Myocardial work and left ventricular mechanical adaptations following isometric exercise training in hypertensive patients.

PURPOSE: Hypertension is a major risk factor for cardiovascular disease. Isometric exercise training (IET) reduces resting and ambulatory blood pressure; however, few studies have investigated the myocardial adaptations following IET. METHODS: We randomly assigned 24 unmedicated hypertensive patients in a cross-over study design to 4-weeks of IET and control period, separated by a 3-week washout period. Speckle tracking echocardiography was used to measure left ventricular (LV) mechanics, and global myocardial work indices were derived from non-invasive LV pressure-strain loops constructed from global longitudinal strain (GLS) indexed to brachial systolic blood pressure. RESULTS: IET significantly improved GLS (- 2.3 ± 2%, p < 0.001) and global work efficiency (2.8 ± 2%, p < 0.001), and significantly reduced global wasted work (- 42.5 ± 30 mmHg%, p < 0.001) with no significant change during the control period. CONCLUSIONS: This is the first evidence to demonstrate that IET significantly improved cardiac health in a relevant patient population. Our findings have important clinical implications for patients with high blood pressure and support the role of IET as a safe and viable therapeutic and preventative intervention in the treatment of hypertension.

Effect of Exercise Training on Ambulatory Blood Pressure Among Patients With Resistant Hypertension: A Randomized Clinical Trial.

Importance: Limited evidence suggests exercise reduces blood pressure (BP) in individuals with resistant hypertension, a clinical population with low responsiveness to drug therapy. Objective: To determine whether an aerobic exercise training intervention reduces ambulatory BP among patients with resistant hypertension. Design, Settings, and Participants: The Exercise Training in the Treatment of Resistant Hypertension (EnRicH) trial is a prospective, 2-center, single-blinded randomized clinical trial performed at 2 hospital centers in Portugal from March 2017 to December 2019. A total of 60 patients with a diagnosis of resistant hypertension aged 40 to 75 years were prospectively enrolled and observed at the hospitals' hypertension outpatient clinic. Interventions: Patients were randomly assigned in a 1:1 ratio to a 12-week moderate-intensity aerobic exercise training program (exercise group) or a usual care control group. The exercise group performed three 40-minute supervised sessions per week in addition to usual care. Main Outcomes and Measures: The powered primary efficacy measure was 24-hour ambulatory systolic BP change from baseline. Secondary outcomes included daytime and nighttime ambulatory BP, office BP, and cardiorespiratory fitness. Results: A total of 53 patients completed the study, including 26 in the exercise group and 27 in the control group. Of these, 24 (45%) were women, and the mean (SD) age was 60.1 (8.7) years. Compared with the control group, among those in the exercise group, 24-hour ambulatory systolic BP was reduced by 7.1 mm Hg (95% CI, -12.8 to -1.4; P = .02). Additionally, 24-hour ambulatory diastolic BP (-5.1 mm Hg; 95% CI, -7.9 to -2.3; P = .001), daytime systolic BP (-8.4 mm Hg; 95% CI, -14.3 to -2.5; P = .006), and daytime diastolic BP (-5.7 mm Hg; 95% CI, -9.0 to -2.4; P = .001) were reduced in the exercise group compared with the control group. Office systolic BP (-10.0 mm Hg; 95% CI, -17.6 to -2.5; P = .01) and cardiorespiratory fitness (5.05 mL/kg per minute of oxygen consumption; 95% CI, 3.5 to 6.6; P < .001) also improved in the exercise group compared with the control group. Conclusions and Relevance: A 12-week aerobic exercise program reduced 24-hour and daytime ambulatory BP as well as office systolic BP in patients with resistant hypertension. These findings provide clinicians with evidence to embrace moderate-intensity aerobic exercise as a standard coadjutant therapy targeting this patient population. Trial Registration: ClinicalTrials.gov Identifier: NCT03090529.

