Similar Postexercise Hypotension After MICT,

HIIT, and SIT Exercises in Middle-Age Adults

SETH F. MCCARTHY1, EMILY J. FERGUSON1,2, CLAUDIA JAROSZ1, KENJI A. KENNO3, and TOM J. HAZELL1
1
Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, CANADA; 2School of
Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, CANADA; and 3Faculty of Human Kinetics, University
of Windsor, Windsor, Ontario, CANADA

ABSTRACT
MCCARTHY, S. F., E. J. FERGUSON, C. JAROSZ, K. A. KENNO, and T. J. HAZELL. Similar Postexercise Hypotension After MICT,
HIIT, and SIT Exercises in Middle-Age Adults. Med. Sci. Sports Exerc., Vol. 55, No. 1, pp. 101-109, 2023. Introduction: Acute bouts of
moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) transiently lower systolic blood pressure (SBP)
and diastolic blood pressure (DBP) in the hours after termed postexercise hypotension (PEH); however, the effects of sprint interval training
(SIT) exercise have yet to be explored in middle-age adults. Although previous work has found no effect of exercise intensity on PEH, no
study has compared submaximal, near maximal, and supramaximal intensities, specifically in middle-age adults where blood pressure (BP)
management strategies may be of greater importance. Purpose: This study examined the effects of MICT, HIIT, and SIT exercises on
PEH in the immediate (≤2 h) and 24 h after exercise specifically in middle-age adults. Methods: Fourteen participants (10 female; age,
46 ± 9 yr; SBP, 116 ± 11 mm Hg; DBP, 67 ± 6 mm Hg; one hypertensive, four prehypertensive, nine normotensive) had their BP measured
before, immediately (15, 30, 60, 120 min), and over 24 h after four experimental sessions: 1) 30-min MICT exercise (65% maximal oxygen
consumption), 2) 20-min HIIT exercise (10  1 min at 90% maximum heart rate with 1-min rest), 3) 16-min SIT exercise (8  15 s all-out
sprints with 2-min rest), and 4) no-exercise control. Postexercise BP was compared with no-exercise control. Results: PEH was similar for all
exercise sessions for SBP (P = 0.388, η2p = 0.075) and DBP (P = 0.206, η2p = 0.108). Twenty-four-hour average SBP was similar for all sessions
P = 0.453, η2p = 0.069), and DBP was similar over 24 h except after MICT exercise compared with HIIT exercise (P = 0.018, d = 1.04).
Conclusions: In middle-age adults, MICT, HIIT, and SIT exercises are effective at reducing SBP; however, the effects on DBP are
smaller, and neither reductions are sustained over 24 h. Key Words: BLOOD PRESSURE, AMBULATORY BLOOD PRESSURE,
MODERATE-INTENSITY CONTINUOUS TRAINING, HIGH-INTENSITY INTERVAL TRAINING, SPRINT INTERVAL
TRAINING, ADULTS

APPLIED SCIENCES
E
xercise has beneficial effects on blood pressure (BP) inverse relationship has been reported between age and BP re-
because a single bout of aerobic exercise can induce ductions, as well as body mass index and reductions in systolic
postexercise hypotension (PEH), which is a reduction BP (SBP) (7). This meta-analysis also noted a significant but
in resting BP in the subsequent hours after the exercise session minimal difference (a difference of 1 mm Hg) in the response
(1,2). PEH is generally characterized by a reduction in total pe- between males and females (7), although direct comparisons
ripheral resistance that is not completely offset by an increase have shown no differences (2,8–11).
in cardiac output (1–6); however, in some cases, a reduction in PEH has most commonly been elicited after moderate-intensity
cardiac output is responsible (6). The response involves both a continuous training (MICT; 30–60 min at 60%–70% maximal ox-
vascular and neural component (1), and the mechanism can ygen consumption (V̇O2max)) exercise in normotensive (SBP/
change based on participant age, BP status, body composition, diastolic BP (DBP); −7/−4 mm Hg [5,10–17]) and hyperten-
and body position (6). Although the PEH response is elicited sive populations (−11/−5 mm Hg [3,5,17–21]). However,
regardless of the participant or exercise characteristics (7), an high-intensity interval training (HIIT) exercise has become
an increasingly popular exercise modality characterized by pe-
riods of near maximal effort interspersed with periods of re-
covery (22), demonstrating similar improvements in physio-
Address for correspondence: Tom J. Hazell, Ph.D., Department of Kinesiology
and Physical Education, Wilfrid Laurier University, 75 University Ave W, logical outcomes such as V̇O2max, body fat, and resting BP
Waterloo, ON N2L 3C5, Canada; E-mail: [email protected]. (23–25) as MICT exercise but with reduced training volume
Submitted for publication March 2022. and time commitment (22). Similarly, HIIT exercise has elic-
Accepted for publication July 2022. ited PEH in normotensive (−7/−4 mm Hg [8,10,12,13,26])
0195-9131/23/5501-0101/0 and hypertensive populations (−12/−8 mm Hg; [26,27]). Sprint
MEDICINE & SCIENCE IN SPORTS & EXERCISE® interval training (SIT) exercise, a more intense version of HIIT
Copyright © 2022 by the American College of Sports Medicine exercise characterized by short periods of supramaximal effort
DOI: 10.1249/MSS.0000000000003017 interspersed with periods of rest (22), has also elicited PEH in

