El objetivo de este estudio fue evaluar el efecto de un programa de ejercicio grupal de moderada intensidad (EGMI) sobre la presión arterial (PA) y la capacidad funcional (VO_2pico) en mujeres posmenopáusicas hipertensas. Treinta mujeres voluntarias (63.36±1.06 años; 158.6±5.50 cm; 70.97±9.44 kg; 28.21±2.60 kg·m^-2) fueron asignadas aleatoriamente a un grupo de EGMI (n=15) y uno control (n=15, GC), el cual mantuvo sus actividades de la vida diaria, durante 12 semanas. Se evaluó la presión arterial sistólica (PAS), diastólica (PAD) y el VO_2pico, estimado usando el test de caminata de seis minutos, tanto antes como después de la intervención. Se encontró cambio significativo en la PAS en el grupo EGMI (cambio promedio [IC 95%], valor p, d de Cohen; -9.2 [-3.95, -14.44] mmHg, p=0.002, d=-0.7), mientras que no se encontraron cambios en el GC. La PAD no presentó cambios en el grupo EGMI, pero aumentó de manera significativa en el GC (10.0 [3.72, 16.27] mmHg, p=0.004, d=1.1). Se observó un incremento significativo en VO_2pico en EGMI (3.87 [2.91, 4.82] ml∙kg^-1∙min^-1, p<0.001, d=1.2), sin diferencia en el GC. Hubo diferencias significativas entre grupos en PAS y en VO_2pico (p=0.05). Nuestra propuesta de EGMI reduce la PAS y mejora la capacidad funcional en mujeres posmenopáusicas hipertensas de +60 años.

Abstract

The aim of this study was to evaluate the effect of a proposal of moderate-intensity group exercise (EGMI) program on blood pressure (BP) and functional capacity (VO_2peak) in hypertensive post-menopausal women. Thirty female volunteers (63.36±1.06 y; 158.6±5.50 cm; 70.97±9.44 kg; 28.21±2.60 kg·m^-2) were randomly assigned to an EGMI group (n=15) and a control (n=15, CG), which maintained its activities of daily life, for 12 weeks. Systolic (SBP), diastolic blood pressure (DBP) and VO_2peak, estimated using the six-minute walk test, were evaluated before and after the intervention. Significant change in SBP was found in the EGMI group (mean change [95% CI], p-value, Cohen’s d; -9.2 [-3.95, -14.44] mmHg, p=0.002, d=-0.7), while no changes were found in CG. DBP was unchanged in the EGMI group but increased significantly in the CG (10.0 [3.72, 16.27] mmHg, p=0.004, d=1.1). A significant increase in estimated VO_2peak was observed in EGMI (3.87 [2.91, 4.82] ml∙kg^-1∙min^-1, p<0.001, d=1.2), with no difference in CG. There were significant differences between the groups in SBP and estimated VO_2peak (p≤0.05). Our proposal of EGMI reduces SBP and improves functional capacity in hypertensive post-menopausal women over 60 years old.

https://doi.org/10.5232/ricyde2021.06602

Referencias/references

Almeida, J., Bessa, M., Lopes, L., Gonçalves, A., Roever, L., & Zanetti, H. R. (2021). Isometric handgrip exercise training reduces resting systolic blood pressure but does not interfere with diastolic blood pressure and heart rate variability in hypertensive subjects: a systematic review and meta-analysis of randomized clinical trials. Hypertension research, 44, 1205-1212.
https://doi.org/10.1038/s41440-021-00681-7

Barón, O., y Díaz, G. (2016). Caminata de seis minutos: propuesta de estandarización del protocolo y aplicación práctica para la evaluación de la hipertensión pulmonar con especial referencia a la de los niños. Revista Colombiana de Cardiología, 23(1), 59-67.
https://doi.org/10.1016/j.rccar.2015.05.011

Benetos, A.; Thomas, F.; Bean, K.; Gautier, S.; Smulyan, H., & Guize, L. (2002). Prognostic value of systolic and diastolic blood pressure in treated hypertensive men. Archives of Internal Medicine, 162(5), 577–581.
https://doi.org/10.1001/archinte.162.5.577