Effects of combined training performed two or four times per week on 24-h blood pressure, glycosylated hemoglobin and other health-related outcomes in aging individuals with hypertension: Rationale and study protocol of a randomized clinical trial.

BACKGROUND: Acute blood pressure lowering after exercise seems to predict the extent of blood pressure reduction after chronic exercise training interventions. Based on that, the same weekly amount of exercise performed more frequently could be more beneficial for controlling blood pressure. PURPOSE: To compare the effects of a combined training program (resistance plus aerobic exercise) performed four or two times per week on 24-h ambulatory blood pressure and other health-related outcomes in middle-aged and older individuals with hypertension. METHODS: This study will be a randomized, parallel group, two-arm, superiority trial. Ninety-eight participants aged 50-80 years with a previous physician diagnosis of hypertension will be randomized to perform two or four sessions per week of combined training using the same total weekly overload. Primary outcomes will be 24-h ambulatory blood pressure and glycosylated hemoglobin; secondary outcomes will be endothelial function, physical fitness and quality of life. The outcomes will be assessed at baseline and at the end of 12 weeks period. RESULTS: Our conceptual hypothesis is that a combined exercise program performed four or two times per week with equalized weekly volume/overload will improve all outcomes in comparison to the baseline values, and that reductions in 24-h blood pressure and glycosylated hemoglobin will be more pronounced in the group that trained four times a week than twice. The results of this trial are expected to provide evidences to support that higher weekly frequency of combined training should be emphasized in aging adults with hypertension.

Effects of short-term aerobic training versus CPAP therapy on heart rate variability in moderate to severe OSA patients.

We compared the effects of 2-month CPAP or exercise training (ET) therapies on the autonomic balance in moderate to severe obstructive sleep apnea (OSA) through heart rate variability (HRV) analysis. Thirty-nine OSA patients were divided into CPAP (n = 18) and ET (n = 21) groups, being further split into hypertensive and non-hypertensive subgroups. All patients were submitted to continuous ECG recordings for HRV analysis. Hemodynamic parameters were recorded by oscillometry. Excessive daytime sleepiness and sleep quality were assessed through the Epworth Sleepiness Scale and the Pittsburgh questionnaire, respectively. ET decreased systolic arterial pressure in hypertensive and non-hypertensive participants when compared to baseline values, whereas diastolic arterial pressure was decreased only in non-hypertensive ones. CPAP had no effect over hemodynamic parameters in either subgroup. ET significantly increased the HRV parameters SDNN and pNN50 in non-hypertensive participants, while reducing the LF/HF ratio in both subgroups. CPAP significantly decreased SDNN in both subgroups. ET significantly decreased excessive daytime sleepiness in both subgroups, but did not affect sleep quality. CPAP significantly improved sleep quality in both subgroups, although global scores were still those of poor sleepers, while excessive daytime sleepiness was normalized only in hypertensive patients. In conclusion, while short-term ET modulated different HRV parameters, leading to a predominant vagal tone in the cardiac sympathovagal balance and decreasing blood pressure in moderate to severe OSA, short-term CPAP had next to no effect in these parameters. We believe ET should be considered as an adjunct interventional strategy in the conservative management of hypertensive or non-hypertensive OSA patients.

Short-Term Effect of Self-Selected Training Intensity on Ambulatory Blood Pressure in Hypertensive Older Women: A Randomized Controlled Trial.

