Original Articles

Short-term blood pressure variability after continuous versus interval aerobic training combined with resistance exercise in ischemic heart disease: a pilot study

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Received: 1 February 2026
Published: 25 March 2026
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Arterial hypertension and increased Blood Pressure Variability (BPV) are major prognostic determinants in patients with Ischemic Heart Disease (IHD). This randomized pilot study compared the effects of Continuous Combined Training (CCT; moderate-intensity continuous aerobic exercise plus resistance training) and Interval Combined Training (ICT; high-intensity interval aerobic exercise plus resistance training) on BPV and Blood Pressure (BP) parameters. Thirty-six clinically stable patients with IHD and hypertension were randomized to CCT or ICT for 12 weeks. Between-group changes in the study outcome were analysed by ANCOVA. Short-term systolic BPV significantly decreased in the CCT group but remained unchanged in the ICT group: [adjusted between-group difference −2.1 mmHg (95% CI: −3.2 to −1.4; p = 0.036). Resting systolic BP decreased similarly in both groups, whereas no significant changes were observed in 24-hour BP values. Peak oxygen uptake improved in both groups with a greater increase in the ICT group [adjusted between-groups difference +1.7 mL·kg⁻¹·min⁻¹ (95% CI: 0.7 to 2.2; p = 0.044). These findings suggest that, in patients with IHD, continuous combined training may be more effective than interval combined training in reducing short-term BPV, whereas interval training may confer greater improvements in aerobic capacity. Further adequately powered studies are warranted to confirm these results.

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1. Wu X, Sha J, Yin Q, et al. Global burden of hypertensive heart disease and attributable risk factors, 1990–2021: insights from the global burden of disease study 2021. Sci Rep 2025;15:14594. DOI: https://doi.org/10.1038/s41598-025-99358-1

2. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mmHg, 1990–2015. JAMA 2017;317:165–82. DOI: https://doi.org/10.1001/jama.2016.19043

3. Chen Y, Zhou ZF, Han JM, et al. Patients with comorbid coronary artery disease and hypertension: a cross-sectional study with data from the NHANES. Ann Transl Med 2022;10:745. DOI: https://doi.org/10.21037/atm-22-2766

4. Weber T, Lang I, Zweiker R, et al. Hypertension and coronary artery disease: epidemiology, physiology, effects of treatment, and recommendations: A joint scientific statement from the Austrian Society of Cardiology and the Austrian Society of Hypertension. Wien Klin Wochenschr 2016;128:467-79. DOI: https://doi.org/10.1007/s00508-016-0998-5

5. Zang J, Liang J, Zhuang X, et al. Intensive blood pressure treatment in coronary artery disease: implications from the Systolic Blood Pressure Intervention Trial (SPRINT). J Hum Hypertens 2022;36:86–94. DOI: https://doi.org/10.1038/s41371-021-00494-8

6. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024;45:3415-537. Erratum in: Eur Heart J 2025;46:1565. DOI: https://doi.org/10.1093/eurheartj/ehae778

7. Parati G, Pomidossi G, Albini F, et al. Relationship of 24-h blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens 1987;5:93–8. DOI: https://doi.org/10.1097/00004872-198702000-00013

8. Cheng X, Song C, Ouyang F, et al. Systolic blood pressure variability: risk of cardiovascular events, chronic kidney disease, dementia, and death. Eur Heart J 2025;46:2673-87. DOI: https://doi.org/10.1093/eurheartj/ehaf256

9. Saladini F, Fania C, Mos L, et al P. Short-term but not long-term blood pressure variability is a predictor of adverse cardiovascular outcomes in young untreated hypertensives. Am J Hypertens 2020;33:1030-7. DOI: https://doi.org/10.1093/ajh/hpaa121

10. Palatini P, Saladini F, Mos L, et al. Short-term blood pressure variability outweighs average 24-h blood pressure in the prediction of cardiovascular events in hypertension of the young. J Hypertens 2019;37:1419-26. DOI: https://doi.org/10.1097/HJH.0000000000002074

11. Kulkarni S, Parati G, Bangalore S, et al. Blood pressure variability: a review. J Hypertens 2025;43:929-938.

12. Wang JG, Yan P, Jeffers BW. Effects of amlodipine and other classes of antihypertensive drugs on long-term blood pressure variability: evidence from randomized controlled trials. J Am Soc Hypertens 2014;8:340-9. DOI: https://doi.org/10.1016/j.jash.2014.02.004

13. Toba, A. Effect of exercise and physical activity on blood pressure reduction. Hypertens Res 2025. https://doi.org/10.1038/s41440-025-02491-7 DOI: https://doi.org/10.1038/s41440-025-02491-7

14. McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J 2024;45:3912-4018. DOI: https://doi.org/10.1093/ehjcvp/pvae084

15. Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021;42:17–96. DOI: https://doi.org/10.1093/eurheartj/ehaa605

16. de Koning IA, Heutinck JM, Vromen T, et al. Cardiac rehabilitation vs. percutaneous coronary intervention for stable angina pectoris: A retrospective study of effects on major adverse cardiovascular events and associated healthcare costs. Eur J Prev Cardiol 2024;31:1987–90. DOI: https://doi.org/10.1093/eurjpc/zwae164

17. Ambrosetti M, Abreu A, Corrà U, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2021;28:460–95. DOI: https://doi.org/10.1177/2047487320913379

18. Dibben GO, Faulkner J, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. Eur Heart J 2023;44:452-69. DOI: https://doi.org/10.1093/eurheartj/ehac747

