4. Discussion
vascular stiffness, atherosclerosis, hypertension, reductions in blood pressure
CELL DAMAGE, SECONDARY, VASODILATATION, ATHEROSCLEROSIS, HYPERTENSION, CORONARY ARTERY DISEASE
Results indicated that resting blood pressure was significantly reduced between and within-group after eight weeks of mild to moderate aerobic exercise training. No significant changes occurred in the mean of resting systolic and diastolic blood pressure, resting heart rate, BMI, cholesterol, LDL, HDL, and functional status from pre-to-post exercise among the control group.In this study, the systolic and diastolic blood pressure reduction following aerobic exercise was less than expected (−2.75 mmHg and −0.83 mmHg, respectively). However, decrease in the systolic and diastolic blood pressures might be the underlying physiological process that occurs due to the increasing shear stress in the blood vessels, which increases the formation of nitric oxide (NOx) vasodilator and contributes to vascular vasodilatation [The findings of this study agree with those of a recent meta-analysis and systematic review of clinical trial studies [The secondary outcomes of this study showed that aerobic exercise effectively reduces resting heart rate, BMI, cholesterol, and LDL. These findings are broadly consistent with previous studies. For example, Madden et al. (2009) [In this study, the results showed that aerobic training does not improve functional ability. This finding is similar to a previous study that reported no improvement in functional status after 12 weeks of aerobic exercise [This study has several strengths. To our knowledge, this is the first study in Saudi Arabia investigating the beneficial effects of regular aerobic exercise on resting blood pressure in sedentary older adults with hypertension living in social home care. Nurse assessors who measured study participants’ blood pressure were blinded for allocation to avoid measurement bias. The physiotherapist and attendance supervised the exercise sessions, and the experimental group participants’ adherence was accomplished excellently. Additionally, all exercise sessions had the correct training time and amount of intensity being completed using heart rate monitors.However, this study has several limitations that should be acknowledged as well. Firstly, it is worth noting that the trial was conducted with a relatively small sample size of 27 sedentary older Saudis with hypertension residing in a social home care. While the study yielded significant findings, the limited number of participants may restrict the generalizability of the results to a larger population. Therefore, future studies with larger sample sizes are necessary to confirm and strengthen the observed effects. Additionally, it is crucial to account for attrition rates and consider the potential influence of the COVID-19 pandemic on participant dropout during the study period. Secondly, the study was exclusively conducted among sedentary older Saudis with hypertension residing in a specific aged-care setting in Makkah, Saudi Arabia. While this design allowed for a focused investigation, it may limit the generalizability of the findings to other populations, including individuals from different regions, cultural backgrounds, or socio-economic status. To ensure the external validity of the results, future research should aim to include a more diverse participant pool. Another limitation is the relatively short duration of the aerobic exercise training intervention, which lasted for eight weeks. While this duration was sufficient to demonstrate significant reductions in resting blood pressure, it is possible that longer intervention periods could yield different or more pronounced effects on blood pressure control. Future studies should explore the impact of extended exercise training durations to evaluate the sustained effects on blood pressure in sedentary older individuals. Moreover, it should be noted that this study focused exclusively on cycling as a form of aerobic exercise intervention. Although cycling is a popular and effective aerobic activity, the findings may not directly apply to other aerobic exercises or physical activity types. Incorporating interventions involving different forms of aerobic exercises, such as walking or swimming, would enhance the comprehensiveness and generalizability of the study. Future research should consider evaluating the effects of various aerobic exercise modalities on blood pressure in sedentary older individuals with hypertension. Additionally, another limitation of this trial is the need for long-term follow-up assessments. This study focused solely on the immediate effects of aerobic exercise training on resting blood pressure. The lack of long-term follow-up hinders our understanding of the durability of the observed reductions in blood pressure over an extended period. Subsequent studies should include long-term follow-up periods to evaluate the maintenance of blood pressure improvements and assess the sustainability of the intervention’s effects. Furthermore, despite efforts to minimize confounding factors, it is vital to acknowledge the possibility of other unmeasured variables influencing the observed outcomes. Factors, such as dietary changes, medication adjustments, and other lifestyle modifications were not explicitly controlled for, which may have influenced the results. Future studies should incorporate comprehensive assessments, including detailed dietary and medication records, to better understand and control potential confounders. Lastly, while the study demonstrated the feasibility and efficacy of aerobic exercise training, it is important to acknowledge that cycling may only be suitable or preferred by some sedentary older individuals. Factors, such as physical limitations, personal preferences, and accessibility to cycling facilities may impact the applicability of the findings to a broader population. Future research should explore and evaluate the feasibility and efficacy of different types of aerobic exercises to provide a range of options for sedentary older individuals with hypertension. Acknowledging these limitations is crucial for comprehensively understanding the study’s scope and potential implications. Future research endeavors should address these limitations to enhance the findings’ validity, generalizability, and clinical applicability in managing hypertension among sedentary older individuals residing in social home care settings.The findings of this study may have broad clinical implications because the results reflected a significant reduction in resting systolic and diastolic blood pressure, heart rate, BMI, and cholesterol in the exercise group. Physiologically, reducing cholesterol and LDL concentration in blood circulation may decrease vascular endothelial cell damage, thereby decreasing atherosclerosis and vascular stiffness, which are significant causes of hypertension and coronary artery disease [