Resistance Exercise Training Is More Effective than Interval Aerobic Training in Reducing Blood Pressure During Sleep in Hypertensive Elderly Patients

Effects of dynamic, isometric, and combined resistance training on ambulatory blood pressure in treated men with hypertension: a randomized controlled trial

Ambulatory blood pressure (ABP) monitoring is a widespread recommendation for the diagnosis and management of hypertension. Dynamic resistance training (DRT) and isometric handgrip training (IHT) have been recommended for hypertension treatment, but their effects on ABP have been poorly studied. Additionally, combined dynamic and isometric handgrip resistance training (CRT) could produce an additive effect that has yet to be tested. Thus, this randomized controlled trial was designed to evaluate the effects of DRT, IHT and CRT on mean ABP and ABP variability. Fifty-nine treated men with hypertension were randomly allocated to 1 of four groups: DRT (8 dynamic resistance exercises, 50% of 1RM, 3 sets until moderate fatigue), IHT (4 sets of 2 min of isometric handgrip at 30% of MVC), CRT (DRT + IHT) and control (CON - 30 min of stretching). Interventions occurred 3 times/week for 10 weeks, and ABP was assessed before and after the interventions. ANOVAs and ANCOVAs adjusted for pre-intervention values were employed for analysis. Mean 24-h, awake and asleep BPs did not change in either group throughout the study (all, P > 0.05). Nocturnal BP fall as well as the standard deviation, coefficient of variation and the average real variability of ABP also did not change significantly in either group (all, P < 0.05). Changes in all these parameters adjusted to the pre-intervention values were also similar among the four groups (all, p > 0.05). In treated men with hypertension, 10 weeks of DRT, IHT or CRT does not decrease ABP levels nor change ABP variability.

Impact of resistance exercise program on muscle strength, cardiopulmonary function and glycolipid metabolism of bedridden population aged 80 years and above: A randomized controlled trial

BACKGROUND

This study aimed to evaluate the impact of a resistance exercise program in the bedridden older adults in China.

METHODS

The patients aged 80 years and above with stable diseases were randomly divided into control group (receiving routine treatment and nursing) and training group (receiving the elastic ball and elastic band training applied for 55 minutes, 3 times a week during 6 months).

RESULTS

A total of 59 patients (control group: 30; training groups: 29) completed the study. In terms of muscle strength, the patients of the training group had better grip strength and supine leg lifts and 30-s sit-to-stand actions. In terms of cardiopulmonary function and glycolipid metabolism, the patients in the training groups had better lung capacity and high-density lipoprotein.

CONCLUSION

The low-load and low-intensity resistance training may effectively improve not only the muscle strength of the bedridden older adults, but also the lung function and blood lipid metabolism.

Effects of aerobic exercise on blood pressure in patients with hypertension: a systematic review and dose-response meta-analysis of randomized trials

We aimed to evaluate the dose-dependent effects of aerobic exercise on systolic (SBP) and diastolic blood pressure (DBP) and haemodynamic factors in adults with hypertension. PubMed, Scopus, and Web of Science were searched to April 2022 for randomized trials of aerobic exercise in adults with hypertension. We conducted a random-effects meta-analysis to estimate mean differences (MDs) and 95%CIs for each 30 min/week increase in aerobic exercise. The certainty of evidence was rated using the GRADE approach. The analysis of 34 trials with 1787 participants indicated that each 30 min/week aerobic exercise reduced SBP by 1.78 mmHg (95%CI: -2.22 to -1.33; n = 34, GRADE=low), DBP by 1.23 mmHg (95%CI: -1.53 to -0.93; n = 34, GRADE=moderate), resting heart rate (MD = -1.08 bpm, 95%CI: -1.46 to -0.71; n = 23, GRADE=low), and mean arterial pressure (MD = -1.37 mmHg, 95%CI: -1.80 to -0.93; n = 9, GRADE = low). A nonlinear dose-dependent decrement was seen on SBP and DBP, with the greatest decrement at 150 min/week (MD150 min/week = -7.23 mmHg, 95%CI: -9.08 to -5.39 for SBP and -5.58 mmHg, 95%CI: -6.90 to -4.27 for DBP). Aerobic exercise can lead to a large and clinically important reduction in blood pressure in a dose-dependent manner, with the greatest reduction at 150 min/week. The dose-dependent effects of aerobic exercise on systolic and diastolic blood pressure and haemodynamic factors in adults with hypertension.

