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Resistance exercise and acute blood pressure responses

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Compare the acute hemodynamic and cardiovascular responses of high load/low repetition resistance training (RT) to low load/high repetition RT. Thirteen healthy men performed four sets of 4 repetition maximum (RM) and 20RM leg--extensions without breath--holding. The RT was conducted in a randomized order and with 48 hours between bouts. Non--invasive beat--to--beat systolic and diastolic blood--pressure (SBP/DBP) was measured on the finger, while non--invasive cardiac output (CO) was assessed beat--to--beat by impedance--cardiography. Mean ± SD resting SBP/DBP and CO were 126 ± 14/73 ± 9 mmHg and 5.6 ± 9 L min --1 , respectively. Exercise SBP/DBP values increased to 154 ± 22/99 ±18 and 203 ± 33/126 ± 19 mmHg following 4RM and 20RM RT, respectively (compared to rest, all;; p < 0.001), and 20RM SBP/DBP values were higher than 4RM values (both, p < 0.001). The SBP increased from the first to the fourth set of exercise following the 20RM load (p < 0.01), but not so for the 4RM load. Exercise SBP/DBP values following the 4th rep of 20RM exercise (154 ± 18/91 ± 14), was similar to the 4RM values, but different to the 20th rep of the 20 RM loading (both; p < 0.001). CO increased to 10.8 ± 2.6 and 13.9 ± 2.2 L min --1 , following 4RM and 20RM RT, respectively (compared to rest, both; p < 0.001) and 20RM CO was higher than 4RM CO (p < 0.01). 20RM RT resulted in higher blood--pressure than 4RM RT when performed to voluntary exhaustion. Differences in hemodynamic responses seems to be related to training duration and not to difference in loading.
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Short title: Resistance exercise and acute blood pressure responses
Acute hemodynamic and cardiovascular responses
following resistance exercise to voluntary exhaustion.
Effects of different loadings and exercise durations
Terje Gjovaag1, Asmund Krogh Hjelmeland2, Jonas Belstad Øygard2, Harald Vikne3, Peyman
Mirtaheri4
1Department of Occupational therapy, Prosthetics and Orthotics, Faculty of Health Sciences,
Oslo and Akershus University College, Oslo, Norway
2Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University
College, Oslo, Norway.
3Department of Health Sciences, Faculty of Medicine, University of Oslo, Norway
4Department of Industrial Development, Faculty of Technology, Art and Design, Oslo and
Akershus University College, Oslo, Norway
Corresponding author:
Terje Gjovaag
Department of Occupational therapy, Prosthetics and Orthotics, Faculty of Health Sciences,
Oslo and Akershus University College, Oslo, Norway
POB 4, St. Olavs plass,
N-0130 Oslo, Norway
E-mail: terje.gjovaag@hioa.no
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ABSTRACT
Aim: Compare the acute hemodynamic and cardiovascular responses of high load/low repetition
resistance training (RT) to low load/high repetition RT.
Methods: Thirteen healthy men performed four sets of 4 repetition maximum (RM) and 20RM leg-
extensions without breath-holding. The RT was conducted in a randomized order and with 48 hours
between bouts. Non-invasive beat-to-beat systolic and diastolic blood-pressure (SBP/DBP) was
measured on the finger, while non-invasive cardiac output (CO) was assessed beat-to-beat by
impedance-cardiography.
Results: Mean ± SD resting SBP/DBP and CO were 126 ± 14/73 ± 9 mmHg and 5.6 ± 9 L min-1,
respectively. Exercise SBP/DBP values increased to 154 ± 22/99 ±18 and 203 ± 33/126 ± 19 mmHg
following 4RM and 20RM RT, respectively (compared to rest, all; p < 0.001), and 20RM SBP/DBP
values were higher than 4RM values (both, p < 0.001). The SBP increased from the first to the fourth
set of exercise following the 20RM load (p < 0.01), but not so for the 4RM load. Exercise SBP/DBP
values following the 4th rep of 20RM exercise (154 ± 18/91 ± 14), was similar to the 4RM values, but
different to the 20th rep of the 20 RM loading (both; p < 0.001). CO increased to 10.8 ± 2.6 and 13.9
± 2.2 L min-1, following 4RM and 20RM RT, respectively (compared to rest, both; p < 0.001) and
20RM CO was higher than 4RM CO (p < 0.01).
Conclusion: 20RM RT resulted in higher blood-pressure than 4RM RT when performed to voluntary
exhaustion. Differences in hemodynamic responses seems to be related to training duration and not to
difference in loading.
Keywords: blood pressure, cardiac output, strength training
The authors have no conflict of interest to disclose
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Introduction
When designing resistance training programs, variables like the load, number of repetitions lifted,
number of sets and exercises performed, length of rest periods between sets and exercises, can be
manipulated to stress the muscles in particular ways and thus optimize specific training adaptations in
the exercised muscle. In this respect, it is not uncommon that RT with high repetition/low or medium
load is used to improve local muscular endurance (e.g.1) whereas RT with low repetition/high load is
frequently used to improve muscle strength and power (e.g.2).
Choosing between low rep/high load or high rep/low load RT is, however, not the only factors to
consider when designing a RT program for recreation exercise, rehabilitation and for prophylaxis
purposes. Caution has been raised concerning the very high blood pressure values that can be attained
in the left ventricle during heavy RT (3,4). In this regard, it is argued that RT with a load of 40-60 % of
maximum voluntary contraction (MVC) with 15-20 repetitions result in only modest increases in
blood pressure (5). In contrast, very high systolic and diastolic blood pressure values (320/250 mmHg)
are reported when multiple sets of 90-95 % of MVC are performed to exhaustion (6). Arterial
hypertension during RT may, however, be reduced when the participants perform the exercise with an
open glottis, that is avoiding breath-holding during the RT (7).
There are, however, few studies that have investigated the hemodynamic responses to heavy and
moderate loading RT performed without breath holding. In the light of the increasing use of different
RT programs in exercise rehabilitation and prophylaxis programs of both young and older individuals
(8, 9), there is a need to compare the acute blood pressure responses of low rep/high load (4RM) RT to
high rep/low load (20RM) RT.
The relationship between RT with similar load, but different number of repetitions also need to be
investigated to clarify effect of exercise load versus duration. In addition, although cardiac output
(CO) and systemic vascular resistance (SVR) are major determinants of the blood pressure during
exercise, the acute effects of RT with different loadings on CO and SVR has been little investigated.
Consequently, the main goals of the present study is to compare the acute blood pressure, CO and
SVR responses of RT with moderate and heavy loading protocols and to examine the effects of
exercise volume, duration and resistance.
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Materials and methods
Participants
Thirteen normotensive, healthy and non-smoking males volunteered to participate in the present study.
They did not have any musculoskeletal diseases or other conditions limiting their functional mobility
during leg-extension exercise. The reason for recruiting young, healthy participants in the present
study was to reduce possible influences on the pressure response caused by an age related decline in
arterial wall elasticity (e.g.10). The participants mean ± SD age, height, weight and body mass index
(BMI) were 24.8 ± 3.9 years, 181.4 ± 5.7 cm, 79.7 ± 9.6 kg and 24.3 ± 3.2 kg·m2, respectively. The
participants were instructed to refrain from coffee and meals at least three hours prior to testing and
avoid heavy training and alcohol 24 hours before reporting to the lab. Written informed consent was
obtained from all participants prior to the experiments.
