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Badrov MB, Wood KN, Lalande S, Sawicki CP, Borrell LJ, Barron CC, Vording JL, Fleischhauer A, Suskin N, McGowan CL, Shoemaker JK. Effects of 6 Months of Exercise-Based Cardiac Rehabilitation on Autonomic Function and Neuro-Cardiovascular Stress Reactivity in Coronary Artery Disease Patients. J Am Heart Assoc 2019; 8:e012257. [PMID: 31438760 PMCID: PMC6755845 DOI: 10.1161/jaha.119.012257] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/28/2019] [Indexed: 11/16/2022]
Abstract
Background Autonomic dysregulation represents a hallmark of coronary artery disease (CAD). Therefore, we investigated the effects of exercise-based cardiac rehabilitation (CR) on autonomic function and neuro-cardiovascular stress reactivity in CAD patients. Methods and Results Twenty-two CAD patients (4 women; 62±8 years) were studied before and following 6 months of aerobic- and resistance-training-based CR. Twenty-two similarly aged, healthy individuals (CTRL; 7 women; 62±11 years) served as controls. We measured blood pressure, muscle sympathetic nerve activity, heart rate, heart rate variability (linear and nonlinear), and cardiovagal (sequence method) and sympathetic (linear relationship between burst incidence and diastolic blood pressure) baroreflex sensitivity during supine rest. Furthermore, neuro-cardiovascular reactivity during short-duration static handgrip (20s) at 40% maximal effort was evaluated. Six months of CR lowered resting blood pressure (P<0.05), as well as muscle sympathetic nerve activity burst frequency (48±8 to 39±11 bursts/min; P<0.001) and burst incidence (81±7 to 66±17 bursts/100 heartbeats; P<0.001), to levels that matched CTRL and improved sympathetic baroreflex sensitivity in CAD patients (P<0.01). Heart rate variability (all P>0.05) and cardiovagal baroreflex sensitivity (P=0.11) were unchanged following CR, yet values were not different pre-CR from CTRL (all P>0.05). Furthermore, before CR, CAD patients displayed greater blood pressure and muscle sympathetic nerve activity reactivity to static handgrip versus CTRL (all P<0.05); yet, responses were reduced following CR (all P<0.05) to levels observed in CTRL. Conclusions Six months of exercise-based CR was associated with marked improvement in baseline autonomic function and neuro-cardiovascular stress reactivity in CAD patients, which may play a role in the reduced cardiac risk and improved survival observed in patients following exercise training.
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Affiliation(s)
- Mark B. Badrov
- School of KinesiologyWestern UniversityLondonOntarioCanada
| | | | - Sophie Lalande
- School of KinesiologyWestern UniversityLondonOntarioCanada
| | | | | | | | | | | | - Neville Suskin
- Cardiac Rehabilitation and Secondary Prevention Program of St. Joseph's Health Care LondonLondonOntarioCanada
- Department of Medicine (Cardiology) and Program of Experimental MedicineWestern UniversityLondonOntarioCanada
| | - Cheri L. McGowan
- School of KinesiologyWestern UniversityLondonOntarioCanada
- Department of KinesiologyUniversity of WindsorWindsorOntarioCanada
| | - J. Kevin Shoemaker
- School of KinesiologyWestern UniversityLondonOntarioCanada
- Department of Physiology and PharmacologyWestern UniversityLondonOntarioCanada
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2
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Baddeley-White DS, McGowan CL, Howden R, Gordon BD, Kyberd P, Swaine IL. Blood pressure lowering effects of a novel isometric exercise device following a 4-week isometric handgrip intervention. Open Access J Sports Med 2019; 10:89-98. [PMID: 31417322 PMCID: PMC6600323 DOI: 10.2147/oajsm.s193008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Hypertension is the leading risk factor for global mortality. Isometric resistance exercise training reduces blood pressure (BP). However, the protocols used are often limited by cost/immobility and the use of rigid exercise modalities. In response, a novel more versatile, isometric exercise (IE) device, the IsoBall (IB) was created. Purpose: The aim of this study was to test the BP-lowering effectiveness of this prototype. Methods: Twenty-three healthy participants (29.10±2.19 years old, 173.95±3.83 cm, 75.43±5.06 kg, SBP 127.10±10.37 mmHg, DBP 70.40±6.77 mmHg) were randomly allocated to either a control group (CON) or 2 isometric handgrip (IHG) training groups that used the Zona plus (ZON) and IB devices. The intervention groups completed 3 sessions each week of 4, 2 min IHG at 30% maximal voluntary contraction, with a 1-min rest, for 4 weeks. Resting BP, heart rate (HR) and IHG strength were measured in all groups at baseline and postintervention. Results: Postintervention systolic BP (SBP) was significantly lower in both ZON (114.5±8.2 mmHg, p = 0.000) and IB (119.9±7.0 mmHg, p = 0.000) compared to control (131.0±12.4 mmHg). Postintervention diastolic BP (DBP) was reduced in both intervention groups (ZON 66.6±7.4 mmHg, p = 0.004; IB 65.7±10.0 mmHg, p = 0.012) compared to CON (71.1±8.8 mmHg). Mean arterial pressure (MAP) was reduced in both groups (ZON 82.6±6.8 mmHg, p = 0.000; IB 84.3±9.1 mmHg, p = 0.000) compared to control (91.0±9.7 mmHg). No significant changes were seen in HR or strength (p > 0.05). Conclusion: The results of this study indicate that both the ZON and IB devices elicit significant SBP, DBP and MAP reductions. Despite the ZON group having larger reductions in BP, no significant differences were found between the two devices. Thus, this study indicates the IB device to be an effective alternative to the ZON that can also be used to perform other IE modalities.
