The Effect of Exercise on the Older Adult's Blood Pressure Suffering Hypertension: Systematic Review and Meta-Analysis on Clinical Trial Studies

Yoga-based lifestyle intervention for healthy ageing in older adults: a two-armed, waitlist randomized controlled trial with multiple primary outcomes

Yoga-based clinical research has shown considerable promise in varied ageing-related health outcomes in older adults. However, robust frameworks have yet to be used in intervention research to endorse yoga as a healthy ageing intervention to test the multidimensional construct of healthy ageing. This was an assessor-masked, randomized controlled trial conducted among 258 sedentary, community-dwelling older adults aged 60-80 years, randomly allocated to 26-week yoga-based intervention (YBI) (n = 132) or waitlist control (WLC) (n = 126). The effectiveness of YBI was assessed through two separate global statistical tests, generalized estimating equations and rank sum-based test, against a comprehensive healthy aging panel comprised of ten markers representing the domains of physiological and metabolic, cognitive, physical capability, psychological, and social well-being. The secondary outcomes were individual primary marker scores, Klotho, inflammatory markers, and auxiliary blood markers. We could establish the healthy aging effect of the 26-week YBI over WLC using two models of global statistical test (GEE, β = 0.29; 95% CI = 0.20 to 0.38, p < 0.001), and rank sum-based test (β = 0.28, 95% CI = 0.19 to 0.36, p < 0.001). There were also significant improvements in direction of benefit at individual levels of all the aging markers. Exploratory evaluation with adopted indices from contemporary clinical trials also validated the potential of YBI for healthy aging; HATICE adapted composite score (mean difference =  - 0.18; 95% CI =  - 0.26 to - 0.09, p < 0.001) and healthy ageing index (mean difference =  - 0.33; 95% CI =  - 0.63 to - 0.02, p = 0.03). The global effect of YBI across multiple ageing-related outcomes provides a proof of concept for further large-scale validation. The findings hold a great translational value given the accelerated pace of population aging across the globe. Trial registration: CTRI/2021/02/031373.

Managing Hypertension in Older Adults

PURPOSE OF REVIEW

The population of older adults 60-79 years globally is projected to double from 800 million to 1.6 billion between 2015 and 2050, while adults ≥ 80 years were forecast to more than triple from 125 to 430 million. The risk for cardiovascular events doubles with each decade of aging and each 20 mmHg increase of systolic blood pressure. Thus, successful management of hypertension in older adults is critical in mitigating the projected global health and economic burden of cardiovascular disease.

RECENT FINDINGS

Women live longer than men, yet with aging systolic blood pressure and prevalent hypertension increase more, and hypertension control decreases more than in men, i.e., hypertension in older adults is disproportionately a women's health issue. Among older adults who are healthy to mildly frail, the absolute benefit of hypertension control, including more intensive control, on cardiovascular events is greater in adults ≥ 80 than 60-79 years old. The absolute rate of serious adverse events during antihypertensive therapy is greater in adults ≥ 80 years older than 60-79 years, yet the excess adverse event rate with intensive versus standard care is only moderately increased. Among adults ≥ 80 years, benefits of more intensive therapy appear non-existent to reversed with moderate to marked frailty and when cognitive function is less than roughly the twenty-fifth percentile. Accordingly, assessment of functional and cognitive status is important in setting blood pressure targets in older adults. Given substantial absolute cardiovascular benefits of more intensive antihypertensive therapy in independent-living older adults, this group merits shared-decision making for hypertension targets.

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.