Study design
The overall aim of the study was to examine the hemodynamic and cardiovascular responses of two
bouts of resistance exercise and to assess the effects of different exercise components of the resistance
exercise bout; the exercise load, volume (number of sets) and duration (number of repetitions). To
assess the component of volume, the responses between the first and fourth sets within each bout was
analyzed. To examine the effect of load the 4RM data was compared to the 4th rep of the 20RM
protocol and to examine the effect of duration (number of repetitions) the 4th rep was compared to the
20th rep of the 20RM protocol.
To study this, the subjects reported to the laboratory on three different occasions, and testing was
performed at the same hour of the day on each occasion. On day one, the participants were tested for
their bilateral leg extension one repetition maximum (1RM), four repetition maximum (4RM) and 20
repetition maximum (20RM) in a training apparatus. One week later, on test day two and three, the
subjects completed one bout that consisted of a high-load/few repetition protocol (four sets of 4RM)
and one bout of low load/many repetition protocol in a randomized manner. There were four minutes
of recovery between sets and at least 48 hours of recovery between exercise bouts.
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Procedure, strength testing
Following 5 min. warm up on a stationary ergometer cycle (Lode Excalibur Sport, Groningen, the
Netherlands), strength testing were completed in a leg extension apparatus (Steens Physical, Ski,
Norway). Excessive hip movements were restricted using a strap across the hips fasted to the
apparatus. The strength tests were performed in a standardized order; first the 1RM, then the 4RM,
and finally the 20RM. Pauses between tests were 4-6 min. Only attempts that could be lifted
throughout the full range of motion while maintaining correct technique was approved. During this
session, the participants were extensively coached in the breathing and lifting technique to ensure
correct execution of the breathing pattern (no Valsalva maneuver) and that the subjects managed to lift
the required number of repetitions during the experiments.
Procedure 4RM and 20 RM exercise testing
The participants performed a standard warm-up for five minutes on a stationary ergometer cycle
before they completed either four sets of 4RM or four sets of 20RM of bilateral leg-extensions. The
leg-extensions were completed in a controlled and continuous manner without pauses between
repetitions, using 1 sec. for the lifting phase (extension) and 1 sec. for the lowering phase. The
movements were paced by a metronome (60 beats min-1). To control the effect of breathing on the
blood pressure responses (7), the leg-extensions were performed without breath holding (Valsalva
maneuver), that is with exhalation during the extension phase and inhalation during the flexion phase
of the movement. All hemodynamic and cardiovascular measurements was performed with the
participants sitting in the training apparatus. Resting systolic and diastolic blood pressure (SBP, DBP),
heart rate (HR), stroke volume (SV), cardiac output (CO), end-diastolic volume (EDV), ejection
fraction (EF), and systemic vascular resistance (SVR) were recorded 30-60 seconds prior to start of
each set of exercise and are reported as the mean of the combined 4RM and 20RM resting values.
Exercise values of these variables were measured at the last repetition of each set with the leg fully
extended. For the 20RM protocol, measurements were also completed at the 4th rep. Blood lactate
concentration was measured immediately prior to start of set 1 (rest) and 60 seconds following the last
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repetition in set 4. Rating of perceived exertion (RPE) were assesed by a 0-10 point scale prior to
exercise and immediately following the last repetition of each set.
Instruments and measurements
The SBP and DBP (mmHg) were recorded “beat-to-beat” by a validated volume oscillometric method
(Finapres, Ohmeda 2300, Colorado, USA). This method provides finger-cuff measurements of
peripheral arterial blood pressure, similar to intra-arterial values both at rest and during exercise (11,12).
The relative level of the finger to the heart may affect the mean blood pressure value at the finger,
consequently the participants were instructed to hold their hands open and to keep the arms folded
across their chest in a fixed position and the finger-cuff at the heart level at all times, both at rest and
during exercise (12).
The HR (beats·min-1), SV (mL·beat-1), CO (L·min-1), EDV ( mL) and EF (%) were assessed beat-to-
beat by impedance cardiography (PhysioFlow Enduro, Manatec, Folschviller, France). The reliability
and accuracy of this system has been compared to the direct Fick method both at rest and during
moderate exercise. Mean difference between the two methods was 0.04 L·min-1 at rest and 0.29 L·
min-1 during moderate exercise (13). In addition, the PhysioFlow Enduro has been compared to the
direct Fick method during maximal incremental exercise testing, and the correlation coefficient of the
two techniques was 0.946, (p < 0.01) with an average difference of -2.78% (14). Collectively, these two
studies conclude that the PhysioFlow Enduro provide clinically acceptable assessments of the CO
during both rest, moderate exercise and progressive maximal exercise (13, 14). Lactate concentration (La,
mMol·L-1) in capillary whole blood were measured by a Lactate Pro LT-1710 apparatus (Arkray Inc.,
Kyoto, Japan). Systemic vascular resistance (SVR, dyn· s-1 ·cm-5) was calculated according to
following formulae: MAP/CO x 80.
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Statistical analyses
The data were analyzed by the SPSS version 18.0. Within group differences for SBP and DBP were
analyzed with one-way repeated measures ANOVA and the Sidak post-hoc test when significant
differences between series were found. A paired samples t-test was used when comparing resting and
exercise values of HR, SV, CO, EDV, EF, SVR, RPE and La. The significance level was set at p <
0.05. All results are expressed as means ± standard deviations.
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Results
Maximal strength, 4RM and 20 RM loadings
The participants bilateral leg-extension 1RM was 70.2 ± 9.8 kg (p < 0.001, compared to 4RM and
20RM loads). The 4RM and 20RM loads (kg) were 62.7 ± 8.7 and 33.8 ± 6.1 kgs respectively (p <
0.001). The 4RM and 20RM loads corresponded to 89 ± 3 and 48 ± 7 % of the subjects’ 1RM.
Blood pressure responses. Effect of different loadings and duration
Pre exercise (Rest 0) SBP and DBP values (sitting in the training apparatus) were 126 ± 14 and 73 ± 9
mmHg, respectively. Compared to the corresponding resting values, the SBP and DBP values
increased significantly following set 1, 2, 3 and 4 of both the 4RM (~90 % of 1RM) and the 20RM RT
(~50 % of 1RM), respectively, (all comparisons, p < 0.001; figure 1 and 2). For each of the four sets,
both systolic and diastolic blood pressure increased more following the 20RM loading protocol than
the 4RM loading (all comparisons, p < 0.001; Figure 1 and 2). In the four minutes resting period
between sets, SBP and DBP exercise values showed complete recovery to pre exercise levels (Rest 1,
2 and 3) following both 4RM and 20RM RT.
