Interindividual Postexercise Hypotension Response in Morbid Obesity

Characterizing The Interindividual Postexercise Hypotension Response For Two Order of Concurrent Training In Patients With Morbid Obesity

A quasi-experimental study developed in sedentary morbidly obese men and women (age 43.6±11.3 y; body mass index [BMI] ≥40 kg/m2) were assigned to a CT group of ET plus RT (ET+RT; n=19; BMI 47.8±16.7) or RT plus ET order group (RT+ET; n=17; BMI 43.0±8.0). Subjects of both groups received eight exercise sessions over four weeks. Systolic (SBP), diastolic (DBP), mean arterial pressure [MAP], heart rate at rest [HR], and pulse pressure [PP] measurements before and after 10 minutes postexercise. Secondary outcomes were other anthropometric, body composition, metabolic, and physical condition parameters. Using the ∆SBP reduction, and quartile categorization (Q) in 'high' (Rs: quartile 4), 'moderate' (MRs: quartile 3), 'low' (LRs: quartile 2), and 'nonresponders' (NRs: quartile 1) were reported.

Study Overview

• Status: Completed
• Conditions: Metabolic Syndrome; Morbid Obesity
• Intervention / Treatment: Behavioral: RT+ET; Behavioral: Concurrent training order 1

Detailed Description

Independent of the order (i.e., ET+RT, or RT+ET), each CT session had two sections; RT and ET, which were applied two days per week, during 8 sessions (4 weeks), and where the blood pressure changes were measured only in four opportunities (i.e., once a week in sessions 2, 4, 6, and 8). Thus, the CT included in each session 3 stages; a) callisthenics exercises, b) main exercise (ET+RT or RT+ET), and c) cool down exercises.

Before the starting, the participants were involved in the maximum strength capacity estimated using a submaximal test based on the Brzycki's equation: weight [1.0278-(0.0278*repetitions)] that does not change based on the sex, age of the population, or the exercise modality that is performed (Mayhew et al., 2004). After this procedure, there were applied 4 familiarization sessions that consisted in; session 1: 'knowledge of all measurements', 'knowledge of exercise-machine manipulation', and 'instructions during the exercise program', session 2: 'exercising during cycling', 'weights, and metal bars', session 3: 'applying a few of exercises of RT in 2 to 3 sets of exercises, to know the configuration of each exercise (i.e., ET and RT regimes itself), and session 4: 'applying the 50 to 70% of their CT program' corresponding to a normal session compound. In the 'calisthenic stage', each subject developed 10 minute warm-up with continuous walking, joint mobility and flexibility exercises. In the 'main part' of the session, and independent of the CT order group (ET+RT or RT+ET), the ET section consisted of continuous cycling using a magnetic resistance static bicycle (OxfordTM Fitness, model BE-2701, Chile) for 20 minutes. The intensity of the ET exercise was regulated through the previously used modified Borg scale from 1 to 10 rating of perceived exertion (Gillen et al., 2013) and the participants worked at a level between 5 to 7 points (i.e., moderate-intensity), considering the original 6 to 20 points scale (Borg, 1998), being the subjects regularly controlled to not exceed this intensity restriction. On the other hand, the RT section included 8 to 12 muscle strength exercises of circuit training with the following different muscle groups: (1) forearm, (2) knee flexors and extensors, (3) trunk, (4) chest, (5) shoulder elevators, (6) horizontal shoulder flexors, (7) extensors, and finally (8) plantar flexors. These exercises were performed in one set in a continuous concentric/eccentric voluntary contraction as possible for 60 seconds, followed by 60 to 90 seconds of passive recovery, where each participant was changed to another exercise. The RT section was of 25 minutes in duration time.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Chile
  • Temuco, Chile
    • Universidad de La Frontera

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 59 years (ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• age >18 and <60 years
• women or men
• medical authorization for physical tests
• body mass index (BMI) ≥40 kg/m2, or between 35 and 40 kg/m2 but with previously diagnosed of morbid obesity and candidate for bariatric surgery

Exclusion Criteria:

• physical limitations to performing the physical test (e.g., restrictive injuries of the musculoskeletal system)
• exercise-related dyspnoea or respiratory alterations
• chronic heart disease diagnosed during the time of morbid obesity diagnosed and the starting of the exercise intervention

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NON_RANDOMIZED
• Interventional Model: CROSSOVER
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Endurance Training (ET) plus Resistance Training (RT); Concurrent training of Endurance Training plus Resistance Training order.	Behavioral: RT+ET; aetaer; Other Names: Concurrent training order 2
ACTIVE_COMPARATOR: Resistance Training (RT) plus Endurance Training (ET); Concurrent training of Resistance Training plus Endurance Training order.	Behavioral: Concurrent training order 1; atag; Other Names: Exercise training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Systolic blood pressure measured by a blood pressure cuff	Change from Baseline in systolic blood pressure in the unit of (mmHg)	From baseline to 10 minutes after exercise training
Diastolic blood pressure measured by a blood pressure cuff	Change from Baseline in diastolic blood pressure in the unit of (mmHg)	From baseline to 10 minutes after exercise training
Mean arterial pressure measured by a blood pressure cuff	Change from Baseline in mean arterial blood pressure in the unit of (mmHg)	From baseline to 10 minutes after exercise training

