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Silva JKTNF, Menêses AL, Silva GO, O'Driscoll JM, Ritti-Dias RM, Correia MA, Farah BQ. Acute Effects of Breaking up Sitting Time With Isometric Wall Squat Exercise on Vascular Function and Blood Pressure in Sedentary Adults: Randomized Crossover Trial. J Cardiopulm Rehabil Prev 2024; 44:369-376. [PMID: 38885063 DOI: 10.1097/hcr.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
PURPOSE The World Health Organization has recommended breaking up sitting time to improve cardiovascular health. However, whether isometric exercise can be effectively used as a strategy to break up sitting time remains unclear. Thus, the aim of this study was to analyze the acute effects of breaking up prolonged sitting with isometric wall squat exercise (IWSE) on vascular function and blood pressure (BP) in sedentary adults. METHODS This randomized crossover trial included 17 adults (53% male, 26 ± 6 yr, 22.4 ± 3.6 kg/m 2 ) with high sedentary behavior (≥ 6 hr/d). The participants completed 2 experimental sessions in a randomized order, both sharing a common sitting period of 180 min: Breaks (2-min breaks were incorporated into the IWSE, with participants maintaining their knees at the angle determined by the incremental test, which occurred every 30 min) and Control (sitting for 180 min continuously). Popliteal artery flow-mediated dilation (FMD) and brachial BP were measured before and at 10 and 30 min after the experimental sessions. RESULTS The results did not indicate significant session vs time interaction effects on popliteal FMD and brachial BP ( P > .05). A subanalysis including only participants with popliteal FMD reduction after the Control session (n = 11) revealed that Breaks enhanced popliteal FMD after 10 min (1.38 ± 6.45% vs -4.87 ± 2.95%, P = .002) and 30 min (-0.43 ± 2.48% vs -2.11 ± 5.22%, P = .047). CONCLUSION Breaking up prolonged sitting with IWSE mitigates impaired vascular function resulting from prolonged sitting but has no effect on BP in sedentary adults.
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Affiliation(s)
- Jéssika K T N F Silva
- Author Affiliations: Department of Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, São Paulo, Brazil (Ms Silva, Mr O. Silva, and Drs Ritti-Dias, Correia, and Farah); Graduate Program in Physical Education, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil (Ms Silva and Dr Farah); University of Pernambuco (UPE), Recife, Pernambuco, Brazil (Dr Menêses); School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, United Kingdom (Dr O'Driscoll); Department of Physical Education, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil (Dr Farah)
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Oliveira MDS, Melo PH, Correia MDA, Gerage AM, Ritti-Dias RM, Farah BQ. Effects of Isometric Handgrip Training on Ambulatory Blood Pressure in Individuals Over 18 Years Old: A Systematic Review and Meta-Analysis. J Cardiopulm Rehabil Prev 2024; 44:303-310. [PMID: 39185910 DOI: 10.1097/hcr.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
PURPOSE The aim of this study was to analyze the effects of isometric handgrip training (IHT) on ambulatory blood pressure (BP) in individuals aged 18 yr and older. REVIEW METHODS A systematic review and meta-analysis was performed in Medline and Web of Science, encompassing studies published until July 2023, as well as the gray literature. We calculated the mean difference (MD) and 95% CI using an inverse variance method with a random effects model. SUMMARY Considering both published and unpublished studies, we observed an effect of IHT on awake diastolic BP (MD = -2.02; 95% CI, -3.89 to -0.15 mmHg; P = .03). There were no significant effects on 24-hr systolic BP (MD = -1.31; 95% CI, -3.84 to 1.22 mmHg; P = .31), asleep systolic BP (MD = -0.84; 95% CI, -3.31 to 1.63 mmHg; P = .50), awake systolic BP (MD = -0.93: 95% CI, -3.10 to 1.23 mmHg; P = .40), 24-hr diastolic BP (MD = -0.96; 95% CI, -2.65 to 0.74 mmHg; P = .27), or asleep diastolic BP (MD = -1.27; 95% CI, -3.22 to 0.67 mmHg; P = .20). In conclusion, the effects of IHT on ambulatory BP were observed primarily in awake diastolic BP among individuals over 18 yr of age.
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Affiliation(s)
- Marcelo de Santana Oliveira
- Author Affiliations: Graduate Program in Physical Education, Federal University of Pernambuco, Recife, Brazil (Oliveira, Melo, and Farah); Graduate Program in Medicine, Universidade Nove de Julho, São Paulo, Brazil (Correia); Graduate Program in Physical Education, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil (Gerage); Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil (Melo, Correia, and Ritti-Dias); and Department of Physical Education, Federal Rural University of Pernambuco, Recife, Brazil (Farah)
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Machado I, Ferreira J, Magalhães C, Sousa P, Dias L, Santarém D, Moreira H, Abrantes C. Six-month combined aerobic and resistance exercise program enhances 6-minute walk test and physical fitness in people with peripheral arterial disease: A pilot study. JOURNAL OF VASCULAR NURSING 2024; 42:145-153. [PMID: 39244325 DOI: 10.1016/j.jvn.2024.03.002] [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: 07/26/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Exercise therapy is a recognized non-pharmacological intervention for peripheral arterial disease (PAD); however, the effects of combined exercise remain under investigation. This study aimed to compare the effects of a 6-month combined supervised exercise program (SUP) with a usual care (UC) approach on walking ability, physical fitness, and peripheral blood flow in people with PAD and claudication. METHODS Twenty-three male participants (Age=64.1 ± 6.2years and ABI=0.58±0.07) with PAD and claudication were assigned to either the SUP group (n = 10), engaging in structured supervised treadmill walking combined with three resistance exercises, three times a week, or the UC group (n = 13), receiving advice to walk. The primary outcome measure was walking ability, with assessments conducted at baseline (M0), after 3 months (M3), and 6 months (M6). RESULTS After the 6-month intervention, the SUP group exhibited significant improvements in absolute claudication time (ACT, p = 0.045), maximal walking time (MWT, p = 0.045), maximal walking distance (MWD, p = 0.027), and pause duration (p = 0.045) during the 6-minute walk test (6MWT), when compared to the UC group. Over time, a significant increase in walking speed during the 6MWT (Speed6MWT, p = 0.001) and walking speed without claudication (SpeedNoC, p < 0.001) was found, although no significant differences were found between the groups. The SUP group increased by 0.8 km/h in both Speed6MWT and SpeedNoC, while the UC group increased by 0.3 km/h and 0.6 km/h, respectively. Despite claudication consistently occurring at the same time, the SUP group demonstrated an improved tolerance to pain or a better understanding of pain, enabling them to walk longer distances at higher speeds. A positive effect of SUP was found for chair sit-and-reach test (p = 0.023), percentage of fat mass (p = 0.048), fat-free mass (p = 0.040), and total body water (p = 0.026), suggesting potential benefits attributed to the resistance strength exercises. CONCLUSION A 6-month combined treadmill and resistance exercise program improved walking ability, walking speed, lower body and lower back flexibility, and body composition in people with PAD and claudication.
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Affiliation(s)
- Isabel Machado
- Department of Sports Science, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal; Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal.
| | - Joana Ferreira
- Angiology and Vascular Surgery Department, Trás-os-Montes and Alto Douro Hospital Center (CHTMAD), Vila Real, Portugal; Vascular Surgery Department, Senhora da Oliveira Hospital Center, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Carlos Magalhães
- Physical Medicine and Rehabilitation Department, Trás-os-Montes and Alto Douro Hospital Center (CHTMAD), Vila Real, Portugal
| | - Pedro Sousa
- Imagiology Department, Trás-os-Montes and Alto Douro Hospital Center (CHTMAD), Vila Real, Portugal
| | - Lúcia Dias
- Physical Medicine and Rehabilitation Department, Trás-os-Montes and Alto Douro Hospital Center (CHTMAD), Vila Real, Portugal
| | - Daniel Santarém
- Department of Sports Science, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Helena Moreira
- Department of Sports Science, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal; Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal; Laboratory of Biomechanics, Body Composition and Health (LaB2Health), Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Vila Real, Portugal
| | - Catarina Abrantes
- Department of Sports Science, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal; Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal
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Monfared V, Hashemi M, Kiani F, Javid R, Yousefi M, Hasani M, Jafari A, Vakili MA, Hasani M. The effect of physical activity intervention on blood pressure in 18 low and middle-income countries: a systematic review and meta-analysis of randomized controlled trials. Clin Hypertens 2024; 30:22. [PMID: 39085963 PMCID: PMC11293006 DOI: 10.1186/s40885-024-00281-w] [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: 10/05/2023] [Accepted: 06/26/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND In especially, low and middle-income nations (LMICs), where healthcare access may be restricted, high blood pressure (BP) is a major risk factor for cardiovascular disease and stroke, both of which can even lead to death. Altering one's lifestyle, in conjunction with medical therapy, has been demonstrated to be effective in lowering BP. Recent research has shown that physical activity (PA), in a variety of guises and to varying degrees, can be an effective means of lowering BP. OBJECTIVE The purpose of this meta-analysis and systematic review was to evaluate the impact that PA plays in the development of hypertension in LMICs nations. METHODS An exhaustive search of the available research was carried out in order to locate studies that were pertinent. We searched a number of online databases, such as SCOPUS, Medline, and Web of Science, looking for clinical trials that were published before March of 2023. Studies were only considered for inclusion if they were randomized controlled trials (RCTs), reported on the association between PA and BP, and were carried out in LMICs countries. RESULTS This meta-analysis incorporated a comprehensive collection of 60 studies, encompassing a total of 11,002 people, consisting of 5,630 cases and 5372 controls. The findings indicate that engaging in PA had a notable impact on decreasing systolic blood pressure (SBP), as seen by a weighted mean difference (WMD) of -7.70 mmHg, with a 95% confidence interval (CI) ranging from -9.50 to -5.91 (p < 0.001). Additionally, PA was found to have a significant influence on reducing diastolic blood pressure (DBP), as indicated by a WMD of -3.60 mmHg, with a 95% CI ranging from -4.48to -2.73(p < 0.001). The findings from subgroup analysis indicate that the observed results remained statistically significant when considering individuals with baseline SBP of 120 mmHg or lower and DBP of 80 mmHg or lower. CONCLUSION The incorporation of PA can significantly contribute to the mitigation of high BP within LMICs nations. Additional investigation is required to ascertain the most effective form and amount of PA in order to mitigate BP levels within these specific individuals.
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Affiliation(s)
- Vahid Monfared
- Skeletal Biology Laboratory, College of Health, Oregon State University, Corvallis, OR, 97331, USA
| | - Mohtaram Hashemi
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Fatemeh Kiani
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Reyhane Javid
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Mahsa Yousefi
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdis Hasani
- Department of Physical Education, Farhangian University, Tehran, Iran
| | - Ali Jafari
- Student Research Committee, Department of Nutrition, School of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Ali Vakili
- Department of Biostatistics and Epidemiology, Health Management and Social Development Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Motahareh Hasani
- Health Management and Social Development Research Center, Golestan University of Medical Sciences and Health Services, Hirkan Boulevard, Gorgan, 4918936316, Iran.
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Farah BQ, Forjaz CLM, O'Driscoll JM, Millar PJ, Oliveira MS, Fecchio R, Kanegusuku H, Sousa JCS, Correia MA, Ritti-Dias RM. Characteristics associated with responsiveness to isometric handgrip training in medicated hypertensive patients: secondary data analysis. J Hypertens 2024; 42:1421-1426. [PMID: 38690928 DOI: 10.1097/hjh.0000000000003749] [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: 05/03/2024]
Abstract
OBJECTIVE Isometric handgrip training (IHT) has been shown to reduce blood pressure (BP) in hypertensive patients. However, factors that predict responsiveness to IHT are largely unknown. The aim of this study was to investigate the patient characteristics associated with the antihypertensive response to IHT using a recommended statistical approach for evaluating interindividual responses. METHODS Data from four randomized controlled trials were combined, totaling 81 patients undergoing IHT (48.8% women; 60 ± 11 years) and 90 control patients (45.6% women; 62 ± 12 years). IHT consisted of 4 × 2 min isometric contractions at 30% of maximal voluntary contraction, performed three times/week for 8-12 weeks. BP was measured at baseline and following IHT and control interventions. The interindividual variation was assessed by the standard deviation of the individual responses (SD ir ), and linear regression analyses were conducted to explore response predictors. RESULTS IHT significantly decreased both SBP (-5.4; 95% confidence interval (CI) -9.5 to -1.3 mmHg) and DBP (-2.8; 95% CI -5.1 to -0.6 mmHg). The interindividual variation of BP change was moderate for systolic (SD ir = 5.2 mmHg, 0.30 standardized units) and low for diastolic (SD ir = 1.7 mmHg, 0.15 standardized units). Sex, age, and BMI were not associated with the antihypertensive effect of IHT. However, a higher baseline SBP ( b = -0.467, P < 0.001) and absence of dihydropyridine calcium channel blockers use ( b = 0.340, P = 0.001) were associated with greater BP reductions. CONCLUSION IHT reduced BP in medicated hypertensive patients regardless of age, sex, and BMI. Patients with a higher baseline SBP and those not prescribed dihydropyridine calcium channel blockers were more responsive to IHT.
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Affiliation(s)
- Breno Q Farah
- Graduate Program in Physical Education, Universidade Federal Rural de Pernambuco, Recife
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho
| | - Claudia L M Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Jamie M O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent
- Department of Cardiology, St George's Healthcare NHS Trust, Tooting, London, UK
| | - Philip J Millar
- Human Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Marcelo S Oliveira
- Graduate Program in Physical Education, Universidade Federal Rural de Pernambuco, Recife
- Postgraduate Program in Nutrition, Universidade Federal de Pernambuco, Recife
| | - Rafael Fecchio
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho
| | | | - Julio C S Sousa
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Marilia A Correia
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho
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Lin S, Sun P, Huang L, Hernandez M, Yu H, Jan YK. Effects of the intensity, duration and muscle mass factors of isometric exercise on acute local muscle hemodynamic responses and systematic blood pressure regulation. Front Bioeng Biotechnol 2024; 12:1444598. [PMID: 39148945 PMCID: PMC11324600 DOI: 10.3389/fbioe.2024.1444598] [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: 06/05/2024] [Accepted: 07/24/2024] [Indexed: 08/17/2024] Open
Abstract
Isometric exercise is a non-pharmacologic intervention to improve muscle hemodynamic responses and blood pressure in humans. However, the effects of intensity, duration, and muscle mass factors of isometric exercise on local muscle hemodynamic responses and systemic blood pressure regulation have not been studied. The purpose of this study was to assess whether various modes of isometric exercise could induce various levels of muscle hemodynamic responses that are related to the blood pressure changes. Near-infrared spectroscopy was used to assess muscle hemodynamic responses after 4 isometric exercise protocols in 20 healthy adults. One-way analysis of variance (ANOVA) with repeated measures was used to assess the effect of factors of isometric exercise on oxyhemoglobin, deoxy-hemoglobin, blood volume, and oxygenation. For oxygenation, the lowest mean was recorded for the unilateral isometric handgrip exercise at 30% of MVC for 2 min (-0.317 ± 0.379 μM) while the highest mean was observed for the isometric wall squat (1.496 ± 0.498 μM, P < 0.05). Additionally, both the bilateral isometric handgrip exercise at 30% MVC for 1 min (1.340 ± 0.711 μM, P < 0.05) and the unilateral isometric handgrip exercise at 20% MVC for 3 min (0.798 ± 0.324 μM, P < 0.05) are significantly higher than 30% of MVC for 2 min. Blood pressure showed an inverse trend with oxygenation changes of the forearm muscle. The study indicates that the duration and muscle mass of isometric exercise are more effective on oxygenation responses and systematic blood pressure regulation, and suggests that the local muscle oxygenation factor following isometric contractions may mediate systematic blood pressure regulation.
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Affiliation(s)
- Songmei Lin
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Pu Sun
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Liwan Huang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Manuel Hernandez
- Department of Biomedical and Translational Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Hongjun Yu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Department of Physical Education, Tsinghua University, Beijing, China
| | - Yih-Kuen Jan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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Edwards JJ, Coleman DA, Ritti-Dias RM, Farah BQ, Stensel DJ, Lucas SJE, Millar PJ, Gordon BDH, Cornelissen V, Smart NA, Carlson DJ, McGowan C, Swaine I, Pescatello LS, Howden R, Bruce-Low S, Farmer CKT, Leeson P, Sharma R, O'Driscoll JM. Isometric Exercise Training and Arterial Hypertension: An Updated Review. Sports Med 2024; 54:1459-1497. [PMID: 38762832 PMCID: PMC11239608 DOI: 10.1007/s40279-024-02036-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/20/2024]
Abstract
Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research.
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Affiliation(s)
- Jamie J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK
| | - Damian A Coleman
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK
| | - Raphael M Ritti-Dias
- Graduate Program in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil
| | - Breno Q Farah
- Department of Physical Education, Universidade Federal Rural de Pernambuco, Recife, Brazil
| | - David J Stensel
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Sam J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Philip J Millar
- Human Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, ON, Canada
| | - Ben D H Gordon
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Debra J Carlson
- School of Health, Medical and Applied Sciences, CQ University, North Rockhampton, QLD, Australia
| | - Cheri McGowan
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Ian Swaine
- Sport Science, University of Greenwich, London, UK
| | - Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT, 06269, USA
| | - Reuben Howden
- Department of Applied Physiology, Health and Clinical Sciences, UNC Charlotte, Charlotte, NC, 28223, USA
| | - Stewart Bruce-Low
- Department of Applied Sport and Exercise Science, University of East London, London, UK
| | | | - Paul Leeson
- Oxford Clinical Cardiovascular Research Facility, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Rajan Sharma
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Jamie M O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK.
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
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Lee J, Zarezadehmehrizi A, LaVoy EC, Markofski MM, Park Y. Exercise Training Improves Brachial Artery Endothelial Function, but Does Not Alter Inflammatory Biomarkers in Patients with Peripheral Artery Disease: a Systematic Review and Meta-analysis. J Cardiovasc Transl Res 2024; 17:585-597. [PMID: 37870688 DOI: 10.1007/s12265-023-10451-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/06/2023] [Indexed: 10/24/2023]
Abstract
The study aimed to systematically review the effects of exercise training (EX) on brachial artery flow-mediated dilation (FMD) and inflammatory biomarkers in patients with peripheral artery disease (PAD). Five electronic databases were searched: (i) patients with PAD aged ≥ 18; (ii) structured EX ≥ 2 weeks; (iii) measured brachial artery FMD; and (iv) measured blood inflammatory biomarkers. Eighteen studies met the inclusion criteria. EX increased FMD but had no effect on C-reactive protein, interleukin-6, and tumor necrosis factor-α. Subgroups with moderate intensity had a greater increase in FMD than subgroups with vigorous intensity. There was no difference in effect on FMD and three inflammatory biomarkers between subgroups training for ≤ 12 weeks and > 12 weeks of EX, < 50 min and ≥ 50 min of session duration, and < 150 min and ≥ 150 min of weekly volume, respectively. These results suggest that EX-induced improvement in vascular function can be independent of the improvement of systemic inflammation.
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Affiliation(s)
- Junghoon Lee
- Laboratory of Integrated Physiology, Department of Health and Human Performance, University of Houston, 3875 Holman St, Houston, TX, 77204-6015, USA
| | - Aliasghar Zarezadehmehrizi
- Laboratory of Integrated Physiology, Department of Health and Human Performance, University of Houston, 3875 Holman St, Houston, TX, 77204-6015, USA
| | - Emily C LaVoy
- Laboratory of Integrated Physiology, Department of Health and Human Performance, University of Houston, 3875 Holman St, Houston, TX, 77204-6015, USA
| | - Melissa M Markofski
- Laboratory of Integrated Physiology, Department of Health and Human Performance, University of Houston, 3875 Holman St, Houston, TX, 77204-6015, USA
| | - Yoonjung Park
- Laboratory of Integrated Physiology, Department of Health and Human Performance, University of Houston, 3875 Holman St, Houston, TX, 77204-6015, USA.
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Cucato G, Longano PP, Perren D, Ritti-Dias RM, Saxton JM. Effects of additional exercise therapy after a successful vascular intervention for people with symptomatic peripheral arterial disease. Cochrane Database Syst Rev 2024; 5:CD014736. [PMID: 38695785 PMCID: PMC11064885 DOI: 10.1002/14651858.cd014736.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is characterised by obstruction or narrowing of the large arteries of the lower limbs, usually caused by atheromatous plaques. Most people with PAD who experience intermittent leg pain (intermittent claudication) are typically treated with secondary prevention strategies, including medical management and exercise therapy. Lower limb revascularisation may be suitable for people with significant disability and those who do not show satisfactory improvement after conservative treatment. Some studies have suggested that lower limb revascularisation for PAD may not confer significantly more benefits than supervised exercise alone for improved physical function and quality of life. It is proposed that supervised exercise therapy as adjunctive treatment after successful lower limb revascularisation may confer additional benefits, surpassing the effects conferred by either treatment alone. OBJECTIVES To assess the effects of a supervised exercise programme versus standard care following successful lower limb revascularisation in people with PAD. SEARCH METHODS We searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, two other databases, and two trial registers, most recently on 14 March 2023. SELECTION CRITERIA We included randomised controlled trials which compared supervised exercise training following lower limb revascularisation with standard care following lower limb revascularisation in adults (18 years and older) with PAD. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were maximum walking distance or time (MWD/T) on the treadmill, six-minute walk test (6MWT) total distance, and pain-free walking distance or time (PFWD/T) on the treadmill. Our secondary outcomes were changes in the ankle-brachial index, all-cause mortality, changes in health-related quality-of-life scores, reintervention rates, and changes in subjective measures of physical function. We analysed continuous data by determining the mean difference (MD) and 95% confidence interval (CI), and dichotomous data by determining the odds ratio (OR) with corresponding 95% CI. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We identified seven studies involving 376 participants. All studies involved participants who received either additional supervised exercise or standard care after lower limb revascularisation. The studies' exercise programmes varied, and included supervised treadmill walking, combined exercise, and circuit training. The duration of exercise therapy ranged from six weeks to six months; follow-up time ranged from six weeks to five years. Standard care also varied between studies, including no treatment or advice to stop smoking, lifestyle modifications, or best medical treatment. We classified all studies as having some risk of bias concerns. The certainty of the evidence was very low due to the risk of bias, inconsistency, and imprecision. The meta-analysis included only a subset of studies due to concerns regarding data reporting, heterogeneity, and bias in most published research. The evidence was of very low certainty for all the review outcomes. Meta-analysis comparing changes in maximum walking distance from baseline to end of follow-up showed no improvement (MD 159.47 m, 95% CI -36.43 to 355.38; I2 = 0 %; 2 studies, 89 participants). In contrast, exercise may improve the absolute maximum walking distance at the end of follow-up compared to standard care (MD 301.89 m, 95% CI 138.13 to 465.65; I2 = 0 %; 2 studies, 108 participants). Moreover, we are very uncertain if there are differences in the changes in the six-minute walk test total distance from baseline to treatment end between exercise and standard care (MD 32.6 m, 95% CI -17.7 to 82.3; 1 study, 49 participants), and in the absolute values at the end of follow-up (MD 55.6 m, 95% CI -2.6 to 113.8; 1 study, 49 participants). Regarding pain-free walking distance, we are also very uncertain if there are differences in the mean changes in PFWD from baseline to treatment end between exercise and standard care (MD 167.41 m, 95% CI -11 to 345.83; I2 = 0%; 2 studies, 87 participants). We are very uncertain if there are differences in the absolute values of ankle-brachial index at the end of follow-up between the intervention and standard care (MD 0.01, 95% CI -0.11 to 0.12; I2 = 62%; 2 studies, 110 participants), in mortality rates at the end of follow-up (OR 0.92, 95% CI 0.42 to 2.00; I2 = 0%; 6 studies, 346 participants), health-related quality of life at the end of follow-up for the physical (MD 0.73, 95% CI -5.87 to 7.33; I2 = 64%; 2 studies, 105 participants) and mental component (MD 1.04, 95% CI -6.88 to 8.95; I2 = 70%; 2 studies, 105 participants) of the 36-item Short Form Health Survey. Finally, there may be little to no difference in reintervention rates at the end of follow-up between the intervention and standard care (OR 0.91, 95% CI 0.23 to 3.65; I2 = 65%; 5 studies, 252 participants). AUTHORS' CONCLUSIONS There is very uncertain evidence that additional exercise therapy after successful lower limb revascularisation may improve absolute maximal walking distance at the end of follow-up compared to standard care. Evidence is also very uncertain about the effects of exercise on pain-free walking distance, six-minute walk test distance, quality of life, ankle-brachial index, mortality, and reintervention rates. Although it is not possible to confirm the effectiveness of supervised exercise compared to standard care for all outcomes, studies did not report any harm to participants from this intervention after lower limb revascularisation. Overall, the evidence incorporated into this review was very uncertain, and additional evidence is needed from large, well-designed, randomised controlled studies to more conclusively demonstrate the role additional exercise therapy has after lower limb revascularisation in people with PAD.
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Affiliation(s)
- Gabriel Cucato
- Department of Sport, Exercise, and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Paulo Pl Longano
- Ciências da Reabilitação, Universidade Nove de Julho, São Paulo, Brazil
| | - Daniel Perren
- Department of Vascular Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | | | - John M Saxton
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
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Xiao YC, Li WY, Zhang L, Fan JF, Wang WZ, Wang YK. Effect of supervised exercise training on cardiovascular function in patients with intermittent claudication: a systematic review and meta-analysis of randomized controlled trials. Clin Res Cardiol 2024:10.1007/s00392-024-02423-4. [PMID: 38451260 DOI: 10.1007/s00392-024-02423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
This study aimed to determine the effect of supervised exercise training (SET) on cardiovascular function in patients with intermittent claudication (IC). A systematic search in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases was conducted. Primary outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), rate pressure product (RPP), cardiac output (CO), peak oxygen consumption (VO2peak), and heart rate variability (HRV). Secondary outcomes were maximum walking distance (MWD) and pain-free walking distance (PFWD). Outcomes were reported as weighted mean difference (WMD) between the SET group and the control group and synthesized by using the random-effects model. Seventeen RCTs with a total of 936 patients were included in this review. SET resulted in significant improvements of SBP (WMD = - 7.40, 95% CI - 10.69 ~ - 4.11, p < 0.001, I2 = 15.2%), DBP (WMD = - 1.92, 95% CI - 3.82 ~ - 0.02, p = 0.048, I2 = 0.0%), HR (WMD = - 3.38, 95% CI - 6.30 ~ - 0.46, p = 0.023, I2 = 0.0%), RPP (WMD = - 1072.82, 95% CI - 1977.05 ~ - 168.59, p = 0.020, I2 = 42.7%), and VO2peak with plantar flexion ergometer exercise (WMD = 5.57, 95% CI 1.66 ~ 9.49, p = 0.005, I2 = 62.4%), whereas CO and HRV remained statistically unaltered. SET also improved MWD (WMD = 139.04, 95% CI 48.64 ~ 229.44, p = 0.003, I2 = 79.3%) and PFWD (WMD = 40.02, 95% CI 23.85 ~ 56.18, p < 0.001, I2 = 0.0%). In conclusion, SET is effective in improving cardiovascular function in patients with IC, which was confirmed on outcomes of cardiovascular function associated with exercise ability. The findings hold out that the standard therapy of SET can improve not only walking distance but also cardiovascular function in patients with IC.
