicators.

RESULTS

 The CT intervention in postmenopausal women resulted in improved gait (stride length (p = 0.006); speed (p = 0.013); double support time (p = 0.045); and improved postural control (displacement area of postural sway in a normal base of support with eyes open (p = 0.006). Combined training increased functional indicators (abdominal - p = 0.031; aerobic capacity - p = 0.002).

CONCLUSION

 In conclusion, combined aerobic plus strength training effectively improved gait and balance control in older women. The postmenopausal women from the CT group walked faster and with bigger steps after the intervention than the control group. In addition, they presented decreased postural sway in standing and decreased the percentage of double support time while walking, which means improved static and dynamic balance control and functional indicators.

Effects of exercise training on metabolic syndrome risk factors in post-menopausal women - A systematic review and meta-analysis of randomised controlled trials

BACKGROUND & AIMS

Alterations in the hormonal profiles as women transition to the menopause predisposes individuals to the metabolic syndrome (MetS). In post-menopausal women, this can be exacerbated by sedentary behaviour and physical inactivity. Physical activity can convey many health benefits including improvement in MetS risk factors. However, it remains to be elucidated how differing exercise intensities and its mode of delivery can ameliorate MetS risk factors and resultant progression amongst post-menopausal women. The purpose of this systematic review and meta-analysis was to investigate the effects and efficacy of exercise training on MetS risk factors in post-menopausal women.

METHODS

Database searches using PubMed, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials were conducted from inception to December 2021 for randomised controlled studies (RCTs) investigating exercise training (>8 weeks) in at least one of the MetS risk factors in post-menopausal women. Utilising the random-effects model, appropriate standardised mean differences (SMD) or mean differences (MD) with 95% confidence interval (CI) for each MetS risk factor were used to calculate the overall effect size between the exercise and control groups. Sub-group analyses were performed for exercise intensity, modality, and duration for each risk factor. Meta-regression was performed for categorical (health status) and continuous (body mass index) covariates.

RESULTS

39 RCTs (40 studies) involving 2132 participants were identified as eligible. Overall, the meta-analysis shows that exercise training significantly improved all MetS risk factors: waist circumference (WC) [MD: -2.61 cm; 95% CI: -3.39 to -1.86 cm; p < 0.001; 21 studies]; triglycerides (TG) [SMD: -0.40 mmol/L; 95% CI: -0.71 to -0.09 mmol/L; p = 0.01; 25 studies]; high-density lipoprotein (HDL) [SMD: 0.84 mmol/L (95% CI: 0.41-1.27 mmol/L; p < 0.001; 26 studies]; fasting glucose (BG) [SMD: -0.38 mmol/L (95% CI: -0.60 to -0.16 mmol/L; p < 0.001; 20 studies]; systolic blood pressure (SBP) [MD: -5.95 mmHg (95% CI: -7.98 to -3.92 mmHg; p < 0.001; 23 studies]; and diastolic blood pressure (DBP) [MD: -4.14 mmHg (95% CI: -6.19 to -2.08 mmHg; p < 0.001; 23 studies]. Furthermore, sub-group analyses identified that moderate intensity and combined exercise training significantly improved MetS risk factors (p < 0.05) except for HDL, with combined exercise being the most effective. Long duration (≥12 weeks) training also significantly improved MetS risk factors except for TG. Meta-regression revealed no moderating effects on any MetS risk variables.

CONCLUSION

This study reinforces the importance of regular physical activity as a non-pharmacological tool in the reduction of MetS risk in post-menopausal women, with significant metabolic improvements seen in interventions spanning 8-10 weeks. Moderate intensity and combined training significantly benefitted abdominal obesity, dyslipidaemia, dysglycaemia and hypertension in post-menopausal women. Improvements in at least one MetS risk were also seen with other exercise modalities and intensities.

Effect of Exercise on Arterial Stiffness in Healthy Young, Middle-Aged and Older Women: A Systematic Review

Arterial stiffness, an age-dependent phenomenon, is improved with exercise, which in turn may prevent cardiovascular diseases in women. However, there is a lack of consolidated information on the impact of exercise on arterial stiffness among healthy women. The aim of this review was to (i) analyse the effect of exercise on arterial stiffness in healthy young, middle-aged, and older women, and (ii) recommend types, intensity, and frequency for each age group. Database searches on PubMed, ScienceDirect, Web of Science, and Scopus were conducted using PRISMA guidelines until September 2022. The keywords were: exercise, women/female, and arterial stiffness. The inclusion criteria were: healthy women, supervised exercise, and arterial stiffness measures. Study quality and bias were assessed using the PEDro scale. Fifty-one papers were classified into young (n = 15), middle-aged (n = 14), and older (n = 22) women. Improvements in arterial stiffness were observed among: young women (Pulse Wave Velocity, PWV: 4.9-6.6 m/s), following an 8-week high-intensity aerobic (3 days/week) or hypoxic high-intensity interval training; middle-aged women (PWV: 5.1-7.9 m/s), aerobic exercise with moderate intensity or stretching exercise at "moderate to heavy" (Borg Scale), 20-30 s per site, 10 s of rest interval for 30 min; and for older women (PWV: 7.9-15.6 m/s), resistance training at light intensity, aerobic exercise at any intensity, or a combination of the two exercises. This review shows that arterial stiffness increases with age in healthy women and has an inverse relationship with exercise intensity. Therefore, when prescribing exercise to improve arterial stiffness, age and arterial stiffness measures should be accounted for.

Protein-Added Healthy Lunch-Boxes Combined with Exercise for Improving Physical Fitness and Vascular Function in Pre-Frail Older Women: A Community-Based Randomized Controlled Trial

Purpose

Preventive or therapeutic interventions are key to maintaining independence in pre-frail and/or frail elderly. Therefore, we investigated whether multi-component interventions were effective in physical fitness levels and vascular functions in pre-frail older women.

Patients and Methods

Sixty participants aged ≥ 65 years (81.5 ± 4.3 yrs) were divided equally into control group, diet group, aerobic exercise and diet group, and aerobic exercise with electromyostimulation and diet group. For 8 weeks, the participants received a set of protein-added meals twice daily on weekdays. The aerobic exercise groups performed 45 mins of stepping exercise at 50-70% of the maximal heart rate for 3 days/week, and the aerobic exercise with electromyostimulation was applied on each limb in 8 weeks. Blood pressure, physical fitness, cardiovascular biomarkers, pulse wave velocity, and flow-mediated dilation were measured before and after the 8-week.

Results

There were no group differences in age, height, weight, body mass index, free fat mass, and %body fat at baseline. The right grip strength significantly increased in the diet group, aerobic exercise and diet group, and aerobic exercise with electromyostimulation and diet group (p < 0.05). Short physical performance battery, 6-min walking distance, and flow-mediated dilation significantly increased in the aerobic exercise and diet group and aerobic exercise with electromyostimulation and diet group (p < 0.05). Blood pressure and pulse wave velocity did not differ between interventions. High-density lipoprotein-cholesterol levels significantly increased after 8 weeks in all intervention groups (p < 0.05). There were no significant differences in glucose, HbA1c, total cholesterol, low-density lipoprotein-cholesterol, triglyceride, insulin, Homeostatic Model Assessment for Insulin Resistance, nitric oxide, and C-reactive protein levels.

Conclusion

These results show that multi-component interventions appear to improve physical fitness and vascular function in pre-frail older women. Thus, possible strategies to prevent early frailty including proper nutrition and exercise may be needed.

Effects of Concurrent Strength and Endurance Training on Measures of Physical Fitness in Healthy Middle-Aged and Older Adults: A Systematic Review with Meta-Analysis

BACKGROUND

There is evidence that in older adults the combination of strength training (ST) and endurance training (ET) (i.e., concurrent training [CT]) has similar effects on measures of muscle strength and cardiorespiratory endurance (CRE) compared with single-mode ST or ET, respectively. Therefore, CT seems to be an effective method to target broad aspects of physical fitness in older adults.

