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| The cardiovascular effects of upper-limb aerobic exercise in hypertensive patients |
| Westhoff TH, Schmidt S, Gross V, Joppke M, Zidek W, van der Giet M, Dimeo F |
| Journal of Hypertension 2008 Jul;26(7):1336-1342 |
| clinical trial |
| 5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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BACKGROUND: Aerobic exercise is broadly recommended as a helpful adjunct to obtain blood pressure control in hypertension. Several hypertensive patients, however, are limited by musculoskeletal complaints or vascular occlusive disease from lower-limb exercise such as jogging or cycling. In the present randomized-controlled study, we evaluate whether an aerobic arm-cycling program provides a measurable cardiovascular benefit. METHODS: Twenty-four probands were randomly assigned to sedentary activity or a heart rate controlled 12 week exercise program, consisting of arm-cycling at target lactate concentrations of 2.0 +/- 0.5 mmol/l. Endothelial function was assessed by flow-mediated dilation of the brachial artery. Augmentation index and large/small artery compliance (C1 and C2) were measured by computerized pulse-wave analysis of the radial artery. RESULTS: The exercise program led to a significant reduction in systolic (134.0 +/- 20.0 to 127.0 +/- 16.4 mmHg; p = 0.03) and diastolic blood pressure (73.0 +/- 21.6 to 67.1 +/- 8.2 mmHg; p = 0.02) accompanied by a significant improvement in C2 (3.5 +/- 1.6 to 4.8 +/- 2.0 ml/mmHg x 100; p = 0.004). Flow-mediated dilation, augmentation index, and C2 were not significantly affected (p > 0.05). Physical performance as derived from lactate and heart rate curves of lower-limb stress tests was unchanged, whereas maximal workload in an upper-limb ergometry significantly increased (p = 0.005). Blood pressure and vascular parameters remained unchanged in the control group. CONCLUSION: Regular arm aerobic exercise leads to a marked reduction in systolic and diastolic blood pressures and an improvement in small artery compliance. Arm-cycling is a reasonable option for hypertensive patients who want to support blood pressure control by sports despite having coxarthrosis, gonarthrosis, or intermittent claudication.
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