Research Report
Research Report
Postaerobic Exercise Blood Pressure Reduction
in Very Old Persons With Hypertension
Joana Oliveira, PT, MSc1; Jos Mesquita-Bastos, MD, PhD2;
Cristina Argel de Melo, PT, PhD3; Fernando Ribeiro, PT, PhD4
ABSTRACT
Background and Purpose: A single bout of aerobic exercise
acutely decreases blood pressure, even in older adults with
hypertension. Nonetheless, blood pressure responses to aero-
bic exercise in very old adults with hypertension have not yet
been documented. Therefore, this study aimed to assess the
effect of a single session of aerobic exercise on postexercise
blood pressure in very old adults with hypertension.
Methods: Eighteen older adults with essential hypertension
were randomized into exercise (N = 9, age: 83.4 3.2 years
old) or control (N = 9, age: 82.7 2.5 years old) groups.
The exercise group performed a session of aerobic exercise
constituting 2 periods of 10 minutes of walking at an inten-
sity of 40% to 60% of the heart rate reserve. The control
group rested for the same period of time. Anthropometric
variables and medication status were evaluated at base-
line. Heart rate and systolic and diastolic blood pressures
were measured at baseline, after exercise, and at 20 and
40 minutes postexercise.
Results: Systolic blood pressure showed a significant inter-
action for group time (F3,24 = 6.698; P = .002; p2 =
0.153). In the exercise group, the systolic blood pressure at
20 (127.3 20.9 mm Hg) and 40 minutes (123.7 21.0
mm Hg) postexercise was significantly lower in comparison
with baseline (135.6 20.6 mm Hg). Diastolic blood pressure
did not change. Heart rate was significantly higher after the
exercise session. In the control group, no significant differ-
ences were observed.
Conclusions: A single session of aerobic exercise acutely
reduces blood pressure in very old adults with hypertension
and may be considered an important nonpharmacological
strategy to control hypertension in this age group.
1Physiotherapy Private Practice, Viseu, Portugal.
2School
of Health Sciences, University of Aveiro, Aveiro,
Portugal.
3Physiotherapy Department, Escola Superior de Tecnologia
de Sade, VN Gaia, Portugal.
4School of Health Sciences, University of Aveiro, Aveiro,
Portugal and CINTESIS.UA, Aveiro, Portugal.
The authors declare that they have no conflicts of interests.
Address correspondence to: Fernando Ribeiro, PT, PhD,
School of Health Sciences, University of AveiroBldg 30,
Agras do CrastoCampus Universitrio de Santiago, 3810-
193 Aveiro, Portugal (fernando.ribeiro@ua.pt).
Richard W Bohannon was the Decision Editor.
DOI: 10.1519/JPT.0000000000000049
8 Volume 39 Number 1 January-March 2016
Copyright 2016 The Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
JGPT-D-14-00043_LR 8
Key Words: aerobic exercise, arterial hypertension, blood
pressure, physical activity
(J Geriatr Phys Ther 2016;39:8-13.)
