High-intensity interval training and hypertension: maximizing the benefits of exercise?

Abstract

Essential arterial hypertension is the most common risk factor for cardiovascular morbidity and mortality. Regular exercise is a well-established intervention for the prevention and treatment of hypertension. Continuous moderate-intensity exercise training (CMT) that can be sustained for 30 min or more has been traditionally recommended for hypertension prevention and treatment. On the other hand, several studies have shown that high-intensity interval training (HIT), which consists of several bouts of high-intensity exercise (~85% to 95% of HR(MAX) and/or VO(2MAX) lasting 1 to 4 min interspersed with intervals of rest or active recovery, is superior to CMT for improving cardiorespiratory fitness, endothelial function and its markers, insulin sensitivity, markers of sympathetic activity and arterial stiffness in hypertensive and normotensive at high familial risk for hypertension subjects. This compelling evidence suggesting larger beneficial effects of HIT for several factors involved in the pathophysiology of hypertension raises the hypothesis that HIT may be more effective for preventing and controlling hypertension.

Keywords: Exercise; arterial stiffness; autonomic nervous system; endothelial function; hypertension.

Figure 1

Schematic representation of key abnormalities (and their integration) of young normotensive individuals at high familial risk for hypertension, the effects of exercise training (HIT vs. CMT), and the implications for hypertension prevention. Adapted from [13,14,27]. HIT, high-intensity interval training. CMT, continuous moderate-intensity training.

Figure 2

Blood pressure response to a graded exercise testing before and after 16 weeks of HIT, CMT or control intervention in young normotensive women at high familial risk for hypertension. (A) HIT, high-intensity interval training group. (B) CMT, continuous moderate-intensity training group. (C) ConFH+, nonexercise control group at familial risk for hypertension. (D) ConFH-, nonexercise control group without familial risk for hypertension. Data are presented as mean±standard deviation. ^# Different from ConFH+ at the same period (P<0.05). Different from after follow-up in the same group (¨ P<0.05; ¨¨ P<0.01; ¨¨¨ P<0.001). (Reprinted from [13] (Ciolac EG, et al. Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypert Res. 2010; 33: 836-843). ©2010 The Japanese Society of Hypertension. Used with permission).

Figure 3

Norepinephrine (A), endothelin-1 (B) and NOx (C) response to a graded exercise testing before and after 16 weeks of HIT, CMT or control intervention in young normotensive women at high familial risk for hypertension. 1, resting phase (blood sample collected after 60 min of supine resting. 2, exercise phase (blood sample collected immediately after last stage of exercise). 3, recovery phase (blood sample collected 10 min after last stage of exercise). Data are presented as mean±standard deviation. HIT, high-intensity interval training group. CMT, continuous moderate-intensity training group. ConFH+, nonexercise control group at familial risk for hypertension. ConFH-, nonexercise control group without familial risk for hypertension. ^* Different from HIT, CMT and ConFH+ before follow-up (P<0.05). ^# Different from ConFH+ after follow-up (P<0.05). Different from before follow-up in the same group (¨ P<0.05; ¨¨ P<0.01). (Reprinted from reference [13] (Ciolac EG, et al. Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypert Res 2010; 33: 836-843). ©2010 The Japanese Society of Hypertension. Used with permission).

Figure 4

Recovery heart rate to a graded exercise testing (first minute decrease) before and after 16 weeks of HIT, CMT or control intervention in young normotensive women at high familial risk for hypertension. Data are presented as mean±standard deviation. HIT, high-intensity interval training group. CMT, continuous moderate-intensity training group; CON, nonexercise control group; bpm, beats per minute. ^* Different from before follow-up in the same group (P < 0.01). ¨ Different from HIT after follow-up (P < 0.05). (Adapted from reference [14] (Ciolac EG, et al. Heart rate response to exercise and cardiorespiratory fitness of young women at high familial risk for hypertension: effects of interval vs continuous training. Eur J Cardiov Prev Rehabil 2011; 18: 824-830). ©2011 The European Society of Cardiology. Used with permission).

Figure 5

Arterial stiffness (pulse wave velocity) before and after 16 weeks of HIT, CMT or control intervention in (A) long-term treated hypertensive patients and (B) young normotensive women at high familial risk for hypertension. Data are presented as mean±standard deviation. HIT, high-intensity interval training group. CMT, continuous moderate-intensity training group; CON, nonexercise control group; FH+, with familial risk for hypertension; FH-, without familial risk for hypertension; m/s, meters per second. ^à Different from HIT, CMT and CON FH+ before followup (P < 0.001). ¨ Different from HIT and CON FH- after follow-up (P < 0.05). Different from before follow-up in the same group (* P < 0.05; ** P < 0.01). (Adapted from reference [13] (Ciolac EG, et al. Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neurohumoral abnormalities of young normotensive women at high familial risk for hypertension. Hypert Res 2010; 33: 836-843) and [11] (Guimarães GV, et al. Effects of continuous versus interval exercise training on the blood pressure and arterial stiffness in treated hypertensive subjects: a randomized controlled study. Hypert Res 2010; 33: 627-632) ©2010 The Japanese Society of Hypertension. Used with permission) .