Effects of Isometric Handgrip Training in Patients With Peripheral Artery Disease: A Randomized Controlled Trial

BackgroundMeta‐analyses have shown that isometric handgrip training (IHT) can reduce brachial systolic and diastolic blood pressure (BP) by >6/4 mm Hg, respectively. However, whether IHT promotes these effects among patients with peripheral artery disease, who exhibit severe impairment in cardiovascular function, is currently unknown. This study aimed to evaluate the effects of IHT on the cardiovascular function of patients with peripheral artery disease. Methods and ResultsA randomized controlled trial with peripheral artery disease patients assigned to either the IHT or control group was conducted. The IHT group performed 3 sessions per week, for 8 weeks, of unilateral handgrip exercises, consisting of 4 sets of isometric contractions for 2 minutes at 30% of maximum voluntary contraction and a 4‐minute interval between sets. The control group received a compression ball in order to minimize the placebo effects, representing sham training. The primary outcome was brachial BP. The secondary outcomes were central BP, arterial stiffness parameters, cardiac autonomic modulation, and vascular function. The IHT program reduced diastolic BP (75 [10] mm Hg preintervention versus 72 [11] mm Hg postintervention), with no change in the control group (74 [11] mm Hg preintervention versus 74 [11] mm Hg postintervention), with this between‐group difference being significant (P=0.04). Flow‐mediated dilation improved in the IHT group (6.0% [5.7] preintervention versus 9.7% [5.5] postintervention), with no change in the control group (7.6% [5.5] preintervention versus 7.4% [5.1] postintervention), with this between‐group difference being significant (P=0.04). There was no change in other measured variables over the intervention period. ConclusionsIHT reduced brachial diastolic BP and improved local vascular function in patients with peripheral artery disease

Factors Associated with Quality of Life in Patients with Systemic Arterial Hypertension

Background: Hypertensive patients present, in addition to worse cardiovascular health, lower health-related quality of life compared to normotensive subjects. Factors such as functional capacity, functional status, pain, participation in social activities, mental and emotional health, fatigue and energy level, along with perception of general health, seem to be relevant for evaluation in this population. However, evidence is unclear in hypertensive patients. Objective: To analyze the factors associated with quality of life in hypertensive patients. Methods: Forty-five patients were recruited. The dependent variables of the present study are the quality of life domains. Demographic data and clinical conditions were considered independent variables. The Medical Outcomes Short-Form Health Survey (SF-36) questionnaire was used to measure quality of life. Handgrip strength, blood pressure and anthropometric indicators were evaluated. Crude and adjusted linear regression analysis was used. Results: It was verified that education level, body mass index and muscle strength were associated with the functional capacity domain (p < 0,05), whereas systolic blood pressure was associated with the physical domain (p < 0,05). Women presented lower quality of life on the pain domain compared to men and educational level was associated with the social domain (p < 0,05). Conclusion: Hypertensive patients with lower levels of body mass index, higher levels of education and muscle strength presented a better quality of life on the physical domain, while the social aspects presented a positive relationship with education level. Women presented a worse quality of life on the pain domain compared to men

Supervised, but Not Home-Based, Isometric Training Improves Brachial and Central Blood Pressure in Medicated Hypertensive Patients: A Randomized Controlled Trial

