Similar Postexercise Hypotension After MICT,

HIIT, and SIT Exercises in Middle-Age Adults

SETH F. MCCARTHY1, EMILY J. FERGUSON1,2, CLAUDIA JAROSZ1, KENJI A. KENNO3, and TOM J. HAZELL1
1
Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, CANADA; 2School of
Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, CANADA; and 3Faculty of Human Kinetics, University
of Windsor, Windsor, Ontario, CANADA

ABSTRACT
MCCARTHY, S. F., E. J. FERGUSON, C. JAROSZ, K. A. KENNO, and T. J. HAZELL. Similar Postexercise Hypotension After MICT,
HIIT, and SIT Exercises in Middle-Age Adults. Med. Sci. Sports Exerc., Vol. 55, No. 1, pp. 101-109, 2023. Introduction: Acute bouts of
moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) transiently lower systolic blood pressure (SBP)
and diastolic blood pressure (DBP) in the hours after termed postexercise hypotension (PEH); however, the effects of sprint interval training
(SIT) exercise have yet to be explored in middle-age adults. Although previous work has found no effect of exercise intensity on PEH, no
study has compared submaximal, near maximal, and supramaximal intensities, specifically in middle-age adults where blood pressure (BP)
management strategies may be of greater importance. Purpose: This study examined the effects of MICT, HIIT, and SIT exercises on
PEH in the immediate (≤2 h) and 24 h after exercise specifically in middle-age adults. Methods: Fourteen participants (10 female; age,
46 ± 9 yr; SBP, 116 ± 11 mm Hg; DBP, 67 ± 6 mm Hg; one hypertensive, four prehypertensive, nine normotensive) had their BP measured
before, immediately (15, 30, 60, 120 min), and over 24 h after four experimental sessions: 1) 30-min MICT exercise (65% maximal oxygen
consumption), 2) 20-min HIIT exercise (10  1 min at 90% maximum heart rate with 1-min rest), 3) 16-min SIT exercise (8  15 s all-out
sprints with 2-min rest), and 4) no-exercise control. Postexercise BP was compared with no-exercise control. Results: PEH was similar for all
exercise sessions for SBP (P = 0.388, η2p = 0.075) and DBP (P = 0.206, η2p = 0.108). Twenty-four-hour average SBP was similar for all sessions
P = 0.453, η2p = 0.069), and DBP was similar over 24 h except after MICT exercise compared with HIIT exercise (P = 0.018, d = 1.04).
Conclusions: In middle-age adults, MICT, HIIT, and SIT exercises are effective at reducing SBP; however, the effects on DBP are
smaller, and neither reductions are sustained over 24 h. Key Words: BLOOD PRESSURE, AMBULATORY BLOOD PRESSURE,
MODERATE-INTENSITY CONTINUOUS TRAINING, HIGH-INTENSITY INTERVAL TRAINING, SPRINT INTERVAL
TRAINING, ADULTS

E
xercise has beneficial effects on blood pressure (BP)
because a single bout of aerobic exercise can induce
postexercise hypotension (PEH), which is a reduction
in resting BP in the subsequent hours after the exercise session
(1,2). PEH is generally characterized by a reduction in total pe-
ripheral resistance that is not completely offset by an increase
in cardiac output (1–6); however, in some cases, a reduction in
cardiac output is responsible (6). The response involves both a
vascular and neural component (1), and the mechanism can
change based on participant age, BP status, body composition,
and body position (6). Although the PEH response is elicited
regardless of the participant or exercise characteristics (7), an
Address for correspondence: Tom J. Hazell, Ph.D., Department of Kinesiology
and Physical Education, Wilfrid Laurier University, 75 University Ave W,
Waterloo, ON N2L 3C5, Canada; E-mail: thazell@wlu.ca.
Submitted for publication March 2022.
Accepted for publication July 2022.
0195-9131/23/5501-0101/0
MEDICINE & SCIENCE IN SPORTS & EXERCISE®
Copyright © 2022 by the American College of Sports Medicine
DOI: 10.1249/MSS.0000000000003017
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inverse relationship has been reported between age and BP re-
ductions, as well as body mass index and reductions in systolic
BP (SBP) (7). This meta-analysis also noted a significant but
minimal difference (a difference of 1 mm Hg) in the response
between males and females (7), although direct comparisons
have shown no differences (2,8–11).
PEH has most commonly been elicited after moderate-intensity
continuous training (MICT; 30–60 min at 60%–70% maximal ox-
ygen consumption (V̇O2max)) exercise in normotensive (SBP/
diastolic BP (DBP); −7/−4 mm Hg [5,10–17]) and hyperten-
sive populations (−11/−5 mm Hg [3,5,17–21]). However,
high-intensity interval training (HIIT) exercise has become
an increasingly popular exercise modality characterized by pe-
riods of near maximal effort interspersed with periods of re-
covery (22), demonstrating similar improvements in physio-
logical outcomes such as V̇O2max, body fat, and resting BP
(23–25) as MICT exercise but with reduced training volume
and time commitment (22). Similarly, HIIT exercise has elic-
ited PEH in normotensive (−7/−4 mm Hg [8,10,12,13,26])
and hypertensive populations (−12/−8 mm Hg; [26,27]). Sprint
interval training (SIT) exercise, a more intense version of HIIT
exercise characterized by short periods of supramaximal effort
interspersed with periods of rest (22), has also elicited PEH in

101

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 normotensive populations (−7/−5 mm Hg), although it has
only been characterized in younger populations (≤40 yr
[10,12,28–31]).
Most studies show little to no effect of exercise intensity on
PEH after MICT exercise (2,14,21,32,33); however, these
studies all compare submaximal intensities (15–45 min,
40%–75% V̇O2max) that are of low to moderate intensity.