There were no significant differences for neither SBP nor DBP after the 4RM loading protocol
compared to the 4th rep of the 20RM loading protocol. Consequently, when the duration of exercise
was similar (8.1 ± 0.5 and 7.8 ± 0.6 sec., respectively) there was no effect of an increase in exercise
loading from 50 % of 1RM to 90 % of 1RM (table 1). Both SBP and DBP values following the 4th
rep of 20RM RT were significantly lower than the corresponding values following the 20th rep of the
20RM exercise bout (both; p < 0.001; Table 1).
Blood pressure responses. Effect of exercise volume.
For the 4RM loading protocol, there were no differences in blood pressure values between set 1-4.
Thus, there seems to be no additive effect of multiple sets (e.g. volume) on the blood pressure
response during 4RM resistance training. For the 20RM protocol, there were no significant
differences in blood pressure values between set 1- 3 during 20RM RT, but a significant difference
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between the SBP of set 1 (mean 192 mmHg ± 36) and set 4 (mean 217 mmHg ± 36) (p < 0.01; Figure
1). Thus, for 20RM protocol, there seems to be an effect of total exercise volume on the blood
pressure response.
Mean Arterial Pressure (MAP)
MAP resting values was 92 ± 10 mmHg. Compared to rest, exercise MAP (average of four sets)
increased significantly to 127 ± 20 and 165 ± 24 mmHg following the 4RM and 20RM RT,
respectively (both, p < 0.001). 20RM exercise MAP was different from 4RM exercise MAP (p <
0.001).
SV, HR, CO, EDV, EF and SVR responses to 4RM and 20RM RT (Table 2)
Compared to rest, exercise SV following 4RM and 20RM RT increased moderately with about 20 %
and 30 %, respectively (both, p < 0.001), and the increase was significantly larger for the 20RM
loading protocol than the 4RM protocol (p < 0.05). The increases in SV were mainly the result of an
increased EDV both following the 4RM and 20RM loading protocols (compared to rest, both; p <
0.001), while the EF was unchanged from rest with either type of loading protocol. Together with a
higher HR following the 20RM compared to 4RM loading protocol (p < 0.001), resulted in about 30 %
higher CO following 20RM exercise compared to 4RM exercise (p < 0.001). When compared to
resting values, the SVR decreased about 25 and 20 % following the 4RM and 20RM exercise,
respectively (p < 0.001 and p < 0.01), but there were no differences between 4RM and 20RM exercise
values.
La and RPE responses to 4RM and 20RM RT (Table 2)
Compared to the resting values, La levels increased by 46 % following the 4RM exercise (p < 0.001),
while La levels increased by 117 % following the 20RM bout (p < 0.001). The 20RM post exercise
lactate levels were higher than 4RM post exercise levels (p < 0.001). Post exercise RPE following the
4RM exercise was close to “very hard” (7 on the RPE scale), and close to “very-very hard” (10 on the
RPE scale) following 20RM exercise (compared to rest, both; p < 0.001). The difference in post
exercise RPE between the 4RM and 20RM exercise bouts was significant (p < 0.001).
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Discussion
Blood pressure responses
In the present study, we have examined the separate effects of exercise load (4RM and 20RM),
volume (number of sets) and duration (number of repetitions) on important hemodynamic and
cardiovascular parameters. We found that both exercise loadings increased the exercise blood pressure
significantly from rest, which is in accordance with previous studies (6,15). There was, however, a
distinct difference in the pressure-response between the two loading conditions. Compared to 4RM
RT, the systolic and diastolic blood pressure was significantly elevated for 20RM exercise. Since the
load in kgs was substantially less for 20RM RT compared to 4RM RT, this demonstrates that the
absolute load (kg) lifted, is not the prime determinant of the blood pressure response. Moreover, our
results contradict the assumption that when RT is performed with a load corresponding to 70 % of
1RM or below, the intensity is not high enough to produce maximum blood pressure reactions (5).
There was no difference in blood pressure response comparing the 4th repetition of the 20RM protocol
to the 4RM protocol, clearly showing that increases in the external load does not increase blood
pressure further, when the duration of exercise is kept similar (Table 1). However, when the 20RM
exercise was performed to exhaustion, the exercise lasted about 38 seconds and blood pressures were
significantly elevated compared to the 4th rep of 20RM exercise (duration 7.8 sec.). Consequently, the
blood pressure response during RT is more related to the overall time of stimulus (number of
repetitions) than the absolute resistance in kg. We have, however, only examined this during 4RM and
20RM resistance exercise, and the relationship between blood pressure, exercise duration and the
external load during resistance training, needs to be examined in more detail in future studies.
Our findings are also in contrast to arguments that one should increase the number of repetitions
performed in each set before increasing the external resistance (16). On the contrary, in order to control
blood pressure responses, one should rather shorten the duration of exercise by increasing the
resistance or weight lifted (i.e. a lower total number of repetitions). In relation to this, increasing the
volume of exercise by performing multiple sets of resistance exercise does not seem to have a
cumulative effect on the exercise blood pressure. Thus, it seems that several sets of exercise could be
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used in regular training without an additive increase in exercise blood pressure, at least for 4RM RT.
This response may be different with shorter rest intervals, but this was not investigated in the present
study.
Since the classical work of MacDougall et al. (6) it is frequently cautioned (e.g17,18) that very high
blood pressure values can be reached when performing low rep/high load resistance training. In this
respect, referral to the study of MacDougall et al. (6) may not be entirely justified. In the latter study,
five male body-builders performed double leg-presses without (obvious) Valsalva maneuver at 90 %
of 1RM to voluntary exhaustion. This resulted in a mean systolic/diastolic blood pressure of 320/225
mmHg, but the body-builders lifted as many as 17 repetitions (exercise duration ~40-60 sec.) before
exhaustion, which does not fit well with a an exercise load of 90 % of 1RM. In comparison, the
participants in the present study managed to lift four repetitions at 89 % of 1RM.
Thus, with respect to exercise duration and repetition number, the exercise performed by the body
builders (17 reps to failure; in other words 17RM exercise) is comparable to the 20RM exercise
performed in the present study.
The impact of exercise duration on the pressure response, is in fact, elegantly demonstrated by
MacDougall et al. (6), showing that the blood pressure during 17RM leg press, increaseses repetition-
by-repetition. These findings have, however, attracted less focus than the extremely high blood
pressure values that were reported in the same study.
It is suggested the hemodynamic response during resistance training depend mainly on the degree of
voluntary effort or relative muscular workload (15,19). In this respect, RT with a load of 50 % of 1RM
(20RM) may be classified as “moderate intensity” and a load of 90 % of 1RM (4RM) as “high
intensity”. It may easily be assumed that moderate intensity RT require less voluntary effort than high
intensity RT, but when a load of 50 % of 1RM is lifted to voluntary exhaustion, the physiological
responses (the degree of effort) are far from moderate. In that respect, both heart rate, cardiac output,
lactate levels and subjective ratings of perceived exertion were substantially higher following 20RM
exercise compared to 4RM RT. RPE scorings show that 20RM exercise were rated close to maximal,
with a mean score of 9.2 on a 10 point scale, versus a score of 6.3 for 4RM RT. In fact, all our subjects
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verbalized that they clearly preferred 4RM exercise to 20RM exercise. Hence, performing 20RM
training require a high voluntary effort to complete, and this may be the key to understand the
hemodynamic responses of “moderate intensity” resistance training.
