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Background

Elevated blood pressure, or hypertension, is a major risk factor for cardiovascular disease, stroke, and heart attack, which are the leading causes of deaths worldwide.

Exercise is recommended for patients with hypertension.

A single bout of endurance or resistance exercise reduces blood pressure (BP) to levels below baseline or non-exercise days.

Reduced BP after exercise has been attributed to decreased cardiac output and peripheral vascular resistance.

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Rationale

The influence of exercise order on post- exercise BP has been previously investigated in patients with normal BP, and no difference was found in the BP changes after distinct exercise order. However, it remains unclear whether similar responses would be observed in hypertensive subjects who are known to present alterations in the cardiovascular system.

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Purpose and Hypothesis

The aim of this study was to evaluate the effects of the order of endurance and resistance exercises on postexercise BP and hemodynamics in hypertensive women.

Because endurance exercise leads to decreased peripheral vascular resistance in individuals with hypertension, the authors hypothesized that peripheral vascular resistance would decrease if endurance exercise is performed after resistance exercise.

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Methodology- Participants

n= 19 Female (6= Control, 7= E+R, 6= R+E)

All subjects were postmenopausal women without hormone replacement therapy using antihypertensive medication.

Exclusion: diabetic, a smoker, physically active, presented an abnormal resting or

exercise electrocardiography, or presented resting systolic/ diastolic BP >160/105 mm Hg.

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Methodology – Dependent Variables

BP, peripheral vascular resistance, cardiac output, stroke volume, and heart rate were measured.

BP was monitored by finger Photoplethysmography.

Heart rate was automatically calculated from systolic BP intervals.

Stroke volume, cardiac output, and peripheral vascular resistance were calculated using Modelflow.

Modelflow- Computation of aortic blood flow from the arterial pressure wave by

simulating a nonlinear, time-varying 3-element model of aortic input impedance that incorporates data related to gender, age, height and body weight.

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Methodology – Independent Variables

Endurance exercise followed by resistance exercise (E + R)

Resistance exercise followed by endurance exercise (R + E)

The endurance exercise protocol consisted of 30 minutes of walking on a treadmill at 50–60% of heart rate reserve.

The resistance exercise protocol consisted of 3 sets of 10 repetitions for knee extension, rowing machine, leg curl, lateral pull-down, adductor chair, bench press, and biceps curl at a workload of 50% of 1RM.

Control (C) - subjects remained inactive for 50 minutes

3 SESSIONS

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Statistical Analysis

A One-way repeated measures analysis of variance (ANOVA) was used to compare preintervention values among the experimental sessions.

A 2-way repeated measures ANOVA was used to compare the hemodynamic responses among the sessions, with session (C, E + R, and R + E) and time (preintervention and postintervention) as main factors.

Post hoc comparisons were made using the Newman-Keuls test.

A value of p < 0 < 0.05 was accepted as statistically significant.

The data are presented as the mean + SE for quantitative variables and as a frequency distribution for categorical variables.

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Results

Compared with preintervention values:

Systolic, diastolic, and mean BPs increased after the C session and did not change after the E + R and R + E sessions.

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Results

Figure 1. Systolic, diastolic, and mean blood pressures responses (Δ) measured at the control (squares and solid line), endurance exercise followed by resistance exercise (circles and dotted line), and resistance exercise followed by endurance exercise (triangles and dashed line) sessions in hypertensive women (n = 19). *Significantly different from preintervention (p ≤ 0.05). † Significantly different from the control sessions (p ≤ 0.05).

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Results

Peripheral vascular resistance increased after the C session and did not change after the E + R and R + E sessions, whereas cardiac output decreased after the C session and did not change after the E + R and R + E sessions.

Stroke volume did not change after the C session and decreased after the E + R and R + E sessions. However, heart rate decreased after the C session and increased after the E + R and R + E sessions.

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Results

Figure 2. Hemodynamic responses (Δ) measured at the control (squares and solid line), endurance exercise followed by resistance exercise (circles and dotted line), and resistance exercise followed by endurance exercise (triangles and dashed line) sessions in hypertensive women (n = 19). *Significantly different from preintervention (p ≤ 0.05). †Significantly different from the control sessions (p ≤ 0.05).

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Conclusion

Regardless of the order of endurance and resistance exercises, combined exercise sessions abolished increases in BP observed in a control condition because of a reduction in peripheral vascular resistance.

Combined exercises should be prescribed to control BP in hypertensive patients, regardless of the order in which it is accomplished.

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References

Menêses AL, Forjaz CL, de Lima PF, Batista RM, Monteiro Mde F, Ritti-Dias RM. Influence of endurance and resistance exercise order on the postexercise hemodynamic responses in hypertensive women. J Strength Cond Res. 2015 Mar;29(3):612-8. doi: 10.1519/JSC.0000000000000676. PMID: 25264665