INTRODUCTION
Hypertension is a prevalent cardiovascular risk factor in
Europe, with values between 30% and 45% and increas-
ing with aging.1 In the United States, hypertension affects
29.6% of adults and 71.6% of older adults.2 In Portugal,
the overall prevalence of hypertension among the adult
population aged 18 to 90 years is 42.2%, with a much
higher prevalence in older adults (74.9%) in comparison
with adults younger than 35 years old (6.8%) and 35 to
64 years old (46.9%).3
A single exercise session, either aerobic4-15 or resis-
tance,16-19 is a well-established intervention promoting a
transient reduction in blood pressure in the period after
exercise to values less than those observed before exercise,
a phenomenon designated as postexercise hypotension.20
This reduction has been observed in middle-aged persons
with normotension7,15 and with hypertension,4-6,12-14,19
as well as in older adults both with normotension9 and
hypertension.8,10,11,16,18 The clinical utility of this transient
decrease in blood pressure in patients with hypertension
is related to the duration of the effect in the period of
time subsequent to the exercise even when performing
mild exercise and simulated activities of daily living.12
Therefore, this approach may have a role as a nonpharma-
cological intervention assisting in the control of hyperten-
sion.21-24 Previous studies assessing blood pressure after
exercise with auscultatory devices showed a decrease in
blood pressure for up to 9010,25,26 and 120 minutes27
in persons with hypertension. In addition, studies using
ambulatory blood pressure monitors reported a decrease
for up to 75 and 8.7 hours4 compared with rest. Indeed, the
reduction in blood pressure as a result of a single session of
exercise seems especially relevant for assisting in the con-
trol of blood pressure during day-time periods when blood
pressure is typically at its highest levels28 and for allowing
the performance of activities of daily living at lower levels
of blood pressure.12
Despite evidence related to postexercise blood pressure
reduction as a result of a single session of aerobic exercise
09/12/15 4:28 AM

in old adults with hypertension,8,10,11,18 there is a lack of
studies enrolling very old adults with hypertension (>80
years old). The study of this particular age group seems per-
tinent, as the prevalence of hypertension increases steeply
with age2,3 and the demographics of our country, as well
as other westernized countries, are changing as adults aged
older than 80 years are representing a larger and increasing
segment of the overall population.29 In addition, results
are less predictable in this age group because one of the
mechanisms previously proposed to explain the transient
decrease in blood pressure following aerobic exercise-a
decrease in peripheral vascular resistance21,24-could be
particularly limited in this age group due to the increased
arterial stiffness with aging.30 In this sense, this study aims
to assess the acute effects of a single session of aerobic
exercise on postexercise blood pressure in very old adults
with hypertension.
METHODS
Participants
Participants (5 men and 13 women), aged between 80
and 90 years, were recruited in 3 community centers. We
recruited participants of both sexes, as the transient reduc-
tion in blood pressure after exercise does not appear to be
affected by sex.28 Participants were randomly assigned,
by the method of minimization,31 into 2 groups of 9
the group that participated in a single session of aerobic
exercise and the control group. Noninstitutionalized older
adults (aged 80 years) with diagnosed essential arte-
rial hypertension (systolic blood pressure 140 mm Hg,
diastolic blood pressure 90 mm Hg, or being medicated
for hypertension) according to the recommendations of
the European Society of Cardiology/European Society of
Hypertension1 were considered eligible to participate in
the study if they were able to walk without assistance.
Exclusion criteria included participation in regular exercise
sessions (>2 hours per week) in the 12 months previous to
the study, diabetes, smoking, uncontrolled hypertension,
unstable angina pectoris, or any contraindication or medi-
cal condition that would limit participation in exercise (eg,
peripheral arterial occlusive disease and musculoskeletal
disorder). The ethics committee of the Faculty of Sport of
University of Porto approved the study. Written informed
consent was obtained, and all procedures were conducted
in accordance with the Declaration of Helsinki.
Procedures and Measurements
On the basis of inspection of their medical records in the
community centers, potential participants in the study
were asked to participate. Those who agreed to partici-
pate received detailed explanations about the procedures
and were familiarized with the experimental protocol, the
monitoring techniques, and apparatus.
Journal of GERIATRIC Physical Therapy
Copyright 2016 The Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
JGPT-D-14-00043_LR 9
Research Report
Participants were asked to avoid intense or strenuous
exercise and caffeine-containing products or alcohol con-
sumption 48 hours before the beginning of the study. In
addition, no large meals were allowed within 3 hours before
the study. The evaluation room was kept quiet, and speak-
ing was not allowed during blood pressure measurements.
Initially, height and weight measurements were attained
using a standard wall-mounted stadiometer and scale,
respectively. Body mass index (BMI) was calculated from
the ratio of weight (kg) to squared height (m2). Participants
rested 5 minutes in a seated position before the assessment
of blood pressure. Resting systolic and diastolic blood
pressures and heart rate were measured by an oscillometric
method using a digital automatic blood pressure monitor
(M6, Omron Healthcare Co, Kyoto, Japan). This device
was validated according to the International Protocol cri-
teria and can be used to evaluate blood pressure in older
persons.32 Participants sat down, resting their right arm on
a table so the brachial artery was level with the heart. Two
measurements were then obtained at intervals of 1 minute,
and their average was recorded. If there was more than
5 mm Hg of difference between the 2 readings, 1 more
reading was obtained for averaging.33,34 Participants were
then randomly assigned, by the method of minimization,31
into the exercise or the control group. Minimization was
based on age, sex, and medication.
