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Blood pressure (BP) management reduces the risk of cardiovascular disease (CVD). The renin-angiotensin-aldosterone system (RAAS) plays an important role in regulating and maintaining blood volume and pressure. This analysis aimed to investigate the effect of exercise training on plasma renin, angiotensin-II and aldosterone, epinephrine, norepinephrine, urinary sodium and potassium, BP and heart rate (HR). We systematically searched PubMed, Web of Science, and the Cochrane Library of Controlled Trials until 30 November 2022. The search strategy included RAAS key words in combination with exercise training terms and medical subject headings. Manual searching of reference lists from systematic reviews and eligible studies completed the search. A random effects meta-analysis model was used. Eighteen trials with a total of 803 participants were included. After exercise training, plasma angiotensin-II (SMD -0.71; 95% CI -1.24, -0.19; p = 0.008; n = 9 trials), aldosterone (SMD -0.37; 95% CI -0.65, -0.09; p = 0.009; n = 8 trials) and norepinephrine (SMD -0.82; 95% CI -1.18, -0.46; p < 0.001; n = 8 trials) were reduced. However, plasma renin activity, epinephrine, and 24-h urinary sodium and potassium excretion remained unchanged with exercise training. Systolic BP was reduced (MD -6.2 mmHg; 95% CI -9.9, -2.6; p = 0.001) as was diastolic BP (MD -4.5 mmHg; 95% CI -6.9, -2.1; p < 0.001) but not HR (MD -3.0 bpm; 95% CI -6.0, 0.4; p = 0.053). Exercise training may reduce some aspects of RAAS and sympathetic nervous system activity, and this explains some of the anti-hypertensive response., (© 2023. The Author(s).)

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Worldwide, raised blood pressure (BP) or hypertension is the global leading risk factor for the development of cardiovascular diseases and all-cause mortality, with the highest prevalence found in Asian and African origin populations. Post-exercise hypotension (PEH), defined as a sustained reduction in BP after a single bout of exercise is an important physiological phenomenon in BP management. However, little is known about the hypotensive effect of a single bout of exercise in non-Caucasian populations. We systematically summarized the acute effects of a single bout of aerobic exercise on BP in a population of African or Asian origin. We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations with optimal BP, high normal BP or hypertension published in a peer reviewed journal up to August 2021. A subsequent meta-analysis was performed using random-effect models fitted to estimate effect sizes. We identified 10 aerobic exercise trials performed in individuals of Asian origin (n = 136; mean age: 29.51 (21.2-69) years: 78% male; baseline systolic BP/diastolic BP: 118.9 ± 9.64/68.9 ± 2.69 mmHg) and 11 aerobic exercise trials involving individuals of African origin (n = 157; mean age: 41.05 (29.9-49) years; 59% male; baseline systolic BP/diastolic BP: 134.5 ± 8.65 mmHg/82.2 ± 3.24 mmHg). Non-significant reductions in office systolic BP and diastolic BP at 30 min post exercise (-2.25 [-6.38, 1.88] mmHg, p = 0.28/-1.02 [-2.51, 0.47] mmHg, p = 0.18) and 60 min post exercise (-2.80 [-7.90, 2.28], p = 0.27/-1.95, [-5.66, 1.75], p = 0.3) were observed compared to the control intervention. No statistically significant differences were found between both ethnic groups (p > 0.05). Ambulatory BP was reported only in a few African groups. No effect was found on 24h-systolic BP post exercise, but 24h-diastolic BP was statistically significantly reduced (-1.89 [-3.47, -0.31] mmHg, p < 0.01) after a bout of aerobic exercise compared to the control intervention. The available evidence is insufficient to recommend a single session of aerobic exercise as an efficient tool to lower BP in African and Asian populations. Though, the paucity of data in non-Caucasian populations underscores the need for additional efforts to establish the efficacy of single bouts of exercise, including isometric and dynamic resistance exercise, as a potential non-pharmacological adjunct to help lowering BP in the daily life of descendants of Asian or African origin., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: To perform a systematic review of studies assessing the effects of regular exercise on heart rate variability (HRV) in individuals with lower extremity arterial disease (LEAD) and symptoms of claudication., Methods: A systematic search in the electronic databases MEDLINE, Embase, and Scielo, was conducted and updated on January 21, 2023. Randomized clinical trials investigating patients with LEAD and IC, assessing ≥ 4 wk of exercise interventions, and reporting at least one HRV measure (e.g., time or frequency domains) at baseline and follow-up were included. Two reviewers independently screened studies for inclusion, performed data extraction, and quality assessment of included studies., Results: Data from 7 trials were included (i.e., 5 walking, 1 resistance, and 1 isometric handgrip training), totaling 327 patients (66% males; range: 61 - 68 yr; ankle brachial index: 0.4 - 0.7). Following exercise training, three studies investigating walking training reported an increase in parasympathetic modulation indices and/or a decrease in sympathetic modulation indices (n = 2) as well as an increase in non-linear indices (n = 1)., Conclusion: The current evidence is weak, and larger randomized controlled trials are needed to confirm the efficacy of exercise training in improving HRV. Additionally, the high divergence in the methodology of studies indicated the need for standard tools to improve the quality of HRV measurements in exercise trials. It is recommended to use standard procedures in future trials investigating HRV., Competing Interests: Declaration of Competing Interest No potential conflict of interest is reported by the author(s)., (Copyright © 2023. Published by Elsevier Inc.)

Aims: A key treatment for patients with varying stages of heart failure with preserved ejection fraction (HFpEF) is exercise. Yet, despite a Class 1A recommendation, only one-third of patients exercise sufficiently. A huge treatment gap exists between guidelines and clinical practice. PRIORITY aims to establish the feasibility, clinical effectiveness and cost-effectiveness of a hybrid centre and home-based personalized exercise and physical activity intervention for patients along the HFpEF continuum., Methods: An assessor-blinded, multicenter randomized controlled trial will be conducted among 312 patients along the HFpEF continuum. Participants will be randomized (1:1) to the PRIORITY intervention or a comparator group receiving only a written exercise prescription. Participants in the PRIORITY group will receive 18 supervised centre-based exercise sessions during one year, supplemented with a remotely guided home-based physical activity program. Outcomes will be assessed at baseline, 4 months, one and two years. The primary outcome is the peak oxygen uptake (pVO2) at 1-year. Secondary outcomes include physical activity, other physical fitness parameters, cardiovascular health, echocardiographic parameters, health-related quality of life and costs at 1-year FU. Machine learning algorithms will analyse big data on physical activity collected during the 1-year intervention to develop models that can predict physical activity uptake and adherence as well as changes in fitness and health. A cost-utility analysis will be performed to evaluate the cost-effectiveness of the PRIORITY intervention compared to the control condition., Discussion: We anticipate that participants in the supervised home-based exercise intervention group will have a greater increase in pVO2 compared to those receiving a written exercise prescription., Trial Registration Number: This trial is registered at ClinicalTrials.gov (NCT04745013) and is currently in the recruitment stage., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 De Wilde, Bekhuis, Kuznetsova, Claes, Claessen, Coninx, Decorte, De Smedt, Hansen, Lannoo, Van Craenenbroeck, Verhaeghe and Cornelissen.)

