Véronique Cornelissen

Effects of Endurance Training on Blood Pressure, Blood Pressure–Regulating Mechanisms, and Cardiovascular Risk Factors

Previous meta-analyses of randomized controlled trials on the effects of chronic dynamic aerobic endurance training on blood pressure reported on resting blood pressure only. Our aim was to perform a comprehensive meta-analysis including resting and ambulatory blood pressure, blood pressure–regulating mechanisms, and concomitant cardiovascular risk factors. Inclusion criteria of studies were: random allocation to intervention and control; endurance training as the sole intervention; inclusion of healthy sedentary normotensive or hypertensive adults; intervention duration of ≥4 weeks; availability of systolic or diastolic blood pressure; and publication in a peer-reviewed journal up to December 2003. The meta-analysis involved 72 trials, 105 study groups, and 3936 participants. After weighting for the number of trained participants and using a random-effects model, training induced significant net reductions of resting and daytime ambulatory blood pressure of, respectively, 3.0/2.4 mm Hg (P<0.001) and 3.3/3.5 mm Hg (P<0.01). The reduction of resting blood pressure was more pronounced in the 30 hypertensive study groups (−6.9/−4.9) than in the others (−1.9/−1.6; P<0.001 for all). Systemic vascular resistance decreased by 7.1% (P<0.05), plasma norepinephrine by 29% (P<0.001), and plasma renin activity by 20% (P<0.05). Body weight decreased by 1.2 kg (P<0.001), waist circumference by 2.8 cm (P<0.001), percent body fat by 1.4% (P<0.001), and the homeostasis model assessment index of insulin resistance by 0.31 U (P<0.01); HDL cholesterol increased by 0.032 mmol/L−1 (P<0.05). In conclusion, aerobic endurance training decreases blood pressure through a reduction of vascular resistance, in which the sympathetic nervous system and the renin-angiotensin system appear to be involved, and favorably affects concomitant cardiovascular risk factors.

Exercise Training for Blood Pressure: A Systematic Review and Meta-analysis

Background We conducted meta‐analyses examining the effects of endurance, dynamic resistance, combined endurance and resistance training, and isometric resistance training on resting blood pressure (BP) in adults. The aims were to quantify and compare BP changes for each training modality and identify patient subgroups exhibiting the largest BP changes. Methods and Results Randomized controlled trials lasting ≥4 weeks investigating the effects of exercise on BP in healthy adults (age ≥18 years) and published in a peer‐reviewed journal up to February 2012 were included. Random effects models were used for analyses, with data reported as weighted means and 95% confidence interval. We included 93 trials, involving 105 endurance, 29 dynamic resistance, 14 combined, and 5 isometric resistance groups, totaling 5223 participants (3401 exercise and 1822 control). Systolic BP (SBP) was reduced after endurance (−3.5 mm Hg [confidence limits −4.6 to −2.3]), dynamic resistance (−1.8 mm Hg [−3.7 to −0.011]), and isometric resistance (−10.9 mm Hg [−14.5 to −7.4]) but not after combined training. Reductions in diastolic BP (DBP) were observed after endurance (−2.5 mm Hg [−3.2 to −1.7]), dynamic resistance (−3.2 mm Hg [−4.5 to −2.0]), isometric resistance (−6.2 mm Hg [−10.3 to −2.0]), and combined (−2.2 mm Hg [−3.9 to −0.48]) training. BP reductions after endurance training were greater (P<0.0001) in 26 study groups of hypertensive subjects (−8.3 [−10.7 to −6.0]/−5.2 [−6.8 to −3.4] mm Hg) than in 50 groups of prehypertensive subjects (−2.1 [−3.3 to −0.83]/−1.7 [−2.7 to −0.68]) and 29 groups of subjects with normal BP levels (−0.75 [−2.2 to +0.69]/−1.1 [−2.2 to −0.068]). BP reductions after dynamic resistance training were largest for prehypertensive participants (−4.0 [−7.4 to −0.5]/−3.8 [−5.7 to −1.9] mm Hg) compared with patients with hypertension or normal BP. Conclusion Endurance, dynamic resistance, and isometric resistance training lower SBP and DBP, whereas combined training lowers only DBP. Data from a small number of isometric resistance training studies suggest this form of training has the potential for the largest reductions in SBP.

Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials.

Objective To assess the influence of resistance training on resting blood pressure in healthy sedentary adults. Methods A comprehensive literature search with the MEDLINE computerized database was conducted and reference lists of published articles and reviews on the topic were checked. Inclusion criteria were as follows: the study involved a randomized, controlled trial; resistance training was the sole intervention; participants were sedentary normotensive and/or hypertensive adults with no other concomitant disease; the article was published in a peer-reviewed journal up to December 2003. We identified nine randomized controlled trials, involving 12 study groups and 341 participants. A standard protocol was used to extract information on sample size, participant characteristics, study design, training method and duration, and study outcomes. Pooled blood pressure estimates were obtained, weighted by either the number of participants in the training group or the inverse of the variance for blood pressure change. Results The weighted net changes of blood pressure, after adjustment for control observations, averaged −3.2 [95% confidence limits (CL) −7.1 to +0.7]/−3.5 (95% CL −6.1 to −0.9) mmHg when weighted for the number of trained participants, and −6.0 (95% CL −10.4 to −1.6)/ −4.7 (95% CL −8.1 to −1.4) mmHg, when weighted by the reciprocal of the variance for the blood pressure change. Conclusions Our results suggest that moderate intensity resistance training is not contraindicated and could become part of the non-pharmacological intervention strategy to prevent and combat high blood pressure. However, additional studies are needed, especially in the hypertensive population.

Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension : a meta-analysis

Objective To perform a meta-analysis on the incidence of cardiovascular events in white-coat hypertension (WCHT), masked and sustained hypertension in comparison with true normotension. Methods We searched for individual studies, in which the adjusted relative risk of incident cardiovascular events was assessed in patients with WCHT, masked and sustained hypertension versus normotension in the same study population. For each type of hypertension, the weighted overall hazard ratio (HR) and 95% confidence intervals (CI) were calculated. Results Seven studies were identified, involving a total of 11 502 participants. Four studies were performed in the population, two in primary care and one in specialist care. Two studies were exclusively on treated hypertensive patients; individuals on antihypertensive treatment were included in all the other studies except one. Cut-off blood pressure was 140/90 mmHg for office blood pressure in all studies and 135/85 mmHg (83 in one study) for out-of-office blood pressure. The average age of the study populations was 63 years; 53% were men. The endpoint consisted of cardiovascular death in one study and of various aggregates of fatal and non-fatal cardiovascular events in the others. During an average follow-up of 8.0 years, there were 912 first cardiovascular events. The overall adjusted HR versus normotension was 1.12 (95% CI 0.84–1.50) for WCHT (P = 0.59), 2.00 (1.58–2.52) for masked hypertension (P < 0.001), and 2.28 (1.87–2.78) for sustained hypertension (P < 0.001). Conclusion The meta-analysis indicates that the incidence of cardiovascular events is not significantly different between WCHT and true normotension, whereas the outcome is worse in patients with masked or sustained hypertension.

Impact of Resistance Training on Blood Pressure and Other Cardiovascular Risk Factors :A Meta-Analysis of Randomized, Controlled Trials

We reviewed the effect of resistance training on blood pressure and other cardiovascular risk factors in adults. Randomized, controlled trials lasting ≥4 weeks investigating the effects of resistance training on blood pressure in healthy adults (age ≥18 years) and published in a peer-reviewed journal up to June 2010 were included. Random- and fixed-effects models were used for analyses, with data reported as weighted means and 95% confidence limits. We included 28 randomized, controlled trials, involving 33 study groups and 1012 participants. Overall, resistance training induced a significant blood pressure reduction in 28 normotensive or prehypertensive study groups [−3.9 (−6.4; −1.2)/−3.9 (−5.6; −2.2) mm Hg], whereas the reduction [−4.1 (−0.63; +1.4)/−1.5 (−3.4; +0.40) mm Hg] was not significant for the 5 hypertensive study groups. When study groups were divided according to the mode of training, isometric handgrip training in 3 groups resulted in a larger decrease in blood pressure [−13.5 (−16.5; −10.5)/−6.1(−8.3; −3.9) mm Hg] than dynamic resistance training in 30 groups [−2.8 (−4.3; −1.3)/−2.7 (−3.8; −1.7) mm Hg]. After dynamic resistance training, VO2 peak increased by 10.6% (P=0.01), whereas body fat and plasma triglycerides decreased by 0.6% (P<0.01) and 0.11 mmol/L (P<0.05), respectively. No significant effect could be observed on other blood lipids and fasting blood glucose. This meta-analysis supports the blood pressure–lowering potential of dynamic resistance training and isometric handgrip training. In addition, dynamic resistance training also favorably affects some other cardiovascular risk factors. Our results further suggest that isometric handgrip training may be more effective for reducing blood pressure than dynamic resistance training. However, given the small amount of isometric studies available, additional studies are warranted to confirm this finding.

