Original Article

Hemodynamic Responses to an Isometric Handgrip Training Protocol

Claudio Gil Soares de Araújo1,2, Carlos Vieira Duarte2, Fábio de Albuquerque Gonçalves2, Hugo Baptista de
Oliveira Medeiros2, Flávio Areal Lemos2, André Luiz Gouvêa2
CLINIMEX - Clínica de Medicina do Exercício1; Programa de Pós-Graduação em Educação Física - Universidade Gama Filho2 - Rio de Janeiro,
RJ – Brazil

Abstract
Background: In the past, isometric exercises were proscribed for heart disease. However, recent evidence suggests
that an isometric handgrip training (IHT) protocol – four sets of two minutes at 30% of maximum strength – produces
favorable effects on the autonomic modulation and reduces resting systolic (SBP) and diastolic (DBP) blood pressure.

Objective: Aiming at obtaining support for broad clinical applicability, we quantified the main hemodynamic responses
during an IHT session in patients from a supervised physical exercise program.

Methods: Forty-one patients (36 men) underwent the IHT with measurements of heart rate (HR) and BP before,
during each of the two series performed with the left arm and one minute after completion. Measurements were
obtained by an electrocardiogram signal in a digital Tango + oscillometric tensiometer, previously validated for
physical exercise conditions.

Results: The IHT was appropriately carried out, with no clinical adverse reactions. There was a small increase in SBP and
DBP levels, respectively, of 16 and 7 mmHg (p <0.05) and an even smaller increase in HR - 3 bpm - (p <0.05) when we
compared the data obtained at 80 seconds of the last series with the pre-exercise ones. HR, SBP and DBP values had
almost returned to baseline one minute post-exercise.

Conclusions: IHT was well tolerated by patients undergoing exercise programs, resulting in a transient and modest
hemodynamic effect, without inducing rapid cardiac vagal inactivation, characteristic of dynamic and short exercises.
(Arq Bras Cardiol 2011;97(5):413-419)

Keywords: Exercise; heart rate; cardiovascular diseases; rehabilitation.

Introduction The isometric or static muscle training has been widely

The regular practice of physical exercise has been used for training athletes and healthy individuals for decades.
widely recommended for the general population 1 and Throughout time, these exercises were progressively
particularly for those with heart disease2, based on abundant replaced by joint movement or dynamic exercises and are
epidemiological and clinical evidence3. Most of these data currently rarely used as part of the strength training of a
is primarily based on predominantly aerobic exercises; cardiac rehabilitation session8. Nevertheless, it has been
however, the scientific knowledge and interest in strength known for many years that an isometric handgrip exercise
training with sports and clinical applications are increasing4. during cardiac catheterization induces hemodynamic and
In fact, in many everyday situations, human beings need ventricular function responses11, and it was around 1990,
to perform movements that require significant amounts with the advent of modern non-invasive techniques for the
of strength and muscular power 5,6. While in the past, study of vascular and autonomic functions that the interest
predominantly static exercises were prohibited for most in this kind of exercise was renewed, as a possibility that can
individuals with hypertension and heart disease, more favorably influence the pressure behavior of normotensive
recent institutional guidelines4,7-10 have been promoting, and even hypertensive individuals.
to a greater or lesser extent, the progressive use of these The hemodynamic behavior during isometric exercise
exercises in clinical practice. has been the object of physiological studies since the
mid-1970s12-15; however, in the last ten years, Canadian
Mailing Adress: Claudio Gil Soares de Araújo •
researchers have been using what was called the “Isometric
Rua Siqueira Campos, 93/101, Copacabana - 22031-070 - Rio de Janeiro – Handgrip Training” (IHT)16-22. With few exceptions19 the IHT
RJ - Brazil involves obtaining a maximum value bilaterally for handgrip
E-mail: cgil@cardiol.br, cgaraujo@iis.com.br strength, followed by two 2-minute duration series for
Manuscript received March 04, 2011; revised manuscript received April 15,
2011; accepted June 13, 2011. each hand, alternating sides of body, comprising a total of