Objectives: This crossover study design aimed to assess hemodynamic, cardiac autonomic, and vascular responses to high-intensity interval (HIIE) vs moderate-intensity continuous exercise (MICE) in older individuals with hypertension., Methods: Twenty (67 ± 7 y) older individuals with hypertension were randomly assigned to perform HIIE, MICE, or control (CON) sessions in the heated swimming pool (30-32°C). Blood pressure (BP), arterial stiffness, endothelial reactivity, and heart rate variability (HRV) were measured pre, post, and 45 min (recovery) after each intervention followed by 24-h ambulatory BP and HRV., Results: One single aerobic exercise session was not effective to provoke post-exercise hypotension and vascular improvements. HIIE was superior to MICE and CON to increasing parasympathetic modulation at post and recovery. Exercise sessions showed to disturb the autonomic system at nighttime compared to CON., Conclusions: These results may have important implications in water-based therapy and the elderly with hypertension.

Purpose: Cardiorespiratory fitness (CRF) is an independent predictor of mortality, and females typically achieve smaller improvements in CRF than males after exercise-based cardiac rehabilitation. High-intensity interval training (HIIT) has been shown to produce superior improvements in CRF than traditional cardiac rehabilitation, but the sex differences are unknown. The purpose of this systematic review and meta-analysis was to evaluate sex differences for changes in CRF and cardiometabolic health indicators after HIIT in adults with coronary artery disease (CAD)., Methods and Results: A systemic search of five electronic databases for studies examining the effect of HIIT on measured CRF and cardiometabolic health indicators in adults with CAD was performed. Data (published and unpublished) from 14 studies were included in the meta-analyses with approximately eightfold greater male than female participation (n = 836 vs n = 103). Males with CAD achieved a near-significant absolute improvement in CRF (mean difference [MD] = 1.07, 95% confidence interval [CI] = -0.08 to 2.23 mL·kg-1⋅min-1, P = 0.07) after HIIT when compared with control; there were insufficient data to conduct such an analysis in females. Significantly smaller improvements in CRF were experienced by females than males (MD = -1.10, 95% CI = -2.08 to -0.12 mL·kg-1⋅min-1, P = 0.03); there was no sex difference for the relative (percentage) change in CRF after HIIT. Females achieved significantly smaller reductions in body mass index (MD = -0.25, 95% CI = -0.03 to -0.47 kg·m-2, P = 0.02) and fasting blood glucose (MD = -0.38, 95% CI = -0.05 to -0.72, P = 0.03); no sex differences were observed for other cardiometabolic health indicators., Conclusion: There are no sex differences for relative improvements in CRF after HIIT; however, females are greatly underrepresented in trials. Future studies should increase female participation and perform sex-based analyses to determine sex-specific outcomes following HIIT., (Copyright © 2021 by the American College of Sports Medicine.)

Background: Post-exercise hypotension (PEH) is an important tool in the daily management of patients with hypertension. Varying the exercise parameters is likely to change the blood pressure (BP) response following a bout of exercise. In recent years, high-intensity interval exercise (HIIE) has gained significant popularity in exercise-based prevention and rehabilitation of clinical populations. Yet, to date, it is not known whether a single session of HIIE maximizes PEH more than a bout of moderate-intensity continuous exercise (MICE). Objective: To compare the effect of HIIE vs. MICE on PEH by means of a systematic review and meta-analysis. Methods: A systematic search in the electronic databases MEDLINE, Embase, and SPORTDiscus was conducted from the earliest date available until February 24, 2020. Randomized clinical trials comparing the transient effect of a single bout of HIIE to MICE on office and/or ambulatory BP in humans (≥18 years) were included. Data were pooled using random effects models with summary data reported as weighted means and 95% confidence interval (CIs). Results: Data from 14 trials were included, involving 18 comparisons between HIIE and MICE and 276 (193 males) participants. The immediate effects, measured as office BP at 30- and 60-min post-exercise, was similar for a bout of HIIE and MICE ( p > 0.05 for systolic and diastolic BP). However, HIIE elicited a more pronounced BP reduction than MICE [(-5.3 mmHg (-7.3 to -3.3)/ -1.63 mmHg (-3.00 to -0.26)] during the subsequent hours of ambulatory daytime monitoring. No differences were observed for ambulatory nighttime BP ( p > 0.05). Conclusion: HIIE promoted a larger PEH than MICE on ambulatory daytime BP. However, the number of studies was low, patients were mostly young to middle-aged individuals, and only a few studies included patients with hypertension. Therefore, there is a need for studies that involve older individuals with hypertension and use ambulatory BP monitoring to confirm HIIE's superiority as a safe BP lowering intervention in today's clinical practice. Systematic Review Registration: PROSPERO (registration number: CRD42020171640)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Marçal, Goessler, Buys, Casonatto, Ciolac and Cornelissen.)

