Sport therapy for hypertension: why, how, and how much?

Effects of Three Traditional Chinese Fitness Exercises Combined with Antihypertensive Drugs on Patients with Essential Hypertension: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Objective

To compare the efficacy of three different traditional Chinese exercises (Tai Chi, Baduanjin, and Wuqinxi) combined with antihypertensive drugs (AHD) on patients with essential hypertension (EH).

Method

Eight electronic databases were searched to identify randomized controlled trials (RCTs) comparing the effects of traditional Chinese fitness exercises combined with AHD and AHD alone. The analysis mainly consists of network meta-analysis (NMA) and pairwise meta-analysis. The Cochrane assessment tool was adopted to assess the risk of bias of included literatures. This study used STATA/SE 15.1 (StataCorp, 2017), R software (version 4.0.1), and Cochrane's Review Manager software (version 5.4) to conduct data analysis and figures generation.

Results

A total of 30 RCTs were included in this study, of which 16 evaluated Tai Chi plus AHD versus AHD, 11 evaluated Baduanjin plus AHD versus AHD, and 3 evaluated Wuqinxi plus AHD versus AHD. No RCT compared directly among the three traditional Chinese fitness exercises. Pairwise meta-analysis showed that Tai Chi plus AHD was significantly superior to AHD alone in reducing systolic blood pressure (SBP) and diastolic blood pressure (DBP). BDJ plus AHD was statistically superior to AHD alone in reducing SBP, DBP, and endothelin (ET) and increasing nitric oxide (NO). NMA results indicated that Tai Chi plus AHD (WMD −12.42 mmHg, 95% CI: −15.29 to −9.55) and Baduanjin plus AHD (WMD −7.03 mmHg, 95% CI: −9.80 to −4.26) were superior to AHD, and Tai Chi was more effective than other traditional exercises in lowering SBP, Tai Chi plus AHD (WMD −7.56 mmHg, 95% CI: −10.15 to −4.96) and Baduanjin plus AHD (WMD −4.51 mmHg, 95% CI: −7.38 to −1.65) were superior to AHD in reducing DBP, Baduanjin plus AHD (WMD 4.26 μmol/L, 95%CI: 2.68 to 5.83) was statistically superior to AHD in increasing NO, and Tai Chi plus AHD (WMD −7.64 pg/ml, 95% CI: −10.46 to −4.83) and Baduanjin plus AHD (WMD −9.23 pg/ml, 95% CI: −10.85 to −7.61) were superior to AHD in lowering ET.

Conclusion

Compared with AHD alone, both Tai Chi plus AHD and Baduanjin plus AHD showed significant benefit in regulating SBP, DBP, and ET. Among the three traditional Chinese fitness exercises, Tai Chi may be the best as an adjunctive therapy for SBP reduction. These findings provided evidence for the therapeutic benefit of either Tai Chi or Baduanjin exercise as an adjunct therapy for patients with EH. Limited by the methodological quality and quantity of included studies, results need to be interpreted with caution, and it is necessary to carry out further high-quality RCTs on traditional Chinese fitness exercise-assisted treatment of EH in the future.

Running to Lower Resting Blood Pressure: A Systematic Review and Meta-analysis

BACKGROUND

According to previous epidemiological studies, there are pros and cons for the relationship between running regularly and changes in resting blood pressure (RBP), and the changes may depend on the form of exercise.

OBJECTIVE

The aims of the current systematic review were to summarize the effects of running regularly on RBP and to investigate the most efficacious form of running in reducing RBP for this purpose.

METHODS

The inclusion criteria were: randomized controlled trials, involving healthy adults or adults with hypertension, the exercise group only performed regular running and the control group did not exercise, and the study reported the mean resting systolic blood pressure (RSBP) and/or diastolic blood pressure (RDBP). The mean difference (MD) in RBP in each trial was defined as follows: (mean value at post-intervention in the exercise group - mean value at baseline in the exercise group) - (mean value at post-intervention in the control group - mean value at baseline in the control group) and was calculated. The weighted MD (WMD) was defined as the synthesis of all MD. A linear meta-regression analysis, exercise intensity [the percentage of maximum heart rate] (%) and total exercise time throughout the intervention (hours) were selected as explanatory variables and the MD in RBP served as the objective variable.

