Central Hemodynamic Adjustments during Post-Exercise Hypotension in Hypertensive Patients with Ischemic Heart Disease: Concurrent Circuit Exercise versus High-Intensity Interval Exercise. A Preliminary Study

Abstract

Concurrent aerobic plus resistance exercise (RAE) and high-intensity interval exercise (HIIE) are both effective at inducing post-exercise hypotension (PEH) in patients with hypertension. However, central hemodynamic changes associated with PEH in hypertensive subjects with underlying ischemic heart disease (IHD) have been poorly investigated. The study aim was to compare the acute effects produced by these two exercise modalities on left ventricular diastolic function and left atrial function. Twenty untrained male patients with a history of hypertension and IHD under stable pharmacological therapy were enrolled. Each patient underwent three exercise sessions: RAE, HIIE and a control session without exercise, each lasting 45 min. An echocardiography examination was performed before and between 30 min and 40 min from the end of the exercise sessions. Following the exercise sessions, BP values decreased in a similar way in RAE and HIIE and were unchanged after the control session. Compared to pre-session, the ratio between early filling velocity (E) and mitral annulus early diastolic velocity (E’). E/E’ increased after HIIE and remained unchanged after both RAE and control sessions (between-sessions p 0.002). Peak atrial longitudinal strain (PALS) increased slightly after RAE (+1.4 ± 1.1%), decreased after HIIE (−4.6 ± 2.4%) and was unchanged after the control session (between-sessions p 0.03). Peak atrial contraction strain (PACS) was mildly increased after RAE, was reduced after HIIE and was unchanged after the control session. Atrial volume was unchanged after both exercise sessions. Left ventricular and left atrial stiffness increased significantly after HIIE, but remained unchanged after the RAE and control sessions. Stroke volume and cardiac output increased after RAE, decreased after HIIE, and were unchanged after the control session. In conclusion, single session of RAE and HIIE brought about similar PEH in hypertensive subjects with IHD, while they evoked different central hemodynamic adjustments. Given its neutral effects on diastolic and atrial functions, RAE seems more suitable for reducing blood pressure in hypertensive patients with IHD.

Acute Left Atrial Response to Different Eccentric Resistance Exercise Loads in Patients with Heart Failure with Middle Range Ejection Fraction: A Pilot Study

“…When compared with previous research, the increase in PALS and PACS after ECC-RE observed in the present study suggests that acute LA response to exercise could vary in relation to different exercise modalities and loads. This result is in agreement with another recent study, in which PALS and PACS increased, albeit not significantly, after a session of concurrent, aerobic plus resistance, exercise, while they were significantly decreased after a session of high-intensity interval exercise in subjects with hypertension and ischemic heart disease [ 36 ]. We observed that PALS increased in a similar manner after ECC-20 and ECC-50, while PACS increased to a greater extent after ECC-50 (+28.4%) than after ECC-20 (+18.1%).…”

Efficacy and Safety of a Combined Aerobic, Strength and Flexibility Exercise Training Program in Patients with Implantable Cardiac Devices

“…Marzolini et al [ 32 ] compared aerobic training alone versus aerobic plus resistance training, demonstrating that combined training was more effective on body composition, strength, and some indicators of cardiovascular fitness. However, most of the studies performed so far refer to patients with ischemic heart disease or heart failure [ 19 , 20 , 32 , 33 , 34 ].…”

Post-Exercise Hypotension: An Alternative Management Strategy for Hypertension and Cardiovascular Disease?

“…Exercise intensity and duration have a significant effect on PEH. It has been shown that while a single session of aerobic plus resistance exercise (RAE) and high-intensity interval exercise (HIIE) can both bring about similar PEH in hypertensive patients with ischemic heart disease (IHD), RAE appears to have significantly less effect on diastolic and atrial functions, which makes it more suitable for reducing blood pressure in hypertensive patients with IHD [ 9 ]. Another method of inducing PEH is using sprint interval training (SIT), which has shown that the length of the interval between successive sprints and the age of the subjects can affect their post-exercise response.…”