Cardiovascular responses
Cardiac output is determined by the product of HR and SV, and the present study show that both 4RM
and 20RM RT significantly increased CO, and our results are comparable to data following leg-press
(20) or isokinetic leg-extensions (19). The maximal CO in the present study (~14 L min-1) is, however,
only about 50 % of the maximal CO reported during intense short-term endurance exercise (21). In the
latter study, exercise SV peaked at 140-150 mL beat-1, while exercise SV in the present study changed
very little, and reached exercise values of 90-100 mL beat-1. Thus, similar to previous studies (22) SV
contributed very little to the increases in CO, and the increased CO in the present study was mainly
caused by increases in the heart rate (Table 2). Since the mean arterial pressure (MAP) is the product
of the cardiac output and systemic vascular resistance (SVR), an increase in cardiac output will
concurrently increase the blood pressure. In the present study, the SVR during 20RM exercise were
similar to 4RM exercise, but since CO was about 30 % higher during 20RM exercise, this would
largely explain the difference in blood pressure between 4RM and 20RM exercise.
An increased afterload (systemic vascular resistance) and decreased venous return could explain why
some studies observe little change in SV following dynamic resistance training (e.g.19,22, present study).
This was, however, not the case in the present study as there was a significant decrease in SVR for
both RT conditions. The effect of resistance training on systemic vascular resistance is little
investigated, but our study clearly shows a decrease in the SVR of about 30 % following 4RM and
20RM exercise. Our measurement system allows for online inspection of SVR data, and during testing
we could observe a progressive decline in the SVR during repeated contractions. Following
termination of exercise, SVR very quickly recovered to resting values (data not shown). This would
imply that venous return and cardiac filling was not compromised during exercise, and this is
substantiated by the fact that compared to rest, exercise end-diastolic volume (EDV) increased both
following 4RM and 20RM RT. Thus, repeated forceful contraction of the leg muscles may provide a
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powerful muscle pump that enhances venous return and ventricular filling, as suggested by
MacDougall et al. (6). Left ventricular ejection fraction (EF) did not change with either type of RT,
and this is in agreement with data following leg press exercise at 60-70 % of 1RM (23). Hence, we
assume the small changes in SV in the present study are mainly caused by the observed increases in
EDV. We have, however, not investigated how changes in contractility may affect cardiovascular
responses during RT, so this topic remains to be examined.
Conclusion
The present results suggest that low rep/high load resistance exercise results in significantly lower
blood pressure than high rep/low load resistance exercise when the lifting is performed to voluntary
exhaustion. It is possible that the elevated hemodynamic response to 20RM compared with 4RM
exercise might reflect the total duration of contractile activity and increased sympathetic drive. We
suggest that low rep/high load exercise is preferable to high rep/low load resistance exercise during
rehabilitation exercise. In addition, one should preferably increase resistance before increasing the
repetition number if management of blood pressure responses is of concern.
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TITLES OF TABLES
Table 1. Effect of exercise load and number of repetitions on blood pressure responses
during 4RM and 20RM exercise bouts
Table 2. Cardiovascular and physiological responses to 4RM and 20RM exercise bouts
TITLES OF FIGURES
Figure 1. Systolic blood pressure (SBP) during resting and at the end of the last contraction for each
4RM and 20RM set.
Figure 2. Diastolic blood pressure (DBP) during resting and at the end of the last contraction for each
4RM and 20RM set.
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Table 1. Effect of exercise load and number of repetitions on blood pressure responses
during 4RM and 20RM exercise bouts
Time, sec
SBP, mmHg
DBP, mmHg
Resting values
n.a
126 ± 14
73 ± 9
4th rep 20RM load
7.8 ± 0.6
154 ± 18***
91 ± 14***
4th rep 4 RM load
8.1 ± 0.5
154 ± 22***.†††
99 ± 18***,†††
20th rep 20RM load
38.3 ± 2.8§§§
203 ± 33***,§§§
126 ± 19***,§§§
LEGEND TABLE 1
Resting values are means ± SD of recordings prior to 4RM and 20 RM trials. Time, SBP and DBP
data are means ± SD of four sets of exercise. n.a = non applicable. Time (sec) = time taken to
complete 4 and 20 repetitions, respectively. N = 13. *** different from Resting, p < 0.001. ††† 20th rep
20RM different from 4th rep 4RM, p < 0.001. §§§ 20th rep 20RM different from 4th rep 20RM, p <
0.001.
19
Table 2 Cardiovascular and physiological responses to 4RM and 20RM exercise bouts
Rest
4RM RT
SV (mL· beat-1)
74 ± 9
90 ± 11***
HR (beats·min-1)
75 ± 8
124 ± 14***
CO (L ·min-1)
5.6 ± 0.7
10.8 ± 2.6***
EDV (mL)
148 ± 21
177 ± 25***
EF (%)
52 ± 6.0
52 ± 8.2
SVR (dyn· s-1 ·cm-5)
Lactate (mMol· L-1)
RPE (0-10)
1263 ± 196
1.3 ± 0.3
0.9 ± 0.8
980 ± 305 ***
2.8 ± 0.7***
6.3 ± 1.6 ***
955 ± 206 **
10.3 ±1.3***,†††
9.2 ± 0.8***,†††
LEGEND TABLE 2
Values are means ± SD. ***p < 0.001, **p < 0.01; Rest vs. Exercise. ††† p < 0.001, †† p < 0.01, p < 0.05;
4RM vs. 20RM RT. N=13. Resting values are means of recordings prior to 4RM and 20 RM trials.
4RM and 20RM values are means of four sets of resistance exercise.
20
LEGEND FIGURE 1
Values are means ± SD. N = 13. Rest 0 values are baseline recordings prior to start of exercise, while
Rest 1-3 are resting values between sets of exercise (all resting values are means of 4RM and 20RM
recordings). *** p < 0.001; Rest 0, 1, 2 and 3 compared to Set 1, 2, 3 and 4 of 20RM exercise,
respectively. §§§ p < 0.001; Rest 0, 1, 2 and 3 compared to Set 1, 2, 3 and 4 of 4RM exercise,
respectively. ††† p < 0.001; Set 1-4 of 4RM exercise compared to corresponding set of 20RM exercise.
21
LEGEND FIGURE 2
Values are means ± SD. N = 13. Rest 0 values is baseline recordings prior to start of exercise, while
Rest 1-3 are resting values between sets of exercise (all resting values are means of 4RM and 20RM
recordings). ** p < 0.01, *** p < 0.001; Rest 0, 1, 2 and 3 compared to Set 1, 2, 3 and 4 of 20RM
exercise, respectively. §§§ p < 0.001; Rest 0, 1, 2 and 3 compared to Set 1, 2, 3 and 4 of 4RM exercise,
respectively. †† p < 0.01, ††† p < 0.001; Set 1-4 of 4RM exercise compared to corresponding set of
20RM exercise.