101

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 normotensive populations (−7/−5 mm Hg), although it has This is similar (10–15 participants) to previous work comparing
only been characterized in younger populations (≤40 yr the effect of exercise intensity on PEH (10,12,13). Data collec-
[10,12,28–31]). tion for this study began in July of 2019 and thus was
Most studies show little to no effect of exercise intensity on interrupted multiple times by regional COVID-19 lockdowns.
PEH after MICT exercise (2,14,21,32,33); however, these Twenty-eight participants completed the familiarization ses-
studies all compare submaximal intensities (15–45 min, sion, six participants did not return after regional COVID-19 re-
40%–75% V̇O2max) that are of low to moderate intensity. strictions were lifted, seven participants dropped out because of
Meta-analyses and systematic reviews comparing the effects time constraints, and one participant dropped out because of
of HIIT and MICT exercise on PEH have produced conflicting personal reasons. Thus, 14 participants completed all four ex-
evidence. The first in this area suggested superior PEH re- perimental sessions (Table 1). Using updated (37) and tradi-
sponses after HIIT exercise compared with MICT exercise tional (38) hypertension guidelines, the sample was composed
(34); however, a more recent meta-analysis with a greater of one participant living with hypertension (medicated), four
number of studies suggested similar PEH after MICT and participants living with prehypertension, and nine normotensive
HIIT exercises (35). Notably, these articles misclassify SIT ex- participants. Participants were nonsmokers and screened using
ercise as HIIT exercise preventing appropriate comparisons the Physical Activity Readiness Questionnaire+. Participants
between exercise protocols. Although the changes in BP seem were considered middle-age for the purposes of this study if
to be similar between aerobic exercise protocols (35), the they were between the ages of 30 and 60 yr during the time
mechanisms seem to differ (36). Studies have noted greater of participation, and their physical activity level was assessed
cardiac output offset by greater reductions in total peripheral using the Canadian Society for Exercise Physiology Physical
resistance (10), larger reductions in baroreflex sensitivity and Activity and Sedentary Behaviour Questionnaire (39). This
heart rate variability (27), and greater reductions in systemic was reflected in our data, as participant’s V̇O2max ranged from
and cutaneous vascular resistance (26) after HIIT exercise good to excellent based on their age and biological sex. Exclu-
compared with MICT exercise. The only study to directly sion criteria include any medical history of cardiovascular dis-
compare MICT, HIIT, and SIT exercises demonstrated that, ease as well as the use of β-blockers to treat hypertension.
in normotensive participants, HIIT exercise elicited a greater The experimental procedures were explained in full detail to
duration PEH response compared with MICT and SIT exer- all participants, and all provided written informed consent be-
cises when measured for 3 h after exercise (12). To date, no fore any data collection. The Research Ethics Board at Wilfrid
studies have examined the effect of SIT exercise on PEH spe- Laurier University approved this study.
cifically in a middle-age population where BP management Study design. Participants completed four experimental
strategies may be of greater importance. The identification of sessions (~3.5 h each) during which BP was measured. Exper-
the PEH response has clinical importance because it has a imental sessions consisted of three exercise sessions: (i) MICT
APPLIED SCIENCES