Meta-analyses and systematic reviews comparing the effects
of HIIT and MICT exercise on PEH have produced conflicting
evidence. The first in this area suggested superior PEH re-
sponses after HIIT exercise compared with MICT exercise
(34); however, a more recent meta-analysis with a greater
number of studies suggested similar PEH after MICT and
HIIT exercises (35). Notably, these articles misclassify SIT ex-
ercise as HIIT exercise preventing appropriate comparisons
between exercise protocols. Although the changes in BP seem
to be similar between aerobic exercise protocols (35), the
mechanisms seem to differ (36). Studies have noted greater
cardiac output offset by greater reductions in total peripheral
resistance (10), larger reductions in baroreflex sensitivity and
heart rate variability (27), and greater reductions in systemic
and cutaneous vascular resistance (26) after HIIT exercise
compared with MICT exercise. The only study to directly
compare MICT, HIIT, and SIT exercises demonstrated that,
in normotensive participants, HIIT exercise elicited a greater
duration PEH response compared with MICT and SIT exer-
cises when measured for 3 h after exercise (12). To date, no
studies have examined the effect of SIT exercise on PEH spe-
cifically in a middle-age population where BP management
strategies may be of greater importance. The identification of
the PEH response has clinical importance because it has a
APPLIED SCIENCES
moderate-strong correlation (r > 0.45) with chronic BP reduc-
tions (15,18), while also assisting in the detection of responders
and nonresponders to different exercise protocols (13). Acute re-
ductions of −7/−4 mm Hg (18) and −9/−4 mm Hg (15) were
moderately-strongly correlated (r > 0.65) with chronic reductions
(−9/−7 and −7/−5 mm Hg) after 4- (15) and 8-wk MICT (18).
To our knowledge, no study has compared the effect of
MICT, HIIT, and SIT exercises on PEH specifically in
middle-age adults, both in the immediate hours after exercise
and in the 24-h period afterward. Therefore, the purpose of this
study was to examine the effect of MICT, HIIT, and SIT exer-
cises on PEH specifically in middle-age adults. PEH was mea-
sured in the immediate hours after exercise (<2 h) in a labora-
tory setting, and ambulatory BP (AMBP) was measured over
the remainder of the day (~24 h) throughout activities of daily
living. We hypothesized that the PEH response will be similar
after MICT, HIIT, and SIT exercises in the immediate (<2 h)
and 24 h after exercise.
MATERIALS AND METHODS
Participants. A sample size calculation was completed
a priori using GPower 3.1 based on previous work examining
changes in BP after HIIT in hypertensive and normotensive par-
ticipants (26) demonstrating that 12 participants were necessary.
102 Official Journal of the American College of Sports Medicine
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This is similar (10–15 participants) to previous work comparing
the effect of exercise intensity on PEH (10,12,13). Data collec-
tion for this study began in July of 2019 and thus was
interrupted multiple times by regional COVID-19 lockdowns.
Twenty-eight participants completed the familiarization ses-
sion, six participants did not return after regional COVID-19 re-
strictions were lifted, seven participants dropped out because of
time constraints, and one participant dropped out because of
personal reasons. Thus, 14 participants completed all four ex-
perimental sessions (Table 1). Using updated (37) and tradi-
tional (38) hypertension guidelines, the sample was composed
of one participant living with hypertension (medicated), four
participants living with prehypertension, and nine normotensive
participants. Participants were nonsmokers and screened using
the Physical Activity Readiness Questionnaire+. Participants
were considered middle-age for the purposes of this study if
they were between the ages of 30 and 60 yr during the time
of participation, and their physical activity level was assessed
using the Canadian Society for Exercise Physiology Physical
Activity and Sedentary Behaviour Questionnaire (39). This
was reflected in our data, as participant’s V̇O2max ranged from
good to excellent based on their age and biological sex. Exclu-
sion criteria include any medical history of cardiovascular dis-
ease as well as the use of β-blockers to treat hypertension.
The experimental procedures were explained in full detail to
all participants, and all provided written informed consent be-
fore any data collection. The Research Ethics Board at Wilfrid
Laurier University approved this study.
Study design. Participants completed four experimental
sessions (~3.5 h each) during which BP was measured. Exper-
imental sessions consisted of three exercise sessions: (i) MICT
exercise, (ii) HIIT exercise, (iii) SIT exercise, and one
no-exercise control session (CTRL). The order of experimen-
tal sessions was systematically rotated to avoid any learning
effects. Participants were instructed to refrain from physical
activity, alcohol, and caffeine for at least 12 h before each ex-
perimental session.
Preexperimental procedures. All participants com-
pleted a laboratory familiarization session before data collec-
tion to introduce testing procedures and reduce any learning
effects during subsequent experimental sessions. Participants
had their BP measured four times using an automated
oscillometric device (Dinamap Carescape V100; Critikon,
Tampa, FL) with 2 min between each measurement. BP was
always measured on the left arm, and an appropriately sized
cuff was selected based on the circumference of the partici-
pant’s upper arm in line with the manufacturer’s instructions.
The first measurement was discarded, and the final three were
TABLE 1. Participant characteristics (n = 14).
Sex (men/women) 4/10
Age (yr) 46 ± 9
Height (m) 1.71 ± 0.07
Weight (kg) 76.4 ± 12.5
Body mass index (kg·m−2) 26.0 ± 3.8
V̇O2max (mL·kg−1·min−1) 33.41 ± 8.56
Resting SBP (mm Hg) 116 ± 11
Resting DBP (mm Hg) 67 ± 6
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averaged to determine the participant’s resting BP. Partici-
pants had their V̇O2max determined during a graded exercise
test to exhaustion performed on a motorized treadmill (4Front;
Woodway, Waukesha, WI). V̇O2 and V̇CO2 were measured
continuously using an online gas collection system (MAX-II;
AEI Technologies, Pittsburgh, PA), which was calibrated with
gases of known concentrations and a 3-L syringe for flow and
silicon facemask (Vmask; Hans Rudolph Inc., Shawnee, KS).
After a 5-min treadmill warm-up, each participant ran at a
self-selected pace (4–7 mph) with incremental increases in
grade (2%) applied every 2 min until volitional fatigue.
