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Cardiovascular Responses to Unilateral, Bilateral, and Alternating Limb

Resistance Exercise Performed Using Different Body Segments

Article  in  The Journal of Strength and Conditioning Research · March 2017

DOI: 10.1519/JSC.0000000000001160

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CARDIOVASCULAR RESPONSES TO UNILATERAL,
BILATERAL, AND ALTERNATING LIMB RESISTANCE
EXERCISE PERFORMED USING DIFFERENT BODY
SEGMENTS
OSVALDO C. MOREIRA,1 LUCAS L. FARACI,2 DIHOGO G. DE MATOS,3 MAURO L. MAZINI FILHO,3
SANDRO F. DA SILVA,4 FELIPE JOSÉ AIDAR,3,5 ROBERT C. HICKNER,6,7 AND CLÁUDIA E.P. DE OLIVEIRA2
1
Institute of Biological Sciences and Health, Federal University of Viçosa, Campus Florestal, Florestal, Minas Gerais, Brazil;
2
Physical Education Department, Federal University of Viçosa, Campus Viçosa, Viçosa, Minas Gerais, Brazil; 3Department of
Sports Science, Exercise and Health, University of Tra´s-os-Montes and Alto Douro, Vila Real, Portugal; 4Department of Physical
Education, University of Lavras, Lavras, Minas Gerais, Brazil; 5Fire Brigade of Minas Gerais, 5th Battalion Fire Military Fire
Brigade of the State of Minas Gerais, Uberlandia, Minas Gerais, Brazil; 6Departments of Kinesiology, and Physiology, Center for
Health Disparities, Human Performance Laboratory, East Carolina University, Greenville, South California; and 7Department of
Biokinetics, Exercise and Leisure Sciences, College of Health Sciences, University of KwaZulu-Nata, Durban, South Africal

ABSTRACT and third sets and also for the bilateral third set of the knee
Moreira, OC, Faraci, LL, de Matos, DG, Mazini Filho, ML, da extensions as compared with the barbell rows. It was concluded
Silva, SF, Aidar, FJ, Hickner, RC, and de Oliveira, CEP. from the data of this study that the cardiovascular response was
Cardiovascular responses to unilateral, bilateral and alternating increased from rest to postexercise in all forms of exercise,
limb resistance exercise performed using different body seg- especially immediately after the third set of RE. For exercises
ments. J Strength Cond Res 31(3): 644–652, 2017—The aim performed bilaterally with the upper body (biceps curls), there
of this study was to verify and compare the cardiovascular was a greater cardiovascular response when compared with the
responses to unilateral, bilateral, and alternating limb resis- same exercise performed unilaterally or with lower-body exercise
tance exercise (RE) performed using different body segments. performed bilaterally.
Fifteen men experienced in RE were studied during biceps
curls, barbell rows, and knee extension exercises when per-
KEY WORDS health, resistance training, blood pressure, rate
pressure product
formed bilaterally, unilaterally, and using alternating limbs. The
protocol consisted of 3 sets of 10 repetitions at 80% of 10
INTRODUCTION

