title: Exercise training improves ambulatory blood pressure but not arterial stiffness in heart transplant recipients.
abstract: BACKGROUND
  Hypertension is the most prevalent comorbidity after heart transplantation (HT). Exercise training (ET) is widely recommended as a key non-pharmacologic intervention for the prevention and management of hypertension, but its effects on ambulatory blood pressure (ABP) and some mechanisms involved in the pathophysiology of hypertension have not been studied in this population. The primary purpose of this study was to investigate the effects of ET on ABP and arterial stiffness of HT recipients.
  
  
  METHODS
  40 HT patients, randomized to ET (n = 31) or a control group (n = 9) underwent a maximal graded exercise test, 24-hour ABP monitoring, and carotid-femoral pulse wave velocity (PWV) assessment before the intervention and at a 12-week follow-up assessment. The ET program was performed thrice-weekly and consisted primarily of endurance exercise (40 minutes) at ~70% of maximum oxygen uptake (Vo2MAX).
  
  
  RESULTS
  The ET group had reduced 24-hour (4.0 ± 1.4 mm Hg, p < 0.01) and daytime (4.8 ± 1.6 mm Hg, p < 0.01) systolic ABP, and 24-hour (7.0 ± 1.4 mm Hg, p < 0.001) daytime (7.5 ± 1.6 mm Hg, p < 0.001) and nighttime (5.9 ± 1.5 mm Hg, p < 0.001) diastolic ABP after the intervention. The ET group also had improved Vo2MAX (9.7% ± 2.6%, p < 0.001) after the intervention. However, PWV did not change after ET. No variable was changed in the control group after the intervention.
  
  
  CONCLUSIONS
  The 12-week ET program was effective for reducing ABP but not PWV in heart transplant recipients. This result suggests that endurance ET may be a tool to counteract hypertension in this high-risk population.
authors: Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil.
authors: Lucas Nóbilo
authors: LN
authors: Pascoalino
authors: Exercise and Chronic Disease Research Laboratory, Physical Education Department, School of Sciences, São Paulo State University - UNESP, Bauru, São Paulo, Brazil. Electronic address: ciolac@fc.unesp.br.
authors: Emmanuel Gomes
authors: EG
authors: Ciolac
authors: Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil; Syrian-Lebanese Hospital, São Paulo, São Paulo, Brazil.
authors: Aline Cristina
authors: AC
authors: Tavares
authors: Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil.
authors: Rafael Ertner
authors: RE
authors: Castro
authors: Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil.
authors: Silvia Moreira
authors: SM
authors: Ayub-Ferreira
authors: Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil.
authors: Fernando
authors: F
authors: Bacal
authors: Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil.
authors: Victor Sarli
authors: VS
authors: Issa
authors: Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil.
authors: Edimar Alcides
authors: EA
authors: Bocchi
authors: Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil.
authors: Guilherme Veiga
authors: GV
authors: Guimarães
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000534:rehabilitation*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D012189:Retrospective Studies; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000502:physiology*; D055815:Young Adult
keywords: arterial stiffness; blood pressure; exercise; heart transplantation; hypertension; rehabilitation