19. Kambic T, Šarabon N, Lainscak M, Hadžić V. Combined resistance training with aerobic training improves physical performance in patients with coronary artery disease: A secondary analysis of a randomized controlled clinical trial. Front Cardiovasc Med 2022;9:909385 DOI: https://doi.org/10.3389/fcvm.2022.909385

20. Caminiti G, Mancuso A, Raposo AF, et al. Different exercise modalities exert opposite acute effects on short-term blood pressure variability in male patients with hypertension. Eur J Prev Cardiol 2019;26:1028-31. DOI: https://doi.org/10.1177/2047487318819529

21. Caminiti G, Iellamo F, Mancuso A, et al. Effects of 12 weeks of aerobic versus combined aerobic plus resistance exercise training on short-term blood pressure variability in patients with hypertension. J Appl Physiol (1985) 2021;130:1085-92. DOI: https://doi.org/10.1152/japplphysiol.00910.2020

22. Li S, Chen X, Jiao H, et al. The effect of high-intensity interval training on exercise capacity in patients with coronary artery disease: a systematic review and meta-analysis. Cardiol Res Pract 2023;2023:7630594. DOI: https://doi.org/10.1155/2023/7630594

23. Li L, Liu X, Shen F, et al. Effects of high-intensity interval training versus moderate-intensity continuous training on blood pressure in patients with hypertension: A meta-analysis. Medicine (Baltimore) 2022;101:e32246. DOI: https://doi.org/10.1097/MD.0000000000032246

24. Romero-Vera L, Ulloa-Díaz D, Araya-Sierralta S, et al. Effects of high-intensity interval training on blood pressure levels in hypertensive patients: a systematic review and meta-analysis of randomized clinical trials. Life (Basel) 2024;14:1661. DOI: https://doi.org/10.3390/life14121661

25. Eldridge SM, Chan CL, Campbell MJ, et al PAFS consensus group. CONSORT 2010 statement: Extension to randomised pilot and feasibility trials. BMJ 2016;355:i5239. DOI: https://doi.org/10.1136/bmj.i5239

26. Kammin EJ. The 6-Minute Walk Test: Indications and Guidelines for Use in Outpatient Practices. J Nurse Pract 2022;18:608-10. DOI: https://doi.org/10.1016/j.nurpra.2022.04.013

27. Mena L, Pintos S, Queipo NV, et al. A reliable index for the prognostic significance of blood pressure variability. J Hypertens 2005;23:505–11. DOI: https://doi.org/10.1097/01.hjh.0000160205.81652.5a

28. Kulkarni S, Parati G, Bangalore S, et al. Blood pressure variability: a review. J Hypertens 2025;43:929-38. DOI: https://doi.org/10.1097/HJH.0000000000003994

29. Flight L, Julious SA. Practical guide to sample size calculations: An introduction. Pharm Stat 2016;15:68–74. DOI: https://doi.org/10.1002/pst.1709

30. Lin M, Lin Y, Li Y, Lin X. Effect of exercise training on blood pressure variability in adults: A systematic review and meta-analysis. PLoS One 2023;18:e0292020. DOI: https://doi.org/10.1371/journal.pone.0292020

31. Lopes S, Mesquita-Bastos J, Garcia C, et al. Aerobic exercise improves central blood pressure and blood pressure variability among patients with resistant hypertension: Results of the EnRicH trial. Hypertens Res Off J Jpn Soc Hypertens 2023;46:1547–57. DOI: https://doi.org/10.1038/s41440-023-01229-7

32. Seidel M, Pagonas N, Seibert FS, et al. The differential impact of aerobic and isometric handgrip exercise on blood pressure variability and central aortic blood pressure. J Hypertens 2021;39:1269–73. DOI: https://doi.org/10.1097/HJH.0000000000002774

33. Hao Z, Tran J, Lam A, et al. Aerobic, resistance, and isometric exercise to reduce blood pressure variability: a network meta-analysis of 15 clinical trials. J Clin Hypertens (Greenwich) 2025;27:e70050. DOI: https://doi.org/10.1111/jch.70050

34. Zercher S, Muth B, Stock J, Edwards DG.The effects of high-intensity interval training and moderate-intensity continuous training in sedentary individuals on blood pressure reactivity. Physiology 2025 40:S1. DOI: https://doi.org/10.1152/physiol.2025.40.S1.0878

35. MartinezAguirre-Betolaza A, Mujika I, Fryer SM, et al. Effects of different aerobic exercise programs on cardiac autonomic modulation and hemodynamics in hypertension: data from EXERDIET-HTA randomized trial. J Hum Hypertens 2020;34:709-18. DOI: https://doi.org/10.1038/s41371-020-0298-4

36. Gomes-Neto M, Durães AR, Conceição LSR, et al. High-intensity interval training versus moderate-intensity continuous training on exercise capacity and health-related quality of life in patients with coronary artery disease: An updated systematic review and meta-analysis. Braz J Phys Ther 2025;29:101137. DOI: https://doi.org/10.1016/j.bjpt.2024.101137

37. Hannan AL, Hing W, Simas V, et al. High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: a systematic review and meta-analysis. Open Access J Sports Med 2018;9:1–17. DOI: https://doi.org/10.2147/OAJSM.S150596

How to Cite



1.
Vitarelli M, Calandri C, Caminiti G, Volterrani M, Iellamo F, Perrone MA, et al. Short-term blood pressure variability after continuous versus interval aerobic training combined with resistance exercise in ischemic heart disease: a pilot study. Eur J Transl Myol [Internet]. 2026 Mar. 25 [cited 2026 Apr. 20];. Available from: https://www.pagepressjournals.org/bam/article/view/14885