Zahedan Journal of Research in Medical Sciences
Zahedan Journal of Research in Medical Sciences

article information

Zahedan Journal of Research in Medical Sciences: Vol.22, issue 1; e92708
published online: December 11, 2019
article type: Research Article
received: April 29, 2019
revised: July 21, 2019
accepted: July 30, 2019
DOI: https://doi.org/10.5812/zjrms.92708
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The Effects of 8 Weeks Pilates, Walking, and Combined Pilates and Walking on Heart Arrhythmia

authors:

avatar Shahla Hoseini Niya ORCID 1 , avatar Majid Vahidian-Rezazadeh ORCID 1 , * , avatar Hadi Heidari Mokarrar ORCID 2

Department of Sport Sciences, University of Sistan and Baluchestan, Zahedan, Iran
Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

how to cite: Hoseini Niya S, Vahidian-Rezazadeh M, Heidari Mokarrar H. The Effects of 8 Weeks Pilates, Walking, and Combined Pilates and Walking on Heart Arrhythmia. Zahedan J Res Med Sci. 2020;22(1):e92708. https://doi.org/10.5812/zjrms.92708.

Abstract

Background:

Heart is one of the essential body organs whose deviation from its normal function leads to abnormal heart rate, including bradycardia and tachycardia and may cause cardiac Arrhythmia.

Objectives:

The purpose of the present study is to examine the effects of 8 weeks Pilates, walking, and combined Pilates and walking exercise on heart Arrhythmia.

Methods:

In this quasi-experimental study, 30 female patients with tachycardia aging 24 to 59 years old in Zahedan were selected and categorized into three distinct Pilates, walking, and combined Pilates and walking groups (10 people per group). The training program was eight weeks, three sessions per week, with a 60% to 70% maximal heart rate. Resting heart rate (RHR) was measured with electrocardiography (ECG). Resting systolic and diastolic blood pressure was measured using a digital gauge in three different steps, the first step of the measurement was performed 24 hours before doing exercise, the second one at the end of the fourth week, and the last one at the end of the eighth week. Data were analyzed using one-way analysis of variance (ANOVA), repeated measure ANOVA, Bonferroni post hoc test by the statistical package in social science (SPSS) software version 20.

Results:

The results demonstrated that RHR decreased at the end of the eighth week of Pilates (P < 0.01), walking (P < 0.05), and combined Pilates and walking (P < 0.001). Resting systolic blood pressure decreased at the end of the eighth week of the Pilates, walking, and combined walking and Pilates. Resting diastolic blood pressure also reduced after walking, and combined Pilates and walking exercise.

Conclusions:

The results showed that RHR, systolic, and diastolic blood pressure significantly decreased after eight weeks of training in Pilates, walking, and combined training groups. Therefore, it seems that all three physical activity models can substantially decrease the resting blood pressure and are not superior to each other. Pilates training is likely to be more effective in reducing the heart rate of patients with cardiac tachycardia compared to the walking and combined training groups.

1. Background

Today, cardiovascular diseases are the most common cause of death. They are considered the primary cause of about 40% of death numbers in developed and undeveloped countries (1). Although there is no sufficient information on the starting point of arrhythmia, sinus tachycardia frequently happens after acute heart stroke (2). In acute heart stroke, approximately all rhythm abnormalities like tachycardia and bradycardia are the most common. Heartbeat irregularities are heart diseases, including bradycardia (slow beating) and tachycardia (fast beating), which may culminate in abnormal heart rhythm. One of the most dangerous side effects following an acute heart stroke is tachyarrhythmia (3). Cardiovascular diseases are caused by various factors such as high blood pressure and incorrect lifestyle (4). High blood pressure is among the risk factors of cardiovascular diseases. Hypertension has no symptom until it is completely developed. It augments the heart beating level and weakens heart muscles (5).

