Int J Sports Med
DOI: 10.1055/a-2602-9020
Training & Testing

Hypoxic exercise enhances post-exercise hypotension compared to normoxic exercise

1   Department of Physical Education, Graduate School, Kyung Hee University, Yongin, Korea (the Republic of)
,
Min-Hyeok Jang
1   Department of Physical Education, Graduate School, Kyung Hee University, Yongin, Korea (the Republic of)
,
Jean-Hee Han
1   Department of Physical Education, Graduate School, Kyung Hee University, Yongin, Korea (the Republic of)
,
1   Department of Physical Education, Graduate School, Kyung Hee University, Yongin, Korea (the Republic of)
2   Department of Sports Coaching, College of Physical Education, Kyung Hee University, Yongin, Korea (the Republic of)
,
Jung-Hyun Kim
1   Department of Physical Education, Graduate School, Kyung Hee University, Yongin, Korea (the Republic of)
3   Department of Sports Medicine, College of Physical Education, Kyung Hee University, Yongin, Korea (the Republic of)
› Author Affiliations
Preview

Abstract

This study aimed to investigate the effect of aerobic exercise under hypoxic conditions (FiO2: 14.9%) on post-exercise hypotension compared to normoxic exercise matched for mechanical and physiological intensities. Twenty sedentary men completed three exercise sessions using a crossover design: (1) hypoxic exercise at 50% of peak power output, (2) normoxic exercise at 50% of peak power output (normoxic exercise matched for mechanical intensity), and (3) normoxic exercise with heart rates matched for hypoxic exercise. Expired gases and peripheral and muscle oxygen saturation were measured during the exercise. Blood pressure and hemodynamic variables were assessed before and after each exercise session. Hypoxic exercise and normoxic exercise matched for physiological intensity elicited higher heart rate, oxygen consumption, and ventilation compared to normoxic exercise matched for mechanical intensity (p<0.05). Hypoxic exercise showed the lowest ventilation efficiency (p<0.01) and the most severe systemic and muscle hypoxemia (p<0.01) during exercise. Only hypoxic exercise induced significant post-exercise hypotension (−6.9 mmHg; p<0.01) with a significant increase in common femoral artery diameter during recovery (p<0.05). Our findings suggested that hypoxic exercise significantly enhances post-exercise vasodilation compared to normoxic exercise, resulting in greater post-exercise hypotension. This highlighted hypoxic exercise as a promising strategy for managing hypertension with reduced mechanical stress, particularly beneficial for individuals with low exercise tolerance.



Publication History

Received: 30 January 2025

Accepted: 02 May 2025

Article published online:
07 July 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
  • References

