**2. Effects of exercise training in the arterial hypertension**

For the past two decades, aerobic exercise (AE) has been used as a non-pharmacological therapy for cardiovascular disease control [11]. During an acute session of aerobic exercise, it is possible to verify the increase of specific cardiovascular parameters, such as cardiac output and blood pressure [12]. Interestingly, after the session, the values return to normal. However, blood pressure may fall below preexercise values; a phenomenon called post-exercise hypotension [13]. Additionally, aerobic training promotes significant changes in cardiovascular parameters. Long-term moderate-intense exercise promotes a reduction in arterial stiffness [14], a reduction in blood pressure [15], and an increase in cardiac efficiency [16]. Similarly, strength training is also helpful in lowering blood pressure as well as improving cardiovascular function [17].

Previous studies have shown that aerobic exercise causes structural and functional adaptations in the cardiovascular system [18, 19]. Thus, the heart has an essential morphological adaptation, characterized by an increase in the ventricular cavity, which is necessary for the more excellent supply of oxygen and nutrients [20]. The vascular system presents significant changes, such as increased vascular density due to the formation of new blood capillaries, associated with a higher vasodilator capacity [20]. RT has been well used to increase muscle strength, power, and endurance. However, it is essential to highlight how these effects are related to cardiovascular health in healthy individuals or those with CVD. Although RT is encouraged, the evidence is still controversial. However, evidence demonstrates a significant blood pressure reduction in unmedicated and medicated hypertensive patients [21].

Regarding the intensity of exercise, this may influence cardiovascular responses [22]. However, an optimal intensity for cardioprotection is not yet known [5]. In healthy individuals, cardiovascular changes seem to be more significant when subjected to the most intense effort [23]. Although high intensities have shown important outcomes for cardiovascular health, such as improved endothelial function, individuals with CVD need greater care in the assessment and prescription of intense exercise [5].

Arterial hypertension (AH) is considered as a major risk factor for diseases such as stroke and acute myocardial infarction [24]. SAH is diagnosed in individuals with sustained systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mm Hg [25]. The high prevalence of hypertension is related to

**73**

*Exercise Training and Cardiac Remodeling DOI: http://dx.doi.org/10.5772/intechopen.89311*

als to chronic exercise [31].

to reduce blood pressure levels.

observed, with their signaling pathways.

non-modifiable factors such as ethnicity, gender, genetic factors, as well as modifiable environmental factors such as eating habits, physical activity level, smoking, and alcohol use, among others [24]. However pharmacological strategies for the treatment of hypertension are effective in controlling the disease, side effects, and health-care expenses which are considered relevant problems. In this sense, physical exercise has been considered as one of the most important and efficient strategies

Among the potential effects of exercise on hypertensive patients, post-exercise

Exercise recommendations for hypertension treatment and prevention are based on existing evidence and are continually updated [32]. Thus, aerobic, resistance, and combined exercise present as effective alternatives (90–150 min per week at moderate intensity) [33]. Besides, other alternative strategies such as tai chi chuan, yoga, and even Kaatsu training have shown promising results, but due to the low body of evidence, they were considered limited to include the new recommendations [34, 35]. A randomized controlled trial (RCT) of 207 hypertensive subjects showed that 120 minutes of walking at moderate intensity without dietary control twice a week was able to reduce cardiovascular disease [36]. Also, during controlled eating, moderate aerobic exercise reduced blood pressure, total cholesterol levels,

However, high-intensity interval training (HIIT) in cardiovascular responses in hypertensive patients has been increasingly discussed [15]. Therefore, another RCT with 245 hypertensive men (45–70 years) showed that 8 weeks of interval training performed at intensities of 60–78% (heart rate reserve—HRR) 3 times a week was able to promote a decreasing effect in reducing blood pressure and promote an increase in high-density lipoprotein (HDL) levels, improving lipid profile [38]. Additionally, a protocol using higher intensities (85–90% of HRR) is equally effective in promoting hypotensive effect in elderly hypertensive individuals, besides promoting increased nitric oxide, and appeals to important hemodynamic modulators [39]. RT is part of the recommendation for treatment and prevention of hypertension. Recently, a systematic meta-analysis review showed that RT, performed 3 times a week, with loads of 40–80% of 1 maximal repetition (MR), can lower blood pressure in individuals with high blood pressure [40]. Thus, RT has been a valuable alternative or complementary treatment

**3. Characteristics of cardiac remodeling: effects of exercise training**

The myocardium is primarily composed of myocytes, vessels, and interstitial collagen matrix. Changes in the composition of these compartments reflect the process of cardiac remodeling that is closely associated with cardiac dysfunction [41]. Cardiac hypertrophy is more often related to these events, and according to the type of hypertrophy (physiological or pathological), different models of it are

Cardiac remodeling can be defined as the set of cardiac molecular, cellular, and interstitial modifications that will be clinically displayed by changes in cavity

hypotension is of clinical relevance because it indicates a reduction in the progression of cardiovascular disease, and low resting BP values are associated with reduced risk of death [28]. Interestingly, hypertensive individuals have more significant reductions in blood pressure when compared to non-hypertensive individuals, both acutely and chronically [29, 30]. Besides, it has recently been proposed that acute response may be able to predict the responsiveness of hypertensive individu-

for non-pharmacological control of hypertension [26, 27].

medication use, and the risk of cardiovascular events [37].

#### *Exercise Training and Cardiac Remodeling DOI: http://dx.doi.org/10.5772/intechopen.89311*

*Sports, Health and Exercise Medicine*

aerobic exercise [9, 10].

remodeling associated with physical exercise.

improving cardiovascular function [17].

