ABC | Volume 115, Nº1, July 2020

Original Article Acute Effect of Interval vs. Continuous Exercise on Blood Pressure: Systematic Review and Meta-Analysis Raphael José Perrier-Melo, 1 Eduardo Caldas Costa, 2 Breno Quintella Farah, 3 Manoel da Cunha Costa 4 Faculdade Pernambucana de Saúde, 1 Recife, PE - Brazil Universidade Federal do Rio Grande do Norte - Educação Física, 2 Natal, RN - Brazil Universidade Federal Rural de Pernambuco, 3 Recife, PE - Brazil Universidade de Pernambuco - Educação Física, 4 Recife, PE – Brazil Mailing Address: Raphael José Perrier-Melo • Faculdade Pernambucana de Saúde - Educação Física - Av. Mal. Mascarenhas de Morais, 4861. Postal Code 51210-902, Recife, PE – Brazil E-mail: perrierprof@gmail.com Manuscript received February 25, 2019, revised manuscript May 14, 2019, accepted June 23, 2019 DOI: https://doi.org/10.36660/abc.20190107 Abstract Background: Continuous aerobic exercise (CE) is one of the main non-pharmacological recommendations for hypertension prevention and treatment. CE is safe and effective to reduce blood pressure chronically, as well as in the first few hours after its performance, a phenomenon known as post-exercise hypotension (PEH). Interval exercise (IE) also results in PEH. Objective: This systematic review and meta-analysis sought to compare the magnitude of PEH between CE and IE in adults. Methods: A systematic review of studies published in journals indexed in the PubMed, Web of Knowledge, Scopus and CENTRAL databases was performed until March 2020, which compared the magnitude of PEH between CE and IE. PEH was defined as between 45-60 minutes post-exercise. The differences between groups on blood pressure were analyzed using the random effects model. Data were reported as weighted mean difference (WMD) and 95% confidence interval (CI). A p-value <0.05 was considered statistically significant. The TESTEX scale (0-15) was used to verify the methodological quality of the studies. Results: The IE showed a higher magnitude of PEH on systolic blood pressure (WMD: -2.93 mmHg [95% CI: -4.96, -0.90], p = 0.005, I2 = 50%) and diastolic blood pressure (WMD: -1,73 mmHg [IC95%: 2,94, -0,51], p= 0.005, I 2 = 0%) when compared to CE (12 studies, 196 participants). The scores of the studies on the TEXTEX scale varied from 10 to 11 points. Conclusions: The IE resulted in a higher magnitude of PEH when compared to CE between 45 and 60 minutes post- exercise. The absence of adverse event data during IE and CE in the studies prevents comparisons of the safety of these strategies. (Arq Bras Cardiol. 2020; 115(1):5-14) Keywords: Hypertension; Blood Pressure; Post-Exercise Hypotension; Exercise Therapy; Exercise; Review. Regarding physical exercises, the guidelines for the prevention and treatment of hypertension recommend aerobic exercises performed continuously (CE), mainly of moderate intensity, as they are safe and effective for reducing BP levels, improving the cardiovascular and metabolic risk profile, in addition to increasing cardiorespiratory fitness. 3,9 The antihypertensive effects of CE can occur acutely, 10,11 a phenomenon known as post-exercise hypotension (PEH), or chronically, after several sessions of physical exercise over weeks or months. 12,13 In recent years, special attention has been given to exercises that can enhance the magnitude and duration of PEH, considering that this effect would reduce cardiovascular overload in the hours after the exercise session, thus decreasing the risk of cardiovascular events. 14,15 Additionally, more recent studies have shown that individuals with greater PEH after an exercise session, tend to have a greater reduction in resting BP after weeks of training (i.e., greater chronic effect). 16 Therefore, the magnitude of PEH seems to predict the magnitude of the chronic antihypertensive effect, which represents an important practical applicability. PEH can occur with different “doses” of physical exercise, both aerobic and strength. 16 In relation to aerobic exercises, a systematic review and previous meta- analysis 11 showed that PEH occurs after performing CE Introduction Hypertension affects between 30 and 40% of the world’s population. 1,2 In Brazil, its prevalence varies from 22.3 to 43.9%, affecting more than 60% of the elderly. 3,4 Hypertension is directly associated with the incidence of heart and cerebrovascular diseases, 3 responsible for approximately 20% of deaths in individuals over 30 years of age, 5 in addition to generating costs of around R$ 30.8 billion reais per year. 6 Changes in lifestyle, including physical activity, healthy eating habits, weight reduction and smoking cessation have been strongly recommended for the prevention and treatment of hypertension. 1,3 In fact, changes in lifestyle result in reductions in blood pressure (BP) levels, which reduce the risk of cardiovascular events. 3,7,8 5