Postexercise Hypotension after Heart Transplant

Duration of Water-Based Exercise on Hemodynamic and Sleep Quality: An of Hypertensives and Normotensives Subanalysis

Purpose: This study aimed to determine whether a better hemodynamic profile and a better sleep quality are associated with the duration of physical exercise in the water; secondly, it aims to determine whether better sleep quality is associated with a more favorable hemodynamic profile. Methods: 97 subjects (85 women, age 59.46 ± 10.62) were included in the study. Groups were divided into normotensive (n = 46) and hypertensive individuals, (n = 51) duration of water aerobics (1-6 (n = 18), 7-11 (n = 11), 12-35 (n = 26), and > 36 months (n = 42), respectively), and sleep quality (Good, Poor, and Sleep Disordered). The peripheral (brachial), central (through applanation tonometry), and arterial blood pressure were assessed, and the Pittsburgh Sleep Quality Index questionnaire was collected. Results: We found that the groups practicing water-based exercise for a more extended period (>6 months) did not present improved pressure values and sleep quality. The best (though still weak) relationship between the water-based exercise time and the sleep quality values occurred between the group of 7-11 exercising for over 36 months (r = - 0.29 for both). When multivariate regression analysis was performed, there was interaction between AIx@75bpm and sleep quality score, as well as between AIx@75bpm and the age of subjects (p = .006 and 0.003, respectively). Conclusion: The data from the present study reported that subjects who participated for a longer time in the water aerobics training protocol had no additional hemodynamic and sleep quality benefits compared to volunteers with shorter duration groups (<6 months).

Effectiveness of Physical Activity and Exercise on Ambulatory Blood Pressure in Adults with Resistant Hypertension: A Systematic Review and Meta-Analysis

INTRODUCTION

Resistant hypertension (RHT) is a phenotype of hypertension that is challenging to manage by medications alone. While high grade evidence supports physical activity (PA) and exercise to reduce blood pressure (BP) in hypertension, it is unclear whether these are also effective for RHT.

AIMS

To determine the quality of evidence for the effectiveness of PA and exercise and the change of magnitude of 24-hour ambulatory BP (24hABP) in adults with RHT.

METHODS

Scopus, MEDLINE, CINHAL, Web of Science, Embase and SPORTDiscus databases were searched. Cochrane risk of bias tools, Review Manager and Grading of the Recommendation Assessment, Development and Evaluation were used to assess the methodological quality, the clinical heterogeneity and quality of the evidence.

RESULTS

Four studies comprising 178 individuals in total were included. A meta-analysis with random effects showed decreased 24hABP. The experimental group demonstrated grater mean differences for 24hABP following the PA and exercise programmes (systolic - 9.88 mmHg, 95% CI: - 17.62, - 2.14, I2 = 72%, p = 0.01; diastolic - 6.24 mmHg, 95% CI: - 12.65, 0.17, I2 = 93%,p = 0.06); and aerobic exercise (systolic - 12.06 mmHg, 95% CI: - 21.14, - 2.96, I2 = 77%, p = 0.009, diastolic - 8.19 mmHg, 95% CI: - 14.83, - 1.55, I2 = 92% ,p = 0.02). In the included studies, indirectness and publication bias were 'moderate' while inconsistency and imprecision were rated as 'low'. Thus, the overall quality of the evidence was considered to be 'low'.

CONCLUSIONS

Low certainty evidence suggests that PA and aerobic exercise added to usual care may be more effective in 24hABP reduction in RHT than usual care alone.

REGISTRATION

PROSPERO-2019 CRD42019147284 (21.11.2019).

Acute high-intensity interval exercise versus moderate-intensity continuous exercise in heated water-based on hemodynamic, cardiac autonomic, and vascular responses in older individuals with hypertension

OBJECTIVES

This crossover study design aimed to assess hemodynamic, cardiac autonomic, and vascular responses to high-intensity interval (HIIE) vs moderate-intensity continuous exercise (MICE) in older individuals with hypertension.

