Postexercise hypotension due to resistance exercise is not mediated by autonomic control: A systematic review and meta-analysis

Farinatti, Paulo; Polito, Marcos Doederlein; Massaferri, Renato; Monteiro, Walace David; Vasconcelos, D. V.; Johnson, Blair T.; Pescatello, Linda S.

doi:10.1016/j.autneu.2021.102825

Cited by 12 publications

(18 citation statements)

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“…We systematically searched six different databases following PRISMA guidelines. The development of the PEH √ list is based on our (Pescatello et al, 1991(Pescatello et al, , 2004(Pescatello et al, , 2007(Pescatello et al, , 2016Keese et al, 2011;Ash et al, 2013;Headley et al, 2017;Cordeiro et al, 2018;Cilhoroz et al, 2019;Zaleski et al, 2019;Babcock et al, 2020;Farinatti et al, 2021) and others (Hacke et al, 2018;de Brito et al, 2019) long history of performing well-controlled PEH studies (Guadagnoli and Velicer, 1988;Pescatello et al, 1991Pescatello et al, , 2003Pescatello et al, , 2004Pescatello et al, , 2015aPescatello et al, , 2017Pescatello et al, , 2019Thomas et al, 2006;Moher et al, 2009;Casonatto et al, 2011;Johnson et al, 2014;Matzer et al, 2017) as well as the methodological study quality standards of the Cochrane risk of bias tool (Higgins et al, 2011) and Downs and Black checklist for methodological quality (Downs and Black, 1998). The PEH √ list is comprehensive addressing essential study design considerations.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Methodological Quality of Postexercise Hypotension Aerobic Exercise Interventions

Day

Pescatello

2022

Front. Physiol.

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BackgroundPostexercise hypotension (PEH) is the immediate reduction in blood pressure (BP) of 5–8 mmHg that occurs after a single bout of aerobic exercise among adults with hypertension. Across PEH studies, there are variations in the level of rigor of the study designs and methods that limit the conclusions that can be made about PEH.ObjectiveTo develop and then apply a methodological study quality evaluation checklist to aerobic exercise PEH studies to provide methodological guidance.MethodsWe developed a PEH checklist (PEH√list) based upon contemporary methodological study quality standards. The PEH√list contains 38 items divided into three categories: sample (n = 10 items), study (n = 23 items), and intervention characteristics (n = 5 items). We then systematically searched six databases to January 2019 to identify and then evaluate studies that: (1) enrolled adults ≥18 years with hypertension and without other chronic diseases or conditions; (2) included a bout of aerobic exercise and a non-exercise control session; and (3) were published in English.ResultsOf 17,149 potential studies, 64 qualified. Participants (N = 1,489) were middle-aged (38.6 ± 15.6 year), overweight (26.1 ± 2.5 kg/m2) mostly men (64.4%) with elevated BP (systolic BP 129.5 ± 15.2/diastolic BP 81.0 ± 10.1 mmHg). Overall, the qualifying studies satisfactorily reported 53.9 ± 13.3% (24.2–82.8%) of the relevant items on the PEH√list. Of note, only 20.3% of the studies disclosed BP was measured following professional guidelines, 18.8% reported BP was taken by the same assessor pre- and post-intervention, and 35.5% stated participants abstained from caffeine, alcohol, and physical activity prior to testing. Half (51.5%) indicated they statistically controlled for pre-exercise/baseline BP. Meanwhile, 100% of the studies reported the setting in which the BP measurements were taken, time from the end of the exercise to the start of the BP measurements, and if relevant, the length of the ambulatory BP monitoring period.ConclusionOverall, the PEH√list items were not well satisfied; especially items with potential confounding effects on PEH. We contend the PEH√list provides guidance to investigators on the important methodological study considerations in PEH aerobic exercise studies that should be attended to in the future.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [#CRD42020221996].

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Section: Discussionmentioning

confidence: 99%

Evaluating the Methodological Quality of Postexercise Hypotension Aerobic Exercise Interventions

Day

Pescatello

2022

Front. Physiol.

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“…Although PEH is more evident in hypertensive individuals, this phenomenon also occurs in normotensive individuals 9,26,30 . In fact, in our study, most of the participants were considered normotensive, with some classified as pre-hypertensive.…”

Section: Discussionmentioning

confidence: 95%

“…The resetting in the baroreflex that blunts sympathetic outflow to the vascular beds occurs after exercise, which reduces the vasoconstriction responsiveness, contributing to sustained vasodilation post-exercise. Also, a decreased sympathetic tone and vagal activity increase after exercise would lead to reduced cardiac output 30 .…”

Section: Discussionmentioning

confidence: 99%

Impact of resistance exercise order on postexercise hemodynamic measures in middle-aged and older women

Graça

Oliveira

Ribeiro

et al. 2022

Motriz: rev. educ. fis.