The exercise group participated in a session of aerobic
exercise containing 2 periods of 10 minutes of walking at
an intensity of 40% to 60% of the heart rate reserve, with
a recovery period of 5-minute in-between. Participants
walked on a large, flat, quiet, open space. The 5-minute
recovery between each period of walking consisted of
active recovery (gentle walking) for 2 minutes and 3 min-
utes of passive recovery in a sitting position. Before and
after the 2 periods of walking, participants performed
5 minutes of warm-up (stretching exercises, active mobi-
lization exercises, and gentle walking) and 5 minutes
of cool-down (gentle walking and stretching exercises),
respectively. Thus, the overall duration of the exercise
session was 35 minutes, that is, 5 minutes of warm-up, 2
periods of 10 minutes of aerobic exercise (walking) with a
recovery period of 5-minute in-between, and 5 minutes of
cool-down. The exercise intensity for the 2 periods of 10
minutes of walking was calculated as 40% to 60% of the
heart rate reserve. The theoretical maximum heart rate of
this population group was calculated using the formula of
Tanaka: 208 bpm (age 0.7).35 During the session, the
heart rate was continuously monitored with a heart rate
monitor (Polar Electro RS100, Kempele, Finland), and
the walking velocity was adjusted to ensure that each par-
ticipant achieved the exercise intensity previously deter-
mined. The control group did not engage in any physical
exercise, remaining seated during the 35 minutes. After
the exercise session or the control period, the participants
remained at rest in the seated position for 40 minutes,
9
09/12/15 4:28 AM
 Research Report

during which time no intake of water or other fluid was Table 1. Sample Characteristics and Comparison Between
allowed. Heart rate and blood pressure were measured Groups
at rest, immediately after the exercise session, at 20 and Control Group Exercise Group
40 minutes after the end of the exercise session. All the Variables (N = 9) (N = 9) P
assessments were conducted at the same time of the day General characteristics
(morning) by the same examiner. Age (y) 82.7 2.5 83.4 3.2 .57
Females (N, %) 6 (66.7%) 7 (77.8%) .60
Data Analysis
The data were analyzed using SPSS software version 17.0 Anthropometric variables
(SPSS Inc, Chicago, IL). The normality of the data distribu- Weight (kg) 69.3 8.5 70.7 8.5 .73
tion was tested with the Shapiro-Wilk test. The data were
Height (m) 1.57 0.04 1.57 0.06 .92
normally distributed. Descriptive statistics were used to cal-
culate the mean and standard deviation. The Student inde- BMI (kg/m2) 28.0 2.5 28.5 2.0 .68
pendent t test was used for comparisons between groups in Baseline blood pressure and heart rate
age, weight, height, BMI, baseline heart rate, and systolic SBP (mm Hg) 135.2 20.3 135.6 20.6 .97
and diastolic blood pressures. The chi-square test was used
DBP (mm Hg) 68.4 12.8 69.4 6.2 .84
for comparisons between groups regarding sex and medica-
tion. To examine the effect of the exercise session on heart HR (bpm) 76.7 10.5 70.2 10.0 .20
rate, systolic and diastolic blood pressure, a 2 4 repeated- Medication
measures analysis of variance (rest/exercise baseline/ Antiplatelets (N, %) 6 (66.7%) 6 (66.7%) 1.00
post/20/40 min) was used to compare results between
Diuretics (N, %) 3 (33.3%) 3 (33.3%) 1.00
groups over time (group time). When a significant group
time interaction was observed, post hoc means compari- ACE inhibitors (N, %) 9 (100%) 9 (100%) 1.00
sons were performed using Bonferroni tests. Effect size was Lipid-lowering
8 (88.9%) 7 (77.8%) .53
reported using the partial eta-squared (p2). Values 0.01 drugs (N, %)
p2 < 0.06 represent a small effect, values 0.06 p2 < 0.14 Abbreviations: ACE, angiotensin-converting enzyme; BMI, body mass index; HR, heart rate;
DBP, diastolic blood pressure; SBP, systolic blood pressure.
