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Lopes S, Diniz F, Mesquita Bastos J, Oliveira J, Polónia J, Alves AJ, Ribeiro F, Figueiredo D. "What do we think?": a qualitative exploratory study of acceptability and experiences of individuals with resistant hypertension after completing a physical exercise program (the EnRICH trial). Disabil Rehabil 2024; 46:2662-2669. [PMID: 37424233 DOI: 10.1080/09638288.2023.2229237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/18/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Aerobic exercise training programs decrease blood pressure in individuals with resistant hypertension. However, participants' experiences regarding exercise training participation are unknown and often undervalued. Therefore, participant's experiences and program acceptability of the exercise arm of the EnRicH trial, a randomized clinical trial investigating the effect of a 12-week aerobic exercise training program in individuals with resistant hypertension were analysed. METHODS An exploratory qualitative study was conducted with twenty individuals with resistant hypertension (11 males, mean age 58.9 ± 8.9 years), after the exercise program. Four focus group interviews were performed to explore participants' perspectives. The interviews were digitally audio-recorded, transcribed verbatim, and subjected to thematic analysis. RESULTS Five themes emerged from the data analyses: 1) main impacts of participating in the exercise program; 2) facilitators of adherence; 3) perceived barriers; 4) perception of the program structure; and 5) global satisfaction with the program. Positive physical and emotional changes were reported, associated with reduced perceived stress and irritability, and decreased blood pressure. Adherence to the exercise program was facilitated by personalized supervision and feedback, the personal commitment to attend the training sessions, and different schedule options. Lack of motivation, peer support, physical health limitations, and difficulty in conciliating schedules were identified as barriers to the maintenance of exercise training after the program. CONCLUSION The qualitative analysis demonstrates the acceptability of the program. Peer and health professional's support, commitment to health professionals, and boosting individual-perceived advantages are key-points to promote participants adherence.
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Affiliation(s)
- Susana Lopes
- School of Health Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
- Physiotherapy Department, Polytechnic of Coimbra, ESTeSC Coimbra Health School, Coimbra, Portugal
- Saúde Positiva, Clínica de Saúde Física e Mental, Aveiro, Portugal
| | - Filipa Diniz
- Saúde Positiva, Clínica de Saúde Física e Mental, Aveiro, Portugal
- Education and Psychology Department, University of Aveiro, Aveiro, Portugal
| | - José Mesquita Bastos
- School of Health Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
- Cardiology Department, Hospital Infante D. Pedro, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - José Oliveira
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Jorge Polónia
- Faculty of Medicine, University of Porto, Porto, Portugal
- Hypertension and Cardiovascular Risk Unit, Unidade Local de Saúde Matosinhos, Matosinhos, Portugal
| | - Alberto Jorge Alves
- Research Center in Sports Sciences, Health and Human Development, CIDESD, University of Maia, Maia, Portugal
- OncoMove, Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Fernando Ribeiro
- School of Health Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - Daniela Figueiredo
- Centre for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Ferreira MJ, Sebastião E, Pelicioni PHS. Feasible and Safe Approaches for Exercise Adherence in Hypertension. Am J Hypertens 2024; 37:394-395. [PMID: 38497804 DOI: 10.1093/ajh/hpae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Maycon Junior Ferreira
- Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo,Brazil
| | - Emerson Sebastião
- Department of Health and Kinesiology, University of Illinois Urbana-Champaign, Urbana, Illinois, United States
| | - Paulo Henrique Silva Pelicioni
- School of Health Sciences, University of New South Wales, Randwick, Australia
- Neuroscience Research Australia, University of New South Wales, Randwick, Australia
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Le Bourvellec M, Delpech N, Hervo J, Bosquet L, Enea C. Effect of exercise modalities on postexercise hypotension in pre- and postmenopausal women: a systematic review and meta-analysis. J Appl Physiol (1985) 2024; 136:864-876. [PMID: 38328822 DOI: 10.1152/japplphysiol.00684.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 02/09/2024] Open
Abstract
Hormonal changes associated with menopause increase the risk of hypertension. Postexercise hypotension (PEH) is an important tool in the prevention and management of hypertension; however, menopause may alter this response. The aim of this systematic review and meta-analysis [International Prospective Registered of Systematic Review (PROSPERO): CRD42023297557] was to evaluate the effect of exercise modalities (aerobic, AE; resistance, RE; and combined exercise, CE: AE + RE) on PEH in women, according to their menopausal status (premenopausal or postmenopausal). We searched controlled trials in PubMed, Web of Science, EBSCO, and Science Direct published between 1990 and March 2023. Inclusion criteria were normotensive, pre- and hypertensive, pre- and postmenopausal women who performed an exercise session compared with a control session and reported systolic blood pressure (SBP) and diastolic blood pressure (DBP) for at least 30 min after the sessions. Methodological quality was assessed using the PEDro scale. Standardized mean differences (Hedge's g) and their 95% confidence intervals (CIs) were calculated, and Q-test and Z-test were conducted to assess differences between moderators. Forty-one trials with 718 women (474 menopausal) were included. Overall, we found with moderate evidence that SBP and DBP decreased significantly after exercise session (SBP: g = -0.69, 95% CI -0.87 to -0.51; DBP: g = -0.31, 95% CI -0.47 to -0.14), with no difference between premenopausal and postmenopausal women. Regarding exercise modalities, RE is more effective than AE and CE in lowering blood pressure (BP) in women regardless of menopausal status. In conclusion, women's menopausal status does not influence the magnitude of PEH, and the best modality to reduce BP in women seems to be RE.NEW & NOTEWORTHY This meta-analysis has demonstrated that a single bout of exercise induces postexercise hypotension (PEH) in women and that the hormonal shift occurring with menopause does not influence the magnitude of PEH. However, we have shown with moderate evidence that the effectiveness of exercise modalities differs between pre- and postmenopausal women. Resistance and combined exercises are the best modalities to induce PEH in premenopausal women, whereas resistance and aerobic exercises are more effective in postmenopausal women.