OBJECTIVES

The aim was to examine the effects of CT on measures of physical fitness (i.e., muscle strength, power, balance and CRE) in healthy middle-aged and older adults aged between 50 and 73 years. We also aimed to identify key moderating variables to guide training prescription.

STUDY DESIGN

We conducted a systematic review with meta-analysis of randomized controlled trials.

DATA SOURCES

The electronic databases PubMed, Web of Science Core Collection, MEDLINE and Google Scholar were systematically searched until February 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included randomized controlled trials that examined the effects of CT versus passive controls on measures of physical fitness in healthy middle-aged and older adults aged between 50 and 73 years.

RESULTS

Fifteen studies were eligible, including a total of 566 participants. CT induced moderate positive effects on muscle strength (standardized mean difference [SMD] = 0.74) and power (SMD = 0.50), with a small effect on CRE (SMD = 0.48). However, no significant effects were detected for balance (p > 0.05). Older adults > 65 years (SMD = 1.04) and females (SMD = 1.05) displayed larger improvements in muscle strength compared with adults ≤ 65 years old (SMD = 0.60) and males (SMD = 0.38), respectively. For CRE, moderate positive effects (SMD = 0.52) were reported in those ≤ 65 years old only, with relatively larger gains in females (SMD = 0.55) compared with males (SMD = 0.45). However, no significant differences between all subgroups were detected. Independent single training factor analysis indicated larger positive effects of 12 weeks (SMD = 0.87 and 0.88) compared with 21 weeks (SMD = 0.47 and 0.29) of CT on muscle strength and power, respectively, while for CRE, 21 weeks of CT resulted in larger gains (SMD = 0.62) than 12 weeks (SMD = 0.40). For CT frequency, three sessions per week produced larger beneficial effects (SMD = 0.91) on muscle strength compared with four sessions (SMD = 0.55), whereas for CRE, moderate positive effects were only noted after four sessions per week (SMD = 0.58). A session duration of > 30-60 min generated larger improvements in muscle strength (SMD = 0.99) and power (SMD = 0.88) compared with > 60-90 min (SMD = 0.40 and 0.29, respectively). However, for CRE, longer session durations (i.e., > 60-90 min) seem to be more effective (SMD = 0.61) than shorter ones (i.e., > 30-60 min) (SMD = 0.34). ET at moderate-to-near maximal intensities produced moderate (SMD = 0.64) and small positive effects (SMD = 0.49) on muscle strength and CRE, respectively, with no effects at low intensity ET (p > 0.05). Finally, intra-session ST before ET produced larger gains in muscle strength (SMD = 1.00) compared with separate sessions (SMD = 0.55), whereas ET and ST carried out separately induced larger improvements in CRE (SMD = 0.58) compared with intra-session ET before ST (SMD = 0.49).

CONCLUSIONS

CT is an effective method to improve measures of physical fitness (i.e., muscle strength, power, and CRE) in healthy middle-aged and older adults aged between 50 and 73 years, regardless of sex. Results of independent single training factor analysis indicated that the largest effects on muscle strength were observed after 12 weeks of training, > 30-60 min per session, three sessions per week, higher ET intensities and when ST preceded ET within the same session. For CRE, the largest effects were noted after 21 weeks of training, four sessions per week, > 60-90 min per session, higher ET intensities and when ET and ST sessions were performed separately. Regarding muscle power, the largest effects were observed after 12 weeks of training and > 30-60 min per session.

Combined effect of physical exercise and hormone replacement therapy on cardiovascular and metabolic health in postmenopausal women: A systematic review and meta-analysis

The cardioprotective effect of postmenopausal hormone replacement therapy (HRT) has been demonstrated in several studies. Similarly, physical exercise has yielded positive results. However, the effects of their combination remain inconclusive. This review describes the combined effects of physical exercise and hormone therapy on cardiovascular and metabolic health in postmenopausal women. We searched the Scopus, Web of Science, PubMed, and Embase databases and included randomized controlled trials published up to December 2021 on the combined effects of physical exercise and hormone therapy on cardiovascular and metabolic health in postmenopausal women. We identified 148 articles, of which only seven met the inclusion criteria (386 participants; 91 [23%] HRT + exercise; 104 [27%] HRT; 103 [27%] exercise; 88 [23%] placebo). The combined treatment further decreased systolic blood pressure (SBP) compared to the isolated effect of aerobic training (AT) (mean difference [MD]=-1.69; 95% confidence interval [CI]=-2.65 to -0.72, n=73). Nevertheless, it attenuated the decrease in diastolic blood pressure (DBP) (MD=0.78; 95%CI: 0.22-1.35, n=73), and the increase in peak oxygen consumption (VO2 peak) promoted by exercise (AT + HRT=2.8±1.4 vs AT + placebo=5.8±3.4, P=0.02). The combination of AT and oral HRT improved SBP. However, AT alone seemed to have a better effect on physical fitness and DBP in postmenopausal women.

Improved arterial stiffness after combined aerobic and resistance training: correlation with heart rate variability change in prehypertensive offspring of hypertensive parents

Prehypertensive offspring of hypertensive parents are strongly linked to pathological processes of hypertension in later life. It is observed that young adults with high blood pressure (BP) have increased arterial stiffness, which is linked to autonomic anomalies. The purpose of the present study was to assess the effect of combined resistance and aerobic exercise training on BP, brachial-ankle pulse wave velocity (baP-WV), and heart rate variability (HRV) in prehypertensive young men with hypertensive parents. Thirty prehypertensive males aged 19.6±1.2 years were randomly assigned to either a combined exercise training group (CBT, n=15) or no exercise group (CON, n=15). The CBT group performed combined exercise for 8 weeks, 3 times per week. BP, baP-WV, HRV, peak oxygen consumption (VO_2peak), and muscle strength were measured before and after the exercise intervention. Systolic BP (-5.1 mmHg, 3.9% decrease, P<0.05), diastolic BP (-3.9 mmHg, 6.1% decrease, P<0.01), mean arterial pressure (-4.2 mmHg, 4.7% decrease, P<0.05), baPWV (-0.4 m/sec, 3.5% decrease, P<0.01), standard deviation of all RR intervals (+58.5% increase, P<0.05) and very low frequency (VLF) (+34.6% increase, P<0.01), VO_2peak (+11.7% increase, P<0.01) and one-repetition maximum leg press (+30.3% increase, P<0.01) were significantly improved in the CBT group after 8 weeks of training versus the CON group. Additionally, a reduction in baPWV was associated with an increase in the VLF power of HRV (r=0.72, P<0.01). These findings indicate that the combined training improves BP, arterial stiffness, vagal activity, cardiorespiratory fitness, and lower-body muscle strength in prehypertensive offspring of hypertensive parents.

Aerobic exercise combined with resistance exercise training improves cardiopulmonary function and blood lipid of patients with breast cancer: A systematic review and meta-analysis

BACKGROUND

To compare the therapy effects following the aerobic exercise combined with resistance exercise training (AET + RET) and common care treatment for patients with breast cancer.

METHODS

Articles about the effects of AET + RET on the breast cancer patients in 4 online databases were searched. The differences of cardiopulmonary function, blood pressure, blood lipid, and body mass index between the AET + RET treatment and the usual care treatment were compared.

RESULTS

Totally, 8 articles were involved into the meta-analysis. The qualities of the 8 articles were medium. The combination results showed that AET + RET increased the VO2peak (weighted mean difference (WMD) = 2.93 mL/kg/min; 95% CI: 0.38, 5.49; P = .02) and VO2max (WMD = 6.98 mL/kg/min; 95% CI: 2.04, 15.92; P = .01), demonstrating its improving effects in cardiopulmonary function. Moreover, the AET + RET decreased the TG (WMD = -57.95 mg/dL; 95% CI: -112.25, -3.64; P = .04), demonstrating its improving effects in blood lipid. While or the HRpeak, RERpeak, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, and body mass index, there are no significant differences between the AET + RET and usual care treatment (P < .05).

