Effects of autonomic nervous system activation on endothelial function in response to acute exercise in hypertensive individuals: study protocol for a randomized double-blind study

Gustavo Waclawovsky, Liliana Fortini Cavalheiro Boll, Salvador Gomes Neto, Maria Claudia Costa Irigoyen, Alexandre M Lehnen, Gustavo Waclawovsky, Liliana Fortini Cavalheiro Boll, Salvador Gomes Neto, Maria Claudia Costa Irigoyen, Alexandre M Lehnen

Abstract

Background: Arterial hypertension has a direct association with endothelial dysfunction and major cardiovascular events. There is evidence showing the benefits of aerobic exercise on flow-mediated dilation (FMD) in hypertensive individuals but little is known about the effect of autonomic nervous system (ANS) activation on FMD of the brachial artery in response to different types of exercise in this specific population. This study aims to examine the effects of ANS activation on FMD of the brachial artery in response to exercise in hypertensive individuals following a session of different types of exercise including aerobic exercise (AE), resistance exercise (RE), or combined exercise (CE).

Methods: Thirty-nine hypertensive volunteers aged 35 to 55 years will be randomly assigned to two exercise sessions: AE (40 min on a cycle ergometer at 60% of HR reserve), RE (4 lower limb sets with 12 repetitions at 60% 1-RM for 40 min), or CE (RE for 20 min + AE for 20 min). Each exercise group will be randomized to receive either an α1-adrenergic blocker (doxazosin 0.05 mg/kg-1) or placebo. Ultrasound measurement of FMD is performed 10 min before and 10, 40, and 70 min after exercise. ANS activation is monitored using a Finometer and measurements are taken during 10 min before each FMD assessment. Arterial stiffness is assessed by pulse wave velocity (PWV) analysis using a Complior device.

Discussion: We expect to demonstrate the effect of ANS activation on FMD of the brachial artery in hypertensive individuals in response to different types of exercise. This study may give some insight on how to improve exercise prescription for hypertension management.

Trial registration: https://ichgcp.net/clinical-trials-registry/NCT04371757" title="See in ClinicalTrials.gov">NCT04371757". Registered on May 1, 2020.

Keywords: Aerobic exercise; Autonomic nervous system; Endothelium; Randomized clinical trial; Resistance exercise; Systemic arterial hypertension.

Conflict of interest statement

The authors declare that there are no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Study design. IPAq: International Physical Activity Questionnaire; AE: aerobic exercise session; RE: resistance exercise session; CE: combined exercise; FMD: flow-mediated dilation; BFV: blood flow velocity; DBA: diameter of brachial artery; VR: vascular resistance
Fig. 2
Fig. 2
Schedule of enrolment, interventions, and assessment. Adapted from SPIRIT Figure 2013. **Subjects will be allocated to perform twice (X-X) each exercise session on alpha-1 adrenergic block and placebo conditions. IPAq: International Physical Activity Questionnaire; BP: blood pressure; 1-RM: one-repetition maximum; BFV: blood flow velocity; DBA: diameter of brachial artery; FMD: flow-mediated dilation; ANS: autonomic nervous system. Study period: -t1, on-site screening (at Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia – ICFUC), media postings, and patient databases; -t2, first visit of the volunteer to the research (ICFUC); -t3, second visit of the volunteer to the research (ICFUC); 0, contact with the independent researcher not involved with the study for volunteer randomization access; t1: pre-exercise assessments (10 min); t2, t3, t4: post-exercise session evaluation (10, 40, 70 min)
Fig. 3
Fig. 3
Schedule of intervention day. BP: blood pressure; HR: heart rate; SBP: systolic BP; DBP: diastolic BP; ANS: autonomic nervous system; FMD: flow-mediated dilation; 1-RM: one-repetition maximum

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