Effect of Acute and Chronic Ingestion of Exogenous Ketone Supplements on Blood Pressure: A Systematic Review and Meta-Analysis

Exogenous ketone supplements have been suggested to have potential cardiovascular benefits, but their overall effect on blood pressure is unclear. Our objective was to perform a systematic review and meta-analysis on the effects of exogenous ketone supplements on blood pressure (BP) and concomitant changes in resting heart rate (HR). Five databases were searched on January 27th, 2023, for randomized and non-randomized studies. A random-effects model meta-analysis was performed including all studies jointly and separately for acute and chronic ingestion of ketone supplements. Out of 4012 studies identified in the search, 4 acute and 6 chronic studies with n = 187 participants were included. Pooled results (n = 10) showed no change in systolic (SMD [95% CI]= -0.14 [-0.40; 0.11]; I2= 30%; p = 0.17) or diastolic BP (-0.12 [-0.30; 0.05]; I2= 0%; p = 0.69), with a potential tendency observed toward increased resting heart rate (0.17 [-0.14; 0.47]; I2= 40%; p = 0.10). Similar results for systolic and diastolic BP were observed when assessing separately the effect of acute and chronic ingestion of ketone supplements (p ≥ 0.33). Supplement dosage was found to modulate the increase in resting heart rate (0.019 ± 0.006; p = 0.013; R2=100%), suggesting that higher supplement doses lead to a higher resting heart rate. Based on currently available data, acute or prolonged ingestion of ketone supplements does not seem to modulate BP. However, a tendency for HR to increase after acute ingestion was observed, particularly with higher doses. Higher quality studies with appropriate standardized measurements are needed to confirm these results.

Global Prevalence of Obstructive Sleep Apnea in the Elderly and Related Factors: A Systematic Review and Meta-Analysis Study

PURPOSE

The aims of current meta-analysis was to combine data and statistics on the global prevalence of OSA and related factors in older adults.

DESIGN

A systematic review and meta-analysis.

METHODS

To find related studies, various databases were searched including Embase, PubMed, Scopus, Web of Science (WoS), MagIran, and SID (two local databases) using appropriate keywords, MeSH and controlled vocabulary, with no time limitation up to June, 2021. Heterogeneity of studies was evaluated using I2, and Egger's regression intercept was used to detect publication bias.

FINDINGS

39 studies with a total sample size of 33,353 people were included. The pooled prevalence of OSA in older adults was 35.9% (95% confidence interval: 28.7%-43.8%; I2 = 98.81%). Considering the high heterogeneity of included studies, subgroup analysis was conducted and yielded the most prevalent in Asia continent with 37.0% (95% CI: 22.4%-54.5%; I2 = 97.32%). However, heterogeneity was remained at high level. In the majority of studies, OSA was significantly and positively related to obesity, increased BMI, age, cardiovascular diseases, diabetes, and daytime sleepiness.

CONCLUSIONS

Results of this study showed that global prevalence of OSA in older adults is high and is significantly related to obesity, increased BMI, age, cardiovascular diseases, diabetes, and daytime sleepiness. These findings can be used by experts working on the diagnosis and management of OSA in the geriatric population. These findings can be used by experts on the diagnosis and treatment of OSA in the older adults. Due to high heterogeneity, findings should be interpreted with great caution.

Improved Maximal Workload and Systolic Blood Pressure After Cardiac Rehabilitation Following Thoracic Aortic Repair: A SYSTEMATIC REVIEW AND META-ANALYSIS

PURPOSE

It is of clinical importance to gain more knowledge about the risks and benefits of exercise in patients recovering from thoracic aortic repair. Therefore, the aim of this review was to perform a meta-analysis on changes in cardiorespiratory fitness, blood pressure, and the incidence of adverse events during cardiac rehabilitation (CR) in patients recovering from thoracic aortic repair.

REVIEW METHODS

We performed a systematic review and random-effects meta-analysis of outcomes before versus after outpatient CR in patients recovering from thoracic aortic repair. The study protocol was registered (PROSPERO CRD42022301204) and published. MEDLINE, EMBASE, and CINAHL were systematically searched for eligible studies. Overall certainty of evidence was scored with Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

SUMMARY

We included five studies with data from in total 241 patients. Data from one study could not be used in our meta-analysis because they were provided in a different unit of measure. Four studies with data of 146 patients were included in the meta-analysis. The mean maximal workload increased with 28.7 W (95% CI: 21.8-35.6 W, n = 146, low certainty of evidence). The mean systolic blood pressure during exercise testing increased with 25.4 mm Hg (95% CI: 16.6-34.3, n = 133, low certainty of evidence). No exercise-induced adverse events were reported. These outcomes indicate that CR seems beneficial and safe to improve exercise tolerance in patients recovering from thoracic aortic repair, although outcomes were based on data from a small, heterogeneous group of patients.