METHODS

Twenty (67 ± 7 y) older individuals with hypertension were randomly assigned to perform HIIE, MICE, or control (CON) sessions in the heated swimming pool (30-32°C). Blood pressure (BP), arterial stiffness, endothelial reactivity, and heart rate variability (HRV) were measured pre, post, and 45 min (recovery) after each intervention followed by 24-h ambulatory BP and HRV.

RESULTS

One single aerobic exercise session was not effective to provoke post-exercise hypotension and vascular improvements. HIIE was superior to MICE and CON to increasing parasympathetic modulation at post and recovery. Exercise sessions showed to disturb the autonomic system at nighttime compared to CON.

CONCLUSIONS

These results may have important implications in water-based therapy and the elderly with hypertension.

Exercise Training in Heart Failure With Reduced Ejection Fraction and Permanent Atrial Fibrillation: A Randomized Clinical Trial

BACKGROUND

Heart failure (HF) associated with atrial fibrillation (AF) increases patients' physical inactivity, worsening their clinical condition and mortality. Exercise training is safe and has clear benefits in HF. However, little is known about the effects of exercise training on heart failure patients with reduced ejection fraction and permanent atrial fibrillation (HFAF).

OBJECTIVE

To test the hypothesis that exercise training improves functional capacity, cardiac function, and quality of life in patients with HFAF.

METHODS

This randomized clinical trial was conducted at the Heart Institute. Patients with HFAF, LVEF ≤40% and resting HR ≤80 bpm were included in the study. Cardiopulmonary testing, echocardiography, autonomic, and quality of life assessment were performed before and after the 12-week protocol period.

RESULTS

Twenty-six patients, 58±1 years, were randomized to exercise training (HFAF-trained, n=13) or no training (HFAF-untrained, n=13). At baseline, no differences between groups were found. Exercise improved VO₂ peak, slope VE/VCO₂, and quality of life. HFAF-trained significantly decreased resting HR (from 73±2 to 69±2 bpm, P=.02) and recovery HR (from 148±11 to 128±9 bpm, P=.001). Concomitantly, LVEF increased (from 31±1 to 36±0.9 %, P=.01), LA decreased (from 52±1.2 to 47±1mm, P=.03), and LV-ESV and LV-EDV deceased (from 69±2 to 64±1.8 mL/m², and 99±2.1 to 91±2, P<.05, respectively). No changes were observed in the untrained group.

CONCLUSION

Exercise training can improve exercise capacity, quality of life, and cardiac function in patients with heart failure with reduced ejection fraction and permanent atrial fibrillation.

Hemodynamic response to exercise is impaired in individuals with Parkinson's disease

PURPOSE

To assess hemodynamic and cardiac autonomic response to high-intensity interval exercise (HIIE) versus moderate-intensity continuous exercise (MICE) in individuals with Parkinson's disease (PD).

METHODS

12 individuals (six men) with PD were randomly assigned to perform HIIE (4 min of warm-up followed by 21 min alternating 1 min at levels 15-17 with 2 min at levels 9-11 of rating of perceived exertion [RPE] in a cycle ergometer), MICE (4 min of warm-up followed by 26 min at levels 11-14 of RPE in a cycle ergometer) and control (CON; 30 min of sitting rest) interventions in separate days. Heart rate (HR), blood pressure (BP), endothelial reactivity and heart rate variability (HRV) were assessed before, immediately after and 45 min after each intervention. HR and exercise workload were measured during each intervention.

RESULTS

Despite the within (high- vs. low-intensity intervals of HIIE) and between (HIIE vs. MICE) differences in workload during exercise sessions, HR was not different between high- (average HR = 98±18 bpm) and low-intensity (average HR 97±19 bpm) intervals of HIIE, as well as between HIIE (average HR = 97±18 bpm) and MICE (average HR = 93±19 bpm) throughout the exercise. There were significant, but small, increases (P < 0.01) in HR and systolic BP at post HIIE and MICE, which returned to levels similar to pre-intervention during recovery. There were no within- and betweenintervention differences in diastolic BP, endothelial reactivity and HRV.

