Key result
Isometric bilateral knee extension significantly impaired myocardial work efficiency (-8%, p=0.002) compared to handgrip and control in trained hypertensive patients with ischemic heart disease.
Why the study?
Isometric exercise effectively reduces BP, but its acute effects on myocardial work have been poorly studied in patients with hypertension and underlying IHD.
Do different isometric exercise modalities (bilateral knee extension vs handgrip) affect myocardial work in trained hypertensive patients with ischemic heart disease?
RCT (n=48)
1:1:1 ratio
Do different isometric exercise modalities (bilateral knee extension vs handgrip) affect myocardial work in trained hypertensive patients with ischemic heart disease?
Isometric bilateral knee extension, but not handgrip, impairs myocardial work efficiency and evokes a greater hemodynamic response in trained hypertensive patients with ischemic heart disease.
Clinicians should avoid bilateral knee extension during isometric training in these patients; extends evidence on modality-specific myocardial effects.
Background: Isometric exercise effectively reduces blood pressure (BP) but its effects on myocardial work have been poorly studied. For the present study, we compared acute changes in myocardial work during two different isometric exercises, namely, bilateral knee extension and handgrip, in patients with hypertension and underlying ischemic heart disease (IHD). Methods: This was a randomized pilot study in which 48 stable, trained patients with hypertension and IHD were enrolled. Patients were randomly assigned to perform a single session of bilateral knee extension (IKE) or handgrip (IHG) exercises or no exercise (control), with a 1:1:1 ratio. Both exercises were performed at 30% of maximal voluntary contraction and lasted three minutes. Echocardiography and BP measurements were performed at rest, during the exercise, and after ten minutes of recovery. Results: Both exercises were tolerated well, and no side effects occurred. During the exercise, the systolic BP increased significantly in the IKE group compared with the IHG and control groups (ANOVA p < 0.001). Left ventricular global longitudinal strain decreased significantly in the IKE group (−21%) compared with the IHG and control groups (ANOVA p 0.002). The global work index increased significantly in the IKE group (+28%) compared with the IHG and control groups (ANOVA p 0.034). Global constructive work and wasted work increased significantly in the IKE group compared with the IHG and control groups (ANOVA p 0.009 and <0.001, respectively). Global work efficiency decreased significantly in the IKE group (−8%) while remaining unchanged in the IHG and control groups (ANOVA p 0.002). Conclusions: Myocardial work efficiency was impaired during isometric bilateral knee extension but not during handgrip, which evoked a limited hemodynamic response.
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Caminiti et al. (2025) conducted an RCT in hypertension and ischemic heart disease (n=48). Bilateral knee extension (IKE) or handgrip (IHG) exercises vs. no exercise (control) was evaluated on Global work efficiency (-8%, p=0.002). Isometric bilateral knee extension significantly impaired myocardial work efficiency (-8%, p=0.002) compared to handgrip and control in trained hypertensive patients with ischemic heart disease.
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