Background: Low cardiorespiratory fitness (V̇O 2peak ) is highly associated with chronic disease and mortality from all causes. Whilst exercise training is recommended in health guidelines to improve V̇O 2peak , there is considerable inter-individual variability in the V̇O 2peak response to the same dose of exercise. Understanding how genetic factors contribute to V̇O 2peak training response may improve personalisation of exercise programs. The aim of this study was to identify genetic variants that are associated with the magnitude of V̇O 2 peak response following exercise training., Methods: Participant change in objectively measured V̇O 2 peak from 18 different interventions was obtained from a multi-centre study (Predict-HIIT). A genome-wide association study was completed (n = 507), and a polygenic predictor score (PPS) was developed using alleles from single nucleotide polymorphisms (SNPs) significantly associated (P < 1 × 10 -5 ) with the magnitude of V̇O 2 peak response. Findings were tested in an independent validation study (n = 39) and compared to previous research., Results: No variants at the genome-wide significance level were found after adjusting for key covariates (baseline V̇O 2 peak , individual study, principal components which were significantly associated with the trait). A Quantile-Quantile plot indicates there was minor inflation in the study. Twelve novel loci showed a trend of association with V̇O 2 peak response that reached suggestive significance (P < 1 × 10 -5 ). The strongest association was found near the membrane associated guanylate kinase, WW and PDZ domain containing 2 (MAGI2) gene (rs6959961, P = 2.61 × 10 -7 ). A PPS created from the 12 lead SNPs was unable to predict V̇O 2 peak response in a tenfold cross validation, or in an independent (n = 39) validation study (P > 0.1). Significant correlations were found for beta coefficients of variants in the Predict-HIIT (P < 1 × 10 -4 ) and the validation study (P <  × 10 -6 ), indicating that general effects of the loci exist, and that with a higher statistical power, more significant genetic associations may become apparent., Conclusions: Ongoing research and validation of current and previous findings is needed to determine if genetics does play a large role in V̇O 2 peak response variance, and whether genomic predictors for V̇O 2 peak response trainability can inform evidence-based clinical practice. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), Trial Id: ACTRN12618000501246, Date Registered: 06/04/2018, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374601&isReview=true .

Background: Exercise is key in the primary prevention and management of hypertension. Yet, current exercise recommendations are predominantly based on meta-analyses involving populations of European descent. Since blood pressure (BP) responses to pharmaceutical interventions are known to differ among ethnic groups, we aimed to investigate the BP responses to exercise training in non-European descendants., Purpose: The aim of this study was to systematically summarize the available literature on the efficacy of exercise on BP in healthy adults (age ≥18 years) of African or Asian origin., Methods: We searched the MEDLINE database for randomized controlled trials that evaluated the effect of exercise training on BP in healthy African and Asian adults with optimal BP, elevated BP or hypertension and published in a peer-reviewed journal up to May 2019. Random effect models were fitted to estimate the effect sizes., Results: We identified 22 trials involving individuals of Asian origin ( n  = 931; mean age: 44 years; 41% male) and four trials involving individuals of African origin ( n  = 510; mean age: 56.7 years; 80% male). Aerobic exercise training significantly ( p  < 0.001) reduced systolic and diastolic BP in each ethnic group. Resistance training did not affect the BP of Asian participants with optimal BP. The effect of resistance training in Asians with elevated BP or hypertension and Africans could not be determined due to lack of data. Sub-analyses suggested somewhat larger reductions in systolic BP following aerobic training in hypertensive Africans compared with hypertensive Asians., Conclusions: We found favorable effects of aerobic exercise training on BP in the African and the Asian populations. However, the overall low number of studies and especially the lack of data on resistance training and combined training in African and Asian populations warrant more research to improve the quality of evidence.

Exercise training improves peak oxygen uptake, an important predictor of mortality in coronary artery disease patients. The influence of clinical and disease characteristics on training response is not well established in coronary artery disease. Therefore, we aimed to evaluate whether baseline cardiovascular disease variables and training intensity can predict the maximal aerobic response to exercise training. The Study on Aerobic INTerval EXercise training in coronary artery disease patients (SAINTEX-CAD) previously showed that 12 weeks of aerobic interval training and continuous training equally improved peak oxygen uptake in coronary artery disease patients. We identified 24 exercise non-responders (change peak oxygen uptake <1 ml/kg/min) among 167 participants in SAINTEX-CAD. In a between-group comparison, exercise non-responders were older, their baseline peak oxygen uptake and oxygen uptake efficiency slope were higher, and exercise non-responders were more frequently included after elective percutaneous coronary intervention (all p  < 0.05). In multiple logistic regression analysis, age (odds ratio = 1.11 (1.04-1.18), p  = 0.001), history of elective percutaneous coronary intervention (odds ratio = 3.31 (1.12-9.76), p  = 0.030) and higher baseline peak oxygen uptake (odds ratio = 1.16 (1.06-1.27), p  = 0.001) were independent predictors of exercise non-response. In multiple linear regression analysis, age (ß = -0.605, p  = 0.001), history of elective percutaneous coronary intervention (ß = -15.401, p  = 0.010), training intensity (ß=0.447, p  = 0.008), baseline physical activity (ß=0.014, p  = 0.003) and oxygen uptake efficiency slope (ß = -0.014, p  < 0.001) predicted percentage change in peak oxygen uptake and explained 41% of the variability in percentage change in peak oxygen uptake. To summarize, 14% of coronary artery disease patients were exercise non-responders. Higher baseline peak oxygen uptake and oxygen uptake efficiency slope, history of elective percutaneous coronary intervention, older age, lower training intensity and lower baseline physical activity were predictors of training non-response. Identification of patients with a large likelihood of non-response is a first step towards patient tailored exercise programmes.

There is heterogeneity in the observed O 2peak response to similar exercise training, and different exercise approaches produce variable degrees of exercise response (trainability). The aim of this study was to combine data from different laboratories to compare O 2peak trainability between various volumes of interval training and Moderate Intensity Continuous Training (MICT). For interval training, volumes were classified by the duration of total interval time. High-volume High Intensity Interval Training (HIIT) included studies that had participants complete more than 15 min of high intensity efforts per session. Low-volume HIIT/Sprint Interval Training (SIT) included studies using less than 15 min of high intensity efforts per session. In total, 677 participants across 18 aerobic exercise training interventions from eight different universities in five countries were included in the analysis. Participants had completed 3 weeks or more of either high-volume HIIT ( n = 299), low-volume HIIT/SIT ( n = 116), or MICT ( n = 262) and were predominately men ( n = 495) with a mix of healthy, elderly and clinical populations. Each training intervention improved mean O 2peak at the group level ( P < 0.001). After adjusting for covariates, high-volume HIIT had a significantly greater ( P < 0.05) absolute O 2peak increase (0.29 L/min) compared to MICT (0.20 L/min) and low-volume HIIT/SIT (0.18 L/min). Adjusted relative O 2peak increase was also significantly greater ( P < 0.01) in high-volume HIIT (3.3 ml/kg/min) than MICT (2.4 ml/kg/min) and insignificantly greater ( P = 0.09) than low-volume HIIT/SIT (2.5 mL/kg/min). Based on a high threshold for a likely response (technical error of measurement plus the minimal clinically important difference), high-volume HIIT had significantly more ( P < 0.01) likely responders (31%) compared to low-volume HIIT/SIT (16%) and MICT (21%). Covariates such as age, sex, the individual study, population group, sessions per week, study duration and the average between pre and post O 2peak explained only 17.3% of the variance in O 2peak trainability. In conclusion, high-volume HIIT had more likely responders to improvements in O 2peak compared to low-volume HIIT/SIT and MICT.

