Exercise for High Blood Pressure in Teens

Overseen By Eva C Diaz, M.D.

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Arkansas Children's Hospital Research Institute

Must not be taking: Inhalers, Albuterol

Disqualifiers: Class 3 obesity, Asthma, Autism, Diabetes, Epilepsy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

45 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this study is to compare two types of exercises, isometric exercise (like squats and planks) and aerobic exercise (such as running), to see which one is more effective at improving blood pressure in teenagers aged 13 to 17.5 years. The main question the study aims to answer is: - Do the effects of one session of isometric exercise on the blood pressure of adolescents compare to the effects of one session of aerobic exercise? Adolescents diagnosed with high blood pressure may qualify for this study. Participants will be randomly assigned to either a single session of isometric exercise or a single session of aerobic exercise. * Participants will attend 3 study visits in total. * Study visits should be completed within 4 weeks of enrollment. * At the initial visit, samples (example: blood) will be collected and body measurements will be taken. * Participants will be asked to answer questionnaires (diet, growth, and others) * At visit 2, participants will have their blood pressure measured using a 24 hour blood pressure monitor. * At visit 3, participants will participate in a single session of either aerobic or isometric exercise. They will wear a 24-hour blood pressure monitor immediately after the exercise session.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it requires that high blood pressure is treated with lifestyle changes only, not medication. If you are on medication for high blood pressure, you may not be eligible to participate.

What data supports the effectiveness of the treatment for high blood pressure in teens?

Research shows that aerobic exercise can lower blood pressure by 5-7 mmHg in people with high blood pressure. Additionally, weight training has been found to maintain and even further reduce blood pressure in hypertensive adolescents after initial endurance training. ^{1 2 3 4 5}

Is exercise safe for managing high blood pressure in teens?

Exercise, including aerobic and resistance training, is generally safe for managing high blood pressure in teens. Studies show no reported complications in hypertensive children and adolescents, and exercise can help reduce blood pressure without adverse effects. ^{6 7 8 9 10}

How does the treatment of aerobic and isometric exercise for high blood pressure in teens differ from other treatments?

This treatment is unique because it uses physical activity, specifically aerobic and isometric exercises, to lower blood pressure without medication. Aerobic exercise is widely recommended for its effectiveness in reducing blood pressure, while isometric exercise is less commonly used but has shown potential benefits in recent studies. ^{10 11 12 13 14}

Research Team

Eva C Diaz, MD

Principal Investigator

Arkansas Children's Nutrition Center

Eligibility Criteria

The BEE-Power Study is for teenagers aged 13 to 17.5 with high blood pressure, aiming to see if one session of isometric (like squats) or aerobic exercise (such as running) can improve their condition. Participants will have three study visits over four weeks, including exercises, questionnaires, and blood pressure monitoring.

Inclusion Criteria

HBP treated with lifestyle modifications only

I am between 13 and 17.5 years old.

My BMI is between 35 and less than 40, or it's high for my age group.

Exclusion Criteria

I use inhalers daily for my asthma.

Other pre-existing medical conditions or medications as determined by the investigators to affect the outcomes of interest

Parent/participant refusal to have blood drawn

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Baseline Assessment

Initial visit where samples are collected, body measurements are taken, and questionnaires are completed

1 day

1 visit (in-person)

Blood Pressure Monitoring

Participants have their blood pressure measured using a 24-hour blood pressure monitor

1 day

1 visit (in-person)

Exercise Intervention

Participants engage in a single session of either aerobic or isometric exercise, followed by 24-hour blood pressure monitoring

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after the exercise intervention

1-2 weeks

Treatment Details

Interventions

• Aerobic exercise
• Isometric exercise

Trial Overview This trial tests the effectiveness of a single session of either isometric or aerobic exercise on lowering blood pressure in teens with obesity-related hypertension. They'll be randomly assigned to one type of exercise and monitored using a 24-hour blood pressure device after exercising.

Participant Groups

Group I: Isometric Exercise Experimental Treatment 1 Intervention

After baseline 24-hour blood pressure measurements are taken at visit 2, participants will attend a final study visit where they will engage in a single session of isometric exercise. The exercise routines will include 5 to 10-minute warm-up and cool-down periods, along with a 30-minute workout. Twenty-four hour blood pressure measurements will be taken after the exercise bout.

Group II: Aerobic Exercise Active Control 1 Intervention

After baseline 24-hour blood pressure measurements are taken at visit 2, participants will attend a final study visit where they will engage in a single session of aerobic exercise. The exercise routines will include 5 to 10-minute warm-up and cool-down periods, along with a 30-minute workout. Twenty-four hour blood pressure measurements will be taken after the exercise bout.

