Greater Reduction of Blood Pressure with Exercise Intervention Than Standard Care After Recent Ischaemic Atroke: A Randomized Clinical Trial

Abstract Context and Objectives: Ischaemic stroke (IS) causes disability and uses massive public health resources. Cumulative disability from recurrence may be reduced with cardiometabolic risk reduction strategies e.g., lowering blood pressure (BP). We hypothesized that intensive exercise plus best available care in adults with recent IS improves fitness, glucose metabolism, muscle protein synthesis in paretic limbs compared to controls. BP changes were compared between intervention (INT) and controls (CON). Research Design and Setting: A randomised, interventional clinical trial conducted in Jamaican adults subjects: We investigate 103 adults with recent IS and residual weakness. Forty-nine subjects (24 women: mean age 61.5; 25 men: mean age 63.8) received task-oriented exercise training (TEXT) plus best available care. Fifty-four subjects (23 women: mean age 60.2; 31 men: mean age 61.3) received best care, including exercise advice. Measurements: We measured baseline, 3-month and 6-month BP. Results: After recent IS, TEXT plus best available care reduced systolic BP by 21 mmHg and diastolic by 12 mmHg compared to controls, independent of medication adherence, body composition; stroke severity. Men in the TEXT group had increased lean mass (P < 0.007), VO2 max (P = 0.03); 6-minute walk distance (P = 0.003). Leg press on paretic (P = 0.004) and non-paretic (P < 0.001) increased with TEXT vs CON over 6 months, in both sexes (P-values for sex difference > 0.2). Time-to-chair-rise decreased in both sexes who received intervention vs controls (P <0.04) Conclusions: TEXT results in significant blood pressure reduction in adults with recent ischaemic stroke and residual weakness when compared with best available medical care only.

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Faculty Opinions recommendation of Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718178532.793492562 ◽

2014 ◽

Author(s):

Andrea Semplicini

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Randomized Clinical Trial ◽

Blood Pressure Reduction ◽

Pressure Reduction

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Effect of Aerobic Exercise Training and Essential Amino Acid Supplementation for 24 Weeks on Physical Function, Body Composition, and Muscle Metabolism in Healthy, Independent Older Adults: A Randomized Clinical Trial

The Journals of Gerontology Series A ◽

10.1093/gerona/gly109 ◽

2018 ◽

Vol 74 (10) ◽

pp. 1598-1604 ◽

Cited By ~ 11

Author(s):

Melissa M Markofski ◽

Kristofer Jennings ◽

Kyle L Timmerman ◽

Jared M Dickinson ◽

Christopher S Fry ◽

...

Keyword(s):

Older Adults ◽

Clinical Trial ◽

Body Composition ◽

Protein Synthesis ◽

Muscle Strength ◽

Randomized Clinical Trial ◽

Walking Speed ◽

Muscle Protein ◽

Muscle Protein Synthesis ◽

Before And After

Abstract Background Essential amino acids (EAA) and aerobic exercise (AE) acutely and independently stimulate skeletal muscle protein anabolism in older adults. Objective In this Phase 1, double-blind, placebo-controlled, randomized clinical trial, we determined if chronic EAA supplementation, AE training, or a combination of the two interventions could improve muscle mass and function by stimulating muscle protein synthesis. Methods We phone-screened 971, enrolled 109, and randomized 50 independent, low-active, nonfrail, and nondiabetic older adults (age 72 ± 1 years). We used a 2 × 2 factorial design. The interventions were: daily nutritional supplementation (15 g EAA or placebo) and physical activity (supervised AE training 3 days/week or monitored habitual activity) for 24 weeks. Muscle strength, physical function, body composition, and muscle protein synthesis were measured before and after the 24-week intervention. Results Forty-five subjects completed the 24-week intervention. VO2peak and walking speed increased (p < .05) in both AE groups, irrespective of supplementation type, but muscle strength increased only in the EAA + AE group (p < .05). EAA supplementation acutely increased (p < .05) muscle protein synthesis from basal both before and after the intervention, with a larger increase in the EAA + AE group after the intervention. Total and regional lean body mass did not change significantly with any intervention. Conclusions In nonfrail, independent, healthy older adults AE training increased walking speed and aerobic fitness, and, when combined with EAA supplementation, it also increased muscle strength and EAA-stimulated muscle protein synthesis. These increases occurred without improvements in muscle mass.

