Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial

Wilby Williamson; Adam James Lewandowski; Odaro John Huckstep; Winok Lapidaire; Alexander Ooms; Cheryl Tan; Afifah Mohamed; Maryam Alsharqi; Mariane Bertagnolli; William Woodward; Cameron Dockerill; Annabelle McCourt; Yvonne Kenworthy; Holger Burchert; Aiden Doherty; Julia Newton; Henner Hanssen; John Kennedy Cruickshank; Richard McManus; Jane Holmes; Chen Ji; Sharon Love; Elena Frangou; Colin Everett; Melvyn Hillsdon; Helen Dawes; Charlie Foster; Paul Leeson

doi:10.1016/j.eclinm.2022.101445

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. 2022 May 13:48:101445. doi: 10.1016/j.eclinm.2022.101445. eCollection 2022 Jun.

Authors

Wilby Williamson^{1

2}, Adam James Lewandowski^{1

3}, Odaro John Huckstep^{1

4}, Winok Lapidaire¹, Alexander Ooms⁵, Cheryl Tan¹, Afifah Mohamed^{1

6}, Maryam Alsharqi¹, Mariane Bertagnolli^{1

7}, William Woodward¹, Cameron Dockerill¹, Annabelle McCourt¹, Yvonne Kenworthy¹, Holger Burchert¹, Aiden Doherty⁸, Julia Newton⁹, Henner Hanssen¹⁰, John Kennedy Cruickshank¹¹, Richard McManus¹², Jane Holmes⁵, Chen Ji¹³, Sharon Love¹⁴, Elena Frangou¹⁴, Colin Everett¹⁵, Melvyn Hillsdon¹⁶, Helen Dawes^{17

17}, Charlie Foster¹⁸, Paul Leeson¹

Affiliations

¹ Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
² School of Medicine, Trinity College Dublin, Dublin, Ireland.
³ Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
⁴ Department of Biology, United States Air Force Academy, CO, USA.
⁵ Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
⁶ Department of Diagnostic Imaging & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
⁷ Hôpital du Sacré-Cœur de Montréal Research Center (CIUSSS Nord-de-l'Île-de-Montréal), School of Physical and Occupational Therapy, McGill University, Montréal, Canada.
⁸ Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, UK.
⁹ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
¹⁰ Department of Sport, Exercise and Health, University of Basel, Switzerland.
¹¹ School of Lifecourse Sciences, Kings College London, London, UK.
¹² Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
¹³ Warwick Clinical Trials Unit, University of Warwick, Warwick, UK.
¹⁴ MRC Clinical Trials Unit, University College London, London, UK.
¹⁵ Clinical Trials Research Unit, University of Leeds, Leeds, West Yorkshire, UK.
¹⁶ Sport and Health Sciences, University of Exeter, Exeter, UK.
¹⁷ Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
¹⁸ School of Policy Studies, University of Bristol, Bristol, UK.

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.

Intepretation: 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.

Keywords: Aerobic training; Blood pressure; Cardiovascular risk; Exercise; High blood pressure; Hypertension; Lifestyle intervention; Prevention; Young adults.

Associated data

ClinicalTrials.gov/NCT02723552

Abstract

Associated data

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