represent a medium effect, and values p2 < 0.14 represent
a large effect.36 The Pearson correlation or the Spearman
rho tests were used to test associations between the changes Systolic blood pressure changed significantly over time
in systolic and diastolic blood pressures (from baseline to (F3,24 = 7.044; P = .001; p2 < 0.468), with a signifi-
40 minutes postexercise) with the variables (age, sex, BMI, cant interaction for group time (F3,24 = 6.698; P =
baseline systolic and diastolic blood pressures, and medica- .002; p2 < 0.153). The exercise group showed a signifi-
tion) that could potentially have an influence on it. The cantly lower systolic blood pressure at 20 and 40 minutes
level of significance was set as P .05. postexercise compared with the values at baseline. In the
control group, no differences were observed in comparison
with baseline (Table 2).
RESULTS No differences were observed in diastolic blood pressure
There were no significant differences between groups in in either group. Diastolic blood pressure did not change sig-
age, proportion of women, anthropometric measurements, nificantly over time (F3,24 = 0.436; P = .729; p2 < 0.052),
medication, and baseline values of blood pressure and heart and there was no observed interaction for group time
rate (Table 1). (F3,24= 0.113; P = .952; p2 < 0.014) (Table 2).

Table 2. Behavior of Heart Rate and Blood Pressure During the Study Period (Values are Mean [Standard Deviation])
Assessment Moment
Variable Group Baseline After 20 min post 40 min post
Control 135.2 (20.3) 137.0 (22.0) 135.0 (22.4) 135.4 (22.3)
SBP (mm Hg)
Exercise 135.6 (20.6) 131.2 (19.5) 127.3 (20.9)a 123.7 (21.0)a
Control 68.4 (12.8) 67.3 (12.5) 69.0 (12.5) 69.6 (10.8)
DBP (mm Hg)
Exercise 69.4 (6.2) 68.5 (9.1) 69.0 (6.0) 69.0 (5.0)
Control 76.7 (10.5) 75.4 (11.2) 73.9 (10.6) 74.9 (11.2)
HR (bpm)
Exercise 70.2 (10.0) 84.3 (7.6)b 68.7 (11.6) 69.0 (10.2)
Abbreviations: DBP, diastolic blood pressure; HR, heart rate; SBP, systolic blood pressure.
aSignificantly different from baseline, P < .05; bsignificantly different from all other assessments, P < .05.

10 Volume 39 Number 1 January-March 2016

Copyright 2016 The Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.

JGPT-D-14-00043_LR 10 09/12/15 4:28 AM


Regarding heart rate, the comparison of groups in
time revealed an effect of time (F3,24= 7.485; P = .001;
p2 < 0.483) with a significant interaction for group time
(F3,24= 6.054; P = .003; p2 < 0.431). The heart rate in
the control group did not change, whereas in the exercise
group, the heart rate measured after the cool-down period
was significantly higher than the heart rate measured at
baseline, 20 and 40 minutes postexercise (Table 2).
The changes in blood pressure (from baseline to the final
assessment) were not correlated with age, sex, anthropo-
metrics, medication, and resting blood pressure. Namely,
no associations were found between the change in sys-
tolic blood pressure and age (r = 0.183; P = .637), BMI
(r = 0.084; P = .830) or resting systolic blood pressure
(r = 0.062; P = .874).
DISCUSSION
The results of this study indicate that a single session of
aerobic exercise promotes short-term beneficial effects in
older adults with hypertension by lowering systolic blood
pressure for up to 40 minutes after the session to values
lower than those observed at baseline.
