The chronic effects of muscle-resistance training in arterial pressure of hypertensive older adults: a meta-analysis

Bunn, Priscila dos Santos; Lima, Nádia de Souza; Venturini, Gabriela Rezende de Oliveira; Silva, Elirez Bezerra da

doi:10.1590/1980-5918.032.AO05

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ORIGINAL ARTICLE • Fisioter. mov. 32 • 2019 • https://doi.org/10.1590/1980-5918.032.AO05 copy

The chronic effects of muscle-resistance training in arterial pressure of hypertensive older adults: a meta-analysis

Os efeitos crônicos do treinamento de resistência muscular na pressão arterial de idosos hipertensos: uma metanálise

Los efectos crónicos del entrenamiento de resistencia muscular en la presión arterial de los ancianos hipertensos: una metanálisis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Little research has been done on the effects of muscle-resistance training (RT) in hypertensive older adults.

Objective:

The aim of this meta-analysis was to verify the efficacy of RT, on a chronic basis, on the systolic (SBP) and diastolic blood pressure (DBP) of hypertensive older adults.

Method:

Several literature databases were explored to find studies on controlled and randomized trials that evaluated the effects of RT in hypertensive older adults for more than 10 weeks. Profile of the participants, sample size, intervention protocol, and results of SBP and DBP were analyzed. The PEDro scale and the Cochrane tool were used to analyze the methodological quality of the studies and the risk of bias, respectively. The RevMan5.3 program was used to analyze the results on the SBP and DBP after the RT intervention and in the control groups.

Results:

The meta-analysis of five studies considering 96 hypertensive individuals who underwent RT and 104 hypertensive control subjects showed that the regular practice of RT from 12 to 16 weeks, three times a week, with three sets from 8 to 12 repetitions at an intensity of 60% to 80% of one-repetition maximum (1-RM), significantly reduced SBP by 7.26 mmHg (95%CI = -9.16 - 5.37) and DBP by 4.84 mmHg (95%CI = -5.89 - 3.79).

Conclusion:

The muscle-resistance training was effective in reducing, chronically, the blood pressure of hypertensive older adults. It can also decrease the need for medication inherent to hypertension.

Keywords:
Resistance Training; Elderly; Hypertension

Study/year	Sample	Results of the variables
Terra et al., 2008 ²⁷27. Terra DF, Mota MR, Rabelo HT, Bezerra LM, Lima RM, Ribeiro AG, et al. Reduction of arterial pressure and double product at rest after resistance exercise training in elderly hypertensive women. Arq Bras Cardiol. 2008;91(5):299-305.	n = 52 hypertensive older women, controlled with antihypertensive medication	RTG:
		SBP(mmHg): Pre-training: 125.2 ± 9.3; Post-training: 114.7 ± 9.2 (p = 0.01 intragroup and pre x post) / p < 0.01 intergroup;
		DBP(mmHg): Pre-training: 72.0 ± 6.8; Post-training: 71.04 ± 7.9 (p = 0.3) / p > 0.05 intergroup.
	Age: 65.9 ± 4.5 years.	CG: No difference was found.
		SBP(mmHg): Pre-training: 124.6 ± 10.1; Post-training: 123.3 ± 13.5;
		DBP(mmHg): Pre-training: 74.2 ± 7.3; Post-training: 73.3 ± 7.5 .
Gonçalves et al., 2014 ²⁸28. Gonçalves CGS, Nakamura FY, Gerage AM, Januário RSB, Nascimento MA, Farinatti TV, et al. Functional and physiological effects of a 12-week programme of resistance training in elderly hypertensive. INT SPORTMED J. 2014;15(1):50-61.	n = 17 hypertensive older adults, controlled with antihypertensive medication, nonsmokers and with sedentary lifestyle for more than six months (>60 years)	RTG:
		SBP(mmHg): Pre-training: 126.0 ± 5.2; Post-training: 122.9 ± 4.49 (p = 0.10); DBP(mmHg): Pre-training: 80.9 ± 3.3; Post-training: 81.9 ± 4.4 (p = 0.08);
	Age: RTG = 65.6 ± 1.9; and CG = 66.1 ± 1.2 years.	CG:
		SBP(mmHg): Pre-training: 137.0 ± 5.0; Post-training: 134.9 ± 4.5;
		DBP(mmHg): Pre-training: 88.3 ± 2.6; Post-training: 88.7 ± 2.7;
Mota et al., 2013 ²⁹29. Mota MR, Oliveira RJ, Dutra MT, Pardono E, Terra DF, Lima RM, et al. Acute and chronic effects of exercise on blood pressure in hypertensive elderly women. J Strength Cond Res. 2013;27(12):3475-80.	n = 64 hypertensive older adults with sedentary lifestyle for more than 6 months, hypertension controlled with antihypertensive medication.	RTG:
		SBP (mmHg): Pre-training: 134.5 ± 14.6; Post-training: 120.2 ± 11.8 (p < 0.05 intergroup from the 3^rd week);
		DBP (mmHg): Pre-training: 76.0 ± 9.2; Post-training: 72.4 ± 9.3 (p < 0.05 intragroup and p > 0.05 intergroup).
	Age: 67.1±6.2 years.	CG:
		SBP (mmHg): Pre-training: 131.8 ± 16.9; Post-training: 132.3 ± 17.6; (p > 0.05)
		DBP (mmHg): Pre-training: 74.3 ± 7.4; Post-training: 73.8 ± 7.8 (p > 0.05)
Dantas et al., 2016 ¹⁰10. Dantas FFO, Brasileiro-Santos MS, Batista RMF, Nascimento LS, Castellano LRC, Ritti-Dias RM, et al. Effect of Strength Training on Oxidative Stress and the Correlation of the Same with Forearm Vasodilatation and Blood Pressure of Hypertensive Elderly Women: A Randomized Clinical Trial. PloS One. 2016;(2):1-19.	n = 25 sedentary hypertensive older women, controlled with antihypertensive medication, aged between 60 and 75 years;	RTG:
		SBP(mmHg): pre-training: 142.9 ± 13.1; Post-training = 137.1 ± 12.2
		DBP(mmHg): pre-training: 68.2 ± 6.2; post-training: 64.9 ± 5.1
	Age: 64.7±4.7 years (RTG) and 67.7±5.6 years (CG).	CG:
		SBP(mmHg): pre-training = 139.9 ± 10.3; post-training: 144.9 ± 14.1 (p = 0.050 intergroup)
		DBP(mmHg): pre-training: 67.4 ± 9.5; post-training: 72.0 ± 7.7 (p = 0.016 intergroup)
Heffernan et al., 2013 ³⁰30. Heffernan KS, Yoon ES, Sharman JE, Davies JE, Shih YT, Chen CH, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res. 2012;36(5):422-7.	n = 21 participants with pre-hypertension or hypertension without treatment.	RTG:
		SBP (mmHg): pre-training = 140 ± 4; post-training = 134 ± 4
		DBP (mmHg): pre-training = 83 ± 2; post-training = 77 ± 2;
	Age: 61±1 years	CG:
		SBP (mmHg): pre-training = 136 ± 4; post-training: 139 ± 4;
		DBP(mmHg): pre-training = 86 ± 2; post-training = 82 ± 2.