Association between Physical Activity Habits with Cardiometabolic Variables, Body Composition, and Physical Performance in Chilean Older Women

This study aimed to associate physical activity habits with cardiometabolic variables (blood pressure, fasting glucose, HDL cholesterol, and triglycerides), body composition (body fat percentage and fat-free mass), and physical performance (handgrip strength (HGS), timed up-and-go (TUG), and walking speed) in Chilean older women. An analytical cross-sectional study analyzed 179 older women with a mean age of 75.4 years distributed into physically inactive (PI) older women (n = 74) and physically active (PA) older women (n = 105). A logistic regression showed that PI older women presented an increased risk of hyperglycemia (OR = 4.70; p = 0.000), high blood pressure (OR = 3.83; p = 0.000), low HDL cholesterol levels (OR = 2.13; p = 0.03), hypertriglyceridemia (OR = 2.54; p = 0.01), excess body fat percentage (OR = 4.33; p = 0.000), low fat-free mass (OR = 2.22; p = 0.02), low HGS in their dominant hand (OR = 3.37; p = 0.001) and non-dominant hand (OR = 3.60; p = 0.0001), and poor performance in TUG (OR = 5.60; p = 0.000) and walking speed (OR = 5.52; p = 0.000). In conclusion, physical inactivity was associated with increased cardiometabolic risk, excess body fat percentage, lower fat-free mass, and poorer physical performance in Chilean older women. At the same time, PA older women showed a lower cardiometabolic risk, better body composition, and better physical performance than PI older women.

Impact of dynamic explosive resistance exercise with elastic bands on pulse pressure in hypertensive older adults: a randomized crossover study

OBJECTIVE

This study aimed to evaluate the acute responses of pulse pressure (PP), SBP, and DBP to dynamic explosive resistance exercise (DERE) with elastic resistance bands in hypertensive older adults.

METHODS

Eighteen hypertensive older adults were randomly assigned to participate in DERE and control sessions. PP, SBP, and DBP were measured before (baseline) and after each session (immediately, 10, and 20 min after the session). The DERE protocol has five sets of two consecutive exercises.

RESULTS

There was an important clinical decrease in PP (Δ = -7.8 mmHg; dz = 0.7) and in DBP (Δ = -6.3 mmHg; dz = 0.6) favoring the exercise session post-20 min in the intersession comparison. DERE also promoted lowering levels in SBP (140.3 ± 16.0 vs. 126.2 ± 14.3 mmHg; Δ = -14.1 mmHg; P  = 0.04) with a large effect size ( dz = 0.9) post-20 min when compared to the control session.

CONCLUSION

Our findings indicate that DERE with elastic resistance bands improved SBP in hypertensive older adults. In addition, our results support the hypothesis that DERE can an important clinical decrease in PP and DBP. According to this, professionals may have additional exercise training possibilities with elastic resistance bands when prescribing resistance exercises for systemic arterial hypertension treatment in this population.

