Exercise, Sports and Hypertension

Contents
1: Haemodynamics of Exercise Testing and Sports Activities
	1.1	 Introduction
	1.2	 Dynamic Exercise
		1.2.1	 BP Changes During Traditional Dynamic Ergometric Tests
		1.2.2	 BP Changes During Prolonged Steady-State Exercise
		1.2.3	 Factors Affecting LV Performance During Exercise
		1.2.4	 BP Changes During Endurance Sports
		1.2.5	 BP Changes During Running
		1.2.6	 BP Changes During Cycling
	1.3	 Isometric Exercise
		1.3.1	 Laboratory Testing
		1.3.2	 Heavy-Resistance Sports
		1.3.3	 How to Assess the Hypertensive Athlete
	References
2: Effect of Physical Activity on Blood Pressure and Prevention of Hypertension
	2.1	 Physical Activity (PA) and Hypertension: Data from Large Cohort Trials
		2.1.1	 PA in Daily Life and Incident Hypertension
		2.1.2	 PA in Daily Life and Future CV Disease in Patients with Hypertension
	2.2	 Impact of Exercise Therapy on BP: Data from Meta-Analyses of Randomized Controlled Trials
		2.2.1	 Blood Pressure Changes Following Dynamic Aerobic Endurance Exercise Therapy
		2.2.2	 Blood Pressure Changes Following Dynamic Resistance Exercise Therapy
		2.2.3	 Blood Pressure Changes Following Isometric Resistance Exercise Therapy
	2.3	 Conclusion
	References
3: Effect of Regular Exercise on Autonomic Nervous System Activity
	3.1	 Physical Activity Versus Physical Inactivity
	3.2	 Physiological Effects of Exercise
	3.3	 Physical Exercise Prescription
	3.4	 The Autonomic Nervous System: How to Measure and Quantify
		3.4.1	 Heart Rate and Heart Rate Variability
		3.4.2	 The Sympathetic Nervous System
			3.4.2.1	 Microneurography
			3.4.2.2	 Norepinephrine Spillover
			3.4.2.3	 Catecholamines
	3.5	 Sympathetic Neural Adaptation to Exercise
		3.5.1	 Acute Effects
		3.5.2	 Long-Term Effects
		3.5.3	 Post-Exercise Effects
	References
4: Endothelial Function and Physical Exercise: A Key to Cardiovascular Protection?
	4.1	 Endothelial Function and Its Mediators
	4.2	 Clinical Significance of Endothelial Dysfunction in Cardiovascular Disease
	4.3	 Physical Activity and Endothelial Function in the Elderly
	4.4	 Does Age Matter?
	4.5	 Physical Activity Can Improve Impaired Endothelium-Dependent Vasodilation in Patients with Cardiovascular Risk Factors or Disease
	4.6	 Future Perspectives
	4.7	 Conclusions
	References
5: Exercise and Microcirculation in Hypertension
	5.1	 Introduction
	5.2	 Regulation of Blood Flow and Vascular Tone in Skeletal Muscle
		5.2.1	 Role of Angiogenesis in the Regulation of Blood Flow
		5.2.2	 Role of Skeletal Muscle Composition in Regulation of Blood Flow
	5.3	 Microvascular Alterations in Essential Hypertension
		5.3.1	 Structural Changes of the Vasculature
		5.3.2	 Functional Alterations of the Vasculature
		5.3.3	 Alterations in Skeletal Muscle
	5.4	 Effect of Exercise in Healthy Subjects
	5.5	 Effects of Exercise in Essential Hypertension
		5.5.1	 Effect on Microvascular Structure
		5.5.2	 Effect on Microvascular Function
		5.5.3	 Role of MicroRNAs
		5.5.4	 Effect of MicroRNAs on the Skeletal Muscle
	5.6	 Conclusion
	References
6: Effect of Regular Physical Activity on Arterial Distensibility
	6.1	 Introduction
	6.2	 Effect of Physical Activity on Blood Pressure and Hypertension
	6.3	 Effect of Physical Activity on Arterial Distensibility
	6.4	 Effect of Resistance and Combined Training Program on Arterial Distensibility
	6.5	 Conclusions
	References
7: Physiological Versus Pathological Left Ventricular Hypertrophy in the Hypertensive Athlete
	7.1	 Introduction
	7.2	 Athlete’s Heart
	7.3	 Hypertensive Heart Disease (HHD)
	7.4	 The Hypertensive Athlete