Intermittent high-intensity exercise for pre- to established hypertension: A systematic review and meta-analysis

OBJECTIVE

To determine the impact of intermittent high-intensity exercise training ([IHIE], including high-intensity interval training [HIIT] and recreational team sports [RTS]) on systolic (SBP) and diastolic blood pressure (DBP) in adults with pre- to established arterial hypertension.

DATA SOURCES

MEDLINE, Cochrane Library, Embase, and SPORTDiscus.

ELIGIBILITY CRITERIA

Randomized controlled trials (RCTs) comparing the impact of IHIE on BP versus a non-exercise control.

DATA COLLECTION AND ANALYSIS

Two authors independently conducted all procedures. Mean differences were calculated using random-effects model. The certainty of the evidence was assessed with GRADE.

RESULTS

Twenty-seven RCTs (18 HIIT and 9 RTS) were analyzed, with median duration of 12 weeks. Participants' (n = 946) median age was 46 years. Overall, IHIE decreased SBP (-3.29 mmHg; 95% CI: -5.19, -1.39) and DBP (-2.62 mmHg; 95% CI: -3.79, -1.44) compared to the control group. IHIE elicited higher decreases in office SBP and DBP of hypertensive subjects (SBP: -7.13 mmHg, [95% CI: -10.12, -4.15]; DBP: -5.81 mmHg, [95% CI: -7.94, -3.69]) than pre-hypertensive (SBP: -2.14 mmHg, [95% CI: -4.36, -0.08]; DBP: -1.83 mmHg, [95% CI: -2.99, -0.67]). No significant differences were found between HIIT (SBP: -2.12 mmHg, [95% CI: -4.78, -0.54]; DBP: -1.89 mmHg, [95% CI: -3.32, -0.48]) and RTS (SBP: -4.18 mmHg, [95% CI: -7.19, -2.43]; DBP: -4.04 mmHg, [95% CI: -6.00, -2.09]). These findings present low/very low certainty of evidence. No adverse cardiovascular events were reported.

CONCLUSIONS

IHIE appears to be safe and to promote substantial decreases in BP, particularly in patients with hypertension. However, the certainty of evidence was low/very low.

PROTOCOL

CRD42020163575.

Aerobic exercise training improves nocturnal blood pressure dipping in medicated hypertensive individuals

OBJECTIVE

The absence of nocturnal blood pressure (BP) reduction at night in hypertensive individuals is associated with an increased cardiovascular risk. The main purpose of the present study was to investigate the effects of an aerobic training intervention on nocturnal BP dipping in medicated hypertensive individuals.

METHODS

At baseline, hypertensive individuals under pharmacological treatment underwent 24-h ambulatory BP monitoring and a morning urine sample to analyze albumin creatinine ratio (UACR). Then, participants were divided into nocturnal dippers ( N = 15; 59 ± 6 years) and nondippers ( N = 20; 58 ± 5 years) according to a day-to-night BP reduction of >10% or <10%, respectively. Next, participants underwent a 3-weekly, 4-month aerobic interval training intervention.

RESULTS

Follow-up measurements revealed a reduction in daytime diastolic BP in dippers and nondippers ( Ptime < 0.001), whereas nighttime systolic BP was reduced only in nondippers ( P = 0.004). Regarding dipping pattern, nocturnal systolic BP dipping increased after training in nondippers (5 ± 3 to 9 ± 7%; P = 0.018), whereas in dippers, there was a decrease in nocturnal dipping after training (14 ± 4 to 10 ± 7%, P = 0.016). Nocturnal diastolic BP dipping did not change in nondippers (8 ± 5 to 10 ± 7%; P = 0.273) but decreased in dippers (17 ± 6 to 12 ± 8%; P = 0.004). In addition, UACR was significantly reduced in both groups after training ( Ptime = 0.020).

CONCLUSION

Aerobic exercise training is associated with nocturnal BP dipping as nighttime BP was lower than before the program in medicated hypertensive individuals with an initial nondipping phenotype. The lack of improvement in individuals with a dipping phenotype warrants further investigation to discern whether dipping phenotypes influence BP responses to exercise training.

High-intensity interval training reduces blood pressure in older adults: A systematic review and meta-analysis

BACKGROUND/OBJECTIVES

The current systematic review and meta-analysis evaluated the effects of High-Intensity Interval Training (HIIT) on blood pressure (BP) in older adults and compared the efficacy of HIIT versus moderate-intensity continuous training (MICT).