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Affiliation(s)
| | - Cheri L McGowan
- Department of Kinesiology, Faculty of Human Kinetics, University of Windsor, Windsor, ON, Canada
| | - Reuben Howden
- Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Benjamin Dh Gordon
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA
| | - Peter Kyberd
- Department of Engineering Science, University of Greenwich, Medway Campus, London, UK
| | - Ian L Swaine
- Department of Life & Sport Sciences, University of Greenwich, Medway Campus, London, UK.,Department of Kinesiology, Faculty of Human Kinetics, University of Windsor, Windsor, ON, Canada
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3
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Boa Sorte Silva NC, Gregory MA, Gill DP, McGowan CL, Petrella RJ. The Impact of Blood Pressure Dipping Status on Cognition, Mobility, and Cardiovascular Health in Older Adults Following an Exercise Program. Gerontol Geriatr Med 2018; 4:2333721418770333. [PMID: 29761133 PMCID: PMC5946337 DOI: 10.1177/2333721418770333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/21/2018] [Accepted: 03/13/2018] [Indexed: 01/04/2023] Open
Abstract
Objectives: To determine whether a dual-task gait and aerobic
exercise intervention differentially impacted older adults with normal blood
pressure (BP) dipping status (dippers) compared to those with nondipping status
(nondippers). Methods: This study was a secondary analysis
involving participants (mean age = 70.3 years, 61% women) who attended a
laboratory-based exercise intervention over a 6-month period (40 min/day and 3
days/week). Participants were assessed in measures of cognition, mobility, and
cardiovascular health at baseline, 3, 6, and 12 months (after a 6-month
no-contact follow-up). Results: We observed improvements in
cognition in both groups at 6 and 12 months, although no between-group
differences were seen. Nondippers demonstrated superior improvements in usual
gait velocity and step length after the exercise intervention compared to
dippers. Dippers reduced daytime systolic BP at 6 and 12 months to a greater
extent than nondippers. Discussion: BP dipping status at baseline
did not influence exercise benefits to cognition but did mediate changes in
mobility and cardiovascular health.
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Affiliation(s)
- Narlon C Boa Sorte Silva
- Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Michael A Gregory
- Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,University of Montreal, Québec, Canada
| | - Dawn P Gill
- Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | | | - Robert J Petrella
- Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
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4
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Somani YB, Baross AW, Brook RD, Milne KJ, McGowan CL, Swaine IL. Acute Response to a 2-Minute Isometric Exercise Test Predicts the Blood Pressure-Lowering Efficacy of Isometric Resistance Training in Young Adults. Am J Hypertens 2018; 31:362-368. [PMID: 29036548 DOI: 10.1093/ajh/hpx173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/25/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This work aimed to explore whether different forms of a simple isometric exercise test could be used to predict the blood pressure (BP)-lowering efficacy of different types of isometric resistance training (IRT) in healthy young adults. In light of the emphasis on primary prevention of hypertension, identifying those with normal BP who will respond to IRT is important. Also, heightened BP reactivity increases hypertension risk, and as IRT reduces BP reactivity in patients with hypertension, it warrants further investigation in a healthy population. METHODS Forty-six young men and women (24 ± 5 years; 116 ± 10/ 68 ± 8 mm Hg) were recruited from 2 study sites: Windsor, Canada (n = 26; 13 women), and Northampton, United Kingdom (n = 20; 10 women). Resting BP and BP reactivity to an isometric exercise test were assessed prior to and following 10 weeks of thrice weekly IRT. Canadian participants trained on a handgrip dynamometer (isometric handgrip, IHG), while participants in the UK trained on an isometric leg extension dynamometer (ILE). RESULTS Men and women enrolled in both interventions demonstrated significant reductions in systolic BP (P < 0.001) and pulse pressure (P < 0.05). Additionally, test-induced systolic BP changes to IHG and ILE tests were associated with IHG and ILE training-induced reductions in systolic BP after 10 weeks of training, respectively (r = 0.58 and r = 0.77; for IHG and ILE; P < 0.05). CONCLUSIONS The acute BP response to an isometric exercise test appears to be a viable tool to identify individuals who may respond to traditional IRT prescription.
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Affiliation(s)
- Yasina B Somani
- Department of Kinesiology, University of Windsor, University of Windsor, Windsor, Ontario, Canada
| | - Anthony W Baross
- Department of Sport and Exercise, University of Northampton, Northampton, United Kingdom
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin J Milne
- Department of Kinesiology, University of Windsor, University of Windsor, Windsor, Ontario, Canada
| | - Cheri L McGowan
- Department of Kinesiology, University of Windsor, University of Windsor, Windsor, Ontario, Canada
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ian L Swaine
- Department of Kinesiology, University of Windsor, University of Windsor, Windsor, Ontario, Canada
- Department of Life and Sport Sciences, University of Greenwich, Medway Campus, London, United Kingdom
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5
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Baross AW, Milne KJ, McGowan CL, Swaine IL. Abstract P486: Effects of Isometric Leg Training on Ambulatory Blood Pressure and Morning Blood Pressure Surge in Young Normotensive Men and Women. Hypertension 2017. [DOI: 10.1161/hyp.70.suppl_1.p486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Cardiovascular disease (CVD) is a major cause of death globally with hypertension reported to be a leading modifiable risk factor. Ambulatory blood pressure (BP), in particular diurnal BP variability, is considered to be associated with CVD risk. In addition, the morning BP surge (MBPS) is thought to be associated with increased stroke risk and to be a destabilizing factor for atherosclerotic plaque. Isometric resistance training (IRT) is an effective method of lowering BP and has been recommended by the American Heart Association as an alternative treatment for reducing BP. To date, few studies have investigated the effects of IRT on ambulatory BP and particularly the morning surge in BP. Therefore, the purpose of this study was to determine whether (i) IRT causes reductions in ambulatory BP and the MBPS, in young normotensives and (ii) there are any sex differences in these changes.
Methods:
Ambulatory BP was measured prior to, and after, 10 weeks of bilateral leg IRT using an isokinetic dynamometer (4 x 2 minute contractions at 20% MVC, with 2 minute rest periods on 3 days per week). Twenty normotensive individuals (10 men, age=21 ± 4 years; 10 women, age=23 ± 5 years) were recruited. A two-way repeated measures ANOVA was used to assess the within and between groups ambulatory (mean 24-h, daytime, night time and diurnal variation) BP and MBPS. MBPS was calculated as: mean systolic BP 2 hours after waking minus the lowest sleeping 1 hour mean systolic BP.
