Effect of Acute Bout of 10 Sessions of Dance Aerobic Exercise Intervention on Blood Pressure Indices Among Ethnic Population with Elevated Cardiovascular Risk

Abstract

The rate pressure product (RPP) is a non-invasive index of myocardial oxygen consumption, derived from heart rate (HR) and systolic blood pressure (SBP). While aerobic exercise is known to improve cardiovascular efficiency, evidence is limited for racialized populations, particularly African Canadians and South Asians who face elevated cardiovascular risk. Objective: The objective of the study was to examine whether a 10-session dance aerobics program provides a cardiovascular stimulus sufficient to affect RPP and blood pressure responses in these groups. Methods: A total of 160 participants with hypertension or related conditions (80 African Canadians, 80 South Asians) completed 10 sessions of community-based aerobic dance. Pre- and post-intervention measurements of systolic blood pressure (SBP), diastolic blood pressure (DBP), HR, and RPP were obtained and analyzed using non-parametric statistical tests. Results: Both groups showed reductions in blood pressure after the intervention. South Asians demonstrated moderate decreases in SBP and RPP, while African Canadians exhibited stable or slightly increased RPP values despite improvements in SBP and DBP. Between-group comparisons showed significant differences in SBP and HR (p < 0.05), but changes in RPP did not reach statistical significance (p > 0.05). Despite the modest reductions in systolic BP (≥5 mmHg), this may carry clinical significance. Conclusion: This study highlights that blood pressure and RPP responses to exercise may differ across ethnic groups. Short-term dance aerobics effectively reduced blood pressure in both African Canadian and South Asian participants, supporting its role as a culturally adaptable intervention. These findings underline the importance of tailoring exercise recommendations to ethnic and cultural contexts and provide a case for larger studies in a multi-ethnic population.

1. Background

The Rate Pressure Product (RPP), also known as the double product, is a non-invasive technique used to estimate myocardial oxygen consumption (MVO2) and assess the heart’s function in clinical and exercise physiology applications [1,2,3,4,5,6,7]. This measurement is calculated by multiplying the heart rate (HR) in beats/minute by the systolic blood pressure (SBP) in millimeters of mercury (mmHg), then dividing the product by 100 [3,4,5]. Within the realm of fitness and exercise, RPP plays a significant role. For instance, during rest exercise testing or the training phase, the measurement could identify ventricular function or provide information about changes in heart oxygen uptake [7,8,9]. Its usage in exercise settings has led to positive outcomes, including more accurate tailoring of exercise intensity to individual fitness levels, better monitoring of cardiovascular responses to exercise, and improved safety and effectiveness of exercise programs. In a study examining university athletes performing plyometric exercises, the authors found that increased exercise workload resulted in elevated myocardial oxygen demand, as indicated by higher RPP scores [10]. Results also highlight the significance of incorporating RPP in athletic training prescriptions, emphasizing the need for improved screening approaches and monitoring options to evaluate athletes’ performance. This is specifically important for athletes with a history of health conditions, as suboptimal RPP levels may elevate the risk of adverse events without proper supervision.

In addition to using the RPP to test athletes’ performance, the benefits of applying the tool to measure indirect MVO2 have been observed in diverse groups diagnosed with cardiovascular disease, demonstrating its broad applicability and usefulness [9]. A clinical study by Stoschitzky suggested that the RPP may be a more reliable predictor of clinical assessment, particularly for high-risk populations [11]. This is due in part that RPP is a reflection of total cardiac workload and oxygen demand, offering a more comprehensive indicator of cardiovascular strain. As noted, its utility has been well documented in research, making a strong case for its integration into risk stratification, treatment planning, and ongoing patient management. The clinical application may offer healthcare professionals a more comprehensive understanding of cardiovascular stress, enabling more informed treatment decisions and potentially improving outcomes in patients with cardiovascular disease. Despite these advantages, the RPP remains underutilized in practice. This limited adoption is partly due to its inability to capture determinants such as contractility, preload, and afterload, factors that independently influence oxygen demand beyond HR and SBP and its sensitivity to medications such as beta blockers [11]. Therefore, further work ought to be carried out to establish clinically relevant thresholds and to reanalyze existing cardiovascular outcome trials data with specific attention to RPP, which could strengthen its role as a practical, low-cost tool to guide both clinical decision making and preventive care.