... One of the well-documented interventions that has been shown to reduce arterial pressure is strength training (ST), which has already been reviewed to set optimal training loads, such as the number of sets [28][29][30][31], repetitions [32][33][34][35] and rest intervals during training sessions [32][33][34][36][37][38]. One of the ST effects is eliciting high muscle protein degradation followed by protein synthesis, which increases basal metabolism and is therefore usually accompanied by changes in nutritional requirements. ...
... One of the well-documented interventions that has been shown to reduce arterial pressure is strength training (ST), which has already been reviewed to set optimal training loads, such as the number of sets [28][29][30][31], repetitions [32][33][34][35] and rest intervals during training sessions [32][33][34][36][37][38]. One of the ST effects is eliciting high muscle protein degradation followed by protein synthesis, which increases basal metabolism and is therefore usually accompanied by changes in nutritional requirements. ...
Article
Full-text available
The combined effect of diet and strength training (ST) on blood pressure (BP) seems to be very important for the treatment of prehypertension and hypertension (HT). Therefore, the aim of this study was to determine whether ST alone or combined with nutrition or supplementation has an impact on the arterial pressure reduction in normotensive and hypertensive populations. A systematic computerized literature search was performed according to the PRISMA guidelines using PubMed, Scopus and Google Scholar; only English language studies published from 1999 until 2018 were included. This systematic search identified the results of 303 individuals from nine studies. The ST program alone had a similar effectiveness as the nutrition program (NP) alone; however, their combination did not result in increased effectiveness in terms of a high BP reduction. The consumption of L-citrulline had a similar effect as ST on lowering BP; on the other hand, caffeine led to an increase in BP during the ST session. Our data suggest that a combination of ST 2–3 times a week at moderate intensity and a NP seems to be equally effective in terms of lowering BP (systolic and diastolic) as ST and NP alone.
... During the work phases of the RTP, BP increases progressively, while during the rest phases, it decreases (2, 22). RTP with shorter sets result in smaller BP increases, while those with shorter rest intervals produce greater BP increases (2,14,15, 22). Thus, traditionally, the ways to reduce BP during RTP are by increasing the duration of the rest between sets (22) or decreasing the number of repetitions in each set (2,14,15). ...
... RTP with shorter sets result in smaller BP increases, while those with shorter rest intervals produce greater BP increases (2,14,15, 22). Thus, traditionally, the ways to reduce BP during RTP are by increasing the duration of the rest between sets (22) or decreasing the number of repetitions in each set (2,14,15). However, these procedures also decrease W:R, which may result in lower training stimulus (31). ...
Article
Full-text available
Paulo, AC, Tricoli, V, Queiroz, ACC, Laurentino, G, and Forjaz, CLM. Blood pressure response during resistance training of different work-to-rest ratio. J Strength Cond Res 33(2): 399-407, 2019-Changes in the work-to-rest ratio (W:R) of resistance training protocols (RTPs) (i.e., decreasing work or increasing rest) reduce the marked elevation in blood pressure (BP) that occurs during RTP execution. However, whether changes in RTP structure without changing W:R can change BP responses to RTP is unknown. To investigate the effect of different structures of rest intervals and number of repetitions per set on BP response among RTP equated and nonequated for W:R, 20 normotensive participants (25 ± 4 years) performed 4 different RTP of the leg extension exercise with the same work but different W:R structures. Two protocols followed the recommendations for cardiovascular disorders: (a) HIGHW:R-3×15:44s-3×15:44s (set×reps:rest between sets), which has high W:R (45reps:88s) and (b) LOWW:R-3×15:88s-3×15:88s, which has low W:R (45reps:176s). The other 2 protocols were W:R-equated to LOWW:R (45reps:176s): (c) LOWW:R-9×5:22s and (d) LOWW:R-45×1:4s. Systolic BP (ΔSBP) and diastolic BP (ΔDBP) were assessed by finger photoplethysmography. There were significant main effects for ΔSBP after RTP (p ≤ 0.05): HIGHW:R-3×15:44s = LOWW:R-3×15:88s > LOWW:R-45×1:4s > LOWW:R-9×5:22s (+87 ± 5 and +84 ± 5 vs. +61 ± 4 vs. 57 ± 4 mm Hg). For ΔDBP, there was a significant interaction between RTP and moment (p ≤ 0.05). Thus, HIGHW:R-3×15:44 > LOWW:R-3×15:88s > LOWW:R-45×1:4s > LOWW:R-9×5:22s (+53 ± 5 vs. +49 ± 5 vs. +44 ± 4 vs. +38 ± 3 mm Hg). HIGHW:R-3×15:44s produced the highest increase in ΔDBP, and LOWW:R-9×5:22s produced the lowest increase in ΔSBP and ΔDBP. Our findings may help the development of RTP protocols that may mitigate pressure peaks without changing important exercise variables (i.e., volume or duration).
... Heart rate, systolic BP, diastolic BP, and mean arterial pressure (MAP) increase significantly during the performance of traditional HLRE (Fleck, 1988, Fleck, 1992, particularly if the exercise involves isometric contractions (MacDougall et al., 1985). It has been demonstrated that the peak exercising HR and BP responses will generally increase to a greater extent with an increase in absolute load (Haslam et al., 1988, Lamotte et al., 2005, de Sousa et al., 2014, during prolonged durations of an exercise set or increased number of repetitions (Lovell et al., 2011, Gotshall et al., 1999, Gjovaag et al., 2015, and with increased muscle mass involvement (MacDougall et al., 1985, de Sousa et al., 2014. Because the magnitude of the cardiovascular response during resistance exercise depends on the muscle mass involved, muscle tension, absolute intensity (i.e. ...
... In regards to the response of Q̇, typically no comparative change, or only small increases in Q̇ are observed during HLRE; which is primarily due to an increased HR response (Miles et al., 1987, Lentini et al., 1993. However, as the load is reduced and repetitions increase over longer exercise durations, Q̇ may respond more similarly to that observed with aerobic exercise, although generally to a smaller degree (Bell, 2008, Baechle and Earle, 2008, Gjovaag et al., 2015. The data available relating to the acute response of SV and/or Q̇ response to BFR exercise is limited , Iida et al., 2007, Renzi et al., 2010, Karabulut et al., 2011b, Nakajima et al., 2008, Poton and Polito, 2014. ...
Thesis
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This thesis provides evidence of central nervous system adaptations as well as reduced exercising haemodynamics and perceptual responses when light-load resistance exercise/training is performed with blood flow restriction. In addition, this type of training appears beneficial in order to target gains in strength and muscle mass in healthy young populations.
... Further, the DBP varies little during moderate exercise when compared to other cardiovascular variables, such as SBP and HR, since the systemic pressure during cardiac diastole tends to remain similar to resting levels. 20 The analyzed cardiovascular variables showed greater response during the protocol of higher intensity and lower volume (4/90%) compared to the protocol of lower intensity and higher volume (15/65%). Thus, we can infer that during dynamic RE, intensity has more pronounced effects on cardiovascular stress than the volume of exercise. ...