PURPOSE: To investigate the short-term effect of self-selected training intensity (SSTI) on ambulatory blood pressure (BP) in hypertensive older women. PARTICIPANTS AND METHODS: This is a randomized, single-blind, two-arm, parallel-group controlled trial that included 40 medicated hypertensive older women (64.4±3.6 years; resting systolic 118±19 and diastolic BP 68±9 mmHg). SSTI intervention was performed three times per week, 30-50 minutes per session (n=20). The control group participated in health education meetings once per week (n=20). Ambulatory BP (primary outcome) and six-minute walking test performance (secondary outcome) were assessed at baseline and following 8 weeks of intervention. Heart rate (HR), rating of perceived exertion (RPE, 6-20), and affective valence (ie, feeling scale, -5/+5) were recorded during all SSTI sessions. Intention-to-treat and per-protocol analyses were used for data analyses. RESULTS: Fifteen participants from the SSTI group and 17 from the control group completed the study. No differences in ambulatory BP (24-h, awake, and asleep) were observed between SSTI and control groups (intention-to-treat and per-protocol analyses; p>0.05). The SSTI group showed a greater six-minute walking test performance than the control group in the intention-to-treat and per-protocol analyses (p<0.05). The participants exercised at 52±10% of HR reserve reported an RPE of 11±1 and an affective valence of 3.4±1.1 over the 8-week period. CONCLUSION: SSTI is a feasible approach to induce a more active lifestyle and increase health-related fitness in hypertensive older women, although it does not improve BP control over a short-term period.

Hemodynamic Effects of a Multidisciplinary Geriatric Rehabilitation Program.

BACKGROUND: Geriatric rehabilitation programs primarily aim at an increase of mobility and functional autonomy of the elderly. The cardiovascular effects of these programs, however, remain elusive. Since regular physical exercise is associated with numerous beneficial cardiovascular effects including a reduction of blood pressure (BP), the present prospective study investigates the hemodynamic effects of a representative standardized rehabilitation program. METHODS: A total of 74 subjects who were hospitalized in a German university hospital for geriatric rehabilitation were enrolled in the study. Peripheral BP, central aortic BP, 24h-ambulatory BP, heart rate and pulse wave velocity as a measure of arterial stiffness were assessed at admission and before discharge from the hospital. The program contained 4-5 sessions of physical activity of individualized intensity per week (≥30 min/session, eg, walking, cycling, stair rising). RESULTS: The mean age of the study population was 82.4±6.9 years; all patients suffered from arterial hypertension (stage 2-3) with a median number of three antihypertensive drugs. The most frequent cause for admission was injurious falls. The mean duration of the rehabilitation program was 17 days and comprised at least 20 physical activity sessions including occupational therapy. The program led to a significant improvement of mobility (Timed Up & Go 29.5±18.5 vs 19.1 ±9.3 s, p<0.001) and Barthel index of activities of daily living score (46.6±19.1 vs 69.8±16.5, p<0.001). Peripheral systolic BP decreased from 135.4±19.0 mmHg at baseline to 129.0±18.4 mmHg at follow-up (p=0.03), whereas peripheral diastolic BP, central aortic BP, 24h-ambulatory BP, heart rate and pulse wave velocity as a measure of arterial stiffness were not significantly altered (p>0.05 each). CONCLUSION: The present representative standardized geriatric rehabilitation program was able to improve mobility, which showed a mild effect on systolic BP but did not affect 24h-ambulatory BP.

[Blood flow restriction training for people with cardiovascular disease: An exploratory review]. / Entrenamiento con restricción parcial de flujo sanguíneo en personas con enfermedades cardiovasculares: una revisión exploratoria.

OBJECTIVE: To analyse the evidence on the effects of blood flow restriction training in people with cardiovascular disease. MATERIALS AND METHODS: We searched MEDLINE, EMBASE, SPORTDiscus, CINAHL, LILACS, SCOPUS and Wiley databases. Experimental and non-experimental studies investigating the effects of blood flow restriction in participants with cardiovascular disease were included. RESULTS: Six clinical trials and three non-experimental studies met the inclusion criteria. The experimental studies were conducted in participants with hypertension and ischaemic heart disease. Non-experimental studies described hemodynamic adaptations and potential adverse effects of therapy. The risk of bias of the included clinical trials was moderate to high. Exercise-induced hemodynamic stress increased significantly during training with blood flow restriction compared with traditional training. The small number of available studies have focused mostly on acute effects, but chronic effects are unknown. CONCLUSION: There is currently no evidence to recommend the use of blood flow restriction in people with cardiovascular disease.