Moreover, studies investigating the RPP with exercise training have suggested that a resting score exceeding 10,000 may be a sign of increased MVO2 and an elevated risk of heart disease, resulting in a strain on the cardiovascular system [8]. This demonstrates that taking BP measurements alone may not reveal or detect the strain on the cardiovascular system, hence the need to also use the RPP. On the contrary, an RPP falling between 7000 and 9000 is considered an appropriate number, indicating a balance between MVO2 demand and supply. This figure also reflects a healthy cardiovascular state. Conversely, a score below 7000 may compromise coronary blood supply, potentially impacting ventricular function (i.e., the heart’s main pumping chambers) [8]. This low score suggests that the heart may not be functioning as efficiently as it should, which affects its ability to pump blood. Consequently, this could lead to conditions such as ischemia or other cardiovascular dysfunctions in patients with cardiac disease. These diverse RPP levels advocate that incorporating the measurement in clinical assessments can enhance the detection of cardiovascular risks that might otherwise go unnoticed with BP measures alone.

Despite its significance, RPP is relatively underexplored in the literature concerning physiological responses to BP. Similarly, research regarding the impact of exercise training on the RPP is limited, especially among racialized or ethnic groups. Most existing studies have focused primarily on European populations, leading to a significant disparity in representation. This inquiry with ethnic populations is particularly significant considering that groups like Black individuals of African origin or South Asians, who present similar cardiovascular profiles and tend to engage less in regular physical activity or exercise, are underrepresented [1,12]. Additionally, individuals from minority groups are less likely to participate in cardiac rehabilitation (CR) programs. Banerjee and colleagues observed that South Asian patients in CR had lower attendance rates compared to Europeans. Indeed, this disparity is linked to several factors, including cultural differences, language barriers, and limited awareness of the benefits of such programs [13,14]. Understanding these barriers and recognizing the different cardiovascular responses to exercise across racial groups can provide critical insights for developing culturally appropriate and individualized exercise recommendations within clinical or community-based settings offering fitness and CR programs. Such efforts are vital for reducing cardiovascular risk among racialized individuals, specifically those with chronic conditions who engage in physical activity. Notably, there is a significant lack of research examining the influence of exercise on the rate of RPP among racialized populations in Canada. This research gap is particularly concerning given the elevated cardiovascular risks faced by both African Canadian and South Asian individuals during physical exertion.

Dance is well supported in the literature for its multifaceted benefits, including improvements in cardiovascular health, emotional well-being, and community engagement [15]. Its accessibility and cultural significance make it a suitable intervention for addressing health disparities related to cardiovascular disease. This study builds on existing research by targeting African Canadian and South Asian populations, often underrepresented in health intervention studies. It is then appropriate that the current study investigated the effect of 10 dance aerobic sessions on BP and the RPP in African Canadians and South Asians diagnosed with hypertension (defined as a blood pressure of 140/90 mmHg) or other cardiovascular ailments, participating in a community-based fitness program. The study objectives were (1) to investigate how physiological responses, including RPP, HR, and BP, may impact the reactions of African Canadian and South Asian participants to the 10 dance aerobic sessions, and (2) to assess the degree of health improvements among the two groups.

2. Methods

The research was a non-randomized study and was conducted at a community centre in a Toronto, Ontario, Canada suburb. The Centre’s Director of Programming endorsed and approved their involvement, while the University Research Ethics Committee approved the principal researcher to utilize the previously gathered anonymized data for the purpose of this study (SU_20_128). After consenting, they were briefed about the study’s objectives and procedures. In total, 160 participants (80 African Canadians and 80 South Asians) were recruited for the study. Their ages ranged from 30 to 80 years. We then provided each participant with information about the study, and if they agreed to participate, they signed an informed consent. They were then required to attend ten consecutive aerobic dance sessions spread out over five weeks, with two sessions per week.

