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Hypertension is the leading risk factor for cardiovascular disease and an independent predictor of mortality. The prevalence of hypertension has doubled in the last two decades and evidence suggests that almost half the individuals are unaware of their condition. The antihypertensive effects of exercise are now undisputable, and exercise training is recommended by the major professional and scientific societies, including the American College of Sports Medicine (ACSM), as first-line treatment to prevent, treat, and control hypertension. This review aims to overview the evidence supporting the current ACSM Frequency, Intensity, Time, and Type exercise recommendations for hypertension, discuss new and emerging evidence on exercise in the treatment of hypertension from our laboratories; and propose future directions of research integrating this new and emerging evidence.

Highlights • First study that directly compared Tai Ji Quan trials published in English and Chinese with meta-regression analysis in the largest sample to date • In trials published in English, Tai Ji Quan reduces systolic blood pressure by 10 mm Hg and diastolic blood pressure 4 mm Hg among adults with hypertension • In trials published in Chinese, Tai Ji Quan reduces systolic pressure by 19 mm Hg and diastolic pressure by 9 mm Hg among adults with hypertension • More confidence should be placed in Tai Ji Quan trials published in English due to their higher methodological quality compared to trials published in Chinese, Background Professional health organizations are not currently recommending Tai Ji Quan alongside aerobic exercise to treat hypertension. We aimed to examine the efficacy of Tai Ji Quan as antihypertensive lifestyle therapy. Methods Tai Ji Quan interventions published in English and Chinese were included when they involved healthy adults, reported pre- and post-intervention blood pressure (BP), and had a non-exercise/non-diet control group. We systematically searched 11 electronic databases for studies published through July 31, 2018, yielding 31 qualifying controlled trials. We (1) evaluated the risk of bias and methodological study quality, (2) performed meta-regression analyses following random-effects assumptions, and (3) generated additive models representing the largest possible clinically relevant BP reductions. Results Participants (n = 3223) were middle-aged (56.6 ± 15.1 years of age, mean ± SD) adults with prehypertension (systolic BP (SBP) = 136.9 ± 15.2 mmHg, diastolic BP (DBP) = 83.4 ± 8.7 mmHg). Tai Ji Quan was practiced 4.0 ± 1.4 sessions/week for 54.0 ± 10.6 min/session for 22.3 ± 20.2 weeks. Overall, Tai Ji Quan elicited significant reductions in SBP (–11.3 mmHg, 95%CI: –14.6 to –8.0; d+ = –0.75) and DBP (–4.8 mmHg, 95%CI: –6.4 to –3.1; d+ = –0.53) vs. control (p < 0.001). Controlling for publication bias among samples with hypertension, Tai Ji Quan trials published in English elicited SBP reductions of 10.4 mmHg and DBP reductions of 4.0 mmHg, which was half the magnitude of trials published in Chinese (SBP reductions of 18.6 mmHg and DBP reductions of 8.8 mmHg). Conclusion Our results indicate that Tai Ji Quan is a viable antihypertensive lifestyle therapy that produces clinically meaningful BP reductions (i.e., 10.4 mmHg and 4.0 mmHg of SBP and DBP reductions, respectively) among individuals with hypertension. Such magnitude of BP reductions can lower the incidence of cardiovascular disease by up to 40%., Graphical Abstract Image, graphical abstract

Monteiro, ER, Pescatello, LS, Winchester, JB, Correa Neto, VG, Brown, AF, Budde, H, Marchetti, PH, Silva, JG, Vianna, JM, and Novaes, JdS. Effects of manual therapies and resistance exercise on postexercise hypotension in women with normal blood pressure. J Strength Cond Res XX(X): 000-000, 2021-The purpose of this investigation was to examine the acute effects of resistance exercise (RE) and different manual therapies (static stretching and manual massage [MM]) performed separately or combined on blood pressure (BP) responses during recovery in women with normal BP. Sixteen recreationally strength-trained women (age: 25.1 ± 2.9 years; height: 158.9 ± 4.1 cm; body mass: 59.5 ± 4.9 kg; body mass index: 23.5 ± 1.9 kg·m-2; baseline systolic BP median: 128 mm Hg; and baseline diastolic BP median: 78 mm Hg) were recruited. All subjects performed 6 experiments in a randomized order: (a) rest control (CON), (b) RE only (RE), (c) static-stretching exercise only (SS), (d) MM only, (e) RE immediately followed by SS (RE + SS), and (f) RE immediately followed by MM (RE + MM). RE consisted of 3 sets of bilateral bench press, back squat, front pull-down, and leg press exercises at 80% of 10RM. Static stretching and MM were applied unilaterally in 2 sets of 120 seconds to each of the quadriceps, hamstring, and calf regions. Systolic (SBP) and diastolic BP were measured before (rest) and every 10 minutes for 60 minutes following (Post 10-60) each intervention. There were significant intragroup differences for RE in Post-50 (p = 0.038; d = -2.24; [INCREMENT] = -4.0 mm Hg). Similarly, SBP intragroup differences were found for the SS protocol in Post-50 (p = 0.021; d = -2.67; [INCREMENT] = -5.0 mm Hg) and Post-60 (p = 0.008; d = -2.88; [INCREMENT] = -5.0 mm Hg). Still, SBP intragroup differences were found for the MM protocol in Post-50 (p = 0.011; d = -2.61; [INCREMENT] = -4.0 mm Hg) and Post-60 (p = 0.011; d = -2.74; [INCREMENT] = -4.0 mm Hg). Finally, a single SBP intragroup difference was found for the RE + SS protocol in Post-60 (p = 0.024; d = -3.12; [INCREMENT] = -5.0 mm Hg). Practitioners should be aware that SS and MM have the potential to influence BP responses in addition to RE or by themselves and therefore should be taken into consideration for persons who are hypertensive or hypotensive.