Feasibility and Efficacy of Low-to-Moderate Intensity Aerobic Exercise Training in Reducing Resting Blood Pressure in Sedentary Older Saudis with Hypertension Living in Social Home Care: A Pilot Randomized Controlled Trial

Background and Objectives: The effect of non-pharmacological aerobic exercise training on blood pressure in sedentary older individuals receiving social home care in Saudi Arabia has not been investigated. This study aimed to examine the effects of aerobic exercise on blood pressure in sedentary older Saudis with hypertension residing in these settings. Materials and Methods: A pilot randomized control trial was conducted with 27 sedentary individuals, aged 60-85, diagnosed with hypertension, and living in social home care in Makkah, Saudi Arabia. Recruitment took place between November 2020 and January 2021, and participants were randomly assigned to either the experimental or control group. The experimental group engaged in three 45 min sessions of low-to-moderate intensity aerobic activity per week for eight weeks. This trail was registered with the ISRCTN registry (ISRCTN50726324). Results: Following eight weeks of mild to moderate aerobic exercise training, the primary outcome of resting blood pressure showed a significant reduction in the experimental group (systolic blood pressure: mean difference [MD] = 2.91 mmHg, 95% confidence interval [CI] = 1.61, 4.21, p = 0.001; and diastolic blood pressure: MD = 1.33 mmHg, 95% CI = 1.16, 1.50, p = 0.001) compared to the control group. Within the experimental group, there was also a significant decrease in systolic blood pressure (MD = -2.75 mmHg, 95% CI = -7.73, 2.22, p = 0.005) and diastolic blood pressure (MD = -0.83 mmHg, 95% CI = -5.81, 4.14, p = 0.02). Conclusions: This trial demonstrates the feasibility and potential benefits of low-to-moderate intensity aerobic exercise training in reducing resting blood pressure among sedentary older Saudis with hypertension residing in this aged care setting.

Effects of exergame and bicycle exercise intervention on blood pressure and executive function in older adults with hypertension: A three-group randomized controlled study

Management of hypertension and prevention of cognitive decline are challenging public health problems. However, the effects of exergame intervention on blood pressure (BP) remain to be explored, and whether exergame intervention is an effective alternative to traditional physical exercise intervention for older adults with hypertension remains to be demonstrated. This study aimed to explore the effectiveness of moderate-intensity exergame intervention and bicycle exercise training on BP and executive function in older hypertensive patients. A total of 128 participants were randomly assigned to the exergame intervention group (n = 41), bicycle exercise intervention group (n = 44), and control group (n = 43). The intervention groups exercised for 60 min, 3 times per week, for 16 weeks, while the control group maintained their normal lifestyle. The results revealed that there were no significant differences between two intervention groups and control group in systolic BP and diastolic BP changes (ps > 0.05). Both intervention groups demonstrated significant improvements in working memory when compared with control group (exergame intervention group: -461.9 ms, p = 0.025; bicycle exercise intervention group: -470.1 ms, p = 0.021). There were no significant differences in systolic BP, diastolic BP, or working memory between the two intervention groups after 16 weeks of training (ps > 0.05). No difference in inhibition or cognitive flexibility was observed between the intervention and control groups (ps > 0.05). The current results showed that moderate-intensity exergame intervention did not produce significant benefits in reducing BP, but yielded similar beneficial effects in working memory to that of bicycle exercise intervention. More studies are needed on whether exergame intervention has the potential to be a promising supplemental therapeutic tool for older adults with hypertension.

Aging, aerobic exercise, and cardiovascular health: Barriers, alternative strategies and future directions

Age-associated cardiovascular (CV) dysfunction, namely arterial dysfunction, is a key antecedent to the development of CV disease (CVD). Arterial dysfunction with aging is characterized by impaired vascular endothelial function and stiffening of the large elastic arteries, each of which is an independent predictor of CVD. These processes are largely mediated by an excess production of reactive oxygen species (ROS) and an increase in chronic, low-grade inflammation that ultimately leads to a reduction in bioavailability of the vasodilatory molecule nitric oxide. Additionally, there are other fundamental aging mechanisms that may contribute to excessive ROS and inflammation termed the "hallmarks of aging"; these additional mechanisms of arterial dysfunction may represent therapeutic targets for improving CV health with aging. Aerobic exercise is the most well-known and effective intervention to prevent and treat the effects of aging on CV dysfunction. However, the majority of mid-life and older (ML/O) adults do not meet recommended exercise guidelines due to traditional barriers to aerobic exercise, such as reduced leisure time, motivation, or access to fitness facilities. Therefore, it is a biomedical research priority to develop and implement time- and resource-efficient alternative strategies to aerobic exercise to reduce the burden of CVD in ML/O adults. Alternative strategies that mimic or are inspired by aerobic exercise, that target pathways specific to the fundamental mechanisms of aging, represent a promising approach to accomplish this goal.

