European Journal of Cardiovascular Medicine

Hypertension Is one of the major non-communicable diseases highly prevalent in all parts of the world. Its appearance is on the rise in recent years. Although it is common in elderly and its relative risk increases with age, it is now also showing rise in young adults and teens probably due to increased inclination towards sedentary lifestyle offered by modern technological evolution.¹ According to reports, in the last decade, the morbidity and mortality has increased by 108%. With limited awareness, it presents a huge risk to the community.²

Medical students are one of the groups at a major risk of developing hypertension early at age. They follow a relatively sedentary lifestyle, having a major syllabus and numerous projects in curriculum followed by dozens of night shifts in a month. All these stress factors precipitate in causing metabolic disease like diabetes and hypertension early in age.^2,3

It has now become a need of hour to find newer modalities for early detection and diagnosis of hypertension and pre hypertensive conditions in the adult population. Changes in the cardiovascular parameters after mild to moderate exercise is one such sign to be looking out for. Measuring this change with the help of bicycle ergometer, treadmill or step ups has been in use for evaluation of patients of ischemic heart disease, monitoring of their treatment, etc.⁴ The present study was aimed to study the changes in cardiovascular parameters, especially systolic blood pressure during bicycle ergometer test in medical students.

Present study was prospective, observational study was conducted in the department of physiology, at MIMSR Medical College, Latur, Maharashtra, India. Study duration was of 1 years (July 2023 to June 2024). Study was approved by institutional ethical committee.

This study was conducted on first-year students of MIMSR Medical College, Latur. Participants were categorized into two groups: exercising and non-exercising individuals, based on their self-reported physical activity levels. Students voluntarily participated in the study and provided informed consent. Each participant filled out a Google Form to provide biodata and general information, including age, gender, physical activity levels, and medical history (if any). Height and weight were measured using a standard stadiometer and weighing scale.

Blood pressure was recorded using a sphygmomanometer. Pre-exercise blood pressure was measured after the participant had rested for at least 5 minutes in a seated position. Post-exercise blood pressure was recorded immediately after completing the bicycle ergometry test.

Exercise Protocol - Participants performed bicycle ergometry for 3 minutes at 60 revolutions per minute (RPM) on a standardized cycle ergometer. No additional resistance was applied beyond the default setting of the ergometer. Participants were instructed to maintain a steady pace throughout the test.

Changes in systolic and diastolic blood pressure pre- and post-exercise were analyzed. Comparisons were made between the exercising and non-exercising groups to assess variations in blood pressure response.

Data was collected and compiled using Microsoft Excel, analyzed using SPSS 23.0 version. Frequency, percentage, means and standard deviations (SD) was calculated for the continuous variables, while ratios and proportions were calculated for the categorical variables. The P-value less than 0.5 was considered as statistically significant.

In present study, as shown in Table 1 that total 73 first-year students of MIMSR Medical College, Latur were studied. Majority of subjects were from 20 years age group (36.99 %) followed by 19 years age group (24.66 %). 78.1% of the respondents were male while 21.9% of the respondents were female. 75.3% of the respondents reported that they do exercise while 24.7% of the respondents reported that they don't do exercise. This could indicate a general awareness of the benefits of exercise among the respondents.

Table 1: General characteristics

As shown in Table 2 that the majority had duration of exercise 15 to 30 Minutes (52.5%) followed by duration of exercise as 30 to 45 Minutes (22%). Longer Exercise Sessions, only a small percentage (13.6%) engages in exercise sessions lasting more than 60 minutes. 54.2% of the respondent's exercise in the morning while 45.8% of the respondent's exercise in the evening.

Table 2: Exercise duration & timing

It was shown in Table 3 that the 42.4% of the respondents engage in sports was their primary form of exercise followed by walking (23.7 %), yoga (18.6%), gym (11.9 %) & running (8.22 %). The data suggests that sports are the most popular form of exercise among the respondents.

Table 3: Categories of exercise

In present study, as shown in Table 4 that the majority of respondents (49.32% + 36.99% = 86.31%) spend between 2 to 6 hours on screens daily.

Table 4: Duration of screentime

As shown in Table 5 that the majority of subjects had sound sleep (56.16%), while 43.84% of the respondents reported not having sound sleep.

Table 5: sound sleep

It was seen from Table 6 that we compared systolic & diastolic BP after exercise in subjects those do exercise & those don’t do exercise. Since p- Value was less than the significance level of 0.05, statistically significant difference between two groups was noted in systolic & diastolic BP after exercise in subjects those do exercise & those don’t do exercise.