On the other hand, the lack of physical activity is another risk factor for cardiovascular diseases. The effects of aerobic exercise on blood pressure in long period exercise planning and increased exercise sessions are frequently studied (6). Many studies have examined the effects of various exercise models on systolic and diastolic blood pressure, and heart rate, either directly or indirectly. Most of research has focused on the effects of exercises on healthy and athletic individuals (7-9). We did not find any research that exclusively examines the effects of various exercises in patients with arrhythmias. Various forms of exercise are given great importance, among which the Pilates and walking have been the most attractive ones. The Pilates is a collection of professional activities in which strength, balance, and flexibility are the most fundamental elements and cooperates body, mind, and soul. The Pilates focuses on the movement of muscles and joints, which are frequently involved in daily activities like sitting, walking, bending, and erecting (10). Also, Pilates improves the pulmonary function index (11).

2. Objectives

As no comprehensive study examined the effects of the exercise on heart arrhythmia, our study tries to answer the following question: can eight weeks of Pilates, walking, and combined Pilates and walking induce significant effects on resting heart rate, resting systolic and diastolic blood pressure of patients with tachycardia?

3. Methods

The present study was done in a quasi-experimental model with a pre-test and post-test design. The purpose of this study was to investigate the effects of Pilates, walking, and combined Pilates and walking exercise for eight weeks on resting heart rate (RHR), resting systolic, and diastolic blood pressure in patients with arrhythmia. Statistical population includes the patients with tachycardia in Zahedan in 2018. The statistical sample consists of 30 females, aging 24 to 59 years old. The exclusion criteria were the patients had tachycardia, having no regular exercise during six last months, having no cardiac surgery, having no knee joint operation, intervertebral disc, and neck operation. The participants were selected purposefully and were categorized into three distinct groups: Pilates (N = 10), walking (N = 10), and combined Pilates and walking (N = 10). In the beginning, an explanatory meeting was held to clarify research process and possible profits and dangers of the study and to let the participants complete a form, including their personal information and their satisfaction to participate in the study procedure. The participants were assured that all their personal information would be confidential, and they were allowed to quit the study as soon as they wish. The participants’ RHR was measured by ECG electrocardiograph, Yasham 310, Germany. Resting systolic and diastolic blood pressure was measured by an AccuMed digital gauge in three different steps. The first measurement was performed 24 hours before starting the exercise, the second one at the end of the fourth week, and the last one was performed 24 hours after the end of the eighth week. In each step, the participants relaxed for 10 to 15 minutes before the measurements. To determine the severity of activities (60% to 70 % maximal heart rate), we used the maximum heart rate formula (12).

HR max = 208 - (0.7 × age)

3.1. Pilates Protocol

Pilates exercise was performed for 60 minutes, three times a week for eight weeks. It consisted of some simple movements, which mostly involved body muscles, gluteal muscle, psoas muscle, and pelvic floor muscle. Actions were done on a bed in standing up, lying down, and sitting states. Activities were started from plain movements and were gradually extended. Whenever it was necessary, the movements needed some specific balance were changed. To follow the overload principle, increasing the movement repetition played incrementally in a way that they were started from 7 and ended to 20. Every session was started with 15 minutes warming up stretching movements, continued with 30 minutes Pilates and was finished with 15 cooling down movements. After consulting the trainer and the researcher, Pilates movements were selected in a way to impose less pressure on the participants’ cardiovascular system. The intensity of exercise was from 60% to 70% of maximum heart rate (13). To control the intensity of exercise, an accurate pulse oximeter, Germany, was used.

3.2. Walking Protocol

The walking process was just performed on a treadmill to control the condition carefully. Therefore, corrected Bruce protocol was applied. This protocol, except its first two steps, was the same as Bruce’s. The first step was started with a 0-degree slope and 1.7 miles/hour speed (0 to 3 minutes). In the second step (4 to 6 minutes), the slope was increased by 5%. The third step was continued with a 10% slope and 1.7 miles/hour speed while the slope and the rate were increased to 12% and 2.5 miles/hour in the fourth step. The fifth step was ended in a 14% slope and 3.4 miles/hour speed (14). Although the protocol has twelve steps, the specialist suggested continuing just up to the fifth step with a 14% slope. At the end of the eighth week, only time and speed were added. Doing exercise was continued as far as the participants were able to go on.

