Williamson, W; Lewandowski, AJ; Huckstep, OJ; Lapidaire, W; Ooms, A; Tan, C; Mohamed, A; ... Leeson, P; + view all Williamson, W; Lewandowski, AJ; Huckstep, OJ; Lapidaire, W; Ooms, A; Tan, C; Mohamed, A; Alsharqi, M; Bertagnolli, M; Woodward, W; Dockerill, C; McCourt, A; Kenworthy, Y; Burchert, H; Doherty, A; Newton, J; Hanssen, H; Cruickshank, JK; McManus, R; Holmes, J; Ji, C; Love, S; Frangou, E; Everett, C; Hillsdon, M; Dawes, H; Foster, C; Leeson, P; - view fewer (2022) Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial. eClinicalMedicine , 48 , Article 101445. 10.1016/j.eclinm.2022.101445.

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Abstract

BACKGROUND: Exercise is advised for young adults with elevated blood pressure, but no trials have investigated efficacy at this age. We aimed to determine whether aerobic exercise, self-monitoring and motivational coaching lowers blood pressure in this group. METHODS: The study was a single-centre, open, two-arm, parallel superiority randomized clinical trial with open community-based recruitment of physically-inactive 18–35 year old adults with awake 24 h blood pressure 115/75mmHg-159/99 mmHg and BMI<35 kg/m2. The study took place in the Cardiovascular Clinical Research Facility, John Radcliffe Hospital, Oxford, UK. Participants were randomized (1:1) with minimisation factors sex, age (<24, 24–29, 30–35 years) and gestational age at birth (<32, 32–37, >37 weeks) to the intervention group, who received 16-weeks aerobic exercise training (three aerobic training sessions per week of 60 min per session at 60–80% peak heart rate, physical activity self-monitoring with encouragement to do 10,000 steps per day and motivational coaching to maintain physical activity upon completion of the intervention. The control group were sign-posted to educational materials on hypertension and recommended lifestyle behaviours. Investigators performing statistical analyses were blinded to group allocation. The primary outcome was 24 h awake ambulatory blood pressure (systolic and diastolic) change from baseline to 16-weeks on an intention-to-treat basis. Clinicaltrials.gov registered on March 30, 2016 (NCT02723552). FINDINGS: Enrolment occurred between 30/06/2016-26/10/2018. Amongst the 203 randomized young adults (n = 102 in the intervention group; n = 101 in the control group), 178 (88%; n = 76 intervention group, n = 84 control group) completed 16-week follow-up and 160 (79%; n = 68 intervention group, n = 69 control group) completed 52-weeks follow-up. There were no group differences in awake systolic (0·0 mmHg [95%CI, -2·9 to 2·8]; P = 0·98) or awake diastolic ambulatory blood pressure (0·6 mmHg [95%CI, -1·4. to 2·6]; P = 0·58). Aerobic training increased peak oxygen uptake (2·8 ml/kg/min [95%CI, 1·6 to 4·0]) and peak wattage (14·2watts [95%CI, 7·6 to 20·9]) at 16-weeks. There were no intervention effects at 52-weeks follow-up. INTERPRETATION: These results do not support the exclusive use of moderate to high intensity aerobic exercise training for blood pressure control in young adults. FUNDING: Wellcome Trust, British Heart Foundation, National Institute for Health Research, Oxford Biomedical Research Centre.

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