Os efeitos crônicos do treinamento de resistência muscular na pressão arterial de idosos hipertensos: uma metanálise

Bunn, Priscila dos Santos; Lima, Nádia de Souza; Venturini, Gabriela Rezende de Oliveira; Silva, Elirez Bezerra da

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ORIGINAL ARTICLE • Fisioter. mov. 32 • 2019 • https://doi.org/10.1590/1980-5918.032.AO05 copiar

Os efeitos crônicos do treinamento de resistência muscular na pressão arterial de idosos hipertensos: uma metanálise

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Introdução:

Pouca pesquisa foi realizada sobre os efeitos do treinamento de resistência muscular (TR) em adultos idosos hipertensos.

Objetivo:

O objetivo da presente metanálise foi verificar a eficácia da TR, de forma crônica, na pressão arterial sistólica (PAS) e diastólica (PAD) de idosos com hipertensão controlada.

Método:

Várias bases de dados da literatura foram exploradas para encontrar estudos que examinaram ensaios clínicos controlados e randomizados que avaliaram os efeitos do TR em idosos hipertensos por um período de mais de 10 semanas. Foi analisado o perfil dos participantes, o tamanho da amostra, o protocolo de intervenção e os resultados da PAS e PAD. A Escala PEDro e a ferramenta Cochrane foram utilizadas para analisar a qualidade metodológica dos estudos e o risco de viés, respectivamente. O programa RevMan5.3 foi usado para analisar os resultados na PAS e PAD após a intervenção TR e nos grupos de controle.

Resultados:

A metanálise de cinco estudos incluiu que, considerando os 96 indivíduos hipertensos submetidos à TR e 104 sujeitos de controle hipertensos, a prática regular de TR por 12 a 16 semanas, três vezes por semana, com três séries de 8 a 12 repetições em uma intensidade de 60% a 80% do teste de uma repetição máxima (1-RM), reduziram significativamente a PAS em 7,26 mmHg (IC 95% = -9,16 - 5,37) e PAD por 4,84 mmHg (IC 95% = -5,89 - 3,79).

Conclusão:

O treinamento resistido muscular foi eficaz na redução crônica da pressão arterial de idosos hipertensos controlados, podendo diminuir a necessidade de medicação anti-hipertensiva. Estes resultados implicam uma maior sobrevivência para esta população, bem como uma possível diminuição da necessidade de medicamentos inerentes à hipertensão.

