Kunimatsu Narumi, Tsukamoto Hayato, Ogoh Shigehiko
Department of Biomedical Engineering, Toyo University, Saitama 351-8510, Japan.
Faculty of Sport Sciences, Waseda University, Saitama 359-1192, Japan.
J Clin Med. 2024 Oct 8;13(19):5975. doi: 10.3390/jcm13195975.
Physical activity and regular exercise are well known to reduce the risks of cerebrovascular and cardiovascular diseases, leading the American College of Sports Medicine to endorse the concept that "exercise is medicine". However, a single bout of exercise temporarily raises arterial blood pressure (BP) to meet the metabolic demands of working muscle, and this BP response is particularly exaggerated in older adults and patients with cardiovascular conditions, such as hypertension, resulting in an exaggerated BP response during exercise. This presents a paradox: while regular exercise is crucial for preventing these diseases, excessively high BP responses during exercise could increase the risk of vascular damage. The mechanisms underlying this exaggerated BP response during exercise remain unclear, and effective exercise regimens for these populations have yet to be established. Currently, low-intensity exercise is recommended; however, its efficacy in disease prevention is uncertain. Notably, even among healthy individuals, there is significant variation in the BP response to exercise. Some healthy individuals, despite having normal resting BP, exhibit an exaggerated BP response during physical activity. Importantly, these individuals are often unaware that their BP becomes excessively elevated during physical activity. Repeated exposure to these heightened BP responses through regular physical activity may increase their long-term risk of cardiovascular disease. How can we prevent disease development in these individuals while still ensuring the effectiveness of exercise? Some studies have shown that individuals with a family history of hypertension may experience this phenomenon even in children and adolescents. Additionally, left ventricular hypertrophy contributes to an exaggerated BP response to exercise, suggesting a possible genetic influence. Conversely, other reports indicate that factors such as arterial stiffness, obesity, and low exercise capacity also contribute to this exaggerated response. Our recent preliminary data suggest that the cognitive benefits of exercise may be diminished in individuals who exhibit an exaggerated BP response during exercise. This implies that individuals with an exaggerated BP response, despite having normal resting BP, may not fully benefit from exercise. In this perspective paper, we review the physiological aspects of this phenomenon and explore strategies to address it. Additionally, we discuss BP responses in athletes within this content. Our goal is to prevent disease while maximizing the benefits of exercise for healthy individuals with an exaggerated BP response, as well as for elderly and cardiovascular patients.
众所周知，体育活动和规律锻炼可降低脑血管疾病和心血管疾病的风险，这使得美国运动医学学院认可了“运动是良药”这一理念。然而，单次运动可使动脉血压（BP）暂时升高，以满足工作肌肉的代谢需求，而且这种血压反应在老年人和患有心血管疾病（如高血压）的患者中尤为明显，导致运动期间血压反应过度。这就产生了一个悖论：虽然规律运动对于预防这些疾病至关重要，但运动期间过高的血压反应可能会增加血管损伤的风险。运动期间这种过度血压反应的潜在机制尚不清楚，针对这些人群的有效运动方案也尚未确立。目前，建议进行低强度运动；然而，其在疾病预防方面的功效尚不确定。值得注意的是，即使在健康个体中，血压对运动的反应也存在显著差异。一些健康个体，尽管静息血压正常，但在体育活动期间血压反应过度。重要的是，这些个体往往并未意识到他们在体育活动期间血压会过度升高。通过规律体育活动反复暴露于这些升高的血压反应中，可能会增加他们患心血管疾病的长期风险。我们如何在确保运动有效性的同时预防这些个体的疾病发展呢？一些研究表明，有高血压家族史的个体甚至在儿童和青少年时期就可能出现这种现象。此外，左心室肥厚会导致运动时血压反应过度，这表明可能存在遗传影响。相反，其他报告指出，诸如动脉僵硬、肥胖和运动能力低下等因素也会导致这种过度反应。我们最近的初步数据表明，在运动期间血压反应过度的个体中，运动对认知的益处可能会减弱。这意味着，尽管静息血压正常，但血压反应过度的个体可能无法从运动中充分获益。在这篇观点论文中，我们回顾了这一现象的生理学方面，并探讨解决这一问题的策略。此外，我们还在此内容中讨论了运动员的血压反应。我们的目标是预防疾病，同时为血压反应过度的健康个体以及老年人和心血管疾病患者最大化运动的益处。