413
 Araújo et al
Hemodynamic Responses to Sustained Handgrip

Original Article

8 minutes of effective isometric exercise and a total time, cuff was then positioned - Orkit K-adult size (Suntech,
considering the intervals and the initial measurements of United States) – on the patient’s right arm, following the
maximum strength, which must be repeated at each session, manufacturer’s recommendations, as well as a chest strap,
of approximately 12 to 13 minutes. under which three electrodes were placed in a position
In 2010, Kelley and Kelley24, in a meta-analysis on the similar to that of the electrocardiographic CC5 leads and
subject, after identifying a few studies with adequate quality, an initial measurement of HR, SBP and DBP was obtained.
observed reductions of 5 to 20 mmHg and 3 to 15 mmHg – Using the most common IHT protocol19, patients then
around 10% –, respectively, for the systolic blood pressure performed a maximal handgrip exertion with the right hand
(SBP) and diastolic blood pressure (DBP), after some weeks and after 10 seconds, they repeated it with the left hand in
of intervention. A more recent randomized clinical trial25 digital equipment suitable for IHT (Zone, USA). One minute
with 49 normotensive subjects found very similar reductions after this measurement, patients were instructed to perform
in blood pressure levels after IHT. Interestingly, in spite of four successive series of two minutes each, exactly 1 minute
several experiments that have been adequately carried out, apart, alternating hands, keeping an intensity corresponding to
doubts still remain about the mechanisms responsible for 30% of the maximum, more easily adjusted by the information
the decrease in resting blood pressure levels after IHT21. continuously available on the equipment display21. Moreover,
Some evidence suggests that, at least for some patients the examiner verbally encouraged the patient during the IHT
or normotensive individuals, there is a share of positive to keep the recommended intensity. The device itself controls
changes in vascular structure and/or function26, with or the duration of the exercises series and their intervals, through
without objective modifications in endothelium-dependent information clearly supplied by the display.
vasodilation16,18, and of a better autonomic modulation20. To eliminate any possibility of interference by the examiner
For a more comprehensive clinical application of IHT, it on any differences or changes in hemodynamic variables, HR,
seems appropriate to know, in more details, the magnitude SBP and DBP measurements were obtained using a digital
of hemodynamic responses associated with this type of Tango+ sphygmomanometer by the oscillometric method
exertion within a clinical context. If the favorable effects (Suntech, United States), using the detection of the RR interval
of IHT are well documented, there is little information on of the electrocardiogram as reference, thus minimizing the
the magnitude of the increase in heart rate (HR) and blood influence of any noise or artifacts of the exercise, a basal
pressure (BP) with this type of isometric exercise in clinical value of 180 mmHg of inflation and a deflation rate of 5
situations, out of hemodynamic rooms or laboratories of
physiology, involving patients that are commonly followed by
cardiologists. Therefore, our main objective was to quantify
the hemodynamic responses during an IHT session in patients Table 1 – Physical characteristics, main clinical data and regular
use of medication (N = 41)*
from a supervised exercise program.