Table 6: Systolic & diastolic BP after exercise

Increasing rates of obesity is one more gift of the sedentary lifestyle. Although not directly it possesses a great risk for development of hypertension. Not only that, high body mass index, high body fat percentage Adversely affects the exercising capacity, power output, stamina and endurance of an individual. With the help of bicycle ergometer test or other stress test through treadmills and step-ups it can be assessed.⁵

A bicycle stress test is typically performed in a doctor's office or hospital. The patient will be asked to change into comfortable clothing and shoes. They will then be seated on a stationary bicycle and fitted with an electrocardiogram (EKG) monitor to record their heart rate and rhythm. The patient will then begin pedaling the bicycle at a slow pace. The workload on the heart will be gradually increased by increasing the speed or resistance of the bicycle. The patient's heart rate, blood pressure, and breathing will be monitored throughout the test.

There are main types of testing: submaximal, maximal and maximal utilizing gas exchange. The maximal test is the most usually performed, and the submaximal is appropriate for hospitalized patients. Gas exchange data are gathered when assessing congestive heart failure and timing for heart transplantation.

Clinical Significance of Abnormal BP Response

1. Exercise-Induced Hypertension (EIH) - Patients with normal resting BP but hypertensive response during exercise are at risk of developing chronic hypertension.
2. Delayed BP Recovery- Autonomic dysfunction and increased cardiovascular mortality risk.
3. Predicting Future Hypertension - Studies indicate that hypertensive responses during exercise are associated with a 2-4 times higher risk of future hypertension.

Premsundar KP et al.⁶, conducted a cross-sectional study among 100 medical students, about 24% students had increased systolic and 15% had increased diastolic BPs at rest. There was a significant increase in both during exercise. Ten minutes after exercise, the systolic BP was in prehypertensive range in 25% and Stage 1 hypertension in 2% students. Body mass index correlated with BP positively. The prevalence of prehypertension among asymptomatic healthy medical students is high. Medical students need orientation to improve their knowledge, attitude, and lifestyle practices early in life for prevention and treatment of hypertension.

Yadav AK⁷ studied 48 randomly selected male and female individuals with age group of 18–24 years and with normal body mass index. SBP and RPP are linearly increased with increasing intensity of exercise and more observed in ergometer bicycling than treadmill exercise. Postexercise mean DBP among the three intensities of exercise: in mild exercise, there was negligible change in case of treadmill exercise and a higher mean DBP was recorded in case of ergometer bicycle exercise; in moderate exercise, value was slightly lower in treadmill exercise and slightly higher in ergometer bicycle exercise, but in severe exercise, mean DBP decreased in both treadmill as well as in ergometer bicycle exercise.

Through this research we aspire to spread awareness about early Hypertension, its causes and possible effect of lifestyle, exercises, Body mass index or male and female genotype on it. who might ignore the need of their body to exercise might be exposed to increased risk of development of metabolic diseases and hypertensive disorders.⁸ They are assessed through bicycle ergometers test for their cardiovascular function at moderate resistance and specified time of 3 min at 60 pedal revolutions per minute.

The limitation of the current study is limited number of sample size. We have studied the cardiovascular response to exercise induced stress. We have not taken the anthropometric measurements, lipid profile, and glycemic status of these students into consideration.

Group that exercises had low variation in blood pressure compared to the group that don't exercise. Used in early detection of pre hypertensive and hypertensive patients, so that early diagnosis and prevention is possible.

Conflict of Interest: None to declare

Source of funding: Nil

1. Ganong WF, Barrett KE, Mcgraw-Hill Education. Ganong's review of medical physiology. New York: Mcgraw Hill Education, Cop; 2016.
2. Hall JE. Guyton and Hall textbook of medical physiology. 14th ed. Philadelphia, Pa: Elsevier; 2021.
3. K Park. Park's textbook of preventive and social medicine. India: Bhanot Publishers; 2017.
4. Bicycle Stress Test [Internet]. Physiopedia. 2020. Available from: https://www.physio-pedia.com/Bicycle_Stress_Test
5. Kim YJ, Chun H, Kim CH. Exaggerated Response of Systolic Blood Pressure to Cycle Ergometer. Annals of Rehabilitation Medicine [Internet]. 2013;37(3):364-67.
6. Balasubramanian V, Premsundar K, Venkat A, K T, A S. Response of cardiovascular system to exercise using bicycle ergometer among first year medical students. National Journal of Physiology, Pharmacy and Pharmacology. 2021;(1):1-7.
7. Yadav AK, Bagi JG. A study to evaluate cardiovascular responses by using treadmill and ergometer bicycle exercise in young adults. Indian J Health Sci Biomed Res 2018;11:81-85.
8. Mohan S, M B, R P. Study of gender variation in muscle function among young adults. National Journal of Physiology, Pharmacy and Pharmacology [Internet]. 2017 [cited 2021 Apr 21];1.