Efectos de diferentes programas de ejercicio físico aeróbico con intervención nutricional en personas adultas con hipertensión primaria y sobrepeso/obesidadestudios EXERDIET-HTA

Résumé

The main objectives of the present doctoral thesis based on four of the EXERDIET-HTA project¿s sub-studies were: (a) to determine some key physical, physiological, clinical, and nutritional markers of health status in obese and sedentary adults with primary hypertension (HTN) characterized by sex and cardiorespiratory fitness (CRF) level, (b) to estimate cardiovascular risk (CVR) and vascular age (VA) profiles analyzing potential sex differences, in order to determine whether VA is higher than chronological age, and whether CVR is associated with a low level of CRF, (c) to determine the effectiveness of different 16-week aerobic exercise programmes with hypocaloric diet on blood pressure (BP), body composition, CRF and pharmacological treatment, and (d) to evaluate the influence of diet and aerobic exercise program intervention on CVR factors and predicted CVR and VA profiles in overweight/obese people with HTN, and to analyze the potential sex differences in the ability to predict VA and CVR via different methods. Methods: Sedentary overweight/obese non-Hispanic white adults (n=175) with HTN participated in the EXERDIET-HTA study. All participants received a hypocaloric diet. Following baseline data collection, participants were randomly allocated to one of the four intervention groups: the attention control (AC) group (only physical activity recommendations), or the three supervised exercise groups (high-volume and moderate-intensity continuous training [MICT], high-volume and high-intensity interval training [HITT], or low-volume HIIT) exercising 2 days a week during 16 weeks. Body composition, BP (by wearing an ambulatory BP monitor), CRF (by Modified Shuttle Walking Test and a peak, symptom-limited cardiopulmonary exercise test), biochemical profile and nutritional condition were measured before and after the intervention. Cardiovascular risk and VA were determined using the Framingham method (FRS) and the new equation for the prediction of 10-year atherosclerotic cardiovascular disease (ASCVD) risk. Results: (a) The studied population showed a high CVR profile including metabolically abnormal obese, with poor CRF level (22.5 ± 5.6 mL·kg¿1·min¿1), and with non-healthy adherence to dietary pattern (Dietary Approaches to Stop Hypertension, 46.3%; Mediterranean Diet, 41.1%; and Healthy Diet Indicator, 37.1%). Women showed a better biochemical and dietary pattern profile than men (P<0.05), but physical and peak exercise physiological characteristics were poorer (P<0.001). (b) The CVR, but not VA (P=0.339), was higher (P<0.001) in men compared with women irrespective of age. Irrespective of sex, VA was higher than chronological age (P<0.001). (c) Following the intervention, there was a significant reduction in BP and body mass in all groups with no between-group differences for BP. However, there was a significantly lower reduction in body mass in the AC group compared with all exercise groups (AC: 6.6%; high-volume MICT: 8.3%; high-volume HIIT: 9.7%; low-volume HIIT: 6.9%). HIIT groups had significantly higher CRF than high-volume MICT, but there were no significant differences between HIIT groups (AC: 16.4%; high-volume MICT: 23.6%; high-volume HIIT: 36.7%; low-volume HIIT: 30.5%). Medication was removed in 7.6% and reduced in 37.7% of the participants. (d) Participants had a significantly lower (P¿ 0.001) FRS-CVR score and VA post-intervention. For ASCVD risk changed neither in men nor in women. After the intervention, women had a lower CVR score than men (p ¿ 0.001), irrespective of the calculation method. Conclusions: (a) The results strongly suggest that targeting key behaviours such as improving nutritional quality and CRF via regular physical activity might contribute to improve health with independent beneficial effects on CVR factors. (b) ASCVD could underestimate the risk of suffering a cardiovascular event in the following 10 years in overweight/obese non-Hispanic white women with HTN compared with men. The VA appears to be a useful tool in communicating CVR in this population irrespective of sex. (c) The combination of a hypocaloric diet with supervised aerobic exercise 2 days/week offers an optimal nonpharmacological tool in the management of BP, CRF and body composition in overweight/obese and sedentary individuals with HTN. High-volume HIIT seems to be better for reducing body mass compared with low-volume HIIT. The exercise-induced improvement in CRF is intensity dependent with low-volume HIIT as a time-efficient method in this population (d) The improvement in CVR factors after 16-week lifestyle changes reduced the risk of suffering a cardiovascular event in overweight/obese adults with HTN through the FRS estimation tool, but not with the ASCVD score. The risk score algorithms could underestimate CVR in women. In