M
repetition maximum with 2-minute rest between sets. Heart rate
(HR) and blood pressure (BP) were measured after the last uscle strength is an important component of
repetition. There was a statistically significant increase in HR, physical fitness and health, and also perfor-
systolic blood pressure (SBP), and rate pressure product (RPP), mance in numerous sports (1). Resistance
from rest to postexercise. The RPP was higher in the third set of training has therefore been very common
and deserving of great attention during planning of training
all exercises and in all 3 forms of execution, when compared with
programs aimed at improving overall fitness. It has been
the first set. Bilateral biceps curls caused a greater increase in
recommended that resistance exercise (RE) be a part of
RPP (first and second sets) and HR, compared with the same
any training program to promote physical fitness and phys-
exercise performed unilaterally. Furthermore, the performance of
ical capacity for sport performance (31).
bilateral biceps curls induced greater HR and RPP, in all sets,
The classic prescription of RE involves the control
compared with bilateral knee extension and barbell rows. There
of numerous variables such as number of sets, order of
was also a significantly higher SBP for the alternating second exercises, interval time, speed of movement, and form of
execution, among others. Such variables can trigger various
Address correspondence to Osvaldo C. Moreira, dihogogmc@ physiological responses during the performance of RE that
hotmail.com. have a direct impact on cardiovascular safety during training
31(3)/644–652 (4,8,10,19,25,26).
Journal of Strength and Conditioning Research One of the variables that influences the cardiovascular
Ó 2015 National Strength and Conditioning Association response to RE is the form of execution, namely, bilateral
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and unilateral. These different forms of execution may execution, would produce more pronounced cardiovascular
trigger different cardiovascular responses (29), because each responses in heart rate (HR), BP, and rate pressure product
involves a different amount of muscle mass, and the hemo- (RPP) when compared with exercises involving reduced
dynamic response is related to muscle mass. The larger the muscle mass, as in the case of unilateral resistance training
contracting muscle mass, the more occlusion, resulting in (18). However, it was also hypothesized that the upper-body
higher blood pressure (BP) and lower blood flow. This can (biceps curls) RE, despite a lower muscle mass, would pro-
promote different cardiovascular responses when we per- duce a higher cardiovascular response than other forms of
form resistance training with different amounts of muscle exercise studied due to previously described differences in
mass engaged in the exercises (9). Knowledge of the cardio- the upper-body vasculature and increased intrathoracic pres-
vascular responses to RE in different situations is important sures with upper-body exercise (2). Thus, the aim of this
because the specific patterns of cardiovascular response can study was to verify and compare the cardiovascular re-
have serious implications for safety of exercise for all indi- sponses to unilateral, bilateral, and alternating limb RE per-
viduals, especially individuals with compromised cardiovas- formed using different body segments. We have labeled the
cular function in particular (1,2). However, studies exercises as upper-body, trunk, and lower-body exercises as
comparing the cardiovascular behavior during RE of differ- determined by the location of the muscles used as the prime
ent executions and using different body segments are not mover for the given exercise. We therefore term biceps curls
prevalent in the scientific literature. as upper limb, barbell row exercise as trunk exercise, and
Considering the above, it is believed that different forms of knee extensions as lower limb exercise.
execution (unilateral, bilateral, and alternating) of strength
training using different body segments (upper limbs, trunk, METHODS
and lower limbs) produce different hormonal responses Experimental Approach to the Problem
(17,19) and muscle function (16), and may also produce dif- Because there are very few studies of the cardiovascular
ferential cardiovascular responses depending on the body response to resistance training comparing different modali-
segment evaluated. It was hypothesized that exercises that ties and different body segments, this study compared the
involve increased muscle mass, such as the bilateral form of responses to RE in healthy individuals with respect to HR,

TABLE 1. Cardiovascular measures at rest and during the three sets of bilateral, unilateral, and alternating forms of
biceps curl exercise.*

Bilateral Unilateral Alternating

Rest
HR (b$min21) 60 6 5 59 6 6 61 6 6
SBP (mm Hg) 119 6 12 119 6 10 123 6 10
DBP (mm Hg) 80 6 6 80 6 6 81 6 4
RPP (mm Hg$b$min21) 7191 6 1064 7128 6 1149 7497 6 1144
First set
HR (b$min21) 123 6 13† 114 6 10† 115 6 9†
SBP (mm Hg) 127 6 15 121 6 12 124 6 11
DBP (mm Hg) 82 6 7 81 6 6 81 6 3
RPP (mm Hg$b$min21) 15,533 6 1865†z 13,875 6 1750† 14,210 6 1535†
Second set
HR (b$min21) 128 6 14†z 116 6 11† 119 6 10†
SBP (mm Hg) 128 6 16 126 6 11 127 6 8
DBP (mm Hg) 81 6 6 82 6 8 82 6 4
RPP (mm Hg$b$min21) 16,850 6 2243†z 14,653 6 1951† 15,190 6 1481†
Third set
HR (b$min21) 133 6 15†z 120 6 10† 122 6 11†
SBP (mm Hg) 133 6 15 134 6 11†§ 131 6 10
DBP (mm Hg) 82 6 7 83 6 7 84 6 5
RPP (mm Hg$b$min21) 17,655 6 2438†§ 16,040 6 2079†§ 16,029 6 1684†§

*HR = heart rate; SBP = systolic blood pressure; DBP = diastolic blood pressure; RPP = rate pressure product.
†Statistically significant difference when compared with the same variable at rest (p # 0.05).
zStatistically significant difference when compared with the same variable for unilateral exercise, in the same set (p # 0.05). Values
are expressed as mean 6 SD.
§Statistically significant difference when compared with same variable during the first set (p # 0.05).

