ACUTE PHYSICAL EXERCISE AND HYPERTENSION IN THE ELDERLY: A SYSTEMATIC REVIEW

Reia, Thaís Amanda; Silva, Roberta Fernanda da; Jacomini, André Mourão; Moreno, Ana Maria Guilmo; Silva, Anderson Bernardino da; Monteiro, Henrique Luiz; Zago, Anderson Saranz

doi:10.1590/1517-869220202604219195

Thaís Amanda Reia

Physical Education Professional

.Universidade Estadual Paulista (UNESP), Graduate Studies Program in Motricity Sciences, Bauru, São Paulo, SP, Brazil.

http://orcid.org/0000-0001-5032-7341

Roberta Fernanda da Silva

Physical Education Professional

.Universidade Estadual Paulista (UNESP), Graduate Studies Program in Motricity Sciences, Bauru, São Paulo, SP, Brazil.

http://orcid.org/0000-0002-8177-9356

André Mourão Jacomini

Physical Education Professional

.Universidade Estadual Paulista (UNESP), Graduate Studies Program in Motricity Sciences, Bauru, São Paulo, SP, Brazil.

http://orcid.org/0000-0002-5445-429X

Ana Maria Guilmo Moreno

Physical Education Professional

.Universidade Estadual Paulista (UNESP), Graduate Studies Program in Motricity Sciences, Bauru, São Paulo, SP, Brazil.

http://orcid.org/0000-0003-2826-1782

Anderson Bernardino da Silva

Physical Education Professional

.Universidade Estadual Paulista (UNESP), Graduate Studies Program in Motricity Sciences, Bauru, São Paulo, SP, Brazil.

http://orcid.org/0000-0002-7912-8810

Henrique Luiz Monteiro

Physical Education Professional

.Universidade Estadual Paulista (UNESP), Graduate Studies Program in Motricity Sciences, Bauru, São Paulo, SP, Brazil.

. Universidade Estadual Paulista (UNESP), Bauru, São Paulo, SP, Brazil.

http://orcid.org/0000-0001-6639-1532

Anderson Saranz Zago

Physical Education Professional

.Universidade Estadual Paulista (UNESP), Graduate Studies Program in Motricity Sciences, Bauru, São Paulo, SP, Brazil.

. Universidade Estadual Paulista (UNESP), Bauru, São Paulo, SP, Brazil.

http://orcid.org/0000-0002-0081-0797

Correspondence: Anderson Saranz Zago. Universidade Estadual Paulista (UNESP), Faculdade de Ciências (School of Sciences), Department of Physical Education, Bauru, São Paulo, SP, Brazil. Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Vargem Limpa, Bauru, São Paulo, SP, Brazil. 17033-360. anderson.zago@unesp.br

All authors declare no potential conflict of interest related to this article

AUTHORS’ CONTRIBUTIONS: Each author made significant individual contributions to this manuscript. TAR: writing, revision, preparation of the entire research project and data analysis; RFS: writing, revision and intellectual concept; AMJ: writing, revision and data analysis; AMGM: writing, revision and data analysis; ABS: writing, revision and intellectual concept; HLM: writing, revision and intellectual concept; ASZ: revision, intellectual concept. All authors reviewed and approved the final version of the manuscript