Our results in very old adults with hypertension agree
with those reported in previous studies involving older
adults with hypertension.8,10,11,16,18 The magnitude of
the decrease in systolic blood pressure is also similar to
that described in the literature, which indicates that the
expected average reduction is 15 mm Hg for systolic blood
pressure.6 In 1982, Wilcox and colleagues37 observed a
decrease of 40 mm Hg in systolic blood pressure after exer-
cise in persons with hypertension and 30 mm Hg in per-
sons with normotension. However, other studies pointed
to more modest reductions in systolic and diastolic blood
pressure, namely 8/9, 14/9, and 10/7 mm Hg in persons
with normotension, prehypertension, and hypertension,
respectively.28 Hypertension is a major risk factor for car-
diovascular disease and stroke1,38; therefore, the control of
blood pressure is a primary concern in older adults with
hypertension due to the elevated risk for cardiovascular
events.1 In this sense, lowering systolic blood pressure
could represent a significant clinical benefit for this age
group. In fact, it is widely accepted that treatments lower-
ing blood pressure could reduce cardiovascular events even
in older adults older than 80 years with hypertension.1
For instance, a subgroup analysis of older adults with
hypertension in the FEVER study revealed a decrease in
cardiovascular events by lowering systolic blood pressure
just less than 140 mm Hg (compared with 145 mm Hg).39
The participants in this study had blood pressures that were
fairly controlled by medication; therefore, the reduction
from 135.6 to 123.7 mm Hg could be less relevant clini-
cally in comparison with those presenting higher values of
resting systolic blood pressure.
The intensity and duration of exercise also seemed to be
key factors to postexercise blood pressure reduction. In a
Journal of GERIATRIC Physical Therapy
Copyright 2016 The Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
JGPT-D-14-00043_LR 11
Research Report
very elegant study, Pescatello and colleagues6 showed that
exercise intensity influences the blood pressure response
after exercise cessation. They submitted 49 men with hyper-
tension to 2 exercise bouts, 1 at 40% and the other at 60%
of maximal oxygen consumption, and observed greater
postexercise blood pressure reduction after the exercise bout
performed at an intensity of 60%. Quinn40 assessed the
effects of 2 exercise sessions lasting 30 minutes, conducted
at 50% and 75% of maximal oxygen uptake, on blood
pressure reduction over a 24-hour period in persons with
normotension and hypertension, and observed a significant
decrease only in the group with hypertension. In addition,
a session of exercise performed at 75% of maximal oxygen
uptake induced greater and longer-lasting absolute reduc-
tions in blood pressure. Likewise, exercise sessions lasting
longer promoted greater decreases in blood pressure; nev-
ertheless, exercise of moderate intensity may be as brief as
10 minutes in duration to decrease resting blood pressure.23
In this study, 2 periods of 10 minutes was used because our
sample was composed of participants older than 80 years.
Therefore, a short-duration session was used, but the session
was within the time period required to potentially reduce
postexercise blood pressure.23 Shorter exercise sessions
are better tolerated by this age group, which makes our
approach attractive from a clinical point of view.
Despite being a recognized phenomenon, the mecha-
nisms responsible for postexercise blood pressure reduction
are not completely understood. It has been suggested that
the acute and transient decrease in systolic blood pressure
is related to decreased cardiac output and/or peripheral
vascular resistance.21,24 The decrease in peripheral vascular
resistance seems to be related to the release of vasodilator
agents (nitric oxide, prostaglandins, and adenosine).41,42
Nonetheless, recent studies have indicated that sustained
vasodilatation after exercise is mainly dependent on the
activation of histamine H1 and H2 receptors.21 Beyond
local vasodilator mechanisms, the combination of centrally
mediated reduction in sympathetic nerve activity21 and
attenuation of signal transduction from sympathetic nerve
activation into vasoconstriction also contributes to the
decrease in blood pressure after exercise.43 However, the
contribution of each 1 of these mechanisms to the postex-
ercise blood pressure response is different depending on
the age of the persons. In older adults, like the participants
in this study, in whom structural and functional vascular
changes are expected and in whom arterial stiffness limits
vasodilation,24 the decrease in blood pressure depends
mainly on cardiac output.10,11 On the basis of previous
evidence,10 one can speculate that the decrease in systolic
blood pressure observed in this study could be attributable
to a reduction in cardiac output due to a decrease in stroke
volume as a result of a lower left ventricular end-diastolic
volume. On the contrary, the lack of changes in diastolic
blood pressure could be related to the limited vasodilation
of older adults in comparison with younger adults.
