Key result
Combined training four vs. twice weekly shows no significant benefit for 24-hour systolic BP variability.
Why the study?
Elevated blood pressure variability is associated with cardiovascular mortality independent of mean blood pressure levels, but the evidence regarding the influence of exercise on short-term variability is inconclusive and the impact of different weekly training frequencies was unknown.
Does combined training performed four times per week compared to twice per week (with matched total weekly volume) improve short-term blood pressure variability at 12 weeks in adults aged 50-80 years with hypertension?
RCT (n=47)
Single-blind (outcome assessors blinded)
Parallel-group, 1:1 allocation ratio
No
Does combined training performed four times per week compared to twice per week (with matched total weekly volume) improve short-term blood pressure variability at 12 weeks in adults aged 50-80 years with hypertension?
Mean Difference: -1.1 (95% CI -2.8–0.5)
Absolute Event Rate: -2% vs -1%
p-value: p=0.184
In older adults with hypertension, 12 weeks of combined aerobic and resistance training reduced 24-hour and daytime systolic blood pressure average real variability regardless of whether the weekly exercise volume was distributed across two or four sessions per week.
Twice-weekly combined training may suffice when volume is matched; small RCT leaves open optimal frequency for BP variability reduction.
Background Elevated blood pressure (BP) variability is associated with cardiovascular mortality, independent of mean BP levels. While exercise may influence short-term BP variability, evidence remains inconclusive, and the impact of different weekly training frequencies is unknown. Purpose To compare the effects of a pragmatic combined training (CT) intervention performed twice vs. four times per week on short-term BP variability in older adults with hypertension. Methods In this randomized clinical trial, men and women aged 50–80 years were assigned to CT twice (CT-2) or four (CT-4) times per week for 12 weeks. The protocol adopted a pragmatic approach, utilizing a weekly exercise dosage: 120–160 min/week and intensity by perceived exertion (4–6). Total volume and overload were matched between groups. Short-term BP variability was assessed via average real variability (ARV) and standard deviation (SD) for 24-hour, daytime, and nighttime periods. Results Forty-seven participants (CT-2: n = 27; CT-4: n = 20) with ≥80% attendance were analyzed. No significant group × time interactions were observed. However, both CT-4 and CT-2 significantly reduced 24-hour systolic ARV (CT-4: −2 ± 1 mmHg, P = 0.003; CT-2: −1 ± 1 mmHg, P = 0.032) and daytime systolic ARV (CT-4: −3 ± 1 mmHg, P = 0.008; CT-2: −2 ± 1 mmHg, P = 0.019). Only CT-2 showed reduced daytime diastolic ARV (−1 ± 1 mmHg; P = 0.016). SD-based indices remained unchanged. Conclusion Twelve weeks of combined training was not associated with statistically significant differences in short-term BP variability between training frequency groups (2 vs. 4) among aging adults with hypertension. Reductions in short-term systolic BP variability were observed over time in both training groups. Clinical Trial Registration: https://clinicaltrials.gov/study/NCT04218903 , NCT04218903.
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Domingues et al. (2026) conducted an RCT in Hypertension (n=47). Combined resistance and aerobic training four times per week (CT-4) vs. Combined resistance and aerobic training twice per week (CT-2; 20-30 min resistance + 40-50 min aerobic per session, volume-matched) was evaluated on Change in 24-hour systolic blood pressure average real variability (ARV, mmHg) (MD -1.1 mmHg, 95% CI -2.8 to 0.5, p=0.184). Combined training four vs. twice weekly showed no significant difference in 24-h systolic BP variability (MD -1.1 mmHg, P=0.184), though both reduced ARV over 12 weeks.
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