12-week Brisk Walking Improved Chronotropic Response in Hypertensive Patients

We investigated the effects of 12-week brisk walking on chronotropic response in hypertensive patients aged 40-69. 77 participants in exercise group underwent 12-week brisk walking, while 66 participants in control group received health education. Chronotropic parameters, resting blood pressure, and physical fitness including peak oxygen consumption (VO_2peak) were measured. After 12 weeks, the systolic blood pressure (SBP) was decreased (-6.104 mmHg, 95%CI -8.913 to -3.295 mmHg, P<0.0001), while metabolic chronotropic relationship (MCR) slope and VO_2peak were increased (0.073, 95%CI 0.001 to 0.145, P=0.046; 1.756 mL/kg/min, 95%CI 0.891 to 2.622 mL/kg/min, P<0.0001) in exercise group compared to baseline. The chronotropic response index (CRI) at 25-75 W load were decreased (-0.210, 95%CI -0.307 to -0.112, P<0.0001; -0.144, 95%CI - 0.204 to -0.083, P<0.0001; -0.078, 95%CI -0.135 to -0.022, P=0.007) in control group after 12 weeks. The relative changes (%Δ) of systolic and diastolic blood pressure were negatively correlated with %ΔVO_2peak (r=-0.233, r=-0.187), while %ΔMCR and %ΔCRI at 50-75 W load were positively correlated with %ΔVO_2peak after 12 weeks (r=0.330, r=0.282, r =0.370). %ΔSBP was also positively correlated with %ΔMCR (r =-0.213). In conclusion, 12-week brisk walking reduced SBP by improving chronotropic response in hypertensive patients aged 40-69. The enhanced chronotropic response was associated with enhanced cardiorespiratory fitness.

Effect of Exercise on Vascular Function and Blood Lipids in Postmenopausal Women: A Systematic Review and Network Meta-Analysis

This study aimed to compare and rank the effectiveness of aerobic exercise (AE), resistance training (RT), combined training (CT), and water exercise (WE) on vascular function and blood lipids in postmenopausal women using a network meta-analysis (NMA).

METHODS

We searched the PubMed, Cochrane, Embase, Web of Science, and EBSCO (SPORTDiscus) databases to identify randomized controlled trials investigating the effects of exercise on vascular function and blood lipids in postmenopausal women. The retrieval period was from inception to March 2022. Two reviewers independently screened the retrieved articles, extracted pertinent data, and assessed the risk of bias of the included studies.

RESULTS

A total of 38 studies involving 1407 patients were included in this study. The results of the NMA indicated that WE had the greatest effect on systolic blood pressure (SBP) (surface under the cumulative ranking [SUCRA] = 84.9) and total cholesterol (TC) (SUCRA = 93.1); CT had the greatest effect on triglycerides (TG) (SUCRA = 96.2), high-density lipoprotein cholesterol (HDL-C) (SUCRA = 94.8), and diastolic blood pressure (DBP) (SUCRA = 91.1); RT had the greatest effect on low-density lipoprotein cholesterol (LDL-C) (SUCRA = 79.4).

CONCLUSION

The results suggest that exercise can effectively improve the PWV, SBP, and DBP and the levels of TC, TG, and LDL-C in postmenopausal women. WE had the best effect on improving TC and SBP. CT had the best effect on improving TG, HDL-C, and DBP. To improve LDL-C, RT can achieve a good effect. Considering the limitations of NMA, more RCTS need to be performed in the future to provide more direct evidence of the effectiveness of various exercise interventions on vascular health in postmenopausal women.

