This book presents the current knowledge on the mechanisms by which exercise lowers blood pressure in hypertension and on its effects on the heart and arteries. In addition, it focuses on the optimal exercise protocols, the international consensus on clinical implementation, and the clinical indications for special populations (obese, diabetic etc). It also addresses possible drawbacks of exercise on left ventricular structure and function. Many experts in epidemiology, patophysiology and clinical research have contributed in preparing the chapters, with the main purpose of guiding clinicians in the optimal application of the present knowledge and to stimulate scientists to fill the gaps in knowledge by performing further research.The book is addressed not only to specialists in Hypertension, Internal Medicine, Cardiology, Metabolism, and Nephrology, but also to general practitioners and all healthcare professionals working in the field of rehabilitation medicine.
Author(s): Paolo Palatini, Enrico Agabiti-Rosei, Giuseppe Mancia
Series: Updates in Hypertension and Cardiovascular Protection
Publisher: Springer
Year: 2022
Language: English
Pages: 222
City: Cham
Contents
1: Haemodynamics of Exercise Testing and Sports Activities
1.1 Introduction
1.2 Dynamic Exercise
1.2.1 BP Changes During Traditional Dynamic Ergometric Tests
1.2.2 BP Changes During Prolonged Steady-State Exercise
1.2.3 Factors Affecting LV Performance During Exercise
1.2.4 BP Changes During Endurance Sports
1.2.5 BP Changes During Running
1.2.6 BP Changes During Cycling
1.3 Isometric Exercise
1.3.1 Laboratory Testing
1.3.2 Heavy-Resistance Sports
1.3.3 How to Assess the Hypertensive Athlete
References
2: Effect of Physical Activity on Blood Pressure and Prevention of Hypertension
2.1 Physical Activity (PA) and Hypertension: Data from Large Cohort Trials
2.1.1 PA in Daily Life and Incident Hypertension
2.1.2 PA in Daily Life and Future CV Disease in Patients with Hypertension
2.2 Impact of Exercise Therapy on BP: Data from Meta-Analyses of Randomized Controlled Trials
2.2.1 Blood Pressure Changes Following Dynamic Aerobic Endurance Exercise Therapy
2.2.2 Blood Pressure Changes Following Dynamic Resistance Exercise Therapy
2.2.3 Blood Pressure Changes Following Isometric Resistance Exercise Therapy
2.3 Conclusion
References
3: Effect of Regular Exercise on Autonomic Nervous System Activity
3.1 Physical Activity Versus Physical Inactivity
3.2 Physiological Effects of Exercise
3.3 Physical Exercise Prescription
3.4 The Autonomic Nervous System: How to Measure and Quantify
3.4.1 Heart Rate and Heart Rate Variability
3.4.2 The Sympathetic Nervous System
3.4.2.1 Microneurography
3.4.2.2 Norepinephrine Spillover
3.4.2.3 Catecholamines
3.5 Sympathetic Neural Adaptation to Exercise
3.5.1 Acute Effects
3.5.2 Long-Term Effects
3.5.3 Post-Exercise Effects
References
4: Endothelial Function and Physical Exercise: A Key to Cardiovascular Protection?