Study	Exercises	Familiarization	Duration (weeks)	Weekly frequency	Intensity	Protocol
Terra et al., 2008 ²⁷27. Terra DF, Mota MR, Rabelo HT, Bezerra LM, Lima RM, Ribeiro AG, et al. Reduction of arterial pressure and double product at rest after resistance exercise training in elderly hypertensive women. Arq Bras Cardiol. 2008;91(5):299-305.	Lateral pulldown, knee extension, chest press, leg abduction, knee flexion, shoulder abduction with dumbbell, standing calf raise, abdominal exercises, trunk extension, and 45-degree leg press.	No	12	3x per week on alternate days	Weeks 1-4: 60% of 1-RM;	3 sets of 12, 10 and 8 repetitions.
					Weeks 5-8: 70% of 1-RM;
					Weeks 9-12: 80% of 1-RM;
Gonçalves et al., 2014 ²⁸28. Gonçalves CGS, Nakamura FY, Gerage AM, Januário RSB, Nascimento MA, Farinatti TV, et al. Functional and physiological effects of a 12-week programme of resistance training in elderly hypertensive. INT SPORTMED J. 2014;15(1):50-61.	Vertical bench press, leg extension, front pull with high pulley, leg curl, barbell curls on Scott bench, seated calf raise, triceps pulley, and crunch.	2 weeks	12	3x per week	The initial load of 40% of 1-RM (increased individually each week for perceived exertion to be between “mild” and “moderate.”	2 sets of 15 repetitions, except calf muscle exercises (2 sets x 20 reps) and crunch (2 sets x 30 reps); 1:2 ratio.
Mota et al., 2013 ²⁹29. Mota MR, Oliveira RJ, Dutra MT, Pardono E, Terra DF, Lima RM, et al. Acute and chronic effects of exercise on blood pressure in hypertensive elderly women. J Strength Cond Res. 2013;27(12):3475-80.	Knee flexion, shoulder abduction with free weights, independent calf lift, crunch, trunk extension, and 45-degree leg press;	Yes (1 month) 12 low-intensity exercise sessions, performing ten repetitions in each set with a 30-second interval between sets.	16	3x per week	60% of 1-RM;	3 sets, 12 repetitions and 60” rest interval between sets.
					70% of 1-RM;	3 sets, 10 repetitions with 60” rest interval between sets.
					80% of 1-RM;	3 sets, 8 repetitions with 90” rest interval between sets.
Dantas et al., 2016 ¹⁰10. Dantas FFO, Brasileiro-Santos MS, Batista RMF, Nascimento LS, Castellano LRC, Ritti-Dias RM, et al. Effect of Strength Training on Oxidative Stress and the Correlation of the Same with Forearm Vasodilatation and Blood Pressure of Hypertensive Elderly Women: A Randomized Clinical Trial. PloS One. 2016;(2):1-19.	Leg press; rowing machine; trunk flexion; knee flexion, bench press, trunk extension, push press, plantar flexion, and front pull.			2x per week	*PES = 5-7	1 set, 9-11 repetitions; 120” interval between sets;
				2x per week		2 sets, 9-11 repetitions; 120” interval between sets;
				2x per week		2 sets, 11-13 repetitions; 90” interval between sets;
				3x per week		2 sets, 11-13 repetitions; 90” interval between sets;
				3x per week		3 sets, 11-13 repetitions; 90” interval between sets;
				3x per week		Weeks 9-11: 3 sets, 13-15 repetitions; 60” interval between sets;
Heffernan et al., 2013 ³⁰30. Heffernan KS, Yoon ES, Sharman JE, Davies JE, Shih YT, Chen CH, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res. 2012;36(5):422-7.	Vertical bench press, front pull, paddling, biceps curl, leg press, knee extension, knee flexion, crunch, and trunk extension;	No	12	3x per week	Initial load: 40% of 1-RM for MMSS and 60% for MMII;	2 sets of 12-15 repetitions.
		No	12	3x per week	The load increased 5% every 3 weeks, until subjects could easily perform 15 repetitions.	2 sets of 12-15 repetitions.