Non-pharmacological interventions for older patients with hypertension: A systematic review and network meta-analysis

OBJECTIVE

To determine the most effective non-pharmacological interventions to control the blood pressure variation in older hypertensive patients.

METHODS

Primary endpoints were office systolic blood pressure (SBP) and diastolic blood pressure (DBP). The quality of evidence was assessed using the "risk of bias 2″ tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. We performed a Bayesian network meta-analysis using R-4.0.2 software to compare the efficacy of interventions.

RESULTS

36 eligible studies (3,531 patients) with a median follow-up of 12 weeks, assessing 18 non-pharmacological interventions, were included. The percentages of high, moderate, low, and very low certainty evidence were 16.7%, 38.9%, 33.3%, and 11.1%, respectively.

CONCLUSION

High certainty evidence suggests that self-management education is most effective in lowering SBP and DBP in older patients with hypertension, followed by moderate-intensity aerobic exercise. Moderate-intensity resistance training is the most effective exercise for lowering SBP.

REGISTRATION

PROSPERO, #CRD42020209850.

Inter-individual variations in response to aerobic and resistance training in hypertensive older adults

BACKGROUND

Hemodynamic responses to physical training are not homogenous and uniform, and considerable inter-individual variations in the blood pressure of hypertensive individuals are noted in both aerobic and resistance training protocols. In this context, this study aimed to evaluate the effects of resistance and aerobic exercise on the blood pressure responses of hypertensive older adults.

METHODS

Groups were randomly divided into resistance training, n = 20; aerobic training, n = 20; control group, n = 21). After the first intervention period (12 weeks), individuals underwent a washout period (six detraining weeks), followed by a second intervention. This process is called the 'cross-over' model, where individuals who performed the aerobic exercise protocol also performed resistance training and vice-versa, constituting another 12 weeks of intervention. Blood pressure, functional performance, glycated hemoglobin and lipid profiles were evaluated preintervention and postintervention.

RESULTS

Varying responses to resistance training or aerobic training stimuli were observed in the hypertensive older adult participants. Both resistance training (pre 133.2 ± 14.1; post 122.4 ± 7.3; P < 0.05) and aerobic training (pre 134.2 ± 14.4; post 123 ± 9.4; P < 0.0.5) were effective in decreasing SBP, but only aerobic training (pre 9955.3 ± 1769.4; post 8800.9 ± 1316.1; P < 0.05) resulted in a decreased double product, and only the resistance training group improved functional performance.

CONCLUSION

Responses to resistance training or aerobic training stimuli varied noticeably between hypertensive older adults and both resistance training and aerobic training were effective in reducing SBP. This knowledge may be useful in providing individually tailored exercise prescriptions for hypertensive older adults.

Effects of low-to-moderate physical activities on older adults with chronic diseases: A systematic review and meta-analysis

AIM

Examined the evidence of low-to-moderate-intensity physical activities to assess the effect in managing hypertension, diabetes mellitus and hyperlipidaemia conditions among community-dwelling older adult.

BACKGROUND

Physical activity is recommended for the maintenance and improvement of health. However, high-intensity physical activity may adversely impact exercise adherence by older adults.

DESIGN

This review was conducted with reference to methods set out in the Cochrane Handbook for Systematic Reviews of Interventions. The PRISMA statement was employed to guide the reporting of the systematic review and meta-analyses.

DATA SOURCES

Seven electronic databases were searched to identify relevant articles that were published in English from 1 January 2000 to 31 December 2020.

REVIEW METHOD

This review included randomised controlled trials and cluster-randomised controlled trials on interventions of physical activities with low-to-moderate intensities compared against usual care without physical activities. Two reviewers independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias Tool. Meta-analysis was performed using RevMan, with Cochran Q and I² used for determining heterogeneity. The overall effect was reviewed with z scores.

