Vol.48 - Número 2, Abril/Junio 2019 Imprimir sólo la columna central

Average blood pressure: Does the use of stairs matter?

 

RUSVELT F VARGAS-MORANTH, ADALGISA E. ALCOCER-OLACIREGUI, PAOLA SANJUAN-GÓMEZ, JAN F LÍO-CARRILLO, GIANINA FONTALVO-DE ALBA, JEFRY MARTÍNEZ-OROZCO, GREYS L. SIERRA-MAURY, JORGE BILBAO-RAMÍREZ.
Universidad Metropolitana. Grupo de Investigación Sanus Viventium.
Barranquilla, Colombia.
E-mail
Recibido 15-ENERO-2019 – ACEPTADO después de revisión el 07-FEBRERO-2019.
There are no conflicts of interest to disclose.

 

ABSTRACT

Objective: To determine if the daily use of stairs is related to values of mean arterial pressure, in a group of inhabitants of a residential complex with 4-floor buildings.
Methods: Descriptive, cross-sectional study. Blood pressure was taken in 125 healthy individuals (50.4% women) living in the 4 floors of each of the 4 buildings of a residential complex. The values of mean arterial pressure were compared according to the residence floor by means of the one-way ANOVA and Bonferroni tests, and the analysis was stratified according to age, sex, obesity, smoking, frequent alcohol drinking and physical activity.
Results: A significant relationship was found (p <0.05) between the mean arterial pressure average and the residence floor, the differences being marked especially between floors one and four (p <0.05). Statistical significance was found (p <0.05) when stratifying mean arterial pressure values according to male sex, abdominal obesity and smoking.
Conclusion: In healthy adults, participants in the study, there was a beneficial effect in the daily use of stairs with respect to the values of mean arterial pressure.
Key words: Physical activity. Mean blood pressure. Stairs. Obesity. Smoking.

 

INTRODUCTION
The practice of physical activity is one of the main components of a healthy lifestyle, essential to prevent cardiovascular diseases [1]. According to the American Heart Association guidelines, 3 to 4 sessions of 40 minutes per week 1of moderate physical activity are recommended, to improve modifiable cardiovascular risk factors such as blood pressure [2]; however, in spite of the benefits of physical activity, in Colombia the prevalence of sedentarism is 78.4% [3].

Going up and down the stairs is considered a moderate physical activity, not only because it gives tone to muscles, but also because it improves motor conditions and contributes to improve cardiovascular health; all this in a natural way and fundamentally with no cost, as no specialized equipment is required [4], and as stairs are quite commonly found [5]; in fact the American Lung Association [6] advises to climb stairs daily for 5 to 10 minutes, around 70 to 100 steps each time. Additionally, climbing stairs consumes almost 10 times the energy in rest, so it is more efficient than walking or even jogging [7], and its benefits in terms of blood pressure reduction have been proven, as well as in other indicators as waist perimeter, fat mass and LDL cholesterol [8].

As the practice of physical activity is often being done in an unconscious manner, and recommended levels are not always reached, in this study the effect of climbing stairs (as a routine necessity) is studied in a residential complex with four buildings, each with four floors and no elevator, on mean blood pressure (MBP), as this indicator is an average assessed of blood pressure in relation to the whole cardiac cycle [9].

 

MATERIALS AND METHODS
A descriptive, cross-sectional study was conducted. A residential complex was selected, with no elevators (Miraflores II), located in the city of Barranquilla, and constituted by four buildings, each with four floors. The number of steps between each floor was 14. As a sample unit, each apartment in the complex was taken account (n=127), and in every apartment, an adult was chosen at random, present on the information collection day, considering the following selection criteria:

  • Signed informed consent
  • Ages from 20 to 59 years
  • Not having hypertension diagnosed
  • No history of cardiovascular disease
  • Not having musculoskeletal problems that would hinder movements
  • Non-pregnant women
  • Going up and down the stairs to reach the apartment at least twice a day.


In two apartments, people did not meet the selection criteria and there was no another adult in this complex that could not meet the criteria, so the final sample was constituted by 125 individuals.

Data collection was carried out during year 2015. For this, a survey was designed, structured to collect the following variables: age, gender, smoking, alcohol consumption; the level of physical activity was measured through the IPAQ questionnaire [10], validated for Colombia.

Height was measured with measuring tape, and weight with an electronic weighing scale, with a 5-gram accuracy, with no shoes. For waist perimeter, a measuring tape graded in centimeters was used, with the individual standing straight and the arms in anatomical position, measured at the middle point between the anterior superior iliac spine and the inferior costal margin [11].

Blood pressure was determined with previously calibrated aneroid sphygmomanometer, with the individual sitting with the back supported on a chair, measured in the right arm, according to the Joint National Committee VIII recommendations, between 8 am and 10 am, by one of the investigators. MBP was estimated by the following formula:

  • MBP = (systolic blood pressure – diastolic blood pressure) / 3 + diastolic pressure.