Background: Increase of exercise capacity (peak VO 2 ) after cardiac rehabilitation improves outcome in patients with coronary artery disease (CAD). Systolic and diastolic function have been associated with peak VO 2 , but their role towards improvement of exercise capacity remains unclear. It is unknown which exercise intensity has the most beneficial impact on left ventricular (LV) geometry and function in CAD patients without heart failure., Methods: 200 stable CAD patients without heart failure were randomized to 3months of aerobic interval training (AIT) or aerobic continuous training (ACT). Cardiopulmonary exercise test and transthoracic echocardiography were scheduled before and after 3months of training., Results: At baseline, a higher peak VO 2 correlated with lower LV posterior wall thickness (p=0.002), higher LV ejection fraction (p=0.008), better LV global longitudinal strain (p=0.043) and lower E/e' (0=0.001). After multivariate stepwise regression analysis only E/é remained an independent predictor of peak VO 2 (p=0.042). Improvement of peak VO 2 after 3months of training correlated with reverse remodeling of the interventricular septum (p=0.005), enlargement of LV diastolic volume (p=0.007) and increase of LV stroke volume (p=0.018) but not with other indices of systolic or diastolic function. Significant reduction of the interventricular septum thickness after cardiac rehabilitation was observed (p=0.012), with a trend towards more reverse remodeling after ACT compared to AIT (p=0.054). In contrast, there were no changes in other parameters of LV geometry, diastolic or systolic function., Conclusion: Systolic and diastolic function are determinants of baseline exercise capacity in CAD patients without heart failure, but do not seem to mediate improvement of peak VO 2 after either AIT or ACT., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Aerobic endurance exercise (AEX) is an effective treatment in the prevention and management of high blood pressure (BP). Growing evidence suggests potential benefits from isometric handgrip (IHG) exercise, which may promote similar or even larger reductions in BP than AEX. We compared the effects of home-based AEX and home-based IHG on BP. Sixty healthy individuals (31 men; mean age, 33.1 years; mean BP, 126.9 ± 1.6/84.7 ± 1.1 mm Hg) were randomized to IHG, AEX, or a control group. Both exercise interventions were performed in the home environment. The IHG group performed daily 4 × 2 minutes sustained grips at 30% of maximal volitional contraction. Participants in the AEX group were advised to perform at least 150 min/wk of aerobic exercise at moderate intensity. Outcome measurements were assessed at baseline and 8 weeks of follow-up. Compared with the control group, AEX resulted in a larger reduction in ambulatory BP; both AEX and IHG exercise tended to induce larger reductions in office systolic BP, and office diastolic BP was significantly more reduced after AEX but not IHG exercise. Responses to training were not significantly different between both the exercise interventions. Eight weeks of home-based AEX results in significant reductions in both ambulatory BP and office BP in healthy adults, whereas IHG reduces only office BP., (Copyright © 2018 American Heart Association. Published by Elsevier Inc. All rights reserved.)

The renin-angiotensin aldosterone system (RAAS) is associated with diverse physiological responses and adaptations to exercise. The angiotensin converting enzyme (ACE) 2 has vasodilatory effects, which might be associated with the blood pressure (BP) responses to acute exercise. The aim of this study was to investigate the role of ACE2 polymorphisms in postexercise hypotension (PEH). Thirty-four medicated hypertensive (61·3 ± 1·7 years, 76·1 ± 2·7 kg, 160 ± 1·6 cm) men (n = 12) and women (n = 22), participated in a control and a moderate intensity exercise session in a randomized order. After both experimental sessions, they left the laboratory wearing an ambulatory BP device for 24-h monitoring. ACE2 polymorphisms (Int-1 and Int-3) were assessed by polymerase chain reaction. Over the course of 5-h monitoring, we observed a significant reduction in SBP and DBP following exercise in the AA/AG of the Int-1 polymorphism (p-interaction = 0·02 and 0·001, respectively), whereas this could not be found in the individuals homozygous G (p-interaction = 0·76 and 0·51, respectively). With regard to Int-3 polymorphism, individuals AA/AG showed a significant reduction in SBP following exercise (p-interaction <0·0001) but not for DBP (p-interaction = 0·06) whereas GG individuals showed only a significant reduction in DBP following exercise (p-interaction = 0·02). Our results suggest that ACE2 polymorphism could affect PEH; however, larger trials are needed to confirm our findings., (© 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)

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., Competing Interests: The authors declare that there are no conflicts of interest.

Introduction: Exercise-based cardiac rehabilitation (CR) independently alters the clinical course of cardiovascular diseases resulting in a significant reduction in all-cause and cardiac mortality. However, only 15%-30% of all eligible patients participate in a phase 2 ambulatory programme. The uptake rate of community-based programmes following phase 2 CR and adherence to long-term exercise is extremely poor. Newer care models, involving telerehabilitation programmes that are delivered remotely, show considerable promise for increasing adherence. In this view, the PATHway (Physical Activity Towards Health) platform was developed and now needs to be evaluated in terms of its feasibility and clinical efficacy., Methods and Analysis: In a multicentre randomised controlled pilot trial, 120 participants (m/f, age 40-80 years) completing a phase 2 ambulatory CR programme will be randomised on a 1:1 basis to PATHway or usual care. PATHway involves a comprehensive, internet-enabled, sensor-based home CR platform and provides individualised heart rate monitored exercise programmes (exerclasses and exergames) as the basis on which to provide a personalised lifestyle intervention programme. The control group will receive usual care. Study outcomes will be assessed at baseline, 3 months and 6 months after completion of phase 2 of the CR programme. The primary outcome is the change in active energy expenditure. Secondary outcomes include cardiopulmonary endurance capacity, muscle strength, body composition, cardiovascular risk factors, peripheral endothelial vascular function, patient satisfaction, health-related quality of life (HRQoL), well-being, mediators of behaviour change and safety. HRQoL and healthcare costs will be taken into account in cost-effectiveness evaluation., Ethics and Dissemination: The study will be conducted in accordance with the Declaration of Helsinki. This protocol has been approved by the director and clinical director of the PATHway study and by the ethical committee of each participating site. Results will be disseminated via peer-reviewed scientific journals and presentations at congresses and events., Trial Registration Number: NCT02717806. This trial is currently in the pre-results stage., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective We aimed to investigate (1) the effects of aerobic interval training (AIT) and aerobic continuous training (ACT) on (sub)maximal exercise measures and its determinants including endothelial function, muscle strength and cardiac autonomic function, and (2) the relationship between exercise capacity and these determinants. Methods Two-hundred coronary artery disease (CAD) patients (58.4 ± 9.1 years) were randomized to AIT or ACT for 12 weeks. All patients performed a cardiopulmonary exercise test and endothelial function measurements before and after the intervention; a subpopulation underwent muscle strength and heart rate variability (HRV) assessments. Results The VO 2 , heart rate and workload at peak and at first and second ventilatory threshold increased (P-time <0.001); the oxygen uptake efficiency slope (P-time <0.001) and half time of peak VO 2 (P-time <0.001) improved. Endothelial function and heart rate recovery (HRR) at 1 and 2 min improved (P-time <0.001), while measures of muscle strength and HRV did not change. Both interventions were equally effective. Significant correlations were found between baseline peak VO 2 and (1) quadriceps strength (r = 0.44; P < 0.001); (2) HRR at 2 min (r = 0.46; P < 0.001). Changes in peak VO 2 correlated significantly with changes in (1) FMD (ρ = 0.17; P < 0.05); (2) quadriceps strength (r = 0.23; P < 0.05); (3) HRR at 2 min (ρ = 0.18; P < 0.05) and Total power of HRV (ρ = 0.41; P < 0.05). Conclusions This multicentre trial shows equal improvements in maximal and submaximal exercise capacity, endothelial function and HRR after AIT and ACT, while these training methods seem to be insufficient to improve muscle strength and HRV. Changes in peak VO 2 were linked to changes in all underlying parameters.