Effects of Concurrent Training with Elastic Tubes in Hypertensive Patients: A Blind Controlled Randomized Clinical Trial.

BACKGROUND: Concurrent training (CT) has been recommended to minimize the deleterious effects of aging. However, few studies have investigated whether this type of training reduces blood pressure in the elderly. Therefore, our objective was to evaluate the effects of CT on the hemodynamic, cardiorespiratory, and muscle strength responses in medicated hypertensive patients. METHODS: Twenty-three hypertensives (62.65 ± 6.4 years) of both sexes were allocated to the concurrent training group (CTG) or control group (CG). The CTG performed aerobic training (70-85% of reserve heart rate) combined with resistance training with elastic tubes (2sets × 15 repetitions) for 8 weeks. Resting blood pressure (BP), peak oxygen consumption (VO2peak), and right knee and elbow flexion strength were evaluated. RESULTS: A reduction of 6.37% was observed in BP and increases of 16.68% in VO2peak and 16% in muscle strength for right elbow flexion in the CTG compared to CG (p < .05). Intragroup comparisons showed reduction of 5% for BP, and increases of 6.79% for VO2peak, 24.79% for elbow flexion, and 16.47% for knee flexion in the CTG (p < .05), without significant improvement in the CG. CONCLUSION: CT promoted a reduction in BP, and increased cardiorespiratory fitness and muscular strength of the upper limbs in the hypertensive older adults.

Patient-level Predictors of Extent of Exposure to a Community Health Worker Intervention in a Randomized Controlled Trial.

Objective: Community health worker (CHW) interventions have been cited as a best practice for reducing health disparities, but patient-level attributes may contribute to differential uptake. We examined patient characteristics associated with the extent of exposure to a CHW coaching intervention among a predominantly low-income, African American population participating in a randomized controlled trial of hypertension interventions. Design: We conducted a within-group longitudinal analysis of those receiving a CHW intervention from a study conducted between September 2003 and August 2005. We employed mixed effects models to ascertain relationships between patients' characteristics, length of time spent with the CHW, and the number of topics discussed during the intervention. Setting: Baltimore, MD. Participants: 140 patients with a diagnosis of hypertension in the CHW intervention arm. Results: Marital status, stress, depression symptomology, and having multiple comorbid conditions were each independently and positively related to the length of time patients spent with CHWs. An indirect relationship between higher perceived physical health and time spent with the CHW was observed. Patients with multiple comorbid conditions discussed more intervention-related topics, while patients who perceived themselves as being healthier discussed fewer topics. Marital status and extreme poverty were the strongest predictors of the length of time spent with the CHW, while having multiple comorbid conditions was the strongest predictor of the number of coaching topics discussed. Conclusions: Differential exposure to a CHW intervention is influenced by patients' physical, psychosocial, and sociodemographic characteristics.

Effect of telerehabilitation on long-term adherence to yoga as an antihypertensive lifestyle intervention: Results of a randomized controlled trial.

BACKGROUND: and purpose: We aimed to investigate the adherence to yoga as an antihypertensive intervention through telerehabilitation. MATERIALS AND METHODS: In a randomized controlled trial patients were consecutively enrolled and randomly assigned to intervention or control group. Both groups received standardized yoga training during three weeks of inpatient rehabilitation. The intervention group received telerehabilitation after discharge; the control group received the usual care. Data was collected at admission (t1), discharge (t2) and at follow up after six (t3) and 12 months (t4). The primary endpoint was follow-up adherence assessed in an intention-to-treat analysis. RESULTS: 228 male rehabilitation patients (mean age 53.3 ±â€¯5.8 years, mean blood pressure 139.5 ±â€¯10.2/ 86.7 ±â€¯8.0 mmHg) The intervention resulted in significantly increased adherence compared to control group (t3: 40.0% vs. 19.5%, p = 0.001; t4: 36.5% vs. 23.9%, p = 0.038); blood pressure and quality of life improved. CONCLUSION: Telerehabilitation significantly improves yoga adherence maintaining achieved health benefits in the long term.

