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Current Hypertension Reviews

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ISSN (Print): 1573-4021
ISSN (Online): 1875-6506

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Meta-Analysis

Effect of Physical Exercise on Cardiac Autonomic Modulation in Hypertensive Individuals: A Systematic Review and Meta-analysis

Author(s): Ayesha Miraj Abidi, Aqsa Mujaddadi*, Shahid Raza and Jamal Ali Moiz

Volume 19, Issue 3, 2023

Published on: 29 August, 2023

Page: [149 - 172] Pages: 24

DOI: 10.2174/1573402119666230803090330

Price: $65

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Abstract

Background: Cardiac autonomic dysfunction is associated with hypertension and exercise training (ET) in healthy individuals is found to improve cardiac autonomic modulation (CAM). However, the effects of physical exercise on CAM in hypertensive individuals are under debate.

Objective: The aim of the review is to systematically evaluate the literature on the effects of physical exercise on CAM in hypertensive individuals and analyse comparative differences in the effects of exercise between hypertensive and normotensive individuals.

Methods: Electronic databases, such as Pubmed, PEDro, Scopus, and Web of Science, were systematically searched from inception up to February, 2022, evaluating the effect of ET on CAM either by heart rate variability (HRV), baroreflex sensitivity or heart rate recovery. Fifteen studies were included in the review. The risk of bias was assessed using the Cochrane risk of bias tool version 2 and the risk of bias in studies of intervention (ROBINS-I) tool. The overall quality of evidence was assessed using the grading of recommendations, assessment, development, and evaluation approach. Ten studies were included in the quantitative analysis. The meta-analysis and sensitivity analysis were performed using review manager 5.4.1; publication bias was assessed using Jamovi 2.2.5 software.

Results: The qualitative analysis revealed low to moderate certainty of evidence for ET and moderate for aerobic training. For the effect of overall ET, the analysis revealed that the standardized mean differences (SMD) showed a significant effect of ET on HF (SMD 1.76, p = 0.04) and RMSSD (SMD 1.19, p < 0.0001) and a significant decrease in LF (SMD -1.78, p = 0.04). Aerobic training revealed nonsignificant improvement in HRV parameters. In the comparative analysis, ET did not show a significant difference in improvement between hypertensive and normotensive individuals.

Conclusion: This review suggests an improvement in CAM with physical exercise in hypertensive individuals, but the overall effect of ET in hypertensive individuals must be interpreted with caution as the robustness of the data is compromised in the sensitivity analysis of the trials. High-quality future trials focusing on different modes of ET interventions are needed to strengthen the findings of the present review.

Keywords: Exercise training, cardiac autonomic function, heart rate variability, baroreflex sensitivity, heart rate recovery, hypertension.