RESULTS

Twenty-two trials (736 subjects) were analyzed. When trials were limited to those involving healthy subjects, the WMD in RBP decreased significantly [RSBP: - 4.2 mmHg (95% confidence intervals (95% CI) - 5.9 to - 2.4); RDBP: - 2.7 mmHg (95% CI - 4.2 to - 1.1)] and did not contain significant heterogeneity (RSBP: P = 0.67, I² = 0.0%; DBP: P = 0.38, I² = 7.2%). When trials were limited to those involving subjects with hypertension, the WMD in RBP decreased significantly [RSBP: - 5.6 mmHg (95% CI - 9.1 to - 2.1); RDBP: - 5.2 mmHg (95% CI - 9.0 to - 1.4)] but contained significant heterogeneity (RSBP: P = 0.01, I² = 62.2%; DBP: P < 0.01, I² = 87.7) and a meta-regression analysis showed that the percentage of maximum heart rate was significantly associated with the WMD in RSBP [slope: 0.56 (95% CI 0.21 to 0.92), intercept: - 48.76 (95% CI - 76.30 to - 21.22), R² = 0.88] and RDBP [slope: 0.45 (95% CI 0.01 to 0.87), intercept: - 38.06 (95% CI - 72.30 to - 4.08), R² = 0.41]. When trials were limited to those involving subjects with hypertension and a mean age ≥ 40 years, a meta-regression analysis showed that total exercise time throughout the intervention was significantly associated with the WMD in RDBP [slope: 0.82 (95% CI 0.54 to 1.09), intercept: - 22.90 (95% CI - 29.04 to - 16.77), R² = 0.99].

CONCLUSIONS

Running regularly decreases RBP, but the changes in subjects with hypertension may differ depending on exercise intensity or total exercise time. Therefore, running regularly at moderate intensity and at a restrained volume is recommended to lower RBP in subjects with hypertension.

Short-Term Resistance Training Improves Cardiac Autonomic Modulation and Blood Pressure in Hypertensive Older Women: A Randomized Controlled Trial

Oliveira-Dantas, FF, Brasileiro-Santos, MdS, Thomas, SG, Silva, AS, Silva, DC, Browne, RAV, Farias-Junior, LF, Costa, EC, and Santos, AdC. Short-term resistance training improves cardiac autonomic modulation and blood pressure in hypertensive older women: a randomized controlled trial. J Strength Cond Res 34(1): 37-45, 2020-This randomized controlled trial investigated the efficacy of short-term resistance training (RT) on cardiac autonomic modulation and peripheral hemodynamic parameters in hypertensive older women. Twenty-five hypertensive older women who were insufficiently active (64.7 ± 4.7 years) participated in this study. Subjects were randomly allocated to a 10-week RT program (2 d·wk in the first 5 weeks; 3 d·wk in the last 5 weeks) or a nonexercise control group. Linear reverse periodization was used for the RT program. Cardiac autonomic modulation, mean blood pressure (MBP), peripheral vascular resistance (PVR), and resting heart rate (RHR) were measured before and after 10 weeks. The RT group reduced cardiac sympathetic modulation (0V%; B = -6.6; 95% confidence interval [CI]: -12.9 to -0.2; p = 0.045; Cohen's d = 0.88) and showed a trend for increased parasympathetic modulation (2V%; B = 12.5; 95% CI: 0-25; p = 0.050; Cohen's d = 0.87) compared with the control group. The RT group reduced MBP (B = -8.5 mm Hg; 95% CI: -13.6 to -3.4; p = 0.001; Cohen's d = 1.27), PVR (B = -14.1 units; 95% CI: -19.9 to -8.4; p < 0.001; Cohen's d = 1.86), and RHR (B = -8.8 b·min; 95% CI: -14.3 to -3.3; p = 0.002; Cohen's d = 1.20) compared with the control group. In the RT group, the changes in 2V% patterns and low-frequency components showed a correlation with changes in MBP (r = -0.60; p = 0.032) and RHR (r = 0.75; p = 0.0003). In conclusion, 10 weeks of RT improved cardiac autonomic modulation and reduced MBP and PVR in hypertensive older women. These results reinforce the importance of RT for this population.

Sex/Gender-Specific Imbalance in CVD: Could Physical Activity Help to Improve Clinical Outcome Targeting CVD Molecular Mechanisms in Women?