Background: Exercise in pregnancy favorably affects maternal and fetal outcomes, yet only 50% of women receive exercise guidance during prenatal care and 15% are told to stop exercising. Reasons for clinician reluctance to recommend exercise include safety concerns and ambiguity of recommendations. To better inform clinicians, this systematic review assembled a consensus exercise prescription (ExRx) for healthy pregnant women framed by the Frequency, Intensity, Time, and Type (FITT) principle. Methods: In April 2021, PubMed, Scopus, SPORTDiscus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane databases were searched. Reports were eligible if: (1) targeted healthy pregnant women, (2) framed the ExRx by the FITT, and (3) published by a professional society from 2000 to 2021 in English. The Appraisal of Guidelines for Research and Evaluation II tool assessed risk of bias. Results: Twelve reports of poor to good quality were included. Nine societies conducted systematic reviews, but only three provided a detailed, transparent description of the review conducted. Although the FITT varied, the most common was most days of the week, moderate intensity, 30 minutes/session to accumulate 150 minutes/week, and aerobic, resistance, and flexibility exercise with three societies advising neuromotor exercise. All professional societies specified activities to avoid and eight societies included contraindications to exercise. Conclusions: This systematic review produced a consensus ExRx for healthy pregnant women to better inform clinicians about advising their patients to exercise during pregnancy. Future research is needed to determine the upper limits of exercise while pregnant and provide better informed guidance relating to safety concerns for women who are pregnant.

INTRODUCTION High salt intake is a widespread cardiovascular risk factor with systemic effects. These effects include an expansion of plasma volume, which may interfere with postexercise hypotension (PEH). However, the effects of high salt intake on central and peripheral indices of PEH remain unknown. We tested the hypothesis that high salt intake would attenuate central and peripheral PEH. METHODS Nineteen healthy adults (7 female/12 male; age, 25 ± 4 yr; body mass index, 23.3 ± 2.2 kg·m; V[Combining Dot Above]O2peak, 41.6 ± 8.7 mL·min·kg; systolic blood pressure (BP), 112 ± 9 mm Hg; diastolic BP, 65 ± 9 mm Hg) participated in this double-blind, randomized, placebo-controlled crossover study. Participants were asked to maintain a 2300 mg·d sodium diet for 10 d on two occasions separated by ≥2 wk. Total salt intake was manipulated via ingestion of capsules containing either table salt (3900 mg·d) or placebo (dextrose) during each diet. On the 10th day, participants completed 50 min of cycling at 60% V[Combining Dot Above]O2peak. A subset of participants (n = 8) completed 60 min of seated rest (sham trial). Beat-to-beat BP was measured in-laboratory for 60 min after exercise via finger photoplethysmography. Brachial and central BPs were measured for 24 h after exercise via ambulatory BP monitor. RESULTS Ten days of high salt intake increased urinary sodium excretion (134 ± 70 (dextrose) vs 284 ± 74 mmol per 24 h (salt), P < 0.001), expanded plasma volume (7.2% ± 10.8%), and abolished PEH during in-laboratory BP monitoring (main effect of diet, P < 0.001). Ambulatory systolic BPs were higher for 12 h after exercise during the salt and sham trials compared with the dextrose trial (average change, 3.6 ± 2.1 mm Hg (dextrose), 9.9 ± 1.4 mm Hg (salt), 9.8 ± 2.5 mm Hg (sham); P = 0.01). Ambulatory central systolic BP was also higher during the salt trial compared with dextrose trial. CONCLUSION High salt intake attenuates peripheral and central PEH, potentially reducing the beneficial cardiovascular effects of acute aerobic exercise.