A Systematically Assembled Signature of Genes to be Deep-Sequenced for Their Associations with the Blood Pressure Response to Exercise.

:Background: Exercise is one of the best nonpharmacologic therapies to treat hypertension. The blood pressure (BP) response to exercise is heritable. Yet, the genetic basis for the antihypertensive effects of exercise remains elusive. Methods: To assemble a prioritized gene signature, we performed a systematic review with a series of Boolean searches in PubMed (including Medline) from earliest coverage. The inclusion criteria were human genes in major BP regulatory pathways reported to be associated with: (1) the BP response to exercise; (2) hypertension in genome-wide association studies (GWAS); (3) the BP response to pharmacotherapy; (4a) physical activity and/or obesity in GWAS; and (4b) BP, physical activity, and/or obesity in non-GWAS. Included GWAS reports disclosed the statistically significant thresholds used for multiple testing. Results: The search yielded 1422 reports. Of these, 57 trials qualified from which we extracted 11 genes under criteria 1, 18 genes under criteria 2, 28 genes under criteria 3, 27 genes under criteria 4a, and 29 genes under criteria 4b. We also included 41 genes identified from our previous work. Conclusions: Deep-sequencing the exons of this systematically assembled signature of genes represents a cost and time efficient approach to investigate the genomic basis for the antihypertensive effects of exercise.

The effect of exercise on blood pressure in chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND OBJECTIVES: Management of hypertension in chronic kidney disease (CKD) remains a major challenge. We conducted a systematic review to assess whether exercise is an effective strategy for lowering blood pressure in this population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We searched MEDLINE, EMBASE, the Cochrane Library, CINAHL and Web of Science for randomized controlled trials (RCTs) that examined the effect of exercise on blood pressure in adults with non-dialysis CKD, stages 3-5. Outcomes were non-ambulatory systolic blood pressure (primary), other blood pressure parameters, 24-hour ambulatory blood pressure, pulse-wave velocity, and flow-mediated dilatation. Results were summarized using random effects models. RESULTS: Twelve studies with 505 participants were included. Ten trials (335 participants) reporting non-ambulatory systolic blood pressure were meta-analysed. All included studies were a high risk of bias. Using the last available time point, exercise was not associated with an effect on systolic blood pressure (mean difference, MD -4.33 mmHg, 95% confidence interval, CI -9.04, 0.38). The MD after 12-16 and 24-26 weeks of exercise was significant (-4.93 mmHg, 95% CI -8.83, -1.03 and -10.94 mmHg, 95% CI -15.83, -6.05, respectively) but not at 48-52 weeks (1.07 mmHg, 95% CI -6.62, 8.77). Overall, exercise did not have an effect on 24-hour ambulatory blood pressure (-5.40 mmHg, 95% CI -12.67, 1.87) or after 48-52 weeks (-7.50 mmHg 95% CI -20.21, 5.21) while an effect was seen at 24 weeks (-18.00 mmHg, 95% CI -29.92, -6.08). Exercise did not have a significant effect on measures of arterial stiffness or endothelial function. CONCLUSION: Limited evidence from shorter term studies suggests that exercise is a potential strategy to lower blood pressure in CKD. However, to recommend exercise for blood pressure control in this population, high quality, longer term studies specifically designed to evaluate hypertension are needed.

Supporting self-management for people with hypertension: a meta-review of quantitative and qualitative systematic reviews.

