Effects of exercise intensity on postexercise hypotension after resistance training session in overweight hypertensive patients

Effect of exercise modalities on postexercise hypotension in pre- and postmenopausal women: a systematic review and meta-analysis

Hormonal changes associated with menopause increase the risk of hypertension. Postexercise hypotension (PEH) is an important tool in the prevention and management of hypertension; however, menopause may alter this response. The aim of this systematic review and meta-analysis [International Prospective Registered of Systematic Review (PROSPERO): CRD42023297557] was to evaluate the effect of exercise modalities (aerobic, AE; resistance, RE; and combined exercise, CE: AE + RE) on PEH in women, according to their menopausal status (premenopausal or postmenopausal). We searched controlled trials in PubMed, Web of Science, EBSCO, and Science Direct published between 1990 and March 2023. Inclusion criteria were normotensive, pre- and hypertensive, pre- and postmenopausal women who performed an exercise session compared with a control session and reported systolic blood pressure (SBP) and diastolic blood pressure (DBP) for at least 30 min after the sessions. Methodological quality was assessed using the PEDro scale. Standardized mean differences (Hedge's g) and their 95% confidence intervals (CIs) were calculated, and Q-test and Z-test were conducted to assess differences between moderators. Forty-one trials with 718 women (474 menopausal) were included. Overall, we found with moderate evidence that SBP and DBP decreased significantly after exercise session (SBP: g = -0.69, 95% CI -0.87 to -0.51; DBP: g = -0.31, 95% CI -0.47 to -0.14), with no difference between premenopausal and postmenopausal women. Regarding exercise modalities, RE is more effective than AE and CE in lowering blood pressure (BP) in women regardless of menopausal status. In conclusion, women's menopausal status does not influence the magnitude of PEH, and the best modality to reduce BP in women seems to be RE.NEW & NOTEWORTHY This meta-analysis has demonstrated that a single bout of exercise induces postexercise hypotension (PEH) in women and that the hormonal shift occurring with menopause does not influence the magnitude of PEH. However, we have shown with moderate evidence that the effectiveness of exercise modalities differs between pre- and postmenopausal women. Resistance and combined exercises are the best modalities to induce PEH in premenopausal women, whereas resistance and aerobic exercises are more effective in postmenopausal women.

Characterizing the interindividual postexercise hypotension response for two order groups of concurrent training in patients with morbid obesity

Background: Postexercise hypotension (PEH) is a common physiological phenomenon occurring immediately after endurance training (ET), resistance training (RT), and ET plus RT, also termed concurrent training (CT); however, there is little knowledge about the interindividual and magnitude response of PEH in morbidly obese patients.

Aim: The aims of this study were (1) to investigate the effect of CT order (ET + RT vs. RT + ET) on the blood pressure responses; 2) characterize these responses in responders and nonresponders, and 3) identify potential baseline outcomes for predicting blood pressure decreases as responders.

Methods: A quasi-experimental study developed in sedentary morbidly obese men and women (age 43.6 ± 11.3 years; body mass index [BMI] ≥40 kg/m²) was assigned to a CT group of ET plus RT (ET + RT; n = 19; BMI 47.8 ± 16.7) or RT plus ET order group (RT + ET; n = 17; BMI 43.0 ± 8.0). Subjects of both groups received eight exercise sessions over four weeks. Primary outcomes include systolic (SBP), diastolic (DBP), mean arterial pressure [MAP], heart rate at rest [HR], and pulse pressure [PP] measurements before and after 10 min post-exercise. Secondary outcomes were other anthropometric, body composition, metabolic, and physical fitness parameters. Using the delta ∆SBP reduction, quartile categorization (Q) in “high” (Rs: quartile 4), “moderate” (MRs: quartile 3), “low” (LRs: quartile 2), and “nonresponders” (NRs: quartile 1) was reported.