Heart rate (HR) was recorded beat-to-beat throughout the test
using an integrated HR monitor (FT1; Polar Electro, Quebec,
Canada). V̇O2max was taken as the greatest 30-s average in the
presence of a plateau in V̇O2 values (<1.35 mL·kg−1·min−1
increase) despite increasing workload or two of the follow-
ing criteria: (i) a respiratory exchange ratio value >1.15, (ii)
within 10 bpm of age-predicted maximum HR (HRmax)
(220 − age), and/or (iii) voluntary exhaustion. After a
5-min cool-down followed by sufficient rest (>5 min), par-
ticipants were allowed to practice each of the three different
exercise protocols using the motorized treadmill in which
all the exercise sessions would be performed. Each partici-
pant completed 5 min of continuous running (at ~65% V̇O2max;
MICT exercise), 3  1-min running efforts (at ~90% HRmax)
with 1-min recovery (HIIT exercise), and 2  15-s “all-out”
sprints with 2-min rest (SIT exercise) to familiarize them to the
respective protocols. Participants were given sufficient rest
(5 min) in between each. After this, participants were fitted with
an AMBP monitor (ABP320; ScottCare, Cleveland, OH) at-
tached to their left arm that they would wear for the next 24 h
to become accustomed to wearing the monitor. Participants re-
corded their breakfast the day of their first experimental session
and replicated it for the remaining sessions.
Experimental session. Participants arrived at the labora-
tory at 0800 h after having consumed breakfast 1 h before ar-
rival (0700 h) and limited their activity on their way to the lab-
oratory (i.e., drove or used public transport). They remained in
the laboratory for the next ~3.5 h. After arriving participants
rested quietly (seated rest for 30-min MICT exercise and
CTRL, 40-min HIIT exercise, 44-min SIT exercise) before
BP measurements to ensure resting state was achieved. Be-
cause differences in the duration of the exercise session, the
rest times were different such that all exercises ended at
0925 h. Participants had their resting BP measured four times
using an automated oscillometric device (V100) with 2 min
between measurements. The first measurement was discarded,
and the final three measurements were averaged. Preexercise
BP was measured at 0830 h during the CTRL and MICT exer-
cise sessions, at 0840 h during the HIIT exercise session, and
at 0844 h during the SIT exercise session. Participants were
fitted with an HR monitor before warm-up for exercise. Partic-
ipants then completed the exercise protocol followed by 2 h of
seated rest for postexercise BP measurements. BP was mea-
sured 15 min (0940 h), 30 min (0955 h), 60 min (1025 h),
and 120 min (1135 h) after exercise. At each time point, BP
EXERCISE INTENSITY AND POSTEXERCISE HYPOTENSION
Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
was measured three times, consecutively (~30 s between mea-
surements), the first measurement was discarded and the re-
maining 2 were averaged. After the last BP measurements,
participants had the opportunity to shower and then had an
AMBP monitor (ABP320) attached to their left arm. The de-
vice was worn for 24 h and automatically measured BP every
30 min during the daytime and once per hour during the
nighttime. The daytime and nighttime periods were based
on each participant’s typical sleep schedule and were stan-
dardized within participant. BP values were averaged for
the 24-h period. In addition, to try and explore the time
course of the PEH response outside of the laboratory set-
ting, AMBP values were averaged together into 2-, 4-, 6-,
and 8-h postsession bins on the day of the session. Partic-
ipants were asked to perform their regular daily activities,
not to engage in physical activity, and to relax and straighten
the arm during the recording interval. Participants were also
asked to document their activities and food/fluid intake
during the day. All participants confirmed no physical ac-
tivity when the monitor was worn. Identical experimental
procedures were followed for the control session except
that participants sat quietly during the exercise period
(0845–0925 h).
Exercise protocols. All exercise protocols began with
a 5-min warm-up (at 3 mph) followed by the MICT exercise
(30 min), HIIT exercise (20 min), or SIT exercise (16 min)
session and a 5-min cool-down at a self-selected pace.
Warm-up and cool-down along with the exercise protocols
were performed on a motorized treadmill (Woodway 4Front)
for consistency. Exercise sessions involved three different pro-
tocols: (i) MICT exercise (30 min of continuous running at 65%
APPLIED SCIENCES
V̇O2max), (ii) HIIT exercise (10  1 min at 90% HRmax with
1-min recovery), and (iii) SIT exercise (8  15-s “all-out” sprint
efforts interspersed with 2-min rest). For both the HIIT and SIT
exercise protocols, the rest periods were passive. Treadmill
speed and grade were manipulated to reach target V̇O2 and
HR for MICT and HIIT exercises, respectively (explained in
full detail hereinafter). For the SIT exercise session, the motor-
ized treadmill (Woodway 4Front) was switched into dynamic
mode, which means that the belt was self-propelled by the par-
ticipant. The start of the CTRL, HIIT, and SIT exercise sessions
were staggered by 5, 10, and 14 min, respectively, so all proto-
cols finished by 0925 h. Verbal encouragement was provided to
participants during all three exercise sessions. The desired in-
tensity for the MICT exercise (65% V̇O2max) and HIIT exercise
(90% HRmax) sessions, respectively, was calculated using the
American College of Sports Medicine Running Equation (40),
using the speed from the graded exercise test and V̇O2 data.
When participants were familiarized with the different exercise
protocols, the treadmill speed and grade were adjusted if needed
to elicit the desired intensity.
PEH calculation. To calculate PEH, at each time point,
SBP and DBP from the exercise sessions were subtracted from
the BP at the same time point during the control session
(PEH = control BP − exercise BP). When considering both
SBP and DBP, this method had the highest intraclass
Medicine & Science in Sports & Exercise® 103
 correlation as previously reported (41). Because this method
does not allow us to determine whether BP was different from
CTRL, we first compared absolute BP during sessions with BP
during CTRL, followed by a comparison of PEH using the afore-
mentioned calculation to determine potential differences between
protocols. In addition, because there are multiple ways to calcu-
late PEH, we have also reported statistical comparisons to
preexercise time points for reach of the exercise sessions.