3.3. Combined Pilates and Walking Protocol

The participants in the combined Pilates and walking group first did some Pilates exercise and then started walking on the treadmill. The Pilates prolonged for 60 minutes; then the training was continued with walking on a treadmill as far as the participants declared their tiredness and inability to continue.

3.4. Statistical Methods

The results were analyzed using the Kolmogorov-Smirnov test. To test the research hypothesis, one-way ANOVA and repeated measure ANOVA were applied. Bonferroni post hoc test was applied to determine differences among the groups. Data were analyzed by SPSS software version 20.

4. Results

The results demonstrated a significant reduction of RHR at the end of eighth Pilates exercise compared to the beginning of the research. This considerable reduction was observed in the walking and combined walking and Pilates group (Table 1).

Table 1.

Comparison of Resting Heart Rate in Different Turns of Exercise Groups

GroupsMean ± SEMaP Value
Pilates1st week4th week6.4 ± 1.3430.003*
8th week16.6 ± 3.3170.002*
Walking1st week4th week2.8 ± 0.8000.020*
8th week6.4 ± 1.8020.019*
Combined training1st week4th week5.7 ± 1.8500.039*
8th week10.1 ± 1.6020.001*

aThe mean difference in sampling time in this study.

In comparison to the first week, resting systolic blood pressure at the end of eighth week showed a significant reduction in the Pilates (P = 0.001), walking (P = 0.01), and combined Pilates and walking groups (P = 0.021), and the comparison of the results in the fourth week with the first one showed a significant reduction of resting systolic blood pressure (Table 2).

Table 2.

Comparison of Resting Systolic Blood Pressure in Different Turns of Exercise Groups

GroupsMean ± SEMP Value
Pilates1st week4th week13 ± 3.350.011*
8th week13 ± 2.0010.001*
Walking1st week4th week7.50 ± 2.7130.066
8th week11 ± 2.7690.010*
Combined training1st week4th week2.5 ± 2.0070.733
8th week10.5 ± 3.0230.021*

As it is demonstrated in Table 3, the participants’ resting blood pressure in the walking group and combined Pilates and walking group showed a significant reduction after eight weeks. This reduction was evident in both walking and combined Pilates and walking groups in the fourth week in comparison to the first week.

Table 3.

Comparison of Resting Diastolic Blood Pressure in Different Turns of Exercise Groups

GroupsMean ± SEMP Value
Pilates1st week4th week6 ± 3.3170.312
8th week6.5 ± 3.660.372
Walking1st week4th week6.5 ± 1.500.006a
8th week9.5 ± 1.570.001a
Combined training1st week4th week5 ± 0.7450.001a
8th week9 ± 2.210.008a

aP < 0.05.

To study average variances among different studied groups, one-way ANOVA was applied. The difference between post-test and pre-test in the studied groups was calculated (gain scores), to control the possible effects of the pretest results on post-test ones. Then, one-way ANOVA was performed. Testing results showed a significant difference in heart rate among the studied groups (P = 0.017). One-way variance analysis of resting systolic and diastolic blood pressure of patients with tachycardia after eight weeks did not result in a significant difference among the studied groups (Table 4).

Table 4.

One-Way ANOVA of Resting Heart Rate as Well as Resting Systolic and Diastolic Blood Pressure of the Studied Groups

Sum of SquaresdfMean SquareFP Value
Between groups
HRrest533.2672266.6334.7560.017*
BPSrest35217.5000.2520.779
BPDrest51.667225.8330.3740.691
Within groups
HRrest1513.72756.063
BPSrest1872.52769.352
BPDrest18652769.074
Total
HRrest2046.96729
BPSrest1907.529
BPDrest1916.66729

Abbreviations: BPDrest, resting diastolic blood pressure; BPSrest, resting systolic blood pressure; HRrest, resting heart rate.

As Levene’s test showed, homogeneity of variances was not fulfilled (P = 0.003). To compare the average in different groups, post hoc Dunnett’s T3 was applied. The results show that RHR in the Pilates group decreased significantly in comparison to the walking group after eight weeks (P = 0.049). Although this reduction was also seen in the combined Pilates and walking group, it was not significant (P = 0.262).

