***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Substantial progress has been made in the awareness , treatment , and prevention of  cardiovascular disease ( CVD ) in women since the first women-specific clinical recommendations for the prevention of CVD were published by the American Heart Association ( AHA ) in 1999.1 The myth that heart disease is a “ man 's disease ” has been debunked ; the rate of public awareness of CVD as the leading cause of death among US women has increased from 30 % in 1997 to 54 % in 2009.2 The age-adjusted death rate result ing from  coronary heart disease ( CHD ) in females , which accounts for about half of all CVD deaths in women , was 95.7 per 100 000 females in 2007 , a third of what it was in 1980.3,4 Approximately 50 % of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies.4 Major r and omized controlled clinical trials such as the Women 's Health Initiative have changed the practice of CVD prevention in women over the past decade.5 The investment in combating this major public health issue for women has been significant , as have the scientific and medical achievements . Despite the gains that have been made , considerable challenges remain . In 2007 , CVD still caused ≈1 death per minute among women in the United States.6 These represent 421 918 deaths , more women 's lives than were cl aim ed by cancer , chronic lower respiratory disease , Alzheimer disease , and accidents combined.6 Reversing a trend of the past 4 decades , CHD death rates in US women 35 to 54 years of age now actually appear to be increasing , likely because of the effects of the obesity epidemic.4 CVD rates in the United States are significantly higher for black females compared with their white counterparts ( 286.1/100 000 versus We reported previously that two otherwise identical training programs at lower ( LI ) and higher intensity ( HI ) similarly reduced resting systolic blood pressure ( BP ) by approximately 4 - 6 mmHg . Here , we determined the effects of both programs on BP-regulating mechanisms , on biomarkers of systemic inflammation and prothrombotic state and on the heart . In this cross-over study ( 3 × 10 weeks ) ,  healthy participants exercised three times 1 h/week at , respectively , 33 % and 66 % of the heart rate ( HR ) reserve , in a r and om order , with a sedentary period in between . Measurements , performed at baseline and at the end of each period , involved blood sampling , HR variability , systolic BP variability ( SBPV ) and cardiac magnetic resonance imaging .  Thirty-nine participants ( 18 men ; mean age 59 years ) completed the study . Responses were not different between both programs ( P>0.05 ) . Pooled data from LI and HI showed a reduction in HR ( -4.3 ± 8.1 % ) and an increase in stroke volume ( + 11 ± 23.1 % ) . No significant effect was seen on SBPV , plasma renin activity , basal nitric oxide and left ventricular mass . Our results suggest that the BP reduction observed appears to be due to a decrease in systemic vascular resistance ; training intensity does not significantly affect the results on mechanisms , biomarkers and the heart Introduction : Several established tools are available to assess study quality and reporting of r and omized controlled trials ; however , these tools were design ed with clinical intervention trials in mind . In exercise training intervention trials some of the traditional study quality criteria , such as participant or research er blinding , are extremely difficult to implement . Methods : We developed the Tool for the assEssment of Study qualiTy and reporting in EXercise ( TESTEX ) – a study quality and reporting assessment tool , design ed specifically for use in exercise training studies . Our tool is a 15-point scale ( 5 points for study quality and 10 points for reporting ) and addresses previously unmentioned quality assessment criteria specific to exercise training studies . Results : There were no systematic differences between the summated TESTEX scores of each observer [ H(2 ) = 0.392 , P = 0.822 ] . There was a significant association between the summated TESTEX scores of the three observers , with almost perfect agreement between observers 1 and 2 [ intra-class correlation coefficient ( ICC ) = 0.93 , 95 % confidence interval ( CI ) 0.82–0.97 , P < 0.001 ] , observers 1 and 3 ( ICC = 0.96 , 95 % CI 0.89–0.98 , P < 0.001 ) and observers 2 and 3 ( ICC = 0.91 , 95 % CI 0.75–0.96 , P < 0.001 ) . Conclusions : The TESTEX scale is a new , reliable tool , specific to exercise scientists , that facilitates a comprehensive review of exercise training trials Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more No previous studies have examined the effects of isometric training intensity upon resting blood pressure ( BP ) . The aims of this study were ( a ) to compare the effects of leg isometric training , performed at two intensities , upon resting systolic-SBP , diastolic-DBP and mean arterial-MAP BP ; and ( b ) to examine selected cardiovascular variables , in an attempt to explain any changes in resting BP following training . Thirty-three participants were r and omly allocated  to either control , high- ( HI ) or low-intensity ( LI ) training for 8 weeks . Participants performed 4 × 2 min exercise bouts 3 × weekly . Resting BP was measured at baseline , 4-weeks and post-training . SBP , DBP and MAP fell significantly in both groups after training . Changes were –5.2 ± 4.0 , –2.6 ± 2.9 and –2.5 ± 2.2 mmHg [ HI ] ; –3.7 ± 3.7 , –2.5 ± 4.8 and –2.6 ± 2.5 mmHg [ LI ] for SBP , DBP and MAP , respectively . There were no significant changes in BP at 4 weeks . No significant changes were observed in any of the other cardiovascular variables examined . These findings suggest that isometric training causes reductions in SBP , DBP and MAP at a range of exercise intensities , when it is performed over 8 weeks . Furthermore , it is possible to reduce resting BP using a much lower isometric exercise intensity than has previously been shown Objectives Isometric h and grip ( IHG ) training ( four , 2-min sustained contractions at 30 % of maximal voluntary contraction , three times per week for 8–10 weeks ) lowers resting arterial blood pressure ( BP ) in hypertensive patients , including those receiving pharmacotherapy , although the mechanisms remain elusive . Ambulatory BP measurements are more efficacious in predicting cardiovascular disease-related events , yet the effects of IHG training on ambulatory BP are unknown . The objective of the current investigation was to test the hypotheses that 8 weeks of IHG training lowers resting and 24 h ambulatory BP concomitantly in medicated hypertensive patients , and may be the result of improved vagal modulation . Methods BP was assessed using brachial artery oscillometry , and coarse-graining spectral analysis was used to determine spectral power . Resting and 24 h ambulatory BP and heart rate variability ( HRV ) were measured pretraining , midtraining , and post-training in 11 medicated hypertensive patients ( mean±SD , resting BP : 113.9±12.7/60.7±11.6 mmHg ) , and in nine medicated hypertensive controls ( resting BP : 117.8±14.3/67.5±4.2 mmHg ) . Results Indices of BP and HRV were not significantly altered with IHG training ( all P>0.05 ) . Conclusion IHG training does not lower resting or ambulatory BP  in hypertensive patients successfully treated with pharmacotherapy to within the normal range ( ⩽120/80 mmHg ) , nor does it improve HRV . Future studies should examine alternative IHG training protocol s in well-managed hypertensive patients and /or target poorly controlled medicated hypertensive patients Abstract To reduce resting blood pressure , a minimum isometric exercise training ( IET ) intensity has been suggested , but this is not known for short-term IET programmes . We therefore compared the effects of moderate- and low-intensity IET programmes on resting blood pressure .  