Hypotensive Effect of Heated Water-based Exercise in Older Individuals with Hypertension

Awassi Yophiwa Ngomane; Bianca Fernandes; Guilherme Veiga Guimarães; Emmanuel Gomes Ciolac

doi:10.1055/a-0828-8017

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2019; 40(04): 283-291
DOI: 10.1055/a-0828-8017

Clinical Sciences

Hypotensive Effect of Heated Water-based Exercise in Older Individuals with Hypertension

Awassi Yophiwa Ngomane

¹Department of Physical Education, Exercise and Chronic Disease Laboratory, São Paulo State University - UNESP, School of Sciences, Campus Bauru, Bauru, Brazil

,

Bianca Fernandes

¹Department of Physical Education, Exercise and Chronic Disease Laboratory, São Paulo State University - UNESP, School of Sciences, Campus Bauru, Bauru, Brazil

,

Guilherme Veiga Guimarães

²University of São Paulo - School of Medicine, Heart Institute, São Paulo, Brazil

,

Emmanuel Gomes Ciolac

¹Department of Physical Education, Exercise and Chronic Disease Laboratory, São Paulo State University - UNESP, School of Sciences, Campus Bauru, Bauru, Brazil

› Author Affiliations

Abstract

Blood pressure (BP) and hemodynamic response to heated water-based (HEx) vs. land-based exercise (LEx) were assessed in 15 (6 men) older hypertensives (age 66.4±4.9 yr) under pharmacological treatment. Participants were randomly assigned to perform 30 min of moderate-intensity HEx (walking inside the pool), LEx (walking on a treadmill) and non-exercise control (CON) intervention. Resting BP, arterial stiffness, endothelial reactivity and heart rate variability (HRV) were measured before, immediately after, and 45 min after interventions. 24-h ambulatory BP monitoring was performed after interventions. Resting systolic (but not diastolic) BP reduced 9.9±3.1 mmHg (P<0.01) 45 min after HEx only. 24-h systolic and diastolic, daytime diastolic and nightime systolic BP were lower (P<0.05) after HEx than both LEx and CON. Daytime systolic BP was also lower (P<0.05) after HEx than CON. Nighttime diastolic was not different between interventions. HEx-induced ambulatory BP reduction ranged 4.5±1.3 mmHg (24-h diastolic BP) to 9.5±3.0 mmHg (nighttime systolic BP), and persisted for 18/11 h in systolic/diastolic BP, when compared with CON. No significant changes in arterial stiffness, endothelial reactivity and HRV were found during any intervention. These results suggest that HEx may have important implications for managing BP in older hypertensive under pharmacological treatment.

Key words

aging - arterial stiffness - endothelial function - exercise - heart rate variability - hypertension