	7.5	 Clinical Tools for Distinguishing Between HHD and Athlete’s Heart
		7.5.1	 Twelve-Lead Resting Electrocardiogram (ECG)
		7.5.2	 Echocardiography
		7.5.3	 Exercise Testing and CPET
		7.5.4	 Cardiac Magnetic Resonance
	7.6	 Conclusions
	References
8: Atrial Fibrillation and Sports: Still a Challenging Problem
	8.1	 Introduction
	8.2	 Possible Mechanisms
		8.2.1	 Triggers Modification in Athletes
		8.2.2	 Substrate Modification in Athletes
		8.2.3	 Modulating Factors Modifications in Athletes
	8.3	 Association Between AF and Sport: A Summary of the Literature
	8.4	 Comment
	8.5	 Conclusive Considerations
	References
9: Metabolic Syndrome: Effect of Physical Activity on Arterial Elasticity
	9.1	 Introduction
	9.2	 Mechanisms Underlying Metabolic Syndrome and Arterial Distensibility Impairment
	9.3	 Effect of Physical Activity on Arterial Distensibility
	9.4	 Effect of Physical Activity on Arterial Stiffness in Patients with the Metabolic Syndrome
	9.5	 Conclusions
	References
10: Effect of Exercise Training on Clinical Outcomes in Patients with Diabetes
	10.1	 Introduction
	10.2	 The Priceless Value of Exercise in Diabetes Prevention
	10.3	 The Inestimable Value of Exercise in Diabetes Management
	10.4	 Exercise on Diabetes Outcomes
	10.5	 Exercise and Diabetes: What the Guidelines Say
	10.6	 Conclusions
	References
11: Effects of Physical Activity on Hypertension of Youth
	11.1	 Introduction
	11.2	 Autonomic Nervous System Activity in Hypertension of the Young
	11.3	 Regular Physical Activity Improves Autonomic Nervous System Regulation
	11.4	 Isolated Systolic Hypertension in the Athlete
	11.5	 Effects of Exercise on Blood Pressure and Metabolic Variables
	11.6	 Effect of Regular Physical Activity on Hypertension-Mediated Organ Damage
		11.6.1	 Effect on the Heart
		11.6.2	 Effect on Carotid Intima–Media Thickness
		11.6.3	 Effect on Arterial Elasticity
	11.7	 Assessment of BP Response to Exercise
	11.8	 Eligibility for Competitive Athletics
	11.9	 Conclusion
	References
12: Exercise and Hypertension in Older Persons
	12.1	 Aging and Physical Activity
	12.2	 Physical Exercise and Hypertension
	12.3	 Mechanisms
	12.4	 Limitations
	References
13: Exercise for Systemic and Pulmonary Arterial Hypertension: Killing Two Birds with One Stone
	13.1	 Introduction
	13.2	 Definition of Pulmonary Hypertension
		13.2.1	 Physiopathology of PAH
		13.2.2	 Normal Pulmonary Hemodynamics in Response to Exercise
		13.2.3	 Exercise Limitation in PAH
			13.2.3.1	 RV Implications
			13.2.3.2	 Ventilation-Perfusion Mismatch
			13.2.3.3	 Muscle Dysfunction
			13.2.3.4	 Inflammation
	13.3	 Exercise Training in PH
		13.3.1	 Possible Effects of Exercise Training on PH
		13.3.2	 Inflammation
		13.3.3	 Antioxidative Effects
		13.3.4	 Vascular and Right Ventricular Effect
	13.4	 Conclusion
	References
14: High Altitude and Blood Pressure: Clinical Implications
	14.1	 What Is High Altitude?
	14.2	 How HA Affects Circulation
		14.2.1	 Effects of Acute HA Exposure on BP in Healthy Individuals at Rest and During Exercise
		14.2.2	 Mechanisms of BP Changes
	14.3	 Clinical Implications
		14.3.1	 HA and Cardiovascular Pathological Conditions
		14.3.2	 HA and Antihypertensive Treatment
		14.3.3	 BP and Hypertension in Highlanders
	14.4	 Conclusions
	References
15: Antihypertensive Therapy in Athletes
	15.1	 Introduction
	15.2	 Choice of Medication
		15.2.1	 ACE Inhibitors
		15.2.2	 Angiotensin II Receptor Blockers
		15.2.3	 Calcium Channel Blockers
		15.2.4	 Alpha Agonists/Blockers
		15.2.5	 Beta Blockers
		15.2.6	 Diuretics
	15.3	 Pharmacological Combinations
	15.4	 Nutraceuticals
	15.5	 Conclusions
	References