Results: Significant pre–post changes were observed in ET + RT in session 2 for SBP (131.6 vs. 123.4 mmHg, p = 0.050) and session 4 (131.1 vs. 125.2 mmHg, p = 0.0002), while the RT + ET group showed significant reductions in session 4 (134.2 vs. 125.3 mmHg, p < 0.001). No significant differences were detected in the sum of the eight sessions for SBP (∑∆SBP) between ET + RT vs. RT + ET (−5.7 vs. −4.3 mmHg, p = 0.552). Interindividual analyses revealed significant differences among frequencies comparing Q1 “NRs” (n = 8; 22.2%), Q2 “LRs” (n = 8; 22.2%), Q3 “MRs” (n = 9; 25.0%), and Q4 “HRs” (n = 11; 30.5%), p < 0.0001. Quartile comparisons showed significant differences in SBP changes (p = 0.035). Linear regression analyses revealed significant association between ∑∆SBP with body fat % (β –3.826, R² 0.211 [21.1%], p = 0.031), skeletal muscle mass [β –2.150, R² 0.125 (12.5%), p = 0.023], fasting glucose [β 1.273, R² 0.078 (7.8%), p = 0.003], triglycerides [β 0.210, R² 0.014 (1.4%), p = 0.008], and the 6-min walking test [β 0.183, R² 0.038 (3.8%), p = 0.044].

Conclusion: The CT order of ET + RT and RT + ET promote a similar ‘magnitude’ in the postexercise hypotensive effects during the eight sessions of both CT orders in 4 weeks of training duration, revealing “nonresponders” and ‘high’ responders that can be predicted from body composition, metabolic, and physical fitness outcomes.

Acute Effects of Wearing Different Surgical Face Masks during High-Intensity, Short-Rest Resistance Exercise on Cardiorespiratory and Pulmonary Function and Perceptual Responses in Weightlifters

This study investigated the effect of wearing a typical surgical mask (SM) or a three-dimensional (3D) SM (3DSM) during whole-body, high-intensity, short-rest resistance exercise on cardiorespiratory, respiratory, and perceptual comfort responses in weightlifters. Twenty elite weightlifters (6 women and 14 men; age = 24.1 ± 4.9 years; height: 167.45 ± 7.60 cm; body mass = 76.48 ± 19.86 kg) who participated in this study performed 3 resistance exercise sessions in a randomized order: (1) without a mask (NM), (2) while wearing a typical SM, and (3) while wearing a 3DSM. Resistance exercise consisted of a descending pyramid scheme starting at 10 repetitions, with a decrease of one repetition per set for the back squat, bench press, and deadlift, as fast as possible at 75% of the one-repetition maximum. Cardiorespiratory and pulmonary function and comfort were measured. Across all conditions, effective postexercise hypotension (PEH) was noted in terms of decreased systolic blood pressure (−4.64%), diastolic BP (−5.36%), mean arterial pressure (−5.02%), and ankle–brachial index (−6.84%). However, the heart rate (40.34%) and rate of pressure product (33.60%) increased, and no effects on pulmonary function were observed in the three conditions. The participants reported higher breathing resistance and tightness when wearing a typical SM than when wearing a 3DSM or no mask. Therefore, both wearing and not wearing a face mask during whole-body, high-intensity, short-rest resistance exercise promoted PEH and exerted no detrimental effect on pulmonary function. Coaches, trainers, and athletes should consider wearing a 3DSM during resistance exercise.

Physical activity and exercise recommendations for people receiving dialysis: A scoping review

INTRODUCTION

Remaining physically active is important to patients undertaking dialysis, however, clinical recommendations regarding exercise type, timing, intensity, and safety precautions vary. The purpose of this scoping review was to analyse and summarise recommendations for physical activity and exercise for people undertaking dialysis and identify areas that require further research or clarification.

MATERIALS AND METHODS

A scoping review of literature from five bibliographic databases (Medline, Scopus, Web of Science, CINAHL, and SPORTDiscus) was conducted. Eligible articles included consensus guidelines, position statements, reviews, or clinical practice guidelines that included specific physical activity and exercise recommendations for people undertaking dialysis. Key search terms included "kidney disease" OR "kidney failure" OR "chronic kidney disease" OR "end stage kidney disease" AND guideline* OR consensus OR "position statement" OR prescription OR statement AND exercise OR "physical activity". Hand searching for relevant articles in all first twenty quartile 1 journals listed on SCImago under 'medicine-nephrology' and 'physical therapy, sports therapy and rehabilitation' using the terms 'exercise and dialysis' was undertaken. Finally, home pages of key societies and professional organisations in the field of sports medicine and nephrology were searched.