Bonilla, D. A.; Paipilla, A. F.; Marín, E.; Vargas, S.; Petro, J. L., & Pérez-Idárraga, A. (2018). Dietary Nitrate from Beetroot Juice for Hypertension: A Systematic Review. Biomolecules, 8(4), e134.
https://doi.org/10.3390/biom8040134

Calin-Jageman, R. J., & Cumming, G. (2019). The new statistics for better science: Ask how much, how uncertain, and what else is known. The American Statistician, 73(sup1), 271-280.
https://doi.org/10.1080/00031305.2018.1518266

Caminiti, G., Iellamo, F., Mancuso, A., Cerrito, A., Montano, M., Manzi, V., & Volterrani, M. (2021). Effects of 12 weeks of aerobic versus combined aerobic plus resistance exercise training on short-term blood pressure variability in patients with hypertension. Journal of Applied Physiology, 130(4), 1085-1092.
https://doi.org/10.1152/japplphysiol.00910.2020

Chamari, K., & Padulo, J. (2015). 'Aerobic' and 'Anaerobic' terms used in exercise physiology: a critical terminology reflection. Sports Medicine-Open, 1(1):9.
https://dx.doi.org/10.1186/s40798-015-0012-1

Chen, C. Y., & Bonham, A. C. (2010). Postexercise Hypotension: Central Mechanisms. Exercise and Sport Sciences Reviews, 38(3), 122–127.
https://doi.org/10.1097/jes.0b013e3181e372b5

Chrysant S. G. (2020). The clinical significance of isolated diastolic hypertension. Postgraduate medicine, 132(7), 624–628.
https://doi.org/10.1080/00325481.2020.1788294

Cornelissen, V. A., & Smart, N. A. (2013). Exercise training for blood pressure: a systematic review and meta‐analysis. Journal of the American heart association, 2(1), e004473. https://doi.org/10.1161/JAHA.112.004473

Conceição, L. S., Neto, M. G., do Amaral, M. A., Martins-Filho, P. R., & Oliveira Carvalho, V. (2016). Effect of dance therapy on blood pressure and exercise capacity of individuals with hypertension: A systematic review and meta-analysis. International Journal of Cardiology, 220, 553–557.
https://doi.org/10.1016/j.ijcard.2016.06.182

Da Silva, A., de Oliveira, S. N., Vieira, B. A., Leite, C., Martins, D. M., Moro, A., Gerage, A. M., & Delevatti, R. S. (2021). Acute effect of bodyweight-based strength training on blood pressure of hypertensive older adults: A randomized crossover clinical trial. Clinical and experimental hypertension, 43(3), 223–229.
https://doi.org/10.1080/10641963.2020.1847130

Da Silva-Grigoletto, M. E.; Viana-Montaner, B. H.; Heredia, J. R.; Mata, F.; Peña, G.; Brito, C. J.; Vaamonde, D.; García-Manso, J. M. (2013). Validación de la escala de esfuerzo percibido subjetivo OMNI-GSE para controlar la intensidad global en sesiones multipropósito en personas mayores. Kronos, 12(1), 32-40.

Domínguez, R.; Garnacho-Castaño, M. V.; Maté-Múñoz, J. L. (2016). Efectos del entrenamiento contra resistencias o resistance training en diversas patologías. Nutrición Hospitalaria, 33(3), 719-733.
http://dx.doi.org/10.20960/nh.284

Esparza-Ros, F.; Vaquero-Cristóbal, R.; & Marfell-Jones M. International Standards for Anthropometric Assessment. The International Society for the Advancement of Kinanthropometry: Murcia, Spain. 2019.