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Aim: to compare the impact of different resistance exercise orders on postexercise hemodynamic measures in resistance-trained nonhypertensive middle-aged and older women. Methods: Twenty-three women (age 50-78 yrs) were randomized into two resistance training (RT) groups: one group started training sessions performing multi-joint exercises followed by single-joint exercises (MS, n = 12; 58.92 ± 5.53 yrs), while the other group performed their sessions in the opposite order (SM, n = 11; 57.93 ± 11.89 yrs). Both groups performed their RT sessions composed of 7 exercises performed in 3 sets of 10-15 repetitions maximum. Blood pressure was measured by automated equipment during pre-training and at 10, 20, 30, 40, 50, and 60 min after the training session. Results: Repeated-measures analysis of variance (ANOVA) identified an isolated effect of time only for systolic blood pressure (p = 0.003) with statistically significant reductions in pre-session measurement at 60 min post-session in both groups (MS: 117.67 ± 15.89 mmHg vs. 111.25 ± 11.84 mmHg and SM: 118.64 ± 15.13 mmHg vs. 111.50 ± 15.62 mmHg). Regarding diastolic blood pressure and subjective perception of effort, no difference was identified between groups (p > 0.05). Conclusion: We conclude that a RT session can promote post-exercise hypotension for systolic blood pressure after 60 min of recovery in middle-aged and nonhypertensive older women regardless of the exercise order.

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“…It is feasible that PEH triggers a rise in sympathovagal balance as a compensatory negative feedback mechanism to a resetting of BRS and reduced BP. A recent meta-analysis ( Farinatti et al, 2021 ) reinforced this premise by investigating the potential relationship between PEH and cardiac autonomic modulation in resistance training. Prolonged reductions in BP of >30 min were inversely related to sympathetic activity, and positively related to parasympathetic activity.…”

Section: Discussionmentioning

confidence: 99%

“…In the work by Francica et al (2015) changes in autonomic modulation were dissociated from BP responses after exercise, while in the present study increases in sympathetic activity and lowered BRS occurred in parallel with a reduction in BP. It has been suggested that fluctuations in autonomic control during PEH might be a consequence rather than a cause of a reduction in BP and that clinically relevant PEH would probably depend on peripheral factors reflecting the ability of vasodilation to counteract the autonomic reaction to bring BP back to baseline levels (i.e., decreased SVR) ( Cunha et al, 2016 ; Fonseca et al, 2018 ; Farinatti et al, 2021 ). It is feasible that PEH triggers a rise in sympathovagal balance as a compensatory negative feedback mechanism to a resetting of BRS and reduced BP.…”

Section: Discussionmentioning

confidence: 99%

Acute effects of mixed circuit training on hemodynamic and cardiac autonomic control in chronic hemiparetic stroke patients: A randomized controlled crossover trial

et al. 2022

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Objectives: To investigate whether a single bout of mixed circuit training (MCT) can elicit acute blood pressure (BP) reduction in chronic hemiparetic stroke patients, a phenomenon also known as post-exercise hypotension (PEH).Methods: Seven participants (58 ± 12 years) performed a non-exercise control session (CTL) and a single bout of MCT on separate days and in a randomized counterbalanced order. The MCT included 10 exercises with 3 sets of 15-repetition maximum per exercise, with each set interspersed with 45 s of walking. Systolic (SBP) and diastolic (DBP) blood pressure, mean arterial pressure (MAP), cardiac output (Q), systemic vascular resistance (SVR), baroreflex sensitivity (BRS), and heart rate variability (HRV) were assessed 10 min before and 40 min after CTL and MCT. BP and HRV were also measured during an ambulatory 24-h recovery period.Results: Compared to CTL, SBP (∆-22%), DBP (∆-28%), SVR (∆-43%), BRS (∆-63%), and parasympathetic activity (HF; high-frequency component: ∆-63%) were reduced during 40 min post-MCT (p < 0.05), while Q (∆35%), sympathetic activity (LF; low-frequency component: ∆139%) and sympathovagal balance (LF:HF ratio: ∆145%) were higher (p < 0.001). In the first 10 h of ambulatory assessment, SBP (∆-7%), MAP (∆-6%), and HF (∆-26%) remained lowered, and LF (∆11%) and LF:HF ratio (∆13%) remained elevated post-MCT vs. CTL (p < 0.05).Conclusion: A single bout of MCT elicited prolonged PEH in chronic hemiparetic stroke patients. This occurred concurrently with increased sympathovagal balance and lowered SVR, suggesting vasodilation capacity is a major determinant of PEH in these patients. This clinical trial was registered in the Brazilian Clinical Trials Registry (RBR-5dn5zd), available at https://ensaiosclinicos.gov.br/rg/RBR-5dn5zd.Clinical Trial Registration:https://ensaiosclinicos.gov.br/rg/RBR-5dn5zd, identifier RBR-5dn5zd

show abstract

Postexercise hypotension due to resistance exercise is not mediated by autonomic control: A systematic review and meta-analysis

Cited by 12 publications

References 64 publications

Evaluating the Methodological Quality of Postexercise Hypotension Aerobic Exercise Interventions

Evaluating the Methodological Quality of Postexercise Hypotension Aerobic Exercise Interventions

Impact of resistance exercise order on postexercise hemodynamic measures in middle-aged and older women

Acute effects of mixed circuit training on hemodynamic and cardiac autonomic control in chronic hemiparetic stroke patients: A randomized controlled crossover trial

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