RESULTS

The systematic search strategy identified 19 articles met the inclusion criteria. Two were specific to pediatric dialysis and three to peritoneal dialysis. Whilst many publications provided recommendations on aerobic exercise, progressive resistance training and flexibility, few provided explicit guidance. Recommendations for the intensity, duration and frequency of aerobic and resistance training varied. Discrepancies or gaps in guidance about precautions, contraindications, termination criteria, progression, and access site precautions were also apparent.

CONCLUSION

Future guidelines should include specific guidance regarding physical activity, safety precautions, and timing and intensity of exercise for individuals who undertake dialysis. Collaborative multidisciplinary guideline development and appropriate exercise counselling may lead to increased participation in physical activity and exercise and facilitate better patient outcomes.

Post-dynamic Resistance Exercise Hypotension: Exploring Individual Responses and Predictors

Background: Post-dynamic resistance exercise hypotension (PREH) has been largely demonstrated. However, little is known regarding the interindividual variation of PREH magnitude and its predictors (i.e. factors of influence).

Aims: To assess the interindividual variation of PREH and its predictors related to the characteristics of the individuals and the exercise protocol.

Methods: This study retrospectively analysed data from 131 subjects included in seven controlled trials about PREH (including at least one dynamic resistance exercise and one control session) conducted by two research laboratories. The interindividual variation was assessed by the standard deviation of the individual responses (SDIR), and linear regression analyses were conducted to explore the predictors.

Results: PREH showed moderate interindividual variation for systolic (SBP, SDIR=4.4mmHg; 0.35 standardised units) and diastolic blood pressures (DBP, SDIR=3.6mmHg; 0.32 standardised units). For systolic PREH, multivariate regression analysis (R2=0.069) revealed higher baseline SBP (B=−0.157, p=0.008) and higher number of sets (B=−3.910, p=0.041) as significant predictors. For diastolic PREH, multivariate regression analysis (R2=0.174) revealed higher baseline DBP (B=−0.191, p=0.001) and higher exercise volume (i.e. number of exercises *sets per exercise *repetitions per sets &gt;150; B=−4.212, p=0.001) as significant predictors.

Conclusion: PREH has a considerable interindividual variation. Greater PREH magnitude is observed in individuals with higher baseline blood pressure and after exercise protocols that comprehend higher number of sets and exercise volume.

Evaluation of the Post-Training Hypotensor Effect in Paralympic and Conventional Powerlifting

High blood pressure (HBP) has been associated with several complications and causes of death. The objective of the study was to analyze the hemodynamic responses in Paralympic bench press powerlifting (PP) and conventional powerlifting (CP) before and after training and up to 60 minutes (min) after training. Ten PP and 10 CP athletes performed five sets of five repetition maximal bench press exercises, and we evaluated systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP, respectively), heart rate (HR), heart pressure product (HPP), and myocardial oxygen volume (MVO2). The SBP increased after training (p < 0.001), and there were differences in the post training and 30, 40, and 60 min later (p = 0.021), between 10 and 40 min after training (p = 0.031, η2p = 0.570), and between CP and PP (p =0.028, η2p = 0.570). In the MBP, there were differences between before and after (p = 0.016) and 40 min later (p = 0.040, η2p = 0.309). In the HR, there was a difference between before and after, and 5 and 10 min later (p = 0.002), and between after and 10, 20, 30, 40, 50, and 60 min later (p < 0.001, η2p = 0.767). In HPP and MVO2, there were differences between before and after (p = 0.006), and between after and 5, 10, 20, 30, 40, 50, and 60 min later (p < 0.001, η2p = 0.816). In CP and PP, there is no risk of hemodynamic overload to athletes, considering the results of the HPP, and training promotes a moderate hypotensive effect, with blood pressure adaptation after and 60 min after exercise.

Acute Blood Pressure Effects in Older Adults with Hypertension After Different Modalities of Exercise: An Experimental Study

This study investigated the acute blood pressure (BP) effects of different exercise modalities in older adults with hypertension. Sixty volunteers were randomly assigned (n = 15/group) into different exercise protocols: resistance, bike, water-based exercise (WE), and a control session-all for ∼45 min. Clinic BP measurements were taken before, immediately after, and 15 and 30 min after protocols. The data were analyzed by one-way analysis of variance; generalized estimating equations, following Bonferroni post hoc (p < .05). Immediately after exercise, the systolic BP (SBP) increased in all exercise protocols (resistance exercise = Δ10.3, bike exercise = Δ5.8, WE = Δ9.5 mmHg; p < .001), while the diastolic BP was not altered. Afterward, the SBP reached the value observed before exercise. In Minute 30, only WE presented a significant reduction for SBP (WE = Δ-4.6 mmHg; p < .05). This study has important clinical implications in hemodynamic safety for acute BP increases immediately after exercises, as well as, in the SBP, reduction benefits for older adults with hypertension.

