Abstract
Objective:
To investigate the blood pressure (BP) responses to cardiovascular stress test after a combined exercise circuit session at moderate intensity.
Method:
Twenty individuals (10 male/10 fem; 33.4± 6.9 years; 70.2± 15.8 kg; 170.4± 11.5 cm; 22.3± 6.8% body fat) were randomized in a different days to control session with no exercise or exercise session consisting of 3 laps of the following circuit: knee extension, bench press, knee flexion, rowing in the prone position, squats, shoulder press, and 5 min of aerobic exercise at 75-85% of age-predicted maximum heart rate and/or 13 on the Borg Rating of Perceived Exertion [scale of 6 to 20]. The sets of resistance exercise consisted of 15 repetitions at ~50% of the estimated 1 repetition maximum test. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at rest and during 1h of recovery in both experimental sessions. After that, blood pressure reactivity (BPR) was evaluated using the Cold Pressor Test.
Results:
During 1h of exercise recovery, there was a reduction in SBP (3-6 mmHg) and DBP (2-5 mmHg) in relation to pre-session rest (p<0.01), while this reduction was not observed in the control session. A decline in BPR (4-7 mmHg; p<0.01) was observed 1h post-exercise session, but not in the control session. Post-exercise reductions in SBP and DBP were significantly correlated with BPR reductions (r=0.50-0.45; p<0.05).
Conclusion:
A combined exercise circuit session at moderate intensity promoted subsequent post-exercise hypotension and acutely attenuated BPR in response to a cardiovascular stress test. In addition, the post-exercise BP reduction was correlated with BPR attenuation in healthy adults of both genders.
blood pressure reduction; vascular reactivity; movement
Introduction
The daily stress levels of the general population have been increasing over the last
decades11. Taylor M, Barr M, Stevens G, Bryson-Taylor D, Agho K, Jacobs J, et
al. Psychosocial stress and strategies for managing adversity: measuring population
resilience in New South Wales, Australia. Popul Health Metr. 2010;14:28.
PMid:20942975 PMCid:PMC2965129. http://dx.doi.org/10.1186/1478-7954-8-28
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. Frequent exposure to stress is considered an important risk factor for the
development of cardiovascular diseases22. Figueredo VM. The time has come for physicians to take notice: the
impact of psychosocial stressors on the heart. Am J Med. 2009;122:704-12.
PMid:19635269. http://dx.doi.org/10.1016/j.amjmed.2009.05.001
http://dx.doi.org/10.1016/j.amjmed.2009....
. Another well-documented risk factor for cardiovascular disease is systemic
hypertension which, in turn, has been related to elevated blood pressure reactivity
(BPR) to stress33. Hines EA, Brow GE. The cold test pressor for measuring the
reactibility of the blood pressure: data concerning 571 normal and hypertensive
subjects. Am Heart J. 1936;11:1-9. http://dx.doi.org/10.1016/S0002-8703(36)90370-8
http://dx.doi.org/10.1016/S0002-8703(36)...
,
44. Wood DL, Sheps SG, Elveback LR, Schirger A. Cold pressor test as a
predictor of hypertension. Hypertension. 1984;6:301-6. PMid:6735451.
http://dx.doi.org/10.1161/01.HYP.6.3.301
http://dx.doi.org/10.1161/01.HYP.6.3.301...
. Exacerbated BPR may suggest poor autonomic modulation due to
increased sympathetic drive, a condition that has been associated with medium to
long-term cardiovascular complications55. Brownley KA, Hinderliter AL, West SG, Girdler SS, Sherwood A, Light
KC. Sympathoadrenergic mechanisms in reduced hemodynamic stress responses after
exercise. Med Sci Sports Exerc. 2003;35:978-86. PMid:12783046.
http://dx.doi.org/10.1249/01.MSS.0000069335.12756.1B
http://dx.doi.org/10.1249/01.MSS.0000069...
. Also, some reports66. Lipp ME, Pereira MM, Justo AP, Matos TM. Cardiovascular reactivity in
hypertensives: differential effect of expressing and inhibiting emotions during
moments of interpersonal stress. Span J Psychol. 2006;9:154-61.
PMid:17120695.
,
77. Lavie CJ, Milani RV. Depression, autonomic function, and
cardiorespiratory fitness: comment on Hughes, et al. (2010). Percept Mot Skills.
2011;112:319-21. PMid:21466105.
http://dx.doi.org/10.2466/02.06.15.20.PMS.112.1.319-321
http://dx.doi.org/10.2466/02.06.15.20.PM...
have demonstrated that individuals who are hyperreactive to stress chronically
increase their risk for psychological disorders such as anxiety, irritability, and
frustration. These feelings are associated with increased sympathetic drive induced by
chronic elevation in BP77. Lavie CJ, Milani RV. Depression, autonomic function, and
cardiorespiratory fitness: comment on Hughes, et al. (2010). Percept Mot Skills.
2011;112:319-21. PMid:21466105.
http://dx.doi.org/10.2466/02.06.15.20.PMS.112.1.319-321
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,
88. Das S, O'Keefe JH. Behavioral cardiology: recognizing and addressing
the profound impact of psychosocial stress on cardiovascular health. Curr Hypertens
Rep. 2008;10:374-81. PMid:18775114. http://dx.doi.org/10.1007/s11906-008-0070-6
http://dx.doi.org/10.1007/s11906-008-007...
.
Maintaining BP within the normal range can require changes in lifestyle including good
nutrition and regular physical activity99. Locks RR, Costa TC, Koppe S, Yamaguti AM, Garcia MC, Gomes ARS.
Effects of strength and flexibility training on functional performance of healthy
older people. Rev Bras Fisioter. 2012;16(3):184-90. PMid:22801513.
http://dx.doi.org/10.1590/S1413-35552012000300003
http://dx.doi.org/10.1590/S1413-35552012...