In the last two decades, new insights have been gained regarding sex/gender-related differences in cardiovascular disease (CVD). CVD represents the leading cause of death worldwide in both men and women, accounting for at least one-third of all deaths in women and half of deaths in women over 50 years in developing countries. Important sex-related differences in prevalence, presentation, management, and outcomes of different CVDs have been recently discovered, demonstrating sex/gender-specific pathophysiologic features in the presentation and prognosis of CVD in men and women. A large amount of evidence has highlighted the role of sex hormones in protecting women from CVDs, providing an advantage over men that is lost when women reach the menopause stage. This hormonal-dependent shift of sex-related CVD risk consequently affects the overall CVD epidemiology, particularly in light of the increasing trend of population aging. The benefits of physical activity have been recognized for a long time as a powerful preventive approach for both CVD prevention and aging-related morbidity control. Exercise training is indeed a potent physiological stimulus, which reduces primary and secondary cardiovascular events. However, the underlying mechanisms of these positive effects, including from a sex/gender perspective, still need to be fully elucidated. The aim of this work is to provide a review of the evidence linking sex/gender-related differences in CVD, including sex/gender-specific molecular mediators, to explore whether sex- and gender-tailored physical activity may be used as an effective tool to prevent CVD and improve clinical outcomes in women.

Aerobic exercise regulates synaptic transmission and reactive oxygen species production in the paraventricular nucleus of spontaneously hypertensive rats

Aerobic exercise lowers blood pressure in patients with hypertension, but the underlying mechanisms remain incompletely understood. The hypothalamic paraventricular nucleus (PVN) plays a key role in the control of sympathetic outflow and cardiovascular tone. We examined whether chronic aerobic exercise altered synaptic transmission and reactive oxygen species (ROS) production in the PVN. In the present study, spontaneously hypertensive rats (SHRs) were subjected to exercise training for 8 weeks, five times per week, with Wistar Kyoto (WKY) rats as the cohort control. Miniature excitatory and inhibitory postsynaptic currents (mEPSCs and mIPSCs) were recorded from the PVN in ex vivo hypothalamic slice preparations obtained after the last training, and biomarkers of oxidative stress and physical indexes were observed. The mean frequency and amplitude, as well as the rise time and the decay time constant of mIPSCs, significantly decreased in 20-wk-old SHRs compared to WKY 20-wk-old controls. In contrast to mIPSCs, only the mean mEPSC frequency was higher, and there were no other changes in mEPSCs in comparison to the control group. SHRs exhibited higher ROS, 8-OHdG, and MDA; and lower SOD1, SOD2, CAT, Ogg1, and SOD and CAT activity in the PVN. These SHRs also had a significant increase in heart rate, blood pressure and sympathetic nerve activity, and higher levels of norepinephrine (NE). Exercise training ameliorated all these abnormalities, resulting in an increase in the mean frequency, amplitude and kinetics of mIPSCs, accompanied by a decrease in the mean frequency of mEPSCs in the PVN. This study demonstrates that moderate intensity, high frequency exercise training induces a selective enhancement of inhibitory synaptic transmission in the PVN, which may dampen sympathetic activity and reduce blood pressure in hypertension. These changes may be due to antioxidant-related adaptations in the PVNs of SHRs.

Amlodipine and enalapril promote distinct effects on cardiovascular autonomic control in spontaneously hypertensive rats: the role of aerobic physical training

BACKGROUND

We compared the autonomic and hemodynamic cardiovascular effects of amlodipine and enalapril treatment associated with an aerobic physical training program on spontaneously hypertensive rats.

METHODS

Eighteen-week-old (n = 48) spontaneously hypertensive rats were assigned to one of two groups: sedentary (n = 24) and trained (n = 24) through a 10-week swimming training program. Each group was subdivided into three groups (n = 8): control (vehicle group), amlodipine (amlodipine group; 10 mg/kg per day) and enalapril (enalapril group; 10 mg/kg per day) (both for 10 weeks). We cannulated the femoral artery and vein of all animals for recording arterial pressure and injecting drugs, respectively. Autonomic assessment was performed by double blockade with propranolol and atropine, analysis of heart rate variability (HRV), systolic arterial pressure variability and baroflex sensitivity.

RESULTS

Arterial pressure reduction was more prominent in the sedentary and trained enalapril groups. Amlodipine sedentary group presented important autonomic adjustments characterized by a predominance of vagal tone in cardiac autonomic balance, increased HRV associated with sympathetic autonomic modulation reduction and increased vagal autonomic modulation, and increased baroflex sensitivity. All findings were not potentialized by physical training. In turn, the enalapril trained group, but not its sedentary counterpart, also had vagal tone prevalence in cardiac autonomic balance, increased HRV, increased baroflex sensitivity and decreased low-frequency band in systolic arterial pressure variability.