Context:Compression socks have become increasingly popular with athletes due to perceived enhancement of exercise performance and recovery. However, research examining the efficacy of compression socks to reduce exercise-associated muscle damage has been equivocal, with few direct measurements of markers of muscle damage.Objective:To examine the influence of compression socks worn during a marathon on creatine kinase (CK) levels.Design:A randomized controlled trial.Setting:2013 Hartford Marathon, Hartford, CT.Participants:Adults (n = 20) randomized to control (CONTROL; n = 10) or compression sock (SOCK; n = 10) groups.Main Outcome Measures:Blood samples were collected 24 hours before, immediately after, and 24 hours following the marathon for the analysis of CK, a marker of muscle damage.Results:Baseline CK levels did not differ between CONTROL (89.3 [41.2] U/L) and SOCK (100.0 [56.2] U/L) (P = .63). Immediately following the marathon (≤1 h), CK increased 273% from baseline (P P = .60 for time × group). The day following the marathon (≤24 h), CK further increased 1094% from baseline (P P = .53 for time × group). These similar trends persisted despite controlling for potential covariates such as age, body mass index, and race finishing time (Ps > .29).Conclusions:Compression socks worn during a marathon do not appear to mitigate objectively measured markers of muscle damage immediately following and 24 hours after a marathon.

Venous thromboembolic (VTE) events such as deep vein thrombosis (DVT) and pulmonary embolism (PE) have been reported in otherwise low-risk healthy athletes following acute bouts of aerobic exercise.To review case reports and assess the commonalities of athletic individuals with VTE, as well as return-to-play (RTP) recommendations.We reviewed 47 reports (20 DVTs, 15 PEs, and 12 DVTs/PEs, 19 women) of trained individuals who were diagnosed with DVT and/or PE following aerobic exercise. We assessed frequency of VTE risk factors, presenting symptoms, and RTP recommendations.The age of women (24.6 ± 7.0 years) was lower (P .01) than of men (40.6 ± 13.6 years). Of the 19 women, 14 (73.7%) used oral contraceptives. Thirteen cases (27.7%) reported a recent period of prolonged inactivity (1 hour), and another 12 cases were found to have an antithrombin disorder following testing after diagnosis. The most frequently reported symptoms were muscle pain in 26 of 32 (81.3%) DVT or DVT/PE cases, and dyspnea in 21 of 27 (77.8%) PE or DVT/PE cases. Despite these common symptoms, the estimated time from first report of symptoms to confirmed diagnosis was 56.3 ± 118.7 days and 25 cases (53.2%) were initially misdiagnosed. Twenty-three cases (48.9%) did not report RTP recommendations, and those which did varied widely.Thirty-two cases (~70%) had at least one of three major risk factors, suggesting that many cases of VTE in athletes may be preventable with better education and awareness. The wide variety of RTP recommendations highlights the need for standardized guidelines in this population.

PurposeThis systematic umbrella review examines and updates the evidence on the relationship between physical activity (PA) and blood pressure (BP) presented in the 2008 Physical Activity Guidelines Advisory Committee Scientific Report.MethodsWe performed a systematic review to identify syst

Insufficient 25-hydroxyvitamin D [25(OH)D] levels are associated with high resting blood pressure (BP). However, the relationship between 25(OH)D and the peak systolic BP (SBP) response to exercise, a predictor of future hypertension, has yet to be investigated. We sought to examine the relationship among serum 25(OH)D and the peak SBP response to a graded exercise stress test (GEST) among a large sample (n = 417) of healthy men (49%) and women (51%) over a broad age range (20–76 years; mean age: 44.1 ± 0.8 years). We hypothesized that individuals with clinically insufficient 25(OH)D would have a greater peak SBP response to a GEST compared to individuals with sufficient 25(OH)D levels. Fasting serum 25(OH)D, anthropometrics, resting BP, and peak exercise SBP were obtained at the baseline visit of a larger clinical trial (STOMP; NCT01140308). Mean 25(OH)D levels were 36.1 ± 0.7 ng/ml, with ∼35% of individuals classified as insufficient (p = 1.000). One unexpected finding emerged such that individuals with sufficient 25(OH)D had higher resting SBP (120 ± 14 mmHg vs. 117 ± 13 mmHg; p = .020) than individuals with insufficient 25(OH)D. In contrast to our hypothesis, 25(OH)D levels were not associated with the peak SBP response to a GEST. Baseline 25(OH)D levels were positively correlated with resting SBP; however, the magnitude of this effect is likely not clinically meaningful.

Background: Systematic reviews (SRs) and meta-analyses (MAs) have proliferated with a concomitant increase in reviews of SRs/MAs or “meta-reviews” (MRs). As uncovered by the 2018 US Physical Activity Guidelines Advisory Committee (PAGAC), there is a paucity of best practice guidance on MRs on physical activity health-related research. This manuscript aims to fill this gap. Methods: In total, the PAGAC conducted 38 literature searches across 3 electronic databases and triaged 20,838 titles, 4913 abstracts, and 2139 full texts from which 1130 articles qualified for the PAGAC Scientific Report. Results: During the MR process, the following challenges were encountered: (1) if the SR/MA authors had limited experience in synthesis methodology, they likely did not account for risk of bias in the conclusions they reached; (2) many SRs/MAs reviewed the same primary-level studies; (3) many SRs/MAs failed to disclose effect modifier analyses; (4) source populations varied; (5) physical activity exposures were nonstandardized; and (6) dose–response effects or effect modification of the physical activity exposure could not be identified. Conclusions: Using examples from the PAGAC Scientific Report, we provide (1) a high-level introduction to MRs; (2) recommended steps in conducting a MR; (3) challenges that can be encountered; and (4) guidance in addressing these challenges.