CONCLUSION

Our results demonstrated that AET + RET can significantly improve the cardiopulmonary function and blood lipid for breast cancer patients.

Effect of exercise on vascular function in hypertension patients: A meta-analysis of randomized controlled trials

Objective

The purpose of this study was to systematically evaluate the effect of exercise on vascular function in patients with pre- and hypertension.

Methods

A systematic review of articles retrieved via the PubMed, Embase, EBSCO, and Web of Science databases was conducted. All the randomized controlled trials published between the establishment of the databases and October 2022 were included. Studies that evaluated the effects of exercise intervention on vascular function in patients with pre- and hypertension were selected.

Results

A total of 717 subjects were included in 12 randomized controlled trials. The meta-analysis showed that in patients with pre- and hypertension, exercise can significantly reduce systolic blood pressure (SBP) (MD = -4.89; 95% CI, -7.05 to -2.73; P < 0.00001) and diastolic blood pressure (DBP) (MD = -3.74; 95% CI, -5.18 to -2.29; P < 0.00001) and can improve endothelium-dependent flow-mediated dilatation (MD = 2.14; 95% CI, 1.71-2.61; P < 0.00001), and exercise did not reduce pulse wave velocity (PWV) (MD = 0.03, 95% CI, -0.45-0.50; P = 0.92). Regression analysis showed that changes in exercise-related vascular function were independent of subject medication status, baseline SBP, age and duration of intervention.

Conclusion

Aerobic, resistance, and high-intensity intermittent exercise all significantly improved SBP, DBP, and FMD in pre- and hypertensive patients, however, they were not effective in reducing PWV, and this effect was independent of the subject's medication status, baseline SBP, age and duration of intervention.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022302646.

Benefits of combined exercise training on arterial stiffness and blood pressure in spontaneously hypertensive rats treated or not with dexamethasone

Dexamethasone (DEX)-induced arterial stiffness is an important side-effect, associated with hypertension and future cardiovascular events, which can be counteracted by exercise training. The aim of this study was to evaluate the mechanisms induced by combined training to attenuate arterial stiffness and hypertension in spontaneously hypertensive rats treated or not with dexamethasone. Spontaneously hypertensive rats (SHR) underwent combined training for 74 days and were treated with dexamethasone (50 µg/kg s. c.) or saline solution during the last 14 days. Wistar rats were used as controls. Echocardiographic parameters, blood pressure (BP) and pulse wave velocity (PWV), as well as histological analyses of the heart and aorta, carotid and femoral arteries were performed. At the beginning, SHR had higher BP and PWV compared with Wistar rats. After 60 days, while BP increased in sedentary SHR, combined exercise training decreased BP and PWV. After 74d, the higher BP and PWV of sedentary SHR was accompanied by autonomic imbalance to the heart, cardiac remodeling, and higher arterial collagen deposition. DEX treatment did not change these parameters. On the other hand, trained SHR had reduced BP and PWV, which was associated with better autonomic balance to the heart, reduced myocardial collagen deposition, as well as lower arterial collagen deposition. The results of this study suggest that combined training, through the reduction of aortic collagen deposition, is an important strategy to reduce arterial stiffness in spontaneously hypertensive rats, and these lower responses were maintained regardless of dexamethasone treatment.

Qigong for Muscle Strength and Static Postural Control in Middle-Aged and Older Postmenopausal Women: A Randomized Controlled Trial

In the present study, we aimed to determine the effects of a Qigong exercise program on the muscle strength and postural control in middle-aged and older postmenopausal women. This is a randomized clinical trial (https://clinicaltrials.gov/ct2/show/NCT03989453) conducted on 125 women who were initially assigned to either an experimental group (n = 63) that performed a Qigong exercise program for 12 weeks or to a control group (n = 62) that did not receive any intervention. Muscle strength (dynamometer) and postural control (stabilometric platform) were evaluated before and immediately after an intervention period. The main findings of this study suggest that the women in the experimental group had improvements in muscle strength, mean velocity of the displacement of the center of pressure (CoP) with both eyes open and closed, and the surface sway area covered by the CoP, as well as the mediolateral and anteroposterior oscillations of the CoP, only with eyes open. The results of the present study determined that a 12 week Qigong exercise program has beneficial effects on muscle strength and postural control of middle-aged and older postmenopausal Spanish women.

Gym and home-based combined training in men with primary hypertension: are they equally effective on functional fitness profile, body composition components, and biochemical parameters of hypertension?

OBJECTIVE

This study aimed to compare the effects of 10 weeks of gym versus home-based combined training on the functional fitness, body composition, and biochemical parameters of hypertension in primary hypertensive men.

METHODS

Forty-six patients (age 48 ± 9 years, BMI 30 ± 4 kg/m²) assigned into three groups: a gym-based combined training (GBCTr: n = 16; resistance at 60-80% of 1RM, using pin-loaded resistance equipment, aerobic at 40-60% HRR, and stretching), home-based combined training (HBCTr: n = 15; resistance at 12-15 RPE, using an elastic exercise band, aerobic at 40-60% HRR, and stretching), and control (CTR, n = 15).

RESULTS

Following GBCTr and HBCTr, the functional aerobic capacity (P = .005 and P = .004, respectively), flexibility (P = .01 and P = .004, respectively), and lower limb muscle strength (P = .01 and P = .02, respectively) was increased significantly compared with the CTR group. The body weight (P = .02), body mass index (P = .008), hip circumference (P = .02), and nitric oxide level in GBCTr and HBCTr group (P = .002 and P = .02, respectively) was decreased significantly compared with the CTR group. No significant changes found in the plasma levels of NADPH oxidase 5, thioredoxin-2, thioredoxin reductase-2, and resting blood pressure after GBCTr and HBCTr compared with the CTR group.

CONCLUSION

These results suggest that in hypertensive men, HBCTr equally to GBCTr improved functional fitness and body composition remarkably without necessarily reducing resting blood pressure. Therefore, they can be advisable substitutes for gaining health benefits.

Functional high-intensity interval training is not equivalent when compared to combined training for blood pressure improvements in postmenopausal women: a randomized controlled trial

INTRODUCTION

Low-volume functional high-intensity interval training (F-HIIT) improves cardiorespiratory fitness, body composition, and physical function similarly to combined training (CT, gold standard protocol), however no previous studies have compared the F-HIIT equivalence with CT in reducing blood pressure in older people, particularly in postmenopausal women (PW). Therefore, the aim of this study (trial registration: NCT03200639) was designed to test whether F-HIIT of low volume is an equivalent strategy to CT for improving blood pressure (BP) in PW.

MATERIAL AND METHOD

Forty-nine PW were divided into two groups: F-HIIT and CT. The F-HIIT protocol was composed of 10 sets of 60 seconds of high-intensity exercises interspersed with 60 seconds of low-intensity exercises for recovery. The CT protocol was composed of 30 minutes of moderate-intensity walking, followed by five total body resistance exercises. Both protocols were performed 3-times-a-week for 12 weeks. The BP from rest condition (before exercise) was measured before and after 12 weeks of intervention in both groups, using an automatic blood pressure monitor. The boundaries values for equivalence for systolic and diastolic BP was set at 5.14 and 2.92 mmHg, respectively.

RESULTS

There was only a significant reduction (P < .05) in systolic BP in CT group from baseline (-3.2 (95% CI, -6.2 to -0.2) mmHg). The difference of systolic BP between F-HIIT and CT was 5.8 (95% CI, 1.3-10.4) mmHg, showing non-equivalence (inferiority) for F-HIIT.

CONCLUSION

Thus, these results suggest that low-volume F-HIIT protocol is not an equivalent strategy when compared to CT for BP improvements in PW.

Effect of combined aerobic and resistance exercise on blood pressure in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The purpose of this study is to evaluate the effects of combined aerobic and resistance exercise on blood pressure (BP) in postmenopausal women. The results of this study will provide an effective means for postmenopausal women to control BP and reduce the morbidity and mortality of cardiovascular disease (CVD).

