Acute Effect of Interval vs. Continuous Exercise on Blood Pressure: Systematic Review and Meta-Analysis

Perrier-Melo, Raphael José; Costa, Eduardo Caldas; Farah, Breno Quintella; Costa, Manoel da Cunha

doi:10.36660/abc.20190107

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Original Article • Arq. Bras. Cardiol. 115 (1) • July 2020 • https://doi.org/10.36660/abc.20190107 copy

Acute Effect of Interval vs. Continuous Exercise on Blood Pressure: Systematic Review and Meta-Analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Continuous aerobic exercise (CE) is one of the main non-pharmacological recommendations for hypertension prevention and treatment. CE is safe and effective to reduce blood pressure chronically, as well as in the first few hours after its performance, a phenomenon known as post-exercise hypotension (PEH). Interval exercise (IE) also results in PEH.

Objective

This systematic review and meta-analysis sought to compare the magnitude of PEH between CE and IE in adults.

Methods

A systematic review of studies published in journals indexed in the PubMed, Web of Knowledge, Scopus and CENTRAL databases was performed until March 2020, which compared the magnitude of PEH between CE and IE. PEH was defined as between 45-60 minutes post-exercise. The differences between groups on blood pressure were analyzed using the random effects model. Data were reported as weighted mean difference (WMD) and 95% confidence interval (CI). A p-value <0.05 was considered statistically significant. The TESTEX scale (0-15) was used to verify the methodological quality of the studies.

Results

The IE showed a higher magnitude of PEH on systolic blood pressure (WMD: -2.93 mmHg [95% CI: -4.96, -0.90], p = 0.005, I2 = 50%) and diastolic blood pressure (WMD: -1,73 mmHg [IC95%: 2,94, -0,51], p= 0.005, I²= 0%) when compared to CE (12 studies, 196 participants). The scores of the studies on the TEXTEX scale varied from 10 to 11 points.

Conclusions

The IE resulted in a higher magnitude of PEH when compared to CE between 45 and 60 minutes post-exercise. The absence of adverse event data during IE and CE in the studies prevents comparisons of the safety of these strategies. (Arq Bras Cardiol. 2020; 115(1):5-14)

Hypertension; Blood Pressure; Post-Exercise Hypotension; Exercise Therapy; Exercise; Review

Authors	Participants	Men (%) / Women (%)	Age (years)	BMI (kg/m²)	Sample characteristic
Pimenta et al.³⁸	n=20 (15 women)	25%/75%	51±8 years	30±6 kg/m²	Hypertensive men and women
Costa et al.³⁰	n= 19 hypertensive women	0/100%	67.6±4.7 years	27.2 kg/m²	Physically active and inactive women
Boeno et al.³⁷	n= 13 pre-hypertensive men	100%/0	22.7±2.6 years	25.3 kg/m²	Pre-hypertensive and physically inactive men
Maya et al.³⁶	n= 30 pre-hypertensive men	100%/0	23±6.5 years	23.9 kg/m²	Pre-hypertensive and physically active men
Santos et al.³⁵	n=15 hypertensive	NI	65.1±4.7 years	29.1 kg/m²	Physically active men and women
Morales-Palomo et al.³⁴	n=7 men and women with metabolic syndrome	57%/43%	55±9 years	29.1 kg/m²	Normotensive men and women with metabolic syndrome
Morales-Palomo et al.³⁴	n= 7 men	100%/0	59±6 years	33 kg/m²	Hypertensive men with metabolic syndrome
Costa et al.²⁹	n= 14 men	100%/0	24.9±4.1 years	24.2 kg/m²	Normotensive and physically active men
Graham et al.³³	n=12 men	100%/0	23±3 anos	24 kg/m²	Pre-hypertensive and physically inactive men
Angadi et al.²⁷	n=11 pre-hypertensive individuals	91%/9%	24.6±3.7 years	24.4 kg/m²	Pre-hypertensive men and women
Lacombe et al.³²	n=13 men	100%/0	57±4 years	28.6 kg/m²	Pre-hypertensive and physically inactive men
Rossow et al.²⁶	n= 15 men	100%/0	25.8±6.5 years	22.6 kg/m²	Trained normotensive men
Rossow et al.²⁶	n=10 women	0/100%	25±3.4 years	22.2 kg/m²	Trained normotensive women
Mourot et al.³¹	n=10 men	100%/0	24.6±0.6 years	21.86 kg/m²	Trained pre-hypertensive men

