Post-exercise hypotension in concurrent training: a systematic review

Mello, Diego De; Ostolin, Thatiane Lopes Valentim Di Paschoale

doi:10.1590/1980-0037.2020v22e72211

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Revista Brasileira de Cineantropometria & Desempenho Humano

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review article • Rev. bras. cineantropom. desempenho hum 22 • 2020 • https://doi.org/10.1590/1980-0037.2020v22e72211 copy

Post-exercise hypotension in concurrent training: a systematic review

A hipotensão pós-exercício no treinamento concorrente: uma revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Physical exercise is capable to reduce blood pressure (BP) acutely in a phenomenon described as post-exercise hypotension (PEH). However, the acute effect of concurrent training on PEH needs clarification. The present review aimed to verify and summarize the acute effect of concurrent training on PEH in normotensive and hypertensive subjects. The search was carried out in the databases PubMed, Scielo, and Lilacs, and resulted in 3806 articles. Only 14 studies met the eligibility criteria and were selected. According to included studies, concurrent training can promote PEH regardless of the order, volume, and intensity prescribed, being an effective strategy in the control of arterial hypertension. There is no consensus in the literature regarding the best prescription strategy, as well as the order of execution of the types of exercise.

Key words
Blood pressure; Exercise; Post-exercise hypotension; Systematic review

Study	Participants	Rest Blood Pressure		Training protocol	Duration	Results
Study	Participants	SBP	DBP	Training protocol	Duration	Results
Keese et al.28Keese F, Farinatti P, Pescatello L, Monteiro WA comparison of the immediate effects of resistance, aerobic, and concurrent exercise on postexercise hypotension. J Strength Cond Res. 2011;25:1429-1436.	21 normotensive men (20.7 ± 0.7 yr)	111.52 ± 2.56 mm Hg	73.86 ± 3.62 mm Hg	CG: 60 min rest AG: 60 min cycle ergometer at 65% VO_{2 peak} ST: 8 strength exercises in 3 sets of 6-8 rep at 80% 1RM CTG: 6 strength exercises in 2 sets at 80% 1RM + 30 min cycle ergometer at 65% VO_{2 peak}	BP monitoring for 120 min	Magnitude reduction BP similar to AG, ST, CTG Longer PEH duration in SBP for AG, CTG. Longer PEH duration in DBP for AG.
Ferrari et al.29Ferrari R, Umpierre D, Vogelb G, Vieira P, Santos L, Mello R, et al. Effects of concurrent and aerobic exercises on postexercise hypotension in elderly hypertensive men. Exp Gerontol 2017;98:1-7.	20 hypertensive men (65.3± 3.3 yr)	120 ±13 mm Hg	71 ± 10 mm Hg	CG: 45 min rest AG: 45 min treadmill at 65-70% VO_{2 max} CTG: 4 strength exercises in 4 sets of 8 rep at 70% 1RM+ 25min treadmill at 65-70% VO_{2 max}	BP monitoring for 60 min and 24-hour ambulatory monitoring	Magnitude reduction BP similar for AG and CTG Longer PEH duration in DPB for AG
Pinto et al.23Pinto S, Umpierre D, Ferreira H, Nunes G, Ferrari R, Alberton C. Postexercise hypotension during different water-based concurrent training intrasession sequences in young women. J Am Soc Hypertens 2017;11(10): 653–659.	30 normotensive women (23.2 ± 4.6 yr)	110.3 ± 8.2 mm Hg	69.2 ± 7.0 mm Hg	SAG: 4 strength exercises in the water in 3 sets of 20s each + 18 min of aerobic exercises in the HR from LT ASG: 18 min of aerobic exercises in the HR from LT + 4 strength exercises in the water in 3 sets of 20s each	BP monitoring for 120 min	Similar reduction BP for GSA and GAS in 10 min for DBP and MBP