METHODS

Eligible studies were searched in five electronic databases until November 2020, and 11 randomized controlled trials that met the inclusion criteria were included in this systematic review and meta-analysis. The random-effects model was used to calculate overall effect sizes of weighted mean differences (WMD) and 95% confidence interval (CI). This study was registered in PROSPERO with the registration number: CRD42021225546.

RESULTS

Compared with the control group, the aerobic combined resistance exercise significantly decreased the systolic blood pressure (SBP) and diastolic blood pressure (DBP) by 0.81 mmHg (95% CI, -1.34 to -0.28) and 0.62 mmHg (95% CI, -1.11 to -0.14), respectively. The results of the meta-analysis also indicated that a significant reduction in brachial-to-ankle pulse wave velocity (baPWV) of - 1.18 m/s (95% CI, -1.81 to -0.56) and heart rate (HR) of -0.22 beats/min (95% CI: -0.42 to -0.02) after combined aerobic and resistance exercise intervention. Subgroup analysis showed that postmenopausal women ≥60 years of age who were overweight or had a normal baseline BP were more sensitive to the combined aerobic and resistance exercise. When combined aerobic and resistance exercise frequency < 3 times/week, weekly exercise time ≥ 150 min, or the duration of exercise lasted for 12 weeks, the SBP and DBP of postmenopausal women could be reduced more effectively.

CONCLUSIONS

The present study indicates that combined aerobic and resistance exercise can significantly reduce BP in postmenopausal women. Accordingly, combined aerobic and resistance exercise may be an effective way to prevent and manage hypertension in postmenopausal women.

Effects of Combined Resistance and Aerobic Training on Arterial Stiffness in Postmenopausal Women: A Systematic Review

The aim of this systematic review was to investigate the effects of combined resistance and aerobic exercise on arterial stiffness in postmenopausal women. Two databases, PubMed and Google Scholar were searched to identify relevant studies. The methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) scale. Only seven studies met the eligibility criteria, and their outcomes were presented. Four studies demonstrated the effects of combined resistance and aerobic training, while three showed the effectiveness of exercise with both training components, aerobic and resistance. In all studies, arterial stiffness was measured by brachial–ankle pulse wave velocity (baPWV). Participants were middle-aged or older postmenopausal women of various health statuses (hypertensive, with comorbidities or healthy). The results unequivocally show that combined training reduces arterial stiffness. The most important finding of this review paper is that the applied type of exercise decreased baPWV in the range of 0.6–2.1 m/s. Moreover, combined resistance and aerobic exercise for 12 weeks, performed three times a week for about 60 min per training session, at a moderate intensity (40–60% HRR or HRmax), may be clinically meaningful to the cardiovascular system. In conclusion, we can say that combined resistance and aerobic training, or exercise with resistance and aerobic components, have important health implications for the prevention of cardiovascular disease and the maintenance or improvement of health in middle-aged and older postmenopausal women with different health conditions.

Exercise Improves Cardiorespiratory Fitness, but Not Arterial Health, after Spinal Cord Injury: The CHOICES Trial

Arterial stiffness, as measured by carotid-femoral pulse wave velocity (cfPWV), is elevated after spinal cord injury (SCI). In the uninjured population, exercise training has been shown to reduce arterial stiffness. In a randomized, multi-center clinical trial, we evaluated the impact of two exercise interventions on cardiovascular disease risk factors in persons with chronic SCI. A total of 46 adults with motor-complete SCI with neurological levels of injury between the fourth cervical and sixth thoracic spinal cord segments (C4-T6) were randomly assigned to either body-weight-supported treadmill training (BWSTT) or arm-cycle ergometer training (ACET). Participants trained 3 days per week for 24 weeks. Exercise session duration progressed gradually to reach 30 and 60 min for ACET and BWSTT, respectively. The primary outcome was arterial stiffness, assessed by cfPWV, and was measured at baseline, 12 weeks of training, and at 24 weeks. Secondary outcomes included cardiorespiratory fitness (CRF) and cardiometabolic health measures and were measured before and after completion of training. Fourteen participants per intervention arm completed the exercise intervention. Our results show no effect of either exercise intervention on arterial stiffness (p = 0.07) and cardiometabolic health measures (p > 0.36). However, peak oxygen uptake increased with ACET compared with BWSTT (p = 0.04). The findings of this trial demonstrate that although 24 weeks of upper-body exercise improved CRF in persons with motor-complete SCI ≥T6, neither intervention resulted in improvements in arterial stiffness or cardiometabolic health measures. ClinicalTrials.gov identifier: NCT01718977.

Sex-Specific Impacts of Exercise on Cardiovascular Remodeling

Cardiovascular diseases (CVD) remain the leading cause of death in men and women. Biological sex plays a major role in cardiovascular physiology and pathological cardiovascular remodeling. Traditionally, pathological remodeling of cardiovascular system refers to the molecular, cellular, and morphological changes that result from insults, such as myocardial infarction or hypertension. Regular exercise training is known to induce physiological cardiovascular remodeling and beneficial functional adaptation of the cardiovascular apparatus. However, impact of exercise-induced cardiovascular remodeling and functional adaptation varies between males and females. This review aims to compare and contrast sex-specific manifestations of exercise-induced cardiovascular remodeling and functional adaptation. Specifically, we review (1) sex disparities in cardiovascular function, (2) influence of biological sex on exercise-induced cardiovascular remodeling and functional adaptation, and (3) sex-specific impacts of various types, intensities, and durations of exercise training on cardiovascular apparatus. The review highlights both animal and human studies in order to give an all-encompassing view of the exercise-induced sex differences in cardiovascular system and addresses the gaps in knowledge in the field.

Effect of an Acute Resistance Training Bout and Long-Term Resistance Training Program on Arterial Stiffness: A Systematic Review and Meta-Analysis

Resistance training (RT) and exercise is useful for preventing cardiovascular disease, systolic hypertension and stroke, which are associated with the stiffening of the larger central arterial system. The aim of this systematic review was to (a) understand the changes in arterial stiffness (AS) in various parts of the body measurement after acute RT bout and long-term RT, and (b) to determine the impact of exercise intensity on these changes in healthy individuals. A systematic computerized search was performed according to the PRISMA in PubMed, Scopus and Google Scholar with final selection of 23 studies. An acute RT bout led to a temporary increase in pulse wave velocity (PWV) regardless of the measurement method or intensity. A long-term RT at above an 80% repetition maximum (RM) have an ambiguous effect on PWV. A low-intensity RT or whole-body vibration training program decreased carotid-femoral PWV and brachial-ankle PWV (d = 1.02) to between 0.7 ± 1.4 ms-1 (p < 0.05) and 1.3 ± 1.07 ms-1 (p < 0.05) and improved other cardiac functions. A long-term RT of moderate (60-80% 1RM) or low intensity (<60% one-repetition maximum (1RM)) can decrease AS. Low and moderate intensity RT is beneficial to reduce high AS to prevent cardiovascular diseases.

INERTIA: A pilot study of the impact of progressive resistance training on blood pressure control in older adults with sarcopenia

Sarcopenia, and high blood pressure are highly prevalent, preventable conditions that pose significant burden for older adults and on the healthcare system. Current prevention and treatment of high blood pressure in sarcopenia, by non-pharmacological approaches remain limited and are far from optimal. Clinical trials and mechanistic studies provide encouraging evidence of a plausible therapeutic effect of progressive resistance training (PRT) on blood pressure in younger, and pre-hypertensive and hypertensive older adults. The impact of PRT on blood pressure has not been empirically tested in older adults with sarcopenia. This pilot study aims to provide effect size confidence intervals, clinical trial and intervention feasibility data, and procedural materials for a full-scale randomized controlled trial that will determine the efficacy of PRT intervention as a therapeutic strategy for blood pressure control in older adults with sarcopenia. Participants (N = 90) will be randomized to receive exercise educational materials or the PRT intervention consisting of 24 supervised exercise sessions over 12-weeks. Follow-up assessments will occur at 12-weeks and one-year later. The primary outcome is systolic blood pressure and diastolic blood pressure, analyzed separately. Microvascular mechanisms linking muscle (perfusion, strength, function) to changes in blood pressure will be explored at baseline and 12-weeks. This study will provide new evidence for the therapeutic effect of PRT as a non-pharmacological strategy for improving blood pressure. Insights gained may also inform of the potential role of muscle strength as a novel target for blood pressure control, and future exercise prescription guidelines related to muscle strengthening in high-risk older adults.

