Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial

Wilby Williamson^{1

2}, Adam James Lewandowski^{1

3}, Odaro John Huckstep^{1

4}, Winok Lapidaire¹, Alexander Ooms⁵, Cheryl Tan¹, Afifah Mohamed^{1

6}, Maryam Alsharqi¹, Mariane Bertagnolli^{1

7}, William Woodward¹, Cameron Dockerill¹, Annabelle McCourt¹, Yvonne Kenworthy¹, Holger Burchert¹, Aiden Doherty⁸, Julia Newton⁹, Henner Hanssen¹⁰, John Kennedy Cruickshank¹¹, Richard McManus¹², Jane Holmes⁵, Chen Ji¹³, Sharon Love¹⁴, Elena Frangou¹⁴, Colin Everett¹⁵, Melvyn Hillsdon¹⁶, Helen Dawes^{17

17}, Charlie Foster¹⁸, Paul Leeson¹

Affiliations

¹ Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
² School of Medicine, Trinity College Dublin, Dublin, Ireland.
³ Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
⁴ Department of Biology, United States Air Force Academy, CO, USA.
⁵ Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
⁶ Department of Diagnostic Imaging & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
⁷ Hôpital du Sacré-Cœur de Montréal Research Center (CIUSSS Nord-de-l'Île-de-Montréal), School of Physical and Occupational Therapy, McGill University, Montréal, Canada.
⁸ Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, UK.
⁹ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
¹⁰ Department of Sport, Exercise and Health, University of Basel, Switzerland.
¹¹ School of Lifecourse Sciences, Kings College London, London, UK.
¹² Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
¹³ Warwick Clinical Trials Unit, University of Warwick, Warwick, UK.
¹⁴ MRC Clinical Trials Unit, University College London, London, UK.
¹⁵ Clinical Trials Research Unit, University of Leeds, Leeds, West Yorkshire, UK.
¹⁶ Sport and Health Sciences, University of Exeter, Exeter, UK.
¹⁷ Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
¹⁸ School of Policy Studies, University of Bristol, Bristol, UK.

PMID: 35706495
PMCID: PMC9112102
DOI: 10.1016/j.eclinm.2022.101445

Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial

Wilby Williamson et al. EClinicalMedicine. 2022.

. 2022 May 13:48:101445.

doi: 10.1016/j.eclinm.2022.101445. eCollection 2022 Jun.

Authors

Affiliations

¹ Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
² School of Medicine, Trinity College Dublin, Dublin, Ireland.
³ Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
⁴ Department of Biology, United States Air Force Academy, CO, USA.
⁵ Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
⁶ Department of Diagnostic Imaging & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
⁷ Hôpital du Sacré-Cœur de Montréal Research Center (CIUSSS Nord-de-l'Île-de-Montréal), School of Physical and Occupational Therapy, McGill University, Montréal, Canada.
⁸ Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, UK.
⁹ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
¹⁰ Department of Sport, Exercise and Health, University of Basel, Switzerland.
¹¹ School of Lifecourse Sciences, Kings College London, London, UK.
¹² Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
¹³ Warwick Clinical Trials Unit, University of Warwick, Warwick, UK.
¹⁴ MRC Clinical Trials Unit, University College London, London, UK.
¹⁵ Clinical Trials Research Unit, University of Leeds, Leeds, West Yorkshire, UK.
¹⁶ Sport and Health Sciences, University of Exeter, Exeter, UK.
¹⁷ Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
¹⁸ School of Policy Studies, University of Bristol, Bristol, UK.

PMID: 35706495
PMCID: PMC9112102
DOI: 10.1016/j.eclinm.2022.101445

Abstract

Background: Exercise is advised for young adults with elevated blood pressure, but no trials have investigated efficacy at this age. We aimed to determine whether aerobic exercise, self-monitoring and motivational coaching lowers blood pressure in this group.

