In the JournalsPerspective

Exercise with breaks in sitting lowers BP in older patients with overweight, obesity

Older patients with overweight or obesity who exercised in the morning had BP reductions that persisted during an 8-hour period vs. those with prolonged sitting, according to a study published in Hypertension.

“Traditionally, the health effects of exercise and sedentary behavior have been studied separately,” Michael J. Wheeler, BSc, PhD candidate at the University of Western Australia in Perth, said in a press release. “We conducted this study because we wanted to know whether there is a combined effect of these behaviors on blood pressure.”

Researchers analyzed data from 67 patients (mean age, 67 years; 35 women; mean BMI, 31 kg/m2) with overweight or obesity who completed three laboratory trial conditions in random order. Each condition was separated by at least 6 days. The three conditions were the following:

sitting: uninterrupted sitting for 8 hours (control);

exercise and sitting: sitting for 1 hour, moderate-intensity treadmill walking for 30 minutes and uninterrupted sitting for 6.5 hours; and

exercise and breaks: sitting for 1 hour, moderate-intensity treadmill walking for 30 minutes and sitting for 6.5 hours that was interrupted every 30 minutes with light-intensity treadmill walking for 3 minutes.

Ratings of perceived exertion and heart rate were measured at the end of each 3-minute walking break and at 5-minute intervals during 30-minute sessions of exercise. Blood samples were also taken to measure epinephrine and norepinephrine.

Compared with uninterrupted sitting, patients during the exercise and sitting condition had lower systolic (–3.4 mm Hg; 95% CI, –4.5 to –2.3) and diastolic BP (–0.8 mm Hg; 95% CI, –1.6 to –0.04). Patients during exercise with breaks condition also had decreases in systolic (–5.1 mm Hg; 95% CI, –6.2 to –4) and diastolic BP (–1.1 mm Hg; 95% CI, –1.8 to –0.3) vs. uninterrupted sitting.

Patients during the exercise with breaks condition had additional reductions in average systolic BP compared with the exercise with sitting condition (–1.7 mm Hg; 95% CI, –2.8 to –0.6). The additional reductions were seen more in women (–3.2 mm Hg; 95% CI, –4.7 to –1.7).

Compared with uninterrupted sitting, women had decreases in epinephrine during the exercise and sitting condition and the exercise with breaks condition (–13% to –12%; P < .05). Epinephrine increased in men during these two conditions (12% to 23%; P < .05). There were no differences in average norepinephrine.

“Although longer-term studies are required to corroborate our findings, this line of evidence may inform clinical and public health discussions around tailored strategies to optimize BP targets in older adults with increased cardiovascular disease risk,” Wheeler and colleagues wrote. – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.

Older patients with overweight or obesity who exercised in the morning had BP reductions that persisted during an 8-hour period vs. those with prolonged sitting, according to a study published in Hypertension.

“Traditionally, the health effects of exercise and sedentary behavior have been studied separately,” Michael J. Wheeler, BSc, PhD candidate at the University of Western Australia in Perth, said in a press release. “We conducted this study because we wanted to know whether there is a combined effect of these behaviors on blood pressure.”

Researchers analyzed data from 67 patients (mean age, 67 years; 35 women; mean BMI, 31 kg/m2) with overweight or obesity who completed three laboratory trial conditions in random order. Each condition was separated by at least 6 days. The three conditions were the following:

sitting: uninterrupted sitting for 8 hours (control);

exercise and sitting: sitting for 1 hour, moderate-intensity treadmill walking for 30 minutes and uninterrupted sitting for 6.5 hours; and

exercise and breaks: sitting for 1 hour, moderate-intensity treadmill walking for 30 minutes and sitting for 6.5 hours that was interrupted every 30 minutes with light-intensity treadmill walking for 3 minutes.

Ratings of perceived exertion and heart rate were measured at the end of each 3-minute walking break and at 5-minute intervals during 30-minute sessions of exercise. Blood samples were also taken to measure epinephrine and norepinephrine.

Compared with uninterrupted sitting, patients during the exercise and sitting condition had lower systolic (–3.4 mm Hg; 95% CI, –4.5 to –2.3) and diastolic BP (–0.8 mm Hg; 95% CI, –1.6 to –0.04). Patients during exercise with breaks condition also had decreases in systolic (–5.1 mm Hg; 95% CI, –6.2 to –4) and diastolic BP (–1.1 mm Hg; 95% CI, –1.8 to –0.3) vs. uninterrupted sitting.