Author(s) / Year/ Type of study	Sampling	Experimental intervention	Control intervention	Parameters measured
Scher et al., 2011¹¹/ crossover	16 hypertensive participants (7 men/9 women, average age 67.6 ± 65.1) were randomized to exercise sessions 1 (E1), 2 (E2), and control.	E1: 20min of resistance exercises (1 lap around the circuit). E2: 40min of resistance exercises (2 laps around the circuit). Both sessions adopted intensity of 40% of 1RM.	40min of rest in the sitting position.	BP was measured every 5min using the auscultatory and oscillometric methods for 20min before the sessions. After each session, BP was measured every 5min for 60min. ABPM was installed and BP was automatically measured every 15min or 20min for 2h.
Mota et al., 2013¹⁸/ parallel	64 hypertensive women were randomized in the EG (n=32, average age 67.5 ± 7) and CG (n=32, average age 66.8± 5.4).	EG: Month 1: 3 weeks of adaptation; Month 2: 16 resistance exercise sessions at 60% of 1RM; Month 3: 16 resistance exercise sessions at 70%; Month 4: 16 resistance exercise sessions at 80%.	Did not perform any exercise.	BP was assessed with an automatic device and HR with a specific monitor. Variables were measured with participants sitting in all exercise and control sessions, every 5min for 20min at pre-exercise rest and after resistance exercise, and also every 15min during a 1h post-exercise recovery period.
Dos Santos et al., 2014¹⁹/ parallel	60 hypertensive women randomized in TRT (n=20, age 62.6±2.5), ERT (n=20, age 64.2±3.1) and CG (n= 20, age 63.1±2.3).	The protocols were combined with 20min of aerobic exercise, 3 times a week for 16 weeks. TRT Group: between 1 and 5 weeks at 70% of 10RMs, 6-11 at 80% and 12-16 at 90% of 10RMs, with an average duration to complete 1 repetition of 3-4 sec in both phases. ERT: between 1-5 weeks at 100% of 10RMs, 6-11 at 110% and 12-16 at 120% with an average duration of 1 repetition of 2-3s (eccentric phase and aid in the concentric phase).	Did not perform any exercise.	BP was measured by an oscillometric device and HR by a monitor after 10, 15, 30, 45 and 60min (time 1, 2, 3 and 4) of rest after control or exercise sessions. Post-exercise BP reduction was analyzed in the first training session after RT familiarization and strength testing, and chronic hypotension was measured after the last training session.
Moreira et al., 2016¹²/ crossover	20 hypertensive women (age 66.8±5.6) undergoing the acute physical exercise session and the chronic training.	The acute exercise session consisted of 10 resisted exercises on machines at 60% of 1RM. Participants then underwent progressive RE training for 12 weeks at 60-80% of 1RM.	Absent.	BP and HR were measured using a digital automatic device after 20min of rest in the pre-intervention period and for 60min after the RE session. These pre-exercise data from the acute session were also used to analyze chronic effects.
Pinto et al., 2018¹⁴/ crossover	18 hypertensive women (age 67±1.7) randomized in TVO, TWVO and CG.	TVO group performed 3 sets of 10 repetitions at 20% of 1RM with VO. The TWVO group performed 3 sets of 10 repetitions at 65% of 1RM without VO. Both exercise sessions were performed on the knee extension equipment with a 1min interval between sets.	Absence of exertion with VO.	BP was measured by a digital device after 10min of rest and was also obtained using continuous noninvasive digital photoplethysmography during the experimental and control sessions.
Coelho-Júnior et al., 2017¹⁷/ parallel	21 normotensive (n=11) and hypertensive (n=10) women randomized in ST (n=11, age 66.7±4.7), RT (n=10, age 67.5±4.4) and CG (n=10, age 66.8±5.4).	RT: 3 sets of 8 to 10 repetitions of each exercise at 70% of 1RM; ST: 3 sets of 8 to 10 repetitions of each exercise at 50% of 1RM. In the ST each repetition should be performed at the highest possible speed.	Did not perform any exercise.	BP was measured 20min before the experimental sessions and for 1h after the exercises (5, 10, 15, 30, 45 and 60min) using an automated oscillometric device.
Ferrari et al., 2017¹³/ crossover	20 hypertensive men (age 65.3 ± 3.3) randomized in AE, ARE and CG.	AE: 45min of walking on the treadmill at 65-70% of VO_2max. ARE: 20min of resistance exercises at 70% of 1RM, followed by 25min of aerobic exercise at 65-70% of VO_2max.	45min of rest in the sitting position.	BP was measured by an oscillometric device after 20min of rest before the sessions. After the sessions, BP was measured every 5min for 1h. ABPM was installed and BP was measured automatically every 15min during the day (11h to 22h) and every 20min at night (22h to 6h).
Orsano et al., 2018¹⁵/ crossover	15 hypertensive women (age 67.1±6.9) randomized in RT and HSRT.	Both sessions consisted of 10 exercises at 70% of 10RM with 1min interval between sets. The RT group completed the concentric and eccentric phases of movement at a moderate pace (2-3s each), and the HSRT group completed the concentric phase as quickly as possible.	Absent.	BP was measured after 15min of rest (time point 0) before the sessions and at 5, 15, 30 and 45min after the experimental sessions using an oscillometric device.
Barili et al., 2018¹⁶/ cross over	16 hypertensive women (age 67±3.7) randomized in HIAE, LIAE and LIAE + VO.	Each subject performed 3 experimental protocols on the treadmill: HIAE (aerobic exercise at 50% of VO_2max); LIAE (aerobic exercise at 30% of VO_2max) and LIAE + VO (aerobic exercise at 30% of VO_2max with blood flow restriction at a pressure equivalent to 130% of SBP measured at rest).	Absent.	BP was measured after 15min of rest before the experimental protocols, after the exercise session, and 30min after recovery.