Objectives We performed a systematic review and meta-analysis to examine the effect of body fat on thermoregulatory responses to exercise in the heat. Design Systematic Review and Meta-analysis. Methods We systematically searched databases (N = 8) for studies that included: healthy participants; an aerobic exercise intervention under heat stress; a measure of body fat by a high and low body fat group; pre- and post-exercise internal temperature, and/or post-exercise mean skin temperature and whole body sweat loss. Criteria to distinguish high body fat and low body fat were determined by each qualifying study. Out of 1222 potential studies, 10 qualified. Robust variance estimation models were utilized to determine the pooled effect size (ES, 95% CI) for interventions that performed unbias comparisons between groups. Results Participants (n = 211) were mostly male (70%) and young (19.3 ± 7.1 years) with a maximal oxygen consumption of 50.42 ± 9.3 ml∙kg-1∙min-1 by high body fat (36.7 ± 11.8%) and low body fat (17.8 ± 5.7%). Exercise duration was between 30 and 60 min at moderate-high intensity (44.1-71.4% VO2max) at 28-40.3 °C and 26-50% humidity. Of the 7 interventions that normalized metabolic heat production to body mass and 5 interventions that normalized to external workload, there were no differences in any of the three outcome variables between groups. Conclusions Many of the included studies did not control for confounding factors that may affect the relationship between body fat and thermoregulation during exercise in the heat such as metabolic heat production and body mass. Given the small number of interventions included, future work must make unbiased comparisons to appropriately assess the independent influence of body fat.

Hypertension is the major risk factor for cardiovascular disease (CVD)—the leading global cause of death.1 2 High systolic blood pressure (SBP) is the top health risk factor for the global burden of disease.2 3 The CVD mortality and morbidity benefits of antihypertensive medications are well established, and their use to treat hypertension is increasing worldwide.4 5 These trends will continue as the American Heart Association (AHA) and American College of Cardiology (ACC) recently established lower blood pressure (BP) thresholds for treatment.6 Exercise was rated in the AHA/ACC report as one of the best non-pharmacological approaches to treat hypertension because aerobic exercise training lowers BP 5–8 mm Hg among adults with hypertension.6 7 The magnitude of these BP reductions may lower CVD risk by 4%–22% and stroke by 6%–41%,4 8 and reduce the resting BP of adults with hypertension into normal ranges. Accordingly, professional organisations from around the world recommend adults with hypertension participate in 30–60 min/day of moderate to vigorous intensity aerobic exercise, such as walking or jogging, on most days of the week with the recommendations for resistance training less consistent9 (table 1). View this table: Table 1 Professional Committee Exercise Recommendations for Hypertension (adapted from Pescatello et al 9) Despite the well documented BP benefits of medications and exercise to treat hypertension, the 2018 Physical Activity Guidelines Advisory Committee (PAGAC) noted in their …

Cordeiro, R, Monteiro, W, Cunha, F, Pescatello, LS, and Farinatti, P. Influence of acute concurrent exercise performed in public fitness facilities on ambulatory blood pressure among older adults in Rio de Janeiro city. J Strength Cond Res 32(10): 2962-2970, 2018-The project "Third-Age Academies'" (TAAs) is a public policy providing supervised physical activities to over 40,000 seniors at open-access facilities (squares etc.) in Rio de Janeiro, Brazil. We investigated whether TAA concurrent exercise circuit induced postexercise hypotension (PEH) in individuals older than 60 years. Blood pressure (BP) was measured by 24-hour ambulatory BP monitoring (ABPM) after counterbalanced CEX and nonexercise (CONT) sessions (n = 16; 66.8 ± 1.4 years; systolic/diastolic BP (SBP/DBP): 132.5 ± 4.3/78.0 ± 2.8 mm Hg). For statistical analyses purposes, groups were divided as exhibiting normal SBP (≤120 mm Hg) or high SBP (>120 mm Hg), based on 24-hour ABPM after CONT. The CEX included 2 aerobic and 9 resistance exercises performed alternately in circuit order (40 minutes at 60-70% heart rate reserve using body mass or fixed loads). 24-hour ambulatory BP monitoring lowered in individuals with high BP (n = 11; medicated = 5) (SBP: -6.5 ± 1.9 mm Hg; mean arterial pressure [MAP]: -4.3 ± 1.5 mm Hg; p < 0.015), particularly within the first 5-6 hours after exercise (SBP: -13.5 ± 2.6 mm Hg; DBP: -9.4 ± 2.2 mm Hg; and MAP: -11.4 ± 1.6 mm Hg, p < 0.05). Significant BP lowering was not detected among participants with normal BP (n = 5; medicated = 4). In conclusion, CEX provoked PEH in older adults with prehypertension to established hypertension. Because of the potential of TAAs to reach large numbers of older adults, our findings are encouraging and should be confirmed in subsequent studies.