Aerobic exercise is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Aerobic Exercise for:

• Rehabilitation after stroke
• Improvement of physical function
• Enhancement of cognitive function
• Reduction of depression

Approved in European Union as Aerobic Exercise for:

• Cardiovascular rehabilitation
• Improvement of physical function
• Enhancement of cognitive function

Approved in Canada as Aerobic Exercise for:

• Rehabilitation after stroke
• Improvement of physical function
• Enhancement of cognitive function

Who Is Running the Clinical Trial?

Arkansas Children's Hospital Research Institute

Lead Sponsor

Trials

141

Recruited

5,025,000+

Findings from Research

In a study involving 99 ninth-grade girls with elevated blood pressure, those who participated in aerobic exercise classes showed significant improvements in cardiorespiratory fitness and a greater reduction in systolic blood pressure compared to those in standard physical education classes.

The results suggest that incorporating aerobic exercise into physical education can be an effective health promotion strategy for high-risk adolescent girls, highlighting its potential benefits for managing blood pressure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of school-based aerobic exercise on blood pressure in adolescent girls at risk for hypertension. Ewart, CK., Young, DR., Hagberg, JM.[2022]

In a study of six adolescents with persistent essential hypertension, weight training led to a significant reduction in systolic blood pressure by 17 mm Hg after 5 months, while maintaining lower diastolic pressure achieved through prior endurance training.

Weight training also resulted in a decrease in systemic vascular resistance, suggesting it may enhance blood flow and contribute to further reductions in blood pressure in hypertensive adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of weight training on blood pressure and hemodynamics in hypertensive adolescents. Hagberg, JM., Ehsani, AA., Goldring, D., et al.[2019]

Physical conditioning can be an effective alternative or complement to medication for managing borderline or mild hypertension, as studies show it can lead to modest reductions in blood pressure.

Exercise programs for hypertensive patients should be personalized based on individual assessments and may include activities like arm crank ergometry and moderate weight training, while avoiding pure isometric exercises.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise prescription for hypertensive patients. Franklin, BA., Gordon, S., Timmis, GC.[2019]

In a study of 27 middle-aged adults with prehypertension and obesity, aerobic exercise significantly reduced both systolic and diastolic blood pressure compared to isometric handgrip (IHG) exercise and a non-exercise control, highlighting its effectiveness as an antihypertensive intervention.

After 8 weeks of training, aerobic exercise continued to lower blood pressure during waking hours, while IHG training resulted in an increase in diastolic blood pressure during sleep, suggesting that aerobic exercise is the preferred method for managing hypertension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The antihypertensive effects of aerobic versus isometric handgrip resistance exercise. Ash, GI., Taylor, BA., Thompson, PD., et al.[2022]

Dynamic aerobic training can significantly lower blood pressure in adults, with an average reduction of -5.3 mmHg for systolic and -4.8 mmHg for diastolic pressure, particularly in hypertensive individuals.

The blood pressure-lowering effects are more pronounced in hypertensive patients compared to those with normal blood pressure, indicating that exercise may be a beneficial intervention for managing high blood pressure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of exercise in blood pressure control: supportive evidence. Fagard, RH.[2019]

In a study of 60 healthy individuals, 8 weeks of home-based aerobic endurance exercise (AEX) led to significant reductions in both ambulatory and office blood pressure (BP), demonstrating its effectiveness in managing high BP.

While isometric handgrip (IHG) exercise also reduced office BP, it was less effective than AEX, indicating that AEX may be a superior option for lowering BP in healthy adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled trial comparing home-based isometric handgrip exercise versus endurance training for blood pressure management. Goessler, KF., Buys, R., VanderTrappen, D., et al.[2019]

Hypertensive children and adolescents have not shown any exercise-related complications in the literature, suggesting that they should not be arbitrarily excluded from sports or exercise.

Dynamic exercise training has been beneficial in reducing blood pressure in hypertensive youth, and as long as there is no target organ damage, participation in exercise should be encouraged to promote lifelong physical activity and potentially prevent adult hypertension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise in hypertensive children and adolescents: any harm done? Alpert, BS.[2008]

In a study of 27 untreated men with mild essential hypertension, aerobic exercise training significantly reduced diastolic blood pressure (DBP) by an average of 9.6 mm Hg, while the placebo group experienced an increase in DBP.

After a crossover to the aerobic regimen, the control group also showed significant reductions in both DBP and systolic blood pressure (SBP), indicating that aerobic exercise is an effective intervention for lowering blood pressure in mildly hypertensive individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Controlled trial of aerobic exercise in hypertension. Martin, JE., Dubbert, PM., Cushman, WC.[2019]

In a study involving 25 patients with controlled hypertension, resistance exercise led to a significant increase in systolic blood pressure immediately after workouts, but diastolic pressure remained stable, indicating a safe acute response to this type of exercise.

