The effects of morning versus evening high-intensity interval exercise on the magnitude of the morning blood pressure surge
Publication: Applied Physiology, Nutrition, and Metabolism
7 February 2025
Abstract
Blood pressure (BP) follows a circadian rhythm, dipping during sleep and surging in the morning. A larger morning BP surge is an independent predictor of cardiovascular events. Acute exercise can produce sustained periods of post-exercise hypotension that last up to 24 h; however, the timing of exercise (morning vs. evening) may influence this response. Whether the timing of exercise influences the morning BP surge remains unknown. The current study investigated the effects of a bout of high-intensity interval exercise (HIIE) performed in the morning versus evening on the magnitude of the morning BP surge in young healthy adults. Twenty-six young, otherwise healthy adults (23 ± 4 years; 15 females) completed a randomized crossover trial where, on different days, they completed a no exercise control visit or performed either morning (0800–1000 h) or evening (1700–1900 h) HIIE. Following each visit, ambulatory BP was assessed in 30 min intervals for 24 hrs. HIIE at either time did not alter the magnitude of the morning BP surge compared to control values (control: 22 ± 5 mmHg; morning exercise: 20 ± 8 mmHg; evening exercise: 22 ± 10 mmHg, P = 0.40) or when grouped separately by sex (visit × sex P = 0.42). A positive correlation existed between Morningness-Eveningness Questionnaire score and the change in nighttime BP following both exercise times (both r = 0.42 and P = 0.04). These findings suggest that HIIE does not attenuate the morning BP surge in young healthy adults and that chronotype can predict nighttime BP responses following HIIE, irrespective of exercise time of day. This study was registered on ClinicalTrials.gov (NCT06702930).
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References
Angadi S.S., Bhammar D.M., Gaesser G.A. 2015. Postexercise hypotension after continuous, aerobic interval, and sprint interval exercise. J. Strength Cond. Res. 29(10): 2888–2893.
Baross A.W., Brook R.D., Kay A.D., Howden R., Gaillard E.C., Gordon B.D.H., et al. 2022. Effects of isometric leg training on ambulatory blood pressure and morning blood pressure surge in young normotensive men and women. Sci. Rep. 12(1): 356.
Ben-Dov I.Z., Kark J.D., Ben-Ishay D., Mekler J., Ben-Arie L., Bursztyn M. 2007. Predictors of all-cause mortality in clinical ambulatory monitoring: unique aspects of blood pressure during sleep. Hypertension, 49(6): 1235–1241.
Bilo G., Grillo A., Guida V., Parati G. 2018. Morning blood pressure surge: pathophysiology, clinical relevance and therapeutic aspects. Integr. Blood Press. Control. 11: 47–56.
Bommarito J.C., Millar P.J. 2024. Effects of aerobic exercise on ambulatory blood pressure responses to acute partial sleep deprivation: impact of chronotype and sleep quality. Am. J. Physiol. Heart Circ. Physiol. 326(1): H291–H301.
Booth J.N., Jaeger B.C., Huang L., Abdalla M., Sims M., Butler M., et al. 2020. Morning blood pressure surge and cardiovascular disease events and all-cause mortality in Blacks: The Jackson Heart Study. Hypertension, 75(3): 835–843.
Brito L.C., Rezende R.A., Mendes C., Silva-Junior N.D., Tinucci T., Cipolla-Neto J., de Moraes Forjaz C.L. 2017. Separate aftereffects of morning and evening exercise on ambulatory blood pressure in prehypertensive men. J. Sports Med. Phys. Fitness, 58(1–2).
Carpes L.O., Domingues L.B., Bertoletti O., Fuchs S.C., Ferrari R. 2022. Inter-individual responses of post-exercise hypotension in older adults with hypertension: an exploratory analysis of different exercise modalities. Front. Physiol. 13: 1050609.
Carter J.R., Lawrence J.E., Klein J.C. 2009. Menstrual cycle alters sympathetic neural responses to orthostatic stress in young, eumenorrheic women. Am. J. Physiol. Endocrinol. Metab. 297(1): E85–E91.
Ciolac E.G., Guimarães G.V., D´Àvila V.M., Bortolotto L.A., Doria E.L., Bocchi E.A. 2009. Acute effects of continuous and interval aerobic exercise on 24-h ambulatory blood pressure in long-term treated hypertensive patients. Int. J. Cardiol. 133(3): 381–387.
Collier S., Fairbrother K., Cartner B., Alley J., Curry C., Dickinson D., Morris D. 2014. Effects of exercise timing on sleep architecture and nocturnal blood pressure in prehypertensives. Vasc. Health Risk Manage. 691.
de Brito L.C., Rezende R.A., da Silva Junior N.D., Tinucci T., Casarini D.E., Cipolla-Neto J., Forjaz C.L.M. 2015. Post-exercise hypotension and its mechanisms differ after morning and evening exercise: a randomized crossover study. PLoS One 10(7): e0132458.