,
1010. Gaesser GA, Angadi SS, Sawyer BJ. Exercise and diet, independent of
weight loss, improve cardiometabolic risk profile in overweight and obese
individuals. Phys Sportsmed. 2011;39:87-97. PMid:21673488.
http://dx.doi.org/10.3810/psm.2011.05.1898
http://dx.doi.org/10.3810/psm.2011.05.18...
. Several studies have attempted to examine the immediate (acute) benefits of
exercise both for healthy individuals1111. Lizardo JHF, Simões HG. Efeitos de diferentes sessões de exercícios
resistidos sobre a hipotensão pós-exercício. Rev Bras Fisioter.
2005;9(3):249-55. and those with cardiometabolic disorders1212. Motta DF, Lima LC, Arsa G, Russo PS, Sales MM, Moreira SR, et al.
Effect of type 2 diabetes on plasma kallikrein activity after physical exercise and
its relationship to post-exercise hypotension. Diabetes Metab. 2010;36:363-8.
PMid:20579916. http://dx.doi.org/10.1016/j.diabet.2010.03.008
http://dx.doi.org/10.1016/j.diabet.2010....
,
1313. Simões GC, Moreira SR, Kushnick MR, Simões HG, Campbell CS.
Postresistance exercise blood pressure reduction is influenced by exercise intensity
in type-2 diabetic and nondiabetic individuals. J Strength Cond Res. 2010;24:1277-84.
PMid:20386125. http://dx.doi.org/10.1519/JSC.0b013e3181d67488
http://dx.doi.org/10.1519/JSC.0b013e3181...
. These studies observed the significant effects of exercise, particularly on
hemodynamic control, due to a phenomenon defined as "post-exercise hypotension"1414. Tipton CM. Concerning postexercise hypotension. Exerc Sport Sci Rev.
2011;39:109. PMid:21430451. http://dx.doi.org/10.1097/JES.0b013e3182164376
http://dx.doi.org/10.1097/JES.0b013e3182...
. Moreover, 24h ambulatory blood pressure measurements showed a protective effect
of previous exercise on BPR during activities of daily living, including a
greater nocturnal dip in BP, when compared to a control day without exercise1515. Morais PK, Campbell CS, Sales MM, Motta DF, Moreira SR, Cunha VN, et
al. Acute resistance exercise is more effective than aerobic exercise for 24h blood
pressure control in type 2 diabetics. Diabetes Metab. 2011;37:112-7. PMid:21159536.
http://dx.doi.org/10.1016/j.diabet.2010.08.008
http://dx.doi.org/10.1016/j.diabet.2010....
.
Although the hemodynamic benefits of aerobic and resistance exercises have been
documented in a variety of reports55. Brownley KA, Hinderliter AL, West SG, Girdler SS, Sherwood A, Light
KC. Sympathoadrenergic mechanisms in reduced hemodynamic stress responses after
exercise. Med Sci Sports Exerc. 2003;35:978-86. PMid:12783046.
http://dx.doi.org/10.1249/01.MSS.0000069335.12756.1B
http://dx.doi.org/10.1249/01.MSS.0000069...
,
77. Lavie CJ, Milani RV. Depression, autonomic function, and
cardiorespiratory fitness: comment on Hughes, et al. (2010). Percept Mot Skills.
2011;112:319-21. PMid:21466105.
http://dx.doi.org/10.2466/02.06.15.20.PMS.112.1.319-321
http://dx.doi.org/10.2466/02.06.15.20.PM...
,
99. Locks RR, Costa TC, Koppe S, Yamaguti AM, Garcia MC, Gomes ARS.
Effects of strength and flexibility training on functional performance of healthy
older people. Rev Bras Fisioter. 2012;16(3):184-90. PMid:22801513.
http://dx.doi.org/10.1590/S1413-35552012000300003
http://dx.doi.org/10.1590/S1413-35552012...
,
1010. Gaesser GA, Angadi SS, Sawyer BJ. Exercise and diet, independent of
weight loss, improve cardiometabolic risk profile in overweight and obese
individuals. Phys Sportsmed. 2011;39:87-97. PMid:21673488.
http://dx.doi.org/10.3810/psm.2011.05.1898
http://dx.doi.org/10.3810/psm.2011.05.18...
11. Lizardo JHF, Simões HG. Efeitos de diferentes sessões de exercícios
resistidos sobre a hipotensão pós-exercício. Rev Bras Fisioter.
2005;9(3):249-55.
12. Motta DF, Lima LC, Arsa G, Russo PS, Sales MM, Moreira SR, et al.
Effect of type 2 diabetes on plasma kallikrein activity after physical exercise and
its relationship to post-exercise hypotension. Diabetes Metab. 2010;36:363-8.
PMid:20579916. http://dx.doi.org/10.1016/j.diabet.2010.03.008
http://dx.doi.org/10.1016/j.diabet.2010....
13. Simões GC, Moreira SR, Kushnick MR, Simões HG, Campbell CS.
Postresistance exercise blood pressure reduction is influenced by exercise intensity
in type-2 diabetic and nondiabetic individuals. J Strength Cond Res. 2010;24:1277-84.
PMid:20386125. http://dx.doi.org/10.1519/JSC.0b013e3181d67488
http://dx.doi.org/10.1519/JSC.0b013e3181...
14. Tipton CM. Concerning postexercise hypotension. Exerc Sport Sci Rev.
2011;39:109. PMid:21430451. http://dx.doi.org/10.1097/JES.0b013e3182164376
http://dx.doi.org/10.1097/JES.0b013e3182...
-
1515. Morais PK, Campbell CS, Sales MM, Motta DF, Moreira SR, Cunha VN, et
al. Acute resistance exercise is more effective than aerobic exercise for 24h blood
pressure control in type 2 diabetics. Diabetes Metab. 2011;37:112-7. PMid:21159536.
http://dx.doi.org/10.1016/j.diabet.2010.08.008
http://dx.doi.org/10.1016/j.diabet.2010....