Results:
There were significant reductions in 24-h ambulatory (4 ± 2 mmHg, p=0.0001; 4 ± 2 mmHg, p=0.0001) systolic BP in both men and women following IRT. This comprised significant reductions in day time (5 ± 5 mmHg, p=0.019; 5 ± 4 mmHg, p=0.002) but not night time (1 ± 5 mmHg, p=0.75; 1 ± 3 mmHg, p=0.3) systolic BP. Additionally, there were significant reductions in the MBPS (6 ± 8 mmHg, p=0.044; 6 ± 7 mmHg, p=0.019). There were no significant differences between men and women in these changes (p>0.05).
Conclusion:
These results support previous research showing that IRT is effective in lowering ambulatory BP. Furthermore, the significant reductions in the MBPS offer the potential for clinically meaningful CVD and stroke risk reduction, provided these effects can be demonstrated in those who are at risk.
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6
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Gregory MA, Boa Sorte Silva NC, Gill DP, McGowan CL, Liu-Ambrose T, Shoemaker JK, Hachinski V, Holmes J, Petrella RJ. Combined Dual-Task Gait Training and Aerobic Exercise to Improve Cognition, Mobility, and Vascular Health in Community-Dwelling Older Adults at Risk for Future Cognitive Decline1. J Alzheimers Dis 2017; 57:747-763. [PMID: 28304305 DOI: 10.3233/jad-161240] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This 6-month experimental case series study investigated the effects of a dual-task gait training and aerobic exercise intervention on cognition, mobility, and cardiovascular health in community-dwelling older adults without dementia. Participants exercised 40 min/day, 3 days/week for 26 weeks on a Biodex GaitTrainer2 treadmill. Participants were assessed at baseline (V0), interim (V1: 12-weeks), intervention endpoint (V2: 26-weeks), and study endpoint (V3: 52-weeks). The study outcomes included: cognition [executive function (EF), processing speed, verbal fluency, and memory]; mobility: usual & dual-task gait (speed, step length, and stride time variability); and vascular health: ambulatory blood pressure, carotid arterial compliance, and intima-media thickness (cIMT). Fifty-six participants [age: 70(6) years; 61% female] were included in this study. Significant improvements following the exercise program (V2) were observed in cognition: EF (p = 0.002), processing speed (p < 0.001), verbal fluency [digit symbol coding (p < 0.001), phonemic verbal fluency (p < 0.001)], and memory [immediate recall (p < 0.001) and delayed recall (p < 0.001)]; mobility: usual & dual-task gait speed (p = 0.002 and p < 0.001, respectively) and step length (p = 0.001 and p = 0.003, respectively); and vascular health: cIMT (p = 0.002). No changes were seen in the remaining outcomes. In conclusion, 26 weeks of dual-task gait training and aerobic exercise improved performance on a number of cognitive outcomes, while increasing usual & dual-task gait speed and step length in a sample of older adults without dementia.
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Affiliation(s)
- Michael A Gregory
- Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Narlon C Boa Sorte Silva
- Lawson Health Research Institute, London, ON, Canada.,School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Dawn P Gill
- Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Cheri L McGowan
- Lawson Health Research Institute, London, ON, Canada.,Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - J Kevin Shoemaker
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | - Jeff Holmes
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Robert J Petrella
- Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada.,Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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7
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McGowan CL, Proctor DN, Swaine I, Brook RD, Jackson EA, Levy PD. Isometric Handgrip as an Adjunct for Blood Pressure Control: a Primer for Clinicians. Curr Hypertens Rep 2017; 19:51. [PMID: 28528376 DOI: 10.1007/s11906-017-0748-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Considered a global health crisis by the World Health Organization, hypertension (HTN) is the leading risk factor for death and disability. The majority of treated patients do not attain evidence-based clinical targets, which increases the risk of potentially fatal complications. HTN is the most common chronic condition seen in primary care; thus, implementing therapies that lower and maintain BP to within-target ranges is of tremendous public health importance. Isometric handgrip (IHG) training is a simple intervention endorsed by the American Heart Association as a potential adjuvant BP-lowering treatment. With larger reductions noted in HTN patients, IHG training may be especially beneficial for those who (a) have difficulties continuing or increasing drug-based treatment; (b) are unable to attain BP control despite optimal treatment; (c) have pre-HTN or low-risk stage I mild HTN; and (d) wish to avoid medications or have less pill burden. IHG training is not routinely prescribed in clinical practice. To shift this paradigm, we focus on (1) the challenges of current HTN management strategies; (2) the effect of IHG training; (3) IHG prescription; (4) characterizing the population for whom it works best; (5) clinical relevance; and (6) important next steps to foster broader implementation by clinical practitioners.
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Affiliation(s)
- Cheri L McGowan
- Department of Kinesiology, Faculty of Human Kinetics, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada. .,Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. .,School of Medicine, Department of Emergency Medicine, Wayne State University, Detroit, MI, USA.
| | - David N Proctor
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Ian Swaine
- Department of Life & Sport Sciences, University of Greenwich, Medway Campus, London, UK
| | - Robert D Brook
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth A Jackson
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Phillip D Levy
- School of Medicine, Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
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8
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Zinszer K, Stone J, Mpaata JC, Muwanguzi S, Adler S, McGowan CL, Levy PD. Success and failure: a firsthand look into Uganda's most recent bednet distribution campaign. Lancet Infect Dis 2017; 17:251-253. [PMID: 28244377 DOI: 10.1016/s1473-3099(17)30057-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/27/2017] [Indexed: 06/06/2023]
Affiliation(s)
- Kate Zinszer
- School of Public Health, University of Montreal, Montreal, Quebec, Canada.