11
09/12/15 4:28 AM
 Research Report
The results of this study are promising, as postexercise
blood pressure reduction seems to be important in the
long term. In fact, it has been suggested that this transient
reduction contributes directly to the chronic reductions in
blood pressure observed after exercise training programs
in persons with hypertension.44 Two recent studies showed
that in adults with hypertension, the magnitude of the acute
decrease in blood pressure after aerobic exercise could pre-
dict long-term blood pressure reductions induced by par-
ticipation in aerobic exercise training.45,46 It is important
to mention that older adults (aged 80 years and older) also
benefit, as do younger adults with hypertension, from the
participation in exercise training programs. Indeed, chronic
reductions in systolic blood pressure have been reported in
adults aged 80 years and older as a result of 6 months of
aerobic exercise training.47 These observations reinforce
the need for future studies assessing the acute and chronic
effects of physical exercise on blood pressure in older
adults, aged 80 years and older, with hypertension.
This study has some limitations. First, the short period
of time used to monitor the blood pressure after exercise
may have masked possible longer-lasting effects of greater
magnitude because the greatest reductions in systolic blood
pressure were observed in the last assessment (40 minutes
postexercise). An ambulatory blood pressure assessment
would enable measuring the duration of the exercise effects
and whether they persist under conditions of daily living.
Second, another limitation relates to the determination of
exercise intensity through the theoretical maximum heart
rate, an indirect indicator. Third, the control condition was
conducted in the sitting position, whereas the exercise was
conducted in standing position. Nevertheless, we found it
impractical to keep the participants in the control group
resting for 35 minutes in a standing position. Fourth, the
use of a between-group design is also a limitation; it is
recommended that future studies in this age group use a
within-subject repeated-measures design.
CONCLUSIONS
The results of this study suggest that a single session of
aerobic exercise acutely reduces blood pressure in very
old adults with hypertension. These results add evidence
supporting the importance of physical activity and aerobic
exercise as a nonpharmacological strategy to control hyper-
tension even in very old adults.
REFERENCES
1. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the
management of arterial hypertension: the Task Force for the Management
of Arterial Hypertension of the European Society of Hypertension (ESH) and
of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):
2159-2219.
2. Gillespie CD, Hurvitz KA. Prevalence of hypertension and controlled
hypertensionUnited States, 2007-2010. MMWR Surveill Summ. 2013;
62(suppl 3):144-148.
12
Copyright 2016 The Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
JGPT-D-14-00043_LR 12
3. Polonia J, Martins L, Pinto F, Nazare J. Prevalence, awareness, treatment
and control of hypertension and salt intake in Portugal: changes over a
decade. The PHYSA study. J Hypertens. 2014;32(6):1211-1221.
4. Pescatello LS, Fargo AE, Leach CN Jr, Scherzer HH. Short-term effect of
dynamic exercise on arterial blood pressure. Circulation. 1991;83(5):
1557-1561.
5. Pescatello LS, Miller B, Danias PG, et al. Dynamic exercise normalizes
resting blood pressure in mildly hypertensive premenopausal women. Am
Heart J. 1999;138(5 pt 1):916-921.
6. Pescatello LS, Guidry MA, Blanchard BE, et al. Exercise intensity alters
postexercise hypotension. J Hypertens. 2004;22(10):1881-1888.
7. Forjaz CL, Cardoso CG Jr, Rezk CC, Santaella DF, Tinucci T. Postexercise
hypotension and hemodynamics: the role of exercise intensity. J Sports Med
Phys Fitness. 2004;44(1):54-62.
8. Cunha RM, Macedo CB, Araujo SF, et al. Subacute blood pressure response
in elderly hypertensive women after a water exercise session: a controlled
clinical trial. High Blood Press Cardiovasc Prev. 2012;19(4):223-237.
9. Lacombe SP, Goodman JM, Spragg CM, Liu S, Thomas SG. Interval
and continuous exercise elicit equivalent postexercise hypotension in
prehypertensive men, despite differences in regulation. Appl Physiol Nutr
Metab. 2011;36(6):881-891.