, the acute effects of the aforementioned exercise modes combined in a circuit
method on post-exercise BP, including the responses to a cardiovascular stress test,
warrant further investigation. Therefore, the purpose of the present study was to
examine the acute BP and stress-induced BPR responses following a circuit
training session composed of both resistance and aerobic exercises at moderate
intensity. Based on the literature1111. Lizardo JHF, Simões HG. Efeitos de diferentes sessões de exercícios
resistidos sobre a hipotensão pós-exercício. Rev Bras Fisioter.
2005;9(3):249-55.
12. Motta DF, Lima LC, Arsa G, Russo PS, Sales MM, Moreira SR, et al.
Effect of type 2 diabetes on plasma kallikrein activity after physical exercise and
its relationship to post-exercise hypotension. Diabetes Metab. 2010;36:363-8.
PMid:20579916. http://dx.doi.org/10.1016/j.diabet.2010.03.008
http://dx.doi.org/10.1016/j.diabet.2010....
13. Simões GC, Moreira SR, Kushnick MR, Simões HG, Campbell CS.
Postresistance exercise blood pressure reduction is influenced by exercise intensity
in type-2 diabetic and nondiabetic individuals. J Strength Cond Res. 2010;24:1277-84.
PMid:20386125. http://dx.doi.org/10.1519/JSC.0b013e3181d67488
http://dx.doi.org/10.1519/JSC.0b013e3181...
14. Tipton CM. Concerning postexercise hypotension. Exerc Sport Sci Rev.
2011;39:109. PMid:21430451. http://dx.doi.org/10.1097/JES.0b013e3182164376
http://dx.doi.org/10.1097/JES.0b013e3182...
-
1515. Morais PK, Campbell CS, Sales MM, Motta DF, Moreira SR, Cunha VN, et
al. Acute resistance exercise is more effective than aerobic exercise for 24h blood
pressure control in type 2 diabetics. Diabetes Metab. 2011;37:112-7. PMid:21159536.
http://dx.doi.org/10.1016/j.diabet.2010.08.008
http://dx.doi.org/10.1016/j.diabet.2010....
, we hypothesized that the proposed circuit training session would promote
post-exercise hypotension and that this phenomenon would be associated with attenuated
stress-induced BPR.
Method
To test the hypothesis of the present study, volunteers were invited to participate in two randomly assigned sessions at the exercise physiology laboratory as follows: 1) combined resistance and aerobic exercises performed in a circuit format; and 2) a control session without exercise. In both sessions, BP was measured at rest and every 15 minutes post-session during 1 hour of recovery following the exercise and non-exercise control sessions. In addition, BPR was evaluated using a cardiovascular stress test before and after the experimental sessions. The relationship between post-exercise BP and BPR response to stress test was also examined.
Subjects
Twenty apparently healthy individuals of both genders (10 men and 10 women), with a mean age of 33.4± 6.9 years (24-50 years), weight of 70.2± 15.8 kg (45-96 kg), height of 170.4± 11.5 cm (149-192 cm), body mass index (BMI) of 23.9± 3.5 kg/m2(-1) (19.2-23.7 kg/m2(-1)), and body fat percentage of 22.3± 6.8% (8.5-35.0%), volunteered to participate. The classification of the subjects as "apparently healthy" was based on the American College of Sports Medicine (ACSM) guidelines for risk stratification of 1995 (interview to gather information on signs, symptoms and/or cardiopulmonary risk factors). None of the subjects were using any medication or had a history of diagnosed cardiovascular or metabolic disease.
The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil (protocol 0047.0.441.000-10). All participants were informed of the experimental methods before giving written consent.
Anthropometric assessment
Standard procedures were used to measure weight, height, and body mass index (BMI).
Body density was determined according to specifications by Jackson and Pollock1616. Jackson AS, Pollock ML. Generalized equations for predicting body
density of men. 1978. Br J Nutr. 2004;91(1):161-8. PMid:14748950. for men ([1.1093800 - 0.0008267 * (sum of skinfolds of the chest, abdomen and
thigh) + 0.0000016 * (sum of skinfolds of the chest, abdomen, and thigh)2 2. Figueredo VM. The time has come for physicians to take notice: the
impact of psychosocial stressors on the heart. Am J Med. 2009;122:704-12.
PMid:19635269. http://dx.doi.org/10.1016/j.amjmed.2009.05.001
http://dx.doi.org/10.1016/j.amjmed.2009....
- 0.0002574 * age]) and Jackson et al.1717. Jackson AS, Pollock ML, Ward A. Generalized equations for predicting
body density of women. Med Sci Sports Exerc. 1980;12:175-81. PMid:7402053.
http://dx.doi.org/10.1249/00005768-198023000-00009
http://dx.doi.org/10.1249/00005768-19802...
for women ([1.0994921 - 0.0009929 * (sum of skinfolds of the triceps,
suprailiac, and thigh) + 0.0000023 * (sum of skinfolds of the triceps, suprailiac,
and thigh)2 2. Figueredo VM. The time has come for physicians to take notice: the
impact of psychosocial stressors on the heart. Am J Med. 2009;122:704-12.
PMid:19635269. http://dx.doi.org/10.1016/j.amjmed.2009.05.001
http://dx.doi.org/10.1016/j.amjmed.2009....
- 0.0001392 * age]). Body fat percentage was derived from Siri equation ([4.91
/ density - 4.5] * 100).
Blood pressure measurement
All BP measurements were taken by the same trained technician through the
auscultatory method following previously described recommendations1818. Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, et al.
Human blood pressure determination by sphygmomanometry. Circulation. 1993;88:2460-70.