Meta-analyses have shown that supervised isometric handgrip training reduces blood pressure in hypertensives. However, the mechanism(s) underlying these effects in medicated hypertensive patients, as well as the effects from home-based exercise training, is uncertain. The purpose of this study was to compare the effects of supervised and home-based isometric handgrip training on cardiovascular parameters in medicated hypertensives. In this randomized controlled trial, 72 hypertensive individuals (38–79 years old, 70% female) were randomly assigned to three groups: home-based, supervised isometric handgrip training or control groups. Home-based and supervised isometric handgrip training was completed thrice weekly (4 × 2 min at 30% of maximal voluntary contraction, with 1-min rest between bouts, alternating the hands). Before and after 12 weeks brachial, central and ambulatory blood pressures (BP), arterial stiffness, heart rate variability, vascular function, oxidative stress and inflammation markers were obtained. No significant (p > 0.05) effect was observed for ambulatory BP, arterial stiffness, heart rate variability, vascular function and oxidative stress and inflammatory markers in all three groups. Brachial BP decreased in the supervised group (Systolic: 132 ± 4 vs. 120 ± 3 mmHg; Diastolic: 71 ± 2 vs. 66 ± 2 mmHg, p < 0.05), whereas no significant differences were observed in the home-based (Systolic: 130 ± 4 vs. 126 ± 3 mmHg; diastolic: 73 ± 3 vs. 71 ± 3 mmHg) and control groups (p > 0.05). Supervised handgrip exercise also reduced central BP systolic (120 ± 5 vs. 109 ± 5 mmHg), diastolic (73 ± 2 vs. 67 ± 2 mmHg); and mean BP (93 ± 3 vs. 84 ± 3 mmHg), whereas no significant effects were found in the home-based (Systolic: 119 ± 4 vs. 115 ± 3 mmHg; Diastolic: 74 ± 3 vs. 71 ± 3 mmHg) and control groups (p > 0.05). In conclusion, supervised, but not home-based, isometric training lowered brachial and central BP in hypertensives

The same storm but not the same boat: Effects of COVID ‐19 stay‐at‐home order on mental health in individuals with overweight

Objective: To describe the effects of stay‐at‐home orders and social distancing during the coronavirus disease (COVID‐19) outbreak on mental health and to compare these outcomes between individuals with normal weight and overweight. Methods: This cross‐sectional study included 1857 Brazilian adults, who were invited through social media to answer an online questionnaire from 5 May 2020 to 17 May 2020. The instrument included questions related to health behaviour, mental health (anxiety, depression, self‐esteem, sadness and stress) and overall health. Overweight was defined as body mass index (BMI) ≥ 25 Kg/m2. Multiple logistic regression was conducted to identify whether overweight is associated with mental health variables. Results: Women reported increased anxiety (36.5% vs 22.2%, P < .01), depression (16.2% vs 8.8%, P < .01), low self‐esteem (19.8% vs 10.6%, P < .01), sadness (17.7% vs 10.2%, P < .01), and stress (29.5% vs 19.3%, P < .01) relative to men. Women with overweight are more likely to report higher feeling of anxiety (OR 1.62, CI 95% 1.22‐2.14), depression (OR 1.79, CI 95% 1.25‐2.55), low self‐esteem (OR 1.82, CI95% 1.28‐2.58) and sadness (OR 1.51, CI 95% 1.08‐2.10), adjusted for age, social isolation days, educational level, chronic diseases, smoke, alcohol intake and physical activity. Conclusion: Women, specially those with overweight are more vulnerable to the deleterious effects of stay‐at‐home orders on mental health during the COVID‐19 pandemic

Acute blood pressure responses after different isometric handgrip protocols in hypertensive patients

OBJECTIVE: The present study analyzed blood pressure responses after a single session of isometric handgrip exercise performed with different volumes and intensities by patients with hypertension. METHODS: This randomized crossover trial submitted 12 hypertensive patients (58±5 years old) to four isometric handgrip exercise sessions in a random order: 4 x 2 min at 30% of the maximal voluntary contraction (S30%); 4 x 2 min at 50% of the maximal voluntary contraction (S50%2min); 4 x 3 min at 30% of the maximal voluntary contraction (S30%3min); and a control session. The systolic and diastolic blood pressure, heart rate, and rate-pressure product were measured pre- and post-exercise (30th min). RESULTS: No significant changes were observed in cardiovascular variables after any session (p>0.05 for all comparisons). Similarly, individual analyses revealed heterogeneity in the responses, including increases in blood pressure observed in some sessions. Patients with reduced blood pressure after an isometric handgrip exercise session exhibited a higher body mass index, diastolic blood pressure and heart rate (p<0.05). They also tended to be younger (p=0.07). CONCLUSION: Isometric handgrip exercise performed with different intensities and volumes did not reduce the blood pressure of hypertensive patients

Sedentary Behavior and Light Physical Activity Are Associated with Brachial and Central Blood Pressure in Hypertensive Patients.