Article
Full-text available
Objective: To determine and compare the cardiovascular responses to three resistance exercise protocols with different volumes and loads. Methods: The study included 15 healthy subjects, experienced in resistance training, who underwent supine bench press exercise with three different volumes and loads separated by 48 hours, with a crossover model: a) 4 repetitions at 90% of one repetition maximum (4/90%), b) 8 repetitions at 80% of one repetition maximum (8/80%), and c) 15 repetitions at 65% of one repetition maximum (15/65%). Immediately following each protocol, measures of heart rate, systolic and diastolic blood pressure were performed, and were used to calculate the rate pressure product. Results: The 4/90% protocol resulted in an increase in heart rate (Δ = 84.57%; effect size [ES] = 0.31), systolic blood pressure (Δ = 24.03%; ES = 0.42), diastolic blood pressure (Δ = 8.47%; ES = 0.27) and rate pressure product (Δ = 129.65%; ES = 0.54). The 8/80% protocol resulted in changes on: heart rate (Δ = 74.94%; ES = 0.57), systolic blood pressure (Δ = 20.67%; ES = 0.27), diastolic blood pressure (Δ = 6.91%; ES = 0.15) and rate pressure product (Δ = 111.78%; ES = 0.48). The 15/65% protocol resulted in alterations on: heart rate (Δ = 66.77%; ES = 0.39), systolic blood pressure (Δ = 16.85%; ES = 0.35), diastolic blood pressure (Δ = 3.38%; ES = 0.13) and rate pressure product (Δ = 96.41%; ES = 0.30). Increases in all variables pre to post resistance exercise were observed for all protocols (p < 0.05). When comparing the three different protocols, it was found that the heart rate (p < 0.001), systolic blood pressure (p = 0.034) and rate pressure product (p < 0.001), were more elevated in the 4/90% compared to the 15/65%. Conclusion: The bench press exercise performed with low volume and high intensity promotes a more pronounced cardiovascular response compared to the same exercise performed with high volume and low intensity.
... Pioneers of monitoring of cardiovascular system of athletes at power sports were John Longhurst and co-authors [2], who was among the first to point out the increased blood pressure and vulnerability of the cardiovascular system of athletes of power sports, and a little later, other researchers began to note that high blood pressure levels are the most common abnormal diagnosis during pre-screening of the cardiovascular system in such athletes [3,4]. Perhaps because of the large static component in the training program [5] or the high blood pressure [6] during exercise, the heart is subjected to an additional hemodynamic loading. It increases the formation of transverse bridges, according to the Frank-Starling law, and activates neurohormonal mechanisms to enhance concavity, leading to its compensatory hypertrophy. ...
... Maximal MS tests are also linked to a peak blood pressure (BP) response (20) as well as a significant increase in heart rate (HR) (9,12). While these responses are related to the volume and intensity of the exercise, the amount of muscular mass involved, the rest interval between the sets, and the type and complexity of the movement (25,27), they are also a function of age. ...
Article
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Soares BRA, Neves RVP, Olher RR, Souza LHR, Santos LCS, Condé RBK, Melo GLR, Ferreira AP, Ernesto C, Oliveira JF, Rosa TS, Moraes MR. Cardiovascular Responses to Maximal Voluntary Contraction in Different Muscle Mass in Young Men. JEPonline 2019;22(1):51-62. The purpose of this study was to evaluate the cardiovascular responses in young trained men submitted to two tests of maximal voluntary isometric contraction (MVIC) with different muscle mass. Thirty-seven men (age, 25 ± 4 yrs) with experience in strength training (ST) performed two maximal effort tests: (a) isometric handgrip (IHG); and (b) isometric leg press (ILP). Three 5-sec contractions were performed with a 3-min pause between each contraction. Blood pressure (BP) and heart rate (HR) were measured at rest, during, and between trials and recovery at 5 min and 10 min. Mean arterial pressure (MAP), rate-pressure product (RPP), and pulse pressure (PP) were calculated. The increase in HR (P=0.0004) and RPP (P=0.0032) were more expressive for the ILP test when compared to IHG. There was no difference for the other cardiovascular parameters. Our findings demonstrate that in young people with ST experience undergoing MVIC testing involving large muscle mass, HR and RPP may be better markers than BP for measuring cardiovascular stress.
... Simultaneously, the endothelium vasodilator agents such as nitric oxide, prostaglandins, adenosine, and potassium release (13) induce the lowering of peripheral vascular resistance. Following aerobic exercise, a hypotensive response may occur in a dose-response pattern in relation to the volume and intensity of the exercise performed (8,9,15,16,22). Nevertheless, the RE presents a more complex interrelationship between training volume and intensity, leading to confusing results concerning the PEH response (31). ...
Article
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Rodriguez D,Nakazato K, Fleck S, Pontes LF, Charro MA, Bocallini DS, Figueira A. Strength Training Methods Does Not Affect Post-Exercise Hypotension and Heart Rate Variability. JEPonline 2017;20(5):36-51. The purpose of this study was to determine the influence of resistance exercise (RE) training methods (circuit [C], multiple sets [MS]) on post-exercise hypotension (PEH) and heart rate variability (HRV) of untrained normotensive adults. The subjects (N = 25; 46.5 ± 4.9 yrs; mean arterial pressure [MAP] 96.4 ± 4.0 mmHg; resting heart rate [HR] 66.5 ± 4.7 beats·min-1) performed C and MS sessions (12 exercises 3 sets; 14 to 17 reps; 60% of 1RM) with equal total work load. Their blood pressure (BP) and HRV were monitored 20 min before and 90 min after the RE sessions. Autonomic regulation was evaluated by normalized low-frequency (LFnu) and high-frequency (HFnu) components of HRV. The MAP remained significantly reduced throughout the post-exercise period compared to rest for both RE sessions (C =-6.1 ± 1.3 mmHg and MS =-6.3 ± 1.5 mmHg; P<0.05), but was not significantly different between C 37 and MS. The LFnu increased while the HFnu decreased following both RE sessions (P<0.05). Thus, both methods caused a similar PEH response. The HFnu increase suggests that PEH is accompanied by increased sympathetic modulation of the heart, which has been previously described for the MS but not for C. This study indicates that PEH is not affected by exercise method, and is determined by central nervous system changes. The cardiovascular response is likely associated with other mechanisms, such as plasma blood volume.
... Longer sets may elicit greater increases in the systolic and diastolic blood pressure, heart rate, as well as rate-pressure product. This effect is not necessarily explained by the fatigue, but because longer sets induce greater cardiovascular responses (Lamotte et al., 2005;Nery et al., 2010;Lovell et al., 2011;Gjovaag et al., 2015;Gjovaag et al., 2016). Therefore, this type of RT prescription should be avoided in elderly, especially those Besides to discuss the information above mentioned by the authors, our main concern regarding the content of authors' review is the statement that "…trainees might performed controlled 2-4 s concentric: 2-4 s eccentric phases, which should maintain muscular tension throughout the range of motion, decrease momentum and reduce high forces by preventing explosive movements.". ...
Article
This letter is a commentary regarding the Mini review by Fisher et al. (2017), entitled “A minimal dose approach to resistance training for the older adult; the prophylactic for aging”, which was recently published in the Experimental Gerontology, 99, 80-86. Although we recognize the experience of the authors in the resistance training research field, as well as we agree with the main message of the article, that is, a minimal dose of resistance training provides several health benefits in elderly individuals, we would like to complement some provided information, and argue, based on strong scientific evidence, against some affirmations.
... Further, the DBP varies little during moderate exercise when compared to other cardiovascular variables, such as SBP and HR, since the systemic pressure during cardiac diastole tends to remain similar to resting levels. 20 The analyzed cardiovascular variables showed greater response during the protocol of higher intensity and lower volume (4/90%) compared to the protocol of lower intensity and higher volume (15/65%). Thus, we can infer that during dynamic RE, intensity has more pronounced effects on cardiovascular stress than the volume of exercise. ...
Article
Full-text available
Objective: To determine and compare the cardiovascular responses to three resistance exercise (RE) protocols with different volumes and loads. Methods: The study included 15 healthy subjects, experienced in resistance training, who underwent supine bench press exercise with three different volumes and loads separated by 48 hours, with a crossover model: a) 4 repetitions at 90% 1RM (4/90%), b) 8 repetitions at 80% 1RM (8/80%), and c) 15 repetitions at 65% 1RM (15/65%). Immediately following each protocol, measures of heart rate (HR), systolic blood pressure (SBP) and diastolic were performed, and were used to calculate the rate pressure product (RPP). Results: The 4/90% protocol resulted increases in HR (∆= 84.57%; ES= 0.31), SBP (∆= 24.03%; ES= 0.42), DBP (∆= 8.47%; ES= 0.27) and RPP (∆= 129.65%; ES= 0.54). The 8/80% protocol resulted in changes on: HR (∆= 74.94%; ES= 0.57), SBP (∆= 20.67%; ES= 0.27), DBP (∆= 6.91%; ES= 0.15) and RPP (∆= 111.78%; ES= 0.48). The 15/65% protocol resulted in alterations on: HR (∆= 66.77%; ES= 0.39), SBP (∆= 16.85%; ES= 0.35), DBP (∆= 3.38%; ES= 0.13) and RPP (∆= 96.41%; ES= 0.30). Increases in all variables pre to post RE were observed for all protocols (p<0.05). When comparing the three different protocols, it was found that the HR (p<0.001), SBP (p=0.034) and RPP (p<0.001), were more elevated in the 4/90% compared to the 15/65%. Conclusion: The bench press exercise performed with low volume and high intensity promotes a more pronounced cardiovascular response compared to the same exercise performed with high volume and low intensity.
Article
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Background: Hypertension and intradialytic hypotension are independent risk factors for mortality in hemodialysis patients. We hypothesized that intradialytic exercise would increase blood pressure (BP) during dialysis and decrease it during the postdialytic period. The present study aimed to investigate the effect of acute intradialytic exercise on BP both during dialysis and for 20 hours post-dialysis, and to detect any differences in effects of aerobic exercise (AE), resistance exercise (RE), and usual care (UC-the control condition). Methods: Eleven patients undergoing maintenance hemodialysis performed two complete sets of AE or RE, with a 1-hour rest between the sets. The patients performed AE, RE and UC over three consecutive weeks at 7 day intervals. Intradialytic BP was measured using an oscillometric BP monitor (n=11), and ambulatory BP was measured for 20 hours after each dialysis session using an ambulatory BP monitor (n=8). Results: The mean BP of the patients in the AE and RE interventions increased during exercise (p<0.05), with the exception of the first set of AE. However, only RE increased BP significantly compared with UC (p<0.05). Following dialysis, daytime ambulatory BP was significantly lower after AE and RE than after UC (p<0.05). Conclusions: Acute intradialytic exercise interventions are effective in increasing BP during dialysis and decreasing daytime ambulatory BP after dialysis. Longer observation periods and larger sample sizes will be needed to confirm our findings. Also further studies should be performed on patients prone to intradialytic hypotension.
Article
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The objectives of this study were to evaluate the reliability and accuracy of a new impedance cardiograph device, the Physio Flow, at rest and during a steady-state dynamic leg exercise (work intensity ranging from 10 to 50 W) performed in the supine position. We compared cardiac output determined simultaneously by two methods, the Physio Flow (Q˙ cPF) and the direct Fick (Q˙ cFick) methods. Forty patients referred for right cardiac catheterisation, 14 with sleep apnoea syndrome and 26 with chronic obstructive pulmonary disease, took part in this study. The subjects' oxygen consumption values ranged from 0.14 to 1.19 l · min−1. The mean difference between the two methods (Q˙ cFick−Q˙ cPF) was 0.04 l · min−1 at rest and 0.29 l · min−1 during exercise. The limits of agreement, defined as mean difference ± 2SD, were −1.34, +1.41 l · min−1 at rest and −2.34, +2.92 l · min−1 during exercise. The difference between the two methods exceeded 20% in only 2.5% of the cases at rest, and 9.3% of the cases during exercise. Thoracic hyperinflation did not alter Q˙ cPF. We conclude that the Physio Flow provides a clinically acceptable and non-invasive evaluation of cardiac output under these conditions. This new impedance cardiograph device deserves further study using other populations and situations.
Article
Background: Isokinetic evaluation and training are commonly used. Hemodynamic response during this type of exercise is unknown and therefore usually not recommended in some patients (elderly, patients with risk factors or with cardiovascular disease). The aim of this study was to evaluate the hemodynamic response during a classical testing and training isokinetic session. Method: 20 healthy young male participated to this study. The hemodynamic response wa continuously and non invasively (Task Force Monitor) measured on a Cybex Norm (knee extension and flexion). The hemodynamic parameters were systolic blood pressure (SBP), heart rate (HR) and cardiac output (Q). Results: A low speed (60 degrees/s) test was more exhausting than one at higher speed (180 degrees/s) which is probably related to its duration. Whereas rest periods seemed sufficient for muscle recovery allowing during training, maintenance of performance over the different sets, changes in hemodynamic parameters (HR, SBP & Q) were observed over successive sets and did not recover totally during rest. Systolic ejection volume did neither change nor contribute to the increase of cardiac output (+ 70 to 84% compared to rest). Values measured during test and training were high but not excessive (HR max = 135 +/- 20 bpm or 70% of HRmax predicted; SBP max = 185 +/- 26 mmHg; Q = 11.2 +/- 2.21/min). Conclusions: Values measured during test and training are high but not excessive. Isokinetic training in cardio-vascular risk patients should be composed of shorter set duration and longer rest periods as generally applied, without loosing maximal muscle contraction over the entire rage of motion.
Article
PURPOSE: Resistance training has become an accepted part of cardiac rehabilitation programs. Because of the potential for a high afterload to have a negative impact on left ventricular function, there has been concern regarding the safety of resistance training for patients with congestive heart failure. METHODS: This study addressed this concern by studying 12 healthy volunteers, 12 patients with stable coronary artery disease, and 12 patients with stable congestive heart failure during upright cycling at 90% of ventilatory threshold, and during one set of 10 repeated leg presses, shoulder presses, and biceps curls at 60% to 70% of 1-repetition maximum. Left ventricular function was measured by echocardiography. RESULTS: The pattern of changes in heart rate, blood pressure, left ventricular ejection fraction, wall thickness, and left ventricular internal diameters was similar across all three groups of subjects, although there were large differences in absolute values. Despite elevations in diastolic and mean arterial pressures during resistance exercise, there was no evidence of significant rest-to-exercise deterioration in left ventricular function during leg press (ejection fraction, 60%-59%, 56%-55%, and 38%-37%), shoulder press (66%-65%, 59%-53%, and 38%-35%), or biceps curls (63%-58%, 53%-54%, and 35%-36%), as compared with cycle ergometry (63%-69%, 51%-57%, and 35%-42%) in the healthy control subjects, the patients with coronary artery disease, and the patients with congestive heart failure, respectively. CONCLUSIONS: Left ventricular function remains stable during moderate-intensity resistance exercise, even in patients with congestive heart failure, suggesting that this form of exercise therapy can be used safely in rehabilitation programs.
Chapter
We are all on a trajectory to heart disease. It’s called age. (J. N. Cohn, University of Minneapolis, at the Annual Scientific Meeting of the Heart Failure Society of America, Toronto, Canada, 2004)
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This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is ‘The trainee consistently demonstrates a knowledge of basic exercise physiology and is able to advise individuals about the risks and benefits of specific exercise programmes.’ Cardiovascular disease is the leading cause of death in developed nations, and there is a clear link with physical inactivity. The benefits of resistance training in patients with coronary heart disease are well documented and can contribute to secondary prevention of heart disease with corresponding improvements in patient survival. This review describes the benefits of resistance exercise for cardiac patients, details of its prescription in this group, and considers safety and contraindications.
To compare the readings of blood pressure by the Riva-Rocci (RR) method with those of peripheral arterial pressure (PAP) as recorded by the Finapres (FP) device, exercise was performed by six male subjects on a cycle ergometer at a constant exercise intensity of 140 W. In addition, forearm volume was determined by impedance plethysmography. At rest, systolic FP values exceeded RR values by greater than or equal to 10 mmHg. During 60-min exercise both values at first increased almost in parallel with each other. While RR reached a plateau after 3 min, FP then started to decrease continuously up to the 10th min and finally stabilized at 20-30 mmHg below RR. The impedance values showed a similar declining slope, indicating vasodilatation. To separate the effects of sympathetic drive from heat elicited vasodilatation, a second experimental series was performed with ischaemic static calf exercise (5 min, 90 N), since this increases the sympathetic tone but prevents systemic heat distribution. In contrast to findings reported from intra-arterial measurements, no exercise effect on the pulse pressure amplification was obtained. However, the heating of one fingertip distal to the FP-cuff led to a significant decrease in PAP compared to the control recording made simultaneously from the other hand. It was concluded that heat induced vasodilatation may make FP unrepresentative of systemic blood pressure, in particular during exercise. Moreover, the FP-cuff seemed to induce substantial vasoconstriction due to venous occlusion. The FP method would therefore be useful for monitoring continuously systemic blood pressure if no (dilative) vasomotor changes occurred or their ranges and time courses were known sufficiently well.
Article
The purpose of this study was to record the blood pressure response to heavy weight-lifting exercise in five experienced body builders. Blood pressure was directly recorded by means of a capacitance transducer connected to a catheter in the brachial artery. Intrathoracic pressure with the Valsalva maneuver was recorded as mouth pressure by having the subject maintain an open glottis while expiring against a column of Hg during the lifts. Exercises included single-arm curls, overhead presses, and both double- and single-leg presses performed to failure at 80, 90, 95, and 100% of maximum. Systolic and diastolic blood pressures rose rapidly to extremely high values during the concentric contraction phase for each lift and declined with the eccentric contraction. The greatest peak pressures occurred during the double-leg press where the mean value for the group was 320/250 mmHg, with pressures in one subject exceeding 480/350 mmHg. Peak pressures with the single-arm curl exercise reached a mean group value of 255/190 mmHg when repetitions were continued to failure. Mouth pressures of 30-50 Torr during a single maximum lift, or as subjects approached failure with a submaximal weight, indicate that a portion of the observed increase in blood pressure was caused by a Valsalva maneuver. It was concluded that when healthy young subjects perform weight-lifting exercises the mechanical compression of blood vessels combines with a potent pressor response and a Valsalva response to produce extreme elevations in blood pressure. Pressures are extreme even when exercise is performed with a relatively small muscle mass.
Article
Arterial hypertension occurring during heavy resistance exercise may be a risk factor for stroke in healthy young adults. Any training method that ameliorates the pressor effect of exercise should reduce the risk of stroke. The objective of this study was to observe the influence of breathing technique on arterial blood pressure (BP) generated during heavy, dynamic weight lifting. BP was recorded in 10 male athletes by radial artery catheterization. Each subject then performed double-leg press sets at 85% and 100% of maximum. Each exercise was performed twice, once with closed glottis Valsalva, and then with slow exhalation during concentric contraction. The mean BP at 100% maximum with Valsalva was 311/284. The highest pressure recorded in an individual was 370/360. With slow exhalation, the mean BP was 198/175 when the same 100% maximum was lifted (p < .005). A reduced pressor response was also noted at 85% maximal lifting with slow exhalation. Arterial hypertension produced during heavy weight lifting with Valsalva is extreme and may be dramatically reduced when the exercise is performed with an open glottis (without Valsalva). It is concluded that heavy resistance exercise is safer when performed while the subject breathes with an open glottis.
Article
We examined cardiac volumes (using echocardiography), intra-arterial blood pressure (BP), and intrathoracic pressure (ITP) in healthy males performing leg press exercise to failure at 95% of their maximum dynamic strength. Compared with preexercise, during the lifting phase of exercise, end-diastolic volume (EDV; 147 +/- 8 to 103 +/- 7 ml) and end-systolic volume (ESV; 54 +/- 5 to 27 +/- 4 ml) decreased (P < 0.05); heart rate (82 +/- 6 to 143 +/- 5 beats/min), systolic BP (160 +/- 6 to 270 +/- 21 Torr), diastolic BP (91 +/- 2 to 183 +/- 18 Torr), ITP (0.8 +/- 0.8 to 57.8 +/- 24 Torr), and peak systolic BP/ESV (SBP/ESV; 3.0 +/- 0.3 to 11.0 +/- 1.5 Torr/ml) increased (P < 0.05); and stroke volume decreased (94 +/- 3 to 77 +/- 4 ml; P > 0.05). Full knee extension was associated with most values returning to preexercise levels except for ESV (38 +/- 7 ml), heart rate (130 +/- 9 beats/min), and ITP (-12.5 +/- 2.1 Torr). During the lowering phase, significant decreases in EDV to 105 +/- 14 ml and ESV to 27 +/- 7 ml were observed with increases in systolic BP to 207 +/- 23 Torr, diastolic BP to 116 +/- 8 Torr, and SBP/ESV to 10.0 +/- 2.5 Torr/ml. Stroke volume decreased to 78 +/- 9 ml (P > 0.05). Thus rapid changes in cardiac volumes, contractility, and pressure occur during weight lifting that are related to different phases of the lift.