The relation between submaximal aerobic exercise improving vascular elasticity through loss of visceral fat and antihypertensive

Purpose: We sought to observe the effect of submaximal aerobic exercise on abdominal obesity in hypertension patients and to clarify a correlation between blood pressure improvement and visceral fat, along with arterial elasticity. Materials and Methods: According to the treatment plan, the patients were divided into two groups: the combined treatment group and the single drug group. During the training period, the subjects in the combined treatment group performed a 60 min treadmill exercise at 65% of Pmax. PWV was measured using blood pressure pulse-wave detectors before and after treatment. We assessed carotid stiffness and visceral fat area by B‑mode ultrasonography. Results: The 24-h SBP and DBP changed significantly in the two groups in the pre- and post-treatment comparison. Significant statistical differences among SBP and DBP in the two groups of combination therapy and drug therapy after 12 months were demonstrated. Visceral fat area was significantly reduced in the combination therapy group compared to the drug therapy group at the last assessment. Compared with the drug group, arterial compliance in the combination therapy group was higher after treatment. Blood pressure showed significant positive correlation with visceral fat area, PWV, β‑stiffness, Ep, and PWVβ in the combination therapy group. Conclusion: The combination of drug therapy and is more effective than just pursuing single drug treatment of hypertension in patients with abdominal obesity. Submaximal aerobic exercise contributes to anti-hypertension. The main mechanism of anti-hypertension in combination with drug therapy and submaximal aerobic exercise is the improvement of vascular elasticity and decreased central body-fat distribution.

Cardiovascular and Autonomic Responses after a Single Bout of Resistance Exercise in Men with Untreated Stage 2 Hypertension

The aim of this paper is to assess the integrated responses of ambulatory blood pressure (BP), cardiac autonomic modulation, spontaneous baroreflex sensitivity (BRS), and vascular reactivity after a single bout of resistance exercise (RE) in men with stage 2 hypertension who have never been treated before. Ten hypertensive men were subjected to a RE session of three sets of 20 repetitions and an intensity of 40% of the 1-repetition maximum (RM) test in seven different exercises. For the control (CTR) session, the volunteers were positioned on the exercise machines but did not perform any exercise. Forearm blood flow was measured by venous occlusion plethysmography. We also analyzed the heart rate variability (HRV), ambulatory BP, blood pressure variability (BPV), and BRS. All measurements were performed at different timepoints: baseline, 20 min, 80 min, and 24 h after both RE and CTR sessions. There were no differences in ambulatory BP over the 24 h between the RE and CTR sessions. However, the area under the curve of diastolic BP decreased after the RE session. Heart rate (HR) and cardiac output increased for up to 80 and 20 min after RE, respectively. Similarly, forearm blood flow, conductance, and vascular reactivity increased 20 min after RE (p < 0.05). In contrast, HRV and BRS decreased immediately after exercise and remained lower for 20 min after RE. We conclude that a single bout of RE induced an increase in vascular reactivity and reduced the pressure load by attenuating AUC of DBP in hypertensive individuals who had never been treated with antihypertensive medications.

Advancements and critical steps for statistical analyses in blood pressure response to resistance training in hypertensive older women: a methodological approach

BACKGROUND

Repeated measures analysis of covariance and three-way analysis of variance with repeated measures are common statistical methods. For a valid interpretation of blood pressure (BP) response to exercise, a variety of additional statistical methods must be implemented. Four additional statistical methods are presented: technical error of measurement (SEM), smallest real difference (SRD), magnitude-based inference and mixed effect modeling technique (MEM). The aim of this perspective article is to demonstrate how to apply already known statistical analyses regarding BP responsiveness in order to improve interpretation and achieve higher reliability for future studies in exercise science.

