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      Acute and Chronic Effects of Aerobic and Resistance Exercise on Ambulatory Blood Pressure

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          Abstract

          Hypertension is a ubiquitous and serious disease. Regular exercise has been recommended as a strategy for the prevention and treatment of hypertension because of its effects in reducing clinical blood pressure; however, ambulatory blood pressure is a better predictor of target-organ damage than clinical blood pressure, and therefore studying the effects of exercise on ambulatory blood pressure is important as well. Moreover, different kinds of exercise might produce distinct effects that might differ between normotensive and hypertensive subjects.

          The aim of this study was to review the current literature on the acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure in normotensive and hypertensive subjects. It has been conclusively shown that a single episode of aerobic exercise reduces ambulatory blood pressure in hypertensive patients. Similarly, regular aerobic training also decreases ambulatory blood pressure in hypertensive individuals. In contrast, data on the effects of resistance exercise is both scarce and controversial. Nevertheless, studies suggest that resistance exercise might acutely decrease ambulatory blood pressure after exercise, and that this effect seems to be greater after low-intensity exercise and in patients receiving anti-hypertensive drugs. On the other hand, only two studies investigating resistance training in hypertensive patients have been conducted, and neither has demonstrated any hypotensive effect. Thus, based on current knowledge, aerobic training should be recommended to decrease ambulatory blood pressure in hypertensive individuals, while resistance exercise could be prescribed as a complementary strategy.

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          Most cited references131

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          Post-resistance exercise hypotension, hemodynamics, and heart rate variability: influence of exercise intensity.

          The occurrence of post-exercise hypotension after resistance exercise is controversial, and its mechanisms are unknown. To evaluate the effect of different resistance exercise intensities on post-exercise blood pressure (BP), and hemodynamic and autonomic mechanisms, 17 normotensives underwent three experimental sessions: control (C-40 min of rest), low- (E40%-40% of 1 repetition maximum, RM), and high-intensity (E80%-80% of 1 RM) resistance exercises. Before and after interventions, BP, heart rate (HR), and cardiac output (CO) were measured. Autonomic regulation was evaluated by normalized low- (LF(R-R)nu) and high-frequency (HF(R-R)nu) components of the R-R variability. In comparison with pre-exercise, systolic BP decreased similarly in the E40% and E80% (-6 +/- 1 and -8 +/- 1 mmHg, P < 0.05). Diastolic BP decreased in the E40%, increased in the C, and did not change in the E80%. CO decreased similarly in all the sessions (-0.4 +/- 0.2 l/min, P < 0.05), while systemic vascular resistance (SVR) increased in the C, did not change in the E40%, and increased in the E80%. Stroke volume decreased, while HR increased after both exercises, and these changes were greater in the E80% (-11 +/- 2 vs. -17 +/- 2 ml/beat, and +17 +/- 2 vs. +21 +/- 2 bpm, P < 0.05). LF(R-R)nu increased, while ln HF(R-R)nu decreased in both exercise sessions. Low- and high-intensity resistance exercises cause systolic post-exercise hypotension; however, only low-intensity exercise decreases diastolic BP. BP fall is due to CO decrease that is not compensated by SVR increase. BP fall is accompanied by HR increase due to an increase in sympathetic modulation to the heart.
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            Type of activity: resistance, aerobic and leisure versus occupational physical activity.

            To define and describe the essential terminology associated with dose-response issues in physical activity and health. Recent consensus documents, position stands, and reports were used to provide reference definitions and methods of classifying physical activity and exercise. The two principal categories of physical activity are occupational physical activity (OPA) and leisure-time physical activity (LTPA). OPA is usually referenced to an 8-h d, whereas the duration of LTPA is quite variable. LTPA includes all forms of aerobic activities, structured endurance exercise programs, resistance-training programs, and sports. Energy expenditure associated with aerobic activity can be expressed in absolute terms (kJ x min(-1)), referenced to body mass (METs), or relative to some maximal physiological response (i.e., maximal heart rate (HR) or aerobic power (VO(2max))). The net cost of physical activity should be used to express energy expenditure relative to dose-response issues. The intensity of resistance training is presented in terms relative to the greatest weight that can be lifted one time in good form (1RM). The intensity of OPA followed the guidance of a previous consensus conference. The intensity of most LTPA can be categorized using the standard aerobic exercise classifications; however, for long-duration (2+ hours) LTPA, the classifications for OPA may be more appropriate. Physical activities should be classified in a consistent and standardized manner in terms of both energy expenditure and the relative effort required.
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              American College of Sports Medicine position stand. Exercise and hypertension.

              Hypertension (HTN), one of the most common medical disorders, is associated with an increased incidence of all-cause and cardiovascular disease (CVD) mortality. Lifestyle modifications are advocated for the prevention, treatment, and control of HTN, with exercise being an integral component. Exercise programs that primarily involve endurance activities prevent the development of HTN and lower blood pressure (BP) in adults with normal BP and those with HTN. The BP lowering effects of exercise are most pronounced in people with HTN who engage in endurance exercise with BP decreasing approximately 5-7 mm HG after an isolated exercise session (acute) or following exercise training (chronic). Moreover, BP is reduced for up to 22 h after an endurance exercise bout (e.g.postexercise hypotension), with greatest decreases among those with highest baseline BP. The proposed mechanisms for the BP lowering effects of exercise include neurohumoral, vascular, and structural adaptations. Decreases in catecholamines and total peripheral resistance, improved insulin sensitivity, and alterations in vasodilators and vasoconstrictors are some of the postulated explanations for the antihypertensive effects of exercise. Emerging data suggest genetic links to the BP reductions associated with acute and chronic exercise. Nonetheless, definitive conclusions regarding the mechanisms for the BP reductions following endurance exercise cannot be made at this time. Individuals with controlled HTN and no CVD or renal complications may participated in an exercise program or competitive athletics, but should be evaluated, treated and monitored closely. Preliminary peak or symptom-limited exercise testing may be warranted, especially for men over 45 and women over 55 yr planning a vigorous exercise program (i.e. > or = 60% VO2R, oxygen uptake reserve). In the interim, while formal evaluation and management are taking place, it is reasonable for the majority of patients to begin moderate intensity exercise (40- or = 30 min of continuous or accumulated physical activity per day. Type: primarily endurance physical activity supplemented by resistance exercise.
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                Author and article information

                Journal
                Clinics (Sao Paulo)
                Clinics
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                March 2010
                : 65
                : 3
                : 317-325
                Affiliations
                [I ]School of Physical Education and Sport, Exercise Hemodynamic Laboratory, Universidade de São Paulo - São Paulo/SP, Brazil
                [II ]Unidade de Hipertensão, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. Tel.: 55 11 3091.3136
                Article
                cln_65p317
                10.1590/S1807-59322010000300013
                2845774
                20360924
                5f96d1a9-a5dc-46a0-bbcc-ab042866f37d
                Copyright © 2010 Hospital das Clínicas da FMUSP
                History
                : 19 August 2009
                : 06 November 2009
                Categories
                Review

                Medicine
                blood pressure,hypertension,physiology and health,exercise
                Medicine
                blood pressure, hypertension, physiology and health, exercise

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