Variable Results
Methods Age (years) 64.3 ± 8.7 (44-84)
Height (cm) 171.4 ± 7.9 (149.7-185.3)
Sample
Weight (kg) 78.6 ± 10.6 (58.5-97.3)
We evaluated 53 (24%) of the patients who were regularly
attending a supervised exercise program, selected by Body Mass Index (kg/m ) 2
26.7 ± 2.6 (22.3-31.6)
convenience due to time availability, acceptance to participate Known coronary artery disease (n) 28 (68%)
in data collection and also by the previous exclusion of those
Acute myocardial infarction (n) 10 (24%)
with chronic atrial fibrillation, external pacemaker rhythm, and
frequent or complex extrasystole – i.e., the presence of more Myocardial revascularization (n) 15 (37%)
than five extrasystoles/min or in pairs or clusters. Technical Percutaneous coronary angioplasty (n) 12 (29%)
difficulties with blood pressure measurement during exercise Systemic arterial hypertension (n) 22 (54%)
(e.g., arm circumference larger than that recommended by
the cuff) or inability to perform the exercise properly led to Diabetes mellitus (n) 9 (21%)
the exclusion of 12 volunteers, determining a final number of Dyslipidemia (n) 32 (78%)
41 patients (36 men and 5 women) for analysis of final results. Ex-smoker (n) 21 (51%)
Eleven of the patients had been regularly submitted to IHT,
as part of their supervised exercise session. Table 1 shows the Beta-blockers (n) 31 (76%)
physical characteristics, main clinical data and cardiovascular Angiotensin antagonists (n) 15 (36%)
medications regularly used by the assessed patients. Vasodilators (n) 15 (36%)
Antilipemic drugs (n) 33 (80%)
Protocol
Platelet antiaggregants (n) 29 (70%)
The study was carried out in a single visit. The patients
signed a free and informed consent form, and remained *Values are expressed as means ± SD (minimum and maximum) for age,
height, body weight and body mass index and as n (percentage of the
sitting comfortably for about 5 minutes, during which the
sample) for the other variables.
protocol to be followed was explained in details. The

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Hemodynamic Responses to Sustained Handgrip

