Exercise training improves blood pressure reactivity to stress: a systematic review and meta-analysis.

Blood pressure (BP) reactivity to stress is associated with cardiovascular events and the incidence of hypertension, therefore, tolerance to stressors is important for better management of cardiovascular risks. Exercise training is among the strategies that have been investigated as blunting the peak response to stressors, however, its efficacy is poorly explored. The aim was to explore the effects of exercise training (at least four weeks) on BP responses to stressor tasks in adults. A systematic review was performed in five electronic databases (MEDLINE, LILACS, EMBASE, SPORTDiscus, and PsycInfo). Twenty-three studies and one conference abstract was included in the qualitative analysis, totaling 1121 individuals, and k = 17 and 695 individuals in the meta-analysis. Favorable results (random-effects) for exercise training were found, with attenuated peak responses in systolic (standardized mean difference (SMD) = -0.34 [-0.56; -0.11], representing average reductions of 2.5 ± 3.6 mmHg) and null effects on diastolic BP (SMD = -0.20 [-0.54; 0.14], representing average reductions of 2.0 ± 3.5 mmHg). The analysis removing outliers' studies improved the effects for diastolic (SMD = -0.21 [-0.38; -0.05]) but not systolic BP (SMD = -0.33 [-0.53; -0.13]). In conclusion, exercise training seems to lower stress-related BP reactivity, therefore has the potential to improve patients' ability to better respond to stressful situations.

Acute effect of interval step exercise versus continuous walk exercise on cardiovascular parameters in hypertensive postmenopausal women: A clinical, controlled, and randomized study.

Aiming the prevention and treatment of hypertension, regular physical exercise has become important to reduce blood pressure. The present experiment compared the effect of interval step exercise with continuous walking exercise on cardiovascular parameters of post-menopausal hypertensive women. The volunteers were submitted to three experimental sessions: control (CO), interval exercise (IE) and continuous exercise (CE), in randomized order. The sessions lasted 120 min and during this period, resting blood pressure was evaluated after 10min of siting rest before exercise, and 30, 40 and 60min of siting rest position after exercise. Heart rate variability (HRV) were estimated at rest before exercise and 30min after exercise. Blood pressure reactivity (BPR) to the Stroop Color-Word test was measured at rest before exercise and 60min after exercise. Twelve women finished the study (59 ± 4 years and BMI of 29.78 ± 4.10 kg/m2). The One way ANOVA showed that systolic blood pressure (SBP) area under the curve over time were lower (p = 0.014) in both exercise sessions comparing with control session. The Generalized estimation equations (GEE) showed that SDNN and RMSSD indices of HRV decreases (p < 0.001) in both exercises session as well, comparing with CO. Maximal SBP during Stroop test were lower after both IE and CE exercises session comparing with CO session. We conclude that interval step exercise can reduce blood pressure responses and improve HRV acutely after its performance and these responses are similar to continuous walking exercise.

A single session of exercise reduces blood pressure reactivity to stress: a systematic review and meta-analysis.

Stressful situations are common in everyday life and disturb homeostasis. So, an exercise session is a strategy to mitigate blood pressure (BP) peaks in response to stress (i.e., BP reactivity), decreasing the cardiovascular risk. This is a systematic review and meta-analysis that aims to verify the effects of a single session of physical exercises on BP reactivity to stress in adults. The searches were performed in digital databases (MEDLINE, LILACS, EMBASE, SPORTDiscus, and PsycInfo) and 29 studies were included, totaling 795 individuals (quantitative analysis: k = 25, n = 659). As for exercise characteristics, 21 of the 29 studies focused on aerobic exercises, and 23 studies focused on low to moderate intensities. As for the stress tests, we have them in the following order from the most to the least frequent: stroop color and word test, cold pressor test, arithmetic test, public speaking, handgrip, trier social stress test, and study task. Favorable metanalytic results (standardized mean differences through random-effects approach) for the exercises were found, with attenuated reactivity in systolic BP (pooled effect size = - 0.38 [- 0.49; - 0.27], representing average reductions of 3.7 ± 3.8 mmHg), diastolic BP (pooled effect size = - 0.51 [- 0.70; - 0.33], representing average reductions of 2.9 ± 3.7 mmHg), and mean BP (pooled effect size = - 0.51 [- 0.72; - 0.31], representing average reductions of 4.1 ± 3.3 mmHg). So, acute physical exercise lowers systolic, diastolic, and mean blood pressure reactivity in response to stressor tasks. However, given the small magnitude of effects, the clinical relevance of this result must be interpreted with caution and be better explored.