Patients during the exercise with breaks condition had additional reductions in average systolic BP compared with the exercise with sitting condition (–1.7 mm Hg; 95% CI, –2.8 to –0.6). The additional reductions were seen more in women (–3.2 mm Hg; 95% CI, –4.7 to –1.7).

Compared with uninterrupted sitting, women had decreases in epinephrine during the exercise and sitting condition and the exercise with breaks condition (–13% to –12%; P < .05). Epinephrine increased in men during these two conditions (12% to 23%; P < .05). There were no differences in average norepinephrine.

“Although longer-term studies are required to corroborate our findings, this line of evidence may inform clinical and public health discussions around tailored strategies to optimize BP targets in older adults with increased cardiovascular disease risk,” Wheeler and colleagues wrote. – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Gina Lundberg

    Gina Lundberg

    What is interesting is that this is a small study with 67 patients that showed the same results as a larger study than this that was published in August (Elhakeem A, et al. J Am Heart Assoc. 2018;doi:10.1161/JAHA.117.007459) that was a more elegant version of this study with 1,600 patients. It had more robust data, but it found the same thing, that physical activity is extremely important for CV health, particularly BP. That study also showed more benefit in women participants. It is also the same age group as this group, early 60s. It is really a comparable, parallel study.

    Exercise is clearly very important in women around 60 years old and it is important that women may get even more benefit from a little exercise than men. It was only 30 minutes daily to see benefit. Most of my patients, especially the ones that say, “I’m so busy, I don’t have time for that,” will agree that they have 30 minutes.

    Researchers from this study particularly focused on it being a morning exercise routine. Doctors traditionally say any exercise, in the morning, evening or whenever you can, but this suggests that morning exercise has more benefit for the prolonged lowering of BP throughout the day.

    It is interesting that they saw a drop in the women for both systolic and diastolic BP, not as much in the diastolic BP for the men.

    It is important that cardiologists encourage their patients that there are multiple benefits for BP, weight loss and preventing CVD such as strokes and heart attacks long term. It is a matter of building it into your routine. If you get up in the morning 30 minutes earlier to walk on the treadmill, which is what these patients did, walk outside or even walk inside your house, you are going to get some long-term benefits.

    The biggest hurdle my patients say is one of two things. No. 1, they say, “I’m too busy and I don’t have time for it.” No. 2, they say, “I am active all day long, I am so busy, I am so active, I never sit down, I don’t think I need to exercise on top of that daily activity.”

    One of the things I really like is to have my patients wear a Fitbit, turn on a pedometer on their iPhone or use some kind of fitness tracker to see how many steps you are really walking in a day. When you do that, you realize that most people do not walk nearly as much as they think they do. It is generally accepted that if you walk less than 5,000 steps a day, that is still considered sedentary. You have to get up to 10,000 or 12,000 steps a day for that to be considered an active lifestyle and your exercise for the day.

    The research is very consistent. (That is why the larger study from August is important.) I am not sure that we need more research on whether exercise benefits us. I do not know of any study that ever said that exercise did not benefit.

    What we need research on is the psychological side of exercise or even the social restraints such as not having any child care, or if you have to get up at a certain time to get your kids to school. Some of those things need to be looked into.

    When I am talking with my patients, I particularly ask them when they come back (and have not been exercising, have not lost weight or have not done some of those diet and exercise goals we talked about in the previous visit), “What are the hurdles to this? What is keeping you from doing this?” For a lot of people, it is time constraints, money constraints and child care. Some people are really honest and say, “I am just not motivated to do it.”

    Research looking at how we can get people to exercise more with those problems, as opposed to trying to prove again and again that exercise is beneficial, is what we need.

    People underestimate the benefits of a healthy diet, routine exercise and a good night’s sleep. They think that it is too good to be true. I will be talking with a patient on these things, and frequently at the end, when we wrap it up and they say, “OK, so are you going to give me a pill for this?” It seems like no matter how much we say that exercise, activity, nutrition, a good night’s sleep is the foundation of all CV risk reduction, patients still undervalue these things. Exercise is free, cost-effective and is so much more beneficial than a pill that might lower your BP 10 mm Hg.

    • Gina Lundberg, MD, FACC
    • Clinical Director, Emory Womens Heart Center
      Associate Professor of Medicine
      Emory University School of Medicine, Atlanta

    Disclosures: Lundberg reports no relevant financial disclosures.