alvina


137

ABSTRACT

Exercise training can improve blood pressure in normotensive, prehypertensive,
and hypertensive subjects. One of the mechanisms of blood pressure reduction
in hypertensive patients with obesity is through weight loss. This study aimed to
examine the effect of exercise training on bodyweight and the relationship
between weight loss and reduction of blood pressure. An experimental pre-post
test design without controls was used to evaluate the effect of exercise training
on weight loss. The study involved 89 elderly aged 50 years or more, consisting
of 40 men and 49 women, who were members of Senayan Sport Fitness Club
and had been exercising for at least three months. Exercise training was
programmed and performed three times a week, consisting of aerobic (walking,
jogging, static cycling), and resistance exercise. All exercise was performed for
one to two hours with mild to moderate intensity. Blood pressure and body
weight were obtained from medical records. Paired t-test showed that systolic
blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure
(MAP), pulse pressure (PP), and body mass index (BMI) were significantly
lower after training [(systolic, 126.3 ± 2.9 vs 122.3 ± 2.7, p=0.02), (diastolic,
80.2 ± 3.1 vs 77.2 ± 2.4, p=0.00), (MAP, 95.6 ± 4.6 vs 92.2 ± 3.4, p=0.00), (PP,
46.1 ± 4.2 vs 45.1 ± 3.6, p=0.04), (BMI, 24.5 ± 2.9 vs 23.6 ± 2.9, p=0.04)].
Duration of training was the most influential factor affecting BMI, (Beta =
0.38; p=0.00). Exercise training could lower BMI and the reduction in diastolic
blood pressure was higher for the subjects aged 70 years and over.

Keywords: Exercise, body mass index, blood pressure, pulse pressure, elderly

*Department of Physiology,
School of Medicine, Atma Jaya
Catholic University

Correspondence
dr. Ignatio Rika Haryono, SpKO
Department of Physiology,
School of Medicine, Atma Jaya
Catholic University
Jl. Pluit Raya No.2
Jakarta  14440
Phone: 021-5469177
Email:
rika_haryono@yahoo.com

Univ Med 2010;29:137-43.

Exercise training decreases body mass index in
subjects aged 50 years and over

Ignatio Rika Haryono*

September-December, 2010September-December, 2010September-December, 2010September-December, 2010September-December, 2010             Vol.29 - No.3            Vol.29 - No.3            Vol.29 - No.3            Vol.29 - No.3            Vol.29 - No.3

UNIVERSA MEDICINA

INTRODUCTION

The effect of exercise training on blood
pressure is obvious. This is the reason why
exercise has been be a part of protocol based
therapy in people with prehypertension and
hypertension. A study by Pinto et al. showed
that fast walking reduced ambulatory systolic

blood pressure (SBP) and diastolic blood
pressure (DBP) by 7.6 and 6.3 mmHg in
hypertensive subjects.(1) Hayashi et al. found
that the decrease in SBP could even reach up
to 10 mmHg.(2) The decrease in blood pressure
is usually greater in hypertensive than in
normotensive persons.(3)

The decrease in blood pressure due to



138

Haryono                                                                                                                                    Training decreases body mass index

exercise training can occur in several ways. One
of the mechanisms of blood pressure reduction
in hypertensive patients with obesity is through
weight loss. SBP and DBP will decrease about
3 mmHg for a 3-9% decrease in body weight.(4)
A study by Engeli et al. showed that in obese
women 5% weight loss reduced levels of
angiotensinogen by 27%, renin by 43%,
aldosterone by 31%, and angiotensin-converting
enzyme (ACE) by 12%.(5)

SBP and DBP, mean arterial pressure
(MAP), and pulse pressure (PP) are risk factors
of cardiovascular diseases. The study by Sesso
showed that increased SBP, DBP, MAP, and PP
in men increases the risk of cardiovascular
disease by 1.43 to 2.52 times.(6) Systolic pressure
tends to increase, while diastolic pressure rises
until 60 years of age and then declines or
stabilizes as increasing age.(7) The difference
between the pattern of increase in systolic
pressure and that in diastolic pressure with
increasing age causes the MAP and PP to be
important factors for assessment of the risk of
cardiovascular disease.(8,9) A study in Japan on
246 healthy middle-aged and older adults (44-
78 years) showed that after moderate and high-
intensity interval walking training body weight
a n d  b o d y  m a s s  i n d e x  ( B M I )  d e c r e a s e d
significantly in women.(10) The objective of the
present study was to investigate the effect of
exercise training on weight loss, SBP, DBP,
MAP, and PP.

METHODS

Research design
An experimental pre-post test design

without controls was used to evaluate the effect
of exercise training on weight loss, SBP, DBP,
MAP, and PP.This study was carried out in
Senayan Sport Fitness Club (SSFC), from
August to October 2010.

Subjects
T h e  s t u d y  s u b j e c t s  c o n s i s t e d  o f  8 9

participants, namely 40 men and 49 women,

who were members of the Senayan Sport Fitness
Club (SSFC), Jakarta. The sample size was
calculated for numeric in paired sample
(á=0.05%, β=0.20%, SD=10, significant mean
difference=4). Inclusion criteria were members
aged 50 years or more, with normal or above
normal blood pressure, who had practiced three
times a week continuously in the last three
months (checked from the daily presence list)
a n d  u n d e r w e n t  r e g u l a r  b l o o d  p r e s s u r e
examination at the SSFC. The sole exclusion
criterion was members who did not practice for
the last three months or more.

Exercise training
The intensity of the training was in

a c c o r d a n c e  w i t h  t h e  i n d i v i d u a l  t r a i n i n g
programs that had been designed based on the
member’s level of fitness and health (50-60%
VO2max) for exercise for at least 30 minutes.
Aerobic training was done either outdoors
(walking, jogging) or indoors (static cycling),
whereas weight training was done indoors.
Exercise was performed three times a week.

Data collection
Data of the subjects included age, gender,

and exercise test variables (SBP, DBP, BMI, and
weight, MAP), which were obtained from
patient fitness and medical records. Pre-exercise
values of blood pressure, height, and body
weight were mean values taken before exercise
bouts in the first 10 days, whereas post-exercise
values were mean values taken before exercise
bouts in the last 10 days of exercise training.
Blood pressure was measured by trained nurses
using a sphygmomanometer (Nova). Body
weight was measured using Camry scales to the
nearest 0.1 kg, and height was measured using
a stature meter to the nearest 0.1 cm. BMI was
calculated as the weight (kg) divided by the
square of the height (m2).

Ethical clearance
Ethical clearance was approved by the

Ethical Commission of Atma Jaya Catholic



139

University. The participants were requested to
give written consent, with attached signature.
I d e n t i f y  o f  a l l  p a r t i c i p a n t s  w a s  k e p t
confidential and used for research purposes
only.

Statistical analysis
The data obtained were processed and

a n a l y z e d  u s i n g  S P S S  v e r s i o n  1 6 . 0 ,  a n d
normality of distribution of the data was
checked using Kolmogorov-Smirnov test.
Paired t-test was performed to confirm the
difference of mean SBP, DBP, MAP, and PP
before and after training, whereas ANOVA was
used to compare the same variables between
a g e  g r o u p s .  T h e  P e a r s o n  o r  S p e a r m a n
correlation test was conducted to determine the
relationship between the above variables.
Significance of the results was set at p <0.05.

RESULTS

Of the participants enrolled in the study,
40 were male (44.9%) and 49 (55.1%) were
female. Mean age of the subjects was 61.3 ±
11.5 years and most of the subjects, both male
and female, were aged 60 to 69 years (47.2%)
(Table 1). There were more female than male
subjects in all age groups.

Exercise test variables consisting of
duration of training, BMI, SBP, DBP, MAP, and
PP, are shown by age group in Table 2, for
comparison of the between-group means. The

mean duration of training was 6.3 years. The
longest duration of training was 7.1 years,
occurring the age group of 70-79 years, and
differed significantly from the duration of
training in the age group of >80 years. The
mean body weight above normal was found in
the age group of 70-79 years, but there was no
difference in BMI between groups. The mean
SBP and mean DBP of all groups were higher
than normal. Mean SBP of age groups 60-69,
70-79, and >80 years were significantly higher
than that of the group of 50-59 years, whereas
for mean DBP no significant between-group
difference was found. The mean MAP of all
groups were within the normal range (70-110
mm Hg). Mean MAP in the age group of 70-
79 years was higher than that in the age group
of 50-59 years. Similarly, the mean PP of all
groups were above normal (30-40 mmHg), and
mean PP of the age group of 60-69 years was
also significantly higher than that of age group
of 50-59 years.

 

Age group 
G ender 

Total (% ) 
Male Female 

50 -59 y 6 8 14 (15.7) 
60 -69 y 19 23 42 (47.2) 
70 -79 y 8 10 18 (20.2) 
>8 0 y 7 8 15 (16.9) 
Total 40 49 89 (100) 

Table 1. Subject distribution according to the
gender and age group

Age group Traini ng durati on (years) 
BMI 

(kg/m2) 
SBP 

(mmHg) 
DBP 

(mmHg) 
MAP 

(mmHg) 
PP 

(mmHg) 

50-59 y 5.3 24.1 120.7 78.4 92.5 42.3 
60-69 y 6.7 25.0 127.6* 79.9 95.8 47.7* 
70-79 y 7.1* 25.9 128.7* 81.9 97.5* 46.8 
>80  y 4.2 23.0 128.2* 80.6 96.5 47.6 

Overall 6.3 24.5 126.3 80.2 95.6 46.1 
 

Table 2. Exercise test variables by age group at baseline

One-way ANOVA test
*Significant at p<0.05, compared to lowest mean value

Univ Med                                                                                                    Vol.29 No.3



140

Haryono                                                                                                                                    Training decreases body mass index

  ∆ BMI ∆ SBP ∆ DBP ∆ MAP ∆ PP 
   p  p  p  p  p 
Age -0.14 0.18 -0.01 0.94 -0.04 0.75 -0.03 0.82 0.02 0.90 
Gender -0.24 0.03 -0.06 0.60 -0.03 0.78 -0.05 0.66 -0.06 0.63 
Training durati on  0.38 0.00  0.07 0.58  0.12 0.32  0.10 0.39  0.01  0.97 
 

Table 4. Multiple regression analysis of age, gender and training duration on exercise variables

β= Standardized coefficients
* Significance at p<0.05

A comparison of pre- and post-training
values of the exercise test variables are shown
in Table 3, where it is apparent that the values
for body mass index and all other parameters
d e c r e a s e d  s i g n i f i c a n t l y  i n t o  t h e  n o r m a l
category after exercise training. Mean post
exercise values of BMI in the age groups of
60-69 and 70-79 years, post exercise SBP the
age group of 50-59 years, and post exercise
DBP of age groups 70-79 and >80 years, fell
into the normal category. However, post
exercise PP of all groups were still above
normal.

Table 4 shows the results of multiple
regression analysis demonstrating that training
duration was the most influential factor
affecting BMI (Beta = 0.38; p=0.00).
However, both age, gender, and training
duration did not affect SBP, DBP, MAP
dan PP.

DISCUSSION

This study was conducted in the elderly to
confirm decrease in body weight after exercise
training and its relationship to changes in
cardiovascular parameters. The results showed
there was significant reduction in BMI and all
exercise test paramenters. Overall, BMI, SBP,
DBP decreased about 3.7%, 4 mmHg, and 3
mmHg, respectively. This could be interpreted
as meaning that a decrease in BMI by 1% will
decrease SBP and DBP by about 1 mmHg. This
result was quite similar to that of other studies.
The study by Steven et al. showed that the
decrease in blood pressure after exercise
training can occur even with a slight decrease
in bodyweight. (12) Mulrow et al. found a
decrease in SBP and DBP of 3 mmHg for a 3-
9% decrease in body weight.(4)

Age 
group 

BMI SBP DBP MAP PP 
Pre Pos p Pre Post p Pre Po p Pre Post p Pre Post p 

50-59 y 24.1 22.7 0.01 120.7 118.1 0.04 78.4 75.9 0.01 92.5 89.9 0.05 42.3 42.2 0.68 
60-69 y 25.0 24.0 0.04 127.6 120.8 0.00 79.9 76.0 0.00 95.8 90.9 0.29 47.7 44.8 0.00 
70-79 y 25.9 24.8 0.04 128.7 122.5 0.01 81.9 78.1 0.03 97.5 92.9 0.02 46.8 44.4 0.02 
>80 y 23.0 22.9 0.74 128.2 127.8 0.62 80.6 78.8 0.06 96.5 95.1 0.62 47.6 49.0 0.07 

Overall  24.5 23.6 0.04 126.3 122.3 0.02 80.2 77.2 0.00 95.6 92.2 0.00 46.1 45.1 0.04 
 

Table 3. Exercise variables before and after training, by age group

One-way ANOVA test



141

A meta-analysis by Cornelissen and
Fagard showed that exercise can lower SBP
and DBP in the normotensive by 3.3 and 3.5
mmHg, respectively, whereas in patients with
hypertension SBP and DBP decreased by 6.9
and 4.9 mmHg.(13) Our subjects consisted of
b o t h  n o r m o t e n s i v e  a n d  h y p e r t e n s i v e
individuals, who were however not divided
into normotensive and hypertensive groups,
because our study emphasized the association
b e t w e e n  w e i g h t  l o s s  a n d  r e d u c e d  b l o o d
pressure. Therefore, the overall mean decrease
in blood pressure was the combined result of
the decreases in both types of subjects, so that
the mean reduction in SBP and DBP was less,
being only 4 and 3 mmHg, respectively.

In the present study the grouping of the
subjects according to age was consistent with
M a c A u l e y ’s  s t u d y  w h i c h  f o u n d  t h a t  t h e
relationship between blood pressure and
physical activity was influenced more by
age.(14) However, although in the present study
post-exercise values of SBP, DBP, MAP, and
PP of the elderly were higher, age had no
influence on the increase in the values of these
exercise variables. This difference may be
caused by the wider age range of the subjects
(16-74 years) in the MacAuley study which
impacted significantly on blood pressure.(14)

A t h o u g h  t h e  d e c r e a s e  i n  S B P  w a s
statistically significant, mean SBP of all age
groups after training, except in the age group
of 50-59 years, was clinically less significant,
because it was still in the prehypertension
category.(15) In contrast, the mean DBP of all
a g e  g r o u p s  a f t e r  t r a i n i n g  w a s  c l i n i c a l l y
significant, as it reflected a beneficial change
i n  c a t e g o r y,  f r o m  p r e h y p e r t e n s i o n  t o
normotension. The clinically non-significant
decrease in SBP may be the result of the
considerably higher SBP values in a number
o f  s u b j e c t s ,  l e a d i n g  t o  n o  c h a n g e  i n
hypertensive category.

The decrease in blood pressure due to
weight loss may occur by several mechanisms.
O b e s i t y,  e s p e c i a l l y  c e n t r a l  o b e s i t y,  i s

associated with an increase in renin angiotensin
aldosteron (RAA) system activity, sympathetic
activity, endothelial dysfunction, and insulin
resistance.(16,17) Engeli et al. found that weight
loss could reduce angiotensinogen, renin,
a l d o s t e r o n e ,  a n d  a n g i o t e n s i n - c o n v e r t i n g
enzyme.(5) The study by Dengel et al. of obese
people showed that weight loss increased
i n s u l i n  s e n s i t i v i t y  a n d  b r a c h i a l  a r t e r y
compliance. (18) Furthermore, the study by
Straznicky et al. found that weight loss in obese
p e o p l e  l o w e r e d  p l a s m a  n o r e p i n e p h r i n e
spillover rate, muscle sympathetic activity, and
increased baroreflex cardiac sensitivity.(19) In
our study, the decrease in blood pressure by
exercise training-induced weight loss may have
been caused by a similar effect on the RAA
s y s t e m ,  i n s u l i n  s e n s i t i v i t y,  s y m p a t h e t i c
activity, and endothelial function.

MAP and PP, in addition to SBP and DBP,
are also risk factors for cardiovascular disease,
especially in the elderly.(6) The MAP value is
determined by the value of SBP and DBP. An
increase in SBP and DBP would increase MAP,
while a decrease in SBP and DBP would lower
MAP. Mean arterial pressure is proportional
t o  c a r d i a c  o u t p u t  ( C O )  a n d  p e r i p h e r a l
resistance. Increased CO and peripheral
resistance will increase MAP and vice versa.(10)
In this study, mean pre- and post exercise MAP
values were within normal range and decreased
significantly due to reduction in SBP and DBP.
The study by Seals et al. also found decreased
SBP and DBP, with consequently decreased
MAP, after three months of aerobic exercise.(20)

The study by Garcia-Palmieria et al.
e x a m i n e d  t h e  r e l a t i o n s h i p  b e t w e e n  P P,
stratified by quartiles, and cardiovascular
mortality in men. They found that the highest
quartile of PP (>57 mmHg) had a 1.4 times
higher cardiovascular mortality than the lowest
quartile (<38 mmHg).(9) Mean pre-and post
exercise PP of all age groups and overall in
the present study were substantially below 57
m m H g  a n d  t h e r e f o r e  d i d  n o t  l e a d  t o  a n
increased risk of cardiovascular mortality.

Univ Med                                                                                                    Vol.29 No.3



142

Haryono                                                                                                                                    Training decreases body mass index

Exercise has been proven to be beneficial
in lowering the blood pressure, especially in
patients with hypertension. Regularity of
exercise training also reduces the risk of
d e v e l o p i n g  c a r d i o v a s c u l a r  d i s e a s e . ( 2 1 )
Programmed and supervised physical activities
are more efficient in sustaining blood pressure
i n  t h e  e l d e r l y  w i t h  h y p e r t e n s i o n . ( 2 2 )  T h e
American College of Sports Medicine (ACSM)
recommends an optimal exercise program to
optimize blood pressure improvement in
hypertension. Exercise should be performed on
most, preferably all days of the week, with
moderate intensity (40-60% VO2max), for 30
minutes of continuous or accumulated activity.
Aerobic or endurance exercise should be the
primary activity, supplemented by weight
training or resistance exercise.(23) The exercise
p r o g r a m s  i n  t h e  p r e s e n t  s t u d y  m e t  t h e
recommended ACSM criteria of exercise for
hypertension.

This study has several limitations that led
to bias and influenced the results. In the first
place, the study did not record the amount of
food consumed by the subjects, which is
important for determining the actual cause of
the loss in bodyweight and the decrease in
blood pressure. Another limitation is that a
n u m b e r  o f  s u b j e c t s  a t  t i m e s  t o o k
antihypertensive medication before blood
pressure examination. Therefore the mean
blood pressure value did not purely reflect the
effect of exercise training; however, this may
be eliminated by taking the mean from 10
examinations.

CONCLUSIONS

Exercise training leads to a lower body
mass index that is also influenced by gender.
Moreover, the reduction in diastolic blood
pressure is higher for persons aged 70 years and
over. It is recommended to examine the effect
of exercise on blood pressure in subjects on a
controlled diet and taking no antihypertensive
medication.

ACKNOWLEDGMENTS

The author would like to thank Sadoso,
MD and all staff of Senayan Sport Fitness Club
for permission for this study and support in
collecting the data.

REFERENCES

1. Pinto A, Di Raimondo D, Tuttolomondo A,
Frenandez P, Arnao V, Licata G. Twenty-four hour
ambulatory blood pressure monitoring to evaluate
effects on blood pressure of physical activity in
hypertensive patients. Clin J Sport Med
2006;16:238-43.

2. Hayashi T, Ohshige K, Tochikubo O. Exclusion
of influence of physical activity on ambulatory
blood pressure. Clin Exp Hypertens 2007;29:23-
30.

3. Whelton SP, Chin A, Xin X, He J. Effect of
aerobic exercise on blood pressure. A meta-
analysis of randomized controlled trials. Ann
Intern Med 2002;136:493-503.

4. Mulrow CD, Chiquette E, Angel L, Grimm R,
Cornell J, Summerbell CD, et al. Withdrawn:
dieting to reduce body weight for controlling
hypertension in adults. Cochrane Database Syst
Rev 2008;8:CD000484.

5. Engeli S, Böhnke J, Gorzelniak K, Janke J,
Schling P, Bader M, et al. Weight loss and the
renin angiotensin aldosterone system.
Hypertension 2005;45:356-61.

6. Sesso HD, Stampfer MJ, Rosner B, Hennekens
CH, Gaziano JM; Manson JAE, et al. Systolic
and diastolic blood pressure, pulse pressure, and
mean arterial pressure as predictors of
cardiovascular disease risk in men. Hypertension
2000;36:801-7.

7. Franklin SS, Gustin W, Wong ND, Larson MG,
Weber MA, Kannel WB, et al. Hemodynamic
patterns of age-related changes in blood pressure.
The Framingham Heart Study. Circulation
1997;96:308-15.

8. Miura K, Dyer AR, Greenland P, Daviglus ML,
Hill MA, Liu K, et al. Pulse pressure compared
with other blood pressure indexes in the
prediction of 25-year cardiovascular and all-cause
mortality rates. The Chicago Heart Association
Detection Project in Industry Study. Hypertension
2001;38:232-7.

9. Garcia-Palmieria MR, Crespob CJ, Geec DM,
Semposb C, Smithb E, Sorlied PD. Wide pulse
pressure is an independent predictor of



143

cardiovascular mortality in Puerto Rican men.
Nutr Metab Cardio Diseases 2005;15:71-8.

10. Nemoto K, Gen-no H, Masuki S, Okazaki K,
Nose H. Effects of high-intensity interval walking
training on physical fitness and blood pressure in
middle-aged and older people. Mayo Clin Proc
2007;82:803-11.

11. Tortora GJ, Derrickson BH. Principles of
anatomy and physiology. 12th ed. Danvers:Wiley
& Sons;2009.

12. Steven VJ, Obarzanek E, Cook NR, Lee IM,
Appel LJ, West DS, et al. Long-term weight loss
and changes in blood pressure: results of the Trials
of Hypertension Prevention, phase II. Ann Intern
Med 2001;134:1-11.

13. Cornelissen VA, Fagard RH. Effect of endurance
training on blood pressure, blood pressure-
regulating mechanisms, and cardiovascular risk
factors. Hypertension 2005;46:667-73.

14. MacAuley D, McCrum EE, Stott G, Evans AE,
McRoberts B, Boreham CA, et al. Physical
activity, physical fitness, blood pressure, and
fibrinogen in the Northern Ireland health and
activity survey. J Epidemiol Community Health
1996;50:258-63.

15. Chobanian AV, Bakris GL, Black HR,
CushmanWC, Green LA, Izzo JL Jr, et al. The
National High Blood Pressure Education Program
Coordinating Committee. JNC 7: complete report.
seventh report of the joint national committee on
prevention, detection, evaluation, and treatment
of high blood pressure. Hypertension
2003;42:1206-52.

16. Mathieu P, Poirier P, Pibarot P, Lemieux I,
Després JP. Visceral obesity: the link among

inflammation, hypertension, and cardiovascular
disease. Hypertension 2009;53:577-84.

17. Wolk R, Shamsuzzaman ASM, Somers VK.
Obesity, sleep apnea, and hypertension.
Hypertension 2003;42:1067-72.

18. Dengel DR, Kelly AS, Olson TP, Kaiser DR,
Dengel JL, Bank AJ. Effects of weight loss on
insulin sensitivity and arterial stiffness in
overweight adults. Metabol 2006;55:907-11.

19. Straznicky NE, Lambert EA, Lambert GW,
Masuo K, Esler MD, Nestel PJ. Effects of dietary
weight loss on sympathetic activity and cardiac
risk factors associated with the metabolic
syndrome. J Clin Endocrinol Metabol
2005;90:5998-6005.

20. Seals DR, Tanaka H, Clevenger CM, Monahan
KD, Reiling MJ, Hiatt WR, et al. Blood pressure
reductions with exercise and sodium restriction
in postmenopausal women with elevated systolic
pressure: role of arterial stiffness. J Am Coll
Cardiol 2001;38:506-13.

21. Djousse L, Driver JA, Gaziano JM. Relation
between modifiable lifestyle factors and lifetime
risk of heart failure. JAMA 2009;302:394-400.

22. Barroso WK, Jardim PC, Vitorino PV, Bittencourt
A, Miquetichuc F. The influence of programmed
physical activity on blood pressure of
hypertensive elderly patients on non-
pharmacologic treatment. Rev Assoc Med Bras
2008;54:328-33.

23. Pescatello LS, Franklin BA, Fagard R, Farquhar
WB, Kelley GA, Ray CA. American College of
Sports Medicine position stand. Exercise and
hypertension. Med Sci Sports Exerc
2004;36:533-53.

Univ Med                                                                                                    Vol.29 No.3