BackgroundPostexercise hypotension (PEH) is the immediate reduction in blood pressure (BP) of 5–8 mmHg that occurs after a single bout of aerobic exercise among adults with hypertension. Across PEH studies, there are variations in the level of rigor of the study designs and methods that limit the conclusions that can be made about PEH.ObjectiveTo develop and then apply a methodological study quality evaluation checklist to aerobic exercise PEH studies to provide methodological guidance.MethodsWe developed a PEH checklist (PEH√list) based upon contemporary methodological study quality standards. The PEH√list contains 38 items divided into three categories: sample (n = 10 items), study (n = 23 items), and intervention characteristics (n = 5 items). We then systematically searched six databases to January 2019 to identify and then evaluate studies that: (1) enrolled adults ≥18 years with hypertension and without other chronic diseases or conditions; (2) included a bout of aerobic exercise and a non-exercise control session; and (3) were published in English.ResultsOf 17,149 potential studies, 64 qualified. Participants (N = 1,489) were middle-aged (38.6 ± 15.6 year), overweight (26.1 ± 2.5 kg/m2) mostly men (64.4%) with elevated BP (systolic BP 129.5 ± 15.2/diastolic BP 81.0 ± 10.1 mmHg). Overall, the qualifying studies satisfactorily reported 53.9 ± 13.3% (24.2–82.8%) of the relevant items on the PEH√list. Of note, only 20.3% of the studies disclosed BP was measured following professional guidelines, 18.8% reported BP was taken by the same assessor pre- and post-intervention, and 35.5% stated participants abstained from caffeine, alcohol, and physical activity prior to testing. Half (51.5%) indicated they statistically controlled for pre-exercise/baseline BP. Meanwhile, 100% of the studies reported the setting in which the BP measurements were taken, time from the end of the exercise to the start of the BP measurements, and if relevant, the length of the ambulatory BP monitoring period.ConclusionOverall, the PEH√list items were not well satisfied; especially items with potential confounding effects on PEH. We contend the PEH√list provides guidance to investigators on the important methodological study considerations in PEH aerobic exercise studies that should be attended to in the future.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [#CRD42020221996].

Considerable variability exists in the cardiometabolic disease biomarker response to exercise. We propose that a major contributor to this heterogeneity is underpowered studies due to small sample sizes. To test our hypothesis, we conducted a systematic review to identify meta-analyses/reviews of randomized controlled trials (RCT) and RCT that examined the cardiometabolic disease biomarker response to aerobic and resistance exercise.

PURPOSE. To conduct a systematic literature review to determine if physical activity is associated with prevention of weight gain in adults. METHODS. The primary literature search was conducted for the 2018 Physical Activity Guidelines Advisory Committee and encompassed literature through June 2017, with an additional literature search conducted to include literature published through March 2018 for inclusion in this systematic review. RESULTS. The literature review identified 40 articles pertinent to the research question. There is strong evidence of an association between physical activity and prevention of weight gain in adults, with the majority of the evidence from prospective cohort studies. Based on limited evidence in adults, however, there is a dose-response relationship and the prevention of weight gain is most pronounced when moderate-to-vigorous intensity physical activity (≥3 METS) is above 150 minutes per week. While there is strong evidence to demonstrate that the relationship between greater time spent in physical activity and attenuated weight gain in adults is observed with moderate-to-vigorous intensity physical activity, there is insufficient evidence available to determine if there is an association between light-intensity activity (

Rocha, J, Cunha, FA, Cordeiro, R, Monteiro, W, Pescatello, LS, and Farinatti, P. Acute effect of a single session of Pilates on blood pressure and cardiac autonomic control in middle-aged adults with hypertension. J Strength Cond Res 34(1): 114-123, 2020-We investigated the blood pressure (BP) and heart rate variability (HRV) responses to a single session of Pilates among adults with hypertension. Thirteen participants (7 women), aged 44-66 years, underwent Pilates and nonexercise control sessions separated by 48-72 hours in a randomized counterbalanced order. Blood pressure and HRV indices were simultaneously assessed 10 minutes before and 60 minutes after all sessions in the supine position: root mean square of successive differences (rMSSD), percentage of successive normal sinus RR intervals >50 ms (pNN50), SD of all normal sinus RR intervals over 24 hours (SDNN), and low-frequency (LF) and high-frequency (HF) bands. After an acute session of Pilates, the mean values for area under the curve for systolic BP (p = 0.004, corresponding to -7.4 ± 8.2 mm Hg) and mean arterial pressure (p = 0.023, corresponding to -5.3 ± 5.4 mm Hg) were significantly lower compared to the control session. No significant difference was detected for diastolic BP (-4.2 ± 4.7 mm Hg, p = 0.106). Concomitant to BP reduction, significant lowering of parasympathetic HRV indices occurred: RR intervals (-64.1 ± 69.9 ms·min, p = 0.043), rMSSD (-8.3 ± 15.4 ms·min, p = 0.013), pNN50 (-3.6 ± 13%·min, p = 0.028), and total power (-3,089.4 ± 5,938 m·min, p = 0.037). No difference was found for sympathetic markers: SDNN (-17.7 ± 34.6 ms·min, p = 0.100), LF (-5.2 ± 21,6 n.u.·min, p = 0.417), and LF:HF ratio (-0.3 ± 5.2 ratio·min, p = 0.422). In conclusion, a single session of Pilates reduced BP by ∼5-8 mm Hg in adults with hypertension during the first 60 minutes of post-exercise recovery. Acute BP reduction was concomitant to lowered cardiac parasympathetic activity. Our findings are promising for the use of Pilates as an alternative exercise modality to lower BP.