Background: The aim of this study was to investigate the acute effect of one single session of isometric handgrip exercise (IHG) on blood pressure (BP) during daily life activities in healthy adults., Methods: Fifteen healthy adults with pre- or stage 1 hypertension (10 men; mean age 48±7.1 years) completed two experimental sessions in random order: one control (rest for 15 minutes) and one low intensity IHG session (4×2 minutes sustained contractions at 30% of maximal volutional contraction interspersed with 1-minute rest intervals). Blood pressure was recorded before each intervention and following the intervention BP was recorded for one hour in the office and thereafter for 6 hours during their daily activities by means of an ambulatory BP device. Physical activity (number of steps and total energy expenditure) was assessed by means of a SenseWear mini device., Results: Systolic BP was higher the first minute after the isometric handgrip exercise but quickly returned to baseline levels after 15 minutes in the office. Over the 7-hour period, systolic blood pressure was significantly lower (-5.4±7.3 vs. +0.23±6.9; P<0.05) after IHG compared to the control session. Although not significant, a tendency was observed towards a lower diastolic blood pressure after IHG compared to control (P=0.09). Physical activity behavior was similar on both days (P>0.05)., Conclusions: This study demonstrates that one single bout of IHG can result in an overall reduction in BP during daily activities. More research is needed to confirm these findings and to explain possible mechanisms responsible for these observed changes.

Background Exercise-based cardiovascular rehabilitation (CR) improves exercise capacity (EC), lowers cardiovascular risk profile and increases physical functioning in the short term. However, uptake of and adherence to a physically active lifestyle in the long run remain problematic. Home-based (HB) exercise programmes have been introduced in an attempt to enhance long-term adherence to recommended levels of physical activity (PA). The current systematic review and meta-analysis aimed to compare the longer-term effects of HB exercise programmes with usual care (UC) or centre-based (CB) CR in patients referred for CR. Design Systematic review and meta-analysis. Methods Non-randomised controlled trials (RCTs) or randomised trials comparing the effects of HB exercise programmes with UC or CB rehabilitation on EC and/or PA, with a follow-up period of ≥12 months and performed in coronary artery disease patients, were searched in four databases (PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled trials (CENTRAL)) from their inception until September 7, 2016. Standardised mean differences (SMDs) were calculated and pooled by means of random effects models. Risk of bias, publication bias and heterogeneity among trials were also assessed. Results Seven studies could be included in the meta-analysis on EC, but only two studies could be included in the meta-analysis on PA (total number of 1440 patients). The results showed no significant differences in EC between HB rehabilitation and UC (SMD 0.10, 95% confidence interval (CI) -0.13 to 0.33). There was a small but significant difference in EC in favour of HB compared to CB rehabilitation (SMD 0.25, 95% CI 0.02-0.48). No differences were found for PA (SMD 0.37, 95% CI -0.18 to 0.92). Conclusions HB exercise is slightly more effective than CB rehabilitation in terms of maintaining EC. The small number of studies warrants the need for more RCTs evaluating the long-term effects of different CR interventions on EC and PA behaviour, as this is the ultimate goal of CR.

Background: Current exercise guidelines recommend aerobic types of exercises on most days of the week, supplemented with dynamic resistance exercise twice weekly. Whereas the blood pressure (BP)-lowering effects of a single session of aerobic exercise have been well studied, less is known about the hypotensive effect of a single bout of resistance exercise., Objectives: To evaluate the transient effect of resistance exercise on BP by means of meta-analytic techniques., Methods: A systematic electronic search in Medline, Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), Elton B Stephens Company (EBSCO), EMBASE and SPORTDiscus was completed in March 2015 identifying randomised controlled trials investigating the effect of a single bout of resistance exercise on resting or ambulatory BP in healthy adults. A subsequent meta-analysis was performed., Results: The meta-analysis involved 30 studies, 81 interventions and 646 participants (normotensive (n = 505) or hypertensive (n = 141)). A single bout of resistance exercise elicited small-to-moderate reductions in office systolic BP at 60 minutes postexercise [-3.3 (-4.0 to -2.6)/-2.7 (-3.2 to -2.1) mmHg (CI 95%)], 90 minutes postexercise [-5.3 (-8.5 to -2.1)/-4.7 (-6.9 to -2.4) mmHg (CI 95%)] and in 24-hour ambulatory BP [-1.7 (-2.8 to -0.67)/-1.2 (-2.4 to -0.022) mmHg (CI 95%)] compared to a control session. The reduction in office BP was more pronounced in hypertensive compared to normotensive individuals (p < 0.01), when using larger muscle groups (p < 0.05) and when participants were recovering in the supine position (p < 0.01)., Conclusion: A single bout of resistance exercise can have a BP-lowering effect that last for up to 24 hours. Supine recovery and the use of larger muscle groups resulted in greater BP reductions after resistance exercise., (© The European Society of Cardiology 2016.)

