Effect of diet and exercise on pulse pressure and cardiac function in morbid obesity: analysis of 24-hour ambulatory blood pressure

Effect of weight loss on blood pressure changes in overweight patients: A systematic review and meta-analysis

To determine quantitative differences between weight loss and changes in clinic blood pressure (BP) and ambulatory BP in patients with obesity or overweight, the authors performed a meta-analysis. PubMed, Embase, and Scopus databases were searched up to June 2022. Studies that compared clinic or ambulatory BP with weight loss were included. A random effect model was applied to pool the differences between clinic BP and ambulatory BP. Thirty-five studies, for a total of 3219 patients were included in this meta-analysis. The clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly reduced by 5.79 mmHg (95% CI, 3.54-8.05) and 3.36 mmHg (95% CI, 1.93-4.75) after a mean body mass index (BMI) reduction of 2.27 kg/m² , and the SBP and DBP were significantly reduced by 6.65 mmHg (95% CI, 5.16-8.14) and 3.63 mmHg (95% CI, 2.03-5.24) after a mean BMI reduction of 4.12 kg/m² . The BP reductions were much larger in patients with a BMI decrease ≥3 kg/m² than in patients with less BMI decrease, both for clinic SBP [8.54 mmHg (95% CI, 4.62-12.47)] versus [3.83 mmHg (95% CI, 1.22-6.45)] and clinic DBP [3.45 mmHg (95% CI, 1.59-5.30)] versus [3.15 mmHg (95% CI, 1.21-5.10)]. The significant reduction of the clinic and ambulatory BP followed the weight loss, and this phenomenon could be more notable after medical intervention and a larger weight loss.

Blood Pressure Changes After a Health Promotion Program Among Mexican Workers

Background: Cardiovascular disease is becoming increasingly prevalent in low and middle-income countries (LMIC), and high blood pressure (BP) is one of the main risk factors. The efficacy and sustainability of worksite health promotion (WHP) programs for BP reduction in LMIC have yet to be determined. Methods: This non-randomized company-based trial evaluated 6- and 12-months effects of a WHP intervention on BP among 2,002 participating workers from seven Mexican companies. Intervention and control groups were assigned at the company level. The intervention included nutrition counseling, physical exercise, and stress management components. Mixed models assessed differences in BP change between intervention and control companies in intent-to-treat (ITT), per-protocol (PerP), and as-treated (AsTr) analyses, and also within-group changes stratified by company, intervention component, and baseline cardiovascular risk factor levels. All analyses were adjusted for potential confounders. We accounted for missing data and loss to follow-up using inverse probability of censoring weighting. Results: ITT analyses revealed mean BP change differences of -1.1 mmHg at 12 months (95% CI: -2.9; 0.6) in intervention companies relative to control companies. PerP and AsTr analyses confirmed this finding. Within-group analyses showed consistent BP reductions at both 6 and 12 months. Substantial differences in BP changes ranging from diastolic -6.1 mmHg, (95% CI: -11.2; -1.2) to systolic -13.0 mmHg (95% CI: -16.0; -10.1) were found among individuals with diabetes at baseline in intervention companies relative to control companies. Conclusion: After 1 year, WHP was associated with modest but uncertain BP reductions. Substantial reductions were mainly observed among diabetic workers.

Moderate Physical Training Ameliorates Cardiovascular Dysfunction Induced by High Fat Diet After Cessation of Training in Adult Rats

We aimed to test whether moderate physical training can induce long-lasting protection against cardiovascular risk factors induced by high fat diet (HFD) intake, even after cessation of training. 90-days-old Wistar rats were submitted to a sedentary lifestyle or moderate physical training, three times a week, for 30 days. Following this, at 120 days-of age, sedentary and trained rats received a hypercaloric diet (HFD) or a commercial diet normal fat diet (NFD) for 30 days. Body weight (BW) and food intake were evaluated weekly. At 150 days-of age, hemodynamic measures (systolic, diastolic, mean blood pressure, pulse pressure, pulse interval and heart rate) were made via an indwelling femoral artery catheter. Beat-to-beat data were analyzed to calculate power spectra of systolic blood pressure (SBP) and pulse interval. After euthanasia, mesenteric fat pads were removed and weighted and total blood was stored for later analysis of lipid profile. Consumption of a HFD increased blood pressure (BP), pulse pressure, low frequency BP variability, BW gain, fat pad stores and induced dyslipidemia. Interestingly, prior physical training was able to partially protect against this rise in BP and body fat stores. Prior physical training did not totally protect against the effects of HFD consumption but previously trained animals did demonstrate resistance to the development of cardiometabolic alterations, which illustrate that the benefits of physical training may be partially maintained even after 30 days of detraining period.

