Comparison of Single Versus Multiple Lifestyle Interventions: Are the Antihypertensive Effects of Exercise Training and Diet-Induced Weight Loss Additive?

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Abstract

Although aerobic exercise training and diet-induced weight loss each have been shown to individually lower elevated blood pressure (BP), it is currently not known whether their combined use produces an additive antihypertensive effect. In this randomized clinical trial we therefore compared the effect on resting BP of exercise training only and dietary modification only with that of exercise training plus dietary modification in 55 sedentary, overweight patients with high normal BP or stage 1 or 2 hypertension. After baseline testing, patients were randomized to 1 of the following 3 interventions for 12 weeks: exercise training only (aerobic exercise; 30 to 45 minutes; 3 to 5 days/week; 60% to 85% of maximal heart rate), dietary modification only (aimed primarily at weight loss via restriction of energy intake and dietary fat), or exercise training plus dietary modification. Forty-eight patients completed the study. In these patients, exercise training plus dietary modification elicited a greater reduction (p ≤0.001) in body weight (−7.1 ± 2.9 vs −1.0 ± 1.8 kg) than exercise training only, and a greater increase (p ≤0.05) in maximal oxygen uptake (4.3 ± 2.6 vs 1.9 ± 2.0 ml/kg/min) versus dietary modification only. However, the reduction in BP with exercise training plus dietary modification (−12.5 ± 6.3/7.9 ± 4.3 mm Hg) did not differ significantly from that with exercise training only (−9.9 ± 6.4/5.9 ± 4.6 mm Hg) or dietary modification only (−11.3 ± 12.1/7.5 ± 4.3 mm Hg). These data indicate that the antihypertensive effects of exercise training and diet-induced weight loss are not additive. This finding has important public health and clinical implications for the millions of overweight persons with high normal BP or stage 1 or 2 hypertension.

In patients with high normal blood pressure or stage 1 or 2 hypertension, the antihypertensive effects of aerobic exercise training and diet-induced weight loss are not additive.

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Participants

Fifty-five men (n = 17) and women (n = 38) between the ages of 21 and 65 years, with high normal BP or stage 1 or 2 hypertension (i.e., systolic BP 130 to 179 mm Hg and/or diastolic BP 85 to 109 mm Hg) volunteered for the study after responding to television and radio requests for study participants. Written informed consent was obtained from each participant. All patients were asymptomatic, had no clinically apparent cardiovascular disease besides elevated BP, had not participated in regular

Results

Of the 55 patients entered into the study, 7 were withdrawn before its completion. Of these patients, 1 (from the exercise training plus dietary modification intervention) relocated to another city, 2 (1 from the dietary modification-only intervention and 1 from the exercise training plus dietary modification intervention) were withdrawn owing to their failure to attend mandatory meetings with the study's counselor, and 4 (1 from the dietary modification-only intervention and 3 from the

Discussion

Existing longitudinal training studies indicate that regular aerobic exercise elicits an average reduction in systolic and diastolic BP of about 10 mm Hg in persons with elevated BP.3, 4, 5 Similarly, diet-induced weight loss has been shown to evoke an equivalent, if not greater, antihypertensive effect in overweight persons with elevated BP.1, 2, 6, 9 The present study demonstrates in overweight patients with high normal BP or stage 1 or 2 hypertension that the BP-lowering effects of exercise

Acknowledgements

We thank Susan Richards, MS, and Shirley Salmon for their assistance with the lifestyle interventions, Laura Becker for manuscript preparation, and the Prestonwood shopping mall for allowing us to use their facility for the lifestyle interventions.

This study was supported in part by research grants from the Bob Smith, MD, Foundation and Merck Human Health Division.

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