VOLUME 31 | NUMBER 3 | MARCH 2017 | 645

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Cardiovascular Responses in Different Body Segments

systolic blood pressure (SBP), diastolic blood pressure Procedures

(DBP), and RPP. Participants performed a 10 repetition All data were collected at the Laboratory of Strength of the
maximum (10RM) during unilateral, bilateral, and alternat- Federal University of Viçosa-MG by an experienced exam-
ing limb biceps curls, knee extensions, and barbell rows. iner. Measures included resting HR and BP, and testing of
Participants then performed 3 3 10 repetitions of each exer- 10RM for each of the tests. Ten repetition maximum tests
cise and exercise modality in a randomized order separated were performed with each form of execution (i.e., unilateral,
by 48 hours for each modality. bilateral, and alternating) and with 3 different exercises, with
a 48-hour interval among tests.
Subjects To measure body weight, a mechanical balance (model Star
The sample consisted of 15 apparently healthy males 300/4; Filizola, São Paulo, Brazil) was used. For the measure-
between 18 and 30 years of age who had at least 1 year ment of height, a stadiometer (model Professional ES2020;
experience with RE. The selection criteria for participation Sanny, São Paulo, Brazil) was used. Height and weight were
in this study involved medical release before participation, then used to calculate the body mass index. All measurements
absence of limitations in the joints involved in the exercises, were performed following the recommendations of the Inter-
BP classified as normal, not taking any medicine or drugs national Standards for Anthropometric Assessment (32).
that influence HR and BP, and signing the informed consent
form. Failure to comply with the inclusion criteria consti- Ten Repetition Maximum Test. The mass of each plate and bar
tuted exclusion. used in this study was determined using the same mechan-
The study was approved by the ethics committee on ical scale as that used for the body mass measures. The
human research of the Federal University of Viçosa, under 10RM tests were performed in the following order: biceps
number 072/2010/Ethics Committee, and all procedures curls (upper limbs), knee extension (lower limbs), and barbell
met the regulatory standards established by the Brazilian rows (trunk).
National Health Council. All volunteers were informed The biceps curl exercise was executed standing in
about the study and signed a consent document before tak- anatomical position, with partially bent knees, feet slightly
ing part in the study in accordance with the Declaration of apart, holding the bar with a supinated grip (starting
Helsinki (1964, revised in 1975, 1983, 1989, 1996, and 2000). position). Beginning from the starting position, the

TABLE 2. Cardiovascular measures at rest and during the three sets of bilateral, unilateral, and alternating forms of
knee extension exercise.*

Bilateral Unilateral Alternating

Rest
HR (b$min21) 62 6 7 61 6 6 61 6 6
SBP (mm Hg) 122 6 9 120 6 13 120 6 9
DBP (mm Hg) 81 6 5 80 6 4 81 6 3
RPP (mm Hg$b$min21) 7575 6 1141 7307 6 1279 9723 6 1034
First set
HR (b$min21) 109 6 9† 107 6 9† 112 6 8†
SBP (mm Hg) 130 6 17 123 6 14 124 6 11
DBP (mm Hg) 79 6 5 80 6 4 80 6 3
RPP (mm Hg$b$min21) 14,169 6 2089† 13,128 6 1779† 13816 6 1153†
Second set
HR (b$min21) 110 6 10† 110 6 10† 115 6 8†
SBP (mm Hg) 136 6 17 129 6 16 129 6 11
DBP (mm Hg) 81 6 7 81 6 4 81 6 3
RPP (mm Hg$b$min21) 14,966 6 1972† 14,157 6 1978† 14787 6 1454†
Third set
HR (b$min21) 112 6 9† 114 6 11† 118 6 8†
SBP (mm Hg) 144 6 15† 133 6 19 133 6 12†
DBP (mm Hg) 80 6 8 81 6 6 81 6 4
RPP (mm Hg$b$min21) 16,080 6 1798†z 15,172 6 2403†z 15630 6 1351†z

*HR = heart rate; SBP = systolic blood pressure; DBP = diastolic blood pressure; RPP = rate pressure product.
†Statistically significant difference when compared with the same variable at rest (p # 0.05).
zStatistically significant difference when compared with same variable during the first set (p # 0.05). Values are expressed as mean 6 SD.

