Effects of Exercise on Hypertension: From Cells to Physiological Systems

341 Pages·2015·5.45 MB·English

by  Linda S. Pescatello (eds.)

Molecular and Translational Medicine
Series Editors: William B. Coleman · Gregory J. Tsongalis
Linda S. Pescatello Editor
Eff ects of
Exercise on
Hypertension
From Cells to Physiological Systems
Molecular and Translational Medicine

Series Editors
William B. Coleman
Gregory J. Tsongalis
More information about this series at h ttp://www.springer.com/series/8176

Linda S. Pescatello
Editor
Effects of Exercise
on Hypertension
From Cells to Physiological Systems
Editor
Linda S. Pescatello
Department of Kinesiology
College of Agriculture
Health, and Natural Resources
University of Connecticut
Storrs , CT , USA
ISSN 2197-7852 ISSN 2197-7860 (electronic)
Molecular and Translational Medicine
ISBN 978-3-319-17075-6 ISBN 978-3-319-17076-3 (eBook)
DOI 10.1007/978-3-319-17076-3
Library of Congress Control Number: 2015939172
Springer Cham Heidelberg New York Dordrecht London
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Foreword
D uring bouts of acute exercise, blood pressure rises. Paradoxically, high levels of
chronic physical activity and aerobic exercise training can prevent some of the age-
associated rise in blood pressure seen in many normal humans, and exercise training
can also lower blood pressure in those with hypertension. The rise in blood pressure
with acute exercise is driven via neural signals known as central command acting in
concert with baroreceptor resetting and feedback from skeletal muscle afferents.
Together, these signals reduce the activity of the parasympathetic nervous system
and increase the activity of the sympathetic nervous system. These adjustments
cause the increase in heart rate and ultimately cardiac output, and also vasoconstric-
tion in many vascular beds. The targets of these neural adjustments also offer clues
about the long-protective effects of physical activity and exercise training on blood
pressure. Likewise the vasodilation in active skeletal muscles and increases in blood
fl ow might offer clues about long-term adaptations that favor vascular health and
reductions in peripheral resistance.
W ith the overview above as a background, the various sites and mechanisms
whereby physical activity and exercise training might infl uence blood pressure
range from the molecular to a systems engineering approach that considers blood
pressure regulation as a hydraulic system. Is it possible to integrate the mechanisms
operating at so many levels into a coherent story that is consistent with the interven-
tional and epidemiological studies in humans on blood pressure, physical activity,
and exercise?
As the fi rst primer on the effects of exercise on human hypertension, Effects of
Exercise on Hypertension : From Cells to Physiological Systems does integrate the
mechanisms operating at so many levels into a coherent story. This volume describes
the state-of-the-art effects of exercise on the many factors underlying essential
hypertension in humans. It contains chapters by distinguished experts on the effects
of exercise on physiological systems known to be involved in hypertension develop-
ment and maintenance as well as less well-known aspects of hypertension such as
the blood pressure lowering effects of exercise under ambulatory conditions and the
infl uence of oxidative stress. The emerging areas of the effects of resistance exercise
v
vi Foreword
and concurrent (combined) aerobic and resistance exercise on blood pressure are
also highlighted. A unique aspect of the book is that it will discuss the effects of
exercise mimetics on vascular cell adaptations in order to begin to elucidate some of
the cellular mechanisms that may underlie the blood pressure response to exercise
training. In this context, the book is ideal for scholars and professionals in cardio-
vascular research and medicine, and allied health care professionals and students in
cardiovascular exercise physiology and related fi elds.
The book begins with a section on the infl uence of modality on the blood pres-
sure response to exercise including public health guidelines related to the Frequency,
Intensity, Type, and Time (or FITT) principle of exercise prescription as well as
clinical implications of research in this area. The second section is unique and cov-
ers mechanisms associated with the blood pressure response to exercise including
vascular and autonomic function, the effects of exercise mimetics on vascular cell
adaptations, arterial stiffness, hemodynamic adaptations, genetic underpinnings,
and animal models. The book concludes with Part III discussing the pleiotropic
effects of exercise on other cardiovascular risk factors including dyslipidemia, the
metabolic syndrome, infl ammation, and oxidative stress. Although the focus of
the book is on human hypertension, several chapters include sections covering the
effects of exercise on relevant animal models of hypertension.
I n the series of chapters in this book, the blood pressure responses to short-term,
acute exercise and more long-term, exercise training will be considered at multiple
levels of integration. Based on the brief outline above, questions to be addressed
within this book are as follows: (1) Does habitual physical activity and aerobic
exercise training do something to vascular smooth muscle which makes it less prone
to vasoconstriction?; (2) Could the balance between vasoconstricting and vasodilat-
ing factors in the vascular endothelium be shifted to favor vasodilation?; (3) Are the
vasoconstricting actions of catecholamines released from the sympathetic nerves
which are active during acute exercise blunted in the long term?; (4) Are there
changes in tonic sympathetic vasoconstrictor nerve activity?; (5) Do the barorecep-
tors become more distensible and do a “better job” of modulating increases in blood
pressure; and (6) How are changes in these mechanisms integrated by the central
nervous system so that blood pressure remains in the normal range or even falls in
patients with mild hypertension who exercise?
I n addition to these fundamental questions that will be largely addressed in the
chapters in Part II, other questions that will be discussed in Parts I and III include
the following: (1) What is the current consensus on the infl uence of aerobic, resis-
tance, and concurrent exercise on blood pressure?; (2) What are new and emerging
areas of research on the infl uence of exercise modality on blood pressure?; (3) How
are current exercise prescription recommendations for hypertension evolving based
on the new fi ndings?; (4) What is the infl uence of the pleiotropic effects of exercise
on other cardiovascular disease risk factors?; and (5) In the post-human genome era
what new information is available about the genetics of hypertension and the
response to exercise training as therapy?
The many questions outlined above highlight the intellectual challenges, or per-
haps the intellectual playground, that involve blood pressure regulation in general
Foreword vii
and the effects of exercise and physical activity more specifi cally. In view of the
worldwide pandemic of physical activity, obesity, and high blood pressure, along
with the vast social cost of this health condition something has to be done! This
volume is a welcome addition to our knowledge and will hopefully frame new ques-
tions and new areas of investigation and integration as novel insights about the
interactions between exercise and blood pressure. In the great scheme of things, the
pressure is on to help the population as a whole to maintain a normal blood pressure
and ward off the many negative health consequences of rising blood pressure.
Physical activity and exercise training are likely to play a key role in this fi ght.
Rochester, MN, USA Michael J. Joyner