moderate-strong correlation (r > 0.45) with chronic BP reduc- exercise, (ii) HIIT exercise, (iii) SIT exercise, and one
tions (15,18), while also assisting in the detection of responders no-exercise control session (CTRL). The order of experimen-
and nonresponders to different exercise protocols (13). Acute re- tal sessions was systematically rotated to avoid any learning
ductions of −7/−4 mm Hg (18) and −9/−4 mm Hg (15) were effects. Participants were instructed to refrain from physical
moderately-strongly correlated (r > 0.65) with chronic reductions activity, alcohol, and caffeine for at least 12 h before each ex-
(−9/−7 and −7/−5 mm Hg) after 4- (15) and 8-wk MICT (18). perimental session.
To our knowledge, no study has compared the effect of Preexperimental procedures. All participants com-
MICT, HIIT, and SIT exercises on PEH specifically in pleted a laboratory familiarization session before data collec-
middle-age adults, both in the immediate hours after exercise tion to introduce testing procedures and reduce any learning
and in the 24-h period afterward. Therefore, the purpose of this effects during subsequent experimental sessions. Participants
study was to examine the effect of MICT, HIIT, and SIT exer- had their BP measured four times using an automated
cises on PEH specifically in middle-age adults. PEH was mea- oscillometric device (Dinamap Carescape V100; Critikon,
sured in the immediate hours after exercise (<2 h) in a labora- Tampa, FL) with 2 min between each measurement. BP was
tory setting, and ambulatory BP (AMBP) was measured over always measured on the left arm, and an appropriately sized
the remainder of the day (~24 h) throughout activities of daily cuff was selected based on the circumference of the partici-
living. We hypothesized that the PEH response will be similar pant’s upper arm in line with the manufacturer’s instructions.
after MICT, HIIT, and SIT exercises in the immediate (<2 h) The first measurement was discarded, and the final three were
and 24 h after exercise.
TABLE 1. Participant characteristics (n = 14).
Sex (men/women) 4/10
MATERIALS AND METHODS Age (yr) 46 ± 9
Height (m) 1.71 ± 0.07
Participants. A sample size calculation was completed Weight (kg) 76.4 ± 12.5
Body mass index (kg·m−2) 26.0 ± 3.8
a priori using GPower 3.1 based on previous work examining V̇O2max (mL·kg−1·min−1) 33.41 ± 8.56
changes in BP after HIIT in hypertensive and normotensive par- Resting SBP (mm Hg) 116 ± 11
Resting DBP (mm Hg) 67 ± 6
ticipants (26) demonstrating that 12 participants were necessary.

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Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
averaged to determine the participant’s resting BP. Partici- was measured three times, consecutively (~30 s between mea-
pants had their V̇O2max determined during a graded exercise surements), the first measurement was discarded and the re-
test to exhaustion performed on a motorized treadmill (4Front; maining 2 were averaged. After the last BP measurements,
Woodway, Waukesha, WI). V̇O2 and V̇CO2 were measured participants had the opportunity to shower and then had an
continuously using an online gas collection system (MAX-II; AMBP monitor (ABP320) attached to their left arm. The de-
AEI Technologies, Pittsburgh, PA), which was calibrated with vice was worn for 24 h and automatically measured BP every
gases of known concentrations and a 3-L syringe for flow and 30 min during the daytime and once per hour during the
silicon facemask (Vmask; Hans Rudolph Inc., Shawnee, KS). nighttime. The daytime and nighttime periods were based
After a 5-min treadmill warm-up, each participant ran at a on each participant’s typical sleep schedule and were stan-
self-selected pace (4–7 mph) with incremental increases in dardized within participant. BP values were averaged for
grade (2%) applied every 2 min until volitional fatigue. the 24-h period. In addition, to try and explore the time
Heart rate (HR) was recorded beat-to-beat throughout the test course of the PEH response outside of the laboratory set-
using an integrated HR monitor (FT1; Polar Electro, Quebec, ting, AMBP values were averaged together into 2-, 4-, 6-,
Canada). V̇O2max was taken as the greatest 30-s average in the and 8-h postsession bins on the day of the session. Partic-
presence of a plateau in V̇O2 values (<1.35 mL·kg−1·min−1 ipants were asked to perform their regular daily activities,
increase) despite increasing workload or two of the follow- not to engage in physical activity, and to relax and straighten
ing criteria: (i) a respiratory exchange ratio value >1.15, (ii) the arm during the recording interval. Participants were also
within 10 bpm of age-predicted maximum HR (HRmax) asked to document their activities and food/fluid intake
(220 − age), and/or (iii) voluntary exhaustion. After a during the day. All participants confirmed no physical ac-
5-min cool-down followed by sufficient rest (>5 min), par- tivity when the monitor was worn. Identical experimental
ticipants were allowed to practice each of the three different procedures were followed for the control session except
exercise protocols using the motorized treadmill in which that participants sat quietly during the exercise period
all the exercise sessions would be performed. Each partici- (0845–0925 h).
pant completed 5 min of continuous running (at ~65% V̇O2max; Exercise protocols. All exercise protocols began with
MICT exercise), 3  1-min running efforts (at ~90% HRmax) a 5-min warm-up (at 3 mph) followed by the MICT exercise
with 1-min recovery (HIIT exercise), and 2  15-s “all-out” (30 min), HIIT exercise (20 min), or SIT exercise (16 min)
sprints with 2-min rest (SIT exercise) to familiarize them to the session and a 5-min cool-down at a self-selected pace.
respective protocols. Participants were given sufficient rest Warm-up and cool-down along with the exercise protocols
(5 min) in between each. After this, participants were fitted with were performed on a motorized treadmill (Woodway 4Front)
an AMBP monitor (ABP320; ScottCare, Cleveland, OH) at- for consistency. Exercise sessions involved three different pro-
tached to their left arm that they would wear for the next 24 h tocols: (i) MICT exercise (30 min of continuous running at 65%