The research suggests that while resistance exercise is generally safe for patients with hypertension, exercising larger muscle groups like the femoral quadriceps at high intensity may cause a greater increase in systolic blood pressure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pressure response after resistance exercise for different body segments in hypertensive people. Battagin, AM., Dal Corso, S., Soares, CL., et al.[2019]

Aerobic exercise is highly effective in reducing blood pressure, especially in hypertensive patients, with guidelines recommending 30-60 minutes of moderate to vigorous exercise 4-7 days a week as a primary strategy for managing hypertension.

While resistance training is considered safe and can be included as an adjunct to aerobic exercise, its role in directly managing hypertension is less established, and it is recommended to be performed 2-3 days a week with proper medical clearance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise as medicine: role in the management of primary hypertension. Millar, PJ., Goodman, JM.[2014]

In a study involving 75 hypertensive patients, aerobic exercise significantly reduced both systolic blood pressure and systemic vascular resistance after 12 weeks, demonstrating its effectiveness in managing hypertension.

In contrast, isometric handgrip training did not lead to any significant changes in blood pressure, suggesting that it may not be a beneficial exercise option for hypertensive patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Aerobic versus isometric handgrip exercise in hypertension: a randomized controlled trial. Pagonas, N., Vlatsas, S., Bauer, F., et al.[2018]

Regular aerobic exercise (AE) effectively reduces blood pressure (BP) across various populations, including normotensive, prehypertensive, and hypertensive individuals, as well as those with comorbidities like diabetes and kidney issues, based on a review of 24 studies.

Isometric exercise training also contributes to BP reduction in all groups, although the effectiveness varies by gender, highlighting the importance of tailored exercise programs for managing hypertension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Different Types of Aerobic Exercise on Individuals With and Without Hypertension: An Updated Systematic Review. Esmailiyan, M., Amerizadeh, A., Vahdat, S., et al.[2023]

Hypertension is common in children and adolescents, often due to vascular and renal issues, and non-pharmacologic therapies like exercise can effectively lower blood pressure.

A proposed multicenter trial aims to determine the optimal intensity, duration, and frequency of exercise needed to achieve the best blood pressure control in young people, with no significant risks associated with dynamic exercise reported.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise as a therapy to control hypertension in children. Alpert, BS.[2019]

Increased physical activity can significantly lower blood pressure in hypertensive individuals, with an average reduction of 12/5 mm Hg, supported by strong evidence (GRADE +++).

Engaging in moderate to vigorous aerobic exercise for at least 3 sessions of 40-60 minutes per week over 8 weeks shows the strongest evidence for blood pressure reduction, while isometric training also provides significant benefits (evidence grade ++).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Aerobic physical activity lowers blood pressure in hypertension]. Börjesson, M., Onerup, A., Lundqvist, S., et al.[2017]

References

1. United States pubmed.ncbi.nlm.nih.gov

Effects of school-based aerobic exercise on blood pressure in adolescent girls at risk for hypertension. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Effect of weight training on blood pressure and hemodynamics in hypertensive adolescents. [2019]

3. England pubmed.ncbi.nlm.nih.gov

Exercise prescription for hypertensive patients. [2019]

4. Netherlands pubmed.ncbi.nlm.nih.gov

The antihypertensive effects of aerobic versus isometric handgrip resistance exercise. [2022]

5. Netherlands pubmed.ncbi.nlm.nih.gov

The role of exercise in blood pressure control: supportive evidence. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

A randomized controlled trial comparing home-based isometric handgrip exercise versus endurance training for blood pressure management. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

Exercise in hypertensive children and adolescents: any harm done? [2008]

8. United States pubmed.ncbi.nlm.nih.gov

Controlled trial of aerobic exercise in hypertension. [2019]

9. Brazil pubmed.ncbi.nlm.nih.gov

Pressure response after resistance exercise for different body segments in hypertensive people. [2019]

10. Canada pubmed.ncbi.nlm.nih.gov

Exercise as medicine: role in the management of primary hypertension. [2014]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Aerobic versus isometric handgrip exercise in hypertension: a randomized controlled trial. [2018]

12. Netherlands pubmed.ncbi.nlm.nih.gov

Effect of Different Types of Aerobic Exercise on Individuals With and Without Hypertension: An Updated Systematic Review. [2023]

13. Germany pubmed.ncbi.nlm.nih.gov

Exercise as a therapy to control hypertension in children. [2019]

14. Sweden pubmed.ncbi.nlm.nih.gov

[Aerobic physical activity lowers blood pressure in hypertension]. [2017]