| | | | | | | | | | - Cheri L McGowan
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada; Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
| | - Phillip D Levy
- Soft Power Health, Jinja, Uganda; Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
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9
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Paquin DJP, Caruana N, Andrews DM, Milne KJ, McGowan CL. Comparative Analysis of Blood Pressure Response to Isometric Handgrip Exercise - Mechanical vs. Computerized. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000486101.14159.fd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Caruana N, Paquin DJ, Milne KJ, Andrews DM, McGowan CL. Analysis Of The Upper Extremity Muscle Response During An Acute Bout Of Isometric Handgrip Exercise. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000486107.96233.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Brook RD, Jackson EA, Giorgini P, McGowan CL. When and how to recommend 'alternative approaches' in the management of high blood pressure. Am J Med 2015; 128:567-70. [PMID: 25644320 DOI: 10.1016/j.amjmed.2014.12.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 12/24/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
Several nonpharmacologic therapies, such as sodium restriction and weight loss, have been promoted by hypertension guidelines based on the trial evidence supporting their capacity to lower blood pressure. However, many patients may not respond or be able to adhere to these nonpharmacologic treatments. Despite numerous formal diet and lifestyle recommendations, the prevalence of hypertension continues to grow worldwide. As such, additional approaches are needed to help combat this public health epidemic. In this review, we outline the evidence supporting the efficacy of a number of alternative approaches for blood pressure lowering. On the basis of the recommendations by a recent American Heart Association scientific statement, we also provide guidance on when and how to implement these methods in clinical practice. The available evidence supports several approaches, including Transcendental Meditation, device-guided slow breathing, and aerobic, resistance, and isometric exercises. Nonetheless, many questions remain, and future recommendations for using alternative approaches will need to be updated as new trials are published.
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Affiliation(s)
- Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Mich.
| | - Elizabeth A Jackson
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Mich
| | - Paolo Giorgini
- Department of Life, Health and Environmental Sciences, Division of Internal Medicine and Nephrology, University of L'Aquila, L'Aquila, Italy
| | - Cheri L McGowan
- Department of Kinesiology, University of Windsor, Windsor, Ontario, Canada
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12
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Moore DJ, Barlow MA, Gonzales JU, McGowan CL, Pawelczyk JA, Proctor DN. Evidence for the emergence of leg sympathetic vasoconstrictor tone with age in healthy women. Physiol Rep 2015; 3:3/1/e12275. [PMID: 25626874 PMCID: PMC4387747 DOI: 10.14814/phy2.12275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
While muscle sympathetic nerve activity (MSNA) is elevated with advancing age, correlational evidence suggests that, in contrast to men, basal MSNA is not related to resting lower limb hemodynamics in women. However, limited data exists in women that have attempted to directly assess the degree of limb sympathetic vasoconstrictor tone, and whether it is altered with age. To address this issue, we measured changes in femoral artery vascular conductance (FVC) during an acute sympatho‐inhibitory stimulus (−60 mm Hg neck suction, NS) in groups of healthy younger (n = 8, 23 ± 1 years) and older (n = 7, 66 ± 1 years) women. The percent change in FVC in response to NS was significantly augmented in the older (P = 0.006 vs. young) women. Although NS caused no significant change (3 ± 3%, P = 0.33) in FVC in the young women, there was a robust increase in FVC (21 ± 5%, P = 0.003) in the old women. Collectively, these findings provide evidence that in women, leg sympathetic vasoconstrictor tone emerges with age. In the present study, we sought to compare the amount of sympathetic vasoconstriction in the resting lower limbs (i.e., legs) of younger and older women. Leg (femoral artery) vascular conductance increased in older but not younger women during an acute sympatho‐inhibitory stimulus. These findings suggest that in women there is an emergence of lower limb sympathetic vasoconstrictor tone with advanced age.
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Affiliation(s)
- David J Moore
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania Intercollege Graduate Degree Program in Physiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Matthew A Barlow
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania Department of Biology, Eastern New Mexico University, Portales, New Mexico
| | - Joaquin U Gonzales
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania Department of Health, Exercise & Sport Sciences, Texas Tech University, Lubbock, Texas
| | - Cheri L McGowan
- Department of Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - James A Pawelczyk
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania Intercollege Graduate Degree Program in Physiology, The Pennsylvania State University, University Park, Pennsylvania
| | - David N Proctor
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania Intercollege Graduate Degree Program in Physiology, The Pennsylvania State University, University Park, Pennsylvania
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13
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Millar PJ, McGowan CL, Cornelissen VA, Araujo CG, Swaine IL. Evidence for the role of isometric exercise training in reducing blood pressure: potential mechanisms and future directions. Sports Med 2014; 44:345-56. [PMID: 24174307 DOI: 10.1007/s40279-013-0118-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hypertension, or the chronic elevation in resting arterial blood pressure (BP), is a significant risk factor for cardiovascular disease and estimated to affect ~1 billion adults worldwide. The goals of treatment are to lower BP through lifestyle modifications (smoking cessation, weight loss, exercise training, healthy eating and reduced sodium intake), and if not solely effective, the addition of antihypertensive medications. In particular, increased physical exercise and decreased sedentarism are important strategies in the prevention and management of hypertension. Current guidelines recommend both aerobic and dynamic resistance exercise training modalities to reduce BP. Mounting prospective evidence suggests that isometric exercise training in normotensive and hypertensive (medicated and non-medicated) cohorts of young and old participants may produce similar, if not greater, reductions in BP, with meta-analyses reporting mean reductions of between 10 and 13 mmHg systolic, and 6 and 8 mmHg diastolic. Isometric exercise training protocols typically consist of four sets of 2-min handgrip or leg contractions sustained at 20-50 % of maximal voluntary contraction, with each set separated by a rest period of 1-4 min. Training is usually completed three to five times per week for 4-10 weeks. Although the mechanisms responsible for these adaptations remain to be fully clarified, improvements in conduit and resistance vessel endothelium-dependent dilation, oxidative stress, and autonomic regulation of heart rate and BP have been reported. The clinical significance of isometric exercise training, as a time-efficient and effective training modality to reduce BP, warrants further study. This evidence-based review aims to summarize the current state of knowledge regarding the effects of isometric exercise training on resting BP.