Original Article

mmHg/s. The values obtained

​​ were shown on the equipment excellent tolerance to the 8-minute exercise protocol. As it
display and duly recorded by the examiner, whereas usually occurs during IHT, patients noticed mild to moderate
the patients were unaware of the obtained values ​​. The fatigue and/or a “burning” sensation in the flexor muscles of the
approximate time needed for each of the measurements fingers, caused by blood hypoperfusion associated to probable
was between 25 and 35 seconds. arterial occlusion resulting from the isometric contraction at 30%
This equipment is properly certified for blood pressure of maximal voluntary force. The results show that the patients
measurements, according to the technical standards of the were normotensive at rest - 115/69 mmHg on average (standard
country of manufacture, and has been used in other clinical error, respectively, 11 and 10 mmHg) - and had an appropriate
studies27-29. Using the device’s manual mode, measurements HR - 64 bpm - before starting the IHT.
were made at rest, prior to determining the maximal handgrip As it might theoretically be expected, some of the
strength, starting the inflation of the cuff at 20 and 80 hemodynamic responses were increased with the continuation
seconds of the two maneuvers made with the left arm and of isometric exertion, being somewhat more pronounced
also 1 minute after completion of the last maneuver. Data in the second minute of the series when compared to
from a pilot analysis showed that after the HR pressure and the first minute, ending the exertion with significant
values ​​measured 1 minute after a single maximal handgrip differences in relation to measurements at rest, in relation
contraction were virtually identical to resting values​​ to SBP and DBP (mean ± standard error of mean) – delta
increment = 16 ± 10 and 7 ± 6 mmHg, respectively –
Statistical Analysis (p <0.05) and minimal difference for HR, which increased
Physical characteristics and clinical data were described only 3 ± 4 bpm (p <0.05 ). There were no differences in the
as means, standard deviations and minimum and maximum responses of HR and BP between the two series (p> 0.05). The
values ​​or by percentage of frequency, as appropriate. For the hemodynamic values ​​obtained 1 minute after IHT completion
hemodynamic variables, the type of distribution was initially are numerically between the pre-exertion and the final exertion
confirmed using the D’Agostino & Pearson test and then ANOVAs measurements for SBP and DBP (p <0.05), whereas HR had
for repeated measures were calculated, which were followed by already returned to pre-exercise values (p > 0.05). The values​​
Bonferroni’s multiple comparison tests. Pearson’s correlations of resting HR and delta HR - maximum minus rest – did not
were analyzed to assess the association between variables. correlate (r = -0.19, p = 0.24).
The statistical significance was set at 5%. Statistical calculations An additional analysis was performed by comparing the
and figures were carried out using Prism software version 5.04 results obtained between the 31 patients who were taking
(GraphPad, USA). The research project meets the requirements beta-blockers and 10 that were not using these drugs. The
of resolution 196/96 of the Ministry of Health and the Declaration values ​​at rest were virtually identical, except for a somewhat
of Helsinki and was appropriately registered with CONEP-MS and lower HR in patients receiving beta-blockers – 69 ± 3.0
institutionally approved by the Committee of Ethics in Research. (mean and standard error of mean) versus 62 ± 2.6 bpm
(p = 0.14). The hemodynamic responses, either in absolute
terms or as variations between resting and maximum values,
Results did not differ with IHT (p> 0.05) between patients with
The 11 individuals who were experienced and had been and without beta-blockers, including the variation between
regularly undergoing IHT training during the supervised exercise resting HR and maximum HR values – 1.4 ± 1.4 versus
program sessions had resting blood pressure levels slightly higher 3.3 ± 1.5 bpm (p = 0.46).
than those who had no previous experience in the technique,
although there was no difference in nature and magnitude of
the acute responses to IHT. Moreover, in preliminary analyses, Discussion
there was no evidence of any difference that could be attributed The present clinical study has some strong points, including
to any subgroup, whether by gender, medical condition, either the relatively large, clinically well-characterized sample, consisting
by use or nonuse of medications with negative chronotropic of patients with great familiarity with the location and laboratory
action. Therefore, we chose to consider the data from all 41 facilities and also with the examiners, which minimized the
patients together, without differentiating by regular participation possibility of emotional or anticipatory influence on the
in IHT or any of these potential intervening variables. measurements that were obtained. The use of digital equipment
In agreement with the diversity of clinical condition and body specific for IHT made it possible for the isometric exertion
size, the results of maximal handgrip strength varied between intensities to be precisely individualized and controlled – thanks
24 and 136 (in equipment units), with means that were almost to the existence of a continuous visual feedback – throughout
identical between the right and left hands, respectively, 78.4 ± the test, as shown by the average percentage of 97%. Moreover,
23 and 77.5 ± 22, and a mean difference for each individual there was an accurate and sophisticated control of hemodynamic
of 10% of the measurement - minimum 0 and maximum 21. variable measurements, eliminating any potential interference or
The degree of accuracy in the maintenance of 30% of maximal biases on the part of the examiners through the use of equipment
handgrip strength for each hand during the two minutes of each with examiner-independent readings. In turn, there are some
series ranged between 90% and 100%, with an average of 97% limitations that deserve further consideration.
in 164 maneuvers (41 patients x 4 maneuvers). Patient selection was not random and included cases with
None of the individuals had any clinical abnormalities or different clinical conditions, which, on the one hand could
inappropriate symptoms during or immediately after IHT, with generate greater variability in results, which did not occur;

415 Arq Bras Cardiol 2011;97(5):413-419

 Araújo et al
Hemodynamic Responses to Sustained Handgrip

Original Article

on the other hand, it can contribute to increase the external widely used as a form of exercise therapy in the treatment of
validity of the study. The blood pressure measurement was arterial hypertension.
performed noninvasively, as it would not be practical to use an In agreement with the experience in the literature and our
intra-arterial measurement device; however, the equipment used own experience of more than one year applying IHT to more
for measurements is considered valid for exercise situations and than one hundred patients – approximately more than seven
allowed the elimination of any possible influence of reading error thousand sessions – there was no evidence of clinical adverse
on the part of the examiner. As only one cuff size was available reactions with IHT, with the procedure being well tolerated and
– adequate for a 27 to 40-cm arm circumference – it was not accepted by patients, including the elderly. Knowing that the
possible to include some of the thinner or smaller patients or handgrip strength tends to decrease with aging in patients of
those who were larger or more obese; however, there is no both sexes30,31, it is quite appropriate that the IHT involves the
theoretical reason to suppose that the modest hemodynamic objective measurement of maximal strength bilaterally in each
responses verified during the IHT would be different in patients patient, thus effectively allowing training load equalization at a
with arm circumferences that were smaller or greater than the percentage of 30% of the maximal individual strength.
limits of 27 and 40 cm of the cuff. The hemodynamic responses to isometric handgrip exertion
No other IHT forms were tested, but only the protocol most have been studied by some authors in the past32, but without
commonly used for training and clinical research; however, the primary goal of supporting a clinical application such as IHT.
very recent data point to similar reductions in BP magnitude Recent physiological studies, with the quantification of some of
using different combinations of intervals and percentages of the cardiorespiratory responses to predominantly static exercises
maximal handgrip strength21, 22. Although this study used relatively using small and different muscle groups and with different
expensive equipment and not readily available in the Brazilian percentages of maximal voluntary strength, have contributed to a
market for IHT performance, other studies have obtained similarly better understanding of the mechanisms associated with IHT and
favorable results on resting SBP and DBP in subjects trained with similar exercises14,15,33-37. Nevertheless, when these physiological
much simpler equipment or materials and even using springs or data, respecting the methodological differences and small samples
balls25. This question seems relevant if the IHT becomes more involved, are compared with our results, one can identify a

140

* *
(mmHg)
PAS(mmHg)

130
* *
*
120
SBP

110

80
* § §
(mmHg)
DBP (mmHg)

* *
70
PAD

1ª Série
1st Series 2ª
2nd Série
Series

60 TIM
IHT TIM
IHT
Pré
Pre 20 80 20 80 Post
Pós 60
TEMPO (s)
Time(s)

Figure 1 – Blood pressure responses to isometric handgrip training in 41 patients from a supervised exercise program. IHT – isometric handgrip training; SBP – systolic
blood pressure; DBP – diastolic blood pressure; *values different from the initial measurement (Pre) and from the immediately previous measurement; § values different
from the initial measurement (Pre) and undistinguishable from the immediately previous measurement.