METHODS

Search was conducted using the databases at PubMed, Scopus, Cochrane Library and EMBASE, for randomized trials comparing the chronic effects (≥4 weeks) of HIIT versus MICT or control group (non-exercise) on BP in older adults (≥60 years) with or without hypertension.

RESULTS

A total of 10 articles (n = 266 participants) were included in this meta-analysis. HIIT were associated with reductions in systolic BP (MD -7.36; 95%CI -11.80 to -2.92; P < 0.01; I² = 24%) and diastolic BP (MD -5.48; 95%CI -8.71 to -2.25; P < 0.01; I² = 40%) versus control group. No differences were found between HIIT and MICT in systolic BP (MD -2.09; 95%CI -9.76 to 5.58; P = 0.59; I² = 0%) and diastolic BP (MD -1.00; 95%CI -6.01 to 4.01; P = 0.69; I² = 0%).

CONCLUSION

HIIT reduces BP in older adults. Additionally, HIIT and MICT provided comparable reductions on BP in this population.

Acute Aerobic Exercise Induces Short-Term Reductions in Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis

[Figure: see text].

Acute effects of different types of exercise on the blood pressure of hypertensive older women: a randomized study

BACKGROUND

The magnitude and duration of the hypotensive effect of exercise may be influence by the type of exercise performed. The aim of the present study was to compare systolic (SBP) and diastolic (DBP) blood pressure for 24 hours after a single session of continuous aerobic (CA), interval aerobic (IA), resistance (RE) exercise and control (C), among hypertensive older women under treatment.

METHODS

The study was conducted on 30 women aged 67.5±5.2 years participating in all sessions applied in random order. After each session, blood pressure was obtained by an oscillometric device and they were submitted to 24-hour ambulatory blood pressure monitoring.

RESULTS

Immediately after the sessions, a lower SBP value was observed in groups CA and IA compared to groups C and RE. During the 24 hours after sessions, there was a greater reduction of SBP after IA than after other types of exercise, with the reduction after RE being greater than after CA and C (P<0.01). In wakefulness period, the reduction of SBP after IA was more intensive, and, during sleep, IA and RE promoted greater reductions of SBP, with reduction of DBP only after RE (P<0.01).

CONCLUSIONS

Immediately after the exercise sessions there was a fall in SBP only after aerobic exercises. However, aerobic exercise in the interval mode and RE were more effective in reducing BP over a period of 24 hours.

Is resistance training alone an antihypertensive therapy? A meta-analysis

Evidence concerning the prescription of isolated resistance training (RT) to hypertensive individuals is limited. Guidelines are divergent concerning RT inclusion for prehypertensive and hypertensive persons. A meta-analysis investigating data with larger sample sizes provides more robust effect size estimates and allows for inferences on clinical choices concerning the effectiveness of RT alone. In this context, the aim of this meta-analysis was to assess the effects of RT alone on the systolic (SBP) and diastolic (DBP) blood pressures in prehypertensive and hypertensive individuals. Data from 13 studies involving 417 participants (207 assigned to RT and 210 controls) were obtained. The results indicate significant reductions in SBP (-6.16 mmHg CI -8.27 to -4.04; I²: 31.0% P value for heterogeneity = 0.136 and effect size = -0.59) and DBP (-3.70 mmHg CI -5.19 to -2.21; I²: 18.3% P value for heterogeneity = 0.106 and effect size = -0.55) when compared to control groups. In conclusion, RT alone is able to reduce SBP and DBP in prehypertensive and hypertensive subjects, especially in elderly individuals.

High versus Low-Moderate Intensity Exercise Training Program as an Adjunct to Antihypertensive Medication: A Pilot Clinical Study

OBJECTIVE

In this pilot clinical study we investigated the effect on blood pressure (BP) of two community-based exercise training programs of high (HIT) vs. low-moderate intensity (LMIT) in hypertensive individuals receiving at least one antihypertensive drug.

METHODS

The study included two phases of physical exercises based on 1-h session, 3 days/week for 12 and 16 weeks, respectively, separately by a 7-week resting period. Each phase was preceded by a four-week conditioning training period. According to the average maximal heart rate at baseline, participants were randomized to HIT (80-90%), LMIT (50-70%) or no-exercise (control). Heart rate was monitored during workout and BP profiles were registered by ambulatory BP monitoring at the beginning and end of each phase.