Background: Peak oxygen uptake is an independent predictor of mortality in patients with coronary artery disease (CAD). However, patients with CAD are not always capable of reaching peak effort, and therefore submaximal gas exchange variables such as the oxygen uptake efficiency slope (OUES) have been introduced. Baseline exercise capacity as expressed by OUES provides prognostic information and this parameter responds to training. Therefore, we aimed to assess the prognostic value of post-training OUES in patients with CAD., Methods: We included 960 patients with CAD (age 60.6 ± 9.5 years; 853 males) who completed a cardiac rehabilitation program between 2000 and 2011. The OUES was calculated before and after cardiac rehabilitation and information on mortality was obtained. The relationships of post-training OUES with all-cause and cardiovascular (CV) mortality was assessed by Cox proportional hazards regression analyses. Receiver operator characteristic curve analysis was performed in order to obtain the optimal cut-off value., Results: During 7.37 ± 3.20 years of follow-up (range: 0.45-13.75 years), 108 patients died, among whom 47 died due to CV reasons. The post-training OUES was related to all-cause (hazard ratio: 0.50, p < 0.001) and CV (hazard ratio: 0.40, p < 0.001) mortality. When significant covariates, including baseline OUES, were entered into the Cox regression analysis, post-training OUES remained related to all-cause and CV mortality (hazard ratio: 0.40, p < 0.01 and 0.26, p < 0.01, respectively). In addition, the change in OUES due to exercise training was positively related to mortality (hazard ratio: 0.49, p < 0.01)., Conclusion: Post-training OUES has stronger prognostic value compared to baseline OUES. The lack of improvement in exercise capacity expressed by OUES after an exercise training program relates to a worse prognosis and can help distinguish patients with favorable and unfavorable prognoses., (© The European Society of Cardiology 2016.)

Background: Aerobic interval training (IT) seems to be superior to continuous training (CT) in improving exercise capacity (peak oxygen uptake (VO2)) in coronary artery disease (CAD) patients in some, but not in all studies. Based on theoretical calculations, these comparative studies stated that the energy expenditure (EE) of both programmes is similar. To date, the caloricity of both programmes has never been objectively measured. Therefore, our aim was to objectively measure the EE of the IT and CT programmes described in the protocol of the SAINTEX-CAD study (based on Wisloff et al.; ITw and CTw), and the actually performed training intensities in the SAINTEX-CAD study by Conraads et al. (ITc and CTc)., Methods: Following a two-week run-in period with three IT and three CT training sessions, 18 male CAD patients (mean age 62.4 ± 6.1 years) performed four training sessions in random order on the cycle ergometer: an ITw, CTw, ITc and CTc test session. The EE was assessed by indirect calorimetry using gas exchange measurements obtained with the Oxycon mobile., Results: We found a higher EE for CTc compared to ITc (352 ± 90.8 kcal versus 269 ± 70.7 kcal; p = 0.026), while CTw and ITw seemed to be isocaloric (317 ± 85.2 kcal versus 273 ± 65.3 kcal; p = 0.42). Higher lactate levels were reached after IT sessions (ITw 5.42 ± 1.42 mmol/l, ITc 5.05 ± 1.38 mmol/l) compared to CT sessions (CTw 2.45 ± 1.04 mmol/l, CTc 3.41 ± 1.44 mmol/l) (p < 0.01). Lactate levels increased above baseline levels (1.91 ± 0.34 mmol/l) except for the CTw session., Conclusion: CTc expended significantly more energy compared to ITc, showing that the programmes used in the SAINTEX-CAD study were not isocaloric. In contrast, isocaloricity was met for CTw and ITw., (© The European Society of Cardiology 2016.)

Hypertension is highly prevalent among patients with coronary artery disease (CAD). Exercise-based cardiac rehabilitation reduces blood pressure (BP). However, less is known about the transient effect of a single bout of exercise on BP. Isometric handgrip exercise has been proposed as a new nonpharmacologic tool to lower BP. We aimed to investigate the acute effect of isometric handgrip exercise on BP in CAD patients. Twenty-one male CAD patients were included. All patients completed two experimental sessions in random order: one control and one low-intensity isometric handgrip session. BP was measured by means of a 24-hour ambulatory BP monitor preintervention, for 1 hour in the office and subsequently for 24 hours. Our results suggest that isometric handgrip exercise performed at low intensity is safe in patients with CAD but does not induce a transient reduction in BP., (Copyright © 2016 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)

Background: Cardiac rehabilitation (CR) can slow or reverse the progression of cardiovascular disease (CVD). However, uptake of community-based CR is very low. E-cardiology, e-health and technology solutions for physical activity uptake and monitoring have evolved rapidly and have potential in CVD management. However, it is unclear what the current technology usage is of CVD patients, and their needs and interests for technology enabled CR., Methods: A technology usage questionnaire was developed and completed by patients from a supervised ambulatory CR program and an adult congenital heart disease clinic and from two community-based CR programs. Results were described and related with age, gender and educational level by Spearman correlations., Results: Of 310 patients, 298 patients (77 % male; mean age 61,7 ± 14,5 years) completed at least 25 questions of the survey and were included in the analysis (completion rate 96 %). Most (97 %) patients had a mobile phone and used the internet (91 %). Heart rate monitors were used by 35 % and 68 % reported to find heart rate monitoring important when exercising at home. Physical activity monitoring was reported by 12 % of the respondents. Respondents were interested in CR support through internet (77 %) and mobile phone (68 %). Many patients reported interest in game-based CR (67 %) and virtual rehabilitation (58 %). At least medium interest in technology enabled CR was reported by 75 % of the patients. Interest decreased with increasing age (r = -0.16; p = 0.005)., Conclusions: CVD patients show interest for technology enabled home-based CR. Our results could guide the design of a technology-based, virtual CR intervention.