How do diet and exercise programmes affect the cardiovascular risk profiles of obese children?

Obesity is a global health issue in both children and adults. Besides its comorbidities, cardiac structure and functions may be impaired from childhood if obesity is not controlled in the growing years. The effects of diet and exercise on the cardiovascular functions and biochemical parameters of obese children were evaluated in this study.In a tertiary hospital, 6-16-year-old of mean age 10.8±2.3 years, non-random voluntarily selected 34 obese children with body mass index above 95th percentile and no syndromic or systemic illnesses were enrolled in this prospective study. Weights, heights, and blood pressures were recorded. Cardiac functions were evaluated by M-mode and tissue Doppler echocardiography. Glucose, HbA1c, cholesterol, triglyceride, liver enzyme, and thyroid hormone levels were analysed. These measurements were repeated after a 6-month diet and exercise programme. The results were compared statistically.Echocardiography of the obese children after diet and exercise showed significantly increased ejection fraction, fractional shortening, mitral annular plane systolic excursion and mitral systolic velocity values, associated with the systolic ventricular functions, and decreased tissue Doppler mitral and tricuspid early diastolic velocities, related with the early diastolic ventricular functions, compared with before diet and exercise (p<0.05). Moreover, the body mass index, glucose, cholesterol, and triglyceride levels significantly decreased after diet and exercise (p<0.05).The systolic and early diastolic cardiac functions are impaired and the biochemical parameters are distorted starting from the childhood because of the obesity. Regular diet and exercise provide significant improvement. Cardiac evaluation should be routinely performed in all obese children and they should be encouraged for a regular diet and exercise for better cardiovascular health.

Non-adherence in Hypertension Management Deficit in Information or Trust?

Hypertension, a leading cause of cardiovascular morbidity and mortality worldwide, continues to challenge health professionals. There are too many patients with uncontrolled hypertension who end up with life altering or life ending complications. Over the years so much hypertension research has been conducted; and numerous effective antihypertensive drugs have been discovered and yet the rate of blood pressure control remains unacceptably low. It is high time that we focused our attention on the optimal use of the available knowledge and medications. More emphasis on teaching the patients and the public at large is required and patients need to have full trust of their health care providers in order to adhere to the prescriptions provided. If patients take their medications as prescribed and follow therapeutic lifestyle changes like physical activity and calorie and salt restrictions, there would be very few patients with uncontrolled hypertension and its complications.

Obesity and Cardiovascular Diseases in a High-Risk Population: Evidence-Based Approach to CHD Risk Reduction

BACKGROUND

Obesity is becoming a worldwide public health problem and it is expected to worsen as its prevalence is increasing in children and adolescents. This report examined the distribution of major cardiovascular disease (CVD) risk factors and the effect of life-style changes on coronary heart disease (CHD) risk prediction in a high risk obese African Americans.

METHODS

We examined the baseline distribution of CVD risk factors in 515 obese African Americans, with mean BMI of 42.9 ± 6.8 kg/m2, and prospectively the effect of a 6-month low-salt, low-fat diet and aerobic-exercise intervention program on risk reduction.

RESULTS

Prevalence of hypertension, dyslipidemia, and diabetes mellitus were 57%, 27% and 24% respectively. Metabolic syndrome was present in 36% and 39% met two features of the syndrome. The 10-year risk prediction for developing CHD ranged from 4% to 17% for women and 6% to 29% for men. After 6 months of life-style changes, many of the risk factors improved, and the CHD risk scores decreased from 6% to 4% in the women and 16% to 13% in the men.

CONCLUSION

The high prevalence and increasing incidence of obesity and associated cardiovascular risk emphasizes the need to focus on obesity reduction in this high risk population.

Effect of aerobic exercise training on arterial stiffness in obese populations : a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Controversy exists as to whether aerobic exercise training decreases arterial stiffness in obese subjects. The aim of this study was to systematically review and quantify the effect of aerobic exercise training on arterial stiffness in obese populations.

METHODS

MEDLINE, Cochrane, Scopus, and Web of Science were searched up until May 2013 for trials assessing the effect of aerobic training interventions lasting 8 weeks or more on arterial stiffness in obese populations (body mass index ≥30 kg/m(2)). Standardized mean difference (SMD) in arterial stiffness parameters (augmentation index, β-stiffness, distensibility, pulse wave velocity, arterial waveforms) was calculated using a random-effects model. Subgroup and meta-regression analyses were used to study potential moderating factors.