METHODS

A total of 27 hypertensive older women (aged 68.37 ± 5.55 years) participated in the present study. A whole-body resistance training (RT) program was performed on two nonconsecutive days per week for 10 weeks. BP was monitored during the 10-week RT intervention and after 15 weeks of detraining. First, individuals were classified as high and low responders, then statistical methods to analyze data included the use of SEM, SRD, magnitude-based inference and MEM.

RESULTS

When magnitude-based inference was used to classify responsiveness, most participants displayed a trivial response. Decrements in SBP between 1 and 10 mmHg were not clinically meaningful but fell within the measurement error of the SBP measurements. Baseline SBP and time of training predicted post-SBP response.

CONCLUSION

Changes over time and declines in SBP might not be a SRD and fell in the SEM. Moreover, SBP responsiveness was the result of inappropriate control of covariates such as period of training.

Hemodynamic responses of resistance exercise performed with repetitions to failure and not to failure in adults with hypertension

OBJECTIVE

To evaluate and compare the hemodynamic responses of resistance exercise (RE) performed with repetitions to failure vs. not to failure in individuals with hypertension.

METHODS

Twenty participants were randomly allocated to perform three experimental sessions: a RE session performed with repetitions to failure (RF); a RE session performed with repetitions not to failure (NRF); and a non-exercise control session (Con). RE sessions were composed of four sets of 10 repetitions in four exercises involving large muscle groups. To ensure that the sets could be performed with RF or NRF, intensities corresponding to 75% and 50% of one-repetition maximum test were adopted in RF and NRF sessions, respectively. The Con was performed in seated rest. Blood pressure and rate-pressure product were measured before, during and after the experimental sessions for 1 h.

RESULTS

SBP and DBP decreased after NRF compared with Con (systolic post 1 h: -7.7 ± 1.1 mmHg, P < 0.001; diastolic post 1 h: -4.2 ± 0.7 mmHg, P = 0.001), and after RF compared with Con (systolic post 1 h: -8.2 ± 1.3 mmHg, P < 0.001; diastolic post 1 h: -7.4 ± 1.4 mmHg, P < 0.001). No significant difference was found in blood pressure between RF and NRF sessions after 1 h. Rate-pressure product was lower during NRF compared with RF (P = 0.001), suggesting a higher cardiovascular demand during the RF session.

CONCLUSION

The RF and NRF sessions are equally effective to promote post-exercise hypotension. In addition, NRF session can reduce cardiac demand during the exercise and should be recommended in adults with hypertension.

No Decrease in Blood Pressure After an Acute Bout of Intermittent Hyperpnea and Hypoxia in Prehypertensive Elderly

Prevalence of hypertension, subjective sleep complaints and snoring increases with age. Worse sleep and snoring, in turn, are independent risk factors to develop hypertension. Both respiratory muscle training (RMT) and intermittent hypoxia (IH) are suggested to have positive effects on these physiological and behavioral variables. This study therefore aimed to test the acute effects of a single bout of RMT, with and without IH, on resting blood pressure (BP) and sleep. Fourteen prehypertensive elderly performed a 60-min session of (a) intermittent voluntary normocapnic hyperpnea (HYP) alone, (b) HYP in combination with IH (HYP&IH) and (c) a sham intervention in randomized order. BP, hemodynamics, heart rate variability (HRV), cardiac baroreflex sensitivity (BRS) and pulse wave velocity (PWV) were assessed before and 15, 30 and 45 min after each intervention. Variables of sleep were assessed with actigraphy, pulse oximetry and with questionnaires during and after the night following each intervention. Neither HYP nor HYP&IH resulted in a decrease in BP. Repeated measures ANOVA revealed no significant interaction effect for systolic BP (p = 0.090), diastolic BP (p = 0.151), HRV parameters, BRS and PWV (all p > 0.095). Fragmentation index was lower after both HYP (−6.5 units) and HYP&IH (−8.4 units) compared to sham, p(ANOVA) = 0.046, although pairwise comparisons reveal no significant differences. There were no other significant effects for the remaining sleep variables. We conclude that one bout of intermittent hyperpnea, alone or in combination with IH, is not effective in lowering blood pressure or improving sleep in prehypertensive elderly.

Acute effects of body-weight resistance exercises on blood pressure and glycemia in middle-aged adults with hypertension

OBJECTIVE

The purpose of the present study was to evaluate the acute effects of single session of body-weight resistance exercises on blood pressure (BP) and glycemia in middle-aged adults with hypertension.