CONCLUSIONS

The present results suggest that hemodynamic response to exercise is impaired in individuals with PD.

Contemporary review of exercise in heart transplant recipients

Heart transplantation (HTx) is a therapeutic option for a selected group of patients with end-stage heart failure. Although secondary prevention including exercise therapy is recommended in the management of patients following HTx, little information is available on their metabolic and physiological consequences in HTx. Therefore, we aimed to conduct a contemporary review the effectiveness of exercise therapy on functional capacity, cardiovascular health and health-related quality of life for adult HTx patients. We searched the database MEDLINE for articles published between January 2015 and October 2020 and were able to include 6 studies involving 202 patients. Larger improvements in exercise capacity were seen after high-intensity interval training and in patients with evidence of cardiac reinnervation. Clinically relevant reductions were observed for daytime and 24 h ambulatory blood pressure after exercise training and following a single bout of aerobic exercise. Finally, limited data suggest that quality of life is higher in HTx patients following high-intensity training. In summary, the available evidence shows the potential for exercise as a vital treatment in patients following HTx. Yet, the scant data calls for more well-designed and adequately powered studies to support its effectiveness and to unravel optimal exercise characteristics, which would allow for more effective and person-tailored exercise prescription.

Effects of heated water-based versus land-based exercise training on vascular function in individuals with peripheral artery disease

Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with poor vascular function, walking impairment, and reduced quality of life. Land-based exercise therapy (LBET) is frequently recommended to improve walking and reduce symptoms. Recently, evidence has suggested that heated-water exercise therapy (HWET) is an effective intervention for PAD. However, the efficacy of LBET versus HWET in PAD patients had not been elucidated. Therefore, we sought to compare effects of LBET with HWET on cardiovascular function, exercise tolerance, physical function, and body composition in PAD patients. PAD patients (n = 53) were recruited and randomly assigned to a LBET group (n = 25) or HWET group (n = 28). The LBET group performed treadmill walking, whereas the HWET group performed walking in heated water for 12 wk. Leg (legPWV) and brachial-to-ankle arterial stiffness (baPWV), blood pressure (BP), ankle-brachial index (ABI), 6-min walking distance (6MWD), claudication onset time (COT), physical function, and body composition were assessed before and after 12 wk. There were significant group-by-time interactions (P < 0.05) for legPWV, BP, 6MWD, COT, body composition, and resting metabolic rate (RMR). Both groups significantly reduced (P < 0.05) legPWV, BP, and body fat percentage, and HWET measures were significantly lower than LBET measures. Both groups significantly increased 6MWD, COT, and RMR, and HWET group measures were significantly greater than LBET measures. A time effect was noted for baPWV reduction in both groups (P < 0.05). These results suggest that both LBET and HWET improve cardiovascular function, exercise tolerance, and body composition, and HWET showed considerably greater improvements compared with LBET in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that although land-based exercise therapy is effective for reducing arterial stiffness and blood pressure in patients with peripheral artery disease (PAD), heated-water exercise therapy demonstrates greater benefits on vascular function. The greater improvements in muscular strength, time to onset of claudication, and exercise tolerance after heated-water exercise therapy may have clinical implications for improving quality of life in patients with PAD. The heated-water exercise therapy intervention demonstrated relatively higher exercise training adherence (∼88%) compared with the land-based exercise intervention (∼81%).

Cardiac reinnervation affects cardiorespiratory adaptations to exercise training in individuals with heart transplantation

PURPOSE

The purpose of this study was to investigate the hemodynamic and cardiorespiratory adaptations to exercise in individuals with heart transplantation with evidence of cardiac reinnervation (cardiac reinnervation group) versus without evidence of cardiac reinnervation (no cardiac reinnervation group).