RESULTS

Eight trials, comprising a total of 235 subjects with an age range of 49-70 years, met the inclusion criteria. Arterial stiffness was not significantly reduced by aerobic training (SMD -0.17; 95 % confidence interval (CI) -0.39, 0.06, P = 0.14). Similarly, post-intervention arterial stiffness was similar between the aerobic-trained and control obese groups (SMD 0.02; 95 % CI -0.28, 0.32, P = 0.88). Neither heterogeneity nor publication bias were detected in these analyses. In subgroup analyses, arterial stiffness was significantly reduced in aerobic-trained subgroups having below median values in post- minus pre-intervention systolic blood pressure (SBP) (P < 0.01), exercise intensity rating score (P < 0.01), and methodological quality score (P < 0.01). Equivalent results were obtained in meta-regression analyses.

CONCLUSION

Based on current published trials, arterial stiffness is generally not reduced in middle-aged and older obese populations in response to aerobic training. However, in studies using low-intensity aerobic training and yielding a decrease in SBP, arterial stiffness may decrease. Long-term studies are needed to assess the prognostic value of these findings.

Physical exercise and morbid obesity: a systematic review

INTRODUCTION

Physical exercise is an important component for the treatment of obesity. Little information is available about the best and safety form of physical exercise concerning the type and volume-intensity to be prescribed for individuals with morbid obesity.

AIM

To investigate the effect of physical exercise programs in medical and surgical treatment for morbid obesity.

METHODS

Was used the systematic search model by databases of the Virtual Health Library in "Science in General Health" (Medline, Lilacs and Ibecs) and PubMed using the following headings: morbid obesity, severe obesity, grade 3 obesity, exercise and physical activity. Were selected papers that used physical exercise programs as an intervention in the treatment for morbid obese patients and those who were in accordance with the inclusion criteria.

RESULTS

Were selected 13 articles. Eight were conducted with individuals in clinical treatment, one in patients awaiting bariatric surgery and four in the postoperative period. It was observed that all selected studies used aerobic activities and six also included strength exercises on their programs.

CONCLUSIONS

Aerobic and strength exercises programs proved being important components in the treatment of morbid obesity. Special care when establishing the volume-intensity exercise is required for adherence to treatment, and a proposal for a valid individualized exercise programs.

Júnior CG, Dias RMR. Efeito do treinamento físico na pressão arterial de adolescentes com obesidade

OBJETIVO: Descrever, por meio de uma revisão sistemática, os efeitos do treinamento físico sobre a pressão arterial em adolescentes com obesidade. FONTES DE DADOS: Recorreu-se à revisão sistemática de ensaios clínicos randomizados que analisaram o efeito do treinamento físico sobre a pressão arterial de adolescentes obesos, publicados em periódicos indexados nas bases de dados PubMed/Medline, Lilacs, SciELO e ISI Web of KnowledgeSM. Foram incluídos os estudos que avaliaram adolescentes publicados até 2010, e que possuíam Grupo Controle. SÍNTESE DOS DADOS: Oito estudos atenderam aos critérios de inclusão. Dois deles utilizaram exercícios de força combinados com aeróbios, enquanto seis empregaram apenas os aeróbios. Cinco estudos utilizaram intervenções complementares, sendo a nutricional a mais frequente. Quatro estudos observaram redução da pressão arterial sistólica no Grupo Exercício comparado ao Controle. Nesses quatro estudos, além da redução da pressão arterial, notou-se diminuição da massa corpórea. Todos aqueles que verificaram redução da pressão arterial utilizaram 12 a 24 semanas de exercícios aeróbios, três a seis sessões semanais, com duração de 50 a 90 minutos e intensidade entre 55 e 75% da frequência cardíaca máxima. CONCLUSÕES: O efeito do treinamento físico na pressão arterial de adolescentes obesos é controverso. A redução da pressão arterial parece ocorrer com programas de treinamento aeróbios que promovam também a redução da massa corpórea.

Preventing obesity in the primary care setting

This article outlines steps on how to move the treatment of obesity to a new paradigm of prevention in the primary care setting. Almost all Americans visit their primary care physician or health care provider for routine health maintenance or some unexpected illness or sickness at one point or another. The primary care office is the most likely entry point to the health care system for most of the population and should be the preferred venue for addressing chronic disease prevention. Prevention in the primary care setting is the short- and long-term solution to obesity.

Impact of obesity and bariatric surgery on cardiovascular disease

Morbid obesity is a growing public health concern with multiple associated cardiovascular comorbidities. Bariatric surgery has emerged as a safe and effective treatment for morbidly obese patients at risk for, or already suffering from, cardiovascular disease. Weight loss induced by the surgery has been shown to improve cardiovascular risk factors, cardiac structure and function, and the clinical course of established cardiovascular disease. The role of adipocyte-derived cytokines in mediating cardiovascular pathophysiology in obesity-and its modulation after weight loss-is under active investigation.