Palavras-chave:
Treinamento de Resistência; Idosos; Hipertensão

Study/year	Sample	Results of the variables
Terra et al., 2008 ²⁷27. Terra DF, Mota MR, Rabelo HT, Bezerra LM, Lima RM, Ribeiro AG, et al. Reduction of arterial pressure and double product at rest after resistance exercise training in elderly hypertensive women. Arq Bras Cardiol. 2008;91(5):299-305.	n = 52 hypertensive older women, controlled with antihypertensive medication	RTG:
		SBP(mmHg): Pre-training: 125.2 ± 9.3; Post-training: 114.7 ± 9.2 (p = 0.01 intragroup and pre x post) / p < 0.01 intergroup;
		DBP(mmHg): Pre-training: 72.0 ± 6.8; Post-training: 71.04 ± 7.9 (p = 0.3) / p > 0.05 intergroup.
	Age: 65.9 ± 4.5 years.	CG: No difference was found.
		SBP(mmHg): Pre-training: 124.6 ± 10.1; Post-training: 123.3 ± 13.5;
		DBP(mmHg): Pre-training: 74.2 ± 7.3; Post-training: 73.3 ± 7.5 .
Gonçalves et al., 2014 ²⁸28. Gonçalves CGS, Nakamura FY, Gerage AM, Januário RSB, Nascimento MA, Farinatti TV, et al. Functional and physiological effects of a 12-week programme of resistance training in elderly hypertensive. INT SPORTMED J. 2014;15(1):50-61.	n = 17 hypertensive older adults, controlled with antihypertensive medication, nonsmokers and with sedentary lifestyle for more than six months (>60 years)	RTG:
		SBP(mmHg): Pre-training: 126.0 ± 5.2; Post-training: 122.9 ± 4.49 (p = 0.10); DBP(mmHg): Pre-training: 80.9 ± 3.3; Post-training: 81.9 ± 4.4 (p = 0.08);
	Age: RTG = 65.6 ± 1.9; and CG = 66.1 ± 1.2 years.	CG:
		SBP(mmHg): Pre-training: 137.0 ± 5.0; Post-training: 134.9 ± 4.5;
		DBP(mmHg): Pre-training: 88.3 ± 2.6; Post-training: 88.7 ± 2.7;
Mota et al., 2013 ²⁹29. Mota MR, Oliveira RJ, Dutra MT, Pardono E, Terra DF, Lima RM, et al. Acute and chronic effects of exercise on blood pressure in hypertensive elderly women. J Strength Cond Res. 2013;27(12):3475-80.	n = 64 hypertensive older adults with sedentary lifestyle for more than 6 months, hypertension controlled with antihypertensive medication.	RTG:
		SBP (mmHg): Pre-training: 134.5 ± 14.6; Post-training: 120.2 ± 11.8 (p < 0.05 intergroup from the 3^rd week);
		DBP (mmHg): Pre-training: 76.0 ± 9.2; Post-training: 72.4 ± 9.3 (p < 0.05 intragroup and p > 0.05 intergroup).
	Age: 67.1±6.2 years.	CG:
		SBP (mmHg): Pre-training: 131.8 ± 16.9; Post-training: 132.3 ± 17.6; (p > 0.05)
		DBP (mmHg): Pre-training: 74.3 ± 7.4; Post-training: 73.8 ± 7.8 (p > 0.05)
Dantas et al., 2016 ¹⁰10. Dantas FFO, Brasileiro-Santos MS, Batista RMF, Nascimento LS, Castellano LRC, Ritti-Dias RM, et al. Effect of Strength Training on Oxidative Stress and the Correlation of the Same with Forearm Vasodilatation and Blood Pressure of Hypertensive Elderly Women: A Randomized Clinical Trial. PloS One. 2016;(2):1-19.	n = 25 sedentary hypertensive older women, controlled with antihypertensive medication, aged between 60 and 75 years;	RTG:
		SBP(mmHg): pre-training: 142.9 ± 13.1; Post-training = 137.1 ± 12.2
		DBP(mmHg): pre-training: 68.2 ± 6.2; post-training: 64.9 ± 5.1
	Age: 64.7±4.7 years (RTG) and 67.7±5.6 years (CG).	CG:
		SBP(mmHg): pre-training = 139.9 ± 10.3; post-training: 144.9 ± 14.1 (p = 0.050 intergroup)
		DBP(mmHg): pre-training: 67.4 ± 9.5; post-training: 72.0 ± 7.7 (p = 0.016 intergroup)
Heffernan et al., 2013 ³⁰30. Heffernan KS, Yoon ES, Sharman JE, Davies JE, Shih YT, Chen CH, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res. 2012;36(5):422-7.	n = 21 participants with pre-hypertension or hypertension without treatment.	RTG:
		SBP (mmHg): pre-training = 140 ± 4; post-training = 134 ± 4
		DBP (mmHg): pre-training = 83 ± 2; post-training = 77 ± 2;
	Age: 61±1 years	CG:
		SBP (mmHg): pre-training = 136 ± 4; post-training: 139 ± 4;
		DBP(mmHg): pre-training = 86 ± 2; post-training = 82 ± 2.