OBJECTIVES: Globally, healthcare policy promotes supported self-management as a strategy for people with long-term conditions. This meta-review aimed to explore how people with hypertension make sense of their condition, to assess the effectiveness of supported self-management in hypertension, and to identify effective components of support. METHODS: From a search of eight databases (January 1993-October 2012; update June 2017) we included systematic syntheses of qualitative studies of patients' experiences, and systematic reviews of randomized controlled trials evaluating the impact of supported self-management on blood pressure and medication adherence. We used meta-ethnography, meta-Forest plots and narrative analysis to synthesise the data. RESULTS: Six qualitative and 29 quantitative reviews provided data from 98 and 446 unique studies, respectively. Self-management support consistently reduced SBP (by between 2 and 6 mmHg), and DBP (by between 1 and 5 mmHg). Information about hypertension and treatment, home BP monitoring (HBPM) and feedback (including telehealth) were widely used in effective interventions. Patients' perceptions of a disease with multiple symptoms contrasted with the professional view of an asymptomatic condition. HBPM, in the context of a supportive patient-professional relationship, changed perceptions of the significance of symptoms and fostered confidence in ability to self-manage hypertension. CONCLUSION: Our systematic qualitative and quantitative meta-reviews tell complementary stories. Supported self-management can improve blood pressure control. Interventions are complex and encompass a broad range of support strategies. HBPM (with or without telehealth) within the context of a supportive patient-professional partnership can bridge the gap between medical and lay perspectives of hypertension and enable effective self-management.

Prescription of physical activity in the management of high blood pressure in Australian general practices.

This study investigated the prevalence of physical activity prescriptions in the management of high blood pressure (BP), the characteristics of people given these, and whether prescriptions were associated with the physical activity beliefs and practices of patients. A retrospective cohort study was undertaken, involving 365 general practitioners (GPs) from across Australia. The records of up to 20 patients per GP with high BP (N = 6512) were audited to identify physical activity and pharmacological prescriptions over four consecutive consultations. A sub-sample (n = 535) of patients completed a physical activity questionnaire. Physical activity prescriptions were recorded for 42.6% of patients with controlled BP, 39.5% for those with mild hypertension and 35.7% of those with moderate to severe hypertension. These were more likely in patients with cardiovascular disease (OR 1.41, 95% CI 1.23-1.62) and diabetes (OR 1.21, 95% CI 1.04-1.42), and less likely in those with moderate to severe hypertension (OR 0.80, 95% CI 0.69-0.94), aged 75 years and over (OR 0.62, 95% CI 0.51-0.74) and with high cholesterol (OR 0.73, 95% CI 0.57-0.94). Patients receiving a physical activity prescription were more likely to report this behaviour as important for their health and that they had increased their levels of participation. Most patients with high BP are not receiving physical activity prescriptions, and GPs show greater readiness to address this behaviour in patients with existing chronic disease. There is a need for efficacious and practical strategies for promoting physical activity that can be adopted in the routine management of high BP in general practice.

Short-Duration High-Intensity Interval Exercise Training Is More Effective Than Long Duration for Blood Pressure and Arterial Stiffness But Not for Inflammatory Markers and Lipid Profiles in Patients With Stage 1 Hypertension.

PURPOSE: The present study compared the effects of 2 different high-intensity interval training (HIIT) protocols on arterial stiffness, lipid profiles, and inflammatory markers in hypertensive patients. METHODS: Thirty hypertensive (stage 1) patients, aged 48.0 ± 3.2 yr, were randomly allocated to the short-duration HIIT (SDHIIT, n = 10), long-duration HIIT (LDHIIT, n = 10), and control (n = 10) groups. After a 2-wk preparatory phase of continuous mild training, patients in the SDHIIT group performed 8 wk of HIIT including 27 repetitions of 30-sec activity at 80% to 100% of (Equation is included in full-text article.)O2peak interspersed with 30-sec passive/active (10%-20% of (Equation is included in full-text article.)O2peak) recovery. Patients in the LDHIIT group performed 8 wk of HIIT, 32 min/session including 4 repetitions of 4-min activity at 75% to 90% of (Equation is included in full-text article.)O2peak interspersed with 4-min passive/active (15%-30% of (Equation is included in full-text article.)O2peak) recovery. Blood pressure (BP), pulse wave velocity (PWV), inflammatory markers, and lipid profiles were measured before and after training. RESULTS: Significant (P < .05) reductions in systolic blood pressure and PWV were found following 2 training protocols, though, only the changes in PWV following the SDHIIT were significantly different than those in the LDHIIT and control groups. Interleukin-6 and triglycerides decreased and interleukin-10 increased significantly (P < .01) following both HIIT programs, whereas the differences between the 2 training protocols were not statistically significant. C-reactive protein and lipids did not change significantly following HIIT. CONCLUSIONS: Performing HIIT improves systolic blood pressure and inflammatory markers in patients with stage 1 hypertension irrespective of the HIIT intensity and duration, and PWV improvement is intensity related.

