Effects of high-intensity bodyweight interval training and breathing exercises on quality of life, psychological distress, inflammatory biomarkers, and blood pressure in adults with hypertension: a randomized controlled trial

Hypertension is a major public health challenge associated with impaired quality of life, psychological distress, inflammation, and cardiovascular risk. This randomized controlled trial compared high-intensity bodyweight interval training (HIBIT), breathing exercises (BE), and their combination with a non-exercise control. Ninety-six adults with hypertension were randomized equally to control, BE, HIBIT, or combined exercise for 10 weeks. Quality of life (QoL), psychological distress, cortisol, C-reactive protein (CRP), interleukin-6 (IL-6), systolic blood pressure (SBP), diastolic blood pressure (DBP), and resting heart rate were assessed at baseline and post-intervention. The primary intention-to-treat analysis included all 96 randomized participants and used ANCOVA adjusted for the corresponding baseline outcome; a per-protocol analysis of 87 participants was conducted as a sensitivity analysis. Adjusted group effects were observed for CRP (F(3, 91) = 4.79, p = 0.004, partial eta squared = 0.136), SBP (F(3, 91) = 19.06, p < 0.001, partial eta squared = 0.386), and DBP (F(3, 91) = 9.42, p < 0.001, partial eta squared = 0.237). Adjusted CRP was lower in the BE and combined-exercise groups than in the control group, while adjusted SBP and DBP were lower in all three intervention groups than in the control group. No adjusted group effects were identified for QoL, psychological distress, cortisol, IL-6, or resting heart rate. The per-protocol analysis produced the same overall pattern. HIBIT, BE, and their combination were associated with lower post-intervention blood pressure than control, but the combined intervention was not superior to either single intervention. The CRP finding and model-sensitive secondary outcomes should be interpreted cautiously and confirmed in larger, more diverse samples. Clinical trial registration number : Thai Clinical Trials Registry, TCTR20230707003 (https://www.thaiclinicaltrials.org), registered 6 July 2023.