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participant performed the movement by making a full elbow encouraged during the test (11). The 10RM tests were per-
flexion and then returned to the starting position. For this formed on 2 nonconsecutive days. On the first testing day,
exercise, we used bars and plates from the Arm Curl Bench the bilateral tests for the 3 body segments were performed in
(SAC models and SDR2; Life Fitness, Rosemont, IL, USA). the following order: upper limbs, lower limbs, and trunk. On
The knee extension exercise was performed on a Leg the second testing day, the unilateral test for each of the 3
Extension machine (model SPLLE; Life Fitness, Rosemont, body segments was performed in the following order: upper
IL,), starting in the sitting position with knees flexed at 908 limbs right and left, lower limbs right and left, and trunk
(starting position). Beginning from the starting position, the right and left. During testing of 10RM, each subject had
participant performed the movement by making full knee a maximum of 5 attempts at each exercise with 2–5 minutes
extension and then returned to the initial position. between attempts (1,11).
The barbell row exercise was conducted on a Life Fitness
Row machine (model SPLROW; Life Fitness, Rosemont, Assessment of Cardiovascular Responses. The responses of the
IL,), starting in the seated position with chest resting on the cardiovascular variables, HR, BP, and RPP, were determined
back of the device with shoulders flexed, forming an angle of for the 3 types of exercise tested in different forms of execution
908 to the trunk. Elbows were extended and a pronated grip (i.e., unilaterally, bilaterally, and alternating left and right sides).
was used (starting position). Beginning from the starting A standard procedure was used for each evaluation, which
position, the participant performed the movement by mak- consisted of rest for 10 minutes in a calm and quiet
ing a horizontal shoulder abduction of 908 with 908 of flexion environment, followed by measures of resting BP and HR in
of the elbow and then returning to the starting position. the supine position. Resting HR was determined using a Polar
To reduce possible errors in the 10RM measures, the heart monitor (model S610; Kempele, Finland) for 10 minutes,
following strategies were adopted: (a) all participants, before with the mean value computed for the last 2-minute time
the start of testing, received standardized instructions interval.
regarding the technical execution of the exercises, (b) the Systolic blood pressure and DBP were measured using
technical movements during all test sessions were monitored a mercury sphygmomanometer (Premium Brand Model:
and adjusted if necessary, and (c) all subjects were verbally Single, Mainland, China), calibrated with a standard adult

TABLE 3. Cardiovascular measures at rest and in response to three sets of bilateral, unilateral, and alternating forms
of barbell rows.*

Bilateral Unilateral Alternating

Rest
HR (b$min21) 60 6 6 59 6 6 59 6 6
SBP (mm Hg) 118 6 10 119 6 11 117 6 10
DBP (mm Hg) 81 6 5 81 6 5 82 6 3
RPP (mm Hg$b$min21) 7105 6 1101 7064 6 1191 6887 6 1057
First set
HR (b$min21) 109 6 3† 112 6 4† 114 6 7†
SBP (mm Hg) 120 6 12 121 6 10 118 6 10
DBP (mm Hg) 81 6 4 79 6 5 81 6 4
RPP (mm Hg$b$min21) 13,131 6 1344† 13,463 6 896† 13407 6 1312†
Second set
HR (b$min21) 114 6 8† 114 6 7† 119 6 8†
SBP (mm Hg) 125 6 13 124 6 11 119 6 11
DBP (mm Hg) 81 6 4 79 6 5 81 6 5
RPP (mm Hg$b$min21) 14,241 6 1982† 14,064 6 920† 14162 6 1278†
Third set
HR (b$min21) 117 6 8†z 117 6 7† 124 6 8†z§k
SBP (mm Hg) 130 6 13† 128 6 8 123 6 10
DBP (mm Hg) 81 6 6 81 6 6 81 6 5
RPP (mm Hg$b$min21) 15,290 6 1838†z 14,981 6 1080†z 15258 6 1212†z

*HR = heart rate; SBP = systolic blood pressure; DBP = diastolic blood pressure; RPP = rate pressure product.
†Statistically significant difference when compared with the same variable at rest (p # 0.05).
zStatistically significant difference when compared with same variable during the first set (p # 0.05).
§Statistically significant difference when compared with unilateral performance during the same set (p # 0.05).
kStatistically significant difference when compared with the same variable executed bilaterally during the same set (p # 0.05).
Values are expressed as mean 6 SD.

VOLUME 31 | NUMBER 3 | MARCH 2017 | 647

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Cardiovascular Responses in Different Body Segments

cuff. The procedure for measurements and classification of Altogether, 9 evaluations were conducted, 1 for each
results were made according to criteria proposed by The exercise conducted using each body segment. These 9
Seventh Report of the Joint National Committee (6) and assessment days had 48-hour or more intervals between
endorsed by the Brazilian Society of Cardiology (3). them, so the assessments were spread over a total of 27 days.
The subjects then performed 3 sets of 10 repetitions of the A balanced Latin square design was used to avoid a treat-
exercise with a load of 80% of 10RM, with an interval of ment order effect.
2-minute rest between sets (1) without warm-up. During the
exercise, the evaluator was positioned beside the research par- Statistical Analyses
ticipant to measure HR and BP, immediately at the end of the The collected data were stored and analyzed using Sigma
exercise set. The subjects were also instructed not to hold their Stat for Windows version 2.03 (Systat Software, San Lean-
breath during the exercises, thus avoiding the BP increase dro, CA, USA). Normality was assessed by the Shapiro-Wilk
associated with the Valsalva maneuver. The HR was measured test. We used the Wilcoxon test to compare the variables at
by registering the highest value presented at the end of each rest and after exercise. Friedman’s test, with Dunn’s post hoc,
set. Systolic blood pressure and DBP were measured with the was used to detect differences in the responses of HR, SBP,
cuff being inflated at the end of the eccentric phase of the last DBP, and RPP among the 3 sets of each form of execution
contraction, with the reading being conducted up to a maxi- (unilateral, bilateral, and alternating) for each exercise. The
mum of 10 seconds after the end of the last repetition (23). Kruskal-Wallis test with Dunn’s post hoc was used to detect
To prevent the speed of movement from differentially differences in the responses of HR, SBP, DBP, and RPP
affecting the cardiovascular responses, the exercises were among the forms of execution (unilateral, bilateral, and alter-
performed using a metronome set to 60 beats per minute, nating) of each exercise and among 3 different body seg-
with the concentric and eccentric phases of each lift lasting 2 ments. A significance level of p # 0.05 was adopted for all
seconds each. The RPP was calculated from the product of treatments.
maximum SBP and maximum HR obtained soon after the
end of the exercise. This procedure was repeated for each RESULTS
form of execution (unilateral, bilateral, and alternating) of Cardiovascular data at rest and in responses to biceps curls,
each exercise (biceps curls, rowing, and knee extension), knee extension, and barbell row exercises are presented in
with an interval of 48 hours between tests. Tables 1–3, respectively. There was a significantly higher HR

Figure 1. Comparison of cardiovascular responses among unilaterally performed biceps curls, leg extension, and barbell rows for each of 3 sets. DBP, diastolic
blood pressure (mm Hg); HR = heart rate (b$min21); RPP = rate pressure product (b$min21 * mm Hg); SBP = systolic blood pressure (mm Hg).

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Figure 2. Comparison of cardiovascular responses among bilaterally performed biceps curls, leg extension, and barbell rows for each of 3 sets. aStatistically
significant difference when compared to the same variable of the biceps curl exercise (p , 0.05); bstatistically significant difference when compared with the
same variable of the knee extension exercise (p , 0.05). DBP = diastolic blood pressure (mm Hg); HR = heart rate (b$min21); RPP = rate pressure product
(b$min21 * mm Hg); SBP = systolic blood pressure (mm Hg).

Figure 3. Comparison of cardiovascular responses among the alternating forms of execution of biceps curls, leg extension, and barbell rows for each of 3 sets.
bStatistically significant difference when compared with the same variable of the knee extension exercise (p , 0.05). DBP = diastolic blood pressure (mm Hg);

HR = heart rate (b$min21); RPP = rate pressure product (b$min21 * mm Hg); SBP = systolic blood pressure (mm Hg).

VOLUME 31 | NUMBER 3 | MARCH 2017 | 649

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Cardiovascular Responses in Different Body Segments

and RPP in response to all 3 forms of exercise and the 3 sets loads, with HR and BP slow to return to their resting state
as compared with resting HR and RPP (Tables 1–3). after performing a series of RE between 8 and 12 repetitions
When comparing the 3 sets of each form of biceps and recovery intervals between 1 and 3 minutes (5,14). Thus,
exercise (unilateral, bilateral, and alternating), the RPP cardiovascular stress increases with increasing number of
attained during the third set was higher than that attained sets performed.
during the first set for all 3 forms of exercise. Furthermore, The biceps curl exercise performed bilaterally in this study
when the 3 forms of exercise were analyzed within a given caused elevation in RPP in relation to unilateral performance
set, there were significant differences between unilateral and in the first (bilateral vs. unilateral = 15,533 vs. 13,875 mm
bilateral biceps exercise for HR in the second and third sets, Hg$b$min21) and second sets (bilateral vs. unilateral =
and also for RPP in the first and second sets (Table 1). 16,850 vs. 14,653 mm Hg$b$min21). Bilateral biceps curls
Similarly, differences were also found in HR during the third also resulted in a higher HR than the unilateral biceps curl
set of barbell row exercise among bilateral, unilateral, and exercise during the second (bilateral vs. unilateral = 128 vs.
alternating forms of exercise (Table 3 and Figure 1). 116 b$min21) and third sets (bilateral vs. unilateral = 133 vs.
Differences were found in HR and RPP for the bilateral 120 b$min21). This indicates that there is a greater cardio-
exercise in the upper limbs when compared with the lower vascular stress during bilateral as compared with unilateral
limbs and trunk (Figure 2). Because for the alternating form bicep curls. In a study by Monteiro et al. (18), acute re-
of exercise, there was a higher SBP for the alternating second sponses of HR, SBP, and RPP during unilateral, bilateral,
and third sets and also the bilateral third set of the knee and alternating knee extension exercise were compared dur-
extensions when compared with the barbell rows (Figure 3). ing 3 sets for each exercise. The authors pointed out that the
manner of execution had no influence on cardiovascular
DISCUSSION responses during exercise, although the authors called atten-
This is one of the few studies that has been conducted to tion to the fact that the responses of HR, SBP, and RPP
investigate the cardiovascular response during strength train- during the bilateral exercise tended to rise nonsignificantly
ing with the 3 different forms of execution (unilateral, bilateral, as compared with unilateral performance. In that same study
and alternating). In all forms of execution, the RPP was (18), higher responses were consistently observed for the
increased from rest to postexercise, especially after the third bilateral and alternating exercise than unilateral exercise
set of RE. As hypothesized, the exercises that caused the when multiple sets were performed. The results of this study,
greatest cardiovascular response were bilateral exercises con- despite being on the lower limbs, provide some evidence
ducted mainly using the upper limbs (biceps curls), as of similar responses to those seen for upper-body exercises
compared with unilateral exercises or compared with exercises performed in this study; however, consistent with
using the muscles of the trunk and lower limbs. We suggest our hypothesis, we showed that the exercises performed
from our findings that manipulation of common variables bilaterally demanded significantly greater cardiovascular
associated with training, including the number of sets per- response compared with exercises performed unilaterally
formed, can impact the acute cardiovascular responses. This or alternating.
should be considered in training situations where cardiovas- The bilateral upper limb biceps curl exercise resulted in
cular responses during exercise are of concern, such as in a higher increase in HR and RPP in all sets compared with
older, obese, or diseased populations (7,13,15,20,22). bilateral knee extension exercises and barbell row exercises,
The observed increase in HR during RE and the pro- which are performed using the lower limbs and trunk
gressive rise with subsequent sets were not unexpected, as musculature as the prime movers, respectively. This finding
HR rises substantially during RE, reaching maximum values is consistent with the results reported by Wickwire et al.
during the final repetitions of a set (30). Furthermore, the (30), who assessed the cardiovascular response to 2 distinct
sum of several sets can further increase the HR as compared RE: elbow flexion and knee extension. The results suggested
with the first set, especially when there are short recovery greater demand on the cardiovascular system for exercises
periods (21,24). performed with the upper limbs. Exercises performed with
The RPP was higher in the third set than the first set for the upper-body segments may produce greater cardiovascu-
all exercises (p # 0.05), regardless of the form of execution lar overload because the demand for myocardial work is
(unilateral, bilateral, and alternating). Similar results have considerably higher due to the structure of the vascular tree
been obtained in another study, in that there was an present in the upper limbs, causing them to develop greater
increased RPP compared with the previous set of bilateral resistance to blood flow (28).
leg press exercise using 3 sets of 10RM with fixed recovery The SBP in the third set of bilateral knee extension
intervals of 3 minutes in healthy young adults (14). Addi- exercise, and the second and third sets of alternating knee
tionally, Castinheiras-Neto et al. (5) found increases in RPP extension exercise was higher compared with the barbell
with a cumulative effect of multiple sets when studying dif- row (trunk) exercise. These findings may be related to the
ferent recovery intervals in the course of the bilateral leg fact that the magnitude of the hypertensive responses to
press. RPP shows a tendency to increase with increasing exercise is directly related to the intensity of effort and the
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amount of muscle mass involved in the exercise. The greater additional set performed. Thus, it is necessary to use
the muscle mass activated within a given body segment, the strategies to control the cardiovascular response, such as
greater the cardiac overload, resulting in increased BP (2). a 1–2 set limit using alternating or unilateral, rather than
According to Polito and Farinatti (23), during dynamic ex- bilateral, exercises when the upper limbs are used. An addi-
ercises, when there is a higher volumetric load on the left tional, or perhaps alternative, approach to limit the number
ventricle, cardiac hemodynamic responses are relatively pro- of sets performed would be to have longer rest intervals
portional to muscle mass and the intensity of effort involved between sets for upper-body exercises. The particular exer-
in the exercise. In addition, RE, especially in the concentric cise prescription must always be tailored to the individual
phase, involves a significant mechanical compression of the considering their specific cardiovascular complication.
peripheral arteries, causing an increase in total peripheral
resistance and decrease in muscle perfusion. This induces REFERENCES
an increase in central sympathetic activity, cardiac output, 1. American College of Sports Medicine (ACSM). American College
and BP to restore blood flow to muscle (12,27). It is a limi- of Sports Medicine position stand. Progression models in resistance
tation of this study that we did not measure the muscle mass training for healthy adults. Med Sci Sports Exerc 41: 687–708, 2009.
engaged in the 3 forms of exercises, but it is assumed that the 2. Battagin, AM, Corso, SD, Soares, CLR, Ferreira, S, Letı́cia, A,
Souza, CD, and Malaguti, C. Pressure response after resistance
muscle mass engaged in the lower-body knee extension exercise for different body segments in hypertensive Patients. Arq
exercise was greater than that of the upper-body exercises. Bras Cardiol 95: 405–411, 2010.
The higher SBP with knee extension exercise than barbell 3. Brazilian Society of Cardiology/Brazilian Society of Hypertension/
row exercise would therefore support our hypothesis that Brazilian Society of Nephrology (BSN). VI brazilian Guidelines on
Hypertension. Arq Bras Cardiol 95: 1–51, 2010.
greater muscle mass induces greater cardiovascular load.
4. Brito, AF, Alves, NF, Araújo, AS, Gonçalves, MC, and Silva, AS.
The results of this study provide indications that there are Active intervals between sets of resistance exercises potentiate the
differential impacts of RE, performed using different forms of magnitude of postexercise hypotension in elderly hypertensive
execution (unilaterally, bilaterally, or with alternating limbs) women. J Strength Cond Res 25: 3129–3136, 2011.
and with different body segments on cardiovascular re- 5. Castinheiras-Neto, AG, Costa-Filho, IR, and Farinatti, PTV.
Cardiovascular responses to resistance exercise are affected by load
sponses. It is therefore recommended that further studies of and intervals series. Arq Bras Cardiol 95: 493–501, 2010.
similar design should be conducted in different populations,
6. Chobanian, AV, Bakris, GL, Black, HR, Cushman, WC, Green, LA,
such as hypertensive and elderly, to evaluate the safety of Izzo Junior, JL, and Roccella, EJ. Joint National Committee on
prescribing particular RE protocols using specific body Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure. National Heart, Lung, and Blood Institute; National High
segments, as the cardiovascular responses, and therefore
Blood Pressure Education Program Coordinating Committee.
safety, can be different for these populations. Seventh report of the joint national committee on prevention,
We can conclude from the data of this study that, in all detection, evaluation, and treatment of high blood pressure.
Hypertension 42: 1206–1252, 2003.
forms of exercise used in this study, the RPP was increased
from rest to postexercise, especially immediately after the 7. Cornelissen, VA, Fagard, RH, Coeckelberghs, E, and Vanhees, L.
Impact of resistance training on blood pressure and other
third set of RE. The exercises that caused the greatest cardiovascular risk factors a meta-analysis of randomized, controlled
cardiovascular response were bilateral exercises conducted trials. Hypertension 58: 950–958, 2011.
mainly in the upper limbs. These upper-body bilateral 8. Cornelissen, VA and Smart, NA. Exercise training for blood
exercises promoted greater increases in cardiovascular pressure: A systematic review and meta-analysis. J Am Heart Assoc 2:
44–73, 2013.
response when compared with exercises using the muscles
9. Croymans, DM, Krell, SL, Katiraie, M, Lam, CY, Harris, RA, and
of the trunk and lower limbs. However, all 3 modes of Roberts, CK. Effects of resistance training on central blood pressure
resistance training (unilateral, bilateral, and alternating) for in obese young men. J Hum Hypertens 7: 157–164, 2013.
the different body segments tested proved safe for apparently 10. de Souza, JC, Tibana, RA, de Sousa, NM, de Souza, VC,
healthy individuals. Karnikowski, MG, Prestes, J, and Campbell, CSG. Association of
cardiovascular response to an acute resistance training session with
PRACTICAL APPLICATIONS the ACE gene polymorphism in sedentary women: A randomized
trial. BMC Cardio Disord 13: 3–11, 2013.
The information provided in this study can assist in pre- 11. Fleck, SJ and Kraemer, WJ. Designing Resistance Training Programs.
scribing RE, especially for individuals, where the cardiovas- Champaign, IL: Human Kinetics, 2004.
cular stress represent a risk for participation in physical _
12. Gelecek, N, Ilçin, N, Subas‚i, SS, Acar, S, Demir, N, and Örmen, M.
activity, increasing the risk of cardiovascular event occur- The effects of resistance training on cardiovascular disease risk
factors in postmenopausal women: A randomized-controlled trial.
rence. Thus, when prescribing resistance training for indi- Health Care Women Inter 33: 1072–1085, 2012.
viduals with any cardiovascular complications, unilateral or 13. Gerage, AM, Forjaz, CL, Nascimento, MA, Januário, RS,
alternating exercises should be prioritized, especially for Polito, MD, and Cyrino, ES. Cardiovascular adaptations to
bicep curls, because this form of exercise results in lower resistance training in elderly postmenopausal women. Int J Sports
Med 34: 806–813, 2013.
cardiovascular responses. Furthermore, professionals must
14. Gotshall, R, Gootman, J, Byrnes, W, Fleck, S, and Valovich, T.
be careful when prescribing multiple sets of RE because the Noninvasive characterization of the blood pressure response to the
cardiovascular responses are more pronounced with each double-leg press exercise. JEPonline 2: 1–6, 1999.

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15. Jesus, RC, Moreira, OC, Oliveira, CE, Doimo, LA, and cardiovascular responses to series still do. Arq Bras Cardiol 90:
Monteiro, WD. Cardiovascular response in three different resistance 382–387, 2008.
exercises to the deltoid muscle. Biosci J 29: 2077–2084, 2013. 25. Ratamess, NA, Chiarello, CM, Sacco, AJ, Hoffman, JR,
16. McCurdy, KW, Langford, GA, Doscher, MW, Wiley, LP, and Faigenbaum, AD, Ross, RE, and Kang, J. The effects of rest interval
Mallard, KG. The effects of short-term unilateral and bilateral lower- length manipulation of the first upper-body resistance exercise in
body resistance training on measures of strength and power. J sequence on acute performance of subsequent exercises in men and
Strength Cond Res 19: 9–15, 2005. women. J Strength Cond Res 26: 2929–2938, 2012.
17. Migiano, MJ, Vingren, JL, Volek, JS, Maresh, CM, Fragala, MS, 26. Rossi, AM, Moullec, G, Lavoie, KL, Gour-Provençal, G, and
Ho, JY, Thomas, GA, Hatfield, DL, Häkkinen, K, Ahtiainen, J, Bacon, SL. The evolution of a Canadian Hypertension Education
Earp, JE, and Kraemer, WJ. Endocrine response patterns to acute Program recommendation: The impact of resistance training on
unilateral and bilateral resistance exercise in men. J Strength Cond Res resting blood pressure in adults as an example. Can J Cardiol 29:
24: 128–134, 2010. 622–627, 2013.
18. Monteiro, WD, Souza, DA, Rodrigues, MN, and Farinatti, PTV. 27. Tibana, RA, Pereira, GB, De Souza, JC, Tajra, V, Vieira, DC,
Cardiovascular responses to acute resistance exercise performed in Campbell, CS, and Prestes, J. Resistance training decreases 24-hour
three different forms of execution. Braz J Sports Med 14: 94–98, 2008. blood pressure in women with metabolic syndrome. Diabetol Metab
19. Mota, MR, Oliveira, RJ, Terra, DF, Pardono, E, de Almeida, JA, and Syndr 5: 27, 2013.
Silva, FM. Acute and chronic effects of resistance exercise on blood 28. Toner, MM, Glickman, EL, and McArdle, WD. Cardiovascular
pressure in elderly women and the possible influence of ACE I/D adjustment to exercise distributed between the upper and lower
polymorphism. Int J Gen Med 6: 581–587, 2013. body. Med Sci Sports Exerc 22: 773–778, 1990.
20. Olher, RD, Bocalini, DS, Bacurau, RF, Rodriguez, D, Figueira, A Jr, 29. Vandervoot, AA, Sale, DG, and Imoroz, JR. Strength velocity
Pontes, FL Jr, and Moraes, MR. Isometric handgrip does not elicit relation and fatigability of unilateral versus bilateral arm extension.
cardiovascular overload or post-exercise hypotension in Eur J Appl Physiol 56: 201–205, 1987.
hypertensive older women. Clin Inter Aging 8: 649–653, 2013.
30. Wickwire, PJ, McLester, JR, Green, JM, and Crews, TR. Acute heart
21. Oliveira, AS and Gonçalves, M. Positioning during resistance elbow rate, blood pressure, and RPE responses during super slow vs.
flexor exercise affects electromyographic activity, heart rate, and traditional machine resistance training protocols using small muscle
perceived exertion. J Strength Cond Res 23: 854–862, 2009. group exercises. J Strength Cond Res 23: 72–79, 2009.
22. Pattyn, N, Cornelissen, VA, Eshghi, SR, and Vanhees, L. The effect 31. Willardson, JM and Burkett, LN. The effect of rest interval length on
of exercise on the cardiovascular risk factors constituting the bench press performance with heavy vs. light loads. J Strength Cond
metabolic syndrome. Sports Med 43: 121–133, 2013. Res 20: 396–399, 2006.
23. Polito, MD and Farinatti, PTV. Responses of heart rate, blood 32. Yanovski, SZ, Hubbard, VS, Heymsfield, SB, and Lukaski, HC.
pressure and double product to resistance exercise: A literature Bioelectrical impedance analysis in body composition
review. Portuguese J Sport Sci 3: 79–91, 2003. measurement: National Institutes of Health Technology
24. Polito, MD, Simão, R, Lira, VA, Nóbrega, ACL, and Assessment Conference Statement. Am J Clin Nutr 64: 524S–532S,
Farinatti, PTV. Fractional series knee extension provides greater 1996.

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