Aerobic exercise training and, to a lesser degree, dynamic resistance training, are recommended to lower blood pressure (BP) among adults with hypertension. Yet the combined influence of these exercise modalities, termed concurrent exercise training (CET), on resting BP is unclear.This study aimed to meta-analyze the literature to determine the efficacy of CET as antihypertensive therapy.Electronic databases were searched for trials that included the following: adults (19 yr), controlled CET interventions, and BP measured pre- and postintervention. Study quality was assessed with a modified Downs and Black Checklist. Analyses incorporated random-effects assumptions.Sixty-eight trials yielded 76 interventions. Subjects (N = 4110) were middle- to older-age (55.8 ± 14.4 yr), were overweight (28.0 ± 3.6 kg·m), and had prehypertension (systolic BP [SBP]/diastolic BP [DBP] = 134.6 ± 10.9/80.7 ± 7.5 mm Hg). CET was performed at moderate intensity (aerobic = 55% maximal oxygen consumption, resistance = 60% one-repetition maximum), 2.9 ± 0.7 d·wk for 58.3 ± 20.1 min per session for 19.7 ± 17.8 wk. Studies were of moderate quality, satisfying 60.7% ± 9.4% of quality items. Overall, CET moderately reduced SBP (db = -0.32, 95% confidence interval [CI] = -0.44 to -0.20, -3.2 mm Hg) and DBP (db = -0.35, 95% CI = -0.47 to -0.22, -2.5 mm Hg) versus control (P0.01). However, greater SBP/DBP reductions were observed among samples with hypertension in trials of higher study quality that also examined BP as the primary outcome (-9.2 mm Hg [95% CI = -12.0 to -8.0]/-7.7 mm Hg [95% CI = -14.0 to -8.0]).Among samples with hypertension in trials of higher study quality, CET rivals aerobic exercise training as antihypertensive therapy. Because of the moderate quality of this literature, additional randomized controlled CET trials that examine BP as a primary outcome among samples with hypertension are warranted to confirm our promising findings.

ObjectiveTo compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension.Data sourcesPubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library.Eligibility criteriaRandomised controlled trails (RCTs) or meta-analyses (MAs) of controlled trials that: (1) involved healthy adults>18 year with hypertension; (2) investigated exercise and BP; (3) reported preintervention and postintervention BP and (4) were published in English. RCTs had an EX+MEDScombined arm; and an EXalone arm and/or an MEDSalone arm; and MAs performed moderator analyses.DesignA systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system.OutcomeThe BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other.ResultsTwelve RCTs qualified with 342 subjects (60% women) who were mostly physically inactive, middle-aged to older adults. There were 13 qualifying MAs with 28 468 participants (~50% women) who were mostly Caucasian or Asian. Most RCTs were aerobic (83.3%), while the MAs involved traditional (46%) and alternative (54%) exercise types. Strong evidence demonstrates EXalone, MEDSalone and EX+MEDScombined reduce BP and EX+MEDScombined elicit BP reductions less than the sum of their parts. Strong evidence indicates EX+MEDScombined potentiate the BP effects of MEDSalone. Although the evidence is stronger for alternative than traditional types of exercise, EXaloneelicits greater BP reductions than MEDSalone.ConclusionsThe combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone.PROSPERO registration numberThe protocol is registered at PROSPERO CRD42020181754.

The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides the evidence base for the Physical Activity Guidelines for Americans, 2nd Edition.The 2018 Physical Activity Guidelines Advisory Committee addressed 38 questions and 104 subquestions selected for their public health relevance, potential to inform public policies and programs, maturity of the relevant science, and applicability to the general US population. Rigorous systematic literature searches and literature reviews were performed using standardized methods.Newly described benefits of physical activity include reduced risk of excessive weight gain in children and adults, incidence of 6 types of cancer, and fall-related injuries in older people. Physical activity is associated with enhanced cognitive function and mental health across the life span, plus improved mental health and physical function. There is no threshold that must be exceeded before benefits begin to accrue; the accrual is most rapid for the least active individuals. Sedentary time is directly associated with elevated risk of all-cause and cardiovascular mortality, incident cardiovascular disease and type 2 diabetes, and selected cancer sites. A wide range of intervention strategies have demonstrated success in increasing physical activity.The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides compelling new evidence to inform physical activity recommendations, practice, and policy.