Effects of Different Periodization Strategies of Combined Aerobic and Strength Training on Heart Rate Variability in Older Women

ABSTRACT

Rodrigues, JAL, Santos, BC, Medeiros, LH, Gonçalves, TCP, and Júnior, CRB. Effects of different periodization strategies of combined aerobic and strength training on heart rate variability in older women. J Strength Cond Res 35(7): 2033-2039, 2021-The preservation of autonomic function has been proposed to be a key determinant of health and longevity. Periodization in combined training (CT) (strength plus aerobic exercise in the same session) might improve autonomic modulation. However, the specific influences of nonperiodized (NP), flexible nonlinear periodized (FNLP), and nonlinear periodized (NLP) strategies of CT on heart rate variability (HRV) are currently unknown. Therefore, we investigated the effects of NP, FNLP, and NLP strategies of CT on HRV in physically active women. In total, 54 physically active older women (61.6 ± 6.3 years) previously engaged in a regular exercise training were randomly allocated into 3 groups: NP, FNLP, and NLP. All the subjects performed 12 weeks of training, 3 times per week, with the sessions divided into aerobic (bicycle or treadmill) and strength exercises. Before and after the exercise training, we examined anthropometric, body composition, and HRV measures (low-frequency [LF], high-frequency [HF], LF/HF, and root mean square successive difference of RR intervals [RMSSD]) during rest, a maximum exercise test, and recovery post-test. Mixed-model measures were used, and statistical significance was set at α = 0.05. The waist circumference reduced only in the NP group (∆ = -2.01%). The RMSSD increased in the NLP (∆ = 76.5%) and LF/HF ratio increased in the FNLP (∆ = 34.51%) during the rest period. There were no differences during the exercise test and recovery after test for LF, HF, LF/HF, or RMSSD. In active women, nonlinear periodization strategies of CT improved one of the cardiovascular health outcomes because HRV is a direct predictor of cardiovascular risk.

Endurance Training Depletes Antioxidant System but Does Not Affect Endothelial Functions in Women with Abdominal Obesity: A Randomized Trial with a Comparison to Endurance-Strength Training

Limited data suggested that inclusion of a strength component into endurance exercises might intensify the beneficial effect of training. However, the available data is limited. Therefore, we aimed to compare the effect of endurance and endurance-strength training on anthropometric parameters, endothelial function, arterial stiffness, antioxidant status, and inflammatory markers in abdominally obese women without serious comorbidities. A total of 101 women were recruited and randomly divided into endurance (n = 52) and endurance-strength (n = 49) groups. During the three-month intervention, both groups performed supervised sixty-minute training three times a week. All studied parameters were measured pre- and post-intervention period. In total, 85 women completed the study. Both training significantly decreased anthropometric parameters. Besides, endurance training decreased endothelial nitric oxide synthase, central aortic systolic pressure, pulse wave velocity, glutathione (GSH), total antioxidant status (TAS), interleukin (IL) 8, matrix metalloproteinase (MMP) 9, and tumor necrosis factor alpha, while endurance-strength training decreased MMP-2 concentrations, and increased IL-6, monocyte chemoattractant protein-1, and MMP-9 levels. We observed significant differences between groups for GSH, TAS, and MMP-9 levels. In summary, endurance and endurance-strength training did not differ in the impact on endothelial function and arterial stiffness. However, endurance training significantly depleted the antioxidant defense, simultaneously reducing MMP-9 levels. The study was retrospectively registered with the German Clinical Trials Register within the number DRKS00019832.

Effects of Aerobic and Resistance Exercise Training on Carotid Intima-Media Thickness in Abdominal Obese Women

Aims: The purpose of this study was to investigate the effects of a 12-week aerobic and resistance training program on waist circumference (WC) and carotid intima-media thickness (CIMT) in abdominal obese middle-aged women. Methods: Subjects were 40 middle-aged women with abdominal obesity (WC >85 cm) but no specific diseases. Subjects were divided into a combined exercise group (aerobic and resistance exercise) and a control group that did not participate in any lifestyle modification. Carotid variables were measured using B-mode ultrasound. A treadmill exercise test was conducted to directly assess the peak oxygen uptake (VO₂peak). Differences in the carotid variables and relative changes between baseline and after 12 weeks were evaluated. Results: After 12 weeks, body weight (70.6 ± 7.8 to 65.6 ± 6.3 kg, P < 0.05), WC (88.8 ± 3.6 to 85.6 ± 3.1 cm, P < 0.01), total cholesterol (215.5 ± 38.4 to 188.2 ± 25.8 mmHg, P < 0.05), low-density lipoprotein cholesterol (150.5 ± 30.6 to 131.6 ± 22.3 mmHg, P < 0.05), triglycerides (164.5 ± 82.3 to 119.9 ± 60.6 mmHg, P < 0.01), VO₂peak (24.2 ± 6.2 to 28.7 ± 4.4 mL/kg/min, P < 0.01), and CIMT (0.61 ± 0.13 to 0.58 ± 0.12 mm, P < 0.05) were significantly improved in the combined exercise group but not in the control group; changes in CIMT were associated with changes in WC decrease (r = 0.41, P < 0.01) and VO₂peak (r = -0.53, P < 0.01). Conclusions: Combined exercise training in abdominal obese women decreased CIMT; these changes were also associated with reduced WC and improved VO₂peak.

Walking exercise and lower-body blood flow restriction: Effects on systemic inflammation, lipid profiles and hematological indices in overweight middle-aged males

The objective of present study is to investigate the effects of walk training with and without blood flow restriction (BFR and no-BFR) on lipid profiles, inflammatory and haematological factors in over-weighed men. Participants were divided into BFR (n = 9) or no-BFR (n = 9) groups. Both groups were exposed to 8-week walk training on a treadmill: 3 sessions/week at a speed of 50 m/min, 5 sets × 2 min/session. There were differences in pre- to post-levels of (TG) and fibrinogen in the BFR group (p ≤ 0.05) that were accompanied by changes in red blood cells (RBC), haemoglobin (HGB) and haematocrit (HCT) levels (p ≤ 0.05). RBC levels were increased in the BFR group (p ≤ 0.05). The groups differed in their mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC). These findings suggest the efficiency of BFR walk training in individuals exposed to chronic diseases associated with overweight, such as metabolic syndrome.

The impact of the 24-h movement spectrum on vascular remodeling in older men and women: a review

Aging is associated with increased risk of cardiovascular and cerebrovascular events, which are preceded by early, negative remodeling of the vasculature. Low physical activity is a well-established risk factor associated with the incidence and development of disease. However, recent physical activity literature indicates the importance of considering the 24-h movement spectrum. Therefore, the purpose of this review was to examine the impact of the 24-h movement spectrum, specifically physical activity (aerobic and resistance training), sedentary behavior, and sleep, on cardiovascular and cerebrovascular outcomes in older adults, with a focus on recent evidence (<10 yr) and sex-based considerations. The review identifies that both aerobic training and being physically active (compared with sedentary) are associated with improvements in endothelial function, arterial stiffness, and cerebrovascular function. Additionally, there is evidence of sex-based differences in endothelial function: a blunted improvement in aerobic training in postmenopausal women compared with men. While minimal research has been conducted in older adults, resistance training does not appear to influence arterial stiffness. Poor sleep quantity or quality are associated with both impaired endothelial function and increased arterial stiffness. Finally, the review highlights mechanistic pathways involved in the regulation of vascular and cerebrovascular function, specifically the balance between pro- and antiatherogenic factors, which mediate the relationship between the 24-h movement spectrum and vascular outcomes. Finally, this review proposes future research directions: examining the role of duration and intensity of training, combining aerobic and resistance training, and exploration of sex-based differences in cardiovascular and cerebrovascular outcomes.