  • 1 Campbell NRC, Schutte AE, Varghese CV. et al São Paulo call to action for the prevention and control of high blood pressure: 2020. J Clin Hypertension 2019; 21 21: 1744-1752
  • 2 Guedes NG, Lopes MV, Moreira RP, Cavalcante TF, de Araujo TL. Prevalence of sedentary lifestyle in individuals with high blood pressure. Int J Nurs Terminol Classif 2010; 21: 50-56
  • 3 Halliwill JR, Buck TM, Lacewell AN, Romero SA. Postexercise hypotension and sustained postexercise vasodilatation: what happens after we exercise?. Exp Physiol 2013; 98: 7-18
  • 4 Wegmann M, Hecksteden A, Poppendieck W. et al. Postexercise hypotension as a predictor for long-term training-induced blood pressure reduction: a large-scale randomized controlled trial. Clin J Sport Med 2018; 28: 509-515
  • 5 Forjaz CL, Cardoso CG, Rezk CC, Santaella DF, Tinucci T. Postexercise hypotension and hemodynamics: the role of exercise intensity. J Sports Med Phys Fit 2004; 44: 54-62
  • 6 Pramsohler S, Burtscher M, Faulhaber M. et al. Endurance Training in Normobaric Hypoxia Imposes Less Physical Stress for Geriatric Rehabilitation. Front Physiol 2017; 8: 514
  • 7 Fornasiero A, Skafidas S, Stella F. et al. Cardiac Autonomic and Physiological Responses to Moderate- intensity Exercise in Hypoxia. Int J Sports Med 2019; 40: 886-896
  • 8 Fornasiero A, Zignoli A, Rakobowchuk M. et al. Post-exercise cardiac autonomic and cardiovascular responses to heart rate-matched and work rate-matched hypoxic exercise. Eur J Appl Physiol 2021; 121: 2061-2076
  • 9 Vedam H, Phillips CL, Wang D. et al. Short-term hypoxia reduces arterial stiffness in healthy men. Eur J Appl Physiol 2009; 105: 19-25
  • 10 Hainsworth R, Drinkhill MJ, Rivera-Chira M. The autonomic nervous system at high altitude. Clin Auton Res 2007; 17: 13-19
  • 11 Dinenno FA. Skeletal muscle vasodilation during systemic hypoxia in humans. J Appl Physiol (1985) 2016; 120: 216-225
  • 12 Casey DP, Joyner MJ. Compensatory vasodilatation during hypoxic exercise: mechanisms responsible for matching oxygen supply to demand. J Physiol 2012; 590: 6321-6326
  • 13 Joyner MJ, Casey DP. Muscle blood flow, hypoxia, and hypoperfusion. J Appl Physiol (1985) 2014; 116: 852-857
  • 14 Millet GP, Debevec T, Brocherie F, Malatesta D, Girard O. Therapeutic use of exercising in hypoxia: promises and limitations. Front Physiol 2016; 7: 224
  • 15 Kleinnibbelink G, Stens NA, Fornasiero A. et al. The acute and chronic effects of high-intensity exercise in hypoxia on blood pressure and post-exercise hypotension: A randomized cross-over trial. Med (Baltim) 2020; 99: e22411
  • 16 Winkler L, Lhuissier FJ, Richalet J-P. Systemic blood pressure at exercise in hypoxia in hypertensive and normotensive patients. J Hypertens 2017; 35: 2402-2410
  • 17 Horiuchi M, Ni-I-Nou A, Miyazaki M, Ando D, Koyama K. Impact of Resistance Exercise under Hypoxia on Postexercise Hemodynamics in Healthy Young Males. Int J Hypertens 2018; 2018: 1456972
  • 18 Saito Y, Nakamura M, Eguchi K, Otsuki T. Mild Hypobaric Hypoxia Enhances Post-exercise Vascular Responses in Young Male Runners. Front Physiol 2019; 10: 546
  • 19 Siebenmann C, Ryrsø CK, Oberholzer L. et al. Hypoxia-induced vagal withdrawal is independent of the hypoxic ventilatory response in men. J Appl Physiol 2019; 126: 124-131
  • 20 Amann M, Pegelow DF, Jacques AJ, Dempsey JA. Inspiratory muscle work in acute hypoxia influences locomotor muscle fatigue and exercise performance of healthy humans. Am J Physiol Regul Integr Comp Physiol 2007; 293: R2036-R2045
  • 21 Dempsey JA, Romer L, Rodman J, Miller J, Smith C. Consequences of exercise-induced respiratory muscle work. Resp Physiol Neurobiol 2006; 151: 242-250
  • 22 Harms CA, Wetter TJ, McClaran SR. et al. Effects of respiratory muscle work on cardiac output and its distribution during maximal exercise. J Appl Physiol 1998; 85: 609-618
  • 23 Casey DP, Madery BD, Curry TB, Eisenach JH, Wilkins BW, Joyner MJ. Nitric oxide contributes to the augmented vasodilatation during hypoxic exercise. J Physiol 2010; 588: 373-385
  • 24 Pohl U, Busse R. Hypoxia stimulates release of endothelium-derived relaxant factor. Am J Physiol Heart Circ Physiol 1989; 256: H1595-H1600
  • 25 Stamler JS, Jia L, Eu JP, McMahon TJ. et al. Blood flow regulation by S-nitrosohemoglobin in the physiological oxygen gradient. Science 1997; 276: 2034-2037
  • 26 Chaudhry R, Miao JH, Rehman A. Physiology, cardiovascular. StatPearls: StatPearls Publishing; 2022
  • 27 Snyder EM, Olson TP, Johnson BD, Frantz RP. Influence of sildenafil on lung diffusion during exposure to acute hypoxia at rest and during exercise in healthy humans. Eur J Appl Physiol 2008; 103: 421-430
  • 28 Park HY, Kim JW, Nam SS. Metabolic, Cardiac, and Hemorheological Responses to Submaximal Exercise under Light and Moderate Hypobaric Hypoxia in Healthy Men. Biol (Basel) 2022; 11: 144
  • 29 Jung K, Seo J, Jung WS, Kim J, Park HY, Lim K. Effects of an Acute Pilates Program under Hypoxic Conditions on Vascular Endothelial Function in Pilates Participants: A Randomized Crossover Trial. Int J Env Res Public Health 2020; 17: 2584
  • 30 Delong C, Sharma S. Physiology, peripheral vascular resistance. 2019
  • 31 Serebrovskaya TV, Manukhina EB, Smith ML, Downey HF, Mallet RT. Intermittent hypoxia: cause of or therapy for systemic hypertension?. Exp Biol Med 2008; 233: 627-650
  • 32 Fecchio RY, Brito LC, Peçanha T, Forjaz C. Post-exercise hypotension and its hemodynamic determinants depend on the calculation approach. J Hum Hyperten 2020; 34: 719-726
  • 33 Brasil IA, Silva J, Pescatello LS, Farinatti P. Central and peripheral mechanisms underlying postexercise hypotension: a scoping review. J Hyperten 2024; 42: 751-763