Author/Year	Results	Conclusion
Scher et al., 2011¹¹	BP was reduced in the first 60 min after session E1 and E2 compared to CG. E1: SBP reduction of 8 mmHg in the oscillometric method and 9 mmHg auscultatory method (p <0.01); DBP reduced 6 mmHg oscillometric method and 3 mmHg auscultation method; E2: SBP reduction of 10 mmHg oscillometric and 12 mmHg auscultatory (p <0.01); DBP reduced oscillometric 7 mmHg and auscultatory 4 mmHg (p <0.05). BP of session E2 was lower than BP after E1 (SBP [95% CI, 0.46–3.9] oscillometric and [95% CI, 1.53–4.48] auscultatory, p <0.01, and DBP [95% CI, 0.4–2.4] oscillometric and [95% CI, 0.3-2.2] auscultation, p <0.05). Only E2 promoted a reduction in the mean 24-hour SBP and awake BP (p <0.05) after exercise, with a higher DBP during sleep (p <0.05). The 24h DBP and the SBP and DBP were higher during sleep after E1 (p <0.05).	Acute sessions of resisted exercise at 40% intensity with different volumes reduced BP during the first 60min in hypertensive elderly subjects. However, only the highest volume promoted a reduction in mean 24h and awake SBP.
Mota et al., 2013¹⁸	SBP: at month 3 there was a significant difference in 30 min (p = 0.009) and 45 min (p = 0.05) recovery period between EG and CG. At month 4 there was a significant difference at all recovery times (p ≤0.05). Acute PEH at months 2 (from 134.5 ± 14.6 to 126.4 ± 16.5) and 3 (from 124.9 ± 11.8 to 121.6 ± 11.9). Mean reduction 14.3 mmHg at the end of the training period. DBP: there was a significant difference at rest (p = 0.001) and in 60min recovery (p = 0.001) only at month 2 between CG and EG. Acute PEH at months 2 (from 80.9 ± 11.1 to 73.0 ± 10.0) and 4 (from 72.4 ± 9.3 to 69.7 ± 9.2). Mean reduction of 3.6 mmHg at the end of the training period. The CG had no variation.	Resistance training at 60% and 70% of 1RM was able to generate a reduction in post-exercise SBP in hypertensive women, while DBP underwent a 60% and 80% of 1RM post-exercise reduction. The 4-month period contributes to a chronic reduction in the EG BP.
Dos Santos et al., 2014¹⁹	There were significant interactions in the groups for lower SBP and DBP than in the CG. When the pre and post intervention periods were compared, there was a reduction in SBP of 6.94 ± 0.2 in the ERT group and 4.17 ± 0.57 mmHg in the TRT; in DBP there was a reduction of 12.03 ± 1.23 in ERT and 8.12 ± 1.10 in TRT. PEH in the ERT group underwent a reduction of 4.01 ± 0.37 in SBP in a greater magnitude than TRT, which had a reduction of 2.52 ± 0.388 mmHg. In DBP there was a reduction of 4.93 ± 0.95 in the ERT and 4.17 ± 0.57 in the TRT.	Both protocols of RT combined with aerobic exercise were effective in reducing BP after 16 weeks. Post-exercise SBP reduction was correlated with the magnitude of change in BP after chronic RT only in the ERT. ERT in combination with aerobic exercise is safe and effective for elderly hypertensive women.
Moreira et al., 2016¹²	There were no acute reductions in BP, but chronic reduction was observed. There were significant chronic decreases in SBP and DBP in participants with acute SBP and DBP reduction (p <0.05). SBP changes after acute RE session were correlated with chronic changes in resting SBP after training (r = 0.47; p = 0.03). Similar correlations between acute and chronic responses were also observed for DBP (r = 0.70; p = 0.01), mean BP (r = 0.58; p = 0.01), and HR (r = 0.73; p <0.01).	Acute BP responses after a single RE session were associated with chronic changes in BP after the training program. This finding makes the magnitude of changes in BP a promising candidate for predicting BP-related individuals, which may contribute to the prescription of resistance training in hypertensive patients.
Pinto et al., 2018¹⁴	Significant elevation in SBP and DBP (p <0.05) at all time points of the experimental sessions compared to the control session. SBP and DBP were lower during rest intervals in the session with VO (p <0.05). A significant difference was observed in SBP and DBP at the pre and post-session time points, but the TVO tended to reduce SBP (from 132.7 ± 3.1 to 129.8 ± 2.9 mmHg) and DBP (from 76.0 ± 2.3 to 74.2 ± 2.5 mmHg), while the TWVO increased SBP (from 130.3 ± 4.2 to 138.5 ± 5.9 mmHg) and reduced DBP (from 73.2 ± 1, 8 to 71.1 ± 2.4 mmHg).	Although there was no significant difference between pre and post BP values in the experimental sessions, TVO presented lower BP values during the intervals at all time points and a tendency to decrease at the post-session time point, besides being easier to perform as the participants were expected to lift lighter loads until failure, proving to be a safer method for hypertensive women as compared to TWVO.