The following obesity criteria were used:

  • Obesity and general overweight, according to the World Health Organization (WHO) [12]; body mass index >29.9 Kg/m2.  
  • Abdominal obesity according to the International Diabetes Federation (IDF) [13]: Abdominal perimeter equal or greater than 90 cm in men and equal or greater than 80 cm in women.

The data obtained were processed by SPSS V24. To do this, a database was designed where the information was introduced already adjusted and reviewed. MBP averages were estimated and compared according to the floor where individuals lived, by single-factor ANOVA; subsequently, data were stratified according to the following variables: age, gender, BMI, abdominal obesity, smoking, alcohol consumption and physical activity, and a Bonferroni post-hoc test was carried out.

The investigation was carried out according to the Good Clinical Practice (GCP), the Declaration of Helsinki and the International Conference on Harmonisation (ICH); respect for human dignity prevailed, as well as the protection of rights and the wellbeing of people; and according to the 8430 Resolution from 1993, this study is considered of risk below the minimum.

 

RESULTS
There were 125 individuals interviewed who met the selection criteria. 50.4% were women, 72% were aged between 20 and 39 years, 80.8% were overweight or obese (BMI>24.9 Kg/m2), 50.8% presented abdominal obesity, 25.6% smoked, 54.4% had low physical activity, and in regard to alcohol consumption, all revealed drinking, but only 19.2% stated doing it frequently; i.e. at least once a week (Table 1). Likewise, the participants were distributed homogeneously in each of the floors: 29.6% in the ground floor, 22.4% in the first and second floors, and 25.6% in the third.

When relating gender to the floor where they lived, there were no significant differences (p>0.05), as there were no differences either for BMI, abdominal obesity, smoking, physical activity and frequent consumption of alcohol (p>0.05); however, there were significant differences for age (p<0.05), as in the ground floor 45.9% of individuals were aged between 40 and 59 years; but in the remaining floors this percentage was no greater than 25%, even being 14.3% in the second floor (Table 1).

Table 1. Percentage (%) distribution of participants according to the floor where they live and related variables
  FLOOR       TOTAL Chi2;
  Ground (n=37) First (n=28)

Second (n=28)

Third (n=32) (n=125) p
GENDER
Female
Male

54.1
45.9
39.3
60.7
53.6
46.4
53.1
46.9
50.4
49.6
1.789
0,617
AGE
20a39
40a59
54.1
45.9
75.0
25.0
85.7
14.3
78.1
21.9
72.0
28.0
9.243
0.026
BMI>24.9 Kg/m2
Yes
No
81.1
18.9
82.1
17.9
71.4
28.6
87.5
12.5
80.8
19.2
2.54
0.467
Abdominal obesity*
Yes
No
54.3
45.7
44.4
55.6
53.6
46.4
50.0
50.0
50.8
49.2
0.701
0.8733
Smoker
Yes
No
37.8
62.2
17.9
82.1
14.3
85.7
28.1
71.9
25.6
74.4
5.780
0.123
Frequent drinker
Yes
No
27.0
73.0
3.6
96.4
21.4
78.6
21.9
78.1
19.2
80.8
6.107 0.107
Physical activity
Low
Moderate
High

48.6
35.1
16.2

67.9
17.9
14.3

53.6
32.1
14.3

50.0
31.3
18.8

54.4
29.6
16.0
3.308 0.769
* Men >89.9 cm; women >79.9 cm

 

The total MBP average was 93.6 (SD +/-: 3.6) mmHg, and when stratifying by floor, it was observed that the averages decreased as the number of steps climbed and descended daily increased, going from 94.9 in the first floor to 92.6 in the fourth floor (Table 2). The Bonferroni post-hoc test showed that the significant differences in MBP were between the people living in the ground floor and those living in the third floor (p=0.049), and between the remaining floors there were no significant differences found (p>0.05) (Table 3).

Table 2. Average of mean blood pressure, in general and according to the floor where they live
Floor where participants live PAM (mmHg)
  Average SD(+/-)
Ground
First
Second
Third
94.9
93.7
92.8
92.6
3.7
2.9
3.5
3.8
Total 93.6
3.6
F test; p 3.06; 0.031


Table 3. Bonferroni test of multiple comparisons for MBP values in the floors where the participants live
MBP (I) FLOOR (J) FLOOR Averages difference (I-J) Typical error p CI 95%
  Ground First
Second
Third
1,205
2,157
2,299*
0,887
0,887
0,855
1
,099
,049
-1,174 a 3,584
-0,222 a 4,536
0,006 a 4,591
  First Ground
Second
Third
-1,205
0,952
1,094
0,887
0,946
0,916
1
1
1
-3,584 a 1,174
-1,586 a 3,491
-1,364 a 3,551
Bonferroni            
  Second

Ground
First
Third

-2,157
-0,952
0,141
0,887
0,946
0,916
,099
1
1
-4,536 a 0,222
-3,491 a 1,586
-2,316 a 2,599
  Third Ground
First
Second
-2,299*
-1,094
-0,141
0,855
0,916
0,916
,049
1
1
-4,591 a -0,006
-3,551 a 1,364
-2,599 a 2,316

 

When stratifying for each of the selected variables in the different floors, there were significant differences found (p<0.05) in the MBP values in men, in people with abdominal obesity, and in smokers, with MBP values being greater in floors one and two than in floors three and fourth (Table 4).