Tibana et al.11Tibana RA, Nascimento DC,Sousa NM, Silva RA, Vieira A, Almeida JA, et al. Efeitos do exercício de força versus combinado sobre a hipotensão pós-exercício em mulheres com síndrome metabólica. Rev Bras Cineantropom Desempenho Hum 2014;16(5):522-533.	30 normotensive women (33.1± 5.0 yr)	122.7 ± 9.2 mm Hg	77.8 ± 9.6 mm Hg	CG: 60 min rest SG: 6 strength exercises in 3 sets of 8 a 12 rep at 80% 1RM CTG: 30 min of treadmill at 65-70% HRR + 6 strength exercises in 3 sets of 8 a 12 rep at 80% 1RM	BP monitoring for 60min	Greater magnitude of BP for GCT
Lovato et al.21Lovato NS, Anunciacao PG, Polito MD. Pressão arterial e variabilidade de freqüência cardíaca após o exercício aeróbio e com pesos realizados na mesma sessão. Rev Bras Med Esporte 2012;18(1):22-5.	9 normotensive men (24.8 ± 1.1yr)	119 ± 3.8 mm Hg	70.4 ± 2.65 mm Hg	SAG: 8 strength exercises in 3 sets of 10 a 15 rep at 60% 1RM + 50 min cycle ergometer at 60% VO_{2 peak} ASG: 50 min cycle ergometer at 60% VO_{2 peak}+ 8 strength exercises in 3 sets of 10 a 15 rep at 60% 1RM	BP monitoring for 60min	Magnitude reduction BP and PEH duration equal between groups
Menêzes et al.24Menêses AL, Forjaz CL, Lima PF, Batista RM, Monteiro MF, Dias RM. Influence of endurance and resistance exercise order on the postexercise hemodynamic responses in hypertensive women. J Strength Cond Res 2015;29:612–618.	19 hypertensive women (57± 2 yr)	130 ± 3.3 mm Hg	68 ± 2 mm Hg	CG: 50 min rest SAG: 7 strength exercises in 3 sets of 10 rep at 50 % 1RM + 30 min treadmill at 50-60% HRR ASG: 30 min treadmill at 50-60% HRR + 7 strength exercises in 3 sets of 10 rep at 50% 1RM	BP monitoring for 30 min	Magnitude reduction BP and PEH duration equal between groups
Saccomani et al.22Saccomani MG, Figueiredo T, Kattenbraker M, Simão R, Forjaz CL, Polito MD. Blood pressure and heart rate variability responses after isolated and combined sessions of aerobic and strength exercises. Int J Sports Med 2014;15(2):178-187.	10 normotensive men (24.5 ± 1.1yr)	115.4 ± 1.7 mm Hg	70.8 ± 2.1 mm Hg	CG: 60 min rest AG: 50 min cycle ergometer at 60% VO_{2 peak}SG: 8 strength exercises in 3 sets of 12 rep at 60% 1RM ASG: 50 min cycle ergometer at 60% VO_{2 peak}+ 8 strength exercises in 3 sets of 12 rep at 60% 1RM SAG: 8 strength exercises in 3 sets of 12 rep at 60% 1RM + 50 min cycle ergometer at 60% VO_{2 peak}	BP monitoring for 60 min	Greater magnitude reduction BP and duration da PEH for GSA e GAS No differences in execution order
Ruiz et al.30Ruiz RJ, Simao R, Saccomani MG, Casonatto J, Alexander JL, Rhea M, et al. Isolated and combined effects of aerobic and strength exercise on post-exercise blood pressure and cardiac vagal reactivation in normotensive men. J Strength Cond Res. 2011;25(3):640-5.	11 normotensive men (26.8 ± 2.9 yr)	122.4 ± 8 mm Hg	76.5 ± 8.4 mm Hg	SG: 8 strength exercises in 3 sets 12RM AG: 40 min cycle ergometer at 60-70% HHR ASG: 40 min cycle ergometer at 60-70% HRR + 8 strength exercises in 3 sets 12RM	BP monitoring for 60 min	Magnitude reduction BP and duration PEH equal between groups