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Affiliation(s)
- Yu-Chen Xiao
- Naval Medical Center of PLA, 880 Xiangyin Road, Shanghai, 200433, China
| | - Wan-Yang Li
- School of Basic Medical Sciences, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Jie-Fu Fan
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Wei-Zhong Wang
- Naval Medical Center of PLA, 880 Xiangyin Road, Shanghai, 200433, China.
| | - Yang-Kai Wang
- Naval Medical Center of PLA, 880 Xiangyin Road, Shanghai, 200433, China.
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Marçal IR, Abreu RM, Cornelis N, Leicht AS, Forjaz CLM, Cucato G, Brenner I, Novakovic M, Ritti-Dias R, Ciolac EG, Cornelissen VA. Effects of exercise training on heart rate variability in individuals with lower extremity arterial disease and claudication: A systematic review. JOURNAL OF VASCULAR NURSING 2023; 41:226-234. [PMID: 38072577 DOI: 10.1016/j.jvn.2023.09.002] [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: 06/28/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE To perform a systematic review of studies assessing the effects of regular exercise on heart rate variability (HRV) in individuals with lower extremity arterial disease (LEAD) and symptoms of claudication. METHODS A systematic search in the electronic databases MEDLINE, Embase, and Scielo, was conducted and updated on January 21, 2023. Randomized clinical trials investigating patients with LEAD and IC, assessing ≥ 4 wk of exercise interventions, and reporting at least one HRV measure (e.g., time or frequency domains) at baseline and follow-up were included. Two reviewers independently screened studies for inclusion, performed data extraction, and quality assessment of included studies. RESULTS Data from 7 trials were included (i.e., 5 walking, 1 resistance, and 1 isometric handgrip training), totaling 327 patients (66% males; range: 61 - 68 yr; ankle brachial index: 0.4 - 0.7). Following exercise training, three studies investigating walking training reported an increase in parasympathetic modulation indices and/or a decrease in sympathetic modulation indices (n = 2) as well as an increase in non-linear indices (n = 1). CONCLUSION The current evidence is weak, and larger randomized controlled trials are needed to confirm the efficacy of exercise training in improving HRV. Additionally, the high divergence in the methodology of studies indicated the need for standard tools to improve the quality of HRV measurements in exercise trials. It is recommended to use standard procedures in future trials investigating HRV.
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Affiliation(s)
- Isabela R Marçal
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa; Exercise and Chronic Disease Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
| | - Raphael M Abreu
- Department of Physiotherapy, LUNEX International University of Health Exercise and Sports, Differdange, Luxembourg. LUNEX ASBL Luxembourg Health & Sport Sciences Research Institute, Differdange, Luxembourg
| | - Nils Cornelis
- Research Group for Cardiovascular Rehabilitation, KU Leuven, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven, Belgium
| | - Anthony S Leicht
- Sport and Exercise Science, James Cook University, Townsville, Australia; Australian Institute of Tropical Health & Medicine, James Cook University, Townsville, Australia
| | - Claudia L M Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of Sao Paulo, São Paulo, Brazil
| | - Gabriel Cucato
- Department of Sport, Exercise and Rehabilitation, Northumbria University, United Kingdom
| | - Ingrid Brenner
- Department of Kinesiology and Trent/Fleming School of Nursing, Trent University, Peterborough, Ontario, Canada
| | - Marko Novakovic
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Raphael Ritti-Dias
- Post-Graduate Program in Rehabilitation Science, University Nove de Julho
| | - Emmanuel G Ciolac
- Exercise and Chronic Disease Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
| | - Véronique A Cornelissen
- Research Group for Cardiovascular Rehabilitation, KU Leuven, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven, Belgium.
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Baffour-Awuah B, Pearson MJ, Dieberg G, Smart NA. Isometric Resistance Training to Manage Hypertension: Systematic Review and Meta-analysis. Curr Hypertens Rep 2023; 25:35-49. [PMID: 36853479 PMCID: PMC10014822 DOI: 10.1007/s11906-023-01232-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Hypertension is the primary risk factor for cardiovascular disease and adequate blood pressure control is often elusive. The objective of this work was to conduct a meta-analysis of trial data of isometric resistance training (IRT) studies in people with hypertension, to establish if IRT produced an anti-hypertensive effect. A database search (PubMed, CINAHL, Cochrane Central Register of Controlled Trials, and MEDLINE) identified randomised controlled and crossover trials of IRT versus a sedentary or sham control group in adults with hypertension. RECENT FINDINGS We included 12 studies (14 intervention groups) in the meta-analyses, with an aggregate of 415 participants. IRT reduced systolic blood pressure (SBP), mean difference (MD) - 7.47 mmHg (95%CI - 10.10, - 4.84), P < 0.01; diastolic blood pressure (DBP) MD - 3.17 mmHg (95%CI - 5.29, - 1.04), P < 0.01; and mean arterial blood pressure (MAP) MD - 7.19 mmHg (95%CI - 9.06, - 5.32), P < 0.0001. Office pulse pressure and resting heart rate was not significantly reduced, neither were 24-h or day-time ambulatory blood pressures (SBP, DBP). Night-time blood pressures, however, were significantly reduced with SBP MD - 4.28 mmHg (95%CI - 7.88, - 0.67), P = 0.02, and DBP MD - 2.22 mmHg (95%CI - 3.55, - 0.88), P < 0.01. IRT does lower SBP, DBP and MAP office and night-time ambulatory SBP and DBP, but not 24-h mean ambulatory blood pressures in people with hypertension.
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Affiliation(s)
- B Baffour-Awuah
- Department of Exercise and Sports Science, School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia
| | - M J Pearson
- Department of Exercise and Sports Science, School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia
| | - G Dieberg
- Department of Exercise and Sports Science, School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia
| | - N A Smart
- Department of Exercise and Sports Science, School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia.