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Affiliation(s)
- Morgane Le Bourvellec
- Laboratory MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, Poitiers, France
| | - Nathalie Delpech
- Laboratory MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, Poitiers, France
| | - Jéromine Hervo
- Laboratoire de Traitement de l'information Médicale (LaTIM), UMR1101, Université Bretagne Occidentale, Brest, France
| | - Laurent Bosquet
- Laboratory MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, Poitiers, France
| | - Carina Enea
- Laboratory MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, Poitiers, France
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Kiernan PA, Day CA, Berkowsky RS, Zaleski AL, Gao S, Taylor BA, Santos LP, Panza G, Kramarz M, McCormick K, Thompson PD, Fernandez AB, Chen MH, Pescatello LS. Reliability and Time Course of Postexercise Hypotension during Exercise Training among Adults with Hypertension. J Cardiovasc Dev Dis 2024; 11:42. [PMID: 38392256 PMCID: PMC10889392 DOI: 10.3390/jcdd11020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Postexercise hypotension (PEH), or the immediate decrease in blood pressure (BP) lasting for 24 h following an exercise bout, is well-established; however, the influence of exercise training on PEH dynamics is unknown. This study investigated the reliability and time course of change of PEH during exercise training among adults with hypertension. PEH responders (n = 10) underwent 12 weeks of aerobic exercise training, 40 min/session at moderate-to-vigorous intensity for 3 d/weeks. Self-measured BP was used to calculate PEH before and for 10 min after each session. The intraclass correlation coefficient (ICC) and Akaike Information Criterion (AIC) determined PEH reliability and goodness-of-fit for each week, respectively. Participants were obese (30.6 ± 4.3 kg∙m-2), middle-aged (57.2 ± 10.5 years), and mostly men (60%) with stage I hypertension (136.5 ± 12.1/83.4 ± 6.7 mmHg). Exercise training adherence was 90.6 ± 11.8% with 32.6 ± 4.2 sessions completed. PEH occurred in 89.7 ± 8.3% of these sessions with BP reductions of 9.3 ± 13.1/3.2 ± 6.8 mmHg. PEH reliability was moderate (ICC ~0.6). AIC analysis revealed a stabilization of maximal systolic and diastolic BP reductions at 3 weeks and 10 weeks, respectively. PEH persisted throughout exercise training at clinically meaningful levels, suggesting that the antihypertensive effects of exercise training may be largely due to PEH. Further studies in larger samples and under ambulatory conditions are needed to confirm these novel findings.
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Affiliation(s)
- Peter A Kiernan
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Christina A Day
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Rachel S Berkowsky
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | | | - Simiao Gao
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | | | - Lucas P Santos
- Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
| | | | - Melody Kramarz
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Kyle McCormick
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | | | | | - Ming-Hui Chen
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
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Gao W, Lv M, Huang T. Effects of different types of exercise on hypertension in middle-aged and older adults: a network meta-analysis. Front Public Health 2023; 11:1194124. [PMID: 37799161 PMCID: PMC10549925 DOI: 10.3389/fpubh.2023.1194124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023] Open
Abstract
Objective This study mainly used network meta-analysis to explore the effect of different types of exercise on hypertension in middle-aged and older adults. Methods Several databases (e.g., PubMed, Embase, and the Cochrane Library) were used to search for randomized controlled trials on the effects of different types of exercise on hypertension in middle-aged and older adults. Results A total of 19 articles and 2,385 participants were included in the analysis. Aerobic exercise interventions [MD = -9.254, P < 0.05, 95% CI (-14.810, -3.698)] and static exercise interventions [MD = -10.465, P < 0.05, 95% CI (-18.135, -2.794)] had a significant effect on the improvement in systolic blood pressure (SBP). For diastolic blood pressure (DBP), aerobic exercise interventions [MD = -1.4096; P > 0.05, 95% CI (-8.2395, 5.4201)] and static exercise interventions [MD = -4.5206, P > 0.05, 95% CI (-14.0436, 5.0023)] were not statistically significant. The results of the surface under the cumulative ranking curve (SUCRA) showed that static exercise improved hypertension better than aerobic exercise. Conclusion Aerobic exercise and static exercise have been shown to have a good effect on the improvement of hypertension, but the effect on DBP is not significant.
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Affiliation(s)
- Wei Gao
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
| | - Moran Lv
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
| | - Tao Huang
- Institute of Physical Education, Huanggang Normal University, Huanggang, China
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Ferreira MJ, dos Santos Ferreira Silva MP, da Silva Dias D, Bernardes N, Irigoyen MC, De Angelis K. Concurrent exercise training induces additional benefits to hydrochlorothiazide: Evidence for an improvement of autonomic control and oxidative stress in a model of hypertension and postmenopause. PLoS One 2023; 18:e0289715. [PMID: 37549182 PMCID: PMC10406179 DOI: 10.1371/journal.pone.0289715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate whether exercise training could contribute to a better modulation of the neurohumoral mechanisms linked to the pathophysiology of arterial hypertension (AH) in postmenopausal hypertensive rats treated with hydrochlorothiazide (HCTZ). METHODS Female spontaneously hypertensive rats (SHR) (150-200g, 90 days old) were distributed into 5 hypertensive groups (n = 7-8 rats/group): control (C), ovariectomized (O), ovariectomized treated with HCTZ (OH), ovariectomized submitted to exercise training (OT) and ovariectomized submitted to exercise training and treated with HCTZ (OTH). Ovarian hormone deprivation was performed through bilateral ovariectomy. HCTZ (30mg/kg/day) and concurrent exercise training (3d/wk) were conducted lasted 8 weeks. Arterial pressure (AP) was directly recorded. Cardiac effort was evaluated using the rate-pressure product (RPP = systolic AP x heart rate). Vasopressin V1 receptor antagonist, losartan and hexamethonium were sequentially injected to evaluate the vasopressor systems. Inflammation and oxidative stress were evaluated in cardiac tissue. RESULTS In addition to the reduction in AP, trained groups improved RPP, AP variability, bradycardic (OT: -1.3 ± 0.4 and OTH: -1.6 ± 0.3 vs. O: -0.6 ± 0.3 bpm/mmHg) and tachycardic responses of baroreflex sensitivity (OT: -2.4 ± 0.8 and OTH: -2.4 ± 0.8 vs. O: -1.3 ± 0.5 bpm/mmHg), NADPH oxidase and IL-10/TNF-α ratio. Hexamethonium injection revealed reduced sympathetic contribution on basal AP in OTH group (OTH: -49.8 ± 12.4 vs. O: -74.6 ± 18.1 mmHg). Furthermore, cardiac sympathovagal balance (LF/HF ratio), IL-10 and antioxidant enzymes were enhanced in OTH group. AP variability and baroreflex sensitivity were correlated with systolic AP, RPP, LF/HF ratio and inflammatory and oxidative stress parameters. CONCLUSION The combination of HCTZ plus concurrent exercise training induced additional positive adaptations in cardiovascular autonomic control, inflammation and redox balance in ovariectomized SHR. Therefore, combining exercise and medication may represent a promising strategy for managing classic and remaining cardiovascular risks in AH.
