Effects of Exercise and Weight Loss on Mental Stress–Induced Cardiovascular Responses in Individuals With High Blood Pressure

Abstract

Abstract-The purpose of this study was to determine the effects of exercise and weight loss on cardiovascular responses during mental stress in mildly to moderately overweight patients with elevated blood pressure. Ninety-nine men and women with high normal or unmedicated stage 1 to stage 2 hypertension (systolic blood pressure 130 to 179 mm Hg, diastolic blood pressure 85 to 109 mm Hg) underwent a battery of mental stress tests, including simulated public speaking, anger recall interview, mirror trace, and cold pressor, before and after a 6-month treatment program. Subjects were randomly assigned to 1 of 3 treatments: (1) aerobic exercise, (2) weight management combining aerobic exercise with a behavioral weight loss program, or (3) waiting list control group. After 6 months, compared with control subjects, participants in both active treatment groups had lower levels of systolic blood pressure, diastolic blood pressure, total peripheral resistance, and heart rate at rest and during mental stress. Compared with subjects in the control group, subjects in the exercise and weight management groups also had greater resting stroke volume and cardiac output. Diastolic blood pressure was lower for the weight management group than for the exercise-only group during all mental stress tasks. These results demonstrate that exercise, particularly when combined with a weight loss program, can lower both resting and stress-induced blood pressure levels and produce a favorable hemodynamic pattern resembling that targeted for antihypertensive therapy. Key Words: hypertension, essential Ⅲ exercise Ⅲ obesity Ⅲ stress Ⅲ hemodynamics E pidemiological studies have shown that increased levels of physical activity reduce the incidence of all-cause mortality and cardiovascular-related deaths. 1 Although the mechanisms responsible for this benefit are not fully understood, exercise is known to have favorable effects on such traditional risk factors as elevated blood pressure (BP), 2 hyperinsulinemia, 3 and hyperlipidemia. 4 Recently, a number of biobehavioral risk factors that potentially may be modifiable with exercise have been identified. 5 For example, exercise has been shown to reduce depression, 6 anxiety, 7 and type A behavior. 8 An exaggerated cardiovascular response to mental stress is an additional risk factor, which has been shown to be associated with myocardial ischemia 9 and is predictive of the future development of hypertension 10,11 and coronary heart disease. 12 A series of cross-sectional studies have shown that individuals who are more active or physically fit have lower cardiovascular responses to stress. 13 Longitudinal studies are less consistent but generally demonstrate that heart rate (HR) and BP levels are attenuated after exercise training in healthy normotensive men and women. 14 However, to the best of our knowledge, the effects of exercise on BP stress responses in hypertensive individuals has not been studied. Moreover, because weight loss is associated with lower clinic BP 15 but has not been studied in...

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