Methods: The study was a single-centre, open, two-arm, parallel superiority randomized clinical trial with open community-based recruitment of physically-inactive 18-35 year old adults with awake 24 h blood pressure 115/75mmHg-159/99 mmHg and BMI<35 kg/m². The study took place in the Cardiovascular Clinical Research Facility, John Radcliffe Hospital, Oxford, UK. Participants were randomized (1:1) with minimisation factors sex, age (<24, 24-29, 30-35 years) and gestational age at birth (<32, 32-37, >37 weeks) to the intervention group, who received 16-weeks aerobic exercise training (three aerobic training sessions per week of 60 min per session at 60-80% peak heart rate, physical activity self-monitoring with encouragement to do 10,000 steps per day and motivational coaching to maintain physical activity upon completion of the intervention. The control group were sign-posted to educational materials on hypertension and recommended lifestyle behaviours. Investigators performing statistical analyses were blinded to group allocation. The primary outcome was 24 h awake ambulatory blood pressure (systolic and diastolic) change from baseline to 16-weeks on an intention-to-treat basis. Clinicaltrials.gov registered on March 30, 2016 (NCT02723552).

Findings: Enrolment occurred between 30/06/2016-26/10/2018. Amongst the 203 randomized young adults (n = 102 in the intervention group; n = 101 in the control group), 178 (88%; n = 76 intervention group, n = 84 control group) completed 16-week follow-up and 160 (79%; n = 68 intervention group, n = 69 control group) completed 52-weeks follow-up. There were no group differences in awake systolic (0·0 mmHg [95%CI, -2·9 to 2·8]; P = 0·98) or awake diastolic ambulatory blood pressure (0·6 mmHg [95%CI, -1·4. to 2·6]; P = 0·58). Aerobic training increased peak oxygen uptake (2·8 ml/kg/min [95%CI, 1·6 to 4·0]) and peak wattage (14·2watts [95%CI, 7·6 to 20·9]) at 16-weeks. There were no intervention effects at 52-weeks follow-up.

Intepretation: These results do not support the exclusive use of moderate to high intensity aerobic exercise training for blood pressure control in young adults.

Funding: Wellcome Trust, British Heart Foundation, National Institute for Health Research, Oxford Biomedical Research Centre.

Keywords: Aerobic training; Blood pressure; Cardiovascular risk; Exercise; High blood pressure; Hypertension; Lifestyle intervention; Prevention; Young adults.

PubMed Disclaimer

Conflict of interest statement

RM has received BP monitors for research from Omron and is working with them to develop a telemonitoring system. He does not personally receive payment for this. The other study investigators declare no competing interests.

Figures

**Figure 2**
Differences between control and intervention for primary and secondary outcomes after 16 weeks moderate to high intensity exercise intervention. Change is presented as adjusted mean in the outcome of interest, in the units for that outcome, with 95% confidence interval error bars. A positive change represents an increase in the outcome measure in the intervention group. Abbreviations: BP = blood pressure, HOMA = homoeostatic model assessment, HDL = high density lipoprotein.

**Figure 3**
Pre-specified exploratory analysis of differences after16 weeks exercise intervention effect in awake systolic blood pressure (Panel A) and awake diastolic blood pressure (Panel B) according to subgroups based on gestational age at birth (<32 weeks, 32–37 weeks, >37 weeks) and gender. Change is reported as the adjusted mean difference in mmHg with error bars representing 95% confidence intervals. A positive change indicates an increase in the outcome in the intervention arm. Abbreviation: gest age = gestational age at birth.

See this image and copyright information in PMC

References

1. Zhang Y., Vittinghoff E., Pletcher M.J., et al. Associations of blood pressure and cholesterol levels during young adulthood with later cardiovascular events. J Am Coll Cardiol. 2019;74(3):330. - PMC - PubMed
1. Chen V., Ning H., Allen N., et al. Lifetime risks for hypertension by contemporary guidelines in African American and White men and women. JAMA Cardiol. 2019;4(5):455–459. - PMC - PubMed
1. Zhang Y., Moran Andrew E. Trends in the prevalence, awareness, treatment, and control of hypertension among young adults in the United States, 1999 to 2014. Hypertension. 2017;70(4):736–742. - PMC - PubMed
1. Lee H., Yano Y., Cho So Mi J., et al. Cardiovascular risk of isolated systolic or diastolic hypertension in young adults. Circulation. 2020;141(22):1778–1786. - PubMed
1. Yano Y., Reis J.P., Colangelo L.A., et al. Association of blood pressure classification in young adults using the 2017 American College of Cardiology/American Heart Association Blood Pressure guideline with cardiovascular events later in life association between young adult hypertension and cardiovascular events in middle ageassociation between young adult hypertension and cardiovascular events in middle age. JAMA. 2018;320(17):1774–1782. - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial

Affiliations

Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical