ABC | Volume 115, Nº1, July 2020

Original Article Perrier-Melo et al. Post-Exercise Hypotension: Interval Vs. Continuous Arq Bras Cardiol. 2020; 115(1):5-14 result in favor of IE disappear (WMD: -0.99 mmHg [95% CI: -2.30, 0.32], p = 0.14; I 2 = 0%; p = 0.97). Discussion To the best of our knowledge, this is the first systematic review and meta-analysis that directly compared the magnitude of PEH after a session of CE and IE in adults. The main finding of this study is that the IE shows a reduction in systolic and diastolic BP of ~ 3 and 1.3 mmHg, respectively, more than the CE (between 45-60 minutes post-exercise). However, it is important to highlight that this result on diastolic BP has considerable influence of a single study. 36 Overall, the present study observed that IE showed a reduction of ~ 8 and 4 mmHg for systolic and diastolic BP, respectively, between 45-60 minutes post-exercise. The reduction observed after CE, however, was ~ 5 and 2.6 mmHg for systolic and diastolic BP, respectively, in the same post-exercise analyzed period. Therefore, a direct comparison (head-to-head) of the effects of these interventions confirmed the superiority of IE over CE in terms of the magnitude of systolic and diastolic PEH between 45-60 minutes. These data are similar to those found in a previous meta-analysis, 11 which observed a reduction in systolic BP of 7.1 and 4.0 mmHg and a reduction in diastolic BP of 2.5 and 3.2 mmHg, respectively, for interval and continuous exercise. However, it is important to highlight that not only the interval versus continuous nature was compared in the present meta- analysis, but interventions that specifically involved IE (at vigorous intensity and “all out”) versus CE (at moderate and vigorous intensity), which was not performed in the previous study. 11 Studies have shown that the magnitude of PEH can be related both to the intensity reached during the exercise session, 10,11,39 and to the exercise volume. 11,40 In the present meta-analysis, most of the included studies ( ~ 66%; n = 8) 29–32,34,36–38 equalized the volume, and / or average intensity, and / or total energy expenditure of IE with CE sessions, which can facilitate the understanding of the impact of the exercise nature (interval vs . continuous) and intensity of stimuli on the PEH magnitude. This aspect is important because studies show that when volume and/ or mean intensity are equalized, PEH is similar between IE and CE. 41,42 However, of the studies included in this systematic review, those that showed volume, and / or mean intensity, and / or total energy expenditure equalized between the exercise protocols, mean reductions of -9.7 and -5 mmHg were observed in systolic BP and -4.3 and -2.2 mmHg in diastolic BP, for IE and CE, respectively. The IE protocols that showed lower volume, and/or mean intensity and/or energy expenditure, 26,27,33,35 showed mean reductions of -6.2 and -3.4 mmHg in systolic and diastolic BP, respectively, which was slightly higher than the mean Table 3 - Methodological quality analysis of the included studies Authors Study quality Partial (0-5) Study quality Partial (0-10) Total (0-15) 1 2 3 4 5 6 a 6 b 6 c 7 8 a 8 b 9 10 11 12 Costa et al. 2020 1 1 1 1 0 4 1 0* - 1 1 1 1 NC 1 1 7 11 Pimenta et al. 2019 1 1 0 1 0 3 1 1 - 1 1 1 1 NC 1 1 8 11 Boeno et al. 2019 1 1 0 1 0 3 1 0* - 1 1 1 1 NC 1 1 7 10 Maya et al. 2018 1 1 0 1 0 3 1 0* - 1 1 1 1 NC 1 1 7 10 Santos et al. 2018 1 1 0 1 0 3 1 0* - 1 1 1 1 NC 1 1 7 10 Morales-Palomo et al. 2017 1 1 0 1 0 3 1 0* - 1 1 1 1 NC 1 1 7 10 Costa et al. 2016 1 1 0 1 0 3 1 0* - 1 1 1 1 NC 1 1 7 10 Graham et al. 2016 1 1 0 1 0 3 1 0* - 1 1 1 1 NC 1 1 7 10 Angadi et al. 2015 1 1 0 1 0 3 1 1 - 1 1 1 1 NC 1 1 8 11 Lacombe et al. 2011 1 1 0 1 0 3 1 1 - 1 1 1 1 NC 1 1 8 11 Rossow et al. 2010 1 1 0 1 0 3 1 0* - 1 1 1 1 NC 1 1 7 10 Mourot et al. 2004 1 1 0 1 0 3 1 0* - 1 1 1 1 NC 1 1 7 10 *- studies that did not report the number of dropouts; however, all ended with the same number of participants who started the intervention, 6c- does not fit, all studies show an acute analysis, NC - no control group. Quality of studies: 1 = Specific eligibility criterion; 2 = Type of randomization specified; 3 = Allocation concealment; 4 = Similar groups in the baseline; 5 = The evaluators were blinded (at least for one main result); 6 = Results evaluated in 85% of participants (6a = 1 point if more than 85% were concluded; 6b = 1 point if adverse events were reported; 6c = if exercise attendance is reported); 7 = Intention to treat statistical analysis; 8 = Statistical comparison between groups were reported (8a = 1 point if comparisons between groups are reported for the variable primary outcome of interest; 8b = 1 point if statistical comparisons between groups are reported for at least one secondary measure); 9 = Point measures and measures of variability for all outcome measures were reported; 10 = Monitoring of activity in the control group; 11 = The intensity related to the exercise remained constant; 12 = Exercise volume and energy expenditure were reported. SOURCE: The author. Recife, 2019. 10