Decreased exercise blood pressure in older adults after exercise training: Contributions of increased fitness and decreased fatness
Open accessAbstract
OBJECTIVE: To describe the contribution of changes in fitness and fatness resulting from exercise training on changes in submaximal exercise blood pressure (BP) during treadmill testing. DESIGN AND SETTING: Prospective, randomised, controlled trial. PARTICIPANTS: Sedentary older adults (n = 115) with untreated prehypertension or mild hypertension. INTERVENTION: Six-month supervised aerobic and strength training. MAIN OUTCOME MEASUREMENT: Systolic BP (SBP) was assessed at rest and during each stage of a maximal graded exercise test (GXT) that determined Vo(2)peak. General and regional fatness was assessed by anthropometry, dual-energy x-ray absorptiometry and MRI. BP changes were calculated for each GXT stage, and multivariate regression models were used to describe the association of changes in exercise BP with changes in fitness and fatness. RESULTS: After training, exercisers versus controls had significantly increased Vo(2)peak and significantly lower measures of general and regional fatness. Also, stage-specific SBP was significantly lower at stage 3 (-9.4 vs -1.6 mm Hg, p = 0.03) and stage 4 (-7.9 vs -1.2 mm Hg, p = 0.03). Pooled regression analysis across all stages showed that exercisers had a 7.1 mm Hg reduction in SBP, but this reduction fell short of statistical significance (p = 0.12) compared with controls. A 1.0 ml/kg/min increase in Vo(2)peak and a 1.0 cm decrease in waist circumference independently predicted a 1.0 mm Hg decrease in exercise SBP (p = 0.04 and p = 0.001, respectively). CONCLUSIONS: Decreased exercise SBP was independently associated with decreased waist circumference, a marker of abdominal obesity and increased fitness. These findings suggest that exercise training improves multiple factors that have an independent influence on SBP.
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The effect of lifestyle interventions on maximal exercise SBP varies, perhaps attributable to training-induced improvements in cardiorespiratory fitness that mask the full treatment effects.
“The effect of lifestyle interventions on maximal exercise SBP also varies (41,42), perhaps attributable to training-induced improvements in cardiorespiratory fitness that mask the full treatment effects.”
From Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing (2022) · cites this paper as [42]
The Results (page unavailable) report that exercisers increased both maximal exercise SBP and VO2peak, while SBP fell at several fixed exercise stages. The Discussion (page unavailable) says fitness and fatness may explain variation in exercise BP response, but the paper does not establish that fitness gains mask the full treatment effect on maximal SBP or assess lifestyle interventions broadly. (LLM, conf=0.83)
Experimental — accuracy not yet measuredOne randomized controlled study has shown significant reductions in systolic BP measured at stages 3 and 4 of a modified Bruce protocol compared to a non-exercise control group.
“Indeed, although there is currently a paucity of data available with respect to the effect of exercise interventions on submaximal exercise BP, one randomized controlled study has shown significant reductions in systolic BP measured at stages 3 and 4 of a modified Bruce protocol compared to a non-exercise control group [62].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [62]
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“The effect of lifestyle interventions on maximal exercise SBP also varies (41,42), perhaps attributable to training-induced improvements in cardiorespiratory fitness that mask the full treatment effects.”
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West, K. S., Helwig, N. J., Schwager, L. E., Hart, T. W., Zucker, A. C., Venenga, J. S., Flores, M., & Jenkins, N. D. M. (2025) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00874.2024 · Cited by 6 · see citing works
- Authors
- Barone, B. B., Wang, N.-Y., Bacher, A. C., & Stewart, K. J.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Barone, B B
- ORCID
- Stewart, K J
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2008-08-26
- Volume
- 43
- Issue
- 1
- Pages
- 52-56
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- PMC
- PMC3725468
- OpenAlex
- W2167430886
- Cited by
- 70
- References
- 19
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 4 · 2019: 2 · 2018: 2 · 2017: 6 · 2015: 7 · 2014: 3 · 2013: 3 · 2012: 5
- FWCI
- 11.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL059164, R01HL59164)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK062707-06, T32DK062707)
- National Center for Research Resources (UL1RR025005, M01RR002719, 5M01RR02715)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- exercise training, blood pressure, older adults, aerobic exercise, resistance training, peak oxygen uptake, cardiorespiratory fitness, abdominal obesity, waist circumference, prehypertension, hypertension, incremental exercise test, sedentary older adults
- MeSH terms
- Adipose Tissue, Aged, Body Composition, Exercise Test, Exercise Therapy, Female, Heart Rate, Humans, Hypertension, Male, Middle Aged, Physical Fitness, Prospective Studies, Absorptiometry, Photon, Multivariate Analysis, Waist Circumference
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