Physical fitness matters more than physical activity in controlling cardiovascular disease risk factors

Background Physical activity (PA) and physical fitness (PF) are inversely associated with the clustering of cardiovascular disease (CVD) risk factors (RF) associated with the metabolic syndrome (MS). However, the role of individual components of PA, that is, intensity, duration and volume, and the inter-relationship with PF in the prevention of the MS and its individual components remains elusive. Design Cross-sectional analysis. Methods The study was based on 1298 (874 male and 424 female) police employees (aged 18–62 years) who participated in the Utrecht Police Lifestyle Intervention Fitness and Training study. PA was assessed with an extensive questionnaire. Peak oxygen uptake and metabolic markers, including blood pressure, fasting glucose, triglycerides, high-density lipoprotein cholesterol and waist circumference, were determined. Results The prevalence of the MS was 18.6% (22.5% in men, 10.6% in women). After adjustment for age and sex, average PA intensity, PA duration, PA volume and PF were each associated with reduced odds of MS. Regression analyses further showed an inverse relation between total CVD risk score and average PA intensity, the hours of PA performed at high intensity (>6 metabolic equivalent values) and PF, but no relation with total hours or the hours of PA performed at low or moderate intensity. When we adjusted our analyses for PF, the relations with the components of PA became nonsignificant. Using pathway analysis, we found that peak oxygen uptake mediated 78% of the effect of average PA intensity and 93% of the effect of the hours performed at high intensity on total CVD risk score. Conclusion PA and PF are inversely associated with the clustering of metabolic abnormalities. With regard to PA, it seems that intensity and more specifically higher intensity is the main characteristic of PA determining its effect on CVD RF. However, compared with PA, PF exerts greater effects on each of these individual CVD RF and its combination.

Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis

Exercise is widely recommended as one of the key preventive lifestyle changes to reduce the risk of hypertension and to manage high blood pressure (BP), but individual studies investigating the effect of exercise on ambulatory BP have remained inconclusive. Therefore, the primary purpose of this systematic review and meta-analysis was to determine the effect of aerobic endurance training on daytime and night-time BP in healthy adults. A systematic literature search was conducted using PubMed and Cochrane Controlled Clinical trial registry from their inception to May 2012. Randomized controlled trials of at least 4 weeks investigating the effects of aerobic endurance training on ambulatory BP in healthy adults were included. Inverse weighted random effects models were used for analyses, with data reported as weighted means and 95% confidence limits. We included 15 randomized controlled trials, involving 17 study groups and 633 participants (394 exercise participants and 239 control participants). Overall, endurance training induced a significant reduction in daytime SBP [−3.2 mmHg, 95% confidence interval (CI), −5.0 to−1.3] and daytime DBP (−2.7 mmHg, 95% CI, −3.9 to −1.5). No effect was observed on night-time BP. The findings from this meta-analysis suggest that aerobic endurance exercise significantly decreases daytime, but not night-time, ambulatory BP.

Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study.