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[1]
Stanaway JD, Afshin A, Gakidou E, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1923-94.
[http://dx.doi.org/10.1016/S0140-6736(18)32225-6] [PMID: 30496105]
[2]
Danaei G, Ding EL, Mozaffarian D, et al. PThe preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009; 6(4): e1000058.
[http://dx.doi.org/10.1371/journal.pmed.1000058]
[3]
Zhou B, Bentham J, di Cesare M, et al. Worldwide trends in blood pressure from 1975 to 2015: A pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet 2017; 389(10064): 37-55.
[4]
Mancia G, Grassi G. The autonomic nervous system and hypertension. Circ Res 2014; 114(11): 1804-14.
[http://dx.doi.org/10.1161/CIRCRESAHA.114.302524] [PMID: 24855203]
[5]
Ivanovic B, Cumming ME, Pinkham CA. Relationships between treated hypertension and subsequent mortality in an insured population. J Insur Med 2004; 36(1): 16-26.
[PMID: 15104026]
[6]
Fu Q, Zhang R, Witkowski S, et al. Persistent sympathetic activation during chronic antihypertensive therapy: a potential mechanism for long term morbidity? Hypertension 2005; 45(4): 513-21.
[http://dx.doi.org/10.1161/01.HYP.0000158312.63381.c1] [PMID: 15738344]
[7]
de Paula Facioli T, Philbois SV, Tank J, de Souza HCD. Physical exercise is essential for cardiac autonomic regulation in hypertensive patients treated with losartan or enal Res Sq 2022.
[http://dx.doi.org/10.21203/rs.3.rs-1284632/v1]
[8]
Dural M, Kabakcı G, Çınar N G. Assessment of cardiac autonomic functions by heart rate recovery, heart rate variability and QT dynamicity parameters in patients with acromegaly. Pituitary 2014; 17(2): 163-70.
[http://dx.doi.org/10.1007/s11102-013-0482-4] [PMID: 23553172]
[9]
Frattola A, Parati G, Gamba P, et al. Time and frequency domain estimates of spontaneous baroreflex sensitivity provide early detection of autonomic dysfunction in diabetes mellitus. Diabetologia 1997; 40(12): 1470-5.
[http://dx.doi.org/10.1007/s001250050851] [PMID: 9447956]
[10]
Grässler B, Thielmann B, Böckelmann I, Hökelmann A. Effects of different exercise interventions on heart rate variability and cardiovascular health factors in older adults: A systematic review. Eur Rev Aging Phys Act 2021; 18(1): 24.
[http://dx.doi.org/10.1186/s11556-021-00278-6] [PMID: 34789148]
[11]
Bhati P, Moiz JA, Menon GR, Hussain ME. Does resistance training modulate cardiac autonomic control? A systematic review and meta-analysis. Clin Auton Res 2019; 29(1): 75-103.
[http://dx.doi.org/10.1007/s10286-018-0558-3] [PMID: 30141031]
[12]
Barcellos FC, Santos IS, Umpierre D, Bohlke M, Hallal PC. Effects of exercise in the whole spectrum of chronic kidney disease: a systematic review. Clin Kidney J 2015; 8(6): 753-65.
[13]
Murad K, Brubaker PH, Fitzgerald DM, Morgan TM, Goff DC, Soliman EZ. Exercise training improves heart rate variability in older patients with heart failure: A randomized, controlled, single-blinded trial. Congest Heart Fail 2012; 18(6): 753-65.
[http://dx.doi.org/10.1111/j.1751-7133.2011.00282.x]
[14]
Mujaddadi A, Moiz JA, Veqar Z, Dar JA. Effect of various exercise training interventions on cardiac autonomic function in obese individuals: A systematic review and meta-analysis. Obes Med 2022; 30: 100383.
[http://dx.doi.org/10.1016/j.obmed.2021.100383]
[15]
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement 2009. Available From: https://www.bmj.com/content/339/bmj.b2535
[http://dx.doi.org/10.1136/BMJ.B2535]
[16]
Sterne JAC, Savović J, Page MJ. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898.
[http://dx.doi.org/10.1136/bmj.l4898] [PMID: 31462531]
[17]
Flemyng E, Dwan K, Moore TH, Page MJ, Higgins JP. Risk of Bias 2 in Cochrane Reviews: A phased approach for the introduction of new methodology. Cochrane Database Syst Rev 2020; 10(11): ED000148.
[http://dx.doi.org/10.1002/14651858.ED000148]
[18]
McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 2021; 12(1): 55-61.
[http://dx.doi.org/10.1002/jrsm.1411]
[19]
Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355(4919)
[http://dx.doi.org/10.1136/bmj.i4919]