METHODS

Twenty-three participants took part in this trial with crossover design and performed two experimental sessions in a random order: Body-weight resistance exercise session (BWR) and a control session without exercise. BWR was composed of four exercises: inverted row, squat, , and sit-ups. The participants performed 3 sets of 30 s, in which they were instructed to perform as much repetitions as possible and as fast as possible. After each session, BP and glycemia were measured continuously for 60 min.

RESULTS

Systolic BP decreased after BWR when compared with control at post 45': -7 (95%CI:-11 to -2) mmHg, p = .003 and post60': -7 (95%CI:-12 to -3) mmHg, p = .003. Diastolic BP decreased after BWR when compared with control at post 15': -6 (95%CI:-9 to -3) mmHg, p < .001; post 30': -6 (95%CI:-9 to -2) mmHg, p = .001; post45': -5 (95%CI:-9 to -2) mmHg, p = .005; and post60': -6 (95%CI: -8 to -3) mmHg, p < .001. No significant difference was found in glycemia between BWR and control sessions.

CONCLUSION

BWR acutely reduces BP in middle-aged adults with hypertension without effects on usual glycemia responses. This alternative form of resistance training could facilitate access, adherence, and reduce health costs related to exercise programs.

Postexercise Hypotension After Muscle Power Training Session in Older Adults With Hypertension

The aim of the present study was to determine the acute effects of a muscle power training (PT) session on arterial blood pressure (BP) in older adults with hypertension. Thirteen participants (64 ± 4 years) with essential hypertension were randomly assigned to a PT session and control session without exercise. During PT, the participants performed three sets of eight repetitions at 50% of the one-repetition maximum tests. The concentric phase during each repetition was performed as fast as possible. The systolic BP (post-15 min: -1.7 ± 1.8 mmHg [p = .048; d = 0.22]; post-30 min: -3.6 ± 1.7 mmHg [p = .010; d = 0.48]; post-45 min: -3.3 ± 1.3 mmHg [p = .002; d = 0.42]; post-60 min: -3.9 ± 1.7 mmHg [p = .003; d = 0.49]) and diastolic BP (post-15 min: -1.5 ± 1.5 mmHg [p = .053; d = 0.20]; post-30 min: -2.2 ± 1.7 mmHg [p = .001; d = 0.29]; post-45 min: -2.0 ± 2.0 mmHg [p = .001; d = 0.27]; post-60 min: -2.0 ± 1.3 mmHg [p < .001; d = 0.26]) reductions were observed at all times after the PT session, compared with the preexercise and control session. PT is an effective strategy to acutely reduce BP in older patients with essential hypertension.

Resistance Exercise Order Does Not Affect the Magnitude and Duration of Postexercise Blood Pressure in Older Women

Tomeleri, CM, Nunes, JP, Souza, MF, Gerage, AM, Marcori, A, Iarosz, KC, Cardoso-Júnior, CG, and Cyrino, ES. Resistance exercise order does not affect the magnitude and duration of postexercise blood pressure in older women. J Strength Cond Res 34(4): 1062-1070, 2020-The aim of this study was to compare the effects of 2 resistance exercise order on postexercise blood pressure (BP) in trained nonhypertensive older women. Sixteen women (68.3 ± 3.3 years, 63.5 ± 11.6 kg, 157.5 ± 5.1 cm) performed 2 sessions with 8 exercises (3 sets of 8-12 repetitions) in distinct orders (from multi- to single-joint exercises [MS] or from single- to multijoint exercises [SM]) and a control session (CS), without exercise. Blood pressure and heart rate (HR) were obtained pre- and postsessions (60 minutes). Postexercise hypotension was observed for systolic BP (SBP) and mean BP in both the MS session (SBP: -6.9 mm Hg, mean BP: -3.3 mm Hg, p ≤ 0.05) and SM session (SBP: -4.6 mm Hg; mean BP: -1.1 mm Hg). Postexercise HR was higher than presession values until 30 minutes of recovery in both training sessions. Furthermore, SBP and mean BP, and HR were lower than the values obtained in the CS (30-60 minutes and 0 minutes, respectively; p ≤ 0.05). There were no differences between the SM and MS sessions in any variable or at any moment. In conclusion, resistance exercise order does not interfere in the magnitude and duration of postexercise hypotension in trained nonhypertensive older women.