CONCLUSION

Amlodipine was more effective in promoting beneficial autonomic cardiovascular adaptations in sedentary animals. In contrast, enalapril achieved better autonomic results only when combined with aerobic physical training.

Exercise Training Improves the Altered Renin-Angiotensin System in the Rostral Ventrolateral Medulla of Hypertensive Rats

The imbalance between angiotensin II (Ang II) and angiotensin 1-7 (Ang 1-7) in the brain has been reported to contribute to cardiovascular dysfunction in hypertension. Exercise training (ExT) is beneficial to hypertension and the mechanism is unclear. This study was aimed to determine if ExT improves hypertension via adjusting renin angiotensin system in cardiovascular centers including the rostral ventrolateral medulla (RVLM). Spontaneously hypertensive rats (SHR, 8 weeks old) were subjected to low-intensity ExT or kept sedentary (Sed) for 12 weeks. Blood pressure elevation coupled with increase in age was significantly decreased in SHR received ExT compared with Sed. The results in vivo showed that ExT significantly reduced or increased the cardiovascular responses to central application of sarthran (antagonist of Ang II) or A779 (antagonist of Ang 1-7), respectively. The protein expression of the Ang II acting receptor AT1R and the Ang 1-7 acting receptor Mas in the RVLM was significantly reduced and elevated in SHR following ExT, respectively. Moreover, production of reactive oxygen species in the RVLM was significantly decreased in SHR following ExT. The current data suggest that ExT improves hypertension via improving the balance of Ang II and Ang 1-7 and antioxidative stress at the level of RVLM.

Cardiorespiratory screening in elite endurance sports athletes: the Quebec study

BACKGROUND

Cardiorespiratory disorders are common in athletes. However, these conditions are often underdiagnosed, which potentially results in impaired performance and increased health risks. The aim of this study was to evaluate, in a research setting, the prevalence of cardiorespiratory disorders in athletes in order to determine the potential value of a screening program.

METHODS

One hundred thirty-three athletes were studied. Each subject underwent a physical examination. A eucapnic voluntary hyperventilation (EVH) test and a methacholine inhalation test were performed to confirm the diagnosis of asthma. A cardiovascular evaluation was also performed, including maximal exercise test with electrocardiogram, 24-hour ambulatory blood pressure monitoring, 24-hour Holter monitoring, and blood sampling.

RESULTS

Seventy-four (56%) athletes had airway hyperresponsiveness to EVH or the methacholine inhalation test. Among those with airway hyperresponsiveness, 45 (61%) athletes were only hyperresponsive to EVH, and 10 (14%) were only hyperresponsive to the methacholine inhalation test (using the criteria of a PC20 ≤ 4 mg/mL). Thirty-two (24%) athletes had a known diagnosis of asthma, while 34 (26%) athletes received a new asthma diagnosis. Ninety-seven (73%) athletes were sensitized to common airborne allergens. Forty-seven (35%) athletes completed the cardiovascular evaluation. Three (6%) and 7 (15%) athletes had a previous or new diagnosis of cardiovascular disease, respectively. Resting systemic hypertension was documented in 2 (4%) athletes and exaggerated blood pressure response to exercise was found in 12 (26%) athletes.

CONCLUSION

This cardiorespiratory screening data set in athletes showed a high prevalence of exercise-induced asthma and exercise hypertension, which in many cases were not previously diagnosed.

Efeitos do treinamento muscular inspiratório em universitários tabagistas e não tabagistas