RESULTS

Fifteen randomised controlled trials with 940 total participants were evaluated. Low-to-moderate-intensity physical activity significantly improved systolic blood pressure [Z = 3.59, p = .0003], HbA1C [Z = 2.10, p = .04] and high-density lipoprotein (HDL) levels [Z = 3.83, p = .0001], compared to usual care. A further subgroup analysis found no significant difference in systolic blood pressure level after three sessions a week as well as after three months. There were insufficient papers to evaluate for both HbA1C and HDL levels.

CONCLUSION

Regular physical activity ranging from low-to-moderate intensity should be encouraged among older adults with chronic diseases.

RELEVANCE FOR CLINICAL PRACTICE

This review suggested that low-to-moderate levels of physical activity could be encouraged among community-dwelling older adults to improve their physical health.

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.

Potential Physiological and Cellular Mechanisms of Exercise That Decrease the Risk of Severe Complications and Mortality Following SARS-CoV-2 Infection

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has unmasked mankind's vulnerability to biological threats. Although higher age is a major risk factor for disease severity in COVID-19, several predisposing risk factors for mortality are related to low cardiorespiratory and metabolic fitness, including obesity, cardiovascular disease, diabetes, and hypertension. Reaching physical activity (PA) guideline goals contribute to protect against numerous immune and inflammatory disorders, in addition to multi-morbidities and mortality. Elevated levels of cardiorespiratory fitness, being non-obese, and regular PA improves immunological function, mitigating sustained low-grade systemic inflammation and age-related deterioration of the immune system, or immunosenescence. Regular PA and being non-obese also improve the antibody response to vaccination. In this review, we highlight potential physiological, cellular, and molecular mechanisms that are affected by regular PA, increase the host antiviral defense, and may determine the course and outcome of COVID-19. Not only are the immune system and regular PA in relation to COVID-19 discussed, but also the cardiovascular, respiratory, renal, and hormonal systems, as well as skeletal muscle, epigenetics, and mitochondrial function.

The effect of exercise training on blood pressure in menopause and postmenopausal women: A systematic review of randomized controlled trials

The prevalence of hypertension is higher in postmenopausal than in premenopausal women. Regular exercise training has been shown to be effective in addressing hypertension. The aim of this systematic review was to synthesize the effect of exercise training on systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in menopausal and postmenopausal women. This review was reported according to the PRISMA statement and registered in PROSPERO. The literature search was done in MEDLINE, Embase, Cochrane CENTRAL and ClinicalTrials. Randomized controlled trials involving menopausal and postmenopausal women undergoing exercise training were included. Two blinded reviewers assessed risk of bias in the included studies by using the Cochrane Risk of Bias tool. A random-effects model was used for all analyses. Significance was set at P < 0.05. Compared with the control group, exercise training resulted in clinically significant reductions on SBP (MD -3.43 mmHg; 95% CI, -5.16, -1.71; P < 0.0001), DBP (MD, -2.25 mmHg; 95% CI, -3.40, -1.11; P = 0.0001) and MAP (MD, -3.48 mmHg; 95% CI, -5.84, -1.11; P = 0.004). Aerobic training (AT) did not produce a significant reduction in SBP, DBP and MAP (P >0.05). Combined training (CT) generated larger reductions. Exercise training generated small but clinically relevant reductions in SBP, DBP and MAP in menopausal and postmenopausal women, younger or older than 65 years, with prehypertension or hypertension. AT did not lead to a clinically relevant improvement in blood pressure (BP) in this population. In addition, CT showed the largest reductions in SBP, DBP and MAP.

Investigational drugs and nutrients for human longevity. Recent clinical trials registered in ClinicalTrials.gov and clinicaltrialsregister.eu

Introduction:Several pharmacological drugs have shown proof of concept for longevity in animal models. I aimed to identify and review those longevity drug candidates that are undergoing clinical trials.Areas covered:Recent (post-2017) longevity clinical trials were found in US and EU clinical trial registries. Longevity drug candidates are the antidiabetic drugs metformin and acarbose, and the immunosuppressant rapamycin. These medicinal drugs are tested on biochemical and clinical markers of aging. In addition, vitamin D supplementation is being investigated in two mega-trials (sample size> 5000) for its efficacy in reducing all-cause mortality.Expert opinion:Anti-aging effects of longevity drug candidates suggest, but do not demonstrate that they prolong life. The two megatrials with vitamin D supplementation make it possible to detect differences in life expectancy between vitamin D and placebo. Therefore, a protocol similar to that for vitamin D could be used to demonstrate pro-longevity effects of metformin, acarbose, and rapamycin.