[20]
Muller K. Statistical Power Analysis for the Behavioral Sciences. Technometrics 1989; 31(4): 499-500.
[http://dx.doi.org/10.1080/00401706.1989.10488618]
[21]
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses BMJ 2003; 327(7414): 557-69.
[http://dx.doi.org/10.1136/bmj.327.7414.557]
[22]
de Freitas Brito A, Brasileiro-Santos MS, Coutinho de Oliveira CV, Sarmento da Nóbrega TK, Lúcia de Moraes Forjaz C, da Cruz Santos A. High-intensity resistance exercise promotes postexercise hypotension greater than moderate intensity and affects cardiac autonomic responses in women who are hypertensive. J Strength Cond Res 2015; 29(12): 3486-93.
[http://dx.doi.org/10.1519/JSC.0000000000001009] [PMID: 25992658]
[23]
Vale AF, Carneiro JA, Jardim PCV, et al. Acute effects of different resistance training loads on cardiac autonomic modulation in hypertensive postmenopausal women. J Transl Med 2018; 16(1): 240.
[http://dx.doi.org/10.1186/s12967-018-1615-3] [PMID: 30165858]
[24]
MartinezAguirre-Betolaza A Mujika Fryer SM. Effects of different aerobic exercise programs on cardiac autonomic modulation and hemodynamics in hypertension: data from EXERDIET-HTA randomized trial. J Hum Hypertens 2020; 34(10): 709-18.
[http://dx.doi.org/10.1038/s41371-020-0298-4] [PMID: 31932699]
[25]
O’Driscoll JM, Boucher C, Vilda M, Taylor KA, Wiles JD. Continuous cardiac autonomic and haemodynamic responses to isometric exercise in females. Eur J Appl Physiol 2021; 121(1): 319-29.
[http://dx.doi.org/10.1007/s00421-020-04525-z] [PMID: 33070245]
[26]
Anunciação PG, Farinatti PTV, Goessler KF, Casonatto J, Polito MD. Blood pressure and autonomic responses following isolated and combined aerobic and resistance exercise in hypertensive older women. Clin Exp Hypertens 2016; 38(8): 710-4.
[http://dx.doi.org/10.1080/10641963.2016.1200601] [PMID: 27936947]
[27]
Trevizani GA, Seixas MB, Benchimol-Barbosa PR. Effect of re-sistance training on blood pressure and autonomic respponses in treated hypertensives. J Strength Cond Res 2018; 32(5): 1462-70.
[http://dx.doi.org/10.1519/JSC.0000000000001995]
[28]
Cordeiro R, Mira PA, Monteiro W, et al. Hemodynamics and cardiac autonomic modulation after an acute concurrent exercise circuit in older individuals with pre- to established hypertension. Clinics (São Paulo) 2021; 76: e1971.
[http://dx.doi.org/10.6061/clinics/2021/e1971] [PMID: 33503175]
[29]
Wong A, Alvarez-Alvarado S, Kinsey AW, Figueroa A. Whole-body vibration exercise therapy improves cardiac autonomic function and blood pressure in obese pre-and stage 1 hypertensive postmenopausal women. J Altern Complement Med 2016; 22(12): 970-6.
[http://dx.doi.org/10.1089/acm.2016.0124] [PMID: 27656953]
[30]
Prasertsri P, Singsanan S, Chonanant C, Boonla O, Trongtosak P. Effects of arm swing exercise training on cardiac autonomic modulation, cardiovascular risk factors, and electrolytes in persons aged 60-80 years with prehypertension: A randomized controlled trial. J Exerc Sci Fit 2019; 17(2): 47-54.
[http://dx.doi.org/10.1016/j.jesf.2018.11.002] [PMID: 30740133]
[31]
Ferreira JB, Plentz RDM, Stein C, Casali KR, Arena R, Lago PD. Inspiratory muscle training reduces blood pressure and sympathetic activity in hypertensive patients: A randomized controlled trial. Int J Cardiol 2013; 166(1): 61-7.
[http://dx.doi.org/10.1016/j.ijcard.2011.09.069] [PMID: 21985749]
[32]
Somers VK, Conway J, Johnston J, Sleight P. Effects of endurance training on baroreflex sensitivity and blood pressure in borderline hypertension. Lancet 1991; 337(8754): 1363-8.
[http://dx.doi.org/10.1016/0140-6736(91)93056-F] [PMID: 1674761]
[33]
Collier SR, Kanaley JA, Carhart R Jr, et al. Cardiac autonomic function and baroreflex changes following 4 weeks of resistance versus aerobic training in individuals with pre-hypertension. Acta Physiol 2009; 195(3): 339-48.
[http://dx.doi.org/10.1111/j.1748-1716.2008.01897.x] [PMID: 18774947]
[34]
Santa-Rosa FA, Shimojo GL, Sartori M, et al. Familial history of hypertension-induced impairment on heart rate variability was not observed in strength-trained subjects. Braz J Med Biol Res 2018; 51(12): e7310.