Background: Aerobic interval training (AIT) and aerobic continuous training (ACT) both improve physical fitness (peak VO2) in coronary artery disease patients. However, little is known about the long-term effects of AIT and ACT on peak VO2 and exercise adherence., Design: This study is a randomized clinical multicenter trial., Methods: In total, 163 patients were assessed after 12 weeks of AIT or ACT and 12 months after their enrollment. Physical fitness and physical activity measures served as the primary outcomes, and peripheral endothelial function, cardiovascular risk factors and quality of life (QoL) served as the secondary outcomes., Results: Twenty-six patients dropped out during the intervention; 11 were lost during the follow-up period. Dropouts (n = 37) consisted of more women (p = 0.001) compared to completers (n = 163). Physical fitness (VO2, heart rate and workload at peak and at thresholds) and physical activity (steps, active energy expenditure [kcal], physical activity duration [minutes]) were preserved at the 1-year follow-up (p-time > 0.05) after both AIT and ACT (p-interaction > 0.05). Forty percent of patients showed increased peak VO2, 52% showed increased active energy expenditure and 91.2% met the recommended levels of 150 minutes/week of moderate physical activity (p-group > 0.05). Further, peripheral endothelial function, QoL and cardiovascular risk factors, except systolic blood pressure (p-time < 0.05), remained stable (p-time > 0.05) after both AIT and ACT (p-interaction > 0.05)., Conclusion: The short-term improvements of center-based AIT and ACT on physical fitness, physical activity, peripheral endothelial function, cardiovascular risk factors and QoL are sustained after a 1-year follow-up period. The majority of patients (>90%) met the recommended physical activity levels of 150 minutes/week., (© The European Society of Cardiology 2016.)

The aim of this systematic review and meta-analysis was to evaluate the effect of exercise training on parameters of the renin-angiotensin-aldosterone system (RAAS) in healthy adults, and to investigate the relation with training induced changes in blood pressure. A systematic search was conducted and we included randomized controlled trials lasting ⩾4 weeks investigating the effects of exercise on parameters of the RAAS in healthy adults (age ⩾18 years) and published in a peer-reviewed journal up to December 2013. Fixed effects models were used and data are reported as weighted means and 95% confidence limits (CL). Eleven randomized controlled trials with a total of 375 individuals were included. Plasma renin activity was reduced after exercise training (n= 7 trials, standardized mean difference -0.25 (95% CL -0.5 to -0.001), P=0.049), whereas no effect was observed on serum aldosterone ((n= 3 trials; standardized mean difference -0.79 (-1.97 to +0.39)) or angiotensin II (n=3 trials; standardized mean difference -0.16 (-0.61 to +0.30). Significant reductions in systolic blood pressure -5.65 mm Hg (-8.12 to -3.17) and diastolic blood pressure -3.64 mm Hg (-5.4 to -1.91) following exercise training were observed. No relation was found between net changes in plasma renin activity and net changes in blood pressure (P>0.05). To conclude, although we observed a significant reduction in plasma renin activity following exercise training this was not related to the observed blood pressure reduction. Given the small number of studies and small sample sizes, larger well-controlled randomized studies are required to confirm our results and to investigate the potential role of the RAAS in the observed improvements in blood pressure following exercise training.

Background: Peak exercise capacity is an independent predictor for mortality in patients with coronary artery disease. However, sometimes cardiopulmonary exercise tests are stopped prematurely. Therefore, submaximal exercise measures such as the oxygen uptake efficiency slope have been introduced. The aim of this study was to assess the prognostic value of the oxygen uptake efficiency slope and other exercise parameters, in patients with coronary artery disease., Methods: Between 2000 and 2011, 1409 patients with coronary artery disease (age 60.7 ± 9.9 years; 1205 males) underwent cardiopulmonary exercise tests. A maximal effort was not reached in 161 (11.5%) patients. The oxygen uptake efficiency slope was calculated and information on mortality was obtained. Cox proportional hazards regression analyses were used to assess the relation of oxygen uptake efficiency slope and other gas exchange variables with all-cause and cardiovascular mortality. Receiver operating characteristic curve analyses was performed to define optimal cut-off values., Results: During an average follow-up of 7.45 ± 3.20 years (range 0.16-13.95 years), 158 patients died, among which 68 patients for cardiovascular reasons. The oxygen uptake efficiency slope was related to all-cause (hazard ratio: 0.568, p < 0.001) and cardiovascular (hazard ratio: 0.461, p < 0.001) mortality. When significant covariates were entered in the analysis, oxygen uptake efficiency slope remained related to mortality (p < 0.05). When other submaximal exercise parameters were added to the model, oxygen uptake efficiency slope and minute ventilation/carbon dioxide production slope also remained significantly related to mortality., Conclusion: The oxygen uptake efficiency slope is an independent predictor for all-cause and cardiovascular mortality in patients with coronary artery disease, irrespective of a truly maximal effort during cardiopulmonary exercise tests. Furthermore, the oxygen uptake efficiency slope provides prognostic information, complementary to the minute ventilation/carbon dioxide production slope and peak exercise capacity., (© The European Society of Cardiology 2015.)

Hypothesis/introduction: Polymorphisms of the angiotensin converting enzyme (ACE) gene can interfere with exercise-induced acute blood pressure (BP) reduction. This cross-over study investigated the acute effect of a single walk on BP and tested whether polymorphisms of the ACE gene might explain the variation in BP responses., Materials and Methods: Thirty-four healthy medicated individuals were randomized to one control and one walking session at 60-75% of heart rate reserve. Subjects left the laboratory wearing an ambulatory BP monitor until waking the next morning., Results: Overall, systolic BP was somewhat lower following the walking session (p=.06), which could be attributed to a consistently lower systolic BP for 5 h after exercise (p-interaction<.04) compared with control rest. Similarly, II/ID individuals had a lower systolic BP (p-interaction=.02) and diastolic BP (p-interaction<.01) for 5 h after walking compared with control rest. Among DD individuals, a single walk did not induce a reduction in BP (p-interaction>.05)., Conclusions: Our results showed that postexercise hypotension can occur after a walk at moderate intensity in carriers of the I allele; we were not able to demonstrate this in DD individuals. Our results suggest that genetic variation in the ACE gene might affect the BP response to exercise, although more research is needed to confirm these findings., (© The Author(s) 2015.)

Background: Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by hypertension in the pulmonary arteries. PAH leads to symptoms such as shortness of breath, dizziness, leg edema and chest pain, impacting heavily on quality of life. The aim of this systematic review and meta-analysis was to determine the effect of exercise training to improve physical fitness and functionality in patients with PAH., Methods: A search was conducted for controlled trials using the databases Medline, Embase, SPORT Discus and Cochrane Central Register of Controlled Trials. Studies were included if at least 80% of the participants presented with group 1 PAH and if the intervention consisted of an exercise training program of at least 3 weeks duration. Data were extracted on study quality, participant and exercise intervention characteristics, and outcomes. Data were pooled by the generic inverse variance method using random effect models and were expressed as weighted means and 95% confidence intervals (CI)., Results: Of 110 identified abstracts, 5 studies with 106 patients (exercise: 53; control: 53; mean age 49.7 years) were included. Disease severity ranged from mild to severe; 96 patients suffered from PAH, 10 patients had chronic thromboembolic pulmonary hypertension. Exercise training led to an increase in 6 minute walk distance (72.5 m; 95% CI 46.0 m to 99.1 m; p < 0.0001) and peak oxygen uptake (2.16 mL/kg/min; 95% CI 2.16 to 3.93; p = 0.02). No severe adverse events during exercise were reported., Conclusions: Our findings suggest that an exercise training program positively influences exercise tolerance and functional capacity in patients with PAH.