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Efektivitas Isometric Handgrip Exercise dalam Menurunkan Tekanan Darah pada Pasien Hipertensi

Jurnal Ilmiah Kesehatan Sandi Husada ◽

10.35816/jiskh.v12i2.364 ◽

2020 ◽

Vol 12 (2) ◽

pp. 615-624

Author(s):

Ricky Nuh Zainuddin ◽

Paramitha Labdullah

Keyword(s):

Blood Pressure ◽

Exercise Intervention ◽

Blood Pressure Reduction ◽

Reduce Blood Pressure ◽

Pharmacological Therapy ◽

Control Group ◽

Handgrip Exercise ◽

Isometric Handgrip ◽

Hypertensive Patients ◽

Isometric Handgrip Exercise

Abstract. Background: Hypertension has a significant impact on public health and has become a major health care burden worldwide. One non-pharmacological therapy that can be given to reduce blood pressure in hypertensive patients is Isometric Handgrip Exercise exercise therapy. This therapy has been shown to reduce blood pressure which is almost the same as intense aerobic exercise. This literature review aims to analyze the effects of the application of Isometric Handgrip Exercise in reducing blood pressure in hypertensive patients. Method: This research explores quantitative evidence published in electronic databases such as Pubmed, and Google Scholar. Using a search strategy, we identified 16 articles that were potentially and relevant to the research objectives, and 4 articles were included in the final analysis. Results: We could see a significant effect on systolic and diastolic blood pressure reduction in the group given the Isometric Handgrip Exercise intervention compared with the control group. Conclusion: Research results from several articles in this review literature show that Isometric Handgrip Exercise exercises are proven to be effective in reducing blood pressure in hypertensive patients.

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Faculty Opinions recommendation of Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718178532.793492688 ◽

2014 ◽

Author(s):

Mauro Oddo ◽

Pierre Bouzat

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Randomized Clinical Trial ◽

Blood Pressure Reduction ◽

Pressure Reduction

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Xanthine oxidase inhibition for the improvement of long-term outcomes following ischaemic stroke and transient ischaemic attack (XILO-FIST) – Protocol for a randomised double blind placebo-controlled clinical trial

European Stroke Journal ◽

10.1177/2396987318771426 ◽

2018 ◽

Vol 3 (3) ◽

pp. 281-290 ◽

Cited By ~ 10

Author(s):

Jesse Dawson ◽

Niall Broomfield ◽

Krishna Dani ◽

David A Dickie ◽

Alex Doney ◽

...

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

White Matter ◽

Ischaemic Stroke ◽

Xanthine Oxidase ◽

Research Network ◽

White Matter Hyperintensity ◽

Double Blind ◽

Oxidase Inhibition ◽

Xanthine Oxidase Inhibition

Background Allopurinol, a xanthine oxidase inhibitor, reduced progression of carotid-intima media thickness and lowered blood pressure in a small clinical trial in people with ischaemic stroke. Xanthine oxidase inhibition for improvement of long-term outcomes following ischaemic stroke and transient ischaemic attack (XILO-FIST) aims to assess the effect of allopurinol treatment on white matter hyperintensity progression and blood pressure after stroke. This paper describes the XILO-FIST protocol. Methods XILO-FIST is a multicentre randomised double-blind, placebo-controlled, parallel group clinical trial funded by the British Heart Foundation and the Stroke Association. The trial has been adopted by the Scottish Stroke Research Network and the UK Clinical Research Network. The trial is registered in clinicaltrials.gov (registration number NCT02122718). XILO-FIST will randomise 464 participants, aged greater than 50 years, with ischaemic stroke within the past month, on a 1:1 basis, to two years treatment with allopurinol 300 mg twice daily or placebo. Participants will undergo brain magnetic resonance imaging, cognitive assessment, ambulatory blood pressure monitoring and blood sampling at baseline and after two years treatment. The primary outcome will be white matter hyperintensity progression, measured using the Rotterdam progression scale. Secondary outcomes will include change in white matter hyperintensity volume, mean day-time systolic blood pressure and measures of cognitive function. Up to 100 will undergo additional cardiac magnetic resonance imaging in a sub-study of left ventricular mass. Discussion If white matter hyperintensity progression is reduced, allopurinol could be an effective preventative treatment for patients with ischaemic stroke and clinical endpoint studies would be needed. If allopurinol reduces blood pressure after stroke, then it could be used to help patients reach blood pressure targets.

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