Statistical analysis. All statistical analyses were per-
formed using SPSS version 26 (IBM, Chicago, IL). Statistical
significance was accepted as P < 0.050, and P < 0.100 was re-
ported as a value that tended to be “approaching significance”
for transparency. All data are presented as mean ± SD. Be-
cause PEH occurs independently of biological sex (2,8–11),
participants were pooled together for all analyses. Because
we used an oscillometric device to measure BP, we have pro-
vided and analyzed mean arterial pressure (MAP). A series of
two-way repeated measures of ANOVA (RM ANOVA) were
conducted to compare between session differences in abso-
lute MAP, SBP, and DBP (session–time), SBP and DBP
PEH (session–time), SBP and DBP 8 h after the session
(session–time), and 24-h SBP and DBP during different
measurement periods (session–period of measurement). A
series of one-way RM ANOVA were conducted to compare
between-session differences for 24-h AMBP, peak PEH, av-
erage PEH, and total area under the curve (AUC) for MAP,
SBP, and DBP. Bonferroni corrections were used for post hoc
analysis where necessary. Partial eta-squared (η2p) values were
calculated to estimate the effect sizes (small, 0.04; medium,
0.06; large, 0.14) for main effects and interactions where nec-
essary. Cohen’s d was calculated to estimate effect size (small,
APPLIED SCIENCES
0.2; medium, 0.5; large, 0.8; very large, 1.3) for individual
post hoc comparisons where necessary. All AUC calculations
were performed using the trapezoid method using changes in
BP relative to baseline.
RESULTS
Exercise sessions. During the MICT exercise session,
average V̇O2 was 64.2% ± 2.7% of V̇O2max, indicating that
the exercise was performed appropriately. Similarly for the
FIGURE 1—Changes in MAP over the acute 2-h period after CTRL, MICT, HIIT, and SIT exercises. A, MAP over time. B, MAP AUC. Note: Values are
mean ± SD, n = 14. aMICT difference vs CTRL (P < 0.050). bHIIT difference vs CTRL (P < 0.050). cSIT difference vs CTRL (P < 0.050). *Different vs
preexercise (P < 0.050).
104 Official Journal of the American College of Sports Medicine
Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
HIIT exercise session, peak HR at the end of each interval
was 88.4% ± 3.4% of HRmax as designed.
Absolute BP. An interaction (session–time; P = 0.003,
η2p = 0.216) was detected for changes in MAP over time
(Fig. 1A) where MAP was reduced by MICT ( P = 0.044,
d = 0.86), HIIT ( P = 0.016, d = 1.00), and SIT
( P = 0.014, d = 1.02) exercises compared with CTRL at
60 min after exercise. There were no other differences between
sessions ( P > 0.134, d < 0.72). When considering differences
between preexercise and postexercise values, there were no dif-
ferences for any of the exercise sessions ( P > 0.999, d < 0.77);
however, during the CTRL session, MAP was greater 15,
30, 60, and 120 min after intervention compared with
preintervention ( P < 0.021, d > 1.02). For MAP AUC, there
was an effect of session ( P < 0.001, η2p =0.403) where MICT
( P = 0.008, d = 1.08), HIIT ( P = 0.034, d = 0.88), and SIT
( P = 0.011, d = 1.04) exercises were lower than CTRL, with
no differences between exercise sessions ( P > 0.999, d < 0.38;
Fig. 1B).
An interaction (session–time; P = 0.002, η2p = 0.231) was
detected for changes in SBP over time (Fig. 2A) where SBP
was reduced by MICT exercise ( P = 0.005, d > 1.09) at 30
and 60 min; by HIIT exercise ( P = 0.005, d > 0.81) at 30,
60, and 120 min; and by SIT exercise ( P = 0.005, d > 1.0) at
30, 60, and 120 min after exercise compared with CTRL.
There were no differences between sessions before exercise
( P > 0.999, d < 0.38) or 15 min after exercise ( P > 0.112,
d < 0.72). When considering differences between preexercise
and postexercise values, there were no differences for any of
the exercise sessions ( P > 0.999, d < 0.45); however, during
the CTRL session, SBP was greater 30, 60, and 120 min after
intervention compared with that after intervention ( P < 0.038,
d > 1.09). For SBP AUC, there was an effect of session
( P < 0.001, η2p =0.408) where MICT ( P = 0.001, d = 1.50),
HIIT ( P = 0.010, d = 1.08), and SIT ( P = 0.024, d = 0.93) ex-
ercises were lower than CTRL, with no differences between
exercise sessions ( P > 0.999, d < 0.13; Fig. 2B).
An interaction (session–time; P = 0.039, η2p = 0.154) was de-
tected for changes in DBP over time (Fig. 3A) where DBP was
reduced by HIIT exercise ( P = 0.064, d = 0.79) at 60 min and
by SIT exercise ( P < 0.064, d > 0.80) at 15 and 60 min after
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FIGURE 2—Changes in SBP over the acute 2-h period after CTRL, MICT, HIIT, and SIT exercises. A, SBP over time. B, SBP AUC. Note: Values are
mean ± SD, n = 14. aMICT difference vs CTRL (P < 0.050). bHIIT difference vs CTRL (P < 0.050). cSIT difference vs CTRL (P < 0.050). *Different vs
preexercise (P < 0.050).

exercise compared with CTRL. There were no differences be-
tween sessions before exercise ( P > 0.500, d < 0.51), 30 min af-
ter ( P > 0.641, d < 0.47), and 120 min after ( P > 0.383,
d < 0.54) exercise. When considering differences between
preexercise and postexercise values, there were no differences
for any of the exercise sessions ( P > 0.957, d < 0.83); however,
during the CTRL session, DBP was greater 15, 30, 60, and
120 min after intervention compared with that before interven-
tion ( P < 0.011, d > 1.11). For DBP AUC, there was an effect
of session ( P = 0.001, η2p = 0.325) where SIT exercise was
lower than CTRL ( P = 0.008, d = 0.98; Fig. 3B), with no other
differences ( P > 0.142, d < 0.66).