Aerobic exercise is considered a strategy for the prevention/treatment of arterial hypertension in reducing the risk of cardiovascular disease. The intensity of these exercises ranges from 40 to 60% of VO2max or 11 to 14 of the perceived effort (Borg Scale). Current studies show that reductions in blood pressure by aerobic exercise are directly linked to intensity, so more vigorous activity may result in more significant reductions in blood pressure [6]. Frequency can range from 3 to 7 days a week [7, 8], and it is recommended to use large muscle groups, lasting 30–60 min [6]. Besides, several studies using resistance training (RT) as an intervention proposal are performed. Recent data indicate that RT has antihypertensive effects and can be used as a treatment strategy when combining with

Consequently, exercise adaptations result in structural and physiological changes imposed on the heart. In this sense, cardiac remodeling occurs in different situations, which may be beneficial or harmful and widely studied in several aspects. Therefore, the purpose of this chapter is to review the aspects of cardiac

For the past two decades, aerobic exercise (AE) has been used as a non-pharmacological therapy for cardiovascular disease control [11]. During an acute session of aerobic exercise, it is possible to verify the increase of specific cardiovascular parameters, such as cardiac output and blood pressure [12]. Interestingly, after the session, the values return to normal. However, blood pressure may fall below preexercise values; a phenomenon called post-exercise hypotension [13]. Additionally, aerobic training promotes significant changes in cardiovascular parameters. Long-term moderate-intense exercise promotes a reduction in arterial stiffness [14], a reduction in blood pressure [15], and an increase in cardiac efficiency [16]. Similarly, strength training is also helpful in lowering blood pressure as well as

Previous studies have shown that aerobic exercise causes structural and functional adaptations in the cardiovascular system [18, 19]. Thus, the heart has an essential morphological adaptation, characterized by an increase in the ventricular cavity, which is necessary for the more excellent supply of oxygen and nutrients [20]. The vascular system presents significant changes, such as increased vascular density due to the formation of new blood capillaries, associated with a higher vasodilator capacity [20]. RT has been well used to increase muscle strength, power, and endurance. However, it is essential to highlight how these effects are related to cardiovascular health in healthy individuals or those with CVD. Although RT is encouraged, the evidence is still controversial. However, evidence demonstrates a significant blood pressure reduction in unmedicated and medicated hypertensive patients [21]. Regarding the intensity of exercise, this may influence cardiovascular responses [22]. However, an optimal intensity for cardioprotection is not yet known [5]. In healthy individuals, cardiovascular changes seem to be more significant when subjected to the most intense effort [23]. Although high intensities have shown important outcomes for cardiovascular health, such as improved endothelial function, individuals with CVD need greater care in the assessment and prescription of

Arterial hypertension (AH) is considered as a major risk factor for diseases such as stroke and acute myocardial infarction [24]. SAH is diagnosed in individuals with sustained systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mm Hg [25]. The high prevalence of hypertension is related to

**2. Effects of exercise training in the arterial hypertension**

**72**

intense exercise [5].

non-modifiable factors such as ethnicity, gender, genetic factors, as well as modifiable environmental factors such as eating habits, physical activity level, smoking, and alcohol use, among others [24]. However pharmacological strategies for the treatment of hypertension are effective in controlling the disease, side effects, and health-care expenses which are considered relevant problems. In this sense, physical exercise has been considered as one of the most important and efficient strategies for non-pharmacological control of hypertension [26, 27].

Among the potential effects of exercise on hypertensive patients, post-exercise hypotension is of clinical relevance because it indicates a reduction in the progression of cardiovascular disease, and low resting BP values are associated with reduced risk of death [28]. Interestingly, hypertensive individuals have more significant reductions in blood pressure when compared to non-hypertensive individuals, both acutely and chronically [29, 30]. Besides, it has recently been proposed that acute response may be able to predict the responsiveness of hypertensive individuals to chronic exercise [31].

Exercise recommendations for hypertension treatment and prevention are based on existing evidence and are continually updated [32]. Thus, aerobic, resistance, and combined exercise present as effective alternatives (90–150 min per week at moderate intensity) [33]. Besides, other alternative strategies such as tai chi chuan, yoga, and even Kaatsu training have shown promising results, but due to the low body of evidence, they were considered limited to include the new recommendations [34, 35]. A randomized controlled trial (RCT) of 207 hypertensive subjects showed that 120 minutes of walking at moderate intensity without dietary control twice a week was able to reduce cardiovascular disease [36]. Also, during controlled eating, moderate aerobic exercise reduced blood pressure, total cholesterol levels, medication use, and the risk of cardiovascular events [37].

However, high-intensity interval training (HIIT) in cardiovascular responses in hypertensive patients has been increasingly discussed [15]. Therefore, another RCT with 245 hypertensive men (45–70 years) showed that 8 weeks of interval training performed at intensities of 60–78% (heart rate reserve—HRR) 3 times a week was able to promote a decreasing effect in reducing blood pressure and promote an increase in high-density lipoprotein (HDL) levels, improving lipid profile [38]. Additionally, a protocol using higher intensities (85–90% of HRR) is equally effective in promoting hypotensive effect in elderly hypertensive individuals, besides promoting increased nitric oxide, and appeals to important hemodynamic modulators [39]. RT is part of the recommendation for treatment and prevention of hypertension. Recently, a systematic meta-analysis review showed that RT, performed 3 times a week, with loads of 40–80% of 1 maximal repetition (MR), can lower blood pressure in individuals with high blood pressure [40]. Thus, RT has been a valuable alternative or complementary treatment to reduce blood pressure levels.