METHODS

Sedentary individuals with heart transplantation (age = 45.5 ± 2.2 years; time elapsed since surgery = 6.7 ± 0.7 years) were divided into the cardiac reinnervation (n = 16) and no cardiac reinnervation (n = 17) groups according to their heart rate response to cardiopulmonary exercise testing. The 24-hour ambulatory blood pressure, carotid-femoral pulse wave velocity, and cardiorespiratory fitness were assessed before and after 12 weeks of a thrice-weekly exercise program (five minutes of warm-up, 30 min of endurance exercise, one set of 10-15 reps in five resistance exercises, and five minutes of cool-down).

RESULTS

The cardiac reinnervation group had reduced (p < 0.01) 24-hour systolic/diastolic blood pressure (7/9 mm Hg), daytime systolic/diastolic blood pressure (9/10 mm Hg) and nighttime diastolic blood pressure (6 mm Hg) after training. The no cardiac reinnervation group reduced (p < 0.05) only 24-hour (5 mm Hg), daytime (5 mm Hg) and nighttime (6 mm Hg) diastolic blood pressure after training. Hourly analysis showed that the cardiac reinnervation group reduced systolic/diastolic blood pressure for 10/21 h, while the no cardiac reinnervation group reduced systolic/diastolic blood pressure for only 3/11 h. The cardiac reinnervation group also improved both maximal oxygen consumption (10.8%) and exercise tolerance (13.4%) after training, but the no cardiac reinnervation group improved only exercise tolerance (9.9%). Pulse wave velocity did not change in both groups.

CONCLUSION

There were greater improvements in ambulatory blood pressure and maximal oxygen consumption in the cardiac reinnervation than the no cardiac reinnervation group. These results suggest that cardiac reinnervation associates with hemodynamic and cardiorespiratory adaptations to exercise training in individuals with heart transplantation.

Hypotensive Effect of Heated Water-Based Exercise Persists After 12-Week Cessation of Training in Patients With Resistant Hypertension

BACKGROUND

Heated water-based exercise (HEx) promotes a marked reduction of blood pressure (BP), but it is not entirely clear whether its effects on BP persist after cessation of HEx.

METHODS

We analyzed the effects of cessation of HEx on 24-hour ambulatory BP monitoring (ABPM) in patients with resistant hypertension (RH). Thirty-two patients (aged 53 ± 6 years) with RH (4 to 6 antihypertensive drugs) were randomly assigned to HEx (n = 16) or control (n = 16) groups. Antihypertensive therapy remained unchanged during the protocol. The HEx group participated in 36 sessions (60 minutes) in a heated pool (32^oC [89.6°F]) for 12 weeks (training), followed by 12 weeks of cessation of training. The control group was evaluated during the same period and instructed to maintain their habitual activities.

RESULTS

HEx and control groups had similar BP levels at baseline. HEx training reduced the 24-hour systolic (-19.5 ± 4.6 vs 3.0 ± 0.7 mm Hg, P = 0.001) and diastolic BP (-11.1 ± 2.4 vs 2.06 ± 0.9 mm Hg, P = 0.001) at week 12, compared with the control group. After 12 weeks of training cessation (week 24), 24-hour BP remained significantly lower in the HEx group than in the control group (-9.6 ± 3.8 vs 6.3 ± 3.5 mm Hg, P = 0.01 and -7.5±2.2 vs 2.2 ± 1.0 mm Hg, P = 0.009, for systolic and diastolic BP, respectively), although these differences were attenuated.

CONCLUSIONS

BP remained lower after cessation of 12-week training among patients with RH who underwent HEx compared with the controls. The carryover effects of HEx on BP may help to overcome the challenging problem of exercise compliance in long-term follow-up.