Impact of therapeutic lifestyle changes in resistant hypertension

Hypertensive individuals are at an increased risk of developing heart disease and stroke. Adopting healthy lifestyles, such as being active on ≥4 days per week, weight-loss in the presence of obesity, consuming a diet rich in fruits and vegetables, and sodium below the recommended threshold, avoiding high alcohol consumption and refraining from smoking have been effective lifestyle therapies to prevent or control stage 1 hypertension (HTN). Among the 1 in 3 Americans who have HTN (systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg), 16% are diagnosed with resistant HTN (RHT). Although there are comparatively fewer studies examining the blood pressure lowering effects of therapeutic lifestyle interventions in patients with resistant HTN, the available literature appears promising. This paper reviews key studies that quantify the blood pressure lowering effects of certain therapeutic lifestyles in patients with RHT and highlights areas needing more attention.

The effects of aquatic and land exercise on resting blood pressure and post-exercise hypotension response in elderly hypertensives

OBJECTIVE

This study compared resting blood pressure (BP) using ambulatory BP monitoring (ABPM) responses in two groups of subjects trained in land exercise (LE) and aquatic exercise (AE), and assessed post-exercise hypotension (PEH) using ABPM, after land- and aquatic-based exercises.

METHODS

ABPM (24 hours) was used to measure the baseline BP in elderly hypertensive women trained in LE and AE and the PEH induced by exercise. For this, 40 subjects were evaluated at rest and after a land- or aquatic-based exercise session (aerobic: 75% of reserve heart rate combined with resistance exercise).

RESULTS

The daytime BP was lower for AE [systolic BP (SBP) 124 ± 1.0 mmHg, diastolic BP (DBP) 70 ± 1.5 mmHg] than for LE (SBP 134 ± 0.9 mmHg, DBP 76 ± 0.9 mmHg), but there were no differences at night-time. The aquatic exercise-induced PEH in the second hour was maintained at the 24th hour post-exercise. For land exercise-induced PEH, it was maintained at the 12th hour post-exercise. The SBP and DBP were lower at the 24th hour for AE than for LE.

CONCLUSIONS

Elderly hypertensive people trained in AE had lower baseline BP during the daytime. SBP and DBP values were lower for individuals trained in AE, and their PEH was more rapid and longer lasting after AE.

Exaggerated post exercise hypotension following concentric but not eccentric resistance exercise: Implications for metabolism

Post exercise hypotension (PEH) is primarily attributed to post-exercise vasodilation via central and peripheral mechanisms. However, the specific contribution of metabolic cost during exercise, independent of force production, is less clear. This study aimed to use isolated concentric and eccentric exercise to examine the role of metabolic activity in eliciting PEH, independent of total work. Twelve participants (6 male) completed upper and lower body concentric (CONC), eccentric (ECC), and traditional (TRAD) exercise sessions matched for work (3 × 10 in TRAD and 3 × 20 in CONC and ECC; all at 65% 1RM). Blood pressure was collected at baseline and every 15 min after exercise for 120 min. Brachial blood flow and vascular conductance were also assessed at baseline, immediately after exercise, and every 30 min after exercise. ⩒O₂ was lower during ECC compared to CONC and TRAD (-2.7 mL/Kg/min ± 0.4 and -2.2 mL/Kg/min ± 0.4, respectively p < 0.001). CONC augmented the PEH response (Peak ΔMAP -3.3 mmHg ± 0.9 [mean ± SE], p = 0.006) through 75 min of recovery and ECC elicited a post-exercise hypertensive response through 120 min of recovery (Peak ΔMAP +4.5 mmHg ± 0.8, p < 0.001). CONC and TRAD elicited greater increases in brachial blood flow post exercise than ECC (Peak Δ brachial flow +190.4 mL/min ± 32.3, +202.3 mL/min ± 39.2, and 69.6 mL/min ± 19.8, respectively, p ≤ 0.005), while conductance increased immediately post exercise in all conditions and then decreased throughout recovery following ECC (-32.9 mL/min/mmHg ± 9.3, p = 0.005). These data suggest that more metabolically demanding concentric exercise augments PEH compared to work-matched eccentric exercise.