Twenty-four-hour AMBP. One participant did not wear
the AMBP monitor at night (because of discomfort); therefore,
the following analyses were run using data from the remaining
no interaction ( P = 0.642, η2p = 0.061; Fig. 4B) or main effect of
session ( P = 0.231, η2p = 0.111) for DBP. The main effect of time
was approaching significance ( P = 0.059, η2p = 0.184), and post hoc
comparisons revealed that a difference between 4 and 6 h after
the session was approaching significance ( P = 0.072, d = 0.82)
with no other differences ( P > 0.379, d ≤ 0.57).
DISCUSSION
To our knowledge, this is the first study to examine the effects
of MICT, HIIT, and SIT exercises on PEH immediately (≤2 h)
and for 24 h after exercise specifically in middle-age adults.
The main findings of this study are the following: a) all exer-
cise sessions elicited similar magnitudes of PEH for MAP,
SBP, and DBP; b) all exercises reduced absolute postexercise

13 participants. One-way RM ANOVA revealed no differ-
ences in 24-h SBP ( P = 0.453, η2p = 0.069; Table 2). During
the 8 h after the session, two-way RM ANOVA revealed no
interaction ( P = 0.957, η2p = 0.028; Fig. 4A), main effect of
session ( P = 0.439, η2p = 0.072), or main effect of time
( P = 0.356, η2p = 0.085) for SBP.
An effect of session ( P = 0.051, η2p = 0.192; Table 2) was
detected for 24-h DBP where 24-h DBP was greater after HIIT
exercise compared with MICT exercise ( P = 0.018, d = 1.04).
During the 8 h after the session, two-way RM ANOVA revealed
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MAP and SBP, although the effects on DBP were smaller;
and c) acute effects of all forms of exercise were not sus-
tained over 8 or 24 h. Although previous work has examined
the effect of different submaximal exercise intensities (40%–
60% V̇O2max) in middle-age adults, our study is the first to
compare the effects of MICT, HIIT, and SIT exercises in
middle-age adults in the immediate (≤2) and 24-h postexer-
cise period.
When evaluating the PEH response using absolute BP values
and AUC, our data demonstrate a clear ability for exercise to

FIGURE 3—Changes in DBP over the acute 2-h period after CTRL, MICT, HIIT, and SIT exercises. A, DBP over time. B, DBP AUC. Note: Values are
mean ± SD, n = 14. bHIIT difference vs CTRL ( P = 0.064). cSIT difference vs CTRL (P < 0.064). *Different vs preexercise (P < 0.050).

EXERCISE INTENSITY AND POSTEXERCISE HYPOTENSION Medicine & Science in Sports & Exercise® 105

Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 TABLE 2. Twenty-four-hour AMBP SBP and DBP after CTRL, MICT, HIIT, and SIT exercises.
CTRL MICT
SBP (mm Hg)
24 h 123 ± 13 120 ± 10
DBP (mm Hg)
24 h 75 ± 10 74 ± 8 d
Values are mean ± SD (n = 13). d − different vs MICT (P = 0.018).
reduce BP in the acute hours after exercise in comparison to
CTRL (Figs. 1, 2, 3). Although some of the acute changes for
DBP were not statistically significant, the data would suggest
that the exercise did elicit important reductions, as nonsignif-
icant reductions were of similar magnitudes to those that
reached statistical significance (while still being supported
by medium-large effect sizes) and could still be indicative
of changes. The muted reductions compared with SBP may
be due to the normotensive nature of the sample, as reduc-
tions are generally greater the higher the resting BP of the
participant (2). This aligns with previous data demonstrating
that the PEH response occurs regardless of participant and/or
exercise characteristics (7). These data demonstrate that HIIT
and SIT exercises can elicit important reductions in BP in
middle-age adults, similar to MICT exercise (10,12,13,32,42),
providing additional support for the efficacy of these exercise
protocols and those previously reported.
When evaluating the PEH response as changes relative to
the CTRL session (PEH = control BP − exercise BP), average
and peak PEH were similar after MICT, HIIT, and SIT exer-
cise, when considering MAP, SBP, and DBP (Table 2), pro-
viding additional evidence that these exercise protocols did
not induce different PEH effects. It is important to highlight
that the exercise sessions were able to blunt the increase in
APPLIED SCIENCES
BP seen during the no-exercise CTRL session. Across all ex-
ercise protocols, the PEH responses we measured were sim-
ilar to the respective literature in normotensive participants
for MICT (5,10–12,14–16,19), HIIT (8,12,13,26,43), and
SIT exercise (10,12,28–31). If these acute reductions were
repeated with chronic training they may contribute to chronic
reductions in BP that could be clinically significant as reduc-
tions as small as 2 mm Hg SBP can reduce stroke mortality
by 10% and ischemic heart disease mortality by 7% (44).
Only one other study has compared the PEH response to
MICT, HIIT, and SIT exercise, though in a young (25 y)
and normotensive (122/68 mm Hg) sample (n = 11), demon-
strating significant reductions in BP following all 3 protocols
FIGURE 4—Changes in SBP and DBP in the 8-h postsession after CTRL, MICT, HIIT, and SIT exercises. A, SBP. B, DBP. Note: Values are mean ± SD
(n = 13). *Four hours different from 6 h when collapsed across sessions (P = 0.072).
106 Official Journal of the American College of Sports Medicine
Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Δ vs CTRL HIIT Δ vs CTRL SIT Δ vs CTRL
−3 ± 6 122 ± 9 −1 ± 7 121 ± 12 −2 ± 6
−1 ± 4 76 ± 8 1±4 75 ± 8 0±4
(12). The absolute reductions after HIIT and SIT exercises
were similar; however, the PEH response after MICT exer-
cise was of a smaller magnitude compared with the current
study (12). It should be noted that Angadi and colleagues
(12) used a cycle ergometer for their exercise modality,
whereas we are the first study to utilize the low-volume HIIT
protocol (10  1 min at 90% HRmax with 1-min recovery) on
a treadmill. Whether there are differences in PEH based on
the mode of exercise is currently unknown; a meta-analysis
did note greater reductions (not statistically different) after
running (−9/−11 mm Hg) compared with cycling studies
(−6/−3 mm Hg [7]).