[http://dx.doi.org/10.1590/1414-431x20187310] [PMID: 30462769]
[35]
Brito LC, Peçanha T, Fecchio RY, et al. Comparison of morning versus evening aerobic-exercise training on heart rate recovery in treated hypertensive men: A randomized controlled trial. Blood Press Monit 2021; 26(5): 388-92.
[http://dx.doi.org/10.1097/MBP.0000000000000545] [PMID: 34001759]
[36]
Earnest CP, Blair SN, Church TS. Heart rate variability and exercise in aging women. J Womens Health 2012; 21(3): 334-9.
[http://dx.doi.org/10.1089/jwh.2011.2932] [PMID: 21967166]
[37]
Hua LPT, Brown CA, Hains SJM, Godwin M, Parlow JL. Effects of low-intensity exercise conditioning on blood pressure, heart rate, and autonomic modulation of heart rate in men and women with hypertension. Biol Res Nurs 2009; 11(2): 129-43.
[http://dx.doi.org/10.1177/1099800408324853] [PMID: 19150992]
[38]
Goldie CL, Brown CA, Hains SMJ, Parlow JL, Birtwhistle R. Synergistic effects of low-intensity exercise conditioning and β-blockade on cardiovascular and autonomic adaptation in pre- and postmenopausal women with hypertension. Biol Res Nurs 2013; 15(4): 433-42.
[http://dx.doi.org/10.1177/1099800412461562] [PMID: 23034540]
[39]
Knoepfli-Lenzin C, Sennhauser C, Toigo M, et al. Effects of a 12-week intervention period with football and running for habitually active men with mild hypertension. Scand J Med Sci Sports 2010; 20 (Suppl. 1): 72-9.
[http://dx.doi.org/10.1111/j.1600-0838.2009.01089.x] [PMID: 20136764]
[40]
Amaro-Vicente G, Laterza MC, Martinez DG, et al. Exercise training improves heart rate recovery after exercise in hypertension. Motriz: Revista de EducaçãoFísica. SciELOBrasil 2019; 25
[http://dx.doi.org/10.1111/j.1469-445X.2002.tb00055.x]
[41]
Masroor S, Bhati P, Verma S, Khan M, Hussain ME. Heart rate variability following combined aerobic and resistance training in sedentary hypertensive women: A randomised control trial. Indian Heart J 2018; 70(Suppl 3 (Suppl 3)): S28-35.
[http://dx.doi.org/10.1016/j.ihj.2018.03.005] [PMID: 30595274]
[42]
Niranjan M, Nagaraja HS, Anupama BK, Bhagyalaks N, Bhat R, Prabha A. Effect of Supervised Integrated Exercise on Deep Breathing- Heart Rate Variability in Male Hypertensive Patients. J Med Sci (Faisalabad, Pak) 2008; 8(4): 350-6.
[http://dx.doi.org/10.3923/jms.2008.350.356]
[43]
Oliveira-Dantas FF. Short-term resistance training improves cardiac autonomic modulation and blood pressure in hypertensive older women: A randomized controlled trial. J Strength Cond Res 2020; 34(1): 37-45.
[http://dx.doi.org/10.1519/JSC.0000000000003182]
[44]
Laterza MC, de Matos LDNJ, Trombetta IC, et al. Exercise training restores baroreflex sensitivity in never-treated hypertensive patients. Hypertension 2007; 49(6): 1298-306.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.106.085548]
[45]
Davy KP, Willis WL, Seals DR. Influence of exercise training on heart rate variability in post-menopausal women with elevated arterial blood pressure. Clin Physiol 1997; 17(1): 31-40.
[http://dx.doi.org/10.1046/j.1365-2281.1997.01010.x] [PMID: 9015656]
[46]
Cozza IC, Di Sacco THR, Mazon JH, et al. Physical exercise improves cardiac autonomic modulation in hypertensive patients independently of angiotensin-converting enzyme inhibitor treatment. Hypertens Res 2012; 35(1): 82-7.
[http://dx.doi.org/10.1038/hr.2011.162] [PMID: 21956728]
[47]
Ehlers TS, Sverrisdottir Y, Bangsbo J, Gunnarsson TP. High-Intensity Interval Training Decreases Muscle Sympathetic Nerve Activity in Men With Essential Hypertension and in Normotensive Controls. Front Neurosci 2020; 14: 841.https://pubmed.ncbi.nlm.nih.gov/33013285/
[http://dx.doi.org/10.3389/fnins.2020.00841] [PMID: 33013285]
[48]
Mariano IM, de Freitas VH, Batista JP, et al. Effect of combined exercise training on heart rate variability in normotensive and hypertensive postmenopausal women. Motriz Revista de EducaçãoFísica 2021; 27(5)
[49]
