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Background High-resistance inspiratory muscle strength training (IMST) is a novel, time-efficient physical training modality. Methods and Results We performed a double-blind, randomized, sham-controlled trial to investigate whether 6 weeks of IMST (30 breaths/day, 6 days/week) improves blood pressure, endothelial function, and arterial stiffness in midlife/older adults (aged 50-79 years) with systolic blood pressure ≥120 mm Hg, while also investigating potential mechanisms and long-lasting effects. Thirty-six participants completed high-resistance IMST (75% maximal inspiratory pressure, n=18) or low-resistance sham training (15% maximal inspiratory pressure, n=18). IMST was safe, well tolerated, and had excellent adherence (≈95% of training sessions completed). Casual systolic blood pressure decreased from 135±2 mm Hg to 126±3 mm Hg (<0.01) with IMST, which was ≈75% sustained 6 weeks after IMST (<0.01), whereas IMST modestly decreased casual diastolic blood pressure (79±2 mm Hg to 77±2 mm Hg, =0.03); blood pressure was unaffected by sham training (all >0.05). Twenty-four hour systolic blood pressure was lower after IMST versus sham training (=0.01). Brachial artery flow-mediated dilation improved ≈45% with IMST (<0.01) but was unchanged with sham training (=0.73). Human umbilical vein endothelial cells cultured with subject serum sampled after versus before IMST exhibited increased NO bioavailability, greater endothelial NO synthase activation, and lower reactive oxygen species bioactivity (<0.05). IMST decreased C-reactive protein (=0.05) and altered select circulating metabolites (targeted plasma metabolomics) associated with cardiovascular function. Neither IMST nor sham training influenced arterial stiffness (>0.05). Conclusions High-resistance IMST is a safe, highly adherable lifestyle intervention for improving blood pressure and endothelial function in midlife/older adults with above-normal initial systolic blood pressure. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03266510.

背景

高阻力吸气肌力量训练（IMST）是一种新颖的、高效省时的物理训练方式。

方法和结果

我们进行了一项双盲、随机、假对照试验，以研究 6 周的 IMST（每天 30 次呼吸，每周 6 天）是否可以改善收缩压≥120mmHg 的中年/老年（50-79 岁）人群的血压、内皮功能和动脉僵硬，同时还研究了潜在的机制和长期效果。36 名参与者完成了高阻力 IMST（75%最大吸气压力，n=18）或低阻力假训练（15%最大吸气压力，n=18）。IMST 安全、耐受性良好，且依从性极佳（≈95%的训练课程完成）。偶然收缩压从 135±2mmHg 降至 126±3mmHg（<0.01），IMST 后 6 周内持续下降约 75%（<0.01），而 IMST 适度降低偶然舒张压（79±2mmHg 至 77±2mmHg，=0.03）；假训练对血压没有影响（均>0.05）。IMST 后 24 小时收缩压低于假训练（=0.01）。肱动脉血流介导的扩张改善了约 45%，IMST （<0.01），但假训练不变（=0.73）。用接受 IMST 前后采集的受试者血清培养的人脐静脉内皮细胞表现出更高的一氧化氮生物利用度、更大的内皮型一氧化氮合酶激活和更低的活性氧生物活性（<0.05）。IMST 降低了 C-反应蛋白（=0.05）并改变了与心血管功能相关的一些循环代谢物（靶向血浆代谢组学）。IMST 或假训练均不影响动脉僵硬（>0.05）。