Different cardiovascular responses to exercise training in hypertensive women receiving ß-blockers or angiotensin receptor blockers: A pilot study.

AIM: To verify the influence of ß-blockers or angiotensin receptor blockers on cardiovascular responses to exercise training in hypertensive post-menopausal women. METHODS: Postmenopausal women were allocated into: healthy control group (CON; n = 9); angiotensin receptor blockers users (ARB; n = 19); and ß-adrenergic blockers users (BB; n = 19). Before and after 12 weeks of combined (aerobic and resistance) exercise training they were evaluated by: heart rate (HR) and its variability (HRV), blood pressure (BP) under stress (Cold pressor and Stroop color tests), and ambulatorial BP and its variability. RESULTS: In ambulatorial BP analysis only in ARB group awake systolic BP decreased (p = .011; ARB: From 122 ± 11 to 117 ± 9; BB: From 118 ± 7 to 114 ± 5; CON: From 121 ± 7 to 127 ± 11 mmHg). There were time effects in BP reactivity to stress, where BP reactivity after Stroop color and Cold pressor test decreased in all groups. In BP variability analysis, only BB group has significative decreased values in systolic SD24 (p = .007; ΔARB = -0.3 ± 2.0; ΔBB = -1.3 ± 2.0; ΔCON = 0.8 ± 1.7 mmHg) and SDdn (p = .006; ΔARB = -0.2 ± 1.6; ΔBB = -1.3 ± 2.0; ΔCON = 0.4 ± 2.1 mmHg). HRV analysis demonstrated that post-training, only in BB group LF/HF decreased (p = .001; ΔARB = 0.1 ± 0.8; ΔBB = -0.4 ± 1.5; ΔCON = 1.0 ± 1.7). CONCLUSION: ARB present pronounced responses in awake ambulatorial systolic BP, while ß-blockers users present greater responses in BP variability. Besides that, exercise can mitigate BP reactivity to stress with no differences between groups. Lastly, there were no major differences in HRV. TRIAL REGISTRY AT "CLINICALTRIALS.GOV": NCT03529838.

Beetroot juice intake with different amounts of nitrate does not change aerobic exercise-mediated responses in heart rate variability in hypertensive postmenopausal women: A randomized, crossover and double-blind study.

OBJECTIVES: To compare the acute effects of a single dose of beetroot juice (BJ) with different concentrations of nitrate (NO3 -) on heart rate variability (HRV) in postmenopausal hypertensive women. METHODS: Thirteen hypertensive postmenopausal women (58.1 ± 4.6 years of age and 27 ± 4 kg/m2 of BMI) completed the protocol that consisted of three visits with different beverage intakes in a randomized and crossover design. The three beverages were BJ with a high content of nitrate (high-NO3 -), BJ with a low content of nitrate (low-NO3 -), and an orange flavored non-caloric drink (OFD). Heart rate (HR) were evaluated during 20 min after sitting rest at 7:20 a.m. (baseline), after they drank one of the drinks, and remained at sitting rest for 120 min and then performed 40 min of aerobic exercise at 65-70% of the HR reserve on a treadmill. HR was recorded for 90 min after exercise for time, frequency, and non-linear domains of HRV index analysis. RESULTS: Two-way ANOVA showed that there were no interaction effects (time∗sessions) in any of the HRV indexes after exercise in all three sessions. HRV indexes increased after exercise (p = <0.05) similarly in all three sessions when compared with the baseline time point. CONCLUSION: Therefore, a single dose of BJ, independent of NO3 - content, does not change aerobic exercise-mediated responses in HRV indexes in hypertensive postmenopausal women.

Effect of combined exercise training on heart rate variability in normotensive and hypertensive postmenopausal women

Abstract Aim: This study aimed to verify and compare the effects of 10 weeks of combined exercise training on the heart rate variability of normotensive (NT) and hypertensive (HT) postmenopausal women. Methods: This is a quasi-experimental controlled clinical trial. Therefore, 14 HT and 12 NT postmenopausal women completed 10 weeks of combined exercise training. The exercise protocol consisted of 45 min of exercise, performed 3 times a week, consisting of 5 min of warm-up, 20 min of resistance exercise, and 20 min of aerobic exercise. Heart rate variability assessments were performed before and after the end of physical training. Results: Heart rate variability was assessed pre- and post-training periods. Mean RR (δNT = 95 ± 88; δHT = 38 ± 127), SDNN (δNT = 9 ± 13; δHT = 3 ± 14), RMSSD (δNT = 10 ± 12; δHT = 2 ± 18), SD1 (δNT = 7 ± 8; δHT = 1 ± 13), and SD2 (δNT = 10 ± 18; δHT = 4 ± 17) showed improvements after the intervention (time effects p < 0.05). No parameters presented group or interaction effects (p ≥ 0.05). Conclusion: In summary, 10 weeks of combined exercise training improved heart rate variability parameters similarly in both NT and HT postmenopausal women. Therefore, combined exercise training may be used to improve autonomic modulation of the heart rate of postmenopausal women, regardless of the presence of hypertension.