PMid:8222141. http://dx.doi.org/10.1161/01.CIR.88.5.2460
http://dx.doi.org/10.1161/01.CIR.88.5.24...
, using a stethoscope (Duo Sonic, Brazil) and a calibrated sphygmomanometer
(Missouri(r), São Paulo, SP, Brazil) certified by Inmetro (National
Institute of Metrology, Quality, and Technology). Measurements were taken from the
left arm with the individual comfortably seated in a quiet room at a controlled
temperature of 25 ºC. The standard auscultatory method was tested against the
automated and previously validated1919. Stergiou GS, Tzamouranis D, Protogerou A, Nasothimiou E, Kapralos C.
Validation of the Microlife Watch BP Office professional device for office blood
pressure measurement according to the International protocol. Blood Press Monit.
2008;13:299-303. PMid:18799957. http://dx.doi.org/10.1097/MBP.0b013e3283057af6
http://dx.doi.org/10.1097/MBP.0b013e3283...
oscillometric method (Microlife BP 3AC1-1, Microlife USA Inc., Dunedin, FL,
USA). Another sample of 30 independent individuals of both genders rested for 10
minutes and their BP was randomly measured using both the auscultatory and
oscillometric methods, the latter conducted by another blinded evaluator.
Correlations between methods were r=0.90 (p<0.001) for systolic blood pressure
(SBP) and r=0.80 (p<0.001) for diastolic blood pressure (DBP). Also, agreement
between methods was evaluated using the Bland-Altman2020. Bland JM, Altman DG. Statistical methods for assessing agreement
between two methods of clinical measurement. Lancet. 1986;8:307-10.
http://dx.doi.org/10.1016/S0140-6736(86)90837-8
http://dx.doi.org/10.1016/S0140-6736(86)...
method. Mean differences were 3.9 mmHg [20.2/-12.4 mmHg] and -3.4 mmHg
[10.5/-17.3 mmHg] for SBP and DBP, respectively.
Blood pressure reactivity (BPR) assessment
BPR measurements were performed using the Cold Pressor Test (CPT)
according to specifications previously described by Hines and Brow33. Hines EA, Brow GE. The cold test pressor for measuring the
reactibility of the blood pressure: data concerning 571 normal and hypertensive
subjects. Am Heart J. 1936;11:1-9. http://dx.doi.org/10.1016/S0002-8703(36)90370-8
http://dx.doi.org/10.1016/S0002-8703(36)...
. These authors demonstrated the high reproducibility of the procedure for
both normotensive and hypertensive individuals. The protocol consisted of immersing
the right hand for 1 minute in water carefully maintained at 4 ºC
(Incoterm(r), Porto Alegre, RS, Brazil). BP measurements were
respectively taken at 30 and 60 seconds of immersion through the auscultatory method.
The two BP values were respectively named Peak30†and Peak60â€, and the
procedure is considered an index of BPR. BP was also measured 2 minutes
after the end of immersion (After2'). Of note, the adoption of the auscultatory
method for BP evaluation was due to the requirement of measurements at 30 and 60
seconds, which would not be possible using the automated oscillometric device.
Experimental sessions
The volunteers underwent two experimental sessions in random order on different days,
48 to 72 hours apart. The combined exercise session consisted of 3 laps of a circuit
with 2 minutes of recovery between laps, including the following resistance and
aerobic exercises: knee extension, bench press, knee flexion, rowing in the prone
position, squat, shoulder press, and 5 minutes up and down a 15-cm high step at
75-85% maximum heart rate and/or 13 on the 15-point Borg Rating of Perceived Exertion
(RPE), a scale that ranges from 6 to 202121. Borg G. Ratings of perceived exertion and heart rates during
short-term cycle exercise and their use in a new cycling strength test. Int J Sports
Med. 1982;3:153-8. PMid:7129724. http://dx.doi.org/10.1055/s-2008-1026080
http://dx.doi.org/10.1055/s-2008-1026080...
. Resistance exercise loads were implemented using dumbbells for upper body
exercises and weights attached to lower limbs for lower body exercises. Each
resistance exercise was performed in sets of 15 repetitions at 50% of the estimated 1
repetition maximum (1RM) as suggested by Tiggemann et al.2222. Tiggemann CL, Korzenowski AL, Brentano MA, Tartaruga MP, Alberton
CL, Kruel LF. Perceived exertion in different strength exercise loads in sedentary,
active, and trained adults. J Strength Cond Res. 2010;24(8):2032-41. PMid:20634752.
http://dx.doi.org/10.1519/JSC.0b013e3181d32e29
http://dx.doi.org/10.1519/JSC.0b013e3181...
,
2323. Tiggemann CL, Pinto RS, Kruel LF. Perceived Exertion in Strength
Training. Rev Bras Med Esporte. 2010;16(4):301-9.
http://dx.doi.org/10.1590/S1517-86922010000400014
http://dx.doi.org/10.1590/S1517-86922010...
with the use of the RPE2121. Borg G. Ratings of perceived exertion and heart rates during
short-term cycle exercise and their use in a new cycling strength test. Int J Sports
Med. 1982;3:153-8. PMid:7129724. http://dx.doi.org/10.1055/s-2008-1026080
http://dx.doi.org/10.1055/s-2008-1026080...
. The resistance exercises were performed with rhythmic control (Metronome
Plus(r)) of one second for the concentric phase and one second for the
eccentric phase. The control session was conducted under the same conditions as the
combined exercise session, with the exception that the subjects did not perform
exercises.