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Affiliation(s)
- Maycon Junior Ferreira
- Exercise Physiology Laboratory, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Danielle da Silva Dias
- Hypertension Unit, Heart Institute (InCor), School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Nathalia Bernardes
- Human Movement Laboratory, Universidade São Judas Tadeu (USJT), São Paulo, SP, Brazil
| | - Maria Claudia Irigoyen
- Hypertension Unit, Heart Institute (InCor), School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Kátia De Angelis
- Exercise Physiology Laboratory, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Translational Physiology Laboratory, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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Cilhoroz BT, Zaleski A, Taylor B, Fernandez AB, Santos LP, Vonk T, Thompson PD, Pescatello LS. The Relationship between Postexercise Hypotension and Heart Rate Variability before and after Exercise Training. J Cardiovasc Dev Dis 2023; 10:jcdd10020064. [PMID: 36826560 PMCID: PMC9958830 DOI: 10.3390/jcdd10020064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023] Open
Abstract
Because data are scarce, we examined the relationship between postexercise hypotension (PEH) and heart rate variability (HRV) before and after aerobic exercise training among adults with hypertension. Participants completed a 12 w aerobic training program. Before and after training, they performed a peak graded exercise stress test (GEST) and nonexercise control (CONTROL) and were left attached to an ambulatory BP monitor. Prior to CONTROL, HRV was measured supine for 5 min using a 12-lead electrocardiogram (ECG). The participants (n = 18) were middle-aged (52.1 ± 11.7 y) and 50% men with hypertension (131.7 ± 9.8/85.9 ± 8.5 mmHg) and obesity (30.0 ± 3.7 kg·m-2). Before training, ambulatory systolic BP (ASBP) and diastolic ABP (ADBP) decreased by 3.2 ± 2.1 mmHg and 2.5 ± 1.5 mmHg, respectively, from baseline after the GEST versus CONTROL (p < 0.05). After training, ASBP tended to decrease by 3.5 ± 2.2 mmHg (p = 0.055) and ADBP decreased by 1.7 ± 2.5 mmHg (p = 0.001) from baseline after the GEST versus CONTROL. Before training, HRV high frequency (HFms2) (β = -0.441), age (β = 0.568), and resting SBP (β = 0.504) accounted for 66.8% of the ASBP response (p = 0.001), whereas the low frequency (LF)/HF ratio (β = 0.516) and resting DBP (β = 0.277) accounted for 35.7% of the ADBP response (p = 0.037). After training, the standard deviation of NN intervals (SDNN) (β = -0.556), age (β = 0.506), and resting SBP (β = 0.259) accounted for 60.7% of the ASBP response (p = 0.004), whereas SDNN (β = -0.236) and resting DBP (β = 0.785) accounted for 58.5% of the ADBP response (p = 0.001). Our preliminary findings show that adults with hypertension and parasympathetic suppression (i.e., lower SDNN and HFms2 and higher LF/HF) may elicit PEH to the greatest degree independent of training status versus adults with parasympathetic predominance, suggesting that resting HRV may be an important determinant of PEH.
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Affiliation(s)
- Burak T. Cilhoroz
- Department of Exercise Science, Falk College of Sports and Human Dynamics, Syracuse University, Syracuse, NY 13244, USA
- Correspondence: ; Tel.: +1-516-725-6889; Fax: +1-315-443-2562
| | - Amanda Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
- Department of Preventive Cardiology, Hartford Hospital, Hartford, CT 06106, USA
| | - Beth Taylor
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | | | - Lucas P. Santos
- Exercise Pathophysiology Laboratory, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-003, Brazil
| | - Thijs Vonk
- Department of Physiology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Paul D. Thompson
- Department of Preventive Cardiology, Hartford Hospital, Hartford, CT 06106, USA
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Álvarez C, Guede-Rojas F, Ramírez-Campillo R, Andrade DC, Vásquez-Gómez J, Rodríguez-Rodríguez F, Ciolac EG, Caamaño-Navarrete F, Delgado-Floody P. Characterizing the interindividual postexercise hypotension response for two order groups of concurrent training in patients with morbid obesity. Front Physiol 2022; 13:913645. [PMID: 36299263 PMCID: PMC9589449 DOI: 10.3389/fphys.2022.913645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Postexercise hypotension (PEH) is a common physiological phenomenon occurring immediately after endurance training (ET), resistance training (RT), and ET plus RT, also termed concurrent training (CT); however, there is little knowledge about the interindividual and magnitude response of PEH in morbidly obese patients. Aim: The aims of this study were (1) to investigate the effect of CT order (ET + RT vs. RT + ET) on the blood pressure responses; 2) characterize these responses in responders and nonresponders, and 3) identify potential baseline outcomes for predicting blood pressure decreases as responders. Methods: A quasi-experimental study developed in sedentary morbidly obese men and women (age 43.6 ± 11.3 years; body mass index [BMI] ≥40 kg/m2) was assigned to a CT group of ET plus RT (ET + RT; n = 19; BMI 47.8 ± 16.7) or RT plus ET order group (RT + ET; n = 17; BMI 43.0 ± 8.0). Subjects of both groups received eight exercise sessions over four weeks. Primary outcomes include systolic (SBP), diastolic (DBP), mean arterial pressure [MAP], heart rate at rest [HR], and pulse pressure [PP] measurements before and after 10 min post-exercise. Secondary outcomes were other anthropometric, body composition, metabolic, and physical fitness parameters. Using the delta ∆SBP reduction, quartile categorization (Q) in “high” (Rs: quartile 4), “moderate” (MRs: quartile 3), “low” (LRs: quartile 2), and “nonresponders” (NRs: quartile 1) was reported. Results: Significant pre–post changes were observed in ET + RT in session 2 for SBP (131.6 vs. 123.4 mmHg, p = 0.050) and session 4 (131.1 vs. 125.2 mmHg, p = 0.0002), while the RT + ET group showed significant reductions in session 4 (134.2 vs. 125.3 mmHg, p < 0.001). No significant differences were detected in the sum of the eight sessions for SBP (∑∆SBP) between ET + RT vs. RT + ET (−5.7 vs. −4.3 mmHg, p = 0.552). Interindividual analyses revealed significant differences among frequencies comparing Q1 “NRs” (n = 8; 22.2%), Q2 “LRs” (n = 8; 22.2%), Q3 “MRs” (n = 9; 25.0%), and Q4 “HRs” (n = 11; 30.5%), p < 0.0001. Quartile comparisons showed significant differences in SBP changes (p = 0.035). Linear regression analyses revealed significant association between ∑∆SBP with body fat % (β –3.826, R2 0.211 [21.1%], p = 0.031), skeletal muscle mass [β –2.150, R2 0.125 (12.5%), p = 0.023], fasting glucose [β 1.273, R2 0.078 (7.8%), p = 0.003], triglycerides [β 0.210, R2 0.014 (1.4%), p = 0.008], and the 6-min walking test [β 0.183, R2 0.038 (3.8%), p = 0.044]. Conclusion: The CT order of ET + RT and RT + ET promote a similar ‘magnitude’ in the postexercise hypotensive effects during the eight sessions of both CT orders in 4 weeks of training duration, revealing “nonresponders” and ‘high’ responders that can be predicted from body composition, metabolic, and physical fitness outcomes.