Beetroot supplementation in women enjoying exercise together (BEE SWEET): Rationale, design and methods

Background

Postmenopausal women exhibit higher rates of disability and cardiovascular disease (CVD) with aging compared to men. Whereas habitual exercise training is a known strategy to enhance physiologic function in men and premenopausal women, exercise-related adaptations are often modest in postmenopausal women. We propose dietary nitrate (beetroot juice) administered prior to exercise training may be a feasible approach to improve mobility and cardio-metabolic health outcomes in postmenopausal women.

Methods

Our randomized, placebo-controlled study aims to determine preliminary effects sizes for changes in functional mobility and endothelium-dependent vasodilation across three study arms: exercise only (EX), exercise + placebo (EX + PL), and exercise + beetroot (EX + BR). Thirty-six postmenopausal women are recruited in small cohorts wherein group exercise is implemented to facilitate social support and adherence to an 8-week training progression. Participants are randomized to one of three study arms (n = 12 per group) following baseline assessments. Post-intervention assessments are used to determine pre-post changes in outcome measures including distance covered during a 6 min walk test, walking economy, muscle speed and power, and endothelial-dependent vasodilation as determined by flow-mediated dilation. Measures of feasibility include recruitment, retention, adherence to exercise prescription, perceived exercise session difficulty, and adverse event rates.

Discussion

Evidence-based, translational strategies are needed to optimize exercise training-related adaptations in postmenopausal women. Findings will inform larger randomized clinical trials to determine if pre-exercise consumption of beetroot juice is an efficacious strategy to promote mobility and attenuate CVD disease risk.

Hemodynamic and creatine kinase changes after a 12-week equipment-based Pilates training program in hypertensive women

Exercise therapy is a conservative strategy to manage hypertension. The aim of this study was to investigate the effects of a 12-week equipment-based Pilates training program on the hemodynamics of medication-controlled hypertensive women. Forty-five women were classified into two groups: medication-controlled hypertensive (n = 30) or control (n = 15). To be eligible for the hypertensive group, participants had to have a clinical diagnosis of hypertension, be taking medication to control their blood pressure and not to have done any exercise activity in the previous three months. In the control group, the participants needed to have normal blood pressure levels and not to have done any exercise activity in the previous three months. All women participated in a 12-week equipment-based Pilates training program (2 × 60min sessions per week). Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR) and creatine kinase levels (CK) were assessed before and after the program. SBP, DBP and heart rate were also assessed before and after each session. There was no statistically significant difference after Pilates training for systolic (normotensive MD 4.1, 95%CI -9.2 to 17.5, hypertensive MD 3.8, 95%CI -5.3 to 13.1) and diastolic (normotensive MD 5.8, 95%CI -2.0 to 13.7, hypertensive MD 4.0, 95%CI -4.3 to 12.4) blood pressure. Heart rate was reduced after Pilates training in both normotensive (MD 4.5, 95%CI 1.1 to 7.8) and medication-controlled hypertensive (MD 7.9, 95%CI 4.4 to 11.4) women. Creatine kinase activity was reduced after Pilates training in medication-controlled hypertensive women (p = 0.019). Blood pressure was not altered, but heart rate and creatinine kinase activity were reduced following 12 weeks of Equipment-based Pilates training.

Effects of Moderate Combined Resistance- and Aerobic-Exercise for 12 Weeks on Body Composition, Cardiometabolic Risk Factors, Blood Pressure, Arterial Stiffness, and Physical Functions, among Obese Older Men: A Pilot Study

We demonstrated the hypothesis that combined exercise improves body composition, cardiometabolic risk factors, blood pressure (BP), arterial stiffness, and physical functions, in obese older men. Older men (n = 20) were randomly assigned to combined exercise training (EXP; n = 10) or control groups (CON; n = 10). The combined exercise was comprised of elastic-band resistance training and walking/running on a treadmill and bicycle at 60–70% of maximal heart rate for 3 days/weeks. EXP showed significant decreases in body weight, body mass index, and %body fat (p < 0.05). The exercise program significantly reduced BP, mean arterial pressure, pulse pressure, and brachial-ankle pulse wave velocity. Furthermore, while the plasma levels of low-density lipoprotein cholesterol and epinephrine were significantly reduced in EXP, VO₂ peak and grip strength were significantly enhanced (p < 0.05). In conclusion, it is indicated that 12-week regular combined exercise improves body composition, cardiometabolic risk factors, hemodynamics, and physical performance in obese older men.

Effects of Elastic Band Exercise on Functional Fitness and Blood Pressure Response in the Healthy Elderly

Purpose: This study investigated the effects of 12 weeks of moderate intensity elastic band exercise (EBE) on functional fitness and blood pressure parameters in the elderly. Methods: 27 healthy older adults were randomly assigned to an exercise group (n = 15, age: 75.1 ± 1.4 years) and a control group (n = 12, age: 72.3 ± 1.4 years). Participants performed EBE for 60 min, three times a week, over the course of three months. The EBE consisted of incremental resistance and aerobic exercises designed to improve whole body fitness. Functional fitness and resting cardiovascular parameters were assessed before and after the exercise training program. Results: Grip strength, sit and reach, and one-leg stance improved significantly in the exercise group, while no significant improvements were found in chair stand and timed up and go (p < 0.05). Cardiovascular parameters including systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure significantly decreased in the exercise group relative to the control group (p < 0.05). Conclusions: Findings of the present study suggest that safe, inexpensive, and easily accessible EBE program with circuit training components play a significant role in improving upper and lower body fitness, as well as cardiovascular fitness, in the elderly.

Combined anthocyanins and bromelain supplement improves endothelial function and skeletal muscle oxygenation status in adults: a double-blind placebo-controlled randomised crossover clinical trial

Anthocyanins and bromelain have gained significant attention due to their antioxidative and anti-inflammatory properties. Both have been shown to improve endothelial function, blood pressure (BP) and oxygen utility capacity in humans; however, the combination of these two and the impacts on endothelial function, BP, total antioxidant capacity (TAC) and oxygen utility capacity have not been previously investigated. The purpose of this study was to investigate the impacts of a combined anthocyanins and bromelain supplement (BE) on endothelial function, BP, TAC, oxygen utility capacity and fatigability in healthy adults. Healthy adults (n 18, age 24 (sd 4) years) received BE or placebo in a randomised crossover design. Brachial artery flow-mediated dilation (FMD), BP, TAC, resting heart rate, oxygen utility capacity and fatigability were measured pre- and post-BE and placebo intake. The BE group showed significantly increased FMD, reduced systolic BP and improved oxygen utility capacity compared with the placebo group (P < 0·05). Tissue saturation and oxygenated Hb significantly increased following BE intake, while deoxygenated Hb significantly decreased (P < 0·05) during exercise. Additionally, TAC was significantly increased following BE intake (P < 0·05). There were no significant differences for resting heart rate, diastolic BP or fatigability index. These results suggest that BE intake is an effective nutritional therapy for improving endothelial function, BP, TAC and oxygen utility capacity, which may be beneficial to support vascular health in humans.