APPLIED SCIENCES
to become accustomed to wearing the monitor. Participants re- V̇O2max), (ii) HIIT exercise (10  1 min at 90% HRmax with
corded their breakfast the day of their first experimental session 1-min recovery), and (iii) SIT exercise (8  15-s “all-out” sprint
and replicated it for the remaining sessions. efforts interspersed with 2-min rest). For both the HIIT and SIT
Experimental session. Participants arrived at the labora- exercise protocols, the rest periods were passive. Treadmill
tory at 0800 h after having consumed breakfast 1 h before ar- speed and grade were manipulated to reach target V̇O2 and
rival (0700 h) and limited their activity on their way to the lab- HR for MICT and HIIT exercises, respectively (explained in
oratory (i.e., drove or used public transport). They remained in full detail hereinafter). For the SIT exercise session, the motor-
the laboratory for the next ~3.5 h. After arriving participants ized treadmill (Woodway 4Front) was switched into dynamic
rested quietly (seated rest for 30-min MICT exercise and mode, which means that the belt was self-propelled by the par-
CTRL, 40-min HIIT exercise, 44-min SIT exercise) before ticipant. The start of the CTRL, HIIT, and SIT exercise sessions
BP measurements to ensure resting state was achieved. Be- were staggered by 5, 10, and 14 min, respectively, so all proto-
cause differences in the duration of the exercise session, the cols finished by 0925 h. Verbal encouragement was provided to
rest times were different such that all exercises ended at participants during all three exercise sessions. The desired in-
0925 h. Participants had their resting BP measured four times tensity for the MICT exercise (65% V̇O2max) and HIIT exercise
using an automated oscillometric device (V100) with 2 min (90% HRmax) sessions, respectively, was calculated using the
between measurements. The first measurement was discarded, American College of Sports Medicine Running Equation (40),
and the final three measurements were averaged. Preexercise using the speed from the graded exercise test and V̇O2 data.
BP was measured at 0830 h during the CTRL and MICT exer- When participants were familiarized with the different exercise
cise sessions, at 0840 h during the HIIT exercise session, and protocols, the treadmill speed and grade were adjusted if needed
at 0844 h during the SIT exercise session. Participants were to elicit the desired intensity.
fitted with an HR monitor before warm-up for exercise. Partic- PEH calculation. To calculate PEH, at each time point,
ipants then completed the exercise protocol followed by 2 h of SBP and DBP from the exercise sessions were subtracted from
seated rest for postexercise BP measurements. BP was mea- the BP at the same time point during the control session
sured 15 min (0940 h), 30 min (0955 h), 60 min (1025 h), (PEH = control BP − exercise BP). When considering both
and 120 min (1135 h) after exercise. At each time point, BP SBP and DBP, this method had the highest intraclass