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Affiliation(s)
- Cristian Álvarez
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Francisco Guede-Rojas
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Rodrigo Ramírez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - David C. Andrade
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
| | - Jaime Vásquez-Gómez
- Centro de Investigación de Estudios Avanzados del Maule (CIEAM), Laboratorio de Rendimiento Humano, Universidad Católica del Maule, Talca, Chile
| | | | - Emmanuel Gomes Ciolac
- Exercise and Chronic Disease Research Laboratory, Department of Physical Education, School of Sciences, Sáo Paulo State University (UNESP), Bauru, Buazil
| | | | - Pedro Delgado-Floody
- Department of Physical Education, Sport and Recreation, Universidad de La Frontera, Temuco, Chile
- Department Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Strength & Conditioning Laboratory, CTS-642 Research Group, Department Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- *Correspondence: Pedro Delgado-Floody,
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Lee SY, Park CL, Cilhoroz BT, Pescatello LS. PTSD symptom clusters and cardiovascular responses to stress: Reactivity and recovery. J Psychosom Res 2022; 161:110996. [PMID: 35933739 PMCID: PMC9588198 DOI: 10.1016/j.jpsychores.2022.110996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/29/2022] [Accepted: 07/23/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) symptoms are associated with high blood pressure (BP) and decreased heart rate variability (HRV) at rest and in response to acute stress. Unique contributions of PTSD symptom clusters to cardiovascular responses to stress are rarely investigated. This study tested whether PTSD-related arousal/reactivity drives relationships of higher PTSD symptoms with higher BP and lower HRV during rest, reactivity (stressor-induced change from baseline), and recovery. METHODS Using a cross-sectional observational design, we enrolled 84 trauma-exposed community adults (83% female; 68% White; Mage = 35) who endorsed at least one core PTSD symptom. Participants completed a physical exam, self-reports of trauma history and PTSD symptoms, and BP and HRV frequency domain measurements during rest, stressor (mental arithmetic task), and recovery. RESULTS Arousal/reactivity was not associated with BP or HRV reactivity but associated with a higher low (LF) to high (HF) frequency (HF) ratio (LF/HF) during recovery reflecting sympathetic predominance. During the stressor, more avoidance and intrusion were associated with increased diastolic blood pressure (DBP) from baseline; more avoidance was associated with parasympathetic predominance (lower LF/HF); and more negative cognitions/mood was associated with decreased systolic blood pressure (SBP), DBP, and LF from baseline. During recovery, more intrusion and negative cognitions/mood were associated with increased SBP from baseline; less negative cognitions/mood was associated with sympathetic predominance (higher LF/HF). CONCLUSIONS PTSD symptom clusters demonstrated differential relationships with SBP, DBP, and HRV during reactivity and recovery. Findings may inform targeted PTSD symptom reduction interventions for disrupting links between PTSD and CVD risk.
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Affiliation(s)
- Sharon Y Lee
- Brown University, Warren Alpert Medical School, Department of Psychiatry and Human Behavior, USA.
| | - Crystal L Park
- University of Connecticut, Department of Psychological Sciences, USA.
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Demir Avci Y, Gözüm S, Karadag E. Effect of Telehealth Interventions on Blood Pressure Control: A Meta-analysis. Comput Inform Nurs 2022; 40:402-410. [PMID: 35120370 DOI: 10.1097/cin.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to find out the effects of telehealth interventions on blood pressure control by conducting a meta-analysis. Six databases were used. The literature review covered the period between December 1, 2020, and January 26, 2021. The meta-analysis was conducted by comprehensive Meta-Analysis Software version 2.2. Categorical variables were analyzed by odds ratios at a confidence interval of 95%. In data formatting and analysis, independent groups (sample size, P value); independent groups (mean, SD); Cohen's d, SE; and paired groups (N, P value) were used. The bias risk was assessed based on the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. Total sample size including 22 studies was 11 120. It was determined that interventions performed through telehealth applications had a significant effect on blood pressure control (odds ratio = -0.14; 95% confidence interval = -0.20 to -0.08; P < .001). In telehealth applications, blood pressure values decreased more when the application was performed through a Web site (-0.31; 95% confidence interval = -0.49 to -0.13), duration of the intervention was 12 months or shorter (-0.18; 95% confidence interval = -0.28 to -0.010), stroke developed in case of hypertension (-0.31, 95% confidence interval = -0.76 to 0.12), and the study was conducted in the Far East countries (-0.24; 95% confidence interval = 0.40 to -0.07). Interventions with telehealth applications are effective in blood pressure management. PROSPERO ID: CRD42021228536.