Isoflavone Supplementation Does Not Potentiate the Effect of Combined Exercise Training on Resting and Ambulatory Blood Pressure in Non-Obese Postmenopausal Women: A Randomized Double-Blind Controlled Trial-A Pilot Study.

Physical exercise and isoflavone supplementation are potential strategies to prevent and treat cardiovascular diseases in postmenopausal women. The aim of this study was to investigate whether there are additive effects of isoflavone supplementation when associated with combined aerobic and resistance exercise on resting and ambulatory blood pressure monitoring (ABPM) and in blood pressure variability (BPV). Thirty-one non-obese postmenopausal women were randomly allocated into two groups: placebo and exercise (Placebo n = 19); and isoflavone supplementation (100 mg/day) and exercise (isoflavone n = 19). ABPM and BPV were evaluated before and after 10 weeks of moderate combined (aerobic and resistance) exercise training. Generalized Estimating Equation (GEE) with Bonferroni correction and intention-to-treat analysis was used to compare the effects of interventions on resting BP, ABPM and BPV. Combined exercise training decreased resting systolic (SBP) and diastolic blood pressure (DBP) and reduced 24 h and awake ambulatory SBP, DBP and mean blood pressure over time, with no additional effects of isoflavone supplementation. No changes were observed in sleep period, or in BPV indexes (Standard Deviation of 24 h (SD), daytime and nighttime interval (SDdn) and average real variability (ARV) in both groups. We conclude that isoflavone supplementation does not potentiate the effects of combined training on resting and ambulatorial systolic and diastolic blood pressure in non-obese postmenopausal women.

The effects of isoflavone supplementation plus combined exercise on salivary markers of oxidative stress in postmenopausal women.

This study tested the effect of isoflavone supplementation in addition to combined exercise training in salivary oxidative stress markers in non-obese postmenopausal women. Thirty-two postmenopausal women without hormone therapy were randomly assigned to exercise + placebo (n = 15) or exercise + isoflavone supplementation (n = 17) groups. They performed 30 sessions of combined exercises (aerobic plus resistance) over ten weeks and consumed 100 mg of isoflavone supplementation or placebo. Saliva samples were collected after an overnight fast. Superoxide dismutase, total antioxidant capacity, thiobarbituric acid reactive substances, catalase, total protein and nitrite were determined before and after ten weeks of the intervention. The ANOVA two-way analysis of variance was applied with α of 5%. Both groups increase (p<0.05) superoxide dismutase activity and decrease catalase levels. There was interaction (time × group) in both nitrite and thiobarbituric acid reactive substances results, with increase (p<0.05) in placebo group and decrease (p<0.05) in isoflavone group. No difference was found for total antioxidant capacity or total protein. The combination of isoflavone supplementation and exercise training can promote an antioxidant effect through reduction of lipid peroxidation and concentrations of salivary nitrite.

A Single Dose of Beetroot Juice Does Not Change Blood Pressure Response Mediated by Acute Aerobic Exercise in Hypertensive Postmenopausal Women.

OBJECTIVE: To verify if acute intake of beetroot juice potentiates post-exercise hypotension (PEH) in hypertensive postmenopausal women. METHODS: Thirteen hypertensive postmenopausal women (58.1 ± 4.62 years and 27.4 ± 4.25 kg/m²) were recruited to participate in three experimental sessions, taking three different beverages: Beetroot juice (BJ), placebo nitrate-depleted BJ (PLA), and orange flavored non-caloric drink (OFD). The participants performed moderate aerobic exercise training on a treadmill, at 65-70% of heart rate reserve (HRR), for 40 min. After an overnight fast, the protocol started at 07h when the first resting blood pressure (BP) was measured. The beverage was ingested at 07h30 and BP was monitored until the exercise training started, at 09h30. After the end of the exercise session, BP was measured every 15 min over a 90-min period. Saliva samples were collected at rest, immediately before and after exercise, and 90 min after exercise for nitrite (NO2-) analysis. RESULTS: There was an increase in salivary NO2- with BJ intake when compared to OFD and PLA. A slight increase in salivary NO2- was observed with PLA when compared to OFD (p < 0.05), however, PLA resulted in lower salivary NO2- when compared to BJ (p < 0.001). There were no changes in salivary NO2- with the OFD. Systolic and diastolic BP decreased (p < 0.001) on all post exercise time points after all interventions, with no difference between the three beverages. CONCLUSION: Acute BJ intake does not change PEH responses in hypertensive postmenopausal women, even though there is an increase in salivary NO2-.