Dodt C., Breckling U., Derad I., Fehm H.L., Born J. 1997. Plasma epinephrine and norepinephrine concentrations of healthy humans associated with nighttime sleep and morning arousal. Hypertension, 30(1): 71–76.
Dolan E., Stanton A., Thijs L., Hinedi K., Atkins N., McClory S., et al. 2005. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension, 46(1): 156–161.
Dunne F.P., Barry D.G., Ferriss J.B., Grealy G., Murphy D. 1991. Changes in blood pressure during the normal menstrual cycle. Clin. Sci. (Colch), 81(s25): 515–518.
Fagard R.H., Van Den Broeke C., De Cort P. 2005. Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice. J. Hum. Hypertens. 19(10): 801–807.
Forjaz C.L.M., Tinucci T., Ortega K.C., Santaella D.F., Mion D., Negrão C.E. 2000. Factors affecting post-exercise hypotension in normotensive and hypertensive humans: Blood Press. Monit. 5(5): 255–262.
Gong S., Liu K., Ye R., Li J., Yang C., Chen X. 2019. Nocturnal dipping status and the association of morning blood pressure surge with subclinical target organ damage in untreated hypertensives. J. Clin. Hypertens. 21(9): 1286–1294.
Horne J.A., Ostberg O. 1976. A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int. J. Chronobiol. 4(2): 97–110.
Imazu A.A., Goessler K.F., Casonatto J., Polito M.D. 2017. The influence of physical training status on postexercise hypotension in patients with hypertension: a cross-sectional study. Blood Press. Monit. 22(4): 196–201.
Jones H., George K., Atkinson G. 2009a. Timing of exercise within the waking period does not alter blood pressure during subsequent nocturnal sleep in normotensive individuals. J. Exerc. Sci. Fit. 7(2): S42–S50.
Jones H., Taylor C.E., Lewis N.C.S., George K., Atkinson G. 2009b. Post-exercise blood pressure reduction is greater following intermittent than continuous exercise and is influenced less by diurnal variation. Chronobiol. Int. 26(2): 293–306.
Kario K. 2010. Morning surge in blood pressure and cardiovascular risk: evidence and perspectives. Hypertension, 56(5): 765–773.
Kario K., Pickering T.G., Umeda Y., Hoshide S., Hoshide Y., Morinari M., et al. 2003. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation, 107(10): 1401–1406.
Kredlow M.A., Capozzoli M.C., Hearon B.A., Calkins A.W., Otto M.W. 2015. The effects of physical activity on sleep: a meta-analytic review. J. Behav. Med. 38(3): 427–449.
Li Y., Thijs L., Hansen T.W., Kikuya M., Boggia J., Richart T., et al. 2010. Prognostic value of the morning blood pressure surge in 5645 subjects from 8 populations. Hypertension, 55(4): 1040–1048.
Lyu B., Hagen E.W., Ravelo L.A., Peppard P.E. 2020. Blood pressure dipping and sleep quality in the Wisconsin Sleep Cohort. J. Hypertens. 38(3): 448–455.
MacDonald J.R. 2002. Potential causes, mechanisms, and implications of post exercise hypotension. J. Hum. Hypertens. 16(4): 225–236.
Metoki H., Ohkubo T., Kikuya M., Asayama K., Obara T., Hashimoto J., et al. 2006. Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the Ohasama study. Hypertension, 47(2): 149–154.
Minson C.T., Halliwill J.R., Young T.M., Joyner M.J. 2000. Influence of the menstrual cycle on sympathetic activity, baroreflex sensitivity, and vascular transduction in young women. Circulation, 101(8): 862–868.
Modesti P.A., Morabito M., Massetti L., Rapi S., Orlandini S., Mancia G., et al. 2013. Seasonal blood pressure changes: an independent relationship with temperature and daylight hours. Hypertension, 61(4): 908–914.
Morales-Palomo F., Ramirez-Jimenez M., Ortega J., Pallarés J., Mora-Rodriguez R. 2017. Acute hypotension after high-intensity interval exercise in metabolic syndrome patients. Int. J. Sports Med. 38(07): 560–567.
Moran V.H., Leathard H.L., Coley J. 2000. Cardiovascular functioning during the menstrual cycle. Clin. Physiol. 20(6): 496–504.
Morris C.J., Hastings J.A., Boyd K., Krainski F., Perhonen M.A., Scheer F.A.J.L., Levine B.D. 2013. Day/night variability in blood pressure: influence of posture and physical activity. Am. J. Hypertens. 26(6): 822–828.