Measurements during the experimental sessions
Resting SBP, DBP, and mean arterial pressure (MAP) measurements were taken every 5
minutes over a 20-minute period and the average was considered for the analyses
(Missouri(r), São Paulo, SP, Brazil). Also, BP was measured after each
circuit lap and every 15 minutes during the 1 hour post-exercise recovery. The same
timeline and measures were followed during the control session. The CPT was conducted
before each session (after 20 minutes of rest) and one hour after the combined
exercise and control sessions. Heart rate (HR) was also measured during each exercise
and at the respective moment in the control session (Pulse Tronic Club
Trainer(r), Direction Technology Co. Ltd., Taiwan). The HR measurements
were considered for aerobic exercise control and identification of the cardiovascular
load imposed by the experimental sessions. The RPE was taken during the combined
exercise session for control of exercise intensity and the mean value considered for
subsequent analyses2121. Borg G. Ratings of perceived exertion and heart rates during
short-term cycle exercise and their use in a new cycling strength test. Int J Sports
Med. 1982;3:153-8. PMid:7129724. http://dx.doi.org/10.1055/s-2008-1026080
http://dx.doi.org/10.1055/s-2008-1026080...
.
Statistical analysis
Data are presented using descriptive statistical procedures (mean, standard
deviation, minimum and maximum values). The Shapiro-Wilk test was used to verify and
present the normality of data distribution. Pearson's correlation was used to examine
the relationship between resting BP measured with auscultatory and oscillometric
methods, as well as BPR in the different moments and the BP response
during and after the exercise and control sessions. The Bland-Altman method2020. Bland JM, Altman DG. Statistical methods for assessing agreement
between two methods of clinical measurement. Lancet. 1986;8:307-10.
http://dx.doi.org/10.1016/S0140-6736(86)90837-8
http://dx.doi.org/10.1016/S0140-6736(86)...
was used to verify agreement between the two BP measurement methods. The
paired-samples t test was used to compare data for correspondent moments of
experimental sessions. A two-way repeated measures ANOVA was conducted to compare BP
and BPR responses within and between experimental sessions [Time (Pre vs.
Post) * Session (Exercise vs. Control)]. Data were considered significant at
P<0.05, and statistical analyses were performed using the
SPSS15.0 software (SPSS Inc., Chicago, IL, USA).
Results
Table 1 presents the mean values for HR and BP at rest and during both experimental sessions (exercise and control) as well as the mean RPE during the exercise session. The circuit training session elicited a mean cardiovascular intensity of 79± 11% of maximum HR and a mean RPE of 13 in the 15-point Borg scale.
Figure 1 illustrates BP and HR responses within each experimental session as well as comparisons between sessions. There was a significant decrease in SBP for all evaluated moments after the circuit training session (p<0.03). No significant changes in SBP were observed after the control session. In addition, SBP response was significantly different in the circuit session when compared to the control session (p<0.03). For DBP, a significant decrease in relation to rest was observed 60 minutes after the circuit session while a significant increase was noted 45 and 60 minutes after the control session. Moreover, DBP response was significantly different in the circuit session when compared to the control session, with higher values for the latter in all of the measurement moments (p<0.03). For MAP, a significant decrease in relation to rest occurred 30, 45, and 60 minutes after the circuit session, and these moments were significantly different when compared to the control session (p<0.03). When comparing the HR of the control and circuit sessions, all moments of recovery were different (p<0.03). However, the HR of the circuit session after 60 minutes of recovery did not differ from the resting HR pre-exercise (p>0.05).
Range (mmHg) of systolic blood pressure (Δ SBP), diastolic blood pressure (Δ DBP), mean arterial pressure (Δ MAP), and heart rate (Δ HR) in the post-exercise session recovery moments (Rec15'-Rec60'). *p<0.03 compared to Control session; † p<0.03 compared to Rest.
Table 2 presents BPR before (Pre) and after (Post) the experimental sessions. It was observed that regardless of the measurement moment (i.e. Pre or Post), the CPT elicited significant increases in both SBP and DBP. However, BPR was significantly attenuated Post-exercise session when compared to Pre (p<0.05). Moreover, SBP was significantly lower at the After2' moment when comparing the Post-exercise session to Pre. For the control session, both SBP and DBP after the CPT (After2') were significantly elevated when compared to resting (p<0.05). Figure 2A-B depicts BPR Pre and Post-exercise sessions. Importantly, there was a significant attenuation of BPR during and after the CPT post-exercise session when compared to the post-no exercise control session (p<0.01).
Range (Î" mmHg) of systolic blood pressure reactivity (SBPR) and diastolic blood pressure reactivity (DBPR) during (Peak30†and Peak60â€) and after (After2â€(tm)) the Cold Pressor Test in the pre-exercise session (Pre-Session) and post-exercise session (Post-Session) moments. *p<0.01 compared to exercise session.
In order to show the importance of post-exercise hypotension in relation to the responses of BPR, Figure 3 presents the correlations between BPR and the mean BP response during one hour of recovery from the experimental sessions. Recovery BP response was positive and significantly correlated with BPR (p<0.05). Despite the moderate intensity of the correlations, they indicate that the greater the decrease in post-exercise BP is, the greater the attenuation of BPR during the CPT (Peak60â€) will be. In contrast, no significant correlations were found between variables in the control session (p>0.05).
Relationship between the variation in blood pressure reactivity during (Peak60â€) the Cold Pressor Test post-session (Post-S) and the variation in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after 1 hour of recovery. p<0.05 compared to significant correlation (r).
Discussion
The main findings of the present study were the occurrence of post-exercise hypotension
after a circuit session involving aerobic and resistance exercises and the attenuation
of BPR in response to subsequent stress induction in apparently healthy
adults of both genders. In addition, the observed results suggest that the post-exercise
decrease in BP is associated with the attenuated BPR in response to a
stressor test. Consistent with previous reports1111. Lizardo JHF, Simões HG. Efeitos de diferentes sessões de exercícios
resistidos sobre a hipotensão pós-exercício. Rev Bras Fisioter.
2005;9(3):249-55.
12. Motta DF, Lima LC, Arsa G, Russo PS, Sales MM, Moreira SR, et al.
Effect of type 2 diabetes on plasma kallikrein activity after physical exercise and
its relationship to post-exercise hypotension. Diabetes Metab. 2010;36:363-8.
PMid:20579916. http://dx.doi.org/10.1016/j.diabet.2010.03.008
http://dx.doi.org/10.1016/j.diabet.2010....
13. Simões GC, Moreira SR, Kushnick MR, Simões HG, Campbell CS.
Postresistance exercise blood pressure reduction is influenced by exercise intensity
in type-2 diabetic and nondiabetic individuals. J Strength Cond Res. 2010;24:1277-84.
PMid:20386125. http://dx.doi.org/10.1519/JSC.0b013e3181d67488
http://dx.doi.org/10.1519/JSC.0b013e3181...
14. Tipton CM. Concerning postexercise hypotension. Exerc Sport Sci Rev.
2011;39:109. PMid:21430451. http://dx.doi.org/10.1097/JES.0b013e3182164376
http://dx.doi.org/10.1097/JES.0b013e3182...
-
1515. Morais PK, Campbell CS, Sales MM, Motta DF, Moreira SR, Cunha VN, et
al. Acute resistance exercise is more effective than aerobic exercise for 24h blood
pressure control in type 2 diabetics. Diabetes Metab. 2011;37:112-7. PMid:21159536.
http://dx.doi.org/10.1016/j.diabet.2010.08.008
http://dx.doi.org/10.1016/j.diabet.2010....
, it was observed post-exercise hypotension, however, research on this phenomenon
after a combined aerobic and resistance exercise session is still necessary. Moreover,
this investigation brings the new finding that the magnitude of post-exercise
hypotension is associated with the degree of BPR attenuation during
stress.
To our knowledge, this is the first study to investigate and compare BP responses and
BPR before and after a circuit session of aerobic and resistance exercises
in apparently healthy adults of both genders. Significant acute cardiovascular effects
of exercise were observed that suggest a transient cardiovascular protection during rest
and induced stress situations even in normotensive individuals. When examining absolute
BP values during recovery, we found a favorable reduction only after the exercise
session. In contrast, DBP had acutely increased after the control session. This acute
exercise-induced reduction in BP was on average 6 and 5 mmHg for SBP and DBP,
respectively (Figure 1A-B). Similarly,
stress-induced BPR was significantly attenuated after the circuit exercise
session but not after the control session, reaching a mean difference of 7 mmHg (Figure 2A-B). The results presented here can have
important clinical implications. Whelton et al.2424. Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, et al.
Primary prevention of hypertension: clinical and public health advisory from the
National High Blood Pressure Education Program. JAMA. 2002;288:1882-8. PMid:12377087.
http://dx.doi.org/10.1001/jama.288.15.1882
http://dx.doi.org/10.1001/jama.288.15.18...
demonstrated that small changes in BP over a long-term follow-up can have a
relevant impact on cardiovascular disease survival. More specifically, the authors
showed that reductions of 3 and 5 mmHg can reduce the risk of acute myocardial
infarction by 8 to 14%, of coronary artery disease by 5 to 9%, and of overall mortality
by 4 to 7%. Furthermore, they showed that a reduction of only 2 mmHg in both SBP and DBP
is associated with a decrease of 6 to 14% and 4 to 6% in acute myocardial infarction and
coronary artery disease, respectively. A small decrease of 2 mmHg in DBP was also
associated with a reduction of 17% in hypertension prevalence in the general
population.
Previous reports have demonstrated the protective effect of a single 30-minute exercise
session performed at 70% of maximum oxygen consumption on BP of hypertensive subjects
during subsequent activities of daily living2525. MacDonald JR, Hogben CD, Tarnopolsky MA, MacDougall JD. Post
exercise hypotension is sustained during subsequent bouts of mild exercise and
simulated activities of daily living. J Hum Hypertens. 2001;15:567-71. PMid:11494096.
http://dx.doi.org/10.1038/sj.jhh.1001223
http://dx.doi.org/10.1038/sj.jhh.1001223...
. These authors verified an attenuated BP response after exercise in comparison
with a control session. Brownley et al.55. Brownley KA, Hinderliter AL, West SG, Girdler SS, Sherwood A, Light
KC. Sympathoadrenergic mechanisms in reduced hemodynamic stress responses after
exercise. Med Sci Sports Exerc. 2003;35:978-86. PMid:12783046.
http://dx.doi.org/10.1249/01.MSS.0000069335.12756.1B
http://dx.doi.org/10.1249/01.MSS.0000069...
showed exercise-induced attenuation of BPR in young normotensive
subjects in response to different modes of stress induction (math and speech
challenges). These observations were done while comparing stress responses between pre
and post-aerobic exercise conditions. Similarly, in the present study, BPR
was examined before and 60 minutes after a combined exercise circuit session. A
protective effect of exercise was observed during the post-exercise recovery period in
relation to the resting pre-exercise period (Figure
1A-C), at the same moments of pre-exercise cardiovascular stress (Table 2), and when comparing the same moments in
the control session (Figure 2A B). A new piece of
evidence found here was the significant relationship between post-exercise BP (i.e.
post-exercise hypotension) and BPR in response to the CPT (Figure 3). Therefore, it is possible that some
mechanisms of exercise-induced post-exercise hypotension are the same as those
underlying attenuated BPR after exercise. In this sense, the protective
effect of exercise on BPR in response to stress would be dependent on its
capability to elicit post-exercise hypotension, however, further investigation is
needed.
Over the last decade, the mechanisms involved in the BP responses to a single bout of
exercise have been investigated with a focus on the peripheral and neural pathways1414. Tipton CM. Concerning postexercise hypotension. Exerc Sport Sci Rev.
