Morning vs Evening Exercise for High Blood Pressure

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Michigan State University

Disqualifiers: Diabetes, Heart failure, Cancer, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

The treatment of high blood pressure, or hypertension, is multifaceted and can include pharmacological therapies (i.e., medications) and lifestyle modifications such as physical activity. Chronotherapy, which describes timing of a treatment with the body's daily rhythms, has recently been used with hypertension medications and has been shown to be effective at lowering blood pressure and reducing the risk of cardiovascular disease events. Specifically, taking medications in the evening was shown to be more effective than morning medication routines. Little information is available about the effectiveness of chronotherapy combined with exercise (i.e., planned physical activity) interventions in older adults with hypertension. The purpose of this study is to examine how exercise training performed in the morning and early evening affects blood pressure and other measures of blood vessel health in postmenopausal females with hypertension.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems likely that you can continue your medication, as the study involves exercise timing rather than medication changes.

What data supports the effectiveness of the treatment 'Morning vs Evening Exercise for High Blood Pressure'?

Research suggests that evening exercise may lead to a greater decrease in blood pressure compared to morning exercise, potentially making it more effective for managing high blood pressure. ^{1 2 3 4 5}

Is it safe to exercise in the morning or evening for people with high blood pressure?

Exercise is generally safe for most people, but there is some evidence that morning exercise might be more challenging for the heart, especially in those with heart disease. However, studies suggest that morning exercise is just as safe as afternoon exercise for cardiac patients in supervised programs, though more research is needed to confirm this for unsupervised activities. ^{1 2 3 6 7}

How does the timing of exercise affect its impact on high blood pressure treatment?

This treatment is unique because it explores the timing of exercise, showing that exercising in the evening may have a greater effect on lowering blood pressure compared to morning exercise, due to the body's natural daily rhythms. ^{1 3 4 8 9}

Eligibility Criteria

This trial is for postmenopausal females aged 55-80 with high blood pressure, who can walk without assistance. It's not for those who are very active, have had cancer in the last 5 years, currently smoke or vape, have certain chronic diseases like heart failure or diabetes, do evening shift work, or have a BMI over 39.

Inclusion Criteria

I am between 55 and 80 years old.

I am a woman who has gone through menopause.

Your blood pressure is too high, even with medication.

Exclusion Criteria

You regularly do at least 150 minutes of moderate exercise or 75 minutes of intense exercise each week.

You have a body mass index higher than 39.

You are currently smoking or using a vape.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in exercise training either in the morning or evening to assess effects on blood pressure and vascular health

6 weeks

Regular exercise sessions

Follow-up

Participants are monitored for changes in blood pressure and vascular health post-training

4 weeks

Treatment Details

Interventions

• AM vs PM Exercise Training (Behavioural Intervention)

Trial Overview The study tests if exercising in the morning vs early evening affects blood pressure and vascular health differently in older women with hypertension. Participants will undergo two phases of exercise training: one before and one after an observation period.

Participant Groups

Group I: Morning (AM) Experimental Treatment 2 Interventions

Exercise starting before 10:01 AM

Group II: Evening (PM) Experimental Treatment 2 Interventions

Exercise starting after 3:59 PM

Who Is Running the Clinical Trial?

Michigan State University

Lead Sponsor

Trials

202

Recruited

687,000+

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

Trials

3,987

Recruited

47,860,000+

Findings from Research

Post-exercise hypotension (PEH) is more pronounced after morning aerobic exercise compared to evening sessions, with systolic blood pressure reductions of -7 mmHg in the morning versus -3 mmHg in the evening, indicating a stronger hypotensive effect in the morning.

Morning exercise leads to a decrease in cardiac output, while evening exercise increases sympathovagal balance and calf blood flow, suggesting different hemodynamic and autonomic responses based on the time of day.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Post-Exercise Hypotension and Its Mechanisms Differ after Morning and Evening Exercise: A Randomized Crossover Study. de Brito, LC., Rezende, RA., da Silva Junior, ND., et al.[2022]

The review of studies suggests that morning exercise does not inherently increase the risk of cardiac events for cardiac patients in supervised rehabilitation programs, indicating it may be as safe as exercising in the afternoon.

However, there is a lack of comprehensive research on how the time of day affects cardiovascular responses to exercise in individuals with heart disease, highlighting the need for further studies to understand the potential risks associated with spontaneous physical activity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chronobiological considerations for exercise and heart disease. Atkinson, G., Drust, B., George, K., et al.[2018]

Evening aerobic training (ET) significantly reduced both clinic and ambulatory blood pressure in treated hypertensive men compared to morning training (MT) and a control group, indicating a greater hypotensive effect from evening exercise.