5. Discussion

The results of the present study showed eight weeks of Pilates, walking, and combined Pilates and walking exercise in patients with tachycardia demonstrated a significant reduction in heart rate. It was also shown that systolic and diastolic blood pressure decreased either, but it was not significant. The results showed that Pilates could induce a significant reduction in resting heart rate in comparison to the walking group. The results of the Gui’s study showed that intermittent exercise significantly reduced the blood pressure of patients with hypertension (15). In some studies, it has been reported that mean and intense physical activities, both will lead to heart rate reduction (15, 16). Another study showed that walking caused a reduction of resting heart rate in patients with chronic heart failure (17). Oh et al. in a study indicated that severe exercise culminates in the reduction of heart rate and systolic blood pressure (18). Also, some research studied the effects of walking on heart rate before and after exercise in senior women, which showed that walking could reduce the heart rate (19). In a study done by Williams and Franklin in two walking and running groups, it was observed that the regular exercise lessened the dangers of Arrhythmias (20). Michael et al. concluded that heart rate during an exercise was managed by both sympathetic and parasympathetic nerves (21). Cunha et al. reported that RHR oscillations depended mainly on sympathetic and vagal modulatory influences, but after maximal exercise, when parasympathetic contribution is negligible, the fast recovery is dependent on vagal reactivation with a later influence of both vagal reactivation and sympathetic withdrawal. Moreover, vagal recovery is improved with greater availability of acetylcholine by anticholinesterase inhibitor administration (22). The procedure in which exercise improves heart rate is not known, but it is generally accepted that exercise will increase nervus vagus and decrease the sympathetic effect of the heart (23). It seems physical activities will reduce the stability against bloodstream and reduce heart rate during resting through increasing the number of capillaries inactive skeleton muscles (24). Heart rate is managed by the sympathetic and parasympathetic system in a way that any failure in the automatic nervous system can increase the activity of sympathetic and decreasing the activity of parasympathetic systems (25). Through improving the balance between sympathetic and parasympathetic systems, exercise improves the systolic function of the left ventricle, which increases cardiac output during exercise and reduces resting heart rate (26). The effect of exercise on the heart wall shows that these types of exercise increase cardiac caves, especially in the left ventricle. Left ventricle will be affected by physical activities more than other parts (27). During Pilates, cardiac output increases through simultaneous increasing of heart rate and beating volume so that tachycardia happens and diastolic time augments, less time will be given to the left ventricle for diastolic filling (28). Pitsavos et al. studied the impact of aerobics with 60% to 80% maximum consumed oxygen on the treadmill in aging women, which resulted in decreasing systolic and diastolic blood pressure after the exercise (29). In a study that examined the effects of the intensity of aerobic exercise on systolic blood pressure both in resting and during the exercise, the results showed that exercise with low and extreme intensity leads to an increase in systolic blood pressure (30). Findings of research on the study of the effects of doing exercise on arterial fibrillation arrhythmia demonstrated that exercise with extreme intensity had no superiority to reduce arterial fibrillation compared to low-intensity exercise (31). Several known mechanisms can be described for blood pressure loss due to exercise. These include reducing adrenergic tone, effects on the sympathetic system, weight loss, and body fat (32). Among other possible causes of decreasing blood pressure, reducing peripheral arterial resistance and increased cardiac output during the exercise can be mentioned (33). Reduction of blood pressure possibly happens due to the reduction of produced cathecholamine after doing exercise. This reaction is involved in decreasing peripheral resistance against circulation and consequently, reduction of blood pressure. Besides, doing an exercise can facilitate sodium secretion from kidneys and lessen the liquid volume and consequently blood pressure (34). Genetic and environmental factors may also affect the influence of sports activities on blood pressure (35). Some researchers believe after doing exercise, an enzyme called dopamine hydroxylase reduces in the hypothalamus that its reduction decreases the peripheral activity of epinephrine in response to the feelings and other stimulations and helps to lessen blood pressure (36). Longtime exercise leads to decreasing blood pressure by affecting baroreceptors. Arterial baroreceptors are located in the carotid sinus of the aortic arch. These receptors are sensitive to stretching and send blood pressure changes by nervous messages to the brain stem through changing the stretches. The messages are sent to the brain stem by baroreceptors. They make the sympathetic system active and impose entrapping effects on the number of heartbeats and therefore, blood pressure is controlled (35). Various findings have been reported about the effects of different sports activities on heart rate and resting systolic and diastolic blood pressure, which can be rooted in the diversity of studied groups, duration of doing exercise, intensity, and time. However, it is necessary to study effective factors in deeply changing these variables.