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Baffour-Awuah B, Pearson MJ, Dieberg G, Wiles JD, Smart NA. An evidence-based guide to the efficacy and safety of isometric resistance training in hypertension and clinical implications. Clin Hypertens 2023; 29:9. [PMID: 36918919 PMCID: PMC10015931 DOI: 10.1186/s40885-022-00232-3] [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: 08/18/2022] [Accepted: 12/20/2022] [Indexed: 03/16/2023] Open
Abstract
More than 30 randomized controlled trials, supported by individual patient-level and group-level meta-analyses and a Delphi analysis of expert opinion, unequivocally show isometric resistance training (IRT) elicits antihypertensive benefits in healthy people and those with chronic illness. We aim to provide efficacy and safety evidence, and a guide for IRT prescription and delivery. Recommendations are made for the use of IRT in specific patient populations and appropriate methods for IRT delivery. Published data suggest IRT consistently elicits mean blood pressure reductions of 7.4/3.3 mmHg systolic blood pressure/diastolic blood pressure, equivalent to antihypertensive medication monotherapy. Blood pressure reductions of this size are associated with an approximate 13% to 22% reduction in major cardiovascular events. Moreover, IRT is safe in a range of patient populations. We suggest that IRT has the greatest potential benefit when used as an antihypertensive therapy in individuals unwilling and/or unable to complete aerobic exercise, or who have had limited adherence or success with it; individuals with resistant or uncontrolled hypertension, already taking at least two pharmacological antihypertensive agents; and healthy or clinical populations, as an adjunct to aerobic exercise and dietary intervention in those who have not yet attained control of their hypertension. IRT is efficacious and produces clinically meaningful blood pressure reductions (systolic blood pressure, 7 mmHg; diastolic blood pressure, 3 mmHg). IRT is safe and typical program delivery requires only about 17 min weekly. IRT should be used as an adjunct to other exercise modalities, in people unable to complete other types of exercise, or in resistant hypertension.
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Affiliation(s)
- Biggie Baffour-Awuah
- Clinical Exercise Physiology, School of Science and Technology, University of New England, Armidale, Australia
| | - Melissa J Pearson
- Clinical Exercise Physiology, School of Science and Technology, University of New England, Armidale, Australia
| | - Gudrun Dieberg
- Clinical Exercise Physiology, School of Science and Technology, University of New England, Armidale, Australia.
| | - Jonathan D Wiles
- Sports Sciences, School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - Neil A Smart
- Clinical Exercise Physiology, School of Science and Technology, University of New England, Armidale, Australia
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14
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O'Driscoll JM, Edwards JJ, Coleman DA, Taylor KA, Sharma R, Wiles JD. One year of isometric exercise training for blood pressure management in men: a prospective randomized controlled study. J Hypertens 2022; 40:2406-2412. [PMID: 35969194 DOI: 10.1097/hjh.0000000000003269] [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
OBJECTIVE Isometric exercise training (IET) over 4-12 weeks is an effective antihypertensive intervention. However, blood pressure (BP) reductions are reversible if exercise is not maintained. No work to date has investigated the long-term effects of IET on resting BP. METHODS We randomized 24 unmedicated patients with high-normal BP to a 1-year wall squat IET intervention or nonintervention control group. Resting BP and various clinically important haemodynamic variables, including heart rate (HR), stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were measured pre and post the 1-year study period. RESULTS One year of IET produced statistically significant reductions in resting systolic (-8.5 ± 5 mmHg, P < 0.001) and diastolic (-7.3 ± 5.8 mmHg, P < 0.001) BP compared with the control group. There was also a significant reduction in resting HR (-4.2 ± 3.7 b/min, P = 0.009) and a significant increase in SV (11.2 ± 2.8 ml, P = 0.012), with no significant change in CO (0.12 ± 2.8 l/min, P = 0.7). TPR significantly decreased following IET (-246 ± 88 dyne·s/cm 5 , P = 0.011). Adherence to the IET sessions was 77% across all participants (3x IET sessions per week), with no participant withdrawals. CONCLUSION This novel study supports IET as an effective long-term strategy for the management of resting BP, producing clinically important, chronic BP adaptations in patients at risk of hypertension. Importantly, this work also demonstrates impressive long-term adherence rates, further supporting the implementation of IET as a means of effective BP management in clinical populations.
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Affiliation(s)
- Jamie M O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London
| | - Jamie J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent
| | - Damian A Coleman
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent
| | - Katrina A Taylor
- School of Sport and Exercise Science, University of Kent, Canterbury, Kent, UK
| | - Rajan Sharma
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London
| | - Jonathan D Wiles
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent
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15
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Edwards JJ, Wiles J, O'Driscoll J. Mechanisms for blood pressure reduction following isometric exercise training: a systematic review and meta-analysis. J Hypertens 2022; 40:2299-2306. [PMID: 35950976 DOI: 10.1097/hjh.0000000000003261] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Isometric exercise training (IET) is established as an effective antihypertensive intervention. Despite this, the physiological mechanisms driving blood pressure (BP) reductions following IET are not well understood. Therefore, we aimed to perform the first meta-analysis of the mechanistic changes measured following IET. METHODS PubMed, Cochrane library and SPORTDiscus were systematically searched for randomized controlled trials published between January 2000 and December 2021 reporting the effects of IET on resting BP and at least one secondary mechanistic parameter following a short-term intervention (2-12 weeks). RESULTS Eighteen studies with a pooled sample size of 628 participants were included in the final analysis. IET produced significant reductions in resting systolic and diastolic BP of 9.35 mmHg (95% confidence interval [CI] = -7.80 to -10.89, P < 0.001) and 4.30 mmHg (CI = -3.01 to -5.60, P < 0.001), respectively. Mechanistically, IET produced a statistically significant reduction in resting heart rate (mean difference [MD]: -1.55 bpm, CI = -0.14 to -2.96, P = 0.031) and a significant increase in stroke volume (MD: 6.35 ml, CI = 0.35 to 12.60, P = 0.038), with no significant change in cardiac output. Conversely, total peripheral resistance (TPR) significantly decreased following IET (MD: -100.38 dyne s -1 cm 5 , CI = -14.16 to -186.61, P = 0.023), with significant improvements in the low frequency to high frequency heart rate variability ratio (MD: -0.41, CI = -0.09 to -0.73, P = 0.013) and baroreceptor reflex sensitivity (MD: 7.43 ms/mmHg, P < 0.001). CONCLUSION This work demonstrates that a reduction in TPR, potentially mediated through enhanced autonomic vasomotor control, is primarily responsible for BP reductions following IET. Furthermore, this novel analysis suggests wall squat interventions to be the most effective IET mode, with clinically relevant differences in BP reductions compared to handgrip and leg extension IET; although future direct comparative research is required.