2011;39:109. PMid:21430451. http://dx.doi.org/10.1097/JES.0b013e3182164376
http://dx.doi.org/10.1097/JES.0b013e3182...
,
2626. Halliwill JR. Mechanisms and clinical implications of post-exercise
hypotension in humans. Exerc Sport Sci Rev. 2001;29:65-70. PMid:11337825.
http://dx.doi.org/10.1097/00003677-200104000-00005
http://dx.doi.org/10.1097/00003677-20010...
. Although it was not within the scope of the present study to investigate the
mechanisms involved in post-exercise cardiovascular responses, it is plausible that
changes in baroreflex sensitivity and the consequent attenuation of sympathetic tone may
be involved2727. Chen CY, Bonham AC. Postexercise hypotension: central mechanisms.
Exerc Sport Sci Rev. 2010;38:122-7. PMid:20577060 PMCid:PMC2936915.
http://dx.doi.org/10.1097/JES.0b013e3181e372b5
http://dx.doi.org/10.1097/JES.0b013e3181...
. Previous studies demonstrated a possible interaction between the release of
P substance (a neuropeptide) from the terminals of sensory nerves
during exercise and its receptor (NK1R) in the post-exercise recovery period
in conjunction with GABAergic activation. This combination makes the nucleus of the
solitary tract more active and consequently inhibits the activity of the ventrolateral
medulla, reduces output to sympathetic nerves, finally promoting post-exercise
hypotension. Therefore, it is possible that reduced sympathetic tonus is involved in the
attenuated BPR during the CPT after a combined exercise circuit session since
a significant correlation was noted between post-exercise BP and BPR, a
condition determined through neural reflex44. Wood DL, Sheps SG, Elveback LR, Schirger A. Cold pressor test as a
predictor of hypertension. Hypertension. 1984;6:301-6. PMid:6735451.
http://dx.doi.org/10.1161/01.HYP.6.3.301
http://dx.doi.org/10.1161/01.HYP.6.3.301...
. In contrast, exercise-induced nitric oxide release and thus peripheral
resistance reduction may also be involved1212. Motta DF, Lima LC, Arsa G, Russo PS, Sales MM, Moreira SR, et al.
Effect of type 2 diabetes on plasma kallikrein activity after physical exercise and
its relationship to post-exercise hypotension. Diabetes Metab. 2010;36:363-8.
PMid:20579916. http://dx.doi.org/10.1016/j.diabet.2010.03.008
http://dx.doi.org/10.1016/j.diabet.2010....
,
2626. Halliwill JR. Mechanisms and clinical implications of post-exercise
hypotension in humans. Exerc Sport Sci Rev. 2001;29:65-70. PMid:11337825.
http://dx.doi.org/10.1097/00003677-200104000-00005
http://dx.doi.org/10.1097/00003677-20010...
,
2828. Santana HA, Moreira SR, Botelho WB Nº, Silva CB, Sales MM, Oliveira
VN, et al. The higher exercise intensity and the presence of allele I of ACE gene
elicit a higher post-exercise blood pressure reduction and nitric oxide release in
elderly women: an experimental study. BMC Cardiovasc Disord. 2011;11:71.
PMid:22136292 PMCid:C3261092. http://dx.doi.org/10.1186/1471-2261-11-71
http://dx.doi.org/10.1186/1471-2261-11-7...
. Future studies are necessary to confirm the relationship between those
mechanisms and the present results.
Regarding the intensity of the combined exercise circuit protocol, there was a
cardiovascular demand of 79± 11% of age-predicted maximum HR and the mean RPE was 13± 1
on the 15-point Borg scale (Table 1). Previous
studies examined the acute effects on BP in different populations. Simões et al.1313. Simões GC, Moreira SR, Kushnick MR, Simões HG, Campbell CS.
Postresistance exercise blood pressure reduction is influenced by exercise intensity
in type-2 diabetic and nondiabetic individuals. J Strength Cond Res. 2010;24:1277-84.
PMid:20386125. http://dx.doi.org/10.1519/JSC.0b013e3181d67488
http://dx.doi.org/10.1519/JSC.0b013e3181...
showed the occurrence of post-exercise hypotension in type 2 diabetics after a
resistance exercise session performed at 43% of 1RM, in which the mean RPE was 11 13 on
the Borg scale. Motta et al.1212. Motta DF, Lima LC, Arsa G, Russo PS, Sales MM, Moreira SR, et al.
Effect of type 2 diabetes on plasma kallikrein activity after physical exercise and
its relationship to post-exercise hypotension. Diabetes Metab. 2010;36:363-8.
PMid:20579916. http://dx.doi.org/10.1016/j.diabet.2010.03.008
http://dx.doi.org/10.1016/j.diabet.2010....
investigated the acute effects of aerobic exercise performed at 90% of the
anaerobic threshold in adults of both genders and observed a cardiovascular demand of
80% of maximum HR and a mean RPE of 13, an intensity similar to the present study. If we
also take into account other reports on RPE and blood lactate responses as indexes of
resistance exercise2929. Moreira SR, Arsa G, Oliveira HB, Lima LC, Campbell CS, Simões HG.
Methods to identify the lactate and glucose thresholds during resistance exercise for
individuals with type 2 diabetes. J Strength Cond Res. 2008;22:1108-15.
PMid:18545200. http://dx.doi.org/10.1519/JSC.0b013e31816eb47c
http://dx.doi.org/10.1519/JSC.0b013e3181...
and aerobic exercise3030. Simões HG, Hiyane WC, Benford RE, Madrid B, Prada FA, Moreira SR, et
al. Lactate threshold prediction by blood glucose and rating of perceived exertion in
people with type 2 diabetes. Percept Mot Skills. 2010;111:365-78. PMid:21162440.
http://dx.doi.org/10.2466/06.13.15.27.PMS.111.5.365-378
http://dx.doi.org/10.2466/06.13.15.27.PM...
intensity, it is plausible to assume that the combined exercise circuit examined
in this study would correspond to a stimulus within the moderate intensity domain.