Habitual Combined Exercise Protects against Age-Associated Decline in Vascular Function and Lipid Profiles in Elderly Postmenopausal Women

Postmenopausal status is associated with increased risks for cardiovascular diseases (CVD). This study investigated differences in vascular function, lipids, body composition, and physical fitness in elderly postmenopausal women active in combined resistance and aerobic exercise (CRAE) training for 1 year versus a sedentary cohort of similar-in-age counterparts. Elderly postmenopausal women performing habitual CRAE training for 1 year (age ~75 year; CRAE, n = 57) and elderly sedentary postmenopausal women (age ~78 year; SED, n = 44) were recruited. Arterial stiffness (brachial-to-ankle pulse-wave velocity, baPWV), blood pressure, blood lipids, anthropometrics, 2-min walking distance, and muscular strength were assessed for both groups. There were significant differences for baPWV, systolic blood pressure, low-density lipoprotein, and body fat percentage, which were significantly lower (p < 0.05) in CRAE vs. SED, and both 2 min walking distance and muscular strength were significantly greater (p < 0.05) in CRAE vs. SED. These results indicate that elderly postmenopausal women participating in habitual CRAE training may have better protection against risks for CVD and have better physical fitness compared to SED counterparts.

The effects of exercise on vascular markers and C-reactive protein among obese children and adolescents: An evidence-based review

Numerous studies have evaluated the effects of exercise training on obese children and adolescents. However, the impact of aerobic and/or resistance exercise alone, without any other interventions, on vascular markers and C-reactive protein (CRP) in obese children and adolescents is still not clear. We performed a literature search in Ovid Medline, PubMed, and SCOPUS databases to identify articles on the effects of exercise on vascular markers and CRP among obese children and adolescents, published between January 2009 and May 2019. Only full-text articles in English that reported on the effect of aerobic and/or resistance exercise on the vascular markers pulse wave velocity (PWV), carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), augmentation index (AIx), or CRP in obese children and adolescents (5-19 years old) were included. The literature search identified 36 relevant articles; 9 articles that fulfilled all the inclusion criteria were selected by two independent reviewers. Aerobic exercise or a combination of aerobic and resistance exercise training significantly improved CIMT and PWV in obese children and adolescents in all studies in which they were measured (2 studies for PWV and 4 studies for CIMT). However, the effects of exercise on FMD and CRP levels were inconclusive, as only half of the studies demonstrated significant improvements (1/2 studies for FMD and 4/8 studies for CRP). The results of our review support the ability of exercise to improve vascular markers such as PWV and CIMT in obese children and adolescents. This finding is important as obesity is a modifiable risk factor of cardiovascular disease (CVD), and exercise may help in reducing the future occurrence of CVD in this population.

Physiological response and cardiorespiratory adaptation after a 6-week Nordic Walking training targeted at lipid oxidation in a group of post-menopausal women

This study examined the effects of a 6-week Nordic Walking (NW) training, at the intensity corresponding to the dominance of lipid metabolism, on the levels of selected physiological indices, the haemodynamic indices of the cardiovascular system and physical fitness in sedentary women older than 55 years of age. In addition, the physiological response of the female body to the walking effort on treadmill with poles (NW) and without poles (W) was compared and the influence of training on this response was determined. A single group study with a pre-test/post-test study design was conducted. Eighteen women performed NW controlled intensity training 3 times a week for 6 weeks. Body composition, resting blood pressure (BP), heart rate (HR), maximum oxygen uptake (VO₂max) as well as circulatory and respiratory indices in two graded walking efforts on mechanical treadmill NW and W were measured before and after training period. The intensity of workouts, which considered the dominance of lipid metabolism, was determined individually, based on the dynamics of changes in the level of physiological indices during the graded intensity NW. After the course of training, body mass, fat mass, resting BP and HR decreased significantly (p < 0.05). HR and respiratory exchange ratio recorded during NW and W at 1.75 m^.s^-1 walking speed decreased, while the oxygen pulse increased (p < 0.05). VO₂max increased significantly (p < 0.05). Before and after the training period HR, oxygen uptake per minute, and energy expenditure during NW were significantly higher than in W (p < 0.05). The study showed that 6-week NW training at the intensity corresponding to the dominance of lipid metabolism can provide improvement in body composition, cardiovascular function and physical performance in previously sedentary women. NW compared to the regular walk with the same speed revealed higher energy expenditure.

Circuit resistance training and cardiovascular health in breast cancer survivors

OBJECTIVE

Cardiovascular disease is the leading cause of death in breast cancer survivors. While evidence shows circuit resistance training (CRT) is effective for improving muscle and cardiorespiratory fitness, whether CRT is an efficacious therapy for decreasing cardiovascular risk in cancer survivors is unclear.

METHODS

Fifty-one breast cancer survivors were recruited to either 12 weeks CRT (n = 26), or a non-exercising wait-list control (n = 25). Two supervised 60 min CRT sessions per week were undertaken, comprising resistance and functional exercises, and aerobic exercise stations. Primary outcome measure was the gold-standard assessment of arterial stiffness, aortic pulse wave velocity (PWV). Secondary outcomes included: cardiorespiratory fitness (CRF), upper and lower body strength, arterial wave reflections, central blood pressure and rate pressure product.

RESULTS

Compared to the control group, the CRT group had a statistically significant medium effect decrease in PWV 0.9 m/s (95% CI: 0.1, 1.7). There were large effect improvements in VO₂ max (4.3 ml kg^-1  min^-1 , 95% CI: 5.8, 2.8), upper and lower body strength (3.7 kg, 95% CI: 1.9, 5.6 and 10.4 kg, 1.6, 19.1) respectively.

CONCLUSION

Findings support the existing literature demonstrating that 12 weeks CRT improves muscle and cardiorespiratory fitness and is also an effective strategy for decreasing a proven cardiovascular risk factor in breast cancer survivors.

Effect of combined circuit exercise on arterial stiffness in hypertensive postmenopausal women: a local public health center-based pilot study

OBJECTIVE

Postmenopausal women have increased arterial stiffness compared with premenopausal women. Regular physical activity including aerobic and resistance exercises are recommended to lower cardiovascular disease risk and to enhance musculoskeletal health in these women. This study examined the effect of combined circuit exercise on arterial stiffness in hypertensive postmenopausal women. Furthermore, it ascertained whether performing this exercise program is feasible in local public health centers with better accessibility than research and commercial facilities.

METHODS

Among 24 hypertensive postmenopausal women, 16 finished this study in either the control (n = 8) or exercise (n = 8) group. Except for one participant who withdrew from the study due to the difficulty of the exercise program, seven participants withdrew due to reasons unrelated to the study. Circuit-type exercise (aerobic- and resistance-combined) program was applied to the exercise group, 60 min/d and 3 d/wk for 12 weeks under supervision. Brachial-ankle pulse wave velocity was measured to assess arterial stiffness.

RESULTS

In response to the combined exercise, brachial-ankle pulse wave velocity was significantly reduced in the hypertensive women (-0.7 m/s; P < 0.05). Weight, body mass index, and total cholesterol level were also significantly decreased after the exercise program (-2.1 kg, -0.8 kg/m, and -16 mg/dL, respectively; P < 0.05). In addition, changes in arterial stiffness were related to body adiposity, blood pressure, and blood lipid alterations (r = 0.61-0.70; P < 0.01).

CONCLUSIONS

Circuit combined exercise is an effective intervention to improve arterial stiffness in hypertensive postmenopausal women, and is feasible in local public health centers.

The effects of stair climbing on arterial stiffness, blood pressure, and leg strength in postmenopausal women with stage 2 hypertension

OBJECTIVE

Menopause is accompanied by a progressive arterial stiffening associated with increases in blood pressure (BP) and decline in muscular function. It is crucial to prevent or reduce the negative effects of menopause on vascular and muscular function by implementing appropriate lifestyle interventions, such as exercise training. We examined the effects of a stair climbing (SC) regimen on arterial stiffness (pulse wave velocity [PWV]), BP, and leg strength in postmenopausal women with stage 2 hypertension.

METHODS

Using a parallel experimental design, participants were randomly assigned to either SC (n = 21) or nonexercising control group (n = 20) for 12 weeks. Participants in the SC group trained 4 d/wk, climbing 192 steps 2 to 5 times/d. Participants' brachial-to-ankle PWV (baPWV), BP, and leg strength were measured at baseline and after 12 weeks of their assigned intervention.