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Affiliation(s)
- Yasemin Demir Avci
- Author Affiliations: Department of Public Health Nursing, Faculty of Nursing (Dr Demir Avci), Department of Public Health Nursing, Faculty of Nursing (Dr Gözüm), and Department of Educational Sciences, Faculty of Education (Dr Karadag˘), Akdeniz University, Antalya, Turkey
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11
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Yamada E, Sakai S, Uchiyama M, Abeywickrama HM, Inoue M, Maeda K, Kikuchi Y, Omatsu K, Koyama Y. Compliance of Static Stretching and the Effect on Blood Pressure and Arteriosclerosis Index in Hypertensive Patients. Clin Pract 2022; 12:306-317. [PMID: 35645313 PMCID: PMC9149945 DOI: 10.3390/clinpract12030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Treatment of high blood pressure is a combination of lifestyle changes and medications, and appropriateexercise therapy is recommended as one of the lifestyle-related changes. Recently, stretching, a low-intensity exercise, was reported to be antihypertensive and effective for improving arteriosclerosis, in addition to aerobic exercise. The present study investigated the short-term effects of continuous stretching and rest-induced rebound on vascular endothelial function in hypertensive patients. Methods: This study was conducted as a single-arm prospective interventional study including patients between 30 and 70 years of age undergoing treatment for hypertension from October 2019 until May 2021. The intervention consisted of six months of daily stretching, one month of rest, and another three months of stretching. We measured arteriosclerosis indices such as cardio ankle vascular index (CAVI), ankle brachial pressure index (ABI) and reactive hyperemia index (RHI), and flexibility at the baseline and one, three, six, seven, and ten months from the baseline. Results: We included a total of ten patients (three males and seven females) with an average age of 60.10 ± 6.05 years. The exercise rate for the entire period was 90% or more, and the anteflexion measurement value improved significantly before and after the intervention (p < 0.001). Blood pressure and CAVI/ABI were well controlled throughout the study period. RHI did not show any significant improvement during the initial six months, and only slightly improved by the third month (p = 0.063). Even after the rest phase and resumption of stretching, RHI remained stable. Conclusions: The compliance of the stretching program we used, evaluated by the exercise implementation rate for the entire period, was 90% or more; therefore, easy to perform and continue by hypertensive patients. However, we did not observe a significant positive effect on arteriosclerosis index or blood pressure in this study.
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Affiliation(s)
- Etsuko Yamada
- Department of Nursing, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi, Niigata 951-8518, Japan; (E.Y.); (S.S.); (M.U.); (H.M.A.); (Y.K.); (K.O.)
| | - Sayuri Sakai
- Department of Nursing, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi, Niigata 951-8518, Japan; (E.Y.); (S.S.); (M.U.); (H.M.A.); (Y.K.); (K.O.)
| | - Mieko Uchiyama
- Department of Nursing, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi, Niigata 951-8518, Japan; (E.Y.); (S.S.); (M.U.); (H.M.A.); (Y.K.); (K.O.)
| | - Hansani M. Abeywickrama
- Department of Nursing, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi, Niigata 951-8518, Japan; (E.Y.); (S.S.); (M.U.); (H.M.A.); (Y.K.); (K.O.)
| | - Masanori Inoue
- Inoue Internal Medicine Clinic, 5-3-5 Meikekaminoyama, Niigata 950-0945, Japan;
| | - Kazuo Maeda
- Maeda Internal Medicine Clinic, 3160-4 Akebono, Niigata 951-8021, Japan;
| | - Yuko Kikuchi
- Department of Nursing, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi, Niigata 951-8518, Japan; (E.Y.); (S.S.); (M.U.); (H.M.A.); (Y.K.); (K.O.)
- Nursing Unit, Gosen Central Hospital, 489-1 Ohta, Gosen 959-1825, Japan
| | - Kentaro Omatsu
- Department of Nursing, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi, Niigata 951-8518, Japan; (E.Y.); (S.S.); (M.U.); (H.M.A.); (Y.K.); (K.O.)
- Division of Emergency Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Niigata 950-3198, Japan
| | - Yu Koyama
- Department of Nursing, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi, Niigata 951-8518, Japan; (E.Y.); (S.S.); (M.U.); (H.M.A.); (Y.K.); (K.O.)
- Correspondence: ; Tel./Fax: +81-25-227-2361
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12
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Treadwell JR, Rouse B, Reston J, Fontanarosa J, Patel N, Mull NK. Consumer Devices for Patient-Generated Health Data Using Blood Pressure Monitors for Managing Hypertension: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e33261. [PMID: 35499862 PMCID: PMC9112087 DOI: 10.2196/33261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/07/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the era of digital health information technology, there has been a proliferation of devices that collect patient-generated health data (PGHD), including consumer blood pressure (BP) monitors. Despite their widespread use, it remains unclear whether such devices can improve health outcomes. Objective We performed a systematic review of the literature on consumer BP monitors that collect PGHD for managing hypertension to summarize their clinical impact on health and surrogate outcomes. We focused particularly on studies designed to measure the specific effect of using a BP monitor independent of cointerventions. We have also summarized the process and consumer experience outcomes. Methods An information specialist searched PubMed, MEDLINE, and Embase for controlled studies on consumer BP monitors published up to May 12, 2020. We assessed the risk of bias using an adapted 9-item appraisal tool and performed a narrative synthesis of the results. Results We identified 41 different types of BP monitors used in 49 studies included for review. Device engineers judged that 38 (92%) of those devices were similar to the currently available consumer BP monitors. The median sample size was 222 (IQR 101-416) participants, and the median length of follow-up was 6 (IQR 3-12) months. Of the included studies, 18 (36%) were designed to isolate the clinical effects of BP monitors; 6 of the 18 (33%) studies evaluated health outcomes (eg, mortality, hospitalizations, and quality of life), and data on those outcomes were unclear. The lack of clarity was due to low event rates, short follow-up duration, and risk of bias. All 18 studies that isolated the effect of BP monitors measured both systolic and diastolic BP and generally demonstrated a decrease of 2 to 4 mm Hg in systolic BP and 1 to 3 mm Hg in diastolic BP compared with non–BP monitor groups. Adherence to using consumer BP monitors ranged from 38% to 89%, and ease of use and satisfaction ratings were generally high. Adverse events were infrequent, but there were a few technical problems with devices (eg, incorrect device alerts). Conclusions Overall, BP monitors offer small benefits in terms of BP reduction; however, the health impact of these devices continues to remain unclear. Future studies are needed to examine the effectiveness of BP monitors that transmit data to health care providers. Additional data from implementation studies may help determine which components are critical for sustained BP improvement, which in turn may improve prescription decisions by clinicians and coverage decisions by policy makers.