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Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 correlation as previously reported (41). Because this method HIIT exercise session, peak HR at the end of each interval
does not allow us to determine whether BP was different from was 88.4% ± 3.4% of HRmax as designed.
CTRL, we first compared absolute BP during sessions with BP Absolute BP. An interaction (session–time; P = 0.003,
during CTRL, followed by a comparison of PEH using the afore- η2p = 0.216) was detected for changes in MAP over time
mentioned calculation to determine potential differences between (Fig. 1A) where MAP was reduced by MICT ( P = 0.044,
protocols. In addition, because there are multiple ways to calcu- d = 0.86), HIIT ( P = 0.016, d = 1.00), and SIT
late PEH, we have also reported statistical comparisons to ( P = 0.014, d = 1.02) exercises compared with CTRL at
preexercise time points for reach of the exercise sessions. 60 min after exercise. There were no other differences between
Statistical analysis. All statistical analyses were per- sessions ( P > 0.134, d < 0.72). When considering differences
formed using SPSS version 26 (IBM, Chicago, IL). Statistical between preexercise and postexercise values, there were no dif-
significance was accepted as P < 0.050, and P < 0.100 was re- ferences for any of the exercise sessions ( P > 0.999, d < 0.77);
ported as a value that tended to be “approaching significance” however, during the CTRL session, MAP was greater 15,
for transparency. All data are presented as mean ± SD. Be- 30, 60, and 120 min after intervention compared with
cause PEH occurs independently of biological sex (2,8–11), preintervention ( P < 0.021, d > 1.02). For MAP AUC, there
participants were pooled together for all analyses. Because was an effect of session ( P < 0.001, η2p =0.403) where MICT
we used an oscillometric device to measure BP, we have pro- ( P = 0.008, d = 1.08), HIIT ( P = 0.034, d = 0.88), and SIT
vided and analyzed mean arterial pressure (MAP). A series of ( P = 0.011, d = 1.04) exercises were lower than CTRL, with
two-way repeated measures of ANOVA (RM ANOVA) were no differences between exercise sessions ( P > 0.999, d < 0.38;
conducted to compare between session differences in abso- Fig. 1B).
lute MAP, SBP, and DBP (session–time), SBP and DBP An interaction (session–time; P = 0.002, η2p = 0.231) was
PEH (session–time), SBP and DBP 8 h after the session detected for changes in SBP over time (Fig. 2A) where SBP
(session–time), and 24-h SBP and DBP during different was reduced by MICT exercise ( P = 0.005, d > 1.09) at 30
measurement periods (session–period of measurement). A and 60 min; by HIIT exercise ( P = 0.005, d > 0.81) at 30,
series of one-way RM ANOVA were conducted to compare 60, and 120 min; and by SIT exercise ( P = 0.005, d > 1.0) at
between-session differences for 24-h AMBP, peak PEH, av- 30, 60, and 120 min after exercise compared with CTRL.
erage PEH, and total area under the curve (AUC) for MAP, There were no differences between sessions before exercise
SBP, and DBP. Bonferroni corrections were used for post hoc ( P > 0.999, d < 0.38) or 15 min after exercise ( P > 0.112,
analysis where necessary. Partial eta-squared (η2p) values were d < 0.72). When considering differences between preexercise
calculated to estimate the effect sizes (small, 0.04; medium, and postexercise values, there were no differences for any of
0.06; large, 0.14) for main effects and interactions where nec- the exercise sessions ( P > 0.999, d < 0.45); however, during
essary. Cohen’s d was calculated to estimate effect size (small, the CTRL session, SBP was greater 30, 60, and 120 min after
APPLIED SCIENCES

0.2; medium, 0.5; large, 0.8; very large, 1.3) for individual intervention compared with that after intervention ( P < 0.038,
post hoc comparisons where necessary. All AUC calculations d > 1.09). For SBP AUC, there was an effect of session
were performed using the trapezoid method using changes in ( P < 0.001, η2p =0.408) where MICT ( P = 0.001, d = 1.50),
BP relative to baseline. HIIT ( P = 0.010, d = 1.08), and SIT ( P = 0.024, d = 0.93) ex-
ercises were lower than CTRL, with no differences between
exercise sessions ( P > 0.999, d < 0.13; Fig. 2B).
RESULTS An interaction (session–time; P = 0.039, η2p = 0.154) was de-
Exercise sessions. During the MICT exercise session, tected for changes in DBP over time (Fig. 3A) where DBP was
average V̇O2 was 64.2% ± 2.7% of V̇O2max, indicating that reduced by HIIT exercise ( P = 0.064, d = 0.79) at 60 min and
the exercise was performed appropriately. Similarly for the by SIT exercise ( P < 0.064, d > 0.80) at 15 and 60 min after

FIGURE 1—Changes in MAP over the acute 2-h period after CTRL, MICT, HIIT, and SIT exercises. A, MAP over time. B, MAP AUC. Note: Values are
mean ± SD, n = 14. aMICT difference vs CTRL (P < 0.050). bHIIT difference vs CTRL (P < 0.050). cSIT difference vs CTRL (P < 0.050). *Different vs
preexercise (P < 0.050).