Authors	Modality	Intervention site/ Supervision	IE Protocol	CE Protocol	Equipment and moment of analysis	Mechanisms related to PEH
Pimenta et al.³⁸	Treadmill	Laboratory/Yes	5x 3 min – 85-95% resVO₂/ 2 min – 50-60% resVO₂	~35min – 60 - 70% res VO₂	Aneroid sphygmomanometer - 60min	Not investigated
Costa et al.³⁰	Treadmill	Laboratory/Yes	10x 1 min – 80-85% RHR/ 2min – 40-45% RHR	30 min – 50-55% RHR	Oscillometric - 60min	IE: → CO, ↓ PVR, ↓ TVI, → AC; CE: → CO, → PVR, ↓ TVI, → AC
Boeno et al.³⁷	Treadmill	Laboratory/Yes	5 km: 1 min- 90% HRmax/ 1min -60% HRmax	5 km – 70% HRmax	Digital sphygmomanometer - 60min	Not investigated
Maya et al.³⁶	Treadmill	Laboratory/Yes	500 kcal: 3 min – 115%AT/ 1min 30s PR	500 kcal: 85% AT	Aneroid sphygmomanometer - 60min	Not investigated
Santos et al.³⁵	Cycle ergometer	Laboratory/Yes	4x 4 min-85-90% RHR/ 2min - 50% RHR	40 min - 60-80% RHR	Aneroid sphygmomanometer - 60min	Not investigated
Morales-Palomo et al.³⁴	Cycle ergometer	Laboratory/Yes	5 x 4 min-90% HRpeak/ 3 min 70% HRpeak (~460 kcal)	~70 min-60% HRpeak (~460 kcal)	Digital sphygmomanometer – 45min	IE: ↑ CO, ↓ SV, ↓ PVR; CE: → CO, → SV, → PVR
Morales-Palomo et al.³⁴	Cycle ergometer	Laboratory/Yes	5 x 4min-90% HRpeak/ 3 min 70% HRpeak (~460 kcal)	~70 min-60% HRpeak (~460 kcal)	Digital sphygmomanometer – 45min	IE: ↑ CO, ↓ SV, ↓ PVR; CE: → CO, → SV, → PVR
Costa et al.²⁹	Treadmill	Laboratory/Yes	10x 1 min-90% MAV/ 1 min - 30% MAV	20 min - 60% MAV	Digital sphygmomanometer – 60min	Not investigated
Graham et al.³³	Cycle ergometer	Laboratory/Yes	5x 30 s – 0.075% BM - all out/4 min 30 s - AR – UULL ergometer	50 min-65% VO₂max	Aneroid sphygmomanometer - 60min	Not investigated
Graham et al.³³	Cycle ergometer	Laboratory/Yes	5x 30s – 0.075% BM - all out/4 min 30 s - AR – LLLL ergometer	50 min-65% VO₂max	Aneroid sphygmomanometer - 60min	Not investigated
Angadi et al.²⁷	Cycle ergometer	Laboratory/Yes	4 x 4min-90-95% HRmax/3 min –50% HRmax	30 min - 75-80% HRmax	Oscillometric - 60min	Not investigated
Angadi et al.²⁷	Cycle ergometer	Laboratory/Yes	6 x 30s- (0.075% BM – all out) /4min – 50% HRmax	30 min - 75-80%HRmax	Oscillometric - 60min	Not investigated
Lacombe et al.³²	Cycle ergometer	Laboratory/Yes	5x 2min - 85% VO₂max/ 2min-40% VO₂max	21 min - 60% VO₂max	Digital sphygmomanometer - 60min	IE: ↓BRS, → CO, ↓SV. CE: BRS, → CO, ↓SV
Rossow et al.²⁶	Cycle ergometer	Laboratory/Yes	4x 30 s -0.07% BM – all out /4 min 30 s- AR	60 min-60% RHR	Digital sphygmomanometer - 60min	IE: ↑ CO, ↓ PVR; CE: CO, ↓ PVR
Mourot et al.³¹	Cycle ergometer	Laboratory/Yes	9x4 min-1^stVT/ 1 min-Ppeak	48 min-1^stVT	Digital sphygmomanometer – 60min	Not investigated

Authors	Study quality					Partial (0-5)	Study quality										Partial (0-10)	Total (0-15)

	1	2	3	4	5		6 a	6 b	6 c	7	8 a	8 b	9	10	11	12
Costa et al. 2020	1	1	1	1	0	4	1	0*	-	1	1	1	1	NC	1	1	7	11
Pimenta et al. 2019	1	1	0	1	0	3	1	1	-	1	1	1	1	NC	1	1	8	11
Boeno et al. 2019	1	1	0	1	0	3	1	0*	-	1	1	1	1	NC	1	1	7	10
Maya et al. 2018	1	1	0	1	0	3	1	0*	-	1	1	1	1	NC	1	1	7	10
Santos et al. 2018	1	1	0	1	0	3	1	0*	-	1	1	1	1	NC	1	1	7	10
Morales-Palomo et al. 2017	1	1	0	1	0	3	1	0*	-	1	1	1	1	NC	1	1	7	10
Costa et al. 2016	1	1	0	1	0	3	1	0*	-	1	1	1	1	NC	1	1	7	10
Graham et al. 2016	1	1	0	1	0	3	1	0*	-	1	1	1	1	NC	1	1	7	10
Angadi et al. 2015	1	1	0	1	0	3	1	1	-	1	1	1	1	NC	1	1	8	11
Lacombe et al. 2011	1	1	0	1	0	3	1	1	-	1	1	1	1	NC	1	1	8	11
Rossow et al. 2010	1	1	0	1	0	3	1	0*	-	1	1	1	1	NC	1	1	7	10
Mourot et al. 2004	1	1	0	1	0	3	1	0*	-	1	1	1	1	NC	1	1	7	10

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[1] Mailing Address: Raphael José Perrier-Melo • Faculdade Pernambucana de Saúde - Educação Física - Av. Mal. Mascarenhas de Morais, 4861. Postal Code 51210-902, Recife, PE – Brazil E-mail: perrierprof@gmail.com