The reductions in blood pressure from ET were linked to decreased systemic vascular resistance and improved vasomotor sympathetic modulation, suggesting that the timing of exercise can influence its effectiveness in managing hypertension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Morning versus Evening Aerobic Training Effects on Blood Pressure in Treated Hypertension. Brito, LC., Peçanha, T., Fecchio, RY., et al.[2019]

In prehypertensive men, morning exercise led to higher heart rates throughout the day compared to a control session, indicating a potential increase in cardiovascular workload.

Evening exercise resulted in lower nighttime blood pressure and reduced cardiac work, suggesting that exercising in the evening may be beneficial for managing blood pressure levels during sleep.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Separate aftereffects of morning and evening exercise on ambulatory blood pressure in prehypertensive men. Brito, LC., Rezende, RA., Mendes, C., et al.[2018]

A systematic review and meta-analysis of 11 studies found that exercising in the morning or evening does not significantly affect systolic or diastolic blood pressure in adults.

Similarly, the timing of exercise (morning vs. evening) showed no significant impact on blood glucose levels, indicating that the time of day may not be a crucial factor for these cardiovascular risk factors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Time of the day of exercise impact on cardiovascular disease risk factors in adults: a systematic review and meta-analysis. Sevilla-Lorente, R., Carneiro-Barrera, A., Molina-Garcia, P., et al.[2023]

In a study of patients with established heart disease, the incidence of cardiac events during supervised exercise was low, with 5 events occurring in 168,111 patient-hours in the morning and 2 events in 84,491 patient-hours in the afternoon.

The risk of experiencing a cardiac event was not significantly different between morning and afternoon exercise sessions, suggesting that both times are safe for patients engaging in regular, submaximal exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Should patients with heart disease exercise in the morning or afternoon? Murray, PM., Herrington, DM., Pettus, CW., et al.[2004]

Intermediate chronotype adults with obesity exhibited higher blood pressure (BP) and heart rate (HR) responses during exercise compared to morning chronotype adults, indicating a potential cardiovascular risk associated with this chronotype.

However, when accounting for aerobic fitness (V̇o2max), the differences in BP responses were no longer significant, suggesting that improved fitness may mitigate these exaggerated BP responses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise blood pressure and heart rate responses to graded exercise testing in intermediate versus morning chronotypes with obesity. Remchak, ME., Dosik, JK., Pappas, G., et al.[2023]

In hypertensive men, post-exercise hypotension (PEH) was significantly greater after evening exercise compared to morning exercise in those taking angiotensin II receptor blockers (ARB), but this effect was not observed in those taking angiotensin-converting enzyme inhibitors (ACEi).

The study found that ACEi use blunted the evening potentiation of PEH, resulting in a smaller decrease in systolic blood pressure after evening exercise compared to ARB users, indicating that the type of antihypertensive medication can influence the body's response to exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of ACEi and ARB on post-exercise hypotension induced by exercises conducted at different times of day in hypertensive men. Brito, LC., Azevêdo, L., Peçanha, T., et al.[2020]

A study of 2,343 Japanese male workers found that exercising in the evening (18:00-21:00) significantly lowers blood pressure compared to other times of day, suggesting optimal timing for exercise to manage hypertension.

Participants with higher blood pressure levels tended to exercise less in the evening, indicating that regular evening physical activity may be crucial for effective blood pressure control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between blood pressure and circadian timing of physical activity of Japanese workers. Imamura, M., Tahara, Y., Suiko, T., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Post-Exercise Hypotension and Its Mechanisms Differ after Morning and Evening Exercise: A Randomized Crossover Study. [2022]

2. New Zealand pubmed.ncbi.nlm.nih.gov

Chronobiological considerations for exercise and heart disease. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Morning versus Evening Aerobic Training Effects on Blood Pressure in Treated Hypertension. [2019]

4. Italy pubmed.ncbi.nlm.nih.gov

Separate aftereffects of morning and evening exercise on ambulatory blood pressure in prehypertensive men. [2018]

5. Australia pubmed.ncbi.nlm.nih.gov

Time of the day of exercise impact on cardiovascular disease risk factors in adults: a systematic review and meta-analysis. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Should patients with heart disease exercise in the morning or afternoon? [2004]

7. United States pubmed.ncbi.nlm.nih.gov

Exercise blood pressure and heart rate responses to graded exercise testing in intermediate versus morning chronotypes with obesity. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Effects of ACEi and ARB on post-exercise hypotension induced by exercises conducted at different times of day in hypertensive men. [2020]

9. Switzerland pubmed.ncbi.nlm.nih.gov

Association between blood pressure and circadian timing of physical activity of Japanese workers. [2022]