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Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
FIGURE 2—Changes in SBP over the acute 2-h period after CTRL, MICT, HIIT, and SIT exercises. A, SBP over time. B, SBP AUC. Note: Values are
mean ± SD, n = 14. aMICT difference vs CTRL (P < 0.050). bHIIT difference vs CTRL (P < 0.050). cSIT difference vs CTRL (P < 0.050). *Different vs
preexercise (P < 0.050).

exercise compared with CTRL. There were no differences be- no interaction ( P = 0.642, η2p = 0.061; Fig. 4B) or main effect of
tween sessions before exercise ( P > 0.500, d < 0.51), 30 min af- session ( P = 0.231, η2p = 0.111) for DBP. The main effect of time
ter ( P > 0.641, d < 0.47), and 120 min after ( P > 0.383, was approaching significance ( P = 0.059, η2p = 0.184), and post hoc
d < 0.54) exercise. When considering differences between comparisons revealed that a difference between 4 and 6 h after
preexercise and postexercise values, there were no differences the session was approaching significance ( P = 0.072, d = 0.82)
for any of the exercise sessions ( P > 0.957, d < 0.83); however, with no other differences ( P > 0.379, d ≤ 0.57).
during the CTRL session, DBP was greater 15, 30, 60, and
120 min after intervention compared with that before interven-
DISCUSSION
tion ( P < 0.011, d > 1.11). For DBP AUC, there was an effect
of session ( P = 0.001, η2p = 0.325) where SIT exercise was To our knowledge, this is the first study to examine the effects
lower than CTRL ( P = 0.008, d = 0.98; Fig. 3B), with no other of MICT, HIIT, and SIT exercises on PEH immediately (≤2 h)
differences ( P > 0.142, d < 0.66). and for 24 h after exercise specifically in middle-age adults.
Twenty-four-hour AMBP. One participant did not wear The main findings of this study are the following: a) all exer-
the AMBP monitor at night (because of discomfort); therefore, cise sessions elicited similar magnitudes of PEH for MAP,
the following analyses were run using data from the remaining SBP, and DBP; b) all exercises reduced absolute postexercise

APPLIED SCIENCES
13 participants. One-way RM ANOVA revealed no differ- MAP and SBP, although the effects on DBP were smaller;
ences in 24-h SBP ( P = 0.453, η2p = 0.069; Table 2). During and c) acute effects of all forms of exercise were not sus-
the 8 h after the session, two-way RM ANOVA revealed no tained over 8 or 24 h. Although previous work has examined
interaction ( P = 0.957, η2p = 0.028; Fig. 4A), main effect of the effect of different submaximal exercise intensities (40%–
session ( P = 0.439, η2p = 0.072), or main effect of time 60% V̇O2max) in middle-age adults, our study is the first to
( P = 0.356, η2p = 0.085) for SBP. compare the effects of MICT, HIIT, and SIT exercises in
An effect of session ( P = 0.051, η2p = 0.192; Table 2) was middle-age adults in the immediate (≤2) and 24-h postexer-
detected for 24-h DBP where 24-h DBP was greater after HIIT cise period.
exercise compared with MICT exercise ( P = 0.018, d = 1.04). When evaluating the PEH response using absolute BP values
During the 8 h after the session, two-way RM ANOVA revealed and AUC, our data demonstrate a clear ability for exercise to

FIGURE 3—Changes in DBP over the acute 2-h period after CTRL, MICT, HIIT, and SIT exercises. A, DBP over time. B, DBP AUC. Note: Values are
mean ± SD, n = 14. bHIIT difference vs CTRL ( P = 0.064). cSIT difference vs CTRL (P < 0.064). *Different vs preexercise (P < 0.050).