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Affiliation(s)
| | | | | | | | - Neha Patel
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nikhil K Mull
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, PA, United States
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Farinatti P, Pescatello LS, Crisafulli A, Taiar R, Fernandez AB. Editorial: Post-Exercise Hypotension: Clinical Applications and Potential Mechanisms. Front Physiol 2022; 13:899497. [PMID: 35492589 PMCID: PMC9039323 DOI: 10.3389/fphys.2022.899497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Paulo Farinatti
- Laboratory of Physical Activity and Health Promotion, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- *Correspondence: Paulo Farinatti,
| | - Linda S. Pescatello
- Department of Kinesiology, University of Connecticut, Mansfield, CT, United States
| | - Antonio Crisafulli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Redha Taiar
- Department of Sport Science, Reims University, Reims, France
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Day C, Wu Y, Pescatello LS. Evaluating the Methodological Quality of Postexercise Hypotension Aerobic Exercise Interventions. Front Physiol 2022; 13:851950. [PMID: 35360233 PMCID: PMC8960741 DOI: 10.3389/fphys.2022.851950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPostexercise hypotension (PEH) is the immediate reduction in blood pressure (BP) of 5–8 mmHg that occurs after a single bout of aerobic exercise among adults with hypertension. Across PEH studies, there are variations in the level of rigor of the study designs and methods that limit the conclusions that can be made about PEH.ObjectiveTo develop and then apply a methodological study quality evaluation checklist to aerobic exercise PEH studies to provide methodological guidance.MethodsWe developed a PEH checklist (PEH√list) based upon contemporary methodological study quality standards. The PEH√list contains 38 items divided into three categories: sample (n = 10 items), study (n = 23 items), and intervention characteristics (n = 5 items). We then systematically searched six databases to January 2019 to identify and then evaluate studies that: (1) enrolled adults ≥18 years with hypertension and without other chronic diseases or conditions; (2) included a bout of aerobic exercise and a non-exercise control session; and (3) were published in English.ResultsOf 17,149 potential studies, 64 qualified. Participants (N = 1,489) were middle-aged (38.6 ± 15.6 year), overweight (26.1 ± 2.5 kg/m2) mostly men (64.4%) with elevated BP (systolic BP 129.5 ± 15.2/diastolic BP 81.0 ± 10.1 mmHg). Overall, the qualifying studies satisfactorily reported 53.9 ± 13.3% (24.2–82.8%) of the relevant items on the PEH√list. Of note, only 20.3% of the studies disclosed BP was measured following professional guidelines, 18.8% reported BP was taken by the same assessor pre- and post-intervention, and 35.5% stated participants abstained from caffeine, alcohol, and physical activity prior to testing. Half (51.5%) indicated they statistically controlled for pre-exercise/baseline BP. Meanwhile, 100% of the studies reported the setting in which the BP measurements were taken, time from the end of the exercise to the start of the BP measurements, and if relevant, the length of the ambulatory BP monitoring period.ConclusionOverall, the PEH√list items were not well satisfied; especially items with potential confounding effects on PEH. We contend the PEH√list provides guidance to investigators on the important methodological study considerations in PEH aerobic exercise studies that should be attended to in the future.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [#CRD42020221996].
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Affiliation(s)
- Christina Day
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- *Correspondence: Christina Day,
| | - Yin Wu
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States
| | - Linda S. Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States
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15
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Swift HT, O'Driscoll JM, Coleman DD, Caux AD, Wiles JD. Acute cardiac autonomic and haemodynamic responses to leg and arm isometric exercise. Eur J Appl Physiol 2022; 122:975-985. [PMID: 35089384 DOI: 10.1007/s00421-022-04894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/13/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Acute cardiovascular responses following a single session of isometric exercise (IE) have been shown to predict chronic adaptations in blood pressure (BP) regulation. It was hypothesised that exercises which recruit more muscle mass induce greater reductions in BP compared to exercises using smaller muscle mass. To test this hypothesis, the current study aimed to compare the acute haemodynamic and autonomic responses to a single session of isometric wall squat (IWS) and isometric handgrip (IHG) training. METHODS Twenty-six sedentary participants performed a single IWS and IHG session in a randomised cross-over design, with training composed of 4 × 2-min contractions, with 2-min rest, at 95 HRpeak and 30% MVC respectively. Haemodynamic and cardiac autonomic variables were recorded pre, during, immediately post, and 1-h post-exercise, with the change from baseline for each variable used for comparative analysis. RESULTS During IWS exercise, there was a significantly greater increase in systolic BP (P < 0.001), diastolic BP (P < 0.001), mean BP (P < 0.001), heart rate (P < 0.001), and cardiac output (P < 0.001), and a contrasting decrease in baroreflex effectiveness index (BEI) and cardiac baroreceptor sensitivity (cBRS). In the 10-min recovery period following IWS exercise, there was a significantly greater reduction in systolic BP (P = 0.005), diastolic BP (P = 0.006), mean BP (P = 0.003), total peripheral resistance (TPR) (P < 0.001), BEI (P = 0.003), and power spectral density (PSD-RRI) (P < 0.001). There were no differences in any variables between conditions 1-h post exercise. CONCLUSIONS Isometric wall squat exercise involving larger muscle mass is associated with a significantly greater post-exercise hypotensive response during a 10-min recovery window compared to smaller muscle mass IHG exercise. The significantly greater reduction in TPR may be an important mechanism for the differences in BP response.
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Affiliation(s)
- Harry T Swift
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK
| | - Jamie M O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK
| | - Damian D Coleman
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK
| | - Anthony De Caux
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK
| | - Jonathan D Wiles
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK.
