Time-course of health-related adaptations in response to combined training in hypertensive elderly: immune and autonomic modulation interactions

Abstract

This article is a methodological description of a randomized clinical trial (ClinicalTrials.gov U1111-1181-4455) aiming to evaluate the time-course (monthly) and associations between blood pressure changes and other health-related adaptations in response to exercise training in hypertensive elderly. Methods: The patients will be randomized to a control or combined training group interventions (aerobic and resistance exercise), with monthly assessments in four months. Although, the changes in baseline blood pressure is the primary clinical outcome, the secondary outcomes include: body composition, cardiorespiratory fitness, muscle strength, arterial stiffness, baroreceptor sensitivity, cardiovascular autonomic modulation, inflammatory markers, oxidative stress, growth factors, tissue remodeling markers, metabolic profile, renal function, cognitive function and quality of life. Results: To support the understanding of the blood pressure changes in hypertensive elderly, a time-course of exercise-induced adaptations including cardiovascular and immunological adaptations are fundamental for research in this field. Conclusion: To investigate the time-course of combined training-induced adaptations including all the diverse aspects of health in hypertensive elderly a well-controlled protocol design is necessary, mainly to clarify the relationship between cardiovascular and immunological exercise-induced adaptations.

Comprehensive Time-Course Effects of Combined Training on Hypertensive Older Adults: A Randomized Control Trial

“…This study was part of a prospective interventional randomized controlled trial, with a parallel control group, executed in Campinas (São Paulo, Brazil) registered on the Brazilian registry of clinical trials ([ ], identifier [U1111-1181-4455]). The sample size calculation (G*Power 3.2.1 software), based on mean blood pressure changes with Training, ensured the number of participants (n = 46) analyzed at the end were above that necessary for 95% power, as estimated previously [ 10 ].…”

“…Table 1 describes the baseline characteristics of the 46 participants that completed the study, and the balance achieved at baseline assessments between groups was not maintained (ES < 0.2) for BMI and RRi. None of the subjects were physically active (<150 min of exercise/week), however we did report their specific Physical activity level (PAL) at baseline [ 10 ]. All subjects were diagnosed with hypertension by their physician and were currently taking antihypertensive medication ( Table 1 ).…”

“…The main outcomes were assessed in both groups at baseline, 4, 8, 12 and 16 weeks of control or training intervention, for primary (BP) and secondary variables (all other variables) as described in the protocol registration [ 10 ] and in the methods section. Each participant was tested at the same time of day and with the same evaluator at each of the 5 testing time points.…”

“…The mechanism mediating the BP reduction with exercise training is still unclear. However, inflammation and autonomic modulation are suggested to be mediators of exercise training effects on BP [ 10 ]. In spontaneously hypertensive rats, two weeks of aerobic training reduced inflammation in the hypothalamic nuclei of cardiovascular control and increased baroreflex sensitivity [ 11 ].…”

“…We hypothesized that reduction in inflammatory markers would be followed by autonomic modulation improvements, which in turn would precede a blood pressure reduction in this population similar to that observed in rats [ 11 ]. However, since hypertensive older adults, unlike spontaneously hypertensive rats, develop hypertension in association with many other health issues, we did not discard the possible impact of other factors [ 10 ].…”