EXERCISE INTENSITY AND POSTEXERCISE HYPOTENSION Medicine & Science in Sports & Exercise® 105

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 TABLE 2. Twenty-four-hour AMBP SBP and DBP after CTRL, MICT, HIIT, and SIT exercises.
CTRL MICT Δ vs CTRL HIIT Δ vs CTRL SIT Δ vs CTRL
SBP (mm Hg)
24 h 123 ± 13 120 ± 10 −3 ± 6 122 ± 9 −1 ± 7 121 ± 12 −2 ± 6
DBP (mm Hg)
24 h 75 ± 10 74 ± 8 d
−1 ± 4 76 ± 8 1±4 75 ± 8 0±4
Values are mean ± SD (n = 13). d − different vs MICT (P = 0.018).

reduce BP in the acute hours after exercise in comparison to (12). The absolute reductions after HIIT and SIT exercises
CTRL (Figs. 1, 2, 3). Although some of the acute changes for were similar; however, the PEH response after MICT exer-
DBP were not statistically significant, the data would suggest cise was of a smaller magnitude compared with the current
that the exercise did elicit important reductions, as nonsignif- study (12). It should be noted that Angadi and colleagues
icant reductions were of similar magnitudes to those that (12) used a cycle ergometer for their exercise modality,
reached statistical significance (while still being supported whereas we are the first study to utilize the low-volume HIIT
by medium-large effect sizes) and could still be indicative protocol (10  1 min at 90% HRmax with 1-min recovery) on
of changes. The muted reductions compared with SBP may a treadmill. Whether there are differences in PEH based on
be due to the normotensive nature of the sample, as reduc- the mode of exercise is currently unknown; a meta-analysis
tions are generally greater the higher the resting BP of the did note greater reductions (not statistically different) after
participant (2). This aligns with previous data demonstrating running (−9/−11 mm Hg) compared with cycling studies
that the PEH response occurs regardless of participant and/or (−6/−3 mm Hg [7]).
exercise characteristics (7). These data demonstrate that HIIT Although most PEH studies (3,4,8,10–20,26,27,31,33,45)
and SIT exercises can elicit important reductions in BP in examine an acute postexercise period (~2 h), longer duration
middle-age adults, similar to MICT exercise (10,12,13,32,42), reductions (>2 h) in BP after exercise are lacking and may
providing additional support for the efficacy of these exercise be indicative of a protective effect of exercise on BP. With that
protocols and those previously reported. in mind, we designed this study to measure BP every 30 min
When evaluating the PEH response as changes relative to during the day and every 60 min during the night over 24 h af-
the CTRL session (PEH = control BP − exercise BP), average ter exercise. Our data demonstrate no differences in 8- or 24-h
and peak PEH were similar after MICT, HIIT, and SIT exer- AMBP after MICT, HIIT, or SIT exercise compared with
cise, when considering MAP, SBP, and DBP (Table 2), pro- CTRL, suggesting that the PEH response only lasted for
viding additional evidence that these exercise protocols did ~2 h. Previous work has demonstrated statistically significant
not induce different PEH effects. It is important to highlight reductions in 24-h AMBP after MICT and HIIT exercises
that the exercise sessions were able to blunt the increase in (42,43,46,47), however this is the first study to measure
APPLIED SCIENCES

BP seen during the no-exercise CTRL session. Across all ex- the response following SIT exercise. While the mechanisms
ercise protocols, the PEH responses we measured were sim- involved in the acute PEH response are well understood
ilar to the respective literature in normotensive participants (1,2,36), the mechanisms responsible for longer reductions
for MICT (5,10–12,14–16,19), HIIT (8,12,13,26,43), and in BP/or a prolonged PEH response have not been estab-
SIT exercise (10,12,28–31). If these acute reductions were lished. Interestingly, Sosner and colleagues (47) did note re-
repeated with chronic training they may contribute to chronic ductions in arterial stiffness following a single HIIT session
reductions in BP that could be clinically significant as reduc- that coincided with reduced AMBP during the day. Previ-
tions as small as 2 mm Hg SBP can reduce stroke mortality ous work that has demonstrated differences in 24-h AMBP
by 10% and ischemic heart disease mortality by 7% (44). after MICT and HIIT exercises has mainly focused on hy-
Only one other study has compared the PEH response to pertensive participants (42,46,47), although one study did
MICT, HIIT, and SIT exercise, though in a young (25 y) find significant reductions after HIIT exercise in young nor-
and normotensive (122/68 mm Hg) sample (n = 11), demon- motensive males (43). Our absolute changes in AMBP are
strating significant reductions in BP following all 3 protocols similar; however, other factors such as timing of measurement

FIGURE 4—Changes in SBP and DBP in the 8-h postsession after CTRL, MICT, HIIT, and SIT exercises. A, SBP. B, DBP. Note: Values are mean ± SD
(n = 13). *Four hours different from 6 h when collapsed across sessions (P = 0.072).