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Affiliation(s)
- Philip J Millar
- Division of Cardiology, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
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Freeman SR, Hanik SAE, Littlejohn ML, Malandruccolo AA, Coughlin J, Warren B, McGowan CL. Sit, breathe, smile: effects of single and weekly seated Qigong on blood pressure and quality of life in long-term care. Complement Ther Clin Pract 2013; 20:48-53. [PMID: 24439645 DOI: 10.1016/j.ctcp.2013.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/10/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
Abstract
Long-term care (LTC) facilities house individuals with diverse combinations of cognitive and physical impairments, and the practice of Seated Qigong eliminates common exercise barriers. This study hypothesized: 1) a single session would lower blood pressure (BP) and improve quality of life (QOL) in a generalized LTC population, and 2) these responses would be attenuated with chronic (weekly) Seated Qigong practice. Ten residents (6 female; 86 ± 7 years) participated in 1X/week Seated Qigong sessions for 10-weeks. BP and QOL were assessed pre- and post-session at baseline and following 5- and 10-weeks of Qigong. Systolic BP was significantly reduced immediately post-session after 10-weeks of Qigong (P = 0.03), yet unchanged at baseline and after 5-weeks (all P > 0.05). Diastolic BP and QOL remained unchanged (P > 0.05). A session of Seated Qigong elicits a hypotensive response with exposure, supporting the notion that repeated sessions may provide advantageous health benefits.
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Affiliation(s)
- Shane R Freeman
- Physical Activity and Cardiovascular Research Laboratory, Department of Kinesiology, University of Windsor, 401 Sunset Ave., Windsor, Ontario, Canada N9B 3P4.
| | - Sarah-Anne E Hanik
- Physical Activity and Cardiovascular Research Laboratory, Department of Kinesiology, University of Windsor, 401 Sunset Ave., Windsor, Ontario, Canada N9B 3P4.
| | - Meagan L Littlejohn
- Physical Activity and Cardiovascular Research Laboratory, Department of Kinesiology, University of Windsor, 401 Sunset Ave., Windsor, Ontario, Canada N9B 3P4.
| | - Amanda A Malandruccolo
- Physical Activity and Cardiovascular Research Laboratory, Department of Kinesiology, University of Windsor, 401 Sunset Ave., Windsor, Ontario, Canada N9B 3P4.
| | - Joanna Coughlin
- School of Dramatic Art, Faculty of Arts and Social Sciences, University of Windsor, 401 Sunset Ave., Windsor, Ontario, Canada N9B 3P4.
| | - Bernie Warren
- School of Dramatic Art, Faculty of Arts and Social Sciences, University of Windsor, 401 Sunset Ave., Windsor, Ontario, Canada N9B 3P4; Schlegel-University of Waterloo Research Institute for Aging, 325 Max Becker Dr., Suite 202, Kitchener, Ontario, Canada N2E 4H5.
| | - Cheri L McGowan
- Physical Activity and Cardiovascular Research Laboratory, Department of Kinesiology, University of Windsor, 401 Sunset Ave., Windsor, Ontario, Canada N9B 3P4; Schlegel-University of Waterloo Research Institute for Aging, 325 Max Becker Dr., Suite 202, Kitchener, Ontario, Canada N2E 4H5.
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Badrov MB, Freeman SR, Millar PJ, McGowan CL. Sex‐differences in the effects of isometric handgrip training on resting blood pressure and resistance vessel function. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.1132.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mark B. Badrov
- Physical Activity and Cardiovascular Research LaboratoryUniversity of WindsorWindsorONCanada
| | - Shane R. Freeman
- Physical Activity and Cardiovascular Research LaboratoryUniversity of WindsorWindsorONCanada
| | - Philip J. Millar
- Clinical Cardiovascular Physiology LaboratoryToronto General HospitalTorontoONCanada
| | - Cheri L. McGowan
- Physical Activity and Cardiovascular Research LaboratoryUniversity of WindsorWindsorONCanada
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Badrov MB, Horton S, Millar PJ, McGowan CL. Cardiovascular stress reactivity tasks successfully predict the hypotensive response of isometric handgrip training in hypertensives. Psychophysiology 2013; 50:407-14. [DOI: 10.1111/psyp.12031] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/20/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Mark B. Badrov
- Physical Activity and Cardiovascular Research Laboratory; Department of Kinesiology; University of Windsor; Windsor; Ontario; Canada
| | - Sean Horton
- Physical Activity and Cardiovascular Research Laboratory; Department of Kinesiology; University of Windsor; Windsor; Ontario; Canada
| | - Philip J. Millar
- Clinical Cardiovascular Physiology Laboratory; University Health Network; Toronto; Ontario; Canada
| | - Cheri L. McGowan
- Physical Activity and Cardiovascular Research Laboratory; Department of Kinesiology; University of Windsor; Windsor; Ontario; Canada
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McGowan CL, Murai H, Millar PJ, Notarius CF, Morris BL, Floras JS. Simvastatin reduces sympathetic outflow and augments endothelium-independent dilation in non-hyperlipidaemic primary hypertension. Heart 2012; 99:240-6. [PMID: 23257173 DOI: 10.1136/heartjnl-2012-302980] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Previous reports, involving hypercholesterolaemic hypertensive subjects, that statins reduce muscle sympathetic nerve activity (MSNA) did not investigate potential neural sites of such sympathoinhibition or determine its consequences for endothelial function or insulin resistance. This study of hypertensive subjects with lower plasma cholesterol tested the hypotheses that lipophilic simvastatin would attenuate resting sympathoexcitation and augment baroreflex modulation of MSNA and heart rate (HR), flow-mediated vasodilation and insulin sensitivity. DESIGN Prospective, randomised, double-blind, placebo-controlled crossover study. SETTING Academic hospital-based study. PATIENTS Fourteen non-hyperlipidaemic primary hypertensive subjects (10 men; overall mean±SD age 58±12 years). INTERVENTIONS Four weeks of simvastatin (80 mg/day) or placebo. MAIN OUTCOME MEASURES Resting blood pressure (BP), HR, MSNA, spontaneous arterial baroreflex MSNA and HR modulation, endothelium-dependent and endothelium-independent vasodilation, and the homoeostatic model assessment of insulin resistance (HOMA-IR). RESULTS Simvastatin lowered MSNA burst frequency (from 32±12 to 25±9 bursts/min) and MSNA burst incidence (from 55±23% to 43±17%; all p<0.01) without affecting BP, HR, baroreflex modulation of either MSNA or HR, or HR variability (all p>0.05). Plasma glucose, insulin, HOMA-IR and endothelium-dependent vasodilation (all p>0.05) were unchanged, whereas endothelium-independent vasodilation increased (7.1±3.8% to 9.7±3.9%, n=13; p<0.01). The fall in MSNA was unrelated to the decrease in low-density lipoprotein cholesterol (r=0.41, p=0.14). CONCLUSIONS These findings are consistent with the concept that, in non-hyperlipidaemic subjects with primary hypertension, simvastatin causes a cholesterol-independent reduction in an elevated central set-point for MSNA, without affecting arterial baroreflex modulation of either MSNA or HR. There may be less neurogenic constraint on endothelium-independent vasodilation as a consequence.
