Characterizing the interindividual postexercise hypotension response for two order groups of concurrent training in patients with morbid obesity

Background: Postexercise hypotension (PEH) is a common physiological phenomenon occurring immediately after endurance training (ET), resistance training (RT), and ET plus RT, also termed concurrent training (CT); however, there is little knowledge about the interindividual and magnitude response of PEH in morbidly obese patients. Aim: The aims of this study were (1) to investigate the effect of CT order (ET + RT vs. RT + ET) on the blood pressure responses; 2) characterize these responses in responders and nonresponders, and 3) identify potential baseline outcomes for predicting blood pressure decreases as responders. Methods: A quasi-experimental study developed in sedentary morbidly obese men and women (age 43.6 +/- 11.3 years; body mass index [BMI] >= 40 kg/m(2)) was 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. Primary outcomes include systolic (SBP), diastolic (DBP), mean arterial pressure [MAP], heart rate at rest [HR], and pulse pressure [PP] measurements before and after 10 min post-exercise. Secondary outcomes were other anthropometric, body composition, metabolic, and physical fitness parameters. Using the delta Delta SBP reduction, quartile categorization (Q) in high (Rs: quartile 4), moderate (MRs: quartile 3), low (LRs: quartile 2), and nonresponders (NRs: quartile 1) was reported. Results: Significant pre-post changes were observed in ET + RT in session 2 for SBP (131.6 vs. 123.4 mmHg, p = 0.050) and session 4 (131.1 vs. 125.2 mmHg, p = 0.0002), while the RT + ET group showed significant reductions in session 4 (134.2 vs. 125.3 mmHg, p < 0.001). No significant differences were detected in the sum of the eight sessions for SBP (Sigma Delta SBP) between ET + RT vs. RT + ET (-5.7 vs. -4.3 mmHg, p = 0.552). Interindividual analyses revealed significant differences among frequencies comparing Q1 NRs (n = 8; 22.2%), Q2 LRs (n = 8; 22.2%), Q3 MRs (n = 9; 25.0%), and Q4 HRs (n = 11; 30.5%), p < 0.0001. Quartile comparisons showed significant differences in SBP changes (p = 0.035). Linear regression analyses revealed significant association between Sigma Delta SBP with body fat % (beta -3.826, R-2 0.211 [21.1%], p = 0.031), skeletal muscle mass [beta -2.150, R-2 0.125 (12.5%), p = 0.023], fasting glucose [beta 1.273, R2 0.078 (7.8%), p = 0.003], triglycerides [beta 0.210, R-2 0.014 (1.4%), p = 0.008], and the 6-min walking test [beta 0.183, R-2 0.038 (3.8%), p = 0.044]. Conclusion: The CT order of ET + RT and RT + ET promote a similar 'magnitude' in the postexercise hypotensive effects during the eight sessions of both CT orders in 4 weeks of training duration, revealing nonresponders and 'high' responders that can be predicted from body composition, metabolic, and physical fitness outcomes.

Automated summary

This study examined the response of postexercise hypotension in morbidly obese patients and investigated the effect of concurrent training order on blood pressure changes. The results showed that both ET + RT and RT + ET orders induced similar postexercise hypotensive effects during the training period. The study also identified predictors of responders and nonresponders based on body composition, metabolic, and physical fitness outcomes.