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16
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Lapointe T, Trudeau F, Sia YT, Houle J. Post-exercise hypotensive response in stroke patients following acute moderate or high intensity cycling session. J Sports Med Phys Fitness 2021; 62:974-980. [PMID: 34651612 DOI: 10.23736/s0022-4707.21.12823-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypertension is highly prevalent in stroke patients and reducing blood pressure is a priority. Aerobic exercise is known to induce post-exercise hypotensive responses, but limited studies have documented this concept in stroke patients. The purpose was to investigate the effect of a single bout of moderate intensity continuous training (MICT) and high intensity interval training (HIIT) on post-exercise ambulatory blood pressure with patients with prior ischemic stroke or transient ischemic attack (TIA). METHODS Ten hypertensive adults (mean age: 70 ± 9 years) with prior ischemic stroke or TIA participated using a randomized crossover design. Ambulatory blood pressure was monitored for up to 8 hours after isocaloric either ergocycle MICT or HIIT of respectively 50% and 95% of peak power output. Blood pressure was compared to pre-exercise resting measure. RESULTS HIIT and MICT induced a decrease of systolic blood pressure of -11.0 ± 9.2 mmHg and -4.7 ± 4.5 mmHg respectively (p= 0.03) immediately after the exercise. Ambulatory systolic blood pressure showed a steady linear increase (R2 = 0.90; p< 0.001) of ~1.2 mmHg/hour and returned to pre-exercise measure after 8 hours. Effect of the two exercise conditions over time did not significantly differ (p= 0.278). Diastolic blood pressure was not affected by both exercises. CONCLUSIONS Those results suggest that HIIT induce a systolic blood pressure reduction of greater magnitude than MICT immediately after cycling exercise among patients with prior ischemic stroke or TIA. For both exercises, effects on ambulatory blood pressure are similar and persist up to 8 hours.
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Affiliation(s)
- Thalia Lapointe
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada -
| | - François Trudeau
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Ying T Sia
- Centre intégré universitaire de santé et de services de la Mauricie and Centre-du-Québec, Trois-Rivières, Québec, Canada
| | - Julie Houle
- Centre intégré universitaire de santé et de services de la Mauricie and Centre-du-Québec, Trois-Rivières, Québec, Canada.,Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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17
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Sardana M, Lin H, Zhang Y, Liu C, Trinquart L, Benjamin EJ, Manders ES, Fusco K, Kornej J, Hammond MM, Spartano N, Pathiravasan CH, Kheterpal V, Nowak C, Borrelli B, Murabito JM, McManus DD. Association of Habitual Physical Activity With Home Blood Pressure in the Electronic Framingham Heart Study (eFHS): Cross-sectional Study. J Med Internet Res 2021; 23:e25591. [PMID: 34185019 PMCID: PMC8277303 DOI: 10.2196/25591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/22/2021] [Accepted: 03/16/2021] [Indexed: 01/18/2023] Open
Abstract
Background When studied in community-based samples, the association of physical activity with blood pressure (BP) remains controversial and is perhaps dependent on the intensity of physical activity. Prior studies have not explored the association of smartwatch-measured physical activity with home BP. Objective We aimed to study the association of habitual physical activity with home BP. Methods Consenting electronic Framingham Heart Study (eFHS) participants were provided with a study smartwatch (Apple Watch Series 0) and Bluetooth-enabled home BP cuff. Participants were instructed to wear the watch daily and transmit BP values weekly. We measured habitual physical activity as the average daily step count determined by the smartwatch. We estimated the cross-sectional association between physical activity and average home BP using linear mixed effects models adjusting for age, sex, wear time, antihypertensive drug use, and familial structure. Results We studied 660 eFHS participants (mean age 53 years, SD 9 years; 387 [58.6%] women; 602 [91.2%] White) who wore the smartwatch 5 or more hours per day for 30 or more days and transmitted three or more BP readings. The mean daily step count was 7595 (SD 2718). The mean home systolic and diastolic BP (mmHg) were 122 (SD 12) and 76 (SD 8). Every 1000 increase in the step count was associated with a 0.49 mmHg lower home systolic BP (P=.004) and 0.36 mmHg lower home diastolic BP (P=.003). The association, however, was attenuated and became statistically nonsignificant with further adjustment for BMI. Conclusions In this community-based sample of adults, higher daily habitual physical activity measured by a smartwatch was associated with a moderate, but statistically significant, reduction in home BP. Differences in BMI among study participants accounted for the majority of the observed association.
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Affiliation(s)
- Mayank Sardana
- Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, CA, United States
| | - Honghuang Lin
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Yuankai Zhang
- Boston University School of Public Health, Boston, MA, United States
| | - Chunyu Liu
- Boston University School of Public Health, Boston, MA, United States
| | - Ludovic Trinquart
- Boston University School of Public Health, Boston, MA, United States
| | - Emelia J Benjamin
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States.,Boston University School of Public Health, Boston, MA, United States.,Framingham Heart Study, Framingham, MA, United States
| | | | - Kelsey Fusco
- Framingham Heart Study, Framingham, MA, United States
| | - Jelena Kornej
- Framingham Heart Study, Framingham, MA, United States
| | | | - Nicole Spartano
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | | | | | | | - Belinda Borrelli
- Henry M Goldman School of Dental Medicine, Center for Behavioral Science Research, Boston University, Boston, MA, United States
| | - Joanne M Murabito
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States.,Framingham Heart Study, Framingham, MA, United States
| | - David D McManus
- Department of Medicine, UMass Medical School, Worcester, MA, United States
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Teixeira E, Fonseca H, Diniz-Sousa F, Veras L, Boppre G, Oliveira J, Pinto D, Alves AJ, Barbosa A, Mendes R, Marques-Aleixo I. Wearable Devices for Physical Activity and Healthcare Monitoring in Elderly People: A Critical Review. Geriatrics (Basel) 2021; 6:38. [PMID: 33917104 PMCID: PMC8167657 DOI: 10.3390/geriatrics6020038] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 01/22/2023] Open
Abstract
The availability of wearable devices (WDs) to collect biometric information and their use during activities of daily living is significantly increasing in the general population. These small electronic devices, which record fitness and health-related outcomes, have been broadly utilized in industries such as medicine, healthcare, and fitness. Since they are simple to use and progressively cheaper, they have also been used for numerous research purposes. However, despite their increasing popularity, most of these WDs do not accurately measure the proclaimed outcomes. In fact, research is equivocal about whether they are valid and reliable methods to specifically evaluate physical activity and health-related outcomes in older adults, since they are mostly designed and produced considering younger subjects' physical and mental characteristics. Additionally, their constant evolution through continuous upgrades and redesigned versions, suggests the need for constant up-to-date reviews and research. Accordingly, this article aims to scrutinize the state-of-the-art scientific evidence about the usefulness of WDs, specifically on older adults, to monitor physical activity and health-related outcomes. This critical review not only aims to inform older consumers but also aid researchers in study design when selecting physical activity and healthcare monitoring devices for elderly people.