Study	1	2	3	4	8	9	10	11	Score
Dantas et al. (2016) ¹⁰10. Dantas FFO, Brasileiro-Santos MS, Batista RMF, Nascimento LS, Castellano LRC, Ritti-Dias RM, et al. Effect of Strength Training on Oxidative Stress and the Correlation of the Same with Forearm Vasodilatation and Blood Pressure of Hypertensive Elderly Women: A Randomized Clinical Trial. PloS One. 2016;(2):1-19.	1	1	1	1	1	1	1	1	7/10
Heffernan et al (2013) ³⁰30. Heffernan KS, Yoon ES, Sharman JE, Davies JE, Shih YT, Chen CH, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res. 2012;36(5):422-7.	1	1	0	1	1	1	1	1	6/10
Terra et al. (2008) ²⁷27. Terra DF, Mota MR, Rabelo HT, Bezerra LM, Lima RM, Ribeiro AG, et al. Reduction of arterial pressure and double product at rest after resistance exercise training in elderly hypertensive women. Arq Bras Cardiol. 2008;91(5):299-305.	1	0	0	1	1	1	1	1	5/10
Mota et al. (2013) ²⁹29. Mota MR, Oliveira RJ, Dutra MT, Pardono E, Terra DF, Lima RM, et al. Acute and chronic effects of exercise on blood pressure in hypertensive elderly women. J Strength Cond Res. 2013;27(12):3475-80.	1	0	0	1	1	1	1	1	5/10
Gonçalves et al (2014) ²⁸28. Gonçalves CGS, Nakamura FY, Gerage AM, Januário RSB, Nascimento MA, Farinatti TV, et al. Functional and physiological effects of a 12-week programme of resistance training in elderly hypertensive. INT SPORTMED J. 2014;15(1):50-61.	0	1	0	0	0	0	1	1	3/10

Author/year	1	2	3	4	5	6	7	Risk
Terra et al. (2008) ²⁷27. Terra DF, Mota MR, Rabelo HT, Bezerra LM, Lima RM, Ribeiro AG, et al. Reduction of arterial pressure and double product at rest after resistance exercise training in elderly hypertensive women. Arq Bras Cardiol. 2008;91(5):299-305.	High	High	Low*	Low*	Low	Low	Low	High
Dantas et al. (2016) ¹⁰10. Dantas FFO, Brasileiro-Santos MS, Batista RMF, Nascimento LS, Castellano LRC, Ritti-Dias RM, et al. Effect of Strength Training on Oxidative Stress and the Correlation of the Same with Forearm Vasodilatation and Blood Pressure of Hypertensive Elderly Women: A Randomized Clinical Trial. PloS One. 2016;(2):1-19.	Low	Low	Low*	Low*	Low	Low	Low	Low
Gonçalves et al (2014) ²⁸28. Gonçalves CGS, Nakamura FY, Gerage AM, Januário RSB, Nascimento MA, Farinatti TV, et al. Functional and physiological effects of a 12-week programme of resistance training in elderly hypertensive. INT SPORTMED J. 2014;15(1):50-61.	Uncertain	Uncertain	Low*	Low*	Uncertain	Low	Low	Uncertain
Mota et al. (2013) ²⁹29. Mota MR, Oliveira RJ, Dutra MT, Pardono E, Terra DF, Lima RM, et al. Acute and chronic effects of exercise on blood pressure in hypertensive elderly women. J Strength Cond Res. 2013;27(12):3475-80.	High	High	Low*	Low*	Low	Low	Low	High
Heffernan et al (2013) ³⁰30. Heffernan KS, Yoon ES, Sharman JE, Davies JE, Shih YT, Chen CH, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res. 2012;36(5):422-7.	Uncertain	Uncertain	Low*	Low*	Low	Low	Uncertain	Uncertain

Certainty assessment							No. of patients		Effect		Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	RT	CG	Relative (95% CI)	Absolute (95% CI)
SBP
5	randomized trials	very serious	not serious	not serious	not serious	none	96	104	-	mean		CRITICAL
										7.26 mmHg	⨁⨁◯◯
										(9.16 higher to 5.37 higher)	LOW
DBP
5	randomized trials	very serious	not serious	not serious	not serious	none	96	104	-	mean		CRITICAL
										4.84 mmHg	⨁⨁◯◯
										(5.89 higher to 3.79 higher)	LOW

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[1] *PSB: Doctoral student, e-mail: priscilabunn@yahoo.com.br