contrast, VA could be a useful and easier tool in the management of individuals with CVR factors. // The main objectives of the present doctoral thesis based on four of the EXERDIET-HTA project¿s sub-studies were: (a) to determine some key physical, physiological, clinical, and nutritional markers of health status in obese and sedentary adults with primary hypertension (HTN) characterized by sex and cardiorespiratory fitness (CRF) level, (b) to estimate cardiovascular risk (CVR) and vascular age (VA) profiles analyzing potential sex differences, in order to determine whether VA is higher than chronological age, and whether CVR is associated with a low level of CRF, (c) to determine the effectiveness of different 16-week aerobic exercise programmes with hypocaloric diet on blood pressure (BP), body composition, CRF and pharmacological treatment, and (d) to evaluate the influence of diet and aerobic exercise program intervention on CVR factors and predicted CVR and VA profiles in overweight/obese people with HTN, and to analyze the potential sex differences in the ability to predict VA and CVR via different methods. Methods: Sedentary overweight/obese non-Hispanic white adults (n=175) with HTN participated in the EXERDIET-HTA study. All participants received a hypocaloric diet. Following baseline data collection, participants were randomly allocated to one of the four intervention groups: the attention control (AC) group (only physical activity recommendations), or the three supervised exercise groups (high-volume and moderate-intensity continuous training [MICT], high-volume and high-intensity interval training [HITT], or low-volume HIIT) exercising 2 days a week during 16 weeks. Body composition, BP (by wearing an ambulatory BP monitor), CRF (by Modified Shuttle Walking Test and a peak, symptom-limited cardiopulmonary exercise test), biochemical profile and nutritional condition were measured before and after the intervention. Cardiovascular risk and VA were determined using the Framingham method (FRS) and the new equation for the prediction of 10-year atherosclerotic cardiovascular disease (ASCVD) risk. Results: (a) The studied population showed a high CVR profile including metabolically abnormal obese, with poor CRF level (22.5 ± 5.6 mL·kg¿1·min¿1), and with non-healthy adherence to dietary pattern (Dietary Approaches to Stop Hypertension, 46.3%; Mediterranean Diet, 41.1%; and Healthy Diet Indicator, 37.1%). Women showed a better biochemical and dietary pattern profile than men (P<0.05), but physical and peak exercise physiological characteristics were poorer (P<0.001). (b) The CVR, but not VA (P=0.339), was higher (P<0.001) in men compared with women irrespective of age. Irrespective of sex, VA was higher than chronological age (P<0.001). (c) Following the intervention, there was a significant reduction in BP and body mass in all groups with no between-group differences for BP. However, there was a significantly lower reduction in body mass in the AC group compared with all exercise groups (AC: 6.6%; high-volume MICT: 8.3%; high-volume HIIT: 9.7%; low-volume HIIT: 6.9%). HIIT groups had significantly higher CRF than high-volume MICT, but there were no significant differences between HIIT groups (AC: 16.4%; high-volume MICT: 23.6%; high-volume HIIT: 36.7%; low-volume HIIT: 30.5%). Medication was removed in 7.6% and reduced in 37.7% of the participants. (d) Participants had a significantly lower (P¿ 0.001) FRS-CVR score and VA post-intervention. For ASCVD risk changed neither in men nor in women. After the intervention, women had a lower CVR score than men (p ¿ 0.001), irrespective of the calculation method. Conclusions: (a) The results strongly suggest that targeting key behaviours such as improving nutritional quality and CRF via regular physical activity might contribute to improve health with independent beneficial effects on CVR factors. (b) ASCVD could underestimate the risk of suffering a cardiovascular event in the following 10 years in overweight/obese non-Hispanic white women with HTN compared with men. The VA appears to be a useful tool in communicating CVR in this population irrespective of sex. (c) The combination of a hypocaloric diet with supervised aerobic exercise 2 days/week offers an optimal nonpharmacological tool in the management of BP, CRF and body composition in overweight/obese and sedentary individuals with HTN. High-volume HIIT seems to be better for reducing body mass compared with low-volume HIIT. The exercise-induced improvement in CRF is intensity dependent with low-volume HIIT as a time-efficient method in this population (d) The improvement in CVR factors after 16-week lifestyle changes reduced the risk of suffering a cardiovascular event in overweight/obese adults with HTN through the FRS estimation tool, but not with the ASCVD score. The risk score algorithms could underestimate CVR in women. In contrast, VA could be a useful and easier tool in the management of individuals with CVR factors.