O hábito de fumar pode reduzir a capacidade aeróbica, aumentar a resistência ao fluxo aéreo e afetar a função dos músculos respiratórios. O objetivo deste estudo foi comparar os efeitos do Treinamento Muscular Inspiratório (TMI) entre dois grupos: tabagistas e não tabagistas. Participaram 44 voluntários universitários, divididos em dois grupos: tabagistas (GT), composto por 20 indivíduos (25,60±7,01 anos) e não tabagistas, constituindo o Grupo Controle (GC), composto por 24 voluntários (24,08±7,52 anos). Ambos os grupos foram submetidos ao TMI, por meio do uso do manovacuômetro aneroide, com duração de 6 semanas, sendo 3 sessões semanais, totalizando 18 sessões. Os resultados mostraram diferença estatisticamente significativa (p<0,05) pós-TMI no GC para as variáveis: Pressão Inspiratória Máxima (PImáx), Pico de Fluxo Expiratório (PFE), Pressão Arterial Média ao repouso (PAM pré-TC6) e Teste de Caminhada de Seis Minutos (TC6). No GT, houve diferença estatisticamente significativa pós-TMI para as variáveis: PImáx, PFE, TC6 e saturação periférica de oxigênio após o TC6 (SpO2 pós-imediata). A comparação das médias das variáveis entre GT e GC mostrou diferença estatisticamente significativa no pós-TMI para as variáveis PImáx e PFE. A variável TC6 não apresentou diferença estatisticamente significativa. Conclui-se que o TMI proporcionou um aumento significativo da força muscular inspiratória, melhora da função pulmonar e melhora do desempenho físico nos indivíduos estudados.

Exercise lowers blood pressure in university professors during subsequent teaching and sleeping hours

BACKGROUND

University professors are subjected to psychological stress that contributes to blood pressure (BP) reactivity and development of hypertension. The purpose of this study was to investigate the effects of exercise on BP in university professors during teaching and sleeping hours.

METHODS

Twelve normotensive professors (42.2 ± 10.8 years, 74.2 ± 11.2 kg, 172.8 ± 10.4 cm, 20.1% ± 6.7% body fat) randomly underwent control (CONT) and exercise (EX30) sessions before initiating their daily activities. EX30 consisted of 30 minutes of cycling at 80%-85% of heart rate reserve. Ambulatory BP was monitored for 24 hours following both sessions.

RESULTS

BP increased in comparison with pre-session resting values during teaching after CONT (P < 0.05) but not after EX30. Systolic, diastolic, and mean arterial BP showed a more pronounced nocturnal dip following EX30 (approximately -14.7, -12.7, and -9.6 mmHg, respectively) when compared with CONT (approximately -6, -5 and -3 mmHg).

CONCLUSION

Exercise induced a BP reduction in university professors, with the main effects being observed during subsequent teaching and sleeping hours.

[Sports and osteoarthrosis]

Many risk factors for developing osteoarthrosis exist. Osteoarthrosis is the most common cause of chronic disability in middle-aged and older people. On the one hand, physical exercise can lead to arthrosis; on the other hand, physical exercise is commonly used in preventing and treating it. Experimental and clinical studies have shown that increased high-impact running or competitive sports result in a higher risk for osteoarthrosis than moderate low-impact running. In particular, sudden-impact loading and twisting movements of the joints can result in premature osteoarthrosis. Also, sports with a high risk for injuries can lead to secondary osteoarthrosis. Preventive exercises to strengthen the skeletal muscles seem to have a pivotal role. There are different therapeutic approaches to osteoarthrosis, which will be more important in the future. Exercise should be a core treatment for people with osteoarthritis, irrespective of age, comorbidity, pain severity, or disability. Exercise should include local muscle strengthening and general aerobic fitness.

Exercise Prescription for the Prevention and Management of Hypertension

Regular physical activity is known to reduce blood pressure in 75% of individuals with hypertension and is a key component of lifestyle therapy for the prevention and management of hypertension. However, the frequency, intensity, duration, and mode of activity play a role in the magnitude and duration of blood pressure reduction. Aerobic activity is the preferred type of activity to lower blood pressure. Acute, moderate-intensity aerobic activity (40%-60% VO2max ) can decrease blood pressure by 5 to 7 mm Hg for up to 22 hours postexercise, so participation in aerobic activity is recommended on most, if not all, days of the week. The recommended duration for aerobic activity is 30 to 60 minutes of continuous or intermittent activity. Resistance activity results in a 3-mm Hg decrease in blood pressure and should supplement the aerobic activity. Low- to moderate-intensity resistance training (30%-40% of a 1—repetition maximum [1RM] for upper body exercises and 50%-60% 1RM for lower body exercises) is recommended 2 to 3 d/wk. The volume of resistance training for blood pressure reduction is 1 to 3 sets of 10 to 15 repetitions for 8 to 10 exercises that target large muscle groups (thighs, hips, back, chest, arms, and abdominals). When prescribing physical activity for the prevention or management of hypertension, it is important to know that certain populations respond differently to activity and that certain medications can inhibit physical performance.