Table 4. Averages (SD +/-) of mean blood pressure by related variables according to the floor where they live
Floor Age Gender BMI>24.9 Kg/m2 Abdominal obesity Smoker Frequent drinker Physical activity
  20a39 40a59 Fem Male Yes No Yes No Yes No Yes No Low Mod High
Ground 94,3
(2,8)
95,8
(4,5)
94,0
(3,8)
96,1
(3,3)
94,8
(3,8)
95,0
(3,7)
96,4
(3,2)
93,6
(3,8)
96,4
(3,2)
93,6
(3,8)
96,2
(3,3)
94,5
(83,8)
95,4
(3,2)
95,1
(5,0)
93,3
(0,0)
First 93,3 (2,8)
95,2
(3,3)
93,9
(2,5)
93,6
(3,3)
91,3
(4,5)
94,3
(2,4)
94,4
(3,0)
93,2
(3,1)
94,4
(3,0)
93,2
(3,1)
90,0
(1,19
93,9
(3,0)
94,2
(2,2)
93,3
(2,4)
92,1
(6,3)
Second 93,0 (2,8) 91,7
(5,8)
93,4
(2,6)
92,1
(4,4)
92,1
(3,1)
93,1
(3,8)
93,1
(4,4)
92,4
(2,2)
93,1
(4,4)
92,4
(2,2)
93,9
(2,5)
92,5
(3,8)
94,1
(2,6)
91,1
(4,4)
91,7
(3,3)
Third 91,9 (3,9)
95,2
(1,8)
92,6
(3,7)
92,7
(4,0)
90,8
(5,0)
92,9
(3,6)
93,6
(3,1)
91,7
(4,2)
93,6
(3,1)
91,7
(4,2)
92,9
(4,5)
92,6
(3,7)
93,3
(3,0)
92,2
(4,8)
91,7
(4,1)
t; p 1.39;
0.132
1.14;
0.346
0.77;
0.621
1,86;
0,021
1,49;
0,089
1,09;
0,335
1,73;
0,037
1,00;
0,398
1,71;
0,050
1,01;
0,383
1,34;
0,177
1,39
;0.128
1,2;
0,19
1,24;
0,218
0,48;
0,868
 

DISCUSSION
In this study, an inversely proportional relationship was between MBP values and the floor where they lived, with lower values in the higher floors (p<0.05), and when the Bonferroni test was applied, it was found that these differences were essentially between the ground floor and the third floor; i.e. between those who do not need to climb the stairs to reach their apartment and those that have to climb 56 steps every time they arrive. It is possible that such MBP reduction is related to the presence of inflammatory markers, such as interleukins 3 and 6, as well as c-reactive protein [14,15] 24 25, and PCSK9 [8].

The results suggest a beneficial impact of physical activity by climbing stairs daily, as described in literature [16]; in this case in relation to MBP values. It is an affordable option that provides aerobic and endurance training without requiring specialized equipment [4,17]. Although none of the participants had hypertension diagnosed, and none had pathological MBP values, they should have their blood pressure monitored, as increases in systolic blood pressure beyond 140 mmHg while climbing the stairs, that decrease diastolic blood pressure or increase it to values greater than in rest, may indicate a pathology [18].

Although there were significant differences in the distribution of age groups in each of the floors, this was not reflected in the stratification of the MBP values analysis by age groups (p<0.05); instead, there were significant differences (p<0.05) between men, who according to literature [19], had a higher energy expenditure than women, as well as those with abdominal obesity, who therefore require a higher metabolic rate, and also in smokers significant differences were observed, in a similar way to Giménez et al [20].

Moderate physical activity is consistent with the strain of walking fast or going up or down the stairs. In spite of having proven that climbing stairs is an efficient exercise [21], in this study such efficiency was not determined, so it is recommended to measure the rate of the climb; i.e. the time by floor and the rate of repetition while MBP and other vital signs are monitored, including heart rate and oxygen saturation, to estimate the aerobic capacity of individuals, as well as to measure horizontal shifts, time to go up and to go down, and the presence of possible hindrances or obstacles in the way.

Campaigns promoting the use of stairs should be carried out, as studies using educational techniques to achieve this have been successful [22,23], as the prevalence of sedentary lifestyles is increasing, so interventions are necessary to promote the type of physical activity that would enable reaching the goal of increasing the prevalence of physical activity performance both in adults as in young people [24].

 

CONCLUSIONS
A beneficial effect was found between climbing stairs and MBP values in the population studied. Climbing stairs could be applied safely as a physical activity and by adjusting an increase in terms of floors, it could be used as training by health care providers or individuals with no access to more sophisticated facilities.

 

ACKNOWLEDGEMENTS
To the people living in the Miraflores II residential complex for their participation, to Jesús Ospino for his dedication and hard work, and the Universidad Metropolitana for financing this study.

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Publication: June 2019



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