The cardiovascular effects of upper-limb aerobic exercise in hypertensive patients.
BACKGROUND
Aerobic exercise is broadly recommended as a helpful adjunct to obtain blood pressure control in hypertension. Several hypertensive patients, however, are limited by musculoskeletal complaints or vascular occlusive disease from lower-limb exercise such as jogging or cycling. In the present randomized-controlled study, we evaluate whether an aerobic arm-cycling program provides a measurable cardiovascular benefit.


METHODS
Twenty-four probands were randomly assigned to sedentary activity or a heart rate controlled 12 week exercise program, consisting of arm-cycling at target lactate concentrations of 2.0 +/- 0.5 mmol/l. Endothelial function was assessed by flow-mediated dilation of the brachial artery. Augmentation index and large/small artery compliance (C(1) and C(2)) were measured by computerized pulse-wave analysis of the radial artery.


RESULTS
The exercise program led to a significant reduction in systolic (134.0 +/- 20.0 to 127.0 +/- 16.4 mmHg; P = 0.03) and diastolic blood pressure (73.0 +/- 21.6 to 67.1 +/- 8.2 mmHg; P = 0.02) accompanied by a significant improvement in C(2) (3.5 +/- 1.6 to 4.8 +/- 2.0 ml/mmHg x 100; P = 0.004). Flow-mediated dilation, augmentation index, and C(2) were not significantly affected (P > 0.05). Physical performance as derived from lactate and heart rate curves of lower-limb stress tests was unchanged, whereas maximal workload in an upper-limb ergometry significantly increased (P = 0.005). Blood pressure and vascular parameters remained unchanged in the control group.


CONCLUSIONS
Regular arm aerobic exercise leads to a marked reduction in systolic and diastolic blood pressures and an improvement in small artery compliance. Arm-cycling is a reasonable option for hypertensive patients who want to support blood pressure control by sports despite having coxarthrosis, gonarthrosis, or intermittent claudication.
Westhoff
Timm H
TH
Department of Nephrology, Charité Campus Benjamin Franklin, Hindenburgdamm, Berlin, Germany. timm.westhoff@charite.de
Schmidt
Sven
S
Gross
Viola
V
Joppke
Marian
M
Zidek
Walter
W
van der Giet
Markus
M
Dimeo
Fernando
F
D000368:Aged; D001916:Brachial Artery / Q000503:physiopathology; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D034941:Upper Extremity / Q000503:physiopathology*