“Using the immediate blood

pressure benefits of
exercise to improve exercise
adherence among adults
with hypertension: a
randomized clinical trial”
ZALESKI, Amanda L., et al. Journal of Hypertension, 2019, 37.9: 1877-1888.

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Context
Hypertension (HT) is the most common, costly, and modifiable cardiovascular disease (CVD) risk
factor, affecting 1.39 billion adults (31%) worldwide.

Participation in regular exercise is recommended as cornerstone lifestyle therapy for the primary
prevention, treatment, and control of HT.

Exercise acutely reduces blood pressure (BP) among adults with HT after a single, isolated exercise
session. These BP reductions are immediate, persist for at least 24 h after the exercise bout, and are
termed postexercise hypotension (PEH).

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Gap, Hypothesis and Purpose

No study has been reported that use PEH as a strategy to improve exercise adherence and BP
control among adults with HT.

We hypothesized that adults using BP and exercise self-monitoring (EXERCISE + PEH) would increase
exercise adherence and improve BP control more than exercise self-monitoring alone (EXERCISE).

Efficacy comparison in between:

- Exercise self-monitoring
- Exercise + Hypotension

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Methods

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Results
- Supervised exercise training

Training characteristics Total sample, n=24 EXERCISE, n=12 EXERCISE + PEH, n12

Frequency (day/week) 2.6 ± 0.4 2.4 ± 0.4 2.8 ± 0.2

Adherence (%) 87.9 ± 12.1 81.6 ± 13.2 94.3 ± 6.6

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Results
- Unsupervised exercise training
Training characteristics Total sample, n=24 EXERCISE, n=12 EXERCISE + PEH, n12

Number of subjects reporting at least one 12 2 10

verified exercise session at home during
12-week study period (n)

Frequency (day/week) 0.4 ± 0.4 0.4 ± 0.4 0.5 ± 0.4

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Results
- Supervised and Unsupervised exercise training

Training characteristics Total sample, n=24 EXERCISE, n=12 EXERCISE + PEH, n12

Frequency (day/week) 2.9 ± 0.6 2.4 ± 0.5 3.2 ± 0.6

Time (min/session) 37.9 ± 12.4 34.1 ± 3.3 41.8 ± 16.7

Adherence (%) 94.9 ± 20.9 82.7 ± 12.2 107.3 ± 18.7

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Results
- Four-week follow-up to the exercise training

Participants among the total sample reported maintaining exercise training for 1.9 ± 1.5
days/week.
- adults who self-monitored their BP report greater exercise frequency (2.6 ± 1.7
days/week) than adults who not self-monitored their BP (1.3 ± 1.1 days/week).

At follow-up, adults who self-monitored their BP were still engaging in 70% (73.9 ± 54.1%)
of their supervised exercise training volume (frequency x time) compared with 30% (33.3
28.7%) of those who were not using BP self-monitoring.

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Discussion
Adults with HT who self-monitored their BP were more adherent to exercise - supervised and
unsupervised, even at 1-month follow-up, in relation to those who were not using BP self-
monitoring.

- self-monitoring of BP may serve an efficacious condition-specific behavioral strategy to

increase exercise adherence among adults with HT.

Self-monitoring of BP resulted in an additional 30 min or 1 day more of aerobic exercise per week.

- Given that exercising as little as 1 day/ week is as effective (or even more so) than
pharmacotherapy for reducing BP and all-cause mortality among those with HT, this additional
amount of exercise is clinically important [8].

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Discussion

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Discussion
Limitations:

- Small sample - larger studies are required to confirm these encouraging findings.
- Absence of a comprehensive analysis of moderators of exercise behavior (perceived risk of
disease, family support, stress, ...)

Strengths:

- The current study is the first rigorously designed RCT to examine our hypothesis
- Technical error was minimized
- all BP assessments performed by a single investigator, at the same time of day, using
the same ambulatory BP monitor for the same subject
- all training sessions were supervised by the same research assistant and in the same
training facility.
Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Discussion
This study is the first RCT to demonstrate that using BP self-monitoring is an efficacious strategy to improve
exercise adherence among adults with HT.

Studies with larger samples are needed to confirm these promising results.

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
 Authors

Amanda Zaleski Linda Pescatello

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023
“Using the immediate blood
pressure benefits of
exercise to improve exercise
adherence among adults
with hypertension: a
randomized clinical trial”
ZALESKI, Amanda L., et al. Journal of Hypertension, 2019, 37.9: 1877-1888.

Mestrado em Atividade Física, Exercício e Saúde - Metodologia de Investigação Ano letivo 2022/2023