10. Brandao Rondon MU, Alves MJ, Braga AM, et al. Postexercise blood
pressure reduction in elderly hypertensive patients. J Am Coll Cardiol. 2002;
39(4):676-682.
11. Hagberg JM, Montain SJ, Martin WH 3rd. Blood pressure and hemodynamic
responses after exercise in older hypertensives. J Appl Physiol (1985). 1987;
63(1):270-276.
12. MacDonald JR, Hogben CD, Tarnopolsky MA, MacDougall JD. Post
exercise hypotension is sustained during subsequent bouts of mild exercise
and simulated activities of daily living. J Hum Hypertens. 2001;15(8):
567-571.
13. MacDonald JR, Rosenfeld JM, Tarnopolsky MA, Hogben CD, Ballantyne
CS, MacDougall JD. Post exercise hypotension is not mediated by the
serotonergic system in borderline hypertensive individuals. J Hum Hypertens.
2002;16(1):33-39.
14. Eicher JD, Maresh CM, Tsongalis GJ, Thompson PD, Pescatello LS. The
additive blood pressure lowering effects of exercise intensity on post-exercise
hypotension. Am Heart J. 2010;160(3):513-520.
15. Ciolac EG, Guimaraes GV, D Avila VM, Bortolotto LA, Doria EL, Bocchi
EA. Acute effects of continuous and interval aerobic exercise on 24-h
ambulatory blood pressure in long-term treated hypertensive patients. Int J
Cardiol. 2009;133(3):381-387.
16. Brito Ade F, de Oliveira CV, Santos Mdo S, Santos Ada C. High-intensity
exercise promotes postexercise hypotension greater than moderate intensity
in elderly hypertensive individuals. Clin Physiol Funct Imaging. 2014;34(2):
126-132.
17. Fisher MM. The effect of resistance exercise on recovery blood pressure in
normotensive and borderline hypertensive women. J Strength Cond Res.
2001;15(2):210-216.
18. Mota MR, Oliveira RJ, Terra DF, et al. Acute and chronic effects of resistance
exercise on blood pressure in elderly women and the possible influence of
ACE I/D polymorphism. Int J Gen Med. 2013;6:581-587.
19. Moraes MR, Bacurau RF, Simoes HG, et al. Effect of 12 weeks of resistance
exercise on post-exercise hypotension in stage 1 hypertensive individuals. J
Hum Hypertens. 2013;26(9):533-539.
20. Kenney MJ, Seals DR. Postexercise hypotension. Key features, mechanisms,
and clinical significance. Hypertension. 1993;22(5):653-664.
21. Halliwill JR, Buck TM, Lacewell AN, Romero SA. Postexercise hypotension
and sustained postexercise vasodilatation: what happens after we exercise?
Exp Physiol. 2013;98(1):7-18.
22. MacDonald JR, MacDougall JD, Hogben CD. The effects of exercising
muscle mass on post exercise hypotension. J Hum Hypertens. 2000;14(5):
317-320.
23. MacDonald JR, MacDougall JD, Hogben CD. The effects of exercise duration
on post-exercise hypotension. J Hum Hypertens. 2000;14(2):125-129.
24. Gomes Anunciacao P, Doederlein Polito M. A review on post-exercise
hypotension in hypertensive individuals. Arq Bras Cardiol. 2011;96(5):
e100-e109.
25. Cleroux J, Kouame N, Nadeau A, Coulombe D, Lacourciere Y. After effects
of exercise on regional and systemic hemodynamics in hypertension.
Hypertension. 1992;19(2):183-191.
26. Bennett T, Wilcox RG, Macdonald IA. Post-exercise reduction of blood
pressure in hypertensive men is not due to acute impairment of baroreflex
function. Clin Sci (Lond). 1984;67(1):97-103.
27. Rueckert PA, Slane PR, Lillis DL, Hanson P. Hemodynamic patterns and
duration of post-dynamic exercise hypotension in hypertensive humans.
Med Sci Sports Exerc. 1996;28(1):24-32.