Forty normotensive participants ( 22.3 ± 3.4 years ; 69.5 ± 15.5 kg ; 170.2 ± 8.7 cm ) were r and omly assigned to groups of differing training intensities [ 20%EMGpeak ( ~23%MVC , maximum voluntary contraction , or 30%EMGpeak ( ~34%MVC ) ] or control group ; 3 weeks of IET at 30%EMGpeak result ed in significant reductions in resting mean arterial pressure ( e.g. −3.9 ± 1.0 mmHg , P < 0.001 ) , whereas 20%EMGpeak did not ( −2.3 ± 2.9 mmHg ; P > 0.05 ) . Moreover , after pooling all female versus male participants , IET induced a 6.9-mmHg reduction in systolic blood pressure in female participants , but only a 1.5-mmHg reduction in systolic blood pressure in male participants , although the difference was not significant . An IET intensity between 20%EMGpeak and 30%EMGpeak is sufficient to elicit significant resting blood pressure reductions in a short-term training period ( 3 weeks ) . In addition , sexual dimorphism may exist in the magnitude of reductions , but further work is required to confirm this possibility , which could be important in underst and ing the mechanisms responsible PURPOSE Research has demonstrated the efficacy of isometric h and grip ( IHG ) training to attenuate resting blood pressure . These studies have relied on the use of programmable digital h and grips for training . This study aim ed to determine the effectiveness of simple , inexpensive spring-loaded h and grip devices in producing hypotensive effects . METHODS The study was a r and omized controlled trial of 49 normotensive participants ( 66.4 ± 0.9 years ; 57 % women ) . Participants in the exercise group ( n = 25 ) trained and had blood pressure measured twice weekly for 8 weeks .  Control  participants ( n = 24 ) completed weekly  blood pressure measurements  . Pre- and posttraining measurements were each assessed over 3 visits . Statistical analysis of the pre-post data involved analyses of variance and hierarchical linear modeling was used to examine changes over time . RESULTS Following 8 weeks , IHG participants demonstrated significant reductions in resting blood pressure . Systolic and diastolic blood pressures were reduced from 122 ± 3 mm Hg to 112 ± 3 mm Hg ( P < .001 ) and from 70 ± 1 mm Hg to 67 ± 1 mm Hg ( P < .05 ) , respectively . Hierarchical linear modeling analysis also revealed a significant cross-level ( ie , group ÷ time ) interaction , with an estimated reduction in systolic blood pressure of 5.4 mm Hg ( P < .001 ) over the training period in the IHG group . CONCLUSIONS In agreement with previous studies , IHG training reduced resting arterial pressure following 8 weeks of training . Hypotensive effects linked to IHG training may be achieved using simple , inexpensive spring h and grip training devices and may provide a convenient and affordable therapeutic alternative or adjunctive therapy for lowering blood pressure PURPOSE This study examined the effects of isometric h and grip training on resting arterial blood pressure , heart rate variability , and blood pressure variability in older adults with hypertension . METHODS Nine subjects performed four 2-min isometric h and grip contractions at 30 % of the maximum voluntary contraction force , 3 d.wk(-1 ) for 10 wk , and eight subjects served as  controls  . RESULTS After training , there was a significant reduction in resting systolic pressure and mean arterial pressure . In addition , power spectral analysis of heart rate variability demonstrated that the low frequency : high frequency area ratio tended to decrease . CONCLUSIONS It is concluded that isometric training at a moderate intensity elicits a hypotensive response and a simultaneous increase in vagal modulation in older adults with hypertension Abstract In this study , we examined the correlations between selected markers of isometric training intensity and subsequent reductions in resting blood pressure .  Thirteen participants performed a  discontinuous incremental isometric exercise test to volitional exhaustion at which point mean torque for the final 2-min stage ( 2min-torquepeak ) and peak heart rate peak ( HRpeak ) were identified . Also , during 4 weeks of training ( 3 sessions per week , comprising 4 × 2 min bilateral leg isometric exercise at 95 % HRpeak ) ,  heart rate (  HRtrain ) , torque (  Torquetrain ) , and changes in EMG amplitude ( ΔEMGamp ) and frequency ( ΔEMGfreq ) were determined . The markers of training intensity were : Torquetrain relative to the 2min-torquepeak ( % 2min-torquepeak ) , EMG relative to EMGpeak ( % EMGpeak ) , HRtrain ΔEMGamp , ΔEMGfreq , and % MVC . Mean systolic ( −4.9 mmHg ) and arter 
    Output:
    
Our study indicated that IRT lowers SBP , DBP and MAP .
The magnitude of effect may be larger in hypertensive males aged ⩾45 years , using unilateral arm IRT for > 8 weeks