Although most PEH studies (3,4,8,10–20,26,27,31,33,45)
examine an acute postexercise period (~2 h), longer duration
reductions (>2 h) in BP after exercise are lacking and may
be indicative of a protective effect of exercise on BP. With that
in mind, we designed this study to measure BP every 30 min
during the day and every 60 min during the night over 24 h af-
ter exercise. Our data demonstrate no differences in 8- or 24-h
AMBP after MICT, HIIT, or SIT exercise compared with
CTRL, suggesting that the PEH response only lasted for
~2 h. Previous work has demonstrated statistically significant
reductions in 24-h AMBP after MICT and HIIT exercises
(42,43,46,47), however this is the first study to measure
the response following SIT exercise. While the mechanisms
involved in the acute PEH response are well understood
(1,2,36), the mechanisms responsible for longer reductions
in BP/or a prolonged PEH response have not been estab-
lished. Interestingly, Sosner and colleagues (47) did note re-
ductions in arterial stiffness following a single HIIT session
that coincided with reduced AMBP during the day. Previ-
ous work that has demonstrated differences in 24-h AMBP
after MICT and HIIT exercises has mainly focused on hy-
pertensive participants (42,46,47), although one study did
find significant reductions after HIIT exercise in young nor-
motensive males (43). Our absolute changes in AMBP are
similar; however, other factors such as timing of measurement
http://www.acsm-msse.org
intervals may have contributed to finding significant differ-
ences. For example, participants were instructed not to engage
in physical activity during the time they wore the monitor;
however, sedentary behavior was not assessed, which could
play a role. In addition, participants were asked to maintain
their regular sleep schedule on days the monitor was worn;
however, there was no assessment of sleep length or quality.
Studies examining the possible predictive nature of the PEH
response after MICT exercise have found moderate, signifi-
cant correlations (r > 0.65) between acute reductions (1 h after
exercise) and chronic reductions (4, 8, and 24 wk) in BP with
training (15,18,48). Our results are in line with these acute re-
sponses that have shown chronic effects (15,18,48). Recent
work suggests that MICT and HIIT exercises elicit compara-
ble reductions in SBP and DBP with training (23,49); how-
ever, the effects of SIT exercise are less understood in part be-
cause of misclassification as HIIT exercise (all-out exercise
being classified as HIIT not SIT). SIT exercise seems to
be effective in reducing SBP with chronic training (50,51),
although only one study has found significant reductions
in DBP (51). Overall, our data add to the various health ben-
efits, including improved aerobic capacity, body composi-
tion, skeletal muscle oxidative capacity, exercise tolerance,
and disease risk that are associated with HIIT and SIT exer-
cises (22,52).
Although the study provides valuable information re-
garding the effect of MICT, HIIT, and SIT exercises on
PEH, it is important to highlight several limitations. It is
important to note that our sample was recreationally active
with good–excellent V̇O2max scores. This should be con-
sidered when interpreting the PEH response, as a less or
more active sample may not respond similarly. Although
the activity journals did provide important information re-
garding the participant’s activities while wearing the mon-
itor, other important information that should be considered
in future studies using AMBP includes length and quality
of sleep, occupation, and sedentary activity. Although the
study does provide important information, the sample
was mostly normotensive, which limits the impact of the
REFERENCES
1. Halliwill JR. Mechanisms and clinical implications of post-exercise
hypotension in humans. Exerc Sport Sci Rev. 2001;29(2):65–70.
2. MacDonald JR. Potential causes, mechanisms, and implications of
post exercise hypotension. J Hum Hypertens. 2002;16(4):225–36.
3. Halliwill JR, Taylor JA, Eckberg DL. Impaired sympathetic vascular
regulation in humans after acute dynamic exercise. J Physiol. 1996;
495(Pt 1):279–88.
4. Cleroux J, Kouame N, Nadeau A, Coulombe D, Lacourciere Y. Baroreflex
regulation of forearm vascular resistance after exercise in hypertensive and
normotensive humans. Am J Physiol. 1992;263(5 Pt 2):H1523–31.
5. Cleroux J, Kouame N, Nadeau A, Coulombe D, Lacourciere Y. After-
effects of exercise on regional and systemic hemodynamics in hyper-
tension. Hypertension. 1992;19(2):183–91.
6. Brito LC, Queiroz AC, Forjaz CL. Influence of population and exercise
protocol characteristics on hemodynamic determinants of post-aerobic
exercise hypotension. Braz J Med Biol Res. 2014;47(8):626–36.
EXERCISE INTENSITY AND POSTEXERCISE HYPOTENSION
Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
results, as the transient reductions in BP after exercise
would be most beneficial in individuals with hypertension.
Unfortunately, we were not able to examine the specific
mechanisms responsible for the PEH response and thus
can only speculate. Although we did standardize the
timing of sessions and the duration of time the participants
wore the AMBP monitor, our results only apply to morn-
ing exercise and may differ if exercise was completed at
a different time of day. Because the potential variations for
HIIT and SIT exercises are infinite, the results from our study
only apply to the particular protocols we used and cannot be
applied to other HIIT or SIT protocols. Finally, menstrual cy-
cle phase was not accounted for when testing female partici-
pants. Whether there is a strong effect of menstrual cycle
phase on the PEH response is unclear because there is conflict-
ing evidence (9,53), although any potential differences in the
response seem to only occur for DBP during the early follicu-
lar phase (days 3–4 of the menstrual cycle [53]) representing a
short time period.
CONCLUSIONS
Overall, MICT, HIIT, and SIT exercises produced similar
PEH in middle-age adults during a 2-h postexercise measure-
ment period. Reductions were present for MAP and SBP, al-
though the effects on DBP were less clear. Finally, these acute
reductions were not sustained over 24 h.