Acknowledgements

References

  • 1.

    Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global burden of disease and risk factors. The World Bank; 2006. https://doi.org/10.1596/978-0-8213-6262-4.

  • 2.

    Pizzetti F, Turazza FM, Franzosi MG, Barlera S, Ledda A, Maggioni AP, et al. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: The GISSI-3 data. Heart. 2001;86(5):527-32. [PubMed ID: 11602545]. [PubMed Central ID: PMC1729969]. https://doi.org/10.1136/heart.86.5.527.

  • 3.

    Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's heart disease: A textbook of cardiovascular medicine. 2. Elsevier Health Sciences; 2007. 1212 p.

  • 4.

    Ignarro LJ, Balestrieri ML, Napoli C. Nutrition, physical activity, and cardiovascular disease: An update. Cardiovasc Res. 2007;73(2):326-40. [PubMed ID: 16945357]. https://doi.org/10.1016/j.cardiores.2006.06.030.

  • 5.

    Tabara Y, Yuasa T, Oshiumi A, Kobayashi T, Miyawaki Y, Miki T, et al. Effect of acute and long-term aerobic exercise on arterial stiffness in the elderly. Hypertens Res. 2007;30(10):895-902. [PubMed ID: 18049020]. https://doi.org/10.1291/hypres.30.895.

  • 6.

    Moraes WM, Souza PR, Pinheiro MH, Irigoyen MC, Medeiros A, Koike MK. Exercise training program based on minimum weekly frequencies: Effects on blood pressure and physical fitness in elderly hypertensive patients. Rev Bras Fisioter. 2012;16(2):114-21. [PubMed ID: 22481693]. https://doi.org/10.1590/s1413-35552012005000013.

  • 7.

    Rayes ABR, de Lira CAB, Viana RB, Benedito-Silva AA, Vancini RL, Mascarin N, et al. The effects of Pilates vs. aerobic training on cardiorespiratory fitness, isokinetic muscular strength, body composition, and functional tasks outcomes for individuals who are overweight/obese: A clinical trial. PeerJ. 2019;7. e6022. [PubMed ID: 30842893]. [PubMed Central ID: PMC6397755]. https://doi.org/10.7717/peerj.6022.

  • 8.

    Azevedo LF, Perlingeiro P, Hachul DT, Gomes-Santos IL, Tsutsui JM, Negrao CE, et al. Predominance of intrinsic mechanism of resting heart rate control and preserved baroreflex sensitivity in professional cyclists after competitive training. PLoS One. 2016;11(1). e0148036. [PubMed ID: 26812615]. [PubMed Central ID: PMC4727792]. https://doi.org/10.1371/journal.pone.0148036.

  • 9.

    Soares-Miranda L, Sattelmair J, Chaves P, Duncan GE, Siscovick DS, Stein PK, et al. Physical activity and heart rate variability in older adults: The Cardiovascular Health Study. Circulation. 2014;129(21):2100-10. [PubMed ID: 24799513]. [PubMed Central ID: PMC4038662]. https://doi.org/10.1161/CIRCULATIONAHA.113.005361.

  • 10.

    Tinoco-Fernandez M, Jimenez-Martin M, Sanchez-Caravaca MA, Fernandez-Perez AM, Ramirez-Rodrigo J, Villaverde-Gutierrez C. The Pilates method and cardiorespiratory adaptation to training. Res Sports Med. 2016;24(3):281-6. [PubMed ID: 27357919]. https://doi.org/10.1080/15438627.2016.1202829.

  • 11.