Resting cardiac vagal modulation (RCVM) and postexercise vagal reactivation (PEVR) are markers of parasympathetic activity. We investigated whether adaptations in these markers to aerobic training are influenced by baseline autonomic control.Forty healthy men (19.2 ± 0.8 yr) of similar cardiorespiratory fitness (VO₂peak = 50.4 ± 5.7 mL·kg⁻¹·min⁻¹) completed the study, being matched for autonomic activity and randomized into four groups: training low-RCVM (TL; n = 11, high-frequency power component [HF] = 48.1 ± 8.2 normalized units [n.u.]) and high-RCVM (TH; n = 11, HF = 63.1 ± 5.9 n.u.) and nonexercise control low-RCVM (CL; n = 9, HF = 47.1 ± 7.5 n.u) and high-RCVM (CH; n = 9, HF = 65.5 ± 8.3 n.u.). Aerobic training groups exercised 3 d·wk⁻¹ for 40 min at 75%-85% HR reserve for 12 wk. Before and after the training period, sequences of 5-min R-R intervals were recorded at rest and immediately after maximal treadmill test to estimate (a) RCVM (HF) and (b) PEVR (root mean square of successive R-R differences-rMSSD(3-5min) = mean value from 3 to 5 min of recovery).Training improved VO₂peak in TL (11.7% ± 5.4%, P0.01) and TH (7.0% ± 2.9%, P0.01), with no difference between groups (P = 0.70), but not in CL (0.8% ± 3.9%) and CH (1.8% ± 6.2%, P = 0.90). Only TL increased RCVM (56.6 ± 13.3 n.u., P = 0.03), approaching TH level (58.9 ± 12.3 n.u.; P = 0.60); rMSSD(3-5min) increased in both training groups (P0.01) but not in controls (P = 0.99). Relative changes in RCVM (ΔHF%) and PEVR (ΔrMSSD(3-5min)%) were significantly correlated in TL (r = 0.61, P = 0.04).PEVR after exercise increased in both exercise training groups, whereas RCVM increased only in the group with low vagal activity at baseline. Vagal reactivation may be improved by aerobic training, even when basal activity remains unaltered.

OBJECTIVE To investigate the effect of oral contraceptive (OC) use and compression socks on hemostatic activation in women flying cross-country to and from a marathon. DESIGN Prospective study. SETTING 2015 Boston Marathon. PARTICIPANTS Women were divided into non-OC using (CONTROL; n = 12), OC-using (OC; n = 15), and OC-using plus compression sock (OC + SOCK; n = 14) groups. INTERVENTION Women in OC + SOCK wore compression socks during flights to and from the marathon. MAIN OUTCOME MEASURES Venous blood samples were collected within 24 hours of arriving in Boston (EXPO), immediately after the marathon (RUN), and within 24 hours after a return flight home (Post-Flight) for analysis of thrombin-antithrombin complex (TAT), d-dimer, and tissue plasminogen activator (t-PA). RESULTS TAT did not increase with exercise (P = 0.48) and was not affected by group (P = 0.08) or the interaction between these 2 factors (P = 0.80). Group, time, and their interaction were significant for d-dimer (all P < 0.05) such that d-dimer increased with acute exercise to a greater extent (Δ d-dimer from expo to postrace = 909.5 ± 1021.9 ng/mL) in the OC + SOCK group relative to OC (Δ d-dimer = 240.0 ± 178.5 ng/mL; P = 0.02) and CONTROL (Δ d-dimer = 230.3 ± 120.3 ng/mL; P = 0.02). There was a significant effect of time, group, and the interaction on t-PA (all P < 0.01) such that t-PA increased with acute exercise to a greater extent (Δ t-PA from expo to postrace = 19.6 ± 10.0 ng/mL) in the CONTROL group relative to OC (Δ t-PA = 4.0 ± 1.8 ng/mL; P < 0.01) and OC + SOCK (Δ t-PA = 3.3 ± 1.2 ng/mL; P < 0.01). CONCLUSIONS Female runners using OCs did not exhibit disproportionately increased coagulation. The use of compression socks in women on OCs, surprisingly, resulted in a greater increase in d-dimer after exercise.