RESULTS

Of 60 individuals randomized, 44 completed the study (HIT, n = 10; LMIT, n = 16; controls, n = 18). BP levels were significantly reduced after the second phase for both LMIT (SBP -3.1 mmHg, DBP -2.4 mmHg) and HIT (SBP -10.8 mmHg, DBP -8.3 mmHg). Similar levels of improvement were also found in daytime and night-time BP. Mean attendance of the prescribed training sessions was 87.4 ± 6.2% for HIT and 87.4 ± 5.3% for LMIT during the first phase and 84.1 ± 5.0% and 85.2 ± 5.9% during the second phase, respectively (p = 0.047).

CONCLUSION

Both HIT and LMIT exercise training programs reduced BP but the HIT modality showed a lower rate of compliance with proposed training schedule. Intensity of training should be individually prescribed to improve tolerance to more high intensity exercises.

Exercise Reduces Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background Although exercise training reduces office blood pressure (BP), scarcer evidence is available on whether these benefits also apply to ambulatory blood pressure (ABP), which is a stronger predictor of cardiovascular disease and mortality. The present study aims to assess the effects of exercise training on ABP in patients with hypertension based on evidence from randomized controlled trials. Methods and Results A systematic search of randomized controlled trials on the aforementioned topic was conducted in PubMed and Scopus (since inception to April 1, 2020). The mean difference between interventions (along with 95% CI) for systolic BP and diastolic BP was assessed using a random-effects model. Sub-analyses were performed attending to (1) whether participants were taking antihypertensive drugs and (2) exercise modalities. Fifteen studies (including 910 participants with hypertension) met the inclusion criteria. Interventions lasted 8 to 24 weeks (3-5 sessions/week). Exercise significantly reduced 24-hour (systolic BP, -5.4 mm Hg; [95% CI, -9.2 to -1.6]; diastolic BP, -3.0 mm Hg [-5.4 to -0.6]), daytime (systolic BP, -4.5 mm Hg [-6.6 to -2.3]; diastolic BP, -3.2 mm Hg [-4.8 to -1.5]), and nighttime ABP (systolic BP, -4.7 mm Hg [-8.4 to -1.0]; diastolic BP, -3.1 mm Hg [-5.3 to -0.9]). In separate analyses, exercise benefits on all ABP measures were significant for patients taking medication (all P<0.05) but not for untreated patients (although differences between medicated and non-medicated patients were not significant), and only aerobic exercise provided significant benefits (P<0.05). Conclusions Aerobic exercise is an effective coadjuvant treatment for reducing ABP in medicated patients with hypertension.

Effects of Two Community-Based Exercise Programs on Adherence, Cardiometabolic Markers, and Body Composition in Older People with Cardiovascular Risk Factors: A Prospective Observational Cohort Study

Cardiovascular disease is one of the leading causes of death globally, and cardiovascular risk factors (CRFs) are major behavioral risk factors. Therefore, community-based programs are being designed based on the prescription of physical exercise from primary care centers to improve people’s health through changes in lifestyle. The objective was to compare the effects of two types of community exercise on adherence, lipid profile, body composition and blood pressure. A prospective observational cohort study was designed with two cohorts of study depending on the duration and type of physical exercise program performed. Fifty-one participants (82.4% women) with CRF completed the observation period in which they carried out a short-term, non-individualized exercise program (3 months), and 42 participants (71.4% women) with CRF completed the observation period in which they conducted a long-term, individualized exercise program (6 months). The results suggest that participants who carried out the longer program with an individualized progression produced greater adherence to physical exercise and a decrease in diastolic blood pressure. In addition, LDL and insulin levels decreased in both groups. Therefore, our results suggest that a longer duration and individualized evolution of the loads of a community exercise program lead to higher levels of physical activity (PA) and improvements diastolic blood pressure.

Effects of Cardiovascular Interval Training in Healthy Elderly Subjects: A Systematic Review