Prescribing high-intensity interval exercise by RPE in individuals with type 2 diabetes: metabolic and hemodynamic responses

We tested the hypothesis that rating of perceived exertion (RPE) is a tool as efficient as the heart rate (HR) response to the cardiopulmonary exercise test (CPX) for prescribing and self-regulating high-intensity interval exercise (HIIE), and that metabolic and hemodynamic response to HIIE is superior than to continuous moderate-intensity exercise (MICE) in individuals with type 2 diabetes mellitus (T2DM). Eleven participants (age = 52.3 ± 3 years) underwent HIIE prescribed and self-regulated by RPE (HIIE_RPE; 25 min), HIIE prescribed and regulated by an individual's HR response to CPX (HIIE_HR; 25 min), MICE prescribed and self-regulated by RPE (30 min) and control (30 min of seated resting) intervention in random order. HR, blood pressure (BP), capillary glucose, endothelial reactivity, and carotid-femoral pulse wave velocity were assessed before, immediately after, and 45 min after each intervention. Exercise HR, speed, and distance were measured during exercise sessions. Twenty-four-hour ambulatory BP was measured after each intervention. Exercise HR, speed, and distance were similar between HIIE_RPE and HIIE_HR. BP response was not different among HIIE_RPE, HIIE_HR, and MICE. Capillary glycaemia reduction was greater (P < 0.05) after HIIE_RPE (48.6 ± 9.6 mg/dL) and HIIE_HR (47.2 ± 9.5 mg/dL) than MICE (29.5 ± 11.5 mg/dL). Reduction (P < 0.05) in 24-h (6.7 ± 2.2 mm Hg) and tendency toward reduction (P = 0.06) in daytime systolic (7.0 ± 2.5 mm Hg) ambulatory BP were found only after HIIE_RPE. These results suggest that HIIE is superior to MICE for reducing glycaemia and ambulatory BP, and that the 6-20 RPE scale is a useful tool for prescribing and self-regulating HIIE in individuals with T2DM.

Effects of heated water-based exercise on blood pressure: a systematic review

Abstract Introduction: Systemic arterial hypertension is one of the main cardiovascular risk factors affecting several population. In this context, heated water-based exercise has emerged as a potential alternative to land- based physical exercise to reduce blood pressure (BP) in hypertensive patients. Objective: To systematically synthesize evidence for the lowering effects of heated water-based exercise on BP in a non-specific population. Methods: Scielo, Pubmed and Scopus electronic databases were searched for studies from 2005 to 2016, with the following descriptors in English: “blood pressure, exercise, immersion, blood pressure and hydrotherapy”. A total of 10,461 articles were found and, after applying the inclusion and exclusion criteria, 13 articles were selected and included in the final analysis. All included articles evaluated individuals from different populations and age groups, submitted to a heated water-based exercise session and/or program. Results: The results suggest that both an acute single session and chronic training period (12 to 24 weeks) of heated water-based exercise may reduce BP in different populations (normotensive, hypertensive, postmenopausal women, and heart transplant populations). The magnitude and duration of acute and chronic hypotensive effect of exercise ranged substantially, which was probably due to the variety of exercise frequency, duration and intensity, as well as due to the studied population. Conclusion: These results suggest that heated water-based exercise may promote acute and chronic hypotensive effects in different populations. However, there is no homogeneity in the protocols used, which may have led to the heterogeneity in magnitude and duration of BP reductions.

Low-intensity isometric handgrip exercise has no transient effect on blood pressure in patients with coronary artery disease

Hypertension is highly prevalent among patients with coronary artery disease (CAD). Exercise-based cardiac rehabilitation reduces blood pressure (BP). However, less is known about the transient effect of a single bout of exercise on BP. Isometric handgrip exercise has been proposed as a new nonpharmacologic tool to lower BP. We aimed to investigate the acute effect of isometric handgrip exercise on BP in CAD patients. Twenty-one male CAD patients were included. All patients completed two experimental sessions in random order: one control and one low-intensity isometric handgrip session. BP was measured by means of a 24-hour ambulatory BP monitor preintervention, for 1 hour in the office and subsequently for 24 hours. Our results suggest that isometric handgrip exercise performed at low intensity is safe in patients with CAD but does not induce a transient reduction in BP.