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Using the immediate blood pressure benefits of exercise to improve exercise adherence among adults with hypertension

a randomized clinical trial

Zaleski, Amanda L.a,b; Taylor, Beth A.a,b; Park, Crystal L.c; Santos, Lucas P.d,e; Panza, Gregorya,b; Kramarz, Melodya; McCormick, Kylea; Thompson, Paul D.b; Fernandez, Antonio B.b; Chen, Ming-Huif; Blissmer, Bryang; Gans, Kim M.h; Pescatello, Linda S.a

doi: 10.1097/HJH.0000000000002115

Background: A single exercise session evokes immediate blood pressure (BP) reductions that persist for at least 24 h, termed postexercise hypotension (PEH). Self-monitoring of PEH may foster positive outcome expectations of exercise, and thus, enhance exercise adherence among adults with hypertension.

Purpose: To compare the efficacy of self-monitoring of exercise (EXERCISE) versus exercise and PEH (EXERCISE + PEH) to improve exercise adherence and BP control among adults with hypertension.

Methods: Adults with high BP were randomized to EXERCISE (n = 12) or EXERCISE + PEH (n = 12). Participants underwent supervised, moderate intensity aerobic exercise training for 40–50 min/session, 3 days/week for 12 weeks and encouraged to exercise unsupervised at home at least 30 min/day, 1–2 days/week. EXERCISE + PEH also self-monitored BP before and after exercise. Adherence was calculated as [(no. of exercise sessions performed/no. of possible exercise sessions) × 100%]. BP was measured pre and posttraining.

Results: Healthy, middle-aged (52.3 ± 10.8 years) men (n = 11) and women (n = 13) with hypertension (136.2 ± 10.7/85.2 ± 8.9 mmHg) completed exercise training with 87.9 ± 12.1% adherence. EXERCISE + PEH demonstrated greater adherence to supervised training (94.3 ± 6.6%) than EXERCISE (81.6 ± 13.2%; P = 0.007). EXERCISE + PEH performed 32.6 ± 22.5 min/week more unsupervised home exercise than EXERCISE (P = 0.004), resulting in greater exercise adherence (107.3 ± 18.7%) than EXERCISE (82.7 ± 12.2%; P = 0.002). Post versus pretraining BP was reduced −7.4 ± 11.3/−4.9 ± 9.9 mmHg (P < 0.025) with no statistical difference between EXERCISE (−5.2 ± 13.3/−3.6 ± 6.1 mmHg) and EXERCISE + PEH (−9.9 ± 11.3/−6.1 ± 6.9 mmHg; P > 0.344).

Conclusion: The current study is the first to demonstrate that PEH self-monitoring is an efficacious tool to improve exercise adherence among a small sample of adults with hypertension. Future research among a larger, more diverse sample is needed to confirm these novel findings and determine whether EXERCISE + PEH translates to better BP control relative to EXERCISE self-monitoring alone.

aDepartment of Kinesiology, University of Connecticut, Storrs

bDepartment of Preventive Cardiology, Hartford Hospital, Hartford

cDepartment of Psychology, University of Connecticut, Storrs, Connecticut, USA

dExercise Pathophysiology Laboratory, Hospital de Clínicas de Porto Alegre

eGraduate Program in Cardiology and Cardiovascular Sciences, Faculty of Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

fDepartment of Statistics, University of Connecticut, Storrs, Connecticut

gCollege of Health Sciences, University of Rhode Island, Kingston, Rhode Island

hDepartment of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut, USA

Correspondence to Amanda L. Zaleski, PhD, Department of Kinesiology, University of Connecticut, Gampel Pavilion, Storrs, CT 06269, USA. Tel: +1 860 972 3454; fax: +1 860 545 2882; e-mail:

Abbreviations: ACC, American College of Cardiology; ACSM, American College of Sports Medicine; AHA, American Heart Association; ANOVA, analysis of variance; BP, blood pressure; CVD, cardiovascular disease; FITT, frequency, intensity, time, and type; HR, heart rate; VO2peak, peak oxygen consumption; PEH, postexercise hypotension; TLFB, timeline followback log

Received 27 December, 2018

Revised 28 February, 2019

Accepted 12 March, 2019

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