Isoflavone supplementation plus combined aerobic and resistance exercise do not change phase angle values in postmenopausal women: A randomized placebo-controlled clinical trial.

OBJECTIVE: The aim of this study was to evaluate the effect of isoflavone supplementation plus combined exercise protocol on phase angle (PhA) values in postmenopausal women. METHODS: Thirty postmenopausal women were randomly assigned in a double blind, placebo-controlled clinical trial divided into two groups: 100 mg/day of isoflavone supplementation (n = 16) and 100 mg/day of starch (placebo; n = 14). In addition, both groups performed a combined aerobic and resistance exercise during 10 weeks. Body composition and PhA were evaluated by bioelectrical impedance. RESULTS: PhA values did not change in the isoflavone group (PRE: 6.7 ±â€¯0.7° to POST: 6.7 ±â€¯0.6°) and in the placebo group (PRE: 7.2 ±â€¯1.0° to POST: 6.8 ±â€¯0.5°); p group = 0.304, p time = 0.227, p group x time interaction = 0.137. Additionally, delta values were not different (0.04 ±â€¯0.5° vs. -0.40 ±â€¯0.99°; p = 0.176) between isoflavone and placebo groups, respectively. CONCLUSION: We conclude that isoflavone supplementation plus combined aerobic and resistance exercise did not change PhA in postmenopausal women. The patients were part of ClinicalTrials.gov: NCT03008785.

The Acute Effects of Mat Pilates on Hemodynamic and Salivary Nitrite Responses After Exercise in Postmenopausal Women.

The aim of this study was to compare the hemodynamic and salivary responses after mat Pilates, aerobics, resistance exercises, and control. A total of 16 normotensive postmenopausal women performed: Pilates, 10 floor exercises; aerobics, 35 min on a treadmill (60-70% of heart rate reserve); resistance exercises, 60% of one-repetition maximum; and control, no physical exercise. Blood pressure and heart rate variability were evaluated at rest and 60 min after the intervention. Saliva samples were collected at rest, immediately after, and 30 and 60 min after exercise for analysis of nitrite concentration and total proteins. Systolic blood pressure, diastolic blood pressure, and mean blood pressure area under the curve were lower (p < .05) after both aerobic and resistance exercises sessions but not after the Pilates session when compared with the control session. Nitrite concentrations in saliva were higher 60 min after the end of all exercise sessions. Heart rate variability was higher after the resistance exercise. Aerobic and resistance exercises were capable of decreasing arterial blood pressure after acute exercise.

Combined exercise training reduces climacteric symptoms without the additive effects of isoflavone supplementation: A clinical, controlled, randomised, double-blind study.

BACKGROUND: Exercise and supplementation with isoflavones are therapies used to prevent and treat climacteric symptoms. AIM: To verify the effects of 10 weeks of combined aerobic and resistance training and isoflavone supplementation on climacteric symptoms in postmenopausal women. METHODS: A randomised, double-blind, controlled clinical trial was performed. A total of 32 postmenopausal women, aged 54.4 ± 5.4 years, with a body mass index of 26.6 ± 3.0 kg/m2 and 5.6 ± 4.6 years after menopause, were randomly assigned to groups: placebo and exercise (PLA + EXE, n = 15) or 100 mg of isoflavone and exercise (ISO + EXE, n = 17). At the beginning and after 10 weeks of aerobic + resistance (20 min each, moderate intensity) training, climacteric symptoms were evaluated using the Blatt-Kupperman Menopausal Index, Cervantes Scale and Menopause Rating Scale. ANCOVA was used for analysis between groups and at different times, with the covariate adjusted by the pre-value. The level of significance considered was p < 0.05. RESULTS: A reduction in climacteric symptoms was observed in both groups, without differences between the interventions. The reductions were 45% and 50% for the Blatt-Kupperman Menopausal Index, 41% and 52% for the MRS and 39% and 39% for the Cervantes Scale in the ISO + EXE and PLA + EXE groups, respectively. In the descriptive analysis of the Blatt-Kupperman Menopausal Index values, there was an increase in the absence of symptoms from 48-77% in the ISO + EXE group and 24-58% in the PLA + EXE group. CONCLUSIONS: A period of 10 weeks of combined training was effective in improving climacteric symptoms in post-menopausal women. However, isoflavone supplementation did not promote additional effects in improving symptoms.