Associations between PM2.5 exposure duration and physical activity intensity on the health of hypertension in urban residents of Beijing

Hypertension is reported to be associated with air pollution and physical activity (PA), and they have different or even conflicting effects on blood pressure (BP). The study evaluated the combined effects of PM2.5 exposure duration and physical activity intensity on systolic blood pressure (SBP) and diastolic blood pressure (DBP) of hypertension. A total of 2613 patients (≥18-year-olds) at baseline who attended surveys from the China Health and Nutrition Survey (2011-2015) in Beijing were selected, as well as the PM2.5 data collected in the same period. The mixed linear effects model and multivariate analysis of variance (MANOVA) were used to explore the multiple effects of PM2.5 exposure duration and PA intensity on SBP and DBP, respectively. The correlation results indicated PM2.5 exposure duration (>15 days) occurred more significant correlations with DBP and longer PM2.5 exposures duration (>60 day) with SBP. The mixed linear effects model showed the important random terms of gender, PA levels, and BMI classification for both SBP and DBP. It also indicated the significant fixed effect from age for both SBP and DBP, and the significant fixed effects from PM2.5 and weight, as well as the interaction in DBP. The random effects of PA levels put effects on different weight people for SBP and on different age people for DBP, while the person of SBP exposed to PM2.5 environments may tend to be affected by BMI classification. The model's main effects showed PA and the interaction with gender could put significant effects on BP. The gender effects and the PA level effects were also improved by the MANOVA results. We concluded that the more PM2.5 exposure duration may lead to more significant correlation with higher BP values. The PA levels could lead to the different effects on the health showing the variations in age, gender, and BMI classification. For SBP of people who are exposed to PM2.5 environments, it may tend to be affected by BMI classification, which also may influence the DBP through weight adjusting first and then cause hypertension. The gender difference of BP may be affected by PA showing the higher PA level and the more gender difference.

Effect of a virtual cardiac rehabilitation program on patients with hypertension: A randomized trial

Abstract Introduction: Hypertension is among the main primary factors for the cause of death from cardiovascular diseases. Among the treatments for hypertension, physical exercise has stood out. However, the adherence of patients with hypertension to the practice of physical exercises is low, and thus strategies such as virtual rehabilitation may be beneficial, in addition to increasing adherence. Objective: This study aimed to evaluate the effect of a virtual cardiovascular rehabilitation (VCR) program on arterial blood pressure, physical conditioning and the quality of life of patients with hypertension. Methods: This is a randomized clinical trial with 59 patients with hypertension, divided into three groups: conventional cardiac rehabilitation (CCR), VCR and control (CO). Before and after the intervention period the patients were submitted to anthropometric data (BMI, body mass index), vital data (SBP, systolic blood pressure; DBP, diastolic blood pressure), quality of life (SF-36 questionnaire), respiratory muscle strength (MIP, maximum inspiratory pressure; MEP, maximum expiratory pressure) and functional capacity (6-MWT, six-minute walk test) assessment. Both VCR and CCR groups underwent aerobic training. Results: VCR protocol increased functional capacity (p < 0.001), expiratory muscle strength (p < 0.002), and quality of life in the domains in relation to limitation of physical (p < 0.018), emotional aspects (p < 0.019), social aspects (p < 0.042), and mental health (p < 0.002) when baseline and post-intervention were compared. Conclusion: The VCR program is an effective treatment strategy for improving the physical capacity and quality of life of patients with hypertension.