The aerobic exercise training in hypertension: A matter of baking ingredients

Exercise training is worldwide considered pivotal for maintaining and restoring general population health. Its potential beneficial effects touch several domains: metabolic, haemodynamic, psychological, and social. The European guidelines for hypertension recom- mend physical activity among the nonpharmacological interventions to manage ‘all patients with hypertension’, and the harder effort is advocated in order to fight against sedentary living. In the domain of the exercise training, there are nonetheless many features to be consid- ered. Indeed, haemodynamic modifications linked to exer- cise strictly depend on the type and the duration of the effort as well as the background of the individual who is going to be trained (i.e. age, sex, hypertensive or not, previously trained, or sedentary ...). In literature, since several years, many attempts have been made to investigate the haemodynamic response to different exercise-training programs, with not always coherent conclusions. In 1987, Douglas et al. reported on the effect of prolonged and high-intensity exercise (triathlon) on left ventricular func- tion and found that immediately after the competition, the athletes presented reduced fractional shortening, driven by altered contractility and preload. These alterations recov- ered 1 day after the exercise, suggesting cardiac ‘fatigue.’ Similarly, 20 years later, Aslani et al. demonstrated that the Ranger training program (consisting in 8 weeks of exhaustive exercise) was associated with impaired left ventricular function. As such, from the available data, it appears that high-intensity exercise is acutely and chroni- cally associated with impaired haemodynamics. In addition, even aerobic exercise, when extremely vigorous like the marathon, is chronically associated with increased arterial stiffness.