Study	Exercises	Familiarization	Duration (weeks)	Weekly frequency	Intensity	Protocol
Terra et al., 2008 ²⁷27. Terra DF, Mota MR, Rabelo HT, Bezerra LM, Lima RM, Ribeiro AG, et al. Reduction of arterial pressure and double product at rest after resistance exercise training in elderly hypertensive women. Arq Bras Cardiol. 2008;91(5):299-305.	Lateral pulldown, knee extension, chest press, leg abduction, knee flexion, shoulder abduction with dumbbell, standing calf raise, abdominal exercises, trunk extension, and 45-degree leg press.	No	12	3x per week on alternate days	Weeks 1-4: 60% of 1-RM;	3 sets of 12, 10 and 8 repetitions.
					Weeks 5-8: 70% of 1-RM;
					Weeks 9-12: 80% of 1-RM;
Gonçalves et al., 2014 ²⁸28. Gonçalves CGS, Nakamura FY, Gerage AM, Januário RSB, Nascimento MA, Farinatti TV, et al. Functional and physiological effects of a 12-week programme of resistance training in elderly hypertensive. INT SPORTMED J. 2014;15(1):50-61.	Vertical bench press, leg extension, front pull with high pulley, leg curl, barbell curls on Scott bench, seated calf raise, triceps pulley, and crunch.	2 weeks	12	3x per week	The initial load of 40% of 1-RM (increased individually each week for perceived exertion to be between “mild” and “moderate.”	2 sets of 15 repetitions, except calf muscle exercises (2 sets x 20 reps) and crunch (2 sets x 30 reps); 1:2 ratio.
Mota et al., 2013 ²⁹29. Mota MR, Oliveira RJ, Dutra MT, Pardono E, Terra DF, Lima RM, et al. Acute and chronic effects of exercise on blood pressure in hypertensive elderly women. J Strength Cond Res. 2013;27(12):3475-80.	Knee flexion, shoulder abduction with free weights, independent calf lift, crunch, trunk extension, and 45-degree leg press;	Yes (1 month) 12 low-intensity exercise sessions, performing ten repetitions in each set with a 30-second interval between sets.	16	3x per week	60% of 1-RM;	3 sets, 12 repetitions and 60” rest interval between sets.
					70% of 1-RM;	3 sets, 10 repetitions with 60” rest interval between sets.
					80% of 1-RM;	3 sets, 8 repetitions with 90” rest interval between sets.
Dantas et al., 2016 ¹⁰10. Dantas FFO, Brasileiro-Santos MS, Batista RMF, Nascimento LS, Castellano LRC, Ritti-Dias RM, et al. Effect of Strength Training on Oxidative Stress and the Correlation of the Same with Forearm Vasodilatation and Blood Pressure of Hypertensive Elderly Women: A Randomized Clinical Trial. PloS One. 2016;(2):1-19.	Leg press; rowing machine; trunk flexion; knee flexion, bench press, trunk extension, push press, plantar flexion, and front pull.			2x per week	*PES = 5-7	1 set, 9-11 repetitions; 120” interval between sets;
				2x per week		2 sets, 9-11 repetitions; 120” interval between sets;
				2x per week		2 sets, 11-13 repetitions; 90” interval between sets;
				3x per week		2 sets, 11-13 repetitions; 90” interval between sets;
				3x per week		3 sets, 11-13 repetitions; 90” interval between sets;
				3x per week		Weeks 9-11: 3 sets, 13-15 repetitions; 60” interval between sets;
Heffernan et al., 2013 ³⁰30. Heffernan KS, Yoon ES, Sharman JE, Davies JE, Shih YT, Chen CH, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res. 2012;36(5):422-7.	Vertical bench press, front pull, paddling, biceps curl, leg press, knee extension, knee flexion, crunch, and trunk extension;	No	12	3x per week	Initial load: 40% of 1-RM for MMSS and 60% for MMII;	2 sets of 12-15 repetitions.
		No	12	3x per week	The load increased 5% every 3 weeks, until subjects could easily perform 15 repetitions.	2 sets of 12-15 repetitions.