There are an increasing number of reports describing deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in otherwise healthy endurance athletes. The Wells score is the most commonly used clinical prediction rule to diagnose DVT/PE in clinical populations. However, the Wells score may have limited utility for recognition of DVT/PE in athletes, contributing to missed or delayed diagnosis.We performed an analysis of the ability of the Wells score to identify DVT/PE events in athletes through a review of published case reports.A systematic search of the literature yielded 11 case reports.The Wells score had a 100% failure rate in identifying athletes with DVT (0/6) and PE (0/5), resulting in a delayed diagnosis for DVT of 20 ± 14 days. Retrospectively removing 'differential diagnosis' from the clinical prediction rule for DVT changed the Wells score median from 0 (range: -1 to 0) to 2 (range: 1 to 2); the threshold for predicting DVT as 'likely'. There were limited clinical characteristics captured in the Wells score for PE that were applicable to athletes, highlighting the need for reappraisal. Although the Wells score failed to accurately triage athletes with known DVT and/or PE, the addition of a D-dimer value (mean: 1566 ± 758ng/dL) to the Wells score correctly identified 9/9 athletes.The Wells score had a 100% failure rate for triaging athletes with known DVT/PE. When performed, D-dimer adequately facilitated the additional diagnostic testing required for a timely diagnosis of DVT/PE in athletes. Improving awareness of an atypical presentation of thrombotic events in athletes may reduce the widespread underestimation of DVT/PE among athletes and facilitate the additional testing required for a timely diagnosis.

Context: Athletic trainers recommend and use a multitude of rehydration (REHY) methods with their patients. The REHY modality that most effectively facilitates recovery is unknown. Objective: To compare 5 common REHY methods for thermoregulatory and stress hormone recovery after exercise dehydration (EXDE) in trained participants. Design: Randomized, cross-over, controlled study. Patients or Other Participants: Twelve physically active, non–heat-acclimatized men (age = 23 ± 4 years, height = 180 ± 6 cm, mass = 81.3 ± 3.7 kg, V̇o2max = 56.9 ± 4.4 mL·min−1·kg−1, body fat = 7.9% ± 3%) participated. Intervention(s): Participants completed 20-hour fluid restriction and 2-hour EXDE; they then received no fluid (NF) or REHY (half-normal saline) via ad libitum (AL), oral (OR), intravenous (IV), or combination IV and OR (IV + OR) routes for 30 minutes; and then were observed for another 30 minutes. Main Outcome Measure(s): Body mass, rectal temperature, 4-site mean weighted skin temperature, plasma stress hormone concentrations, and environmental symptoms questionnaire (ESQ) score. Results: Participants were hypohydrated (body mass −4.23% ± 0.22%) post-EXDE. Rectal temperature for the NF group was significantly greater than for the IV group (P = .023) at 30 minutes after beginning REHY (REHY30) and greater than OR, IV, and IV + OR (P ≤ .009) but not AL (P = .068) at REHY60. Mean weighted skin temperature during AL was less than during IV + OR at REHY5 (P = .019). The AL participants demonstrated increased plasma cortisol concentrations compared with IV + OR, independent of time (P = .015). No differences existed between catecholamine concentrations across treatments (P > .05). The ESQ score was increased at REHY60 for NF, AL, OR, and IV (P < .05) but not for IV + OR (P = .217). The NF ESQ score was greater than that of IV + OR at REHY60 (P = .012). Conclusions: Combination IV + OR REHY reduced body temperature to a greater degree than OR and AL REHY when compared with NF. Future studies addressing clinical implications are needed.

Our purpose was to compare the common modes of rehydration (REHY) on cardiovascular and fluid regulation recovery after exercise dehydration (EXDE). Twelve nonheat-acclimatized trained subjects (age: 23 ± 4 years, weight: 81.3 ± 3.7 kg, height: 180 ± 6 cm, V[Combining Dot Above]O2max: 56.9 ± 4.4 ml·min·kg , and body fat: 7.8 ± 3.0%) completed 20-hour fluid restriction and 2-hour EXDE to -4% body mass, and then were rehydrated to -2% body mass in a randomized, crossover design. The REHY methods included no fluid (NF), ad libitum, oral (OR), intravenous (IV), and a combination of IV and OR (IV + OR) of 1/2-normal saline (0.45% NaCl). The REHY occurred for 30 minutes, and the subjects were observed during rest for 30 minutes. Seated, standing, and mean arterial pressure (MAP) and blood pressure (BP) were measured every 15 minutes throughout REHY. Heart rate (HR), plasma arginine vasopressin concentration [AVP], and thirst perception were measured throughout REHY. The EXDE resulted in a body mass loss of 4.32 ± 0.22%. The REHY returned the subjects to -2.13 ± 0.47% body mass for controlled trials. Seated systolic BP was greater for IV + OR compared with that for OR (p = 0.015). Seated systolic BP and MAP during REHY showed that IV + OR was greater than OR, independent of time (p ≤ 0.011). Upon standing, IV + OR demonstrated a greater BP than both NF (p = 0.012) and OR (p = 0.031) did. The HR was reduced by IV and IV + OR to a greater extent than NF at REHY30 and REHY60 (p < 0.05). The IV + OR [AVP] demonstrated a strong trend for decreasing over time (p = 0.054) and was significantly less than NF at REHY60 (p = 0.003). Practical application seeking to restore cardiovascular function after EXDE, the combined use of IV + OR rather than a single REHY method seems to be most expedient.