Fondo Colombiano de Enfermedades de Alto Costo. (2018). Situación de la enfermedad renal crónica, la hipertensión arterial y la diabetes mellitus en Colombia 2018. [Internet]. Disponible en:
https://cuentadealtocosto.org/site/publicaciones/situacion-de-la-enfermedad-renal-cronica-la-hipertension-arterial-y-la-diabetes-mellitus-en-colombia-2018/. Consultado marzo del 2021

García-Delgado, J. A.; Pérez-Coronel, P. L.; Chí-Arcia, J.; Martínez-Torrez, J.; Pedroso-Morales, I. (2008). Efectos terapéuticos del ejercicio físico en la hipertensión arterial. Revista Cubana de Medicina, 47(3).

Gliemann, L.; Buess, R.; Nyberg, M.; Hoppeler, H.; Odriozola, A.; Thaning, P.; Hellsten, Y.; Baum, O., & Mortensen, S. P. (2015). Capillary growth, ultrastructure remodelling and exercise training in skeletal muscle of essential hypertensive patients. Acta Physiologica, 214(2), 210-220.
https://doi.org/10.1111/apha.12501

Gómez, J. F.; Camacho, P. A.; López-López, J., y López-Jaramillo, P. (2019). Control y tratamiento de la hipertensión arterial: Programa 20-20. Revista Colombiana de Cardiología, 26(2), 99-106.
https://doi.org/10.1016/j.rccar.2018.06.008

Heberle, I., de Barcelos, G. T., Silveira, L., Costa, R. R., Gerage, A. M., & Delevatti, R. S. (2021). Effects of aerobic training with and without progression on blood pressure in patients with type 2 diabetes: A systematic review with meta-analyses and meta-regressions. Diabetes research and clinical practice, 171, 108581.
https://doi.org/10.1016/j.diabres.2020.108581

Hegde, S. M., & Solomon, S. D. (2015). Influence of physical activity on hypertension and cardiac structure and function. Current hypertension reports, 17(10), 1-8.
https://doi.org/10.1007/s11906-015-0588-3

Lima, R., Wofford, M., & Reckelhoff, J. F. (2012). Hypertension in postmenopausal women. Current hypertension reports, 14(3), 254–260.
https://doi.org/10.1007/s11906-012-0260-0

Liubertas, T., Kairaitis, R., Stasiule, L., Capkauskiene, S., Stasiulis, A., Viskelis, P., Viškelis, J., & Urbonaviciene, D. (2020). The influence of amaranth (Amaranthus hypochondriacus) dietary nitrates on the aerobic capacity of physically active young persons. Journal of the International Society of Sports Nutrition, 17(1), 37.
https://doi.org/10.1186/s12970-020-00366-5

Lopes, J., Fonseca, M., Torres‐Costoso, A., López‐Muñoz, P., Alves, A. J., Magalhães, P., & Ribeiro, F. (2020). Low‐and moderate‐intensity aerobic exercise acutely reduce blood pressure in adults with high‐normal/grade I hypertension. The Journal of Clinical Hypertension, 22(9), 1732-1736.
https://doi.org/10.1111/jch.14000

MacDonald, J. R. (2002). Potential causes, mechanisms, and implications of post exercise hypotension. Journal of Human Hypertension, 16(4), 225-236.
https://doi.org/10.1038/sj.jhh.1001377

McTiernan, A., Tworoger, S. S., Ulrich, C. M., Yasui, Y., Irwin, M. L., Rajan, K. B., Sorensen, B., Rudolph, R. E., Bowen, D., Stanczyk, F. Z., Potter, J. D., & Schwartz, R. S. (2004). Effect of exercise on serum estrogens in postmenopausal women: a 12-month randomized clinical trial. Cancer research, 64(8), 2923–2928.
https://doi.org/10.1158/0008-5472.can-03-3393

Ministerio de Salud y Protección Social. (2017). Día Mundial de la Hipertensión - Ficha Técnica 2017. [Internet]. Disponible en:
https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ENT/dia-mundial-hipertension-2017.pdf. Consultado marzo del 2021

Morimoto, K., Morikawa, M., Kimura, H., Ishii, N., Takamata, A., Hara, Y., Uji, M., & Yoshida, K. (2008). Mental stress induces sustained elevation of blood pressure and lipid peroxidation in postmenopausal women. Life sciences, 82(1-2), 99–107.
https://doi.org/10.1016/j.lfs.2007.10.018

Nieto-Cárdenas, O.; García-Cardona, D.; Jiménez, J., y Landázuri, P. (2013). Efecto del ejercicio en subpoblaciones de lipoproteínas de alta densidad y en la presión arterial. Revista de Salud Pública, 15(1), 12-22.