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Affiliation(s)
- Jamie J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
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Hayes P, Ferrara A, Keating A, McKnight K, O'Regan A. Physical Activity and Hypertension. Rev Cardiovasc Med 2022; 23:302. [PMID: 39077709 PMCID: PMC11262345 DOI: 10.31083/j.rcm2309302] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/31/2022] [Accepted: 08/09/2022] [Indexed: 07/31/2024] Open
Abstract
Hypertension and physical inactivity are leading causes of premature mortality. While both are modifiable risk factors for cardiovascular disease, their prevalence remains high. As populations grow older, they are more likely to develop hypertension and to become less physically active. Scientific advances have contributed to understanding of how physical activity improves blood pressure and the clinically relevant ambulatory blood pressure, but this is not reflected in hypertension guidelines for clinical management of hypertension. The aim of this paper is to clearly present up to date knowledge from scientific studies that underpin the role of physical activity in hypertension management. Longitudinal studies in this review demonstrate a protective effect of higher physical activity levels as well as higher levels of cardiorespiratory fitness. Interventional studies report improvements in blood pressure associated with aerobic, resistance and concurrent exercise; the improvements in some studies were greatest among participant groups with established hypertensions; the effect was observed for groups with treatment-resistant hypertension also, a clinically important subgroup. The most recent research provides evidence for the synergy between physical activity and pharmacotherapy for the treatment of hypertension, providing an opportunity for clinicians to promote physical activity as an adjunctive treatment for hypertension as well as a preventative strategy. This review critiques the evidence and summarises the most up to date literature in the field of physical activity and hypertension.
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Affiliation(s)
- Peter Hayes
- School of Medicine, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Alexandra Ferrara
- School of Medicine, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Aoife Keating
- School of Medicine, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Kathryn McKnight
- School of Medicine, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Andrew O'Regan
- School of Medicine, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
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Baffour-Awuah B, Pearson MJ, Smart NA, Dieberg G. Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study. Hypertens Res 2022; 45:483-495. [PMID: 35017680 PMCID: PMC8752388 DOI: 10.1038/s41440-021-00839-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/18/2021] [Accepted: 11/05/2021] [Indexed: 01/21/2023]
Abstract
Uncontrolled hypertension remains the major risk factor for cardiovascular disease. Isometric resistance training (IRT) has been shown to be a useful nonpharmacological therapy for reducing blood pressure (BP); however, some exercise physiologists and other health professionals are uncertain of the efficacy and safety of IRT. Experts' consensus was sought in light of the current variability of IRT use as an adjunct treatment for hypertension. An expert consensus-building analysis (Delphi study) was conducted on items relevant to the safety, efficacy and delivery of IRT. The study consisted of 3 phases: (1) identification of items and expert participants for inclusion; (2) a two-round modified Delphi exercise involving expert panelists to build consensus; and (3) a study team consensus meeting for a final item review. A list of 50 items was generated, and 42 international experts were invited to join the Delphi panel. Thirteen and 10 experts completed Delphi Rounds 1 and 2, respectively, reaching consensus on 26 items in Round 1 and 10 items in Round 2. The study team consensus meeting conducted a final item review and considered the remaining 14 items for the content list. A final list of 43 items regarding IRT reached expert consensus: 7/10 items on safety, 11/11 items on efficacy, 10/12 items on programming, 8/10 items on delivery, and 7/7 on the mechanism of action. This study highlights that while experts reached a consensus that IRT is efficacious as an antihypertensive therapy, some still have safety concerns, and there is also ongoing conjecture regarding optimal delivery.
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Affiliation(s)
- Biggie Baffour-Awuah
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia.
| | - Melissa J. Pearson
- grid.1020.30000 0004 1936 7371Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351 Australia
| | - Neil A. Smart
- grid.1020.30000 0004 1936 7371Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351 Australia
| | - Gudrun Dieberg
- grid.1020.30000 0004 1936 7371Biomedical Sciences, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351 Australia
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Resistance training in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2021; 27:1665-1682. [PMID: 34542742 DOI: 10.1007/s10741-021-10169-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Aerobic training (AT) has been the primary mode of exercise training in cardiac rehabilitation. Historically, the reason for the prescription of AT was that it was speculated that although RT may be beneficial for some clinical outcomes, it may have an adverse effect on ventricular structure and function. However, RT has now made its way into current cardiac rehabilitation guidelines, including those directed towards patients with HF, albeit differences exist across institutions and guidelines. A systematic search of PubMed, EMBASE and Cochrane Trials Register on April 30, 2021, was conducted for exercise-based rehabilitation trials in HF. Randomised and controlled trials that reported on resistance training versus usual care or trials that directly compared RT to an AT intervention were included. Resistance training versus controls improves parameters of lower (SMD 0.76 (95%CI 0.26, 1.25, p = 0.003] and upper extremity muscle strength (SMD 0.85 (95%CI 0.35, 1.35), p = 0.0009], both key parameters of physical function throughout the lifespan. Importantly, RT in isolation, versus control, improves VO2peak [MD: 2.64 ml/kg/min (95%CI 1.67, 3.60), p < 0.00001] and 6MWD [MD: 49.94 m (95%CI 34.59, 65.29), p < 0.00001], without any detrimental effect on left ventricular parameters. Resistance training in HF patients is safe and improves parameters of physical function and quality of life. Where people with HF are unable to, or are not inclined to, partake in aerobic activity, RT alone is appropriate to elicit meaningful benefit.
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Effects of resistance training on endothelial function: A systematic review and meta-analysis. Atherosclerosis 2021; 333:91-99. [PMID: 34399984 DOI: 10.1016/j.atherosclerosis.2021.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/06/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS The effects of resistance training on flow-mediated dilation (FMD), which has been the gold standard non-invasive assessment of endothelial function and is associated with the risk of cardiovascular events, are not well known. We conducted a systematic review to analyze the effects of resistance training on FMD. METHODS We searched Pubmed, Embase, CINAHL, SPORTDiscuss, Scopus, Web of Science and PEDro databases for studies that met the following criteria: (a) randomized controlled trials of resistance exercise with a comparative non-exercise group or contralateral untrained limb in adults and/or elderly; (b) studies that measured post-occlusion brachial artery FMD by ultrasonography, before and after intervention. Mean differences (MDs) with 95 % confidence interval (95 % CI) were calculated using an inverse variance method with a random effects model. RESULTS Twenty-three studies were included in the meta-analysis (n = 785 participants; 53 % females). Resistance training on FMD responses showed a favorable result for the resistance training group (n = 366) compared to the control group (n = 358) (MD 2.39, 95%CI 1.65, 3.14; p<0.00001). Subgroup analysis indicated favorable results for the dynamic resistance training (n = 545; MD 2.12, 95 % CI 1.26, 2.98; p<0.00001) and isometric handgrip training (n = 179; MD 3.32, 95 % CI 1.68, 4.96; p<0.0001) compared to the control group. The effect of resistance training on FMD responses was also favorable regardless of the condition of the participants (Healthy [n = 261]: MD 2.11, 95 % CI 1.04, 3.18; p<0.0001; Cardiovascular disease [n = 310]: MD 2.89, 95 % CI 0.88, 4.90; p = 0.005; metabolic disease [n = 153]: MD 2.40, 95 % CI 1.59, 3.21; p<0.00001). CONCLUSIONS Resistance training improves FMD in healthy individuals and patients with cardiovascular and metabolic diseases.