RESULTS

There was a significant group by time interaction (P < 0.05) for baPWV, and systolic BP (SBP) and diastolic BP (DBP) which significantly decreased (P < 0.05), and leg strength which significantly increased (P < 0.05) after SC compared with no changes in the control. The changes in baPWV were correlated with changes in SBP (r = 0.66, P < 0.05) and leg strength (r = -0.47, P < 0.05).

CONCLUSIONS

SC led to reductions in arterial stiffness, BP, and increases in leg strength in stage 2 hypertensive postmenopausal women. The decrease in arterial stiffness partially explained the improvements in SBP and leg strength. SC may be an effective intervention in the prevention and treatment of menopause/aging-related vascular complications and muscle weakness.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effects of exercise interventions on cardiovascular health in individuals with chronic, motor complete spinal cord injury: protocol for a randomised controlled trial [Cardiovascular Health/Outcomes: Improvements Created by Exercise and education in SCI (CHOICES) Study]

INTRODUCTION

Recent studies demonstrate that cardiovascular diseases and associated complications are the leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). Abnormal arterial stiffness, defined by a carotid-to-femoral pulse wave velocity (cfPWV) ≥10 m/s, is a recognised risk factor for heart disease in individuals with SCI. There is a paucity of studies assessing the efficacy of conventional training modalities on arterial stiffness and other cardiovascular outcomes in this population. Therefore, this study aims to compare the efficacy of arm cycle ergometry training (ACET) and body weight-supported treadmill training (BWSTT) on reducing arterial stiffness in individuals with chronic motor complete, high-level (above the sixth thoracic segment) SCI.

METHODS AND ANALYSIS

This is a multicentre, randomised, controlled, clinical trial. Eligible participants will be randomly assigned (1:1) into either ACET or BWSTT groups. Sixty participants with chronic (>1 year) SCI will be recruited from three sites in Canada (Vancouver, Toronto and Hamilton). Participants in each group will exercise three times per week up to 30 min and 60 min for ACET and BWSTT, respectively, over the period of 6 months. The primary outcome measure will be change in arterial stiffness (cfPWV) from baseline. Secondary outcome measures will include comprehensive assessments of: (1) cardiovascular parameters, (2) autonomic function, (3) body composition, (4) blood haematological and metabolic profiles, (5) cardiorespiratory fitness and (6) quality of life (QOL) and physical activity outcomes. Outcome measures will be assessed at baseline, 3 months, 6 months and 12 months (only QOL and physical activity outcomes). Statistical analyses will apply linear-mixed modelling to determine the training (time), group (ACET vs BWSTT) and interaction (time × group) effects on all outcomes.

ETHICS AND DISSEMINATION

Ethical approval was obtained from all three participating sites. Primary and secondary outcome data will be submitted for publication in peer-reviewed journals and widely disseminated.

TRIAL REGISTRATION NUMBER

NCT01718977; Pre-results.

TRIAL STATUS

Recruitment for this study began on January 2013 and the first participant was randomized on April 2013. Recruitment stopped on October 2018.

The effects of a 12-week jump rope exercise program on abdominal adiposity, vasoactive substances, inflammation, and vascular function in adolescent girls with prehypertension

INTRODUCTION

Childhood obesity is strongly associated with cardiovascular disease (CVD) development. It is necessary to combat unfavorable outcomes of obesity at a young age by utilizing effective interventions, such as exercise.

PURPOSE

We sought to examine the effects of a jump rope exercise program on CVD risk factors, including body composition, vasoactive substances, inflammation, and vascular function in prehypertensive adolescent girls.

METHODS

Forty girls (age 14-16) were recruited and randomly assigned to a jump rope exercise group (EX, n = 20) or control group (CON, n = 20). Body composition, nitrate and nitrite levels, endothelin-1 (ET-1), C-reactive protein (CRP), systolic blood pressure and diastolic blood pressure (SBP, DBP), and arterial stiffness were measured before and after 12 weeks.

RESULTS

There were significant group by time interactions following the 12-week program for body composition (from 33.8 ± 3.6 to 30.2 ± 3.1%), central adiposity (from 86.4 ± 4 to 83.3 ± 5 cm), SBP (from 126 ± 3.3 to 120 ± 2.1 mmHg), and brachial-to-ankle pulse wave velocity (from 8.2 ± 1.0 to 7.4 ± 0.2 m/s). Nitrate/nitrite levels increased (from 54.5 ± 5.1 to 57.2 ± 5.2 µmol) along a reduction in CRP levels (from 0.5 ± 0.4 to 0.2 ± 0.1 mg/L). There were no significant changes in ET-1 (P = 0.22).

CONCLUSIONS

These findings indicate that jump rope exercise may be an effective intervention to improve these CVD risk factors in prehypertensive adolescent girls. Jumping rope is an easily accessible exercise modality that may have important health implications for CVD prevention in younger populations.

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

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

The impact of 2 years of high-intensity exercise training on a model of integrated cardiovascular regulation

KEY POINTS

Heart rate variability, a common and easily measured index of cardiovascular dynamics, is the output variable of complicated cardiovascular and respiratory control systems. Both neural and non-neural control mechanisms may contribute to changes in heart rate variability. We previously developed an innovative method using transfer function analysis to assess the effect of prolonged exercise training on integrated cardiovascular regulation. In the present study, we modified and applied this to investigate the effect of 2 years of high-intensity training on circulatory components to tease out the primary effects of training. Our method incorporated the dynamic Starling mechanism, dynamic arterial elastance and arterial-cardiac baroreflex function. The dynamic Starling mechanism gain and arterial-cardiac baroreflex gain were significantly increased in the exercise group. These parameters remained unchanged in the controls. Conversely, neither group experienced a change in dynamic arterial elastance. The integrated cardiovascular regulation gain in the exercise group was 1.34-fold larger than that in the control group after the intervention. In these previously sedentary, otherwise healthy, middle-aged adults, 2 years of high-intensity exercise training improved integrated cardiovascular regulation by enhancing the dynamic Starling mechanism and arterial-cardiac baroreflex sensitivity.

ABSTRACT

Assessing the effects of exercise training on cardiovascular variability is challenging because of the complexity of multiple mechanisms. In a prospective, parallel-group, randomized controlled study, we examined the effect of 2 years of high-intensity exercise training on integrated cardiovascular function, which incorporates the dynamic Starling mechanism, dynamic arterial elastance and arterial-cardiac baroreflex function. Sixty-one healthy participants (48% male, aged 53 years, range 52-54 years) were randomized to either 2 years of exercise training (exercise group: n = 34) or control/yoga group (controls: n = 27). Before and after 2 years, subjects underwent a 6 min recording of beat-by-beat pulmonary artery diastolic pressure (PAD), stroke volume index (SV index), systolic blood pressure (sBP) and RR interval measurements with controlled respiration at 0.2 Hz. The dynamic Starling mechanism, dynamic arterial elastance and arterial-cardiac baroreflex function were calculated by transfer function gain between PAD and SV index; SV index and sBP; and sBP and RR interval, respectively. Fifty-three participants (controls: n = 25; exercise group: n = 28) completed the intervention. After 2 years, the dynamic Starling mechanism gain (Group × Time interaction: P = 0.008) and the arterial-cardiac baroreflex gain (P = 0.005) were significantly increased in the exercise group but remained unchanged in the controls. There was no change in dynamic arterial elastance in either of the two groups. The integrated cardiovascular function gain in the exercise group increased 1.34-fold, whereas there was no change in the controls (P = 0.02). In these previously sedentary, otherwise healthy middle-aged adults, a 2 year programme of high-intensity exercise training improved integrated cardiovascular regulation by enhancing the dynamic Starling mechanism and arterial-cardiac baroreflex sensitivity, without changing dynamic arterial elastance.