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Affiliation(s)
- Eduardo Teixeira
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Faculty of Psychology, Education and Sports, Lusófona University of Porto, 4000-098 Porto, Portugal
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, 4900-347 Viana do Castelo, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Florêncio Diniz-Sousa
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Lucas Veras
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Giorjines Boppre
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - José Oliveira
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Diogo Pinto
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University Institute of Maia, 4475-690 Maia, Portugal
| | - Alberto Jorge Alves
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University Institute of Maia, 4475-690 Maia, Portugal
| | - Ana Barbosa
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal
| | - Romeu Mendes
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal
- Northern Region Health Administration, 4000-477 Porto, Portugal
| | - Inês Marques-Aleixo
- Research Centre in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Faculty of Psychology, Education and Sports, Lusófona University of Porto, 4000-098 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
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Predictors of Metabolic Syndrome in Adults and Older Adults from Amazonas, Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031303. [PMID: 33535582 PMCID: PMC7908119 DOI: 10.3390/ijerph18031303] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/01/2021] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
Metabolic syndrome has been considered a factor of vulnerability and a major public health problem because it increases the risk of cardiovascular disease and type 2 diabetes. The present study from Amazonas, Brazil aimed to estimate the prevalence of the individual and general components of metabolic syndrome in adults and older adults and identify the independent predictors of metabolic syndrome. The sample of the present cross-sectional study comprised 942 participants (590 women), with a mean age of 59.8 ± 19.7 (range: 17.5 to 91.8). Blood pressure in men (62.5%), abdominal obesity in women (67.3%), and lower high-density lipoprotein cholesterol (HDL-C) in both (52.2% in men and 65.0% in women) were the most prevalent individual risk factors for metabolic syndrome. Women had a higher prevalence of abdominal obesity (p < 0.001), low HDL-C (p < 0.001), and metabolic syndrome (p < 0.001) than men; however, opposite results were seen in men for blood pressure (p < 0.001). The overall prevalence of metabolic syndrome was 47.5%. Advanced age, being female, having a higher body mass index, and a having lower educational level independently increased the odds of metabolic syndrome. Due to the association of metabolic syndrome with deterioration of health status and increased vulnerability, this study sustains the need for early public health interventions in the Amazonas region.
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Lopes J, Fonseca M, Torres-Costoso A, López-Muñoz P, Alves AJ, Magalhães P, Ribeiro F. Low- and moderate-intensity aerobic exercise acutely reduce blood pressure in adults with high-normal/grade I hypertension. J Clin Hypertens (Greenwich) 2021; 22:1732-1736. [PMID: 33460204 DOI: 10.1111/jch.14000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/07/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022]
Abstract
The aim of the study is to compare the acute effects of low- and moderate-intensity aerobic exercise on post-exercise blood pressure in active adults with high-normal/grade I hypertension. Thirteen physically active adults (67.0 ± 8.7 years) randomly completed two aerobic exercise sessions of 30 minutes at low (30% heart rate reserve [HRres]) and moderate (60% HRres) intensity. Blood pressure was assessed pre-session and every hour until 3 hours after. Systolic blood pressure decreased after both exercise intensities without significant differences between sessions at 1 hour after the session (30%: -10.0 ± 12.6% vs 60%: -11.4 ± 12.7 mm Hg, P > .05). Three hours after the 60% session, the systolic blood pressure remained significantly lower than baseline (139.9 ± 12.9 to 129.3 ± 11.9 mm Hg, P < .05), but without significant differences between sessions. No relevant changes were observed in diastolic and mean blood pressure. In conclusion, a single session of aerobic exercise acutely reduces systolic blood pressure in active adults with high-normal/grade I hypertension.
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Affiliation(s)
- José Lopes
- Institute of Biomedicine - iBiMED, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Márcio Fonseca
- School of Higher Education, Polytechnic Institute of Bragança, Bragança, Portugal
| | - Ana Torres-Costoso
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, Spain
| | | | - Alberto Jorge Alves
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, Maia, Portugal
| | - Pedro Magalhães
- School of Higher Education, Polytechnic Institute of Bragança, Bragança, Portugal
| | - Fernando Ribeiro
- Institute of Biomedicine - iBiMED, School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Al-Rousan T, Pesantes MA, Dadabhai S, Kandula NR, Huffman MD, Miranda JJ, Vidal-Perez R, Dzudie A, Anderson CAM. Patients' perceptions of self-management of high blood pressure in three low- and middle-income countries: findings from the BPMONITOR study. Glob Health Epidemiol Genom 2020; 5:e4. [PMID: 32742666 PMCID: PMC7372177 DOI: 10.1017/gheg.2020.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022] Open
Abstract
Hypertension is the leading risk factor for global disease burden. Self-management of high blood pressure (BP) through self-monitoring and self-titration of medications, has proved to be one successful and cost-effective tool to achieve better BP control in many high-income countries but not much is known about its potential in low- and middle-income countries (LMICs). We used semi-structured questionnaires and focus groups in three LMICs; Peru, Cameroon and Malawi to examine perceptions and attitudes of patients diagnosed with essential hypertension towards living with hypertension, BP measurement and treatment, patient-physician relationship and opinions about self-management of high blood pressure. Results in all three countries were comparable. Patients showed varied levels of health literacy related to hypertension. BP measurement habits were mostly affected by resources available and caregiver support. Treatment and adherence to it were primarily affected by cost. Most patients were welcoming of the idea of self-management but skeptical about the ability to do self-monitoring accurately and the safety involving self-titration of medications.
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Affiliation(s)
- Tala Al-Rousan
- Department of Medicine, University of California San Diego School of Medicine Division of Global Public Health, La Jolla, USA
| | - M. Amalia Pesantes
- Department of Medicine, Universidad Peruana Cayetano Heredia, CRONICAS Centre of Excellence in Chronic Diseases, Peru
| | - Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Namratha R. Kandula
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Mark D. Huffman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - J. Jaime Miranda
- Department of Medicine, Universidad Peruana Cayetano Heredia, CRONICAS Centre of Excellence in Chronic Diseases, Peru
| | - Rafael Vidal-Perez
- Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy (CRENC), Yaounde, Cameroon
| | - Cheryl A. M. Anderson
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, USA
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