The aim of this review is to demonstrate the effects of cardiovascular interval training (IT) on healthy elderly subjects. We used the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The following variables were observed: resting heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MBP), heart rate variability (HRV), baroreflex activity (BA), and maximal oxygen uptake (VO_2max). Studies were searched for in the MedLine, PubMed, and Sport Discus databases considering publications between 1990 and 2019. To find the studies, the keywords used were “Interval and Elderly Training” or “Interval Training and Baroreflex Sensing” or “Interval Training and Aging and Pressure Arterial and Blood Pressure Training” or “Interval Training and Variation in Aging and Heart Rate” or “Interval Training and Sensitivity to the Elderly and Baroreflex” or “Interval Training and Variability in the Elderly and Heart Rate.” The systematic search identified 1,140 hits. The analysis of the study was performed through a critical review of the content. One thousand one hundred forty articles were identified. Of these, 1,108 articles were excluded by checking the articles and abstracts. Finally, 32 studies were selected for full reading while 26 studies were eliminated because they did not contain a methodology according to the purpose of this review. Thus, six studies were included for the final analysis. The PEDro score was used for analyzing the study quality and found 4,8 ± 1,3 points (range: 3–6). Positive results were found with the different IT protocols in the observed variables. Results show that IT protocols can be an efficient method for functional improvement of cardiovascular and cardiorespiratory variables in the healthy elderly, especially HR, SBP, DBP, MAP, HRV, BA, and VO_2max. However, this method can be included in the prescription of aerobic training for the elderly to obtain conditional improvements in the cardiovascular system, thus being an important clinical intervention for the public.

Usefulness of Exercise for Home Blood Pressure Control in People with Diabetes: A Study Protocol for a Crossover Randomized Controlled Trial

BACKGROUND

The coexistence of hypertension and diabetes mellitus significantly increases the risk of macrovascular complications in patients with diabetes. Home blood pressure is important because it is more strongly associated with target organ damage and total mortality than clinic blood pressure measurements. Regular moderate aerobic exercise has antihypertensive effects. This study aims to examine the effect of aerobic exercise therapy on blood pressure at home in patients with diabetes.

PATIENTS AND METHODS

In this crossover randomized controlled trial, 110 patients with type 2 diabetes will be randomly assigned to two groups: an exercise preceding group and an exercise lagging group. During the exercise period, patients will be instructed to walk either 30 minutes twice each day or 60 minutes once each day for at least 3 days per week. During the non-exercise period, patients will be permitted to perform physical activity associated with activities of daily life. Patients will be followed up for 56 days. The primary outcome will be the mean nocturnal blood pressure from day 24 to 28 during the exercise period compared to that during the non-exercise period. The secondary outcome will include variation in nocturnal blood pressure, mean blood pressure values and variation of morning and evening blood pressure from day 24 to 28 in the exercise period compared to the non-exercise period, body weight, body mass index and bioelectrical impedance analysis. Biochemical tests such as hemoglobin A1c level, blood glucose level, serum lipid profile, renal function, uric acid levels and liver function tests will also be measured.

DISCUSSION

This randomized controlled trial will provide critical information regarding the effectiveness of moderate exercise on nocturnal blood pressure reduction. If successful, the results of this randomized controlled trial may increase exercise motivation in people with diabetes and may lead to improvement or prevention of target organ damage and overall mortality.

TRIAL REGISTRATION

Trial registration: University Hospital Medical Information Network, UMIN 000035973. Protocol version number: R000040969. Registration date: February 22, 2019. Recruitment began: June 19, 2019. The date of completion of recruitment: July 3, 2020. URL: http://www.umin.ac.jp.

ACUTE EFFECT OF DIFFERENT TYPES OF EXERCISE ON NATRIURETIC PEPTIDES OF WISTAR RATS

ABSTRACT Introduction: The study of the effects of different types of physical exercise on cardiovascular physiology is increasing in the literature. The many mechanisms of hemodynamic control include the atrial release of natriuretic peptides. Although extensive evidence demonstrates their acute effects and the increase in their plasma concentration, it is not known whether both atria respond in a similar way to both types of natriuretic peptide in response to different types of exercise. Objective: To compare the acute responses of different exercise types in the atrial (ANP) and brain (BNP) natriuretic peptides of both atrial cardiomyocytes of Wistar rats. Methods: Animals were divided into control (CG), aerobic (AG), resistance (RG) and combined (ARG). The RG performed six climbs, with a load equivalent to 60% of body weight. The AG ran on a treadmill at a speed of 12m/min for 60 minutes. The ARG exercise consisted of three consecutive ladder climbs, followed by 30 minutes of running. Results: First, the right atrium released more ANP and BNP during all types of exercise; second, the resistance exercise released the most ANP and BNP in both atria; third, in the right atrium, aerobic and combined workouts released more small and medium ANP granules while resistance exercise released larger BNP granules; and fourth, in the left atrium, aerobic exercise released more ANP granules while resistance and combined exercise released larger ANP and BNP granules. Conclusion: All types of exercise induce partial release of natriuretic peptide granules, with greater response to resistance exercise. Furthermore, a particular and different response could be seen in both types of atria in the release of ANP and BNP. Level of evidence II; Therapeutic studies - Investigation of treatment results.