Coelho-Júnior et al., 2017¹⁷	SBP in the ST group decreased by 10 (-7.8 ± 8.0), 15 (7.3 ± 7.4), 30min (-9.1 ± 10.0) and 45min (-7.5 ± 10.2) after the exercise session compared with rest (p = 0.001), while RT showed no significant difference despite a downtrend. DBP showed no significant difference in the CG, RT and ST groups.	An acute session of ST and RT may be effective in causing benefits for BP, but ST has been shown to be superior in inducing a reduction in SBP, indicating the potential of this type of physical training to be used as a non-pharmacological tool in the treatment of hypertensive elderly women.
Ferrari et al., 2017¹³	DBP was lower after AE and ARE compared to the CG at 20min of recovery (p <0.05); mean BP was lower after AE and ARE compared to the CG from 10 to 50min of recovery (p <0.05). SBP decreased after AE from 10 to 50min of recovery and after the ARE session from 10 to 40min (p <0.05). In the CG no immediate effect was observed. DBP decreased after ARE from 10 to 40min of recovery and at 10min after the AE session, while it increased 10, 40, 50 and 60min after control session (p <0.05). Mean BP decreased after ARE from 10 to 30min of recovery and after the AE session at 10min of recovery, while it increased from 40 to 60min after control session (p <0.05). During the first hour after the sessions, DBP was lower after AE (-5 mmHg) and ARE (-6 mmHg) compared to the CG. Daytime DBP was significantly lower after AE (-7 mmHg) when compared to the CG. No significant differences were found between the three experimental sessions for DBP.	Combined exercise produced acute PEH similar to aerobic exercise, but this effect did not last as long as aerobic exercise in hypertensive elderly subjects. During the first hour after the sessions, DBP was lower after AE (-5 mmHg) and ARE (-6 mmHg) compared to the CG. Daytime DBP was significantly lower after AE (-7 mmHg) when compared to the CG. No significant differences were found between the three experimental sessions for nighttime and 24h DBP, or for daytime, nighttime and 24h BP.
Orsano et al., 2018¹⁵	There was no significant difference in SBP between the experimental sessions at baseline and for 30min after the sessions. DBP did not change significantly (p> 0.05) between conditions at baseline and for 45min after the sessions. SBP was significantly higher (p = 0.049) for the HSRT session compared with RT only after 45min of exercise. SBP was also significantly higher (p <0.05) at 30 and 45 min after the HSRT session compared with resting values, while it was significantly higher (p <0.05) at time point 0 only after the RT session in comparison with rest values. DBP was significantly higher (p <0.05) after time point 0 and after 5min only after the RT session in comparison with rest values.	Both HSRT and RT performed at the study intensity and volume present benefits in acute BP responses, suggesting they are safe for elderly hypertensive women receiving medication.
Barili et al., 2018¹⁶	BP increased from rest to post-exertion (p <0.05) and decreased from post-exertion to recovery (p <0.05) in all protocols. SBP and DBP returned to resting levels after the recovery period in LIAE and LIAE + VO. However, in the LIAE protocol, BP was lower after recovery compared to the rest period (p <0.05).	The results support the indication of LIAE and LIAE + VO in chronic intervention protocols with potential benefits for hypertensive elderly patients.

[1] Correspondence: Anderson Saranz Zago. Universidade Estadual Paulista (UNESP), Faculdade de Ciências (School of Sciences), Department of Physical Education, Bauru, São Paulo, SP, Brazil. Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Vargem Limpa, Bauru, São Paulo, SP, Brazil. 17033-360. anderson.zago@unesp.br

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ABSTRACT