Santiago et al.19Santiago DA, Moraes JF, Mazzoccante RP, Boullosa DA, Simões HG, Campbell CG. Corrida em esteira e exercícios de força: efeitos agudos da ordem de realizaçãosobre a hipotensão pós-exercício. Rev Bras Educ Fís Esporte 2013;27(1):67-73.	15 normotensive male and female (29.4 ± 7.3 yr)	117.5 ± 11 mm Hg	68.3 ± 7.7 mm Hg	ASG: 30 min treadmill at 80% HHR + 8 strength exercises in 3 sets of 8 rep at 75% 1RM SAG: 8 8 strength exercises in 3 sets of 8 rep at 75% 1RM + 30 min treadmill at 80% HHR	BP monitoring for 60 min	Greater magnitude reduction BP for GAS
Teixeira et al.27Teixeira L, Dias RM, Tinucci T, Mion JD, Forjaz CL. Post-concurrent exercise hemodynamics and cardiac autonomic modulation. European Journal of Applied Physiology 2011;111(9):2069-78.	20 normotensive male and female (26.1 ± 1yr)	111 ± 2 mm Hg	74 ± 1 mm Hg	CG: 60 min rest AG: 30 min cycle ergometer at 75% VO_{2 peak}SG: 6 strength exercises in 3 sets of 20 rep at 50% 1RM ASG: 30 min cycle ergometer at 75% VO_{2 peak}+ 6 strength exercises in 3 sets of 20 rep at 50% 1RM	BP monitoring for 120min	Greater magnitude reduction BP and duration PEH for AG
Mazzoccante et al.20Mazzoccante R, Moreira S, Sousa I, Sotero R, Simões H, Puga G, et al. Different order of combined exercises: acute effects on 24-hour blood pressure in young men. Rev Bras Educ Fís Esporte 2016;30(4):883-92.	10 normotensive men (22.6 ± 3.7 yr)	120 ± 4,5 mm Hg	68,5 ± 6,3 mm Hg	CG: 60 min rest SAG: 6 strength exercises at 90% 12 RM + 15 min treadmill at 90% LT ASG: 15 min treadmill at 90% LT + 6 strength exercises at 90% of 12RM CT AG: Alternate strength and aerobic exercises in sequence		Greater magnitude reduction BP for GSA Greater duration of PEH for GSA in comparison to GCT
Keese et al.26Keese F, Farinatti P, Pescatello L, Cunha FA, Monteiro WD. Aerobic exercise intensity influences hypotension following concurrent exercise sessions. Int J Sports Med 2012;33:148-153.	21 normotensive men (20.7 ± 0.7 yr)	111.5 ± 2.6 mm Hg	73.9 ± 3.6 mm Hg	CG: 60 min rest SAG: 6 strength exercises in 2 sets of 6 to 8 rep at 80% 1RM + 30 min cycle ergometer at 50/65/80% VO_{2 peak}	BP monitoring for 60 min	Magnitude equal BP reduction between groups regardless of intensity Longer duration PEH in 65% and 80% VO_{2 peak}
Santos et al.31Santos E, Asano R, Filho I, Lopes N, Panelli P, Nascimento D, et al. Acute and chronic cardiovascular response to 16 weeks of combined eccentric or traditional resistance and aerobic training in elderly hypertensive women: A randomized controlled trial. J Strength Cond Res 2014;28(11):3073–3084.	60 hypertensive women (63.3 ± 6.2 yr)	162.15 ± 7.12 mm Hg	88.05 ± 4.22 mm Hg	CG: 60 min rest SEAG: 7 strength exercises in 3 sets of 10 eccentric rep at 100-120% 10 RM + 20 min treadmill at 65-75% HHR STAG: 7 strength exercises in 3 sets of 10 rep at 70-90% 10 RM + 20 min treadmill at 65-75% HRR	BP monitoring for 60 min	Greater magnitude BP reduction for GSEA
Faraji and Nikookheslat25Faraji H, Nikookheslat SA. Effect of concurrent exercise on post-exercise hypotension in borderline hypertensive women: Influence of exercise intensity. Kinesiology 2012;44 (2):166-172.	10 pre hypertensive women (37.6 ± 6.5 yr)	135-150 mm Hg	85-95 mm Hg	CG: 6 hours in rest CMEG: 22 min treadmill at 65% HRmax + 5 strength exercises in 3 sets of 12 rep at 65% 1RM CLEG: 22 min treadmill at 40% of HRmax + 5 strength exercises in3 sets of 12 rep at 40% 1RM	BP monitoring during 6 hours	Longer duration PEH for GCMI