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Affiliation(s)
- Cheri L McGowan
- University Health Network and Mount Sinai Hospital Division of Cardiology, University of Toronto, 600 University Avenue, Toronto, Ontario, Canada
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Millar PJ, McGowan CL. Serial remote ischemic preconditioning and rhythmic isometric exercise training: A hypothesis. Med Hypotheses 2012; 78:822-3. [DOI: 10.1016/j.mehy.2012.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 03/22/2012] [Indexed: 11/24/2022]
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Millar PJ, Levy AS, McGowan CL, McCartney N, MacDonald MJ. Isometric handgrip training lowers blood pressure and increases heart rate complexity in medicated hypertensive patients. Scand J Med Sci Sports 2012; 23:620-6. [PMID: 22260503 DOI: 10.1111/j.1600-0838.2011.01435.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2011] [Indexed: 11/27/2022]
Abstract
Hypertension is characterized by elevated blood pressure (BP) and autonomic dysfunction, both thought to be improved with exercise training. Isometric handgrip (IHG) training may represent a beneficial, time-effective exercise therapy. We investigated the effects of IHG training on BP and traditional and nonlinear measures of heart rate variability (HRV). Pre- and post-measurements of BP and HRV were determined in 23 medicated hypertensive participants (mean ± SEM, 66 ± 2 years) following either 8 weeks of IHG training (n = 13) or control (n = 10). IHG exercise consisted of four unilateral 2-min isometric contractions at 30% of maximal voluntary contraction, each separated by 4 min of rest. IHG training was performed 3 days/week for 8 weeks. IHG training decreased systolic BP (125 ± 3 mmHg to 120 ± 2 mmHg, P < 0.05) and mean BP (90 ± 2 mmHg to 87 ± 2 mmHg, P < 0.05), while sample entropy was increased (1.07 ± 0.1 to 1.35 ± 0.1, P < 0.05) and the fractal scaling distance score was decreased (0.34 ± 0.1 to 0.19 ± 0.1, P < 0.05). No significant changes were observed in traditional spectral or time-domain measures of HRV or control participants. IHG training improves nonlinear HRV, but not traditional HRV, while reducing systolic and mean BP. These results may highlight the benefits of IHG training for patients with primary hypertension.
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Affiliation(s)
- P J Millar
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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Stiller-Moldovan C, Kenno K, McGowan CL. Effects Of Isometric Handgrip Exercise On Post-exercise Hypotension In Medicated Hypertensives. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000384837.94874.1a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Spaak J, Tomlinson G, McGowan CL, Soleas GJ, Morris BL, Picton P, Notarius CF, Floras JS. Dose-related effects of red wine and alcohol on heart rate variability. Am J Physiol Heart Circ Physiol 2010; 298:H2226-31. [PMID: 20418480 DOI: 10.1152/ajpheart.00700.2009] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In healthy subjects a standard drink of either red wine (RW) or ethanol (EtOH) has no effect on muscle sympathetic nerve activity or on heart rate (HR), whereas two drinks increase both. Using time- and frequency-domain indexes of HR variability (HRV), we now tested in 12 subjects (24-47 yr, 6 men) the hypotheses that 1) this HR increase reflects concurrent dose-related augmented sympathetic HR modulation and 2) RW with high-polyphenol content differs from EtOH in its acute HRV effects. RW, EtOH, and water were provided on 3 days, 2 wk apart according to a randomized, single-blind design. Eight-minute segments were analyzed. One alcoholic drink increased blood concentrations to 36 + or - 2 mg/dl (mean + or - SE), and 2 drinks to 72 + or - 4 (RW) and 80 + or - 2 mg/dl (EtOH). RW quadrupled plasma resveratrol (P < 0.001). HR fell after both water drinks. When compared with respective baselines, one alcoholic drink had no effect on HR or HRV, whereas two glasses of both increased HR (RW, +5.4 + or - 1.2; and EtOH, +5.7 + or - 1.2 min(-1); P < 0.001), decreased total HRV by 28-33% (P < 0.05) and high-frequency spectral power by 32-42% (vagal HR modulation), and increased low-frequency power by 28-34% and the ratio of low frequency to high frequency by 98-119% (sympathetic HR modulation) (all, P < or = 0.01). In summary, when compared with water, one standard drink lowered time- and frequency-domain markers of vagal HR modulation. When compared with respective baselines, two alcoholic drinks increased HR by diminished vagal and augmented sympathetic HR modulation. Thus alcohol exerts dose-dependent HRV responses, with RW and EtOH having a similar effect.
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Affiliation(s)
- Jonas Spaak
- University Health Network and Mount Sinai Hospital Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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McGowan CL, Swiston JS, Notarius CF, Mak S, Morris BL, Picton PE, Granton JT, Floras JS. Discordance between microneurographic and heart-rate spectral indices of sympathetic activity in pulmonary arterial hypertension. Heart 2009; 95:754-8. [DOI: 10.1136/hrt.2008.157115] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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McGowan CL, Visocchi A, Faulkner M, Verduyn R, Rakobowchuk M, Levy AS, McCartney N, MacDonald MJ. Isometric handgrip training improves local flow-mediated dilation in medicated hypertensives. Eur J Appl Physiol 2008. [DOI: 10.1007/s00421-008-0681-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Millar PJ, Bray SR, McGowan CL, MacDonald MJ, McCartney N. Effects of isometric handgrip training among people medicated for hypertension: a multilevel analysis. Blood Press Monit 2007; 12:307-14. [PMID: 17890969 DOI: 10.1097/mbp.0b013e3282cb05db] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the longitudinal effects of isometric handgrip (IHG) exercise training on blood pressure using hierarchical linear modeling. METHODS Data from 43 participants who were medicated for hypertension at the time of training were amalgamated from three previous investigations. In each study, IHG training was completed 3 days/week for 8 weeks at 30% of maximal voluntary contraction and resting blood pressure was assessed at twice-weekly intervals throughout. RESULTS Hierarchical linear modeling analysis revealed a linear pattern of blood pressure decline over time with estimated reductions of 5.7 and 3 mmHg reductions in systolic and diastolic pressure, respectively. Participants with higher initial systolic pressure showed greater rates of blood pressure decline (r=-0.67), inferring that individuals with higher blood pressure stand to achieve greater benefits from this method of training. CONCLUSIONS These results provide further evidence that IHG training lowers resting blood pressure among persons medicated for hypertension.