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Cucato G, Perren D, Ritti-Dias RM, Saxton JM. Effects of additional exercise therapy after a successful vascular intervention for patients with symptomatic peripheral arterial disease. Hippokratia 2021. [DOI: 10.1002/14651858.cd014736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Gabriel Cucato
- Department of Sport, Exercise, and Rehabilitation; Northumbria University; Newcastle-upon-Tyne UK
| | - Daniel Perren
- Health Education England North East; Newcastle upon Tyne UK
| | | | - John M Saxton
- Department of Sport, Exercise, and Rehabilitation; Northumbria University; Newcastle-upon-Tyne UK
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Santini L, Almeida Correia M, Oliveira PL, Puech-Leao P, Wolosker N, Cucato GG, Ritti-Dias RM. Functional and Cardiovascular Parameters in Peripheral Artery Disease Patients with Interarm Blood Pressure Difference. Ann Vasc Surg 2020; 70:355-361. [PMID: 32634564 DOI: 10.1016/j.avsg.2020.06.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/18/2020] [Accepted: 06/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND To analyze the impact of interarm blood pressure difference (IAD) on functional and cardiovascular parameters in patients with peripheral artery disease (PAD). METHODS Ninety-eight patients with PAD were recruited in this cross-sectional study. Patients with differences between the right and left arms of systolic and/or diastolic blood pressure ≥10 mm Hg were classified as IAD, whereas the remaining patients were classified as PAD control subjects. Functional parameters included were the 6-min walk test, short physical performance battery, walking impairment questionnaire (WIQ), and the walking estimated-limitation calculated by history. Systemic cardiovascular parameters included were arterial stiffness and heart rate variability. Local cardiovascular parameters assessed in both arms were brachial blood pressure and flow-mediated dilation. RESULTS Patients with IAD presented higher systolic blood pressure and pulse pressure compared with control patients (P < 0.01). The carotid femoral pulse wave velocity tended to be higher and flow-mediated dilation tended to be lower in PAD patients with IAD compared with control subjects (P < 0.09). Patients with IAD presented lower scores in short physical performance battery (P = 0.012), WIQ distance (P = 0.003), WIQ speed (P = 0.008), WIQ stair climbing (P = 0.034), and walking estimated-limitation calculated by history (P = 0.026) when compared with PAD control patients. CONCLUSIONS In patients with PAD, IAD is associated with lower physical function and impairments in cardiovascular parameters compared with PAD patients without IAD.
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Affiliation(s)
- Luiza Santini
- Graduate Program of Health Sciences, Instituto Israelita de Ensino e Pesquisa, São Paulo, São Paulo, Brazil
| | | | - Paulo L Oliveira
- Postgraduate Program in Rehabilitation Sciences, Universidde Nove de Julho, São Paulo, São Paulo, Brazil
| | - Pedro Puech-Leao
- Department of Vascular Surgery, Hospital das Clínicas da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Nelson Wolosker
- Graduate Program of Health Sciences, Instituto Israelita de Ensino e Pesquisa, São Paulo, São Paulo, Brazil
| | - Gabriel G Cucato
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Raphael M Ritti-Dias
- Postgraduate Program in Rehabilitation Sciences, Universidde Nove de Julho, São Paulo, São Paulo, Brazil.
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Ritti-Dias RM. Editorial Commentary: The use of transcutaneous oxygen pressure measurement during exercise to assess buttock claudication: The importance to test interventions. Trends Cardiovasc Med 2020; 31:224. [PMID: 32380074 DOI: 10.1016/j.tcm.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
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A Correia M, Oliveira PL, Farah BQ, Vianna LC, Wolosker N, Puech-Leao P, Green DJ, Cucato GG, Ritti-Dias RM. Effects of Isometric Handgrip Training in Patients With Peripheral Artery Disease: A Randomized Controlled Trial. J Am Heart Assoc 2020; 9:e013596. [PMID: 32067595 PMCID: PMC7070219 DOI: 10.1161/jaha.119.013596] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Meta-analyses have shown that isometric handgrip training (IHT) can reduce brachial systolic and diastolic blood pressure (BP) by >6/4 mm Hg, respectively. However, whether IHT promotes these effects among patients with peripheral artery disease, who exhibit severe impairment in cardiovascular function, is currently unknown. This study aimed to evaluate the effects of IHT on the cardiovascular function of patients with peripheral artery disease. Methods and Results A randomized controlled trial with peripheral artery disease patients assigned to either the IHT or control group was conducted. The IHT group performed 3 sessions per week, for 8 weeks, of unilateral handgrip exercises, consisting of 4 sets of isometric contractions for 2 minutes at 30% of maximum voluntary contraction and a 4-minute interval between sets. The control group received a compression ball in order to minimize the placebo effects, representing sham training. The primary outcome was brachial BP. The secondary outcomes were central BP, arterial stiffness parameters, cardiac autonomic modulation, and vascular function. The IHT program reduced diastolic BP (75 [10] mm Hg preintervention versus 72 [11] mm Hg postintervention), with no change in the control group (74 [11] mm Hg preintervention versus 74 [11] mm Hg postintervention), with this between-group difference being significant (P=0.04). Flow-mediated dilation improved in the IHT group (6.0% [5.7] preintervention versus 9.7% [5.5] postintervention), with no change in the control group (7.6% [5.5] preintervention versus 7.4% [5.1] postintervention), with this between-group difference being significant (P=0.04). There was no change in other measured variables over the intervention period. Conclusions IHT reduced brachial diastolic BP and improved local vascular function in patients with peripheral artery disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02742220.
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Affiliation(s)
- Marilia A Correia
- Associated Graduated Program in Physical Education Universidade de Pernambuco e Universidade da Paraíba Recife Brazil.,Graduated Program in Medicine Universidade Nove de Julho São Paulo Brazil
| | - Paulo L Oliveira
- Graduated Program in Rehabilitation Sciences Universidade Nove de Julho São Paulo Brazil
| | - Breno Q Farah
- Federal Rural University of Pernambuco Recife Brazil
| | - Lauro C Vianna
- Faculty of Physical Education Universidade de Brasília Brasília Brazil
| | | | | | | | - Gabriel G Cucato
- Hospital Israelita Albert Einstein São Paulo Brazil.,Northumbria University Newcastle Upon Tyne United Kingdom
| | - Raphael M Ritti-Dias
- Graduated Program in Rehabilitation Sciences Universidade Nove de Julho São Paulo Brazil
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