S. F. M. was supported by a Canadian Institute of Health Research
Canada Graduate Scholarship (master’s degree), an Ontario Graduate
Scholarship, and a Natural Sciences and Engineering Research Coun-
cil Alexander Graham Bell Canada Graduate Scholarship (doctoral de-
gree). E. J. F. was supported by a Natural Sciences and Engineering
APPLIED SCIENCES
Research Council Graduate Scholarship (master’s degree) and the
R.S. McLaughlin Fellowship (Queen’s University Internal Award).
The authors declare that they have no conflicts of interest to dis-
close. The results of the study are presented clearly, honestly, and
without fabrication, falsification, or inappropriate data manipulation.
The results of the present study do not constitute endorsement by
the American College of Sports Medicine.
Author Contributions: S. F. M., K. A. K., and T. J. H. conceived and
designed the project. S. F. M., E. J. F., and C. J. conducted experi-
ments. S. F. M. and T. J. H. analyzed the data. S. F. M. and T. J. H.
wrote the manuscript. All authors read and approved the manuscript.
7. Carpio-Rivera E, Moncada-Jimenez J, Salazar-Rojas W, Solera-Herrera
A. Acute effects of exercise on blood pressure: a meta-analytic investiga-
tion. Arq Bras Cardiol. 2015;106(5):422–33.
8. Cote AT, Bredin SS, Phillips AA, Koehle MS, Warburton DE.
Greater autonomic modulation during post-exercise hypotension fol-
lowing high-intensity interval exercise in endurance-trained men and
women. Eur J Appl Physiol. 2015;115(1):81–9.
9. Lynn BM, McCord JL, Halliwill JR. Effects of the menstrual cycle
and sex on postexercise hemodynamics. Am J Physiol Regul Integr
Comp Physiol. 2007;292(3):R1260–70.
10. Rossow L, Yan H, Fahs CA, et al. Postexercise hypotension in an
endurance-trained population of men and women following high-intensity
interval and steady-state cycling. Am J Hypertens. 2010;23(4):358–67.
11. Senitko AN, Charkoudian N, Halliwill JR. Influence of endurance
exercise training status and gender on postexercise hypotension. J
Appl Physiol (1985). 2002;92(6):2368–74.
Medicine & Science in Sports & Exercise® 107
 12. Angadi SS, Bhammar DM, Gaesser GA. Postexercise hypotension
after continuous, aerobic interval, and sprint interval exercise. J Strength
Cond Res. 2015;29(10):2888–93.
13. Costa EC, Dantas TC, de Farias Junior LF, et al. Inter- and intra-individual
analysis of post-exercise hypotension following a single bout of
high-intensity interval exercise and continuous exercise: a pilot
study. Int J Sports Med. 2016;37(13):1038–43.
14. Forjaz CL, Cardoso CG Jr, Rezk CC, Santaella DF, Tinucci T. Post-
exercise hypotension and hemodynamics: the role of exercise inten-
sity. J Sports Med Phys Fitness. 2004;44(1):54–62.
15. Hecksteden A, Grutters T, Meyer T. Association between postexer-
cise hypotension and long-term training-induced blood pressure re-
duction: a pilot study. Clin J Sport Med. 2013;23(1):58–63.
16. Keese F, Farinatti P, Pescatello L, Monteiro W. A comparison of
the immediate effects of resistance, aerobic, and concurrent exercise on
postexercise hypotension. J Strength Cond Res. 2011;25(5):1429–36.
17. MacDonald JR, MacDougall JD, Hogben CD. The effects of exercise
duration on post-exercise hypotension. J Hum Hypertens. 2000;
14(2):125–9.
18. Liu S, Goodman J, Nolan R, Lacombe S, Thomas SG. Blood pressure
responses to acute and chronic exercise are related in prehypertension.
Med Sci Sports Exerc. 2012;44(9):1644–52.
19. MacDonald JR, MacDougall JD, Hogben CD. The effects of exercis-
ing muscle mass on post exercise hypotension. J Hum Hypertens.
2000;14(5):317–20.
20. MacDonald J, MacDougall J, Hogben C. The effects of exercise
intensity on post exercise hypotension. J Hum Hypertens. 1999;
13(8):527–31.
21. Pescatello LS, Guidry MA, Blanchard BE, et al. Exercise intensity al-
ters postexercise hypotension. J Hypertens. 2004;22(10):1881–8.
22. Gibala MJ, Gillen JB, Percival ME. Physiological and health-related
adaptations to low-volume interval training: influences of nutrition
and sex. Sports Med. 2014;44(2 Suppl):S127–37.
23. Leal JM, Galliano LM, Del Vecchio FB. Effectiveness of
high-intensity interval training versus moderate-intensity continuous
training in hypertensive patients: a systematic review and meta-analysis.
Curr Hypertens Rep. 2020;22(3):26.
APPLIED SCIENCES
24. Milanovic Z, Sporis G, Weston M. Effectiveness of high-intensity in-
terval training (HIT) and continuous endurance training for VO2max
improvements: a systematic review and meta-analysis of controlled
trials. Sports Med. 2015;45(10):1469–81.
25. Steele J, Plotkin D, Van Every D, et al. Slow and steady, or hard
and fast? A systematic review and meta-analysis of studies com-
paring body composition changes between interval training and
moderate intensity continuous training. Sports (Basel). 2021;
9(11):155.
26. Morales-Palomo F, Ramirez-Jimenez M, Ortega JF, Pallares JG,
Mora-Rodriguez R. Acute hypotension after high-intensity interval
exercise in metabolic syndrome patients. Int J Sports Med. 2017;
38(7):560–7.
27. Lacombe SP, Goodman JM, Spragg CM, Liu S, Thomas SG. Interval
and continuous exercise elicit equivalent postexercise hypotension in
prehypertensive men, despite differences in regulation. Appl Physiol
Nutr Metab. 2011;36(6):881–91.
28. Ketelhut S, Mohle M, Gurlich T, Hottenrott L, Hottenrott K. Opti-
mizing sprint interval exercise for post-exercise hypotension: a ran-
domized crossover trial. Eur J Sport Sci. 2022;1–9.
29. Stuckey MI, Tordi N, Mourot L, et al. Autonomic recovery fol-
lowing sprint interval exercise. Scand J Med Sci Sports. 2012;
22(6):756–63.