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Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
intervals may have contributed to finding significant differ- results, as the transient reductions in BP after exercise
ences. For example, participants were instructed not to engage would be most beneficial in individuals with hypertension.
in physical activity during the time they wore the monitor; Unfortunately, we were not able to examine the specific
however, sedentary behavior was not assessed, which could mechanisms responsible for the PEH response and thus
play a role. In addition, participants were asked to maintain can only speculate. Although we did standardize the
their regular sleep schedule on days the monitor was worn; timing of sessions and the duration of time the participants
however, there was no assessment of sleep length or quality. wore the AMBP monitor, our results only apply to morn-
Studies examining the possible predictive nature of the PEH ing exercise and may differ if exercise was completed at
response after MICT exercise have found moderate, signifi- a different time of day. Because the potential variations for
cant correlations (r > 0.65) between acute reductions (1 h after HIIT and SIT exercises are infinite, the results from our study
exercise) and chronic reductions (4, 8, and 24 wk) in BP with only apply to the particular protocols we used and cannot be
training (15,18,48). Our results are in line with these acute re- applied to other HIIT or SIT protocols. Finally, menstrual cy-
sponses that have shown chronic effects (15,18,48). Recent cle phase was not accounted for when testing female partici-
work suggests that MICT and HIIT exercises elicit compara- pants. Whether there is a strong effect of menstrual cycle
ble reductions in SBP and DBP with training (23,49); how- phase on the PEH response is unclear because there is conflict-
ever, the effects of SIT exercise are less understood in part be- ing evidence (9,53), although any potential differences in the
cause of misclassification as HIIT exercise (all-out exercise response seem to only occur for DBP during the early follicu-
being classified as HIIT not SIT). SIT exercise seems to lar phase (days 3–4 of the menstrual cycle [53]) representing a
be effective in reducing SBP with chronic training (50,51), short time period.
although only one study has found significant reductions
in DBP (51). Overall, our data add to the various health ben- CONCLUSIONS
efits, including improved aerobic capacity, body composi-
Overall, MICT, HIIT, and SIT exercises produced similar
tion, skeletal muscle oxidative capacity, exercise tolerance,
PEH in middle-age adults during a 2-h postexercise measure-
and disease risk that are associated with HIIT and SIT exer-
ment period. Reductions were present for MAP and SBP, al-
cises (22,52).
though the effects on DBP were less clear. Finally, these acute
Although the study provides valuable information re-
reductions were not sustained over 24 h.
garding the effect of MICT, HIIT, and SIT exercises on
PEH, it is important to highlight several limitations. It is S. F. M. was supported by a Canadian Institute of Health Research
Canada Graduate Scholarship (master’s degree), an Ontario Graduate
important to note that our sample was recreationally active Scholarship, and a Natural Sciences and Engineering Research Coun-
with good–excellent V̇O2max scores. This should be con- cil Alexander Graham Bell Canada Graduate Scholarship (doctoral de-
sidered when interpreting the PEH response, as a less or gree). E. J. F. was supported by a Natural Sciences and Engineering

APPLIED SCIENCES
Research Council Graduate Scholarship (master’s degree) and the
more active sample may not respond similarly. Although R.S. McLaughlin Fellowship (Queen’s University Internal Award).
the activity journals did provide important information re- The authors declare that they have no conflicts of interest to dis-
garding the participant’s activities while wearing the mon- close. The results of the study are presented clearly, honestly, and
without fabrication, falsification, or inappropriate data manipulation.
itor, other important information that should be considered The results of the present study do not constitute endorsement by
in future studies using AMBP includes length and quality the American College of Sports Medicine.
of sleep, occupation, and sedentary activity. Although the Author Contributions: S. F. M., K. A. K., and T. J. H. conceived and
designed the project. S. F. M., E. J. F., and C. J. conducted experi-
study does provide important information, the sample ments. S. F. M. and T. J. H. analyzed the data. S. F. M. and T. J. H.
was mostly normotensive, which limits the impact of the wrote the manuscript. All authors read and approved the manuscript.

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