Therefore, exercise protocols within other intensity domains (i.e. intense or severe
domains) should be analyzed.
In relation to the design of the experimental exercise session, the practical application is that a combined exercise circuit session involving both aerobic and resistance exercises constitutes an interesting option to attenuate subsequent cardiovascular stress with relatively short sessions (30-40 minutes). The circuit method is also considered more dynamic, which may significantly influence adherence and chronic benefits (i.e. neuromuscular and cardiovascular adaptation).
The main limitations of the present study were no measurements of BPR during activities of daily life and no measurements for a longer period but only during the CPT 1h post-exercise. It is speculated that this protective effect of combined exercise on BPR lasts for a longer period, however more research is needed to investigate this hypothesis. Furthermore, the stress test was shown to be efficient in eliciting cardiovascular stress regardless of the moment it was applied (pre or post-experimental sessions; Table 2). Another limitation was the non-measurement of heart rate variability and nitric oxide release. Those measurements would enable us to examine their relationship with the observed findings and possibly gather information regarding the mechanisms involved.
The results presented here can be useful for professionals involved in prescribing exercise for cardiovascular health. Apparently, healthy adults of both genders aiming to reduce cardiovascular stress, particularly BP and BPR, can benefit from circuit training involving aerobic and resistance exercises, with duration ranging from 30 to 40 minutes. The training sessions can consist of a circuit of six resistance exercises, alternating lower and upper body muscle groups, followed by 5 minutes of aerobic exercise. The circuit can be performed in 3 laps with sets of 15 repetitions at 50% of the estimated 1RM or 13 on the 15-point Borg scale [6-20] for each resistance exercise and a 2-min recovery interval between laps. The aerobic exercise can be conducted using the linear model between 75-85% of age-predicted maximum HR and/or 13 on the Borg scale.
Despite the potential practical applications of moderate-intensity combined exercise for
decreasing BP and BPR, previous reports have demonstrated that post-exercise
hypotension depends on the intensity1313. Simões GC, Moreira SR, Kushnick MR, Simões HG, Campbell CS.
Postresistance exercise blood pressure reduction is influenced by exercise intensity
in type-2 diabetic and nondiabetic individuals. J Strength Cond Res. 2010;24:1277-84.
PMid:20386125. http://dx.doi.org/10.1519/JSC.0b013e3181d67488
http://dx.doi.org/10.1519/JSC.0b013e3181...
. Therefore, higher intensities should be considered for both aerobic and
resistance exercises, however prior medical screening including orthopedic,
cardiovascular, and metabolic evaluation is strongly recommended.
Conclusions
A single circuit session of resistance and aerobic exercises performed at moderate intensity promoted significant post-exercise decreases in BP. Moreover, BPR measures were attenuated during this post-exercise hypotension condition. Finally, the decrease in BP was significantly correlated with attenuated BPR in healthy adults of both genders.
Acknowledgments
We are grateful to Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil (proc. 474328/2010-4) for their financial support. We also wish to extend our acknowledgments to Salvapé Produtos Ortopédicos Ltda. for donating the digital BP equipment.
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25MacDonald JR, Hogben CD, Tarnopolsky MA, MacDougall JD. Post exercise hypotension is sustained during subsequent bouts of mild exercise and simulated activities of daily living. J Hum Hypertens. 2001;15:567-71. PMid:11494096. http://dx.doi.org/10.1038/sj.jhh.1001223
» http://dx.doi.org/10.1038/sj.jhh.1001223 -
26Halliwill JR. Mechanisms and clinical implications of post-exercise hypotension in humans. Exerc Sport Sci Rev. 2001;29:65-70. PMid:11337825. http://dx.doi.org/10.1097/00003677-200104000-00005
» http://dx.doi.org/10.1097/00003677-200104000-00005 -
27Chen CY, Bonham AC. Postexercise hypotension: central mechanisms. Exerc Sport Sci Rev. 2010;38:122-7. PMid:20577060 PMCid:PMC2936915. http://dx.doi.org/10.1097/JES.0b013e3181e372b5
» http://dx.doi.org/10.1097/JES.0b013e3181e372b5 -
28Santana HA, Moreira SR, Botelho WB Nº, Silva CB, Sales MM, Oliveira VN, et al. The higher exercise intensity and the presence of allele I of ACE gene elicit a higher post-exercise blood pressure reduction and nitric oxide release in elderly women: an experimental study. BMC Cardiovasc Disord. 2011;11:71. PMid:22136292 PMCid:C3261092. http://dx.doi.org/10.1186/1471-2261-11-71
» http://dx.doi.org/10.1186/1471-2261-11-71 -
29Moreira SR, Arsa G, Oliveira HB, Lima LC, Campbell CS, Simões HG. Methods to identify the lactate and glucose thresholds during resistance exercise for individuals with type 2 diabetes. J Strength Cond Res. 2008;22:1108-15. PMid:18545200. http://dx.doi.org/10.1519/JSC.0b013e31816eb47c
» http://dx.doi.org/10.1519/JSC.0b013e31816eb47c -
30Simões HG, Hiyane WC, Benford RE, Madrid B, Prada FA, Moreira SR, et al. Lactate threshold prediction by blood glucose and rating of perceived exertion in people with type 2 diabetes. Percept Mot Skills. 2010;111:365-78. PMid:21162440. http://dx.doi.org/10.2466/06.13.15.27.PMS.111.5.365-378
» http://dx.doi.org/10.2466/06.13.15.27.PMS.111.5.365-378
Publication Dates
-
Publication in this collection
2014 -
Date of issue
Mar 2014
History
-
Received
23 Jan 2013 -
Reviewed
10 June 2013 -
Accepted
11 Aug 2013