Study	1	2	3	4	8	9	10	11	Score
Dantas et al. (2016) ¹⁰10. Dantas FFO, Brasileiro-Santos MS, Batista RMF, Nascimento LS, Castellano LRC, Ritti-Dias RM, et al. Effect of Strength Training on Oxidative Stress and the Correlation of the Same with Forearm Vasodilatation and Blood Pressure of Hypertensive Elderly Women: A Randomized Clinical Trial. PloS One. 2016;(2):1-19.	1	1	1	1	1	1	1	1	7/10
Heffernan et al (2013) ³⁰30. Heffernan KS, Yoon ES, Sharman JE, Davies JE, Shih YT, Chen CH, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res. 2012;36(5):422-7.	1	1	0	1	1	1	1	1	6/10
Terra et al. (2008) ²⁷27. Terra DF, Mota MR, Rabelo HT, Bezerra LM, Lima RM, Ribeiro AG, et al. Reduction of arterial pressure and double product at rest after resistance exercise training in elderly hypertensive women. Arq Bras Cardiol. 2008;91(5):299-305.	1	0	0	1	1	1	1	1	5/10
Mota et al. (2013) ²⁹29. Mota MR, Oliveira RJ, Dutra MT, Pardono E, Terra DF, Lima RM, et al. Acute and chronic effects of exercise on blood pressure in hypertensive elderly women. J Strength Cond Res. 2013;27(12):3475-80.	1	0	0	1	1	1	1	1	5/10
Gonçalves et al (2014) ²⁸28. Gonçalves CGS, Nakamura FY, Gerage AM, Januário RSB, Nascimento MA, Farinatti TV, et al. Functional and physiological effects of a 12-week programme of resistance training in elderly hypertensive. INT SPORTMED J. 2014;15(1):50-61.	0	1	0	0	0	0	1	1	3/10

Author/year	1	2	3	4	5	6	7	Risk
Terra et al. (2008) ²⁷27. Terra DF, Mota MR, Rabelo HT, Bezerra LM, Lima RM, Ribeiro AG, et al. Reduction of arterial pressure and double product at rest after resistance exercise training in elderly hypertensive women. Arq Bras Cardiol. 2008;91(5):299-305.	High	High	Low*	Low*	Low	Low	Low	High
Dantas et al. (2016) ¹⁰10. Dantas FFO, Brasileiro-Santos MS, Batista RMF, Nascimento LS, Castellano LRC, Ritti-Dias RM, et al. Effect of Strength Training on Oxidative Stress and the Correlation of the Same with Forearm Vasodilatation and Blood Pressure of Hypertensive Elderly Women: A Randomized Clinical Trial. PloS One. 2016;(2):1-19.	Low	Low	Low*	Low*	Low	Low	Low	Low
Gonçalves et al (2014) ²⁸28. Gonçalves CGS, Nakamura FY, Gerage AM, Januário RSB, Nascimento MA, Farinatti TV, et al. Functional and physiological effects of a 12-week programme of resistance training in elderly hypertensive. INT SPORTMED J. 2014;15(1):50-61.	Uncertain	Uncertain	Low*	Low*	Uncertain	Low	Low	Uncertain
Mota et al. (2013) ²⁹29. Mota MR, Oliveira RJ, Dutra MT, Pardono E, Terra DF, Lima RM, et al. Acute and chronic effects of exercise on blood pressure in hypertensive elderly women. J Strength Cond Res. 2013;27(12):3475-80.	High	High	Low*	Low*	Low	Low	Low	High
Heffernan et al (2013) ³⁰30. Heffernan KS, Yoon ES, Sharman JE, Davies JE, Shih YT, Chen CH, et al. Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension. Hypertens Res. 2012;36(5):422-7.	Uncertain	Uncertain	Low*	Low*	Low	Low	Uncertain	Uncertain

Certainty assessment							No. of patients		Effect		Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	RT	CG	Relative (95% CI)	Absolute (95% CI)
SBP
5	randomized trials	very serious	not serious	not serious	not serious	none	96	104	-	mean		CRITICAL
										7.26 mmHg	⨁⨁◯◯
										(9.16 higher to 5.37 higher)	LOW
DBP
5	randomized trials	very serious	not serious	not serious	not serious	none	96	104	-	mean		CRITICAL
										4.84 mmHg	⨁⨁◯◯
										(5.89 higher to 3.79 higher)	LOW

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[1] *PSB: Doctoral student, e-mail: priscilabunn@yahoo.com.br