    Giacomini MB, da Silva AM, Weber LM, Monteiro MB. The Pilates Method increases respiratory muscle strength and performance as well as abdominal muscle thickness. J Bodyw Mov Ther. 2016;20(2):258-64. [PubMed ID: 27210841]. https://doi.org/10.1016/j.jbmt.2015.11.003.

  • 12.

    Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37(1):153-6. [PubMed ID: 11153730]. https://doi.org/10.1016/s0735-1097(00)01054-8.

  • 13.

    Eghbali F, Moradi M. [The effect of a course of pilates exercise on hypertension, nitric oxide, and resting heart rate in the eldrly men with hypertension]. J Arak Univ Med Sci. 2017;19(11):1-10. Persian.

  • 14.

    Bruce RA, Lovejoy FW Jr, Pearson R, Paul NG, Brothers GB, Velasquez T. Normal respiratory and circulatory pathways of adaptation in exercise. J Clin Invest. 1949;28(6 Pt 2):1423-30. [PubMed ID: 15407661]. [PubMed Central ID: PMC439698]. https://doi.org/10.1172/JCI102207.

  • 15.

    Gui Y. Intermittent exercises reduce the hypertension syndromes and improve the quality of life. J Sports Med Phys Fitness. 2016;56(1-2):133-40. [PubMed ID: 25611082].

  • 16.

    Perkins SE, Jelinek HF, Al-Aubaidy HA, de Jong B. Immediate and long term effects of endurance and high intensity interval exercise on linear and nonlinear heart rate variability. J Sci Med Sport. 2017;20(3):312-6. [PubMed ID: 27568073]. https://doi.org/10.1016/j.jsams.2016.08.009.

  • 17.

    Tsarouhas K, Karatzaferi C, Tsitsimpikou C, Haliassos A, Kouretas D, Pavlidis P, et al. Effects of walking on heart rate recovery, endothelium modulators and quality of life in patients with heart failure. Eur J Cardiovasc Prev Rehabil. 2011;18(4):594-600. [PubMed ID: 21450607]. https://doi.org/10.1177/1741826710397099.

  • 18.

    Oh DJ, Hong HO, Lee BA. The effects of strenuous exercises on resting heart rate, blood pressure, and maximal oxygen uptake. J Exerc Rehabil. 2016;12(1):42-6. [PubMed ID: 26933659]. [PubMed Central ID: PMC4771152]. https://doi.org/10.12965/jer.150258.

  • 19.

    Munieskhar K, Muralidhar M, Venkatachalam M, Hemalatha D. Comparision of heart rate and blood pressure changes during walking and running before and after training in healthy adult women. Int J Physiother Res. 2014;2(3):537-41.

  • 20.

    Williams PT, Franklin BA. Reduced incidence of cardiac arrhythmias in walkers and runners. PLoS One. 2013;8(6). e65302. [PubMed ID: 23762337]. [PubMed Central ID: PMC3676466]. https://doi.org/10.1371/journal.pone.0065302.

  • 21.

    Michael S, Graham KS, Davis GMO. Cardiac autonomic responses during exercise and post-exercise recovery using heart rate variability and systolic time intervals-a review. Front Physiol. 2017;8:301. [PubMed ID: 28611675]. [PubMed Central ID: PMC5447093]. https://doi.org/10.3389/fphys.2017.00301.

  • 22.

    Cunha FA, Midgley AW, Goncalves T, Soares PP, Farinatti P. Parasympathetic reactivation after maximal CPET depends on exercise modality and resting vagal activity in healthy men. Springerplus. 2015;4:100. [PubMed ID: 25793148]. [PubMed Central ID: PMC4359698]. https://doi.org/10.1186/s40064-015-0882-1.

  • 23.

    Routledge FS, Campbell TS, McFetridge-Durdle JA, Bacon SL. Improvements in heart rate variability with exercise therapy. Can J Cardiol. 2010;26(6):303-12. [PubMed ID: 20548976]. [PubMed Central ID: PMC2903986]. https://doi.org/10.1016/s0828-282x(10)70395-0.

  • 24.

    Chandrasekaran B, Dar O, McDonagh T. The role of apelin in cardiovascular function and heart failure. Eur J Heart Fail. 2008;10(8):725-32. [PubMed ID: 18583184]. https://doi.org/10.1016/j.ejheart.2008.06.002.