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Affiliation(s)
- Philip J Millar
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada.
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McGowan CL, Levy AS, McCartney N, MacDonald MJ. Isometric handgrip training does not improve flow-mediated dilation in subjects with normal blood pressure. Clin Sci (Lond) 2007; 112:403-9. [PMID: 17140398 DOI: 10.1042/cs20060195] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Isometric HG (handgrip) training lowers resting arterial BP (blood pressure), yet the mechanisms are elusive. In the present study, we investigated improved systemic endothelial function as a mechanism of arterial BP modification following isometric HG training in normotensive individuals. This study employed a within-subject repeated measures design primarily to assess improvements in BA FMD (brachial artery flow-mediated dilation; an index of endothelium-dependent vasodilation), with the non-exercising limb acting as an internal control. Eleven subjects performed four 2-min unilateral isometric HG contractions at 30% of maximal effort, three times per week for 8 weeks. Pre-, mid- and post-training resting ABP and BA FMD (exercised arm and non-exercised arm) were measured via automated brachial oscillometry and ultrasound respectively. BA FMD (normalized to the peak shear rate experienced in response to the reactive hyperaemic stimulus) remained unchanged [exercised arm, 0.029±0.003 to 0.026±0.003 to 0.029±0.004%/s−1 (pre- to mid- to post-training respectively); non-exercised arm, 0.023±0.003 to 0.023±0.003 to 0.024±0.003%/s−1 (pre- to mid- to post-training respectively); P=0.22]. In conclusion, improved systemic endothelial function is unlikely to be responsible for lowering arterial BP in this population.
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Affiliation(s)
- Cheri L McGowan
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
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McGowan CL, Visocchi A, Faulkner M, Verduyn R, Rakobowchuk M, Levy AS, McCartney N, MacDonald MJ. Isometric handgrip training improves local flow-mediated dilation in medicated hypertensives. Eur J Appl Physiol 2006; 99:227-34. [PMID: 17106718 DOI: 10.1007/s00421-006-0337-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2006] [Indexed: 01/22/2023]
Abstract
Bilateral isometric handgrip (IHG) training lowers resting arterial blood pressure (BP) in medicated hypertensives. Numerous mechanisms have been suggested, but have yet to be investigated. One such mechanism is that of improved systemic endothelial-dependent vasodilation. The purpose of this investigation was twofold: (1) to determine if bilateral IHG training had any beneficial effects on endothelial-dependent vasodilation, and (2) to see if improved systemic endothelial-dependent vasodilation was responsible for lowering BP. Sixteen participants performed four, 2 min IHG contractions at 30% of their maximal voluntary effort, using either a bilateral (n = 7) or a unilateral IHG protocol (n = 9), three times per week for 8 weeks. Brachial artery (BA) flow-mediated dilation (FMD, an index of endothelial-dependent vasodilation, measured in both arms) was assessed pre- and post-training. Following bilateral IHG training, BA FMD improved in both arms (normalized to peak shear rate 0.005 +/- 0.001 to 0.02 +/- 0.002 s(-1), P < 0.01). Following unilateral IHG training, BA FMD improved in the trained arm only (normalized 0.009 +/- 0.002 to 0.02 +/- 0.005 s(-1), P < 0.01). These findings suggest that although IHG training improves endothelial-dependent vasodilation, the improvements only occur locally in the trained limbs. This suggests that enhanced systemic endothelial-dependent vasodilation is not the mechanism responsible for the observed post-IHG training reductions in BP in medicated hypertensives.
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Affiliation(s)
- Cheri L McGowan
- Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
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McGowan CL, Visocchi A, Faulkner M, Verduyn R, Rakobowchuk M, Levy AS, McCartney N, Macdonald MJ. Isometric handgrip training improves local flow-mediated dilation in medicated hypertensives. Eur J Appl Physiol 2006; 98:355-62. [PMID: 16924526 DOI: 10.1007/s00421-006-0282-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2006] [Indexed: 12/12/2022]
Abstract
Bilateral isometric handgrip (IHG) training lowers resting arterial blood pressure (BP) in medicated hypertensives. Numerous mechanisms have been suggested, but have yet to be investigated. One such mechanism is that of improved systemic endothelial-dependent vasodilation. The purpose of this investigation was twofold: (1) to determine if Bilateral IHG training had any beneficial effects on endothelial-dependent vasodilation, and (2) to see if improved systemic endothelial-dependent vasodilation was responsible for lowering BP. Sixteen participants performed four, 2 min IHG contractions at 30% of their maximal voluntary effort, using either a Bilateral (n = 7) or a Unilateral IHG protocol (n = 9), three times per week for 8 weeks. Brachial artery (BA) flow-mediated dilation (FMD, an index of endothelial-dependent vasodilation, measured in both arms) was assessed pre-and post-training. Following Bilateral IHG training, BA FMD improved in both arms (normalized to peak shear rate, 0.005 +/- 0.001 to 0.02 +/- 0.002 s(-1), P < 0.01). Following Unilateral IHG training, BA FMD improved in the trained arm only (normalized: 0.009 +/- 0.002 to 0.02 +/- 0.005 s(-1), P < 0.01). These findings suggest that although IHG training improves endothelial-dependent vasodilation, the improvements occur only locally in the trained limbs. This suggests that enhanced systemic endothelial-dependent vasodilation is not the mechanism responsible for the observed post-IHG training reductions in BP in medicated hypertensives.