Study	1	2	3	4	5	6	7	8	9	10	11	Score
Tibana et al.11Tibana RA, Nascimento DC,Sousa NM, Silva RA, Vieira A, Almeida JA, et al. Efeitos do exercício de força versus combinado sobre a hipotensão pós-exercício em mulheres com síndrome metabólica. Rev Bras Cineantropom Desempenho Hum 2014;16(5):522-533.	1	1	0	1	0	0	0	1	1	1	1	6/10
Santiago et al.19Santiago DA, Moraes JF, Mazzoccante RP, Boullosa DA, Simões HG, Campbell CG. Corrida em esteira e exercícios de força: efeitos agudos da ordem de realizaçãosobre a hipotensão pós-exercício. Rev Bras Educ Fís Esporte 2013;27(1):67-73.	1	1	0	1	0	0	0	1	1	1	1	6/10
Keese et al.28Keese F, Farinatti P, Pescatello L, Monteiro WA comparison of the immediate effects of resistance, aerobic, and concurrent exercise on postexercise hypotension. J Strength Cond Res. 2011;25:1429-1436.	1	1	0	1	0	0	0	1	1	1	1	6/10
Ferrari et al.29Ferrari R, Umpierre D, Vogelb G, Vieira P, Santos L, Mello R, et al. Effects of concurrent and aerobic exercises on postexercise hypotension in elderly hypertensive men. Exp Gerontol 2017;98:1-7.	1	1	1	1	1	1	1	1	1	1	1	10/10
Pinto et al.23Pinto S, Umpierre D, Ferreira H, Nunes G, Ferrari R, Alberton C. Postexercise hypotension during different water-based concurrent training intrasession sequences in young women. J Am Soc Hypertens 2017;11(10): 653–659.	1	1	0	1	0	0	0	1	1	1	1	6/10
Lovato et al.21Lovato NS, Anunciacao PG, Polito MD. Pressão arterial e variabilidade de freqüência cardíaca após o exercício aeróbio e com pesos realizados na mesma sessão. Rev Bras Med Esporte 2012;18(1):22-5.	1	1	0	1	0	0	0	1	1	1	1	6/10
Menêzes et al.24Menêses AL, Forjaz CL, Lima PF, Batista RM, Monteiro MF, Dias RM. Influence of endurance and resistance exercise order on the postexercise hemodynamic responses in hypertensive women. J Strength Cond Res 2015;29:612–618.	1	1	1	1	1	0	0	1	1	1	1	8/10
Saccomani et al.22Saccomani MG, Figueiredo T, Kattenbraker M, Simão R, Forjaz CL, Polito MD. Blood pressure and heart rate variability responses after isolated and combined sessions of aerobic and strength exercises. Int J Sports Med 2014;15(2):178-187.	1	1	0	1	0	0	0	1	1	1	1	6/10
Ruiz et al.30Ruiz RJ, Simao R, Saccomani MG, Casonatto J, Alexander JL, Rhea M, et al. Isolated and combined effects of aerobic and strength exercise on post-exercise blood pressure and cardiac vagal reactivation in normotensive men. J Strength Cond Res. 2011;25(3):640-5.	1	1	0	1	0	0	0	1	1	1	1	6/10
Teixeira et al.27Teixeira L, Dias RM, Tinucci T, Mion JD, Forjaz CL. Post-concurrent exercise hemodynamics and cardiac autonomic modulation. European Journal of Applied Physiology 2011;111(9):2069-78.	1	1	0	1	0	0	0	1	1	1	1	6/10
Mazzoccante et al.20Mazzoccante R, Moreira S, Sousa I, Sotero R, Simões H, Puga G, et al. Different order of combined exercises: acute effects on 24-hour blood pressure in young men. Rev Bras Educ Fís Esporte 2016;30(4):883-92.	1	0	0	1	0	0	0	1	1	1	1	5/10
Keese et al.26Keese F, Farinatti P, Pescatello L, Cunha FA, Monteiro WD. Aerobic exercise intensity influences hypotension following concurrent exercise sessions. Int J Sports Med 2012;33:148-153.	1	1	0	1	0	0	0	1	1	1	1	6/10
Santos et al.31Santos E, Asano R, Filho I, Lopes N, Panelli P, Nascimento D, et al. Acute and chronic cardiovascular response to 16 weeks of combined eccentric or traditional resistance and aerobic training in elderly hypertensive women: A randomized controlled trial. J Strength Cond Res 2014;28(11):3073–3084.	1	1	1	1	0	0	0	1	1	1	1	7/10
Faraji and Nikookheslat25Faraji H, Nikookheslat SA. Effect of concurrent exercise on post-exercise hypotension in borderline hypertensive women: Influence of exercise intensity. Kinesiology 2012;44 (2):166-172.	1	1	0	1	0	0	0	1	1	1	1	6/10

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[1] Corresponding author Thatiane Lopes Valentim Di Paschoale Ostolin 136 Silva Jardim St, Santos, SP, 5513 CEP: 11015-020 Laboratory of Epidemiology and Human Movement, Federal University of São Paulo, Santos, Brazil E-mail address: thati.ostolin@gmail.com