Prefa ce
This book describes the state-of-the-art effects of exercise on blood pressure as well
as the mechanisms underlying essential hypertension in humans. The chapters are
written by distinguished experts in the fi eld on current and emerging research
regarding the effects of exercise on blood pressure and the physiological systems
known to be involved in hypertension development and maintenance from the cel-
lular to the organ to the whole organism level. Each chapter is organized to initially
defi ne key terminology and basic concepts; discuss and critique the state of the lit-
erature on its given topic as well as the clinical implications and translation of this
research into practice; and conclude with the take-home messages, new directions
for future research, and a list of key resources for use in the clinic, laboratory, or
classroom. The intended audience is academic settings and professional clinicians
and scientists working in the areas of allied health, cardiovascular science, cardio-
vascular and preventive medicine, and exercise science as well as medical and grad-
uate students in the allied health, cardiovascular, and exercise sciences.
The book begins with Part I Exercise and Hypertension that contains systematic
reviews of the infl uence of various exercise modalities and physical fi tness on blood
pressure among those with hypertension framed by the recommended F requency,
I ntensity, T ype, and T ime (FITT) principle of exercise prescription. P art II
Mechanisms for the Blood Pressure Lowering Effects of Exercise discusses various
mechanisms associated with the blood pressure response to exercise including vas-
cular function and structure, the effects of exercise mimetics on vascular cell adap-
tations, arterial stiffness, autonomic function and other hemodynamic adaptations,
genetic underpinnings, and myocardial remodeling. The book concludes with
Part III The Pleiotropic Effects of Exercise on Other Cardiovascular Risk Factors
and their Interactive Effects with Blood Pressure that includes dyslipidemia, the
metabolic syndrome, infl ammation, and oxidative stress.
ix