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Using the immediate blood pressure benefits of exercise to improve exercise adherence among adults with hypertension: a randomized clinical trial
Zaleski AL, Taylor BA, Park CL, Santos LP, Panza G, Kramarz M, McCormick K, Thompson PD, Fernandez AB, Chen M-H, Blissmer B, Gans KM, Pescatello LS
Journal of Hypertension 2019 Sep;37(9):1877-1888
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: Yes; 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*

BACKGROUND: A single exercise session evokes immediate blood pressure (BP) reductions that persist for at least 24 h, termed postexercise hypotension (PEH). Self-monitoring of PEH may foster positive outcome expectations of exercise, and thus, enhance exercise adherence among adults with hypertension. PURPOSE: To compare the efficacy of self-monitoring of exercise (exercise) versus exercise and PEH (exercise+PEH) to improve exercise adherence and BP control among adults with hypertension. METHODS: Adults with high BP were randomized to exercise (n = 12) or exercise+PEH (n = 12). Participants underwent supervised, moderate intensity aerobic exercise training for 40 to 50 min/session, 3 days/week for 12 weeks and encouraged to exercise unsupervised at home at least 30 min/day, 1 to 2 days/week. exercise+PEH also self-monitored BP before and after exercise. Adherence was calculated as ((number of exercise sessions performed / nomber of possible exercise sessions) x 100%). BP was measured pre and posttraining. RESULTS: Healthy, middle-aged (52.3 +/- 10.8 years) men (n = 11) and women (n = 13) with hypertension (136.2 +/- 10.7/85.2 +/- 8.9 mmHg) completed exercise training with 87.9 +/- 12.1% adherence. Exercise+PEH demonstrated greater adherence to supervised training (94.3 +/- 6.6%) than exercise (81.6 +/- 13.2%; p = 0.007). Exercise+PEH performed 32.6 +/- 22.5 min/week more unsupervised home exercise than exercise (p = 0.004), resulting in greater exercise adherence (107.3 +/- 18.7%) than exercise (82.7 +/- 12.2%; p = 0.002). Post versus pretraining BP was reduced -7.4 +/- 11.3/-4.9 +/- 9.9 mmHg (p < 0.025) with no statistical difference between exercise (-5.2 +/- 13.3/-3.6 +/- 6.1 mmHg) and exercise+PEH (-9.9 +/- 11.3/-6.1 +/- 6.9 mmHg; p > 0.344). CONCLUSION: The current study is the first to demonstrate that PEH self-monitoring is an efficacious tool to improve exercise adherence among a small sample of adults with hypertension. Future research among a larger, more diverse sample is needed to confirm these novel findings and determine whether exercise+PEH translates to better BP control relative to exercise self-monitoring alone.
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