Gambassi BB, Schwingel PA, Clementino D, Oliveira D. Influence of resistance training practice on autonomic cardiac control of hypertensive elderly women. J Exerc Physiol Online 2021; 22(1): 37-44.https://www.researchgate.net/publication/330740598l
[50]
Trevizani GA, Peçanha T, Nasario-Junior O, Vianna JM, Silva LP, Nadal J. Cardiac autonomic responses after resistance exercise in treated hypertensive subjects. Front Physiol 2015; 6: 258.
[PMID: 26441677]
[51]
Kazmi SZ, Zhang H, Aziz W, et al. Inverse correlation between heart rate variability and heart rate demonstrated by linear and nonlinear analysis. PLoS One 2016; 11(6): e0157557.
[http://dx.doi.org/10.1371/journal.pone.0157557]
[52]
Taylor JL, Holland DJ, Spathis JG. Guidelines for the delivery and monitoring of high intensity interval training in clinical populations. Prog Cardiovasc Dis 2019; 69(2): 140-6.
[http://dx.doi.org/10.1016/j.pcad.2019.01.004]
[53]
Zaki S, Moiz JA, Bhati P, Menon GR. Efficacy of high-intensity interval training on cardiac autonomic modulation in cardiovascular diseases and lifestyle disorders: A systematic review and meta-analysis. Comp Exerc Physiol 2022; 18(1)
[http://dx.doi.org/10.3920/CEP210009]
[54]
MacDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR. Arterial blood pressure response to heavy resistance exercise. J Appl Physiol 1985; 58(3): 785-90.
[http://dx.doi.org/10.1152/jappl.1985.58.3.785] [PMID: 3980383]
[55]
Lamotte M, Niset G, van de Borne P. The effect of different intensity modalities of resistance training on beat-to-beat blood pressure in cardiac patients. Eur J Cardiovasc Prev Rehabil 2005; 12(1): 12-7.
[http://dx.doi.org/10.1152/jappl.1985.58.3.785]
[56]
Kingwell BA. Nitric oxide-mediated metabolic regulation during exercise: effects of training in health and cardiovascular disease. FASEB J 2000; 14(12): 1685-96.
[http://dx.doi.org/10.1096/fj.99-0896rev] [PMID: 10973917]
[57]
de Abreu RM, Rehder-Santos P, Simões RP, Catai AM. Can high-intensity interval training change cardiac autonomic control? A systematic review. Braz J Phys Ther 2019; 23(4): 279-89.
[http://dx.doi.org/10.1016/j.bjpt.2018.09.010]
[58]
Boutcher SH, Park Y, Dunn SL, Boutcher YN. The relationship between cardiac autonomic function and maximal oxygen uptake response to high-intensity intermittent-exercise training. J Sports Sci 2013; 31(9): 1024-9.
[http://dx.doi.org/10.1080/02640414.2012.762984]
[59]
Buch AN, Coote JH, Townend JN. Mortality, cardiac vagal control and physical training--what’s the link? Exp Physiol 2003; 87(4): 423-75.
[http://dx.doi.org/10.1080/02640414.2012.762984]
[60]
Macedo FN, Mesquita TRR, Melo VU. Increased nitric oxide bioavailability and decreased sympathetic modulation are involved in vascular adjustments induced by low-intensity resistance training. Front Physiol 2016; 7: 265.
[http://dx.doi.org/10.3389/fphys.2016.00265]
[61]
Hu M, Finni T, Zou L, Perhonen M, Sedliak M, Alen M, et al. Effects of strength training on work capacity and parasympathetic heart rate modulation during exercise in physically inactive men. Int J Sports Med 2009; 30(10): 719-24.
[http://dx.doi.org/10.1055/s-0029-1225329]
[62]
Liu J-L, Irvine S, Reid IA, Patel KP, Zucker IH. Chronic exercise reduces sympathetic nerve activity in rabbits with pacing-induced heart failure: a role for angiotensin II. Circulation 2000; 102(15): 1854-62.
[http://dx.doi.org/10.1080/10641960802279132]
[63]
Lewandowski J, Abramczyk P, Dobosiewicz A. The effect of enalapril and telmisartan on clinical and biochemical indices of sympathetic activity in hypertensive patients. Clin Exp Hypertens 2008; 30(5): 423-32.
[64]
Koba S, Xing J, Sinoway LI, Li J. Bradykinin receptor blockade reduces sympathetic nerve response to muscle contraction in rats with ischemic heart failure. Am J Physiol Heart Circ Physiol 2010; 298(5): H1438-44.
[http://dx.doi.org/10.1152/ajpheart.00558.2009] [PMID: 20207818]
[65]
Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology. Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. Circulation 1996; 93(5): 1043-65.
[http://dx.doi.org/10.1161/01.CIR.93.5.1043]

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