Physical activity is recommended as a part of a comprehensive lifestyle approach in the treatment of hypertension, but there is a lack of data about the relationship between different intensities of physical activity and cardiovascular parameters in hypertensive patients. The purpose of this study was to investigate the association between the time spent in physical activities of different intensities and blood pressure levels, arterial stiffness and autonomic modulation in hypertensive patients.In this cross-sectional study, 87 hypertensive patients (57.5 ± 9.9 years of age) had their physical activity assessed over a 7 day period using an accelerometer and the time spent in sedentary activities, light physical activities, moderate physical activities and moderate-to-vigorous physical activities was obtained. The primary outcomes were brachial and central blood pressure. Arterial stiffness parameters (augmentation index and pulse wave velocity) and cardiac autonomic modulation (sympathetic and parasympathetic modulation in the heart) were also obtained as secondary outcomes.Sedentary activities and light physical activities were positively and inversely associated, respectively, with brachial systolic (r = 0.56; P 0.05).Lower time spent in sedentary activities and higher time spent in light physical activities are associated with lower blood pressure, without affecting arterial stiffness and cardiac autonomic modulation in hypertensive patients

Acute and Chronic Effects of Isometric Handgrip Exercise on Cardiovascular Variables in Hypertensive Patients: A Systematic Review

The aim of this study was to describe, through a systematic review, the acute and chronic effects of isometric handgrip exercise on cardiovascular variables in hypertensive individuals. In this systematic review, we included studies that analyzed whether a single bout or a program with isometric exercises affect cardiovascular variables in hypertensive adults. The electronic database PubMed/Medline was searched for relevant studies published until May 2017. Of the 2927 studies initially identified, 2916 were excluded based on title and abstract and five on the basis of full-text assessment, leaving six studies remaining. In addition, one further study cited in the references of the included articles was included in this review, totaling seven studies included (five studies on the chronic effects of isometric handgrip exercise on cardiovascular parameters). None of the acute studies observed post-exercise hypotension. The majority of the chronic studies found decreases in office blood pressure after isometric handgrip training, with training ranging from 6 to 10 weeks, while heart rate variability parameters were improved in one study and did not change in another. Reduction in oxidative stress was observed; however, this variable was only analyzed in one study. In hypertensives, acute responses to isometric handgrip exercise are very limited due to the small number of studies, therefore more research is required. Furthermore, chronic isometric handgrip training reduces blood pressure; however, there is still a gap in the knowledge on the effects of this modality of exercise on other cardiovascular variables-such as endothelial function, oxidative stress, and cardiac autonomic modulation-which should be addressed in future studies.status: publishe

Comparison of blood pressure among tertiles of minutes spent in sedentary activities and in light physical activities.

<p>bSBP = brachial systolic blood pressure; bDBP = brachial diastolic blood pressure; cSBP = central systolic blood pressure; cDBP = central diastolic blood pressure. For sedentary activities, low is < 492.42; mean is 492.42–570.67; and high is > 570.67 min/day. For light physical activities, low is < 297.54; mean is 297.54–356.86; and high is >356.86 min/day. <i>Note</i>: All analyses were adjusted for sex, age, trunk fat, number of antihypertensive drugs, accelerometer wear time and moderate-to-vigorous physical activities.</p

Relationship between light physical activity and brachial and central blood pressure.

<p>bSBP = brachial systolic blood pressure; bDBP = brachial diastolic blood pressure; cSBP = central systolic blood pressure; cDBP = central diastolic blood pressure; LPA = light physical activities. <i>Note</i>: All analyses were adjusted for sex, age, trunk fat, number of antihypertensive drugs, accelerometer wear time and moderate-to-vigorous physical activities.</p

Isometric Exercise Training and Arterial Hypertension:An Updated Review

Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research.</p