Effect of Physical Training on Nitric Oxide Levels in Patients with Arterial Hypertension: An Integrative Review

Abstract

The regular practice of physical exercise as a nonpharmacological treatment of arterial hypertension (AH) has been encouraged due to causing a series of physiological responses in the cardiovascular system, such as the production of vasoactive substances, including nitric oxide (NO). NO is a relaxation factor released by the endothelium, and the decrease in its bioavailability is related to coronary and arterial diseases, such as AH. This study aimed to perform an integrative literature review to elucidate the effect of physical training on NO levels in patients with AH and to establish a relationship between these levels and blood pressure (BP) control. A literature review was was performed by searching PubMed / MEDLINE, Lilacs, Scielo, Cinahl and Embase databases. The search string used was ("arterial hypertension" OR hypertension) AND (exercise OR "physical exercise" OR "aerobic exercise" OR "exercise training" or "physical activity") AND ("nitric oxide"). We included fully available controlled and uncontrolled clinical trials published in English and Portuguese languages in the last 10 years. The review consisted of 16 articles, of which 13 reported an increase in NO production after the physical training intervention, and three studies found no change. In addition, 15 studies observed a reduction in BP after the intervention. In conclusion, regular practice of physical exercises, advocating moderate intensity, can improve NO bioavailability in pre-hypertensive and hypertensive individuals, which seems to be one of the mechanisms responsible for BP reduction.

Effectiveness of High-Intensity Interval Training and Continuous Moderate-Intensity Training on Blood Pressure in Physically Inactive Pre-Hypertensive Young Adults

“…The positive role of exercise training on BP can be perceived through its action on sympathetic activity, enhanced endothelial function and decreased oxidative stress, which cumulatively contributes to the prevention and treatment of hypertension [ 30 ]. In addition, PA may be accountable for reducing exercise-induced oxidative stress by producing an increased level of antioxidants, attenuating vascular and cardiac sympathetic activity, reducing serum vasoconstrictor factor levels and increasing endothelial dilating factors, which that consequently helps in lowering the peripheral vascular resistance and subsequently leads to improved BP [ 16 , 31 ]. A previous meta-analysis revealed that the two most prominent intervention protocols HIIT and CMT were effective in reducing SBP in adults with pre- to established hypertension [ 25 ].…”

Effectiveness of High-Intensity Interval Training and Continuous Moderate-Intensity Training on Blood Pressure in Physically Inactive Pre-Hypertensive Young Adults

“…30 In addition, PA may be accountable for reducing exercise-induced oxidative stress by producing an increased level of antioxidants, attenuating vascular and cardiac sympathetic activity, dropping serum vasoconstrictor factor levels, and rising endothelial dilating factors that consequently helps in lowering the peripheral vascular resistance and subsuquently leading to improved BP. 16,31 Previous meta-analysis revealed that two most prominent intervention protocols HIIT and CMT were effective in reducing SBP in adults with pre-to established hypertension. 25 Our findings correlate with a study that compared the effects of continuous and interval training in the management of hypertension, whereof researchers found SBP reduction in both experimental groups (-16.4±13.2 mmHg and -13.9±12.6 mmHg respectively).…”

We need to talk about why we don’t talk about exercise!

“…In summary, the findings of Facioli et al, 10 add to the mass of evidence that supports, explains, and details the benefits of regular exercise for human health.…”

“…Initially thought of as an atmospheric pollutant, NO was discovered in 1772 by the English chemist Joseph Priestly and it took more than 200 years for its role in the modulation of vascular dilator tone to be identified. 9 In this issue of the IJCS, in a systematic review of 16 clinical trials, Facioli et al 10 evaluated the response to different exercise interventions on NO production and its impact on blood pressure. Thirteen studies showed an increase in NO production and 15 reported a reduction in blood pressure levels.…”