Arq Bras Cardiol 2011;97(5):413-419 416

 Araújo et al
Hemodynamic Responses to Sustained Handgrip

Original Article

reasonable similarity, that is, a minimal hemodynamic somewhat less striking than those found by Helfant et al.11,
effect, especially when the fatigue of the muscle group is which probably occurred because the latter have obtained
not attained, which, in the case of handgrip tends to occur the data during cardiac catheterization in the supine position
as soon as after 3 minutes13. and using handgrip for 3 minutes.
Considering that all patients tested were undergoing
regular supervised exercise programs, any differences that Conclusions
might occur in these hemodynamic responses between
trained and untrained individuals cannot be assessed, nor This study corroborates the clinical impression that the
was the purpose of the present study. IHT, as performed in this study, a is well-tolerated procedure
and cause no adverse signs or symptoms that induces
Although hemodynamic responses were observed as a transient and modest hemodynamic responses in patients
result of IHT performed in this study, the small magnitude of attending supervised exercise and/or cardiac rehabilitation
the differences between the resting conditions and the end programs and who have adequately controlled resting blood
of the exercise suggests a minimal or likely negligible clinical pressure levels. We expect that this study will contribute to
significance, representing less than the variation observed an increased use of IHT in the therapeutic management of
during a walk or even a fast riding exercise without load38. patients with cardiovascular diseases in our country.
This aspect is clinically interesting, as previous studies Future guidelines of the Brazilian Society of Cardiology
with the latter protocol have demonstrated that the rapid (SBC) on the subject of physical exercise might include this
movement of the legs or arms39 and even the bending of type of training as potentially helpful in reducing blood
wrists40 is capable of inducing a rapid and sharp increase pressure levels and producing favorable vascular and
in heart rate and also the SBP41 and that this response can autonomic changes, as it has been well documented in the
be completely abolished by selective pharmacological current medical literature19, 21, 22,24,43.
blockade with atropine42, characterizing the mechanism of
vagal inactivation as responsible for the response.
From the physiological point of view, with an isometric Acknowledgments
muscle contraction of 30% of the maximal strength there This study was partially funded by CNPq and FAPERJ through
is no major vagal inactivation and thus, virtually no HR grants for research productivity and master’s and doctoral
changes. As there should not be an increase in venous degrees. The authors also thank Suntech Inc. for supplying the
return, as there is a mechanical compression of venous digital oscillometric tensiometer.
vessels by muscle contraction at 30% of maximal intensity
in the forearm that is performing the handgrip, the cardiac
Potential Conflict of Interest
output must remain very close to the resting value32. Thus,
the slightest variation in SBP and DBP levels should reflect Dr. Claudio Gil Soares de Araújo - Potential conflict of interest:
primarily the small increase in peripheral vascular resistance Provision of one of the devices used in the study at a special price
caused by occlusion of the arterial vessels in the region of (Tango SunTech, USA).
muscle contraction, without a significant change in cardiac
output. Apparently, the little relevance of the results can be Sources of Funding
found in subgroups of patients, as objectively tested and
This study was partially funded by CNPq and FAPERJ.
confirmed in the comparison made ​​between those with
and without regular use of beta blockers.
Additionally, it is worth mentioning that the SBP, DBP and Academic association
HR values ​​ obtained after only 1 minute of recovery were This article is part of the subject PPGEF - UGF - DEF224 of
already very similar to those at rest, especially for HR, which Carlos Vieira Duarte, Fábio de Albuquerque Gonçalves, Hugo
showed exactly the same results. These data are literally in Baptista de Oliveira Medeiros, Flávio Areal Lemos and André
accordance with the findings of McGowan et al.17 and are Luiz Gouvêa from Universidade Gama Filho.

References
1. Haskell WL, Blair SN, Hill JO. Physical activity: health outcomes and importance update: a scientific statement from the American Heart Association Council on
for public health policy. Prev Med. 2009;49(4):280-2. Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism.
Circulation. 2007;116(5):572-84.
2. Ricardo DR, Araújo CGS. Reabilitação cardíaca com ênfase no exercício: uma
revisão sistemática. Rev Bras Med Esporte. 2006;12(5):279-85. 5. Kraemer WJ, Ratamess NA, French DN. Resistance training for health and
3. Powell KE, Paluch AE, Blair SN. Physical activity for health: what kind? How much? performance. Curr Sports Med Rep. 2002;1(3):165-71.
How intense? On top of what? Annu Rev Public Health. 2011;32:349-65.
6. Phillips SM, Winett RA. Uncomplicated resistance training and health-related
4. Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, et al. outcomes: evidence for a public health mandate. Curr Sports Med Rep.
Resistance exercise in individuals with and without cardiovascular disease: 2007 2010;9(4):208-13.

417 Arq Bras Cardiol 2011;97(5):413-419

 Araújo et al
Hemodynamic Responses to Sustained Handgrip

Original Article

7. Araújo CG, Carvalho T, Castro CL, Costa RV, Moraes RS, Oliveira Filho JA, et 26. Thijssen DH, Maiorana AJ, O’Driscoll G, Cable NT, Hopman MT, Green DJ.
al. Normatização dos equipamentos e técnicas da reabilitação cardiovascular Impact of inactivity and exercise on the vasculature in humans. Eur J Appl
supervisionada. Arq Bras Cardiol. 2004;83(5):448-52. Physiol. 2010;108(5): 845-75.

8. Bjarnason-Wehrens B, Mayer-Berger W, Meister ER, Baum K, Hambrecht R, 27. Cameron JD, Stevenson I, Reed E, McGrath BP, Dart AM, Kingwell BA.
Gielen S. Recommendations for resistance exercise in cardiac rehabilitation: Accuracy of automated auscultatory blood pressure measurement during
recommendations of the German Federation for Cardiovascular Prevention supine exercise and treadmill stress electrocardiogram-testing. Blood Press
and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2004;11(4):352-61. Monit. 2004;9(5):269-75.

9. Carvalho T, Araújo CG, Cortez AA, Ferraz A, Brunetto AF, Herdy AH, et al / 28. Furtado EC, Ramos P dos S, Araújo CG. Medindo a pressão arterial em
Sociedade Brasileira de Cardiologia. Diretriz de reabilitação cardiopulmonar exercício aeróbico: subsídios para reabilitação cardíaca. Arq Bras Cardiol.
e metabólica: aspectos práticos e responsabilidades. Arq Bras Cardiol. 2009;93(1):45-50.
2006;86(1):74-82.
29. Hargens TA, Griffin DC, Kaminsky LA, Whaley MH. The influence of aerobic
10. Sharman JE, Stowasser M. Australian association for exercise and sports exercise training on the double product break point in low-to-moderate risk
science position statement on exercise and hypertension. J Sci Med Sport. adults. Eur J Appl Physiol. 2011;111(2): 313-8.
2009;12(2):252-7.
30. Mroszczyk-McDonald A, Savage PD, Ades PA. Handgrip strength in
11. Helfant RH, De Villa MA, Meister SG. Effect of sustained isometric handgrip cardiac rehabilitation: normative values, interaction with physical
exercise on left ventricular performance. Circulation. 1971;44(6):982-93. function, and response to training . J Cardiopulm Rehabil Prev.
2007;27(5):298-302.
12. Martin CE, Shaver JA, Leon DF, Thompson ME, Reddy PS, Leonard JJ. Autonomic
mechanisms in hemodynamic responses to isometric exercise. J Clin Invest. 31. Vianna LC, Oliveira RB, Araújo CG. Age-related decline in handgrip strength
1974;54(1):104-15. differs according to gender. J Strength Cond Res. 2007;21(4):1310-4.

13. Nagle FJ, Seals DR, Hanson P. Time to fatigue during isometric exercise using 32. Sakakibara Y, Honda Y. Cardiopulmonary responses to static exercise. Ann
different muscle masses. Int J Sports Med. 198;89(5):313-5. Physiol Anthropol. 1990;9(2):153-61.

