Differential Effects of Twice vs. Four Times Weekly Combined Exercise Training in Aging Adults With Hypertension: A Randomized Clinical Trial.

In the intention-to-treat analysis, no significant differences between groups were observed in office and ambulatory blood pressure.

• 98 participants were randomized (CT2, n=49; CT4, n=49)
• 66% women; mean age 64 ± 7 years
• Both groups trained at the same total weekly volume for 12 weeks
• No between-group differences were found for either office BP or ambulatory BP in the intention-to-treat analysis

Within the CT4 group, office systolic and diastolic blood pressure significantly decreased after training in the intention-to-treat analysis.

• Office systolic BP decreased by -8 mmHg (p=0.001) in CT4
• Office diastolic BP decreased by -3 mmHg (p=0.001) in CT4
• Office systolic BP decreased by -4 mmHg (p=0.032) in CT2
• CT4 trained four times per week while CT2 trained twice per week at equivalent total weekly volume

In the per-protocol analysis, office systolic blood pressure was significantly lower in CT4 than CT2 after training.

• 63 participants were retained for per-protocol analysis after excluding those with low adherence (<80%) or missing post-intervention data
• Office systolic BP was -6 mmHg lower in CT4 compared to CT2 (p=0.049)
• This between-group difference was only apparent in the per-protocol analysis, not the intention-to-treat analysis

CT4 demonstrated significant reductions in 24-hour ambulatory systolic and diastolic blood pressure after training.

• 24-h systolic BP decreased by -4 mmHg (p=0.012) in CT4
• 24-h diastolic BP decreased by -2 mmHg (p=0.010) in CT4
• These reductions were observed in the per-protocol analysis
• CT2 did not demonstrate significant reductions in 24-h ambulatory BP

Cardiorespiratory fitness improved in CT4 but not in CT2.

• CT4 showed an 8% improvement in cardiorespiratory fitness (p<0.001)
• CT2 did not show a statistically significant improvement in cardiorespiratory fitness
• Cardiorespiratory fitness was assessed at baseline and post-intervention
• This differential improvement occurred despite equivalent total weekly exercise volume between groups

The additional blood pressure benefits of higher training frequency appeared dependent on high protocol adherence.

• Participants with adherence below 80% were excluded from the per-protocol analysis
• Between-group differences in office systolic BP (-6 mmHg, p=0.049) only emerged in the per-protocol analysis
• The intention-to-treat analysis showed no significant between-group differences
• Authors concluded that 'these additional benefits appear to be dependent on high protocol adherence'

The trial compared combined resistance and aerobic exercise training at two different frequencies while maintaining equivalent total weekly volume over 12 weeks.

• Participants were randomized to CT2 (twice per week, n=49) or CT4 (four times per week, n=49)
• Total weekly volume was kept equivalent at 150 min/week in both groups
• Primary outcome was 24-h ambulatory BP; secondary outcomes included office BP and physical fitness
• Trial registration: ClinicalTrials.gov Identifier: NCT04218903