Metabolic and hormonal responses to different resistance training systems in elderly men

OBJECTIVE

To compare acute and sub-acute responses in hormonal profile and metabolic parameters in elderly people who participated in two methods of strength training (ST) with equalized loads.

METHODS AND MATERIALS

A total of 12 elder individuals (65 ± 3 years) were randomly assigned to two training methods: constant intensity (CI, 3 sets of 10 repetitions with 75% of 1RM) and variable intensity (VI, 1st set: 12 repetitions at 67% of 1RM > 2nd set: 10 repetitions at 75% of 1RM and 3rd set: 8 repetitions at 80% of 1RM). Both methods included the following exercises: leg press, knee extension, and squat with 1 min rest intervals between sets. Free speed of execution and maximum range of movement were encouraged throughout each set for both protocols. Blood samples were analyzed included glucose, testosterone (T), cortisol (C), T/C rate, growth hormone (GH), and lactate at 2 and 24 h post intervention.

RESULTS

There were no observed differences in glucose, testosterone, GH, and lactate concentrations both at 2 and 24 h after the execution of the two training methods. However, significant increases in the levels of T/C rate and decrease on cortisol were observed immediately post exercise for both protocols.

CONCLUSIONS

Although no significant differences were observed between the two interventions in relation to the hormonal and metabolic parameters analyzed, both training methods promoted a favorable response, with a slight superiority noted for the CI method relative to the hormonal profile.

Pathophysiology of Noncardiac Syncope in Athletes

The most frequent cause of syncope in young athletes is noncardiac etiology. The mechanism of noncardiac syncope (NCS) in young athletes is neurally-mediated (reflex). NCS in athletes usually occurs either as orthostasis-induced, due to a gravity-mediated reduced venous return to the heart, or in the context of exercise. Exercise-related NCS typically occurs after the cessation of an exercise bout, while syncope occurring during exercise is highly indicative of the existence of a cardiac disorder. Postexercise NCS appears to result from hypotension due to impaired postexercise vasoconstriction, as well as from hypocapnia. The mechanisms of postexercise hypotension can be divided into obligatory (which are always present and include sympathoinhibition, histaminergic vasodilation, and downregulation of cardiovagal baroreflex) and situational (which include dehydration, hyperthermia and gravitational stress). Regarding postexercise hypocapnia, both hyperventilation during recovery from exercise and orthostasis-induced hypocapnia when recovery occurs in an upright posture can produce postexercise cerebral vasoconstriction. Athletes have been shown to exhibit differential orthostatic responses compared with nonathletes, involving augmented stroke volume and increased peripheral vasodilation in the former, with possibly lower propensity to orthostatic intolerance.

POWERLIFTING SESSIONS PROMOTE SIGNIFICANT POST-EXERCISE HYPOTENSION

ABSTRACT Introduction: Powerlifting (PWL) is a worldwide method, frequently used in resistance training programs. However, the relationship between cardiovascular responses and PWL is still unclear in the literature. Objective: To evaluate acute cardiovascular overload and post-exercise hypotension (PEH) after acute powerlifting exercise session in subjects with experience in the modality. Methods: Nine powerlifting athletes (34 ± 5 years) participated voluntarily in this study. The following exercises were used in the session: squat, bench press and deadlift (95% of 1 RM, 2 to 5 repetitions). The anthropometric parameters and blood pressure (systolic, diastolic and mean) were evaluated immediately, 5', 10', 30', 60' and 24 hours after the exercise session with a non-invasive automatic pressure monitor. Results: Significant differences (p<0.05) were found between rest and immediately after exercise on systolic (135 ± 6 vs. 153 ± 10 mmHg) and mean (102 ± 3 vs. 108 ± 3 mmHg) blood pressures, but no difference was found at diastolic (85 ± 3 vs. 85 ± 4 mmHg) blood pressure. Additionally, the increase in systolic pressure did not reach values considered as a risk of cardiovascular overload. Significant PEH was found after 60 minutes (systolic: -12 ± 12%, diastolic: -5 ± 6% and mean: -7 ± 5%) and 24 hours after PWL session (systolic: -5 ± 4%, diastolic: -8 ± 4% and mean: -7 ± 3%). Conclusion: Our data demonstrated that a PWL session does not increase systolic blood pressure up to the risk range and promotes PEH after 60 minutes of exercise and that this cardiovascular response persisted after 24 hours post-exertion in powerlifting athletes.