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Affiliation(s)
- Cheri L McGowan
- Department of Kinesiology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
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McGowan CL, Levy AS, Millar PJ, Guzman JC, Morillo CA, McCartney N, Macdonald MJ. Acute vascular responses to isometric handgrip exercise and effects of training in persons medicated for hypertension. Am J Physiol Heart Circ Physiol 2006; 291:H1797-802. [PMID: 16648182 DOI: 10.1152/ajpheart.01113.2005] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous work from our laboratory demonstrated that isometric handgrip (IHG) training improved local, endothelium-dependent vasodilation in medicated hypertensives [McGowan CL (PhD Thesis), 2006; McGowan et al. Physiologist 47: 285, 2004]. We investigated whether changes in the capacity of smooth muscle to dilate (regardless of endothelial factors) influenced this training-induced change, and we examined the acute vascular responses to a single bout of IHG. Seventeen subjects performed four 2-min unilateral IHG contractions at 30% of maximal voluntary effort, three times a week for 8 wk. Pre- and posttraining, brachial artery flow-mediated dilation (FMD, an index of endothelium-dependent vasodilation) and nitroglycerin-mediated maximal vasodilation (an index of endothelium-independent vasodilation) were measured in the exercised arm by using ultrasound before and immediately after acute IHG exercise. IHG training resulted in improved resting brachial FMD (P < 0.01) and no change in nitroglycerin-mediated maximal vasodilation. Pre- and posttraining, brachial artery FMD decreased following an acute bout of IHG exercise (normalized to peak shear rate, pre-, before IHG exercise: 0.01 +/- 0.002, after IHG exercise: 0.008 +/- 0.002%/s(-1); post-, before IHG exercise: 0.020 +/- 0.003, after IHG exercise: 0.010 +/- 0.003%/s(-1); P < 0.01). Posttraining, resting brachial artery FMD improved yet nitroglycerin-mediated maximal vasodilation was unchanged in persons medicated for hypertension. This suggests that the training-induced improvements in the resting brachial artery FMD were not due to underlying changes in the forearm vasculature. Acute IHG exercise attenuated brachial artery FMD, and although this impairment may be interpreted as hazardous to medicated hypertensives with already dysfunctional endothelium, the effects appear transient as repeated exposure to the IHG stimulus improved resting endothelium-dependent vasodilation.
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Affiliation(s)
- Cheri L McGowan
- Dept. of Kinesiology, McMaster Univ., 1280 Main St., West, Hamilton, Ontario, Canada
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Rakobowchuk M, McGowan CL, de Groot PC, Bruinsma D, Hartman JW, Phillips SM, MacDonald MJ. Effect of whole body resistance training on arterial compliance in young men. Exp Physiol 2005; 90:645-51. [PMID: 15849230 DOI: 10.1113/expphysiol.2004.029504] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The effect of resistance training on arterial stiffening is controversial. We tested the hypothesis that resistance training would not alter central arterial compliance. Young healthy men (age, 23 +/- 3.9 (mean +/- s.e.m.) years; n = 28,) were whole-body resistance trained five times a week for 12 weeks, using a rotating 3-day split-body routine. Resting brachial blood pressure (BP), carotid pulse pressure, carotid cross-sectional compliance (CSC), carotid initima-media thickness (IMT) and left ventricular dimensions were evaluated before beginning exercise (PRE), after 6 weeks of exercise (MID) and at the end of 12 weeks of exercise (POST). CSC was measured using the pressure-sonography method. Results indicate reductions in brachial (61.1 +/- 1.4 versus 57.6 +/- 1.2 mmHg; P < 0.01) and carotid pulse pressure (52.2 +/- 1.9 versus 46.8 +/- 2.0 mmHg; P < 0.01) PRE to POST. In contrast, carotid CSC, beta-stiffness index, IMT and cardiac dimensions were unchanged. In young men, central arterial compliance is unaltered with 12 weeks of resistance training and the mechanisms responsible for cardiac hypertrophy and reduced arterial compliance are either not inherent to all resistance-training programmes or may require a prolonged stimulus.
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Affiliation(s)
- M Rakobowchuk
- Department of Kinesiology, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
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Rakobowchuk M, McGowan CL, de Groot PC, Hartman JW, Phillips SM, MacDonald MJ. Endothelial function of young healthy males following whole body resistance training. J Appl Physiol (1985) 2005; 98:2185-90. [PMID: 15677730 DOI: 10.1152/japplphysiol.01290.2004] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Given the increasing emphasis on performance of resistance exercise as an essential component of health, we evaluated, using a prospective longitudinal design, the potential for resistance training to affect arterial endothelial function. Twenty-eight men (23 +/- 3.9 yr old; mean +/- SE) engaged in 12 wk of whole body resistance training five times per week using a repeating split-body 3-day cycle. Brachial endothelial function was measured using occlusion cuff-induced flow-mediated dilation. After occlusion of the forearm for 4.5 min, brachial artery dilation and postocclusion blood flow was measured continuously for 15 and 70 s, respectively. Peak and 10-s postocclusion blood flow, shear rate, and brachial artery flow-mediated dilation (relative and normalized to shear rate) were measured pretraining (Pre), at 6 wk of training (Mid), and at 13 wk of training (Post). Results indicated an increase of mean brachial artery diameter by Mid and Post vs. Pre. Peak and 10-s postocclusion blood flow increased by Mid and remained elevated at Post; however, shear rates were not different at any time point. Relative and normalized flow-mediated dilation was also not different at any time point. This study is the first to show that peripheral arterial remodeling does occur with resistance training in healthy young men. In addition, the increase in postocclusion blood flow may indicate improved resistance vessel function. However, unlike studies involving endurance training, flow-mediated dilation did not increase with resistance training. Thus arterial adaptations with high-pressure loads, such as those experienced during resistance exercise, may be quite different compared with endurance training.
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Affiliation(s)
- M Rakobowchuk
- Dept. of Kinesiology, Ivor Wynne Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1
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