Organización Mundial de la Salud. (2013). Información General sobre la Hipertensión en el Mundo – OMS 2013. [Internet]. Disponible en:
http://apps.who.int/iris/bitstream/10665/87679/1/WHO_DCO_WHD_2013.2_spa.pdf. Consultado marzo del 2021

Organización Panamericana de la Salud. La hipertensión arterial como problema de salud comunitario - Manual de normas operativas para un programa de control en los diferentes niveles de atención 1990. [Internet]. Disponible en:
http://iris.paho.org/xmlui/bitstream/handle/123456789/3113/La%20hipertension%20arterial%20como%20problema%20de%20salud%20comunitario.pdf;jsessionid=9EFE619617E4AFDF2055F25A808F328A?sequence=1. Consultado abril del 2020

Patiño-Villada, F.; Arango-Vélez, E.; Quintero-Velásquez, M., y Arenas-Sosa, M. (2011). Factores de riesgo cardiovascular en una población urbana de Colombia. Revista de Salud Pública, 13(3), 433-445.

Peng, Y., Su, Y., Wang, Y. D., Yuan, L. R., Wang, R., & Dai, J. S. (2021). Effects of regular dance therapy intervention on blood pressure in hypertension individuals: a systematic review and meta-analysis. The Journal of Sports Medicine and Physical Fitness, 61(2), 301–309.
https://doi.org/10.23736/S0022-4707.20.11088-0

Pescatello, L. S.; Franklin, B. A.; Fagard, R.; Farquhar, W. B.; Kelley, G. A.; Ray, C. A., & American College of Sports Medicine. (2004). American College of Sports Medicine position stand. Exercise and hypertension. Medicine and Science in Sports and Exercise, 36(3), 533-553.
https://doi.org/10.1249/01.mss.0000115224.88514.3a

Pescatello, L. S.; MacDonald, H. V.; Lamberti, L., & Jhonson, B. T. (2015). Exercise for Hypertension: A Prescription Update Integrating Existing Recommendations with Emerging Research. Current Hypertension Reports, 17(11):87.
https://doi.org/10.1007/s11906-015-0600-y

Polito, M. D., Dias, J. R., Jr, & Papst, R. R. (2021). Resistance training to reduce resting blood pressure and increase muscle strength in users and non-users of anti-hypertensive medication: A meta-analysis. Clinical and experimental hypertension (New York, N.Y. : 1993), 1–12. Advance online publication.
https://doi.org/10.1080/10641963.2021.1901111

Rapsomaniki, E.; Timmis, A.; George, J.; Pujades-Rodriguez, M.; Shah, A. D.; Denaxas, S.; White, I. R.; Caulfield, M. J.; Deanfield, J. E.; Smeeth, L.; Williams, B.; Hingorani, A., & Hemingway, H. (2014). Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet (London, England), 383(9932), 1899–1911.
https://doi.org/10.1016/S0140-6736(14)60685-1

Razzak, Z. A., Khan, A. A., & Farooqui, S. I. (2019). Effect of aerobic and anaerobic exercise on estrogen level, fat mass, and muscle mass among postmenopausal osteoporotic females. International Journal of Health Sciences, 13(4), 10–16.

Rêgo, M. L., Cabral, D. A., Costa, E. C., & Fontes, E. B. (2019). Physical exercise for individuals with hypertension: It is time to emphasize its benefits on the brain and cognition. Clinical Medicine Insights: Cardiology, 13, 1-10.
https://doi.org/10.1177/1179546819839411

Rodríguez-Hernández, M. (2012). La actividad física en la prevención y tratamiento de la hipertensión arterial. InterSedes: Revista de las Sedes Regionales, 13(26), 142-156.