Comparison Between Supervised and Partly Supervised Cardiac Rehabilitation Protocols in Hypertensive Patients: A Randomized Controlled Trial.

BACKGROUND: Hypertension (HTN) is the main cause of cardiovascular diseases accounting for one-third of global mortality. Physical exercise reduces the incidence and prevalence of HTN and cardiovascular morbidity and mortality. Exercises recommended for hypertensive patients include supervised cardiac rehabilitation, which occurs in rehabilitation centers, and partly supervised rehabilitation, with the individual prescription of exercises conducted at patients' residences. OBJECTIVE: Compare clinical and functional parameters of hypertensive patients subjected to two cardiac rehabilitation protocols: supervised and partly supervised. METHOD: Hypertensive patients stage I or II were randomly divided into group one (G1) (partly supervised cardiac rehabilitation) and group two (G2) (supervised cardiac rehabilitation). All patients performed a warm-up, aerobic exercise, strength training and cool-down. Participants' assessments conducted before and after intervention included: physical examination, six-minute walk test, cardiac stress test, metabolic tests, and central and peripheral blood pressure measurements. RESULTS: A total of 61 patients (mean age 60.3±11.3 years, 78.7% women) were randomized (30 in G1 and 31 in G2). At the end of the intervention, G1 increased 30.6 meters (p=0.004) and G2 increased 55.0 meters (p>0.001) the distance covered in the six-minute walk test. G2 showed an increase in the maximum oxygen consumption from 24.7±8.6 mlO2/Kg/min to 28.4±7.5 mlO2/Kg/min (p=0.003). Compliance with the intervention was similar in G1 and G2 (77.5±11% x 82±10%; p=0.654). CONCLUSION: Participants from both groups improved their physical fitness and showed satisfactory compliance and tolerability to the interventions. The supervised exercise was more effective in improving muscle strength and some physical fitness parameters.

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation.

BACKGROUND: The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients. OBJECTIVE: To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease. METHODS: A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach's alpha and the construct validity by the exploratory factorial analysis. RESULTS: The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach's correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension. CONCLUSION: The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Is Pilates an effective rehabilitation tool? A systematic review.

BACKGROUND: Pilates is a system of exercise focusing upon controlled movement, stretching and breathing. Pilates is popular today not only for physical fitness but also for rehabilitation programs. This paper is a review of the literature on the effectiveness of Pilates as a rehabilitation tool in a wide range of conditions in an adult population. METHODS: A systematic literature review was carried out according to the PRISMA guidelines. Electronic databases were searched for cohort studies or randomised controlled trials (RCTs), and inclusion and exclusion criteria were applied. The final RCTs were assessed using the PEDro and CONSORT 2010 checklists. RESULTS: Twenty-three studies, published between 2005 and 2016, met the inclusion criteria. These papers assessed the efficacy of Pilates in the rehabilitation of low back pain, ankylosing spondylitis, multiple sclerosis, post-menopausal osteoporosis, non-structural scoliosis, hypertension and chronic neck pain. Nineteen papers found Pilates to be more effective than the control or comparator group at improving outcomes including pain and disability levels. When assessed using the CONSORT and PEDro scales, the quality of the papers varied, with more falling toward the upper end of the scale. CONCLUSION: The majority of the clinical trials in the last five years into the use of Pilates as a rehabilitation tool have found it to be effective in achieving desired outcomes, particularly in the area of reducing pain and disability. It indicates the need for further research in these many areas, and especially into the benefits of particular Pilates exercises in the rehabilitation of specific conditions.