Full Text

References

References
1 Ayme K, Gavarry O, Rossi P, Guieu R, Boussuges A. Changes in cardio-vascular function after a single bout of exercise performed on land or in water: A comparative study. Int J Cardiol 2014; 176: 1377-1378
2 Bocalini DS, Bergamin M, Evangelista AL, Rica RL, Pontes FLJ, Figueira AJ, Serra AJ, Rossi EM, Tucci PJF, Dos Santos L. Post-exercise hypotension and heart rate variability response after water- and land-ergometry exercise in hypertensive patients. PLoS One 2017; 12: e0180216
3 Carvalho VO, Bocchi EA, Guimaraes GV. The borg scale as an important tool of self-monitoring and self-regulation of exercise prescription in heart failure patients during hydrotherapy. A randomized blinded controlled trial. Circ J 2009; 73: 1871-1876
4 Castro RE, Guimaraes GV, Da Silva JM, Bocchi EA, Ciolac EG. Postexercise hypotension after heart transplant: water- versus land-based exercise. Med Sci Sports Exerc 2016; 48: 804-810
5 Cider A, Schaufelberger M, Sunnerhagen KS, Andersson B. Hydrotherapy - a new approach to improve function in the older patient with chronic heart failure. Eur J Heart Fail 2003; 5: 527-535
6 Cider Å, Sveälv BG, Täng MS, Schaufelberger M, Andersson B. Immersion in warm water induces improvement in cardiac function in patients with chronic heart failure. Eur J Heart Fail 2006; 8: 308-313
7 Ciolac EG. High-intensity interval training and hypertension: Maximizing the benefits of exercise?. Am J Cardiov Dis 2012; 2: 102-110
8 Ciolac EG. Exercise training as a preventive tool for age-related disorders: A brief review. Clinics 2013; 68: 710-717
9 Ciolac EG, Bocchi EA, Bortolotto LA, Carvalho VO, Greve JMD, Guimaraes GV. Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypert Res 2010; 33: 836-843
10 Ciolac EG, Bocchi EA, Greve JM, Guimaraes GV. Heart rate response to exercise and cardiorespiratory fitness of young women at high familial risk for hypertension: Effects of interval vs continuous training. Eur J Cardiov Prev Rehabil 2011; 18: 824-830
11 . Ciolac EG, Castro RE, Greve JM, Bacal F, Bocchi EA, Guimaraes GV. prescribing and regulating exercise with rpe after heart transplant: A pilot study. Med Sci Sports Exerc 2015; 47: 1321-1327
12 Ciolac EG, Guimaraes GV, D'Avila VM, Bortolotto LA, Doria EL, Bocchi EA. Acute aerobic exercise reduces 24-h ambulatory blood pressure levels in long-term-treated hypertensive patients. Clinics 2008; 63: 753-758
13 Ciolac EG, Guimaraes GV, D'Avila VM, Bortolotto LA, Doria EL, Bocchi EA. Acute effects of continuous and interval aerobic exercise on 24-h ambulatory blood pressure in long-term treated hypertensive patients. Int J Cardiol 2009; 133: 381-387
14 Ciolac EG, Rodrigues-da-Silva JM. Resistance training as a tool for preventing and treating musculoskeletal disorders. Sports Med 2016; 46: 1239-1248
15 Cornelissen VA, Buys R, Smart NA. Endurance exercise beneficially affects ambulatory blood pressure: A systematic review and meta-analysis. J Hypertens 2013; 31: 639-648
16 Cruz LGdB, Bocchi EA, Grassi G, Guimaraes GV. Neurohumoral and endothelial responses to heated water-based exercise in resistant hypertensive patients. Circ J 2017; 81: 339-345
17 Day LM, Maki-Petaja KM, Wilkinson IB, McEniery CM. Assessment of brachial artery reactivity using the Endocheck: Repeatability, reproducibility and preliminary comparison with ultrasound. Artery Res 7: 119-120
18 Dimeo F, Pagonas N, Seibert F, Arndt R, Zidek W, Westhoff TH. Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension 2012; 60: 653-658
19 Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M. et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386: 2287-2323
20 Guimaraes GV, Ciolac EG, Carvalho VO, D'Avila VM, Bortolotto LA, Bocchi EA. Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypert Res 2010; 33: 627-632
21 Guimaraes GV, Cruz LGB, Tavares AC, Dorea EL, Fernandes-Silva MM, Bocchi EA. Effects of short-term heated water-based exercise training on systemic blood pressure in patients with resistant hypertension: A pilot study. Blood Press Monit 2013; 18: 342-345
22 Guimaraes GV, de Barros Cruz LG, Fernandes-Silva MM, Dorea EL, Bocchi EA. Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: A randomized controlled trial (HEx trial). Int J Cardiol 2014; 172: 434-441
23 Harriss DJ, Maccsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 Update. Int J Sports Med 2017; 38: 1126-1131
24 He W, Goodkind D, Kowal P. An Aging World: 2015. In: Bureau USC ed., International Population Reports. Washington: U.S. Government Publishing Office; 2016: 95
25 Hickson SS, Butlin M, Broad J, Avolio AP, Wilkinson IB, McEniery CM. Validity and repeatability of the Vicorder apparatus: A comparison with the SphygmoCor device. Hypert Res 2009; 32: 1079-1085
26 Hypertension EETFftMoA. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013; 31: 1925-1938
27 James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith Jr. SC, Svetkey LP, Taler SJ, Townsend RR, Wright Jr. JT, Narva AS, Ortiz E. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311: 507-520
28 Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903-1913
29 Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation 2016; 134: 441-450
30 Ngomane AY, Fernandes B, Balbo JL, Ciolac EG. Acute effects of heated water based exercise on ambulatory blood pressure and heart rate variability in long term treated elderly hypertensive patients: 3203 Board #108 June 2 200 PM - 330 PM. Med Sci Sports Exerc 2017; 49: 907
31 Pardini R, Matsudo S, Araújo T, Andrade E, Braggion G, Andrade D, Oliveira L, Figeira A, Raso V. Validation of the international questionnaire of physical activity level (IPAQ - version 6): Pilot study in young Brazilian adults. Rev Bras Cien Mov 2001; 9: 45-51
32 Pascoalino LN, Ciolac EG, Tavares AC, Castro RE, Ayub-Ferreira SM, Bacal F, Issa VS, Bocchi EA, Guimaraes GV. Exercise training improves ambulatory blood pressure but not arterial stiffness in heart transplant recipients. J Heart Lung Transplant 2015; 34: 693-700
33 Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc 2004; 36: 533-553
34 Pescatello LS, Guidry MA, Blanchard BE, Kerr A, Taylor AL, Johnson AN, Maresh CM, Rodriguez N, Thompson PD. Exercise intensity alters postexercise hypotension. J Hypertens 2004; 22: 1881-1888
35 Pierce DR, Doma K, Leicht AS. Acute effects of exercise mode on arterial stiffness and wave reflection in healthy young adults: A systematic review and meta-analysis. Front Physiol 2018; 9: 73
36 Pradhapan P, Tarvainen MP, Nieminen T, Lehtinen R, Nikus K, Lehtimäki T, Kähönen M, Viik J. Effect of heart rate correction on pre- and post-exercise heart rate variability to predict risk of mortality—an experimental study on the FINCAVAS cohort. Front Physiol 2014; 5-208
37 Schmid J-P, Noveanu M, Morger C, Gaillet R, Capoferri M, Anderegg M, Saner H. Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure. Heart 2007; 93: 722-727
38 Siasos G, Athanasiou D, Terzis G, Stasinaki A, Oikonomou E, Tsitkanou S, Kolokytha T, Spengos K, Papavassiliou AG, Tousoulis D. Acute effects of different types of aerobic exercise on endothelial function and arterial stiffness. Eur J Prev Cardiol 2016; 23: 1565-1572
39 Whelton PK, Carey RM, Aronow WS, Casey Jr. DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith Jr. SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams Sr. KA, Williamson JD, Wright Jr. JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 71: e127-e248