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heart rate at rest measured by a cardiometer watch	Change from Baseline in Heart rate at rest in (beats per minute)	From baseline to 10 minutes after exercise training
Pulse pressure measured by a blood pressure cuff	Change from Baseline in Pulse pressure in the unit of (mmHg)	From baseline to 10 minutes after exercise training
Body mass measured by a scale	Change from Baseline in Body mass in (kg)	From baseline to 10 minutes after exercise training
Body mass index calculated from weight plus height and elevated to square	Change from Baseline in Body mass index in (kg/m2)	From baseline to 10 minutes after exercise training
Waist circumference measured by a flexible tape	Change from Baseline in Waist circumference in (cm)	From baseline to 10 minutes after exercise training
Body fat percentage measured by a digital bioimpedanciometer scale	Change from Baseline in Body fat percentage in (%)	From baseline to 10 minutes after exercise training
Lean mass measured by a digital bioimpedanciometer scale	Change from Baseline in Body fat percentage in (kg)	From baseline to 10 minutes after exercise training
Skeletal muscle mass measured by a digital bioimpedanciometer scale	Change from Baseline in Skeletal muscle mass in (kg)	From baseline to 10 minutes after exercise training
Bone mass measured by a digital bioimpedanciometer scale	Change from Baseline in Bone mass in (kg)	From baseline to 10 minutes after exercise training
Basal metabolic rate measured by a digital bioimpedanciometer scale	Change from Baseline in Basal metabolic rate in (Kcal)	From baseline to 10 minutes after exercise training
Fasting plasma glucose measured by blood sample in fasting state	Change from Baseline in Fasting plasma glucose in (mg/dL)	From baseline to 10 minutes after exercise training
Total cholesterol measured by blood sample in fasting state	Change from Baseline in Total cholesterol in (mg/dL)	From baseline to 10 minutes after exercise training
Low density lipids measured by blood sample in fasting state	Change from Baseline in Low density lipids in (mg/dL)	From baseline to 10 minutes after exercise training
High density lipids measured by blood sample in fasting state	Change from Baseline in High density lipids in (mg/dL)	From baseline to 10 minutes after exercise training
Triglycerides measured by blood sample in fasting state	Change from Baseline in Triglycerides in (mg/dL)	From baseline to 10 minutes after exercise training
Six minutes walking test measured by a walking test into a sport court	Change from Baseline in Six minutes walking test in (m)	From baseline to 10 minutes after exercise training
Handgrip muscle strength of the non-dominant arm measured by a dynamometer hand equipment	Change from Baseline in Handgrip strength in the non-dominant arm measured by dynamometer at sitting position in (kg)	From baseline to 10 minutes after exercise training
Handgrip strength Dominant arm measured by a dynamometer hand equipment	Change from Baseline in Handgrip strength in the Dominant arm measured by dynamometer at sitting position in (kg)	From baseline to 10 minutes after exercise training

Collaborators and Investigators

• Sponsor: Universidad Nacional Andres Bello
• Collaborators: Universidad de La Frontera
• Investigators: Principal Investigator: Pedro Delgado Floody, PhD, Universidad de La Frontera

Publications and helpful links

General Publications

• Delgado-Floody P, Izquierdo M, Ramirez-Velez R, Caamano-Navarrete F, Moris R, Jerez-Mayorga D, Andrade DC, Alvarez C. Effect of High-Intensity Interval Training on Body Composition, Cardiorespiratory Fitness, Blood Pressure, and Substrate Utilization During Exercise Among Prehypertensive and Hypertensive Patients With Excessive Adiposity. Front Physiol. 2020 Oct 19;11:558910. doi: 10.3389/fphys.2020.558910. eCollection 2020.
• Delgado-Floody P, Soriano-Maldonado A, Rodriguez-Perez MA, Latorre-Roman PA, Martinez-Salazar C, Vargas CA, Caamano-Navarrete F, Jerez-Mayorga D, Alvarez C. The Effects of Two Different Concurrent Training Configurations on Markers of Metabolic Syndrome and Fitness in Women With Severe/Morbid Obesity: A Randomised Controlled Trial. Front Physiol. 2021 Sep 21;12:694798. doi: 10.3389/fphys.2021.694798. eCollection 2021.
• Alvarez C, Ramirez-Campillo R, Ramirez-Velez R, Izquierdo M. Effects and prevalence of nonresponders after 12 weeks of high-intensity interval or resistance training in women with insulin resistance: a randomized trial. J Appl Physiol (1985). 2017 Apr 1;122(4):985-996. doi: 10.1152/japplphysiol.01037.2016. Epub 2017 Feb 2.

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 5, 2019
• Primary Completion (ACTUAL): September 5, 2019
• Study Completion (ACTUAL): October 5, 2019

Study Registration Dates

• First Submitted: August 13, 2022
• First Submitted That Met QC Criteria: August 15, 2022
• First Posted (ACTUAL): August 17, 2022

Study Record Updates

• Last Update Posted (ACTUAL): August 24, 2022
• Last Update Submitted That Met QC Criteria: August 19, 2022
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Glucose Metabolism Disorders; Metabolic Diseases; Nervous System Diseases; Overnutrition; Nutrition Disorders; Overweight; Body Weight; Insulin Resistance; Hyperinsulinism; Autonomic Nervous System Diseases; Primary Dysautonomias; Orthostatic Intolerance; Obesity; Metabolic Syndrome; Obesity, Morbid; Hypotension; Post-Exercise Hypotension
• Other Study ID Numbers: UNAB-FCR-KINE2022A

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No