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation / Construção e Validação Psicométrica do HIPER-Q para Avaliar o Conhecimento de Pacientes Hipertensos em Reabilitação Cardíaca

Abstract Background: The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients. Objective: To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease. Methods: A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach's alpha and the construct validity by the exploratory factorial analysis. Results: The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach's correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension. Conclusion: The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Resumo Fundamento: A ausência de instrumentos capazes de mensurar o nível de conhecimento de pacientes hipertensos em programas de reabilitação cardíaca sobre sua doença reflete a carência de recomendações específicas para esses pacientes. Objetivo: Construir e validar um questionário para avaliar o conhecimento de hipertensos em programas de reabilitação cardíaca sobre sua doença. Métodos: foram avaliados 184 hipertensos, com média de idade de 60,5±10 anos, 66,8% homens. A reprodutibilidade foi avaliada pelo cálculo do coeficiente de correlação intraclasse, utilizando-se as situações do método de teste-reteste. A consistência interna foi avaliada pelo alfa de Cronbach, e a validade do construto pela análise fatorial exploratória. Resultados: A versão final do instrumento apresentou 17 questões dispostas em áreas de importância para a educação do paciente. O instrumento proposto apresentou um índice de clareza de 8,7 (0,25). O valor do coeficiente de correlação intraclasse foi de 0,804 e do alfa de Cronbach 0,648. A análise fatorial revelou cinco fatores associados às áreas de conhecimento. No que diz respeito à validade de critério, os pacientes com maior escolaridade e maior renda familiar apresentaram maior conhecimento sobre a hipertensão. Conclusão: O instrumento possui índice de clareza satisfatório e validade adequada, podendo ser utilizado para avaliar o conhecimento de hipertensos participantes de programas de reabilitação cardíaca.

Heart Rate Variability following Combined Aerobic and Resistance Training in Sedentary Hypertensive Women: A Randomised Control Trial.

OBJECTIVE: To investigate the effect of combined aerobic and resistance training (CART) on heart rate variability in sedentary, hypertensive women. PARTICIPANTS: A total of twenty-eight hypertensive (Stage 1 and 2) sedentary women (Age 40.54 ±â€¯4.2 yrs; Height 155.14 ±â€¯5.4 cm; Weight 70.96 ±â€¯10.2 kg; BMI 29.6 ±â€¯4.4; Duration of HTN: 6.43 ±â€¯2.5 yrs) were recruited for the study. METHODS: Participants were randomly assigned to either the CART group that performed combined aerobic and resistance exercise of moderate intensity [aerobic exercise 50-80% of HRmax (maximum heart rate) and resistance exercises at 50-80% of 1 Repetition Maximum (RM)], 5 times/week for 4 weeks, or to the control group that followed conventional treatment without any supervised exercise intervention. MAIN OUTCOME MEASURES: Resting blood pressure was measured and standard heart rate variability (HRV) indices were calculated using time domain (SDNN, pNN50, RMSSD) and frequency domain (LFnu, HFnu, LF/HF and TP) analysis. RESULTS: CART group demonstrated an increase in HFnu, TP, SDNN, and RMSSD, (p < 0.05) along with a significant decrease in LFnu, LF/HF ratio, systolic blood pressure, and diastolic blood pressure (p < 0.05). CONCLUSION: CART showed significant improvement in HRV parameters indicating vagal dominance in middle-aged hypertensive women. Therefore, exercise training in combined form (aerobic and resistance) may be incorporated in the management programs of the patients suffering from hypertension in order to augment improvement in their cardiac autonomic control.