Background: The oxygen uptake efficiency slope (OUES) has been proposed as an independent, reproducible and objective measure of cardiorespiratory function that does not require maximal exercise testing. Existing reference values have been published for healthy paediatric populations and healthy elderly. However, reference ranges and equations for healthy adults of working age are insufficiently documented. The aim of the present study was to establish prediction equations and to describe reference values for healthy men and women aged 20-60 years., Design: Cross-sectional study., Methods: One thousand four hundred and eleven (877 men) healthy individuals (mean age 38.6 years; range 20-60) completed a maximal graded cycle exercise test until volitional exhaustion. Subsequently, oxygen uptake was plotted against the logarithm of total ventilation and the OUES was calculated by means of linear regression analysis., Results: Multivariate regression analyses revealed age, sex and body surface area as statistically significant determinants of the OUES. Following this, sex-specific prediction equations for the OUES were established and cross-validated. Finally, the distribution of the OUES with age was described and reference values were established for men and women separately., Conclusions: This study established a comprehensive set of reference values and reference equations for the OUES for a healthy population of men and women aged between 20 and 60 years., (© The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Background: Exercise-based cardiac rehabilitation increases peak oxygen uptake (peak VO₂), which is an important predictor of mortality in cardiac patients. However, it remains unclear which exercise characteristics are most effective for improving peak VO₂ in coronary artery disease (CAD) patients. Proof of concept papers comparing Aerobic Interval Training (AIT) and Moderate Continuous Training (MCT) were conducted in small sample sizes and findings were inconsistent and heterogeneous. Therefore, we aimed to compare the effects of AIT and Aerobic Continuous Training (ACT) on peak VO₂, peripheral endothelial function, cardiovascular risk factors, quality of life and safety, in a large multicentre study., Methods: Two-hundred CAD patients (LVEF >40%, 90% men, mean age 58.4 ± 9.1 years) were randomized to a supervised 12-week cardiac rehabilitation programme of three weekly sessions of either AIT (90-95% of peak heart rate (HR)) or ACT (70-75% of peak HR) on a bicycle. Primary outcome was peak VO₂; secondary outcomes were peripheral endothelial function, cardiovascular risk factors, quality of life and safety., Results: Peak VO₂ (ml/kg/min) increased significantly in both groups (AIT 22.7 ± 17.6% versus ACT 20.3 ± 15.3%; p-time<0.001). In addition, flow-mediated dilation (AIT+34.1% (range -69.8 to 646%) versus ACT+7.14% (range -66.7 to 503%); p-time<0.001) quality of life and some other cardiovascular risk factors including resting diastolic blood pressure and HDL-C improved significantly after training. Improvements were equal for both training interventions., Conclusions: Contrary to earlier smaller trials, we observed similar improvements in exercise capacity and peripheral endothelial function following AIT and ACT in a large population of CAD patients., (Copyright © 2014. Published by Elsevier Ireland Ltd.)

Background: Exercise training improves exercise capacity (peakVO2), which is closely related to long-term survival in cardiac patients. However, it remains unclear which type and intensity of exercise is most effective for improving exercise tolerance and body weight. Individual studies suggest that aerobic interval training (AIT) might increase peakVO2 more in this population., Objective: We conducted a meta-analysis to summarize the effects of AIT compared with moderate continuous training (MCT) on peakVO2, submaximal exercise capacity, and body weight in patients with coronary artery disease (CAD) with preserved and/or reduced left ventricular ejection fraction (LVEF)., Data Sources and Study Selection: A systematic search was conducted and we included randomized trials comparing AIT and MCT in CAD patients lasting at least 4 weeks, reporting peakVO2 results, and published in a peer-reviewed journal up to May 2013. The primary outcome measure was peakVO2. Secondary outcomes were submaximal exercise capacity parameters and body weight., Synthesis Methods: Random- and fixed-effects models were used and data were reported as weighted means and 95% confidence intervals (CIs)., Results: Nine study groups were included, involving 206 patients (100 AIT, 106 MCT). Overall, AIT resulted in a significantly larger increase in peakVO2 [+1.60 mL/kg/min (95% CI 0.18-3.02; p = 0.03)] compared with MCT. MCT seemed to be more effective in reducing body weight (-0.78 kg; 95% CI -0.01 to 1.58; p = 0.05)., Limitations: The small number of studies might have affected the power to reach significance for the secondary outcomes., Conclusion: In CAD patients with preserved and/or reduced LVEF, AIT is superior to MCT for improving peakVO2, while MCT seems to be more effective in reducing body weight. However, large, well-designed, randomized controlled trials are warranted to confirm these findings.

Hypertension, or the chronic elevation in resting arterial blood pressure (BP), is a significant risk factor for cardiovascular disease and estimated to affect ~1 billion adults worldwide. The goals of treatment are to lower BP through lifestyle modifications (smoking cessation, weight loss, exercise training, healthy eating and reduced sodium intake), and if not solely effective, the addition of antihypertensive medications. In particular, increased physical exercise and decreased sedentarism are important strategies in the prevention and management of hypertension. Current guidelines recommend both aerobic and dynamic resistance exercise training modalities to reduce BP. Mounting prospective evidence suggests that isometric exercise training in normotensive and hypertensive (medicated and non-medicated) cohorts of young and old participants may produce similar, if not greater, reductions in BP, with meta-analyses reporting mean reductions of between 10 and 13 mmHg systolic, and 6 and 8 mmHg diastolic. Isometric exercise training protocols typically consist of four sets of 2-min handgrip or leg contractions sustained at 20-50 % of maximal voluntary contraction, with each set separated by a rest period of 1-4 min. Training is usually completed three to five times per week for 4-10 weeks. Although the mechanisms responsible for these adaptations remain to be fully clarified, improvements in conduit and resistance vessel endothelium-dependent dilation, oxidative stress, and autonomic regulation of heart rate and BP have been reported. The clinical significance of isometric exercise training, as a time-efficient and effective training modality to reduce BP, warrants further study. This evidence-based review aims to summarize the current state of knowledge regarding the effects of isometric exercise training on resting BP.