O'Brien E., Parati G., Stergiou G. 2013. Ambulatory blood pressure measurement: what is the international consensus? Hypertension, 62(6): 988–994.
Palatini P. 2012. Ambulatory and home blood pressure measurement: complementary rather than competitive methods. Hypertension, 59(1): 2–4.
Park S., Jastremski C.A., Wallace J.P. 2005. Time of day for exercise on blood pressure reduction in dipping and nondipping hypertension. J. Hum. Hypertens. 19(8): 597–605.
Pescatello L.S., Guidry M.A., Blanchard B.E., Kerr A., Taylor A.L., Johnson A.N., et al. 2004. Exercise intensity alters postexercise hypotension: J. Hypertens. 22(10): 1881–1888.
Pimenta F.C., Montrezol F.T., Dourado V.Z., da Silva L.F.M., Borba G.A., de Oliveira Vieira W., Medeiros A. 2019. High-intensity interval exercise promotes post-exercise hypotension of greater magnitude compared to moderate-intensity continuous exercise. Eur. J. Appl. Physiol. 119(5): 1235–1243.
Sega R., Facchetti R., Bombelli M., Cesana G., Corrao G., Grassi G., Mancia G. 2005. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni arteriose monitorate e Loro Associazioni (PAMELA) study. Circulation, 111(14): 1777–1783.
Smolensky M.H., Hermida R.C., Portaluppi F. 2017. Circadian mechanisms of 24–16 -hour blood pressure regulation and patterning. Sleep Med. Rev. 33: 4–16.
Somers V.K., Dyken M.E., Mark A.L., Abboud F.M. 1993. Sympathetic-nerve activity during sleep in normal subjects. N. Engl. J. Med. 328(5): 303–307.
Staessen J.A. 1999. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. J. Am. Med. Assoc. 282(6): 539.
Swinton P.A., Hemingway B.S., Saunders B., Gualano B., Dolan E. 2018. A statistical framework to interpret individual response to intervention: paving the way for personalized nutrition and exercise prescription. Front. Nutr. 5: 41.
Terblanche E., Millen A.M.E. 2012. The magnitude and duration of post-exercise hypotension after land and water exercises. Eur. J. Appl. Physiol. 112(12): 4111–4118.
Unger T., Borghi C., Charchar F., Khan N.A., Poulter N.R., Prabhakaran D., et al. 2020. International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension, 75(6):1334–1357.
Verdecchia P., Angeli F., Mazzotta G., Garofoli M., Ramundo E., Gentile G., et al. 2012. Day-night dip and early-morning surge in blood pressure in hypertension: prognostic implications. Hypertension, 60(1): 34–42.
Yang W.-Y., Melgarejo J.D., Thijs L., Zhang Z.-Y., Boggia J., Wei F.-F., et al., for The International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO) Investigators. 2019. Association of office and ambulatory blood pressure with mortality and cardiovascular outcomes. J. Am. Med. Assoc. 322(5): 409.
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Information
Published In
Applied Physiology, Nutrition, and Metabolism
Volume 50 • 2025
Pages: 1 - 11
History
Received: 18 October 2024
Accepted: 16 December 2024
Accepted manuscript online: 17 December 2024
Version of record online: 7 February 2025
Copyright
© 2025 The Author(s). Permission for reuse (free in most cases) can be obtained from copyright.com.
Data Availability Statement
Data generated during this study are available from the corresponding author upon reasonable request.
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Authors
Author Contributions
Conceptualization: JB, PJM
Data curation: JB
Formal analysis: JB
Funding acquisition: PJM
Investigation: JB
Methodology: JB
Project administration: JB, PJM
Resources: PJM
Supervision: PJM
Validation: JB
Visualization: JB
Writing – original draft: JB
Writing – review & editing: JB, PJM
Competing Interests
The authors have no conflicts of interest to disclose.
Funding Information
Natural Sciences and Engineering Research Council of Canada (NSERC)
Ontario Ministry: 34379
Ontario Ministry of Economic Development
This research was supported by a Natural Sciences and Engineering Research Council of Canada (NSERC) (PJM), the Canada Foundation for Innovation (PJM 34379), the Ontario Ministry of Research, Innovation, and Science (PJM 34379), and an Early Researcher Award by the Ontario Ministry of Economic Development, Job Creation and Trade. An Ontario Graduate Student award supported JCB. None of the funding sources had a role in designing or conducting the study; analysis or interpretation of data; or preparation or review of the manuscript before submission.
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Julian C. Bommarito and Philip J. Millar. 2025. The effects of morning versus evening high-intensity interval exercise on the magnitude of the morning blood pressure surge. Applied Physiology, Nutrition, and Metabolism.
50: 1-11.
https://doi.org/10.1139/apnm-2024-0449
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