  • 25.

    Tsai MW, Chie WC, Kuo TB, Chen MF, Liu JP, Chen TT, et al. Effects of exercise training on heart rate variability after coronary angioplasty. Phys Ther. 2006;86(5):626-35. [PubMed ID: 16649887].

  • 26.

    Andreazzi AE, Scomparin DX, Mesquita FP, Balbo SL, Gravena C, De Oliveira JC, et al. Swimming exercise at weaning improves glycemic control and inhibits the onset of monosodium L-glutamate-obesity in mice. J Endocrinol. 2009;201(3):351-9. [PubMed ID: 19297408]. https://doi.org/10.1677/JOE-08-0312.

  • 27.

    Lovic D, Narayan P, Pittaras A, Faselis C, Doumas M, Kokkinos P. Left ventricular hypertrophy in athletes and hypertensive patients. J Clin Hypertens (Greenwich). 2017;19(4):413-7. [PubMed ID: 28247560]. https://doi.org/10.1111/jch.12977.

  • 28.

    Chen HH, Chen YL, Huang CY, Lee SD, Chen SC, Kuo CH. Effects of one-year swimming training on blood pressure and insulin sensitivity in mild hypertensive young patients. Chin J Physiol. 2010;53(3):185-9. [PubMed ID: 21793327]. https://doi.org/10.4077/cjp.2010.amk042.

  • 29.

    Pitsavos C, Chrysohoou C, Koutroumbi M, Aggeli C, Kourlaba G, Panagiotakos D, et al. The impact of moderate aerobic physical training on left ventricular mass, exercise capacity and blood pressure response during treadmill testing in borderline and mildly hypertensive males. Hellenic J Cardiol. 2011;52(1):6-14. [PubMed ID: 21292602].

  • 30.

    Cornelissen VA, Verheyden B, Aubert AE, Fagard RH. Effects of aerobic training intensity on resting, exercise and post-exercise blood pressure, heart rate and heart-rate variability. J Hum Hypertens. 2010;24(3):175-82. [PubMed ID: 19554028]. https://doi.org/10.1038/jhh.2009.51.

  • 31.

    Skielboe AK, Bandholm TQ, Hakmann S, Mourier M, Kallemose T, Dixen U. Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation - A randomized controlled trial. PLoS One. 2017;12(2). e0170060. [PubMed ID: 28231325]. [PubMed Central ID: PMC5322948]. https://doi.org/10.1371/journal.pone.0170060.

  • 32.

    Owen A, Wiles J, Swaine I. Effect of isometric exercise on resting blood pressure: A meta analysis. J Hum Hypertens. 2010;24(12):796-800. [PubMed ID: 20182455]. https://doi.org/10.1038/jhh.2010.13.

  • 33.

    Cornelissen VA, Smart NA. Exercise training for blood pressure: A systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1). e004473. [PubMed ID: 23525435]. [PubMed Central ID: PMC3603230]. https://doi.org/10.1161/JAHA.112.004473.

  • 34.

    Carvalho EE, Crescencio JC, Elias J Jr, Brito LB, Gallo L Jr, Simoes MV. Improved endothelial function and reversal of myocardial perfusion defects after aerobic physical training in a patient with microvascular myocardial ischemia. Am J Phys Med Rehabil. 2011;90(1):59-64. [PubMed ID: 20531160]. https://doi.org/10.1097/PHM.0b013e3181ddd6bb.

  • 35.

    Wallace JP. Exercise in hypertension. A clinical review. Sports Med. 2003;33(8):585-98. [PubMed ID: 12797840]. https://doi.org/10.2165/00007256-200333080-00004.

  • 36.

    Wildman RP, Schott LL, Brockwell S, Kuller LH, Sutton-Tyrrell K. A dietary and exercise intervention slows menopause-associated progression of subclinical atherosclerosis as measured by intima-media thickness of the carotid arteries. J Am Coll Cardiol. 2004;44(3):579-85. [PubMed ID: 15358024]. https://doi.org/10.1016/j.jacc.2004.03.078.