4.1 Endothelial Function and Its Mediators
4.2 Clinical Significance of Endothelial Dysfunction in Cardiovascular Disease
4.3 Physical Activity and Endothelial Function in the Elderly
4.4 Does Age Matter?
4.5 Physical Activity Can Improve Impaired Endothelium-Dependent Vasodilation in Patients with Cardiovascular Risk Factors or Disease
4.6 Future Perspectives
4.7 Conclusions
References
5: Exercise and Microcirculation in Hypertension
5.1 Introduction
5.2 Regulation of Blood Flow and Vascular Tone in Skeletal Muscle
5.2.1 Role of Angiogenesis in the Regulation of Blood Flow
5.2.2 Role of Skeletal Muscle Composition in Regulation of Blood Flow
5.3 Microvascular Alterations in Essential Hypertension
5.3.1 Structural Changes of the Vasculature
5.3.2 Functional Alterations of the Vasculature
5.3.3 Alterations in Skeletal Muscle
5.4 Effect of Exercise in Healthy Subjects
5.5 Effects of Exercise in Essential Hypertension
5.5.1 Effect on Microvascular Structure
5.5.2 Effect on Microvascular Function
5.5.3 Role of MicroRNAs
5.5.4 Effect of MicroRNAs on the Skeletal Muscle
5.6 Conclusion
References
6: Effect of Regular Physical Activity on Arterial Distensibility
6.1 Introduction
6.2 Effect of Physical Activity on Blood Pressure and Hypertension
6.3 Effect of Physical Activity on Arterial Distensibility
6.4 Effect of Resistance and Combined Training Program on Arterial Distensibility
6.5 Conclusions
References
7: Physiological Versus Pathological Left Ventricular Hypertrophy in the Hypertensive Athlete
7.1 Introduction
7.2 Athlete’s Heart
7.3 Hypertensive Heart Disease (HHD)
7.4 The Hypertensive Athlete
7.5 Clinical Tools for Distinguishing Between HHD and Athlete’s Heart
7.5.1 Twelve-Lead Resting Electrocardiogram (ECG)
7.5.2 Echocardiography
7.5.3 Exercise Testing and CPET
7.5.4 Cardiac Magnetic Resonance
7.6 Conclusions
References
8: Atrial Fibrillation and Sports: Still a Challenging Problem
8.1 Introduction
8.2 Possible Mechanisms
8.2.1 Triggers Modification in Athletes
8.2.2 Substrate Modification in Athletes
8.2.3 Modulating Factors Modifications in Athletes
8.3 Association Between AF and Sport: A Summary of the Literature
8.4 Comment
8.5 Conclusive Considerations
References
9: Metabolic Syndrome: Effect of Physical Activity on Arterial Elasticity
9.1 Introduction
9.2 Mechanisms Underlying Metabolic Syndrome and Arterial Distensibility Impairment
9.3 Effect of Physical Activity on Arterial Distensibility
9.4 Effect of Physical Activity on Arterial Stiffness in Patients with the Metabolic Syndrome
9.5 Conclusions
References
10: Effect of Exercise Training on Clinical Outcomes in Patients with Diabetes
10.1 Introduction
10.2 The Priceless Value of Exercise in Diabetes Prevention
10.3 The Inestimable Value of Exercise in Diabetes Management
10.4 Exercise on Diabetes Outcomes
10.5 Exercise and Diabetes: What the Guidelines Say
10.6 Conclusions
References
11: Effects of Physical Activity on Hypertension of Youth
11.1 Introduction
11.2 Autonomic Nervous System Activity in Hypertension of the Young
11.3 Regular Physical Activity Improves Autonomic Nervous System Regulation
11.4 Isolated Systolic Hypertension in the Athlete
11.5 Effects of Exercise on Blood Pressure and Metabolic Variables
11.6 Effect of Regular Physical Activity on Hypertension-Mediated Organ Damage
11.6.1 Effect on the Heart
11.6.2 Effect on Carotid Intima–Media Thickness
11.6.3 Effect on Arterial Elasticity
11.7 Assessment of BP Response to Exercise
11.8 Eligibility for Competitive Athletics
11.9 Conclusion
References
12: Exercise and Hypertension in Older Persons
12.1 Aging and Physical Activity
12.2 Physical Exercise and Hypertension
12.3 Mechanisms
12.4 Limitations
References
13: Exercise for Systemic and Pulmonary Arterial Hypertension: Killing Two Birds with One Stone
13.1 Introduction
13.2 Definition of Pulmonary Hypertension
13.2.1 Physiopathology of PAH
13.2.2 Normal Pulmonary Hemodynamics in Response to Exercise
13.2.3 Exercise Limitation in PAH
13.2.3.1 RV Implications
13.2.3.2 Ventilation-Perfusion Mismatch
13.2.3.3 Muscle Dysfunction
13.2.3.4 Inflammation
13.3 Exercise Training in PH
13.3.1 Possible Effects of Exercise Training on PH
13.3.2 Inflammation
13.3.3 Antioxidative Effects
13.3.4 Vascular and Right Ventricular Effect
13.4 Conclusion
References
14: High Altitude and Blood Pressure: Clinical Implications
14.1 What Is High Altitude?
14.2 How HA Affects Circulation
14.2.1 Effects of Acute HA Exposure on BP in Healthy Individuals at Rest and During Exercise
14.2.2 Mechanisms of BP Changes
14.3 Clinical Implications
14.3.1 HA and Cardiovascular Pathological Conditions
14.3.2 HA and Antihypertensive Treatment
14.3.3 BP and Hypertension in Highlanders
14.4 Conclusions
References
15: Antihypertensive Therapy in Athletes
15.1 Introduction
15.2 Choice of Medication
15.2.1 ACE Inhibitors
15.2.2 Angiotensin II Receptor Blockers
15.2.3 Calcium Channel Blockers
15.2.4 Alpha Agonists/Blockers
15.2.5 Beta Blockers
15.2.6 Diuretics
15.3 Pharmacological Combinations
15.4 Nutraceuticals
15.5 Conclusions
References