14. Seals DR, Chase PB, Taylor JA. Autonomic mediation of the pressor responses 33. Bastos BG, Williamson JW, Harrelson T, Nobrega AC. Left ventricular
to isometric exercise in humans. J Appl Physiol. 1988;64(5):2190-6. volumes and hemodynamic responses to postexercise ischemia in healthy
humans. Med Sci Sports Exerc. 2000;32(6):1114-8.
15. Seals DR, Washburn RA, Hanson PG, Painter PL, Nagle FJ. Increased
cardiovascular response to static contraction of larger muscle groups. J Appl 34. Farthing JP, Krentz JR, Magnus CR, Barss TS, Lanovaz JL, Cummine J, et al.
Physiol. 1983;54(2):434-7. Changes in fMRI cortical activation withcross-education to an immobilized
limb. Med Sci Sports Exerc. 2011, Jan 21 [Epub ahead of print].
16. McGowan CL, Levy AS, McCartney N, MacDonald MJ. Isometric handgrip
training does not improve flow-mediated dilation in subjects with normal blood 35. Liang N, Nakamoto T, Mochizuki S, Matsukawa K. Differential contribution
pressure. Clin Sci (Lond). 2007;112(7):403-9. of central command to the cardiovascular responses during static
exercise of ankle dorsal and plantar flexion in humans. J Appl Physiol.
17. McGowan CL, Levy AS, Millar PJ, Guzman JC, Morillo CA, McCartney N, et al. 2011;110(3):670-80.
Acute vascular responses to isometric handgrip exercise and effects of training
in persons medicated for hypertension. Am J Physiol Heart Circ Physiol. 36. Lykidis CK, Kumar P, Vianna LC, White MJ, Balanos GM. A respiratory
2006;291(4):H1797-802. response to the activation of the muscle metaboreflex during concurrent
hypercapnia in man. Exp Physiol. 2010;95:194-201.
18. McGowan CL, Visocchi A, Faulkner M, Verduyn R, Rakobowchuk M, Levy
AS, et al. Isometric handgrip training improves local flow-mediated dilation in 37. McGowan CL, Notarius CF, McReynolds A, Morris BL, Kimmerly DS,
medicated hypertensives. Eur J Appl Physiol. 2007;99(3):227-34. Picton PE, et al. Effect of angiotensin AT(1) receptor blockade on
sympathetic responses to handgrip in healthy men. Am J Hypertens.
19. Millar PJ, Bray SR, McGowan CL, MacDonald MJ, McCartney N. Effects of 2011;24(5):537-43.
isometric handgrip training among people medicated for hypertension: a
multilevel analysis. Blood Press Monit. 2007;12(5):307-14. 38. Almeida MB, Ricardo DR, Araújo CG. Validação do teste de exercício de
4 segundos em posição ortostática. Arq Bras Cardiol. 2004;83(2):155-9.
20. Millar PJ, MacDonald MJ, Bray SR, McCartney N. Isometric handgrip exercise
improves acute neurocardiac regulation. Eur J Appl Physiol. 2009;107(5):509-15. 39. Silva BM, Vianna LC, Oliveira RB, Ricardo DR, Araújo CG. Similar cardiac
vagal withdrawal at the onset of arm and leg dynamic exercise. Eur J Appl
21. Millar PJ, Paashuis A, McCartney N. Isometric handgrip effects on Physiol. 2008;102(6): 695-701.
hypertension. Curr Hypertens Rev. 2009;5(1):54-60.
40. Vianna LC, Ricardo DR, Araújo CG. Training-related changes in the R-R
22. Taylor AC, McCartney N, Kamath MV, Wiley RL. Isometric training lowers interval at the onset of passive movements in humans. Braz J Med Biol
resting blood pressure and modulates autonomic control. Med Sci Sports Res. 2008;41(9):825-32.
Exerc. 2003;35(2):251-6.
41. Nóbrega AC, Williamson JW, Araújo CG, Friedman DB. Heart rate and
23. Mortimer J, McKune AJ. Effect of short-term isometric handgrip training on blood pressure responses at the onset of dynamic exercise: effect of Valsalva
blood pressure in middle-aged females. Cardiovasc J Afr. 2010;21:1-4. manoeuvre. Eur J Appl Physiol Occup Physiol. 1994;68(4):336-40.
24. Kelley GA, Kelley KS. Isometric handgrip exercise and resting blood 42. Lazzoli JK, Soares PP, da Nóbrega AC, de Araújo CG. Electrocardiographic
pressure: a meta-analysis of randomized controlled trials. J Hypertens. criteria for vagotonia-validation with pharmacological parasympathetic
2010;28(3):411-8. blockade in healthy subjects. Int J Cardiol. 2003;87(2-3):231-6.
25. Millar PJ, Bray SR, MacDonald MJ, McCartney N. The hypotensive effects 43. Millar PJ, MacDonald MJ, McCartney N. Effects of isometric handgrip
of isometric handgrip training using an inexpensive spring handgrip training protocol on blood pressure and neurocardiac modulation. Int J Sports
device. J Cardiopulm Rehabil Prev. 2008;28(3):203-7. Med. 2011;32(3):174-80.

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