28. MacDonald JR. Potential causes, mechanisms, and implications of post
exercise hypotension. J Hum Hypertens. 2002;16(4):225-236.
29. INE I. Censos 2011 Resultados DefinitivosPortugal. IPSP, Lisbon,
Portugal: Instituto Nacional de Estatstica.
Volume 39 Number 1 January-March 2016
09/12/15 4:28 AM

30. Determinants of pulse wave velocity in healthy people and in the presence
of cardiovascular risk factors: establishing normal and reference values.
Eur Heart J. 2010;31(19):2338-2350.
31. Taves DR. Minimization: a new method of assigning patients to treatment
and control groups. Clin Pharmacol Ther. 1974;15(5):443-453.
32. Altunkan S, Iliman N, Altunkan E. Validation of the Omron M6 (HEM-7001-E)
upper arm blood pressure measuring device according to the International
Protocol in elderly patients. Blood Press Monit. 2008;13(2):117-122.
33. Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood
pressure measurement in humans and experimental animals: Part 1: blood
pressure measurement in humans: a statement for professionals from
the Subcommittee of Professional and Public Education of the American
Heart Association Council on High Blood Pressure Research. Hypertension.
2005;45(1):142-161.
34. OBrien E, Asmar R, Beilin L, et al. European Society of Hypertension
recommendations for conventional, ambulatory and home blood pressure
measurement. J Hypertens. 2003;21(5):821-848.
35. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate
revisited. J Am Coll Cardiol. 2001;37(1):153-156.
36. Gray CD, Kinnear PR. IBM SPSS Statistics 19 Made Simple. New York:
Psychology Press; 2012.
37. Wilcox RG, Bennett T, Brown AM, Macdonald IA. Is exercise good for high
blood pressure? Br Med J (Clin Res Ed). 1982;285(6344):767-769.
38. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke
statistics2014 update: a report from the American Heart Association.
Circulation. 2014;129(3):e28-e292.
Journal of GERIATRIC Physical Therapy
Copyright 2016 The Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
JGPT-D-14-00043_LR 13
Research Report
39. Zhang Y, Zhang X, Liu L, Zanchetti A. Is a systolic blood pressure target
<140 mmHg indicated in all hypertensives? Subgroup analyses of findings
from the randomized FEVER trial. Eur Heart J. 2011;32(12):1500-1508.
40. Quinn TJ. Twenty-four hour, ambulatory blood pressure responses following
acute exercise: impact of exercise intensity. J Hum Hypertens. 2000;
14(9):547-553.
41. Fisher AB, Al-Mehdi AB, Manevich Y. Shear stress and endothelial cell
activation. Crit Care Med. 2002;30(5 suppl):S192-S197.
42. Lockwood JM, Pricher MP, Wilkins BW, Holowatz LA, Halliwill JR.
Postexercise hypotension is not explained by a prostaglandin-dependent
peripheral vasodilation. J Appl Physiol. 2005;98(2):447-453.
43. Halliwill JR, Taylor JA, Eckberg DL. Impaired sympathetic vascular regulation
in humans after acute dynamic exercise. J Physiol. 1996;495(pt 1):
279-288.
44. Thompson PD, Crouse SF, Goodpaster B, Kelley D, Moyna N, Pescatello L.
The acute versus the chronic response to exercise. Med Sci Sports Exerc.
2001;33(6 suppl):S438-S445; discussion S452-S453.
45. Liu S, Goodman J, Nolan R, Lacombe S, Thomas SG. Blood pressure
responses to acute and chronic exercise are related in prehypertension.
Med Sci Sports Exerc. 2012;44(9):1644-1652.
46. Hecksteden A, Grutters T, Meyer T. Association between postexercise
hypotension and long-term training-induced blood pressure reduction: a
pilot study. Clin J Sport Med. 2013;23(1):58-63.
47. Vaitkevicius PV, Ebersold C, Shah MS, et al. Effects of aerobic exercise
training in community-based subjects aged 80 and older: a pilot study. J Am
Geriatr Soc. 2002;50(12):2009-2013.
13
09/12/15 4:28 AM