BACKGROUND Exercise-based cardiac rehabilitation increases peak oxygen uptake (peak VO₂), which is an important predictor of mortality in cardiac patients. However, it remains unclear which exercise characteristics are most effective for improving peak VO₂ in coronary artery disease (CAD) patients. Proof of concept papers comparing Aerobic Interval Training (AIT) and Moderate Continuous Training (MCT) were conducted in small sample sizes and findings were inconsistent and heterogeneous. Therefore, we aimed to compare the effects of AIT and Aerobic Continuous Training (ACT) on peak VO₂, peripheral endothelial function, cardiovascular risk factors, quality of life and safety, in a large multicentre study. METHODS Two-hundred CAD patients (LVEF >40%, 90% men, mean age 58.4 ± 9.1 years) were randomized to a supervised 12-week cardiac rehabilitation programme of three weekly sessions of either AIT (90-95% of peak heart rate (HR)) or ACT (70-75% of peak HR) on a bicycle. Primary outcome was peak VO₂; secondary outcomes were peripheral endothelial function, cardiovascular risk factors, quality of life and safety. RESULTS Peak VO₂ (ml/kg/min) increased significantly in both groups (AIT 22.7 ± 17.6% versus ACT 20.3 ± 15.3%; p-time<0.001). In addition, flow-mediated dilation (AIT+34.1% (range -69.8 to 646%) versus ACT+7.14% (range -66.7 to 503%); p-time<0.001) quality of life and some other cardiovascular risk factors including resting diastolic blood pressure and HDL-C improved significantly after training. Improvements were equal for both training interventions. CONCLUSIONS Contrary to earlier smaller trials, we observed similar improvements in exercise capacity and peripheral endothelial function following AIT and ACT in a large population of CAD patients.

Effects of aerobic training intensity on resting, exercise and post-exercise blood pressure, heart rate and heart-rate variability

We aimed to investigate the effects of endurance training intensity (1) on systolic blood pressure (SBP) and heart rate (HR) at rest before exercise, and during and after a maximal exercise test; and (2) on measures of HR variability at rest before exercise and during recovery from the exercise test, in at least 55-year-old healthy sedentary men and women. A randomized crossover study comprising three 10-week periods was performed. In the first and third period, participants exercised at lower or higher intensity (33% or 66% of HR reserve) in random order, with a sedentary period in between. Training programmes were identical except for intensity, and were performed under supervision thrice for 1 h per week. The results show that in the three conditions, that is, at rest before exercise, during exercise and during recovery, we found endurance training at lower and higher intensity to reduce SBP significantly (P<0.05) and to a similar extent. Further, SBP during recovery was, on average, not lower than at rest before exercise, and chronic endurance training did not affect the response of SBP after an acute bout of exercise. The effect of training on HR at rest, during exercise and recovery was more pronounced (P<0.05) with higher intensity. Finally, endurance training had no significant effect on sympathovagal balance. In conclusion, in participants at higher age, both training programmes exert similar effects on SBP at rest, during exercise and during post-exercise recovery, whereas the effects on HR are more pronounced after higher intensity training.

Influence of exercise at lower and higher intensity on blood pressure and cardiovascular risk factors at older age

Objective It is not well known which exercise intensity is needed to obtain blood pressure reductions in response to endurance training. We therefore compared the effect of training at lower and higher intensity on blood pressure, and, in addition on other cardiovascular risk factors, in at least 55-year-old sedentary men and women. Methods We used a randomized crossover design comprising three 10-week periods. In the first and third periods, participants exercised at, respectively, lower and higher intensity (33 and 66% of heart rate reserve) in random order, with a sedentary period in between. Training programmes were identical except for intensity and were performed three times, 1 h per week. Thirty-nine (18 men) out of 48 randomized participants completed the study; age averaged 59 years. Results The change of aerobic power from baseline to the end of each period was more pronounced (P < 0.05) with higher intensity (+3.70 ml/kg min; P < 0.001) than with lower intensity training (+2.31 ml/kg min; P < 0.001). Systolic blood pressures at rest and during submaximal exercise were reduced with both intensities (P < 0.01), whereas diastolic office blood pressure was significantly reduced after higher intensity only (P < 0.01). There were no significant differences in blood pressure reduction between intensities. Ambulatory blood pressure remained unchanged after training. Only higher intensity training reduced weight (−1.09 kg; P < 0.001), body fat (−0.85%; P < 0.001), plasma triglycerides (−0.17 mmol/l; P < 0.05) and oxidized low-density lipoprotein (−5.92 U/l; P < 0.01). Conclusion Higher and lower intensity training reduces systolic office and exercise blood pressure to a similar extent, but does not alter ambulatory blood pressure; only higher intensity training favourably affects anthropometric characteristics and blood lipids.