Ross, R. M.; Murthy, J. N.; Wollak, I. D., & Jackson AS. (2010). The six minute walk test accurately estimates mean peak oxygen uptake. BMC Pulmonary Medicine, 26 10(1), 31.
https://doi.org/10.1186/1471-2466-10-31

Stamler, J.; Stamler, R., & Neaton, J. D. (1993). Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. Archives of Internal Medicine, 153(5), 598–615.
https://doi.org/10.1001/archinte.153.5.598

Sabbahi, A.; Arena, R.; Elokda, A., & Phillips, S. A. (2016). Exercise and Hypertension: Uncovering the Mechanisms of Vascular Control. Progress in Cardiovascular Diseases, 59(3), 226–234.
https://doi.org/10.1016/j.pcad.2016.09.006

Salinas, J.; Bello, M.; Flores, A.; Carbullanca, L., y Torres M. (2005). Actividad física integral con adultos y adultos mayores en chile: resultados de un programa piloto. Revista Chilena de Nutrición, 32(3), 215-224.
http://dx.doi.org/10.4067/S0717-75182005000300006

Stewart, K. J.; Bacher, A. C.; Turner, K. L.; Fleg, J. L.; Hees, P. S.; Shapiro, E. P.; Tayback, M., & Ouyang, P. (2005). Effect of exercise on blood pressure in older persons: a randomized controlled trial. Archives of Internal Medicine, 165(7), 756-762.
https://doi.org/10.1001/archinte.165.7.756

Vargas-Molina, S.; Martín-Rivera, F.; Bonilla, D. A.; Petro, J. L.; Carbone, L.; Romance, R.; de Diego, M.; Schoenfeld, B. J., & Benítez-Porres, J. (2020). Comparison of blood lactate and perceived exertion responses in two matched time-under-tension protocols. Plos One, 15(1), e0227640.
https://doi.org/10.1371/journal.pone.0227640

Waclawovsky, G., Pedralli, M. L., Eibel, B., Schaun, M. I., & Lehnen, A. M. (2021). Effects of Different Types of Exercise Training on Endothelial Function in Prehypertensive and Hypertensive Individuals: A Systematic Review. Arquivos brasileiros de cardiologia, 116(5), 938–947.
https://doi.org/10.36660/abc.20190807

Whaley, M. H.; Kaminsky, L. A.; Dwyer, G. B.; Getchell, L. H., & Norton, J. A. (1992). Predictors of over-and underachievement of age-predicted maximal heart rate. Medicine and Science in Sports and Exercise, 24(10), 1173-1179.

Whelton, P. K.; Carey, R. M.; Aronow, W. S.; Casey, D. E.; Jr Collins, K. J.; Dennison Himmelfarb, C.; DePalma, S. M.; Gidding, S.; Jamerson, K. A.; Jones, D. W.; MacLaughlin, E. J.; Muntner, P.; Ovbiagele, B.; Smith, S. C.; Jr Spencer, C. C.; Stafford, R. S.; Taler, S. J.; Thomas, R. J.; Williams, K. A.; Sr Williamson, J. D.; & Wright Jr, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA. Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(19), e127-e248.
https://doi.org/10.1161/hyp.0000000000000066

Whelton, S. P., Chin, A., Xin, X., & He, J. (2002). Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Annals of internal medicine, 136(7), 493-503.
https://doi.org/10.7326/0003-4819-136-7-200204020-00006

World Medical Association. (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191-2194.
https://doi.org/10.1001/jama.2013.281053

Zanchetti, A., Facchetti, R., Cesana, G. C., Modena, M. G., Pirrelli, A., Sega, R., & SIMONA participants (2005). Menopause-related blood pressure increase and its relationship to age and body mass index: the SIMONA epidemiological study. Journal of hypertension, 23(12), 2269–2276.
https://doi.org/10.1097/01.hjh.0000194118.35098.43