30. Chan HH, Burns SF. Oxygen consumption, substrate oxidation, and
blood pressure following sprint interval exercise. Appl Physiol Nutr
Metab. 2013;38(2):182–7.
31. Rakobowchuk M, Stuckey MI, Millar PJ, Gurr L, Macdonald MJ. Ef-
fect of acute sprint interval exercise on central and peripheral artery
distensibility in young healthy males. Eur J Appl Physiol. 2009;
105(5):787–95.
108 Official Journal of the American College of Sports Medicine
Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
32. Eicher JD, Maresh CM, Tsongalis GJ, Thompson PD, Pescatello LS.
The additive blood pressure lowering effects of exercise intensity on
post-exercise hypotension. Am Heart J. 2010;160(3):513–20.
33. Jones H, George K, Edwards B, Atkinson G. Is the magnitude of
acute post-exercise hypotension mediated by exercise intensity or to-
tal work done? Eur J Appl Physiol. 2007;102(1):33–40.
34. Perrier-Melo RJ, Costa EC, Farah BQ, Costa MDC. Acute effect of
interval vs. continuous exercise on blood pressure: systematic review
and meta-analysis. Arq Bras Cardiol. 2020;115(1):5–14.
35. Marcal IR, Goessler KF, Buys R, Casonatto J, Ciolac EG,
Cornelissen VA. Post-exercise hypotension following a single bout
of high intensity interval exercise vs. a single bout of moderate inten-
sity continuous exercise in adults with or without hypertension: a sys-
tematic review and meta-analysis of randomized clinical trials. Front
Physiol. 2021;12:675289.
36. Perrier-Melo RJ, Germano-Soares AH, Brito AF, Dantas IV, Costa
MDC. Post-exercise hypotension in response to high-intensity inter-
val exercise: potential mechanisms. Rev Port Cardiol (Engl Ed).
2021;40(10):797–9.
37. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/
ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the
prevention, detection, evaluation, and management of high blood
pressure in adults: a report of the American College of Cardiology/
American Heart Association Task Force on clinical practice guide-
lines. Circulation. 2018;138(17):e484–594.
38. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of
the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure: the JNC 7 report. JAMA.
2003;289(19):2560–72.
39. Fowles JR, O’Brien MW, Wojcik WR, d’Entremont L, Shields CA.
A pilot study: validity and reliability of the CSEP-PATH PASB-Q
and a new leisure time physical activity questionnaire to assess phys-
ical activity and sedentary behaviours. Appl Physiol Nutr Metab.
2017;42(6):677–80.
40. Glass S, Dwyer GB, ACSM. ACSM Metabolic Calculation Hand-
book. Baltimore (MD): Lippincott Williams & Wilkins; 2007.
41. Fecchio RY, Chehuen M, Brito LC, Pecanha T, Queiroz ACC, de
Moraes Forjaz CL. Reproducibility (reliability and agreement) of
post-exercise hypotension. Int J Sports Med. 2017;38(13):1029–34.
42. Ciolac EG, Guimaraes GV, D Avila VM, Bortolotto LA, Doria EL,
Bocchi EA. Acute effects of continuous and interval aerobic exercise
on 24-h ambulatory blood pressure in long-term treated hypertensive
patients. Int J Cardiol. 2009;133(3):381–7.
43. Dantas TCB, Farias Junior LF, Frazao DT, et al. A single session of
low-volume high-intensity interval exercise reduces ambulatory
blood pressure in normotensive men. J Strength Cond Res. 2017;
31(8):2263–9.
44. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective
Studies Collaboration. Age-specific relevance of usual blood pres-
sure to vascular mortality: a meta-analysis of individual data for
one million adults in 61 prospective studies. Lancet. 2002;360(9349):
1903–13.
45. MacDonald JR, Hogben CD, Tarnopolsky MA, MacDougall JD.
Post exercise hypotension is sustained during subsequent bouts of
mild exercise and simulated activities of daily living. J Hum
Hypertens. 2001;15(8):567–71.
46. Ciolac EG, Guimaraes GV, D’Avila VM, Bortolotto LA, Doria EL,
Bocchi EA. Acute aerobic exercise reduces 24-h ambulatory blood
pressure levels in long-term-treated hypertensive patients. Clinics
(Sao Paulo). 2008;63(6):753–8.
47. Sosner P, Gayda M, Dupuy O, et al. Ambulatory blood pressure re-
duction following high-intensity interval exercise performed in water
or dryland condition. J Am Soc Hypertens. 2016;10(5):420–8.
48. Wegmann M, Hecksteden A, Poppendieck W, et al. Postexercise hy-
potension as a predictor for long-term training-induced blood pres-
sure reduction: a large-scale randomized controlled trial. Clin J Sport
Med. 2018;28(6):509–15.
http://www.acsm-msse.org
49. Costa EC, Hay JL, Kehler DS, et al. Effects of high-intensity interval
training versus moderate-intensity continuous training on blood pressure
in adults with pre- to established hypertension: a systematic review and
meta-analysis of randomized trials. Sports Med. 2018;48(9):2127–42.
50. Herrod PJJ, Blackwell JEM, Boereboom CL, et al. The time course of
physiological adaptations to high-intensity interval training in older
adults. Aging Med (Milton). 2020;3(4):245–51.
51. Blackwell JEM, Doleman B, Boereboom CL, et al. High-intensity
interval training produces a significant improvement in fitness in
EXERCISE INTENSITY AND POSTEXERCISE HYPOTENSION
Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
less than 31 days before surgery for urological cancer: a
randomised control trial. Prostate Cancer Prostatic Dis. 2020;
23(4):696–704.
52. Gillen JB, Gibala MJ. Is high-intensity interval training a time-efficient
exercise strategy to improve health and fitness? Appl Physiol Nutr
Metab. 2014;39(3):409–12.
53. Esformes JI, Norman F, Sigley J, Birch KM. The influence of men-
strual cycle phase upon postexercise hypotension. Med Sci Sports
Exerc. 2006;38(3):484–91.
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