2.1. Inclusion and Exclusion Criteria

The study eligibility criteria were as follows: (1) participants aged 30 or older; (2) participants were of African origin, including individuals of Black African, Black Canadian, or black Caribbean origin; (3) those from South Asian backgrounds, encompassing India, Pakistan, Sri Lanka, and Bangladesh and (4) participants who had specific health conditions. These conditions could include chronic mild to moderate or stable hypertension or related hypertension heart conditions, such as left ventricular hypertrophy or heart disease. The study included participants with a health condition to enable a more targeted analysis of exercise training as an intervention for higher risk chronic conditions. Furthermore, participants had to be sedentary at the time of enrollment in this study or have not engaged in prescribed exercise within the past six months or longer. The study did not regulate medical prescriptions or dietary consumption. Participants were also required to complete a Physical Activity Questionnaire. The survey inquired about participants’ medication usage, specific medication names, pain issues, and exercise habits.

2.2. Baseline Assessment

Participants’ baseline BP and resting HR measurements were obtained by two Kinesiology placement students using an automated digital electronic BP monitor (Omron BP monitor Model BP710CANN, Medaval Ltd., Cork, Ireland). The BP measurements followed the protocols recommended by Hypertension Canada guidelines to reduce the risk of bias [16]. These guidelines are critical for ensuring both the accuracy and reliability of the measurements over the entire data collection process. To achieve this the following procedure was implemented for BP measurement. Thus, participants were seated in a quiet environment for accuracy, with legs uncrossed, feet flat, back supported, arms supported, and allowed a rest time of ten minutes before the BP readings. BP readings were taken on the left arm, following the standardized procedure. Three separate BP measurements were recorded for each participant while they remained in a seated position. After obtaining BP and HR measurements, the RPP was calculated using an online calculator. The values were determined both at rest and after the exercise sessions to assess the changes in cardiovascular response. The online calculator allowed for calculating the RPP by multiplying the HR and systolic BP values. All participants also completed the same 10-session program led by a certified instructor, minimizing variability, and were consistent with equipment usage.

In addition to collecting BP measurements, the mean arterial pressure (MAP) and pulse pressure (PP) were calculated using online calculators. Participants pre body composition measurements (i.e., weight, BMI, fat%, and water content) were collected using the Tanita TBF-410GS Body Composition Analyzer (Tokyo, Japan). However, we did not gather any post data on body composition assessment following the intervention as there were only ten exercise sessions. Thus, with only ten exercise sessions, significant body composition changes might be minimal or insignificant.

2.3. Exercise Programme

The exercise program consisted of 10 workout sessions. Four classes were held twice weekly on specific days, divided into morning and afternoon sessions. Each participant had the flexibility to choose two preferred days to attend the exercise sessions. The exercise classes commenced with a 5 to 8 min warm-up routine, followed by 30 to 45 min of low-impact aerobic dance movements. The intensity of the aerobic dance movements was targeted to achieve 50–65% of the participant’s maximum heart rate (HRmax). Participants’ heart rates were monitored throughout each exercise session using heart rate watches to ensure they were within the desired intensity range. Moreover, the aerobic dance movements were specifically designed to be low-impact, with each move lasting for approximately 20–28 counts. This approach aimed to minimize joint stress and provide participants with a safe and effective workout environment.

A volunteer certified fitness instructor from the black Afro-Caribbean community led the aerobic classes. The kinesiology students monitored the participants during the workouts, ensuring their safety and adherence to the exercise program. Following the completion of the 10 exercise sessions and a one week sedentary period, participants underwent a reassessment identical to the baseline procedure, including seated rest BP and HR measurements and recalculation of RPP, MAP and PP.

2.4. Statistical Analysis

The Kolmogorov–Smirnov test was administered to check for normality (normal distribution). The test found that all data were not normally distributed; therefore, we used non-parametric statistics for the analysis, thus applying the median to the data instead of the mean ranks [17]. Moreover, the Mann–Whitney U test determined the statistically significant differences between the two groups regarding cardiovascular parameters (i.e., pre-measurements, post-measurements, and pre/post-measurements). The Wilcoxon analysis compared the median difference between the two groups on SBP, DBP, HR, and RPP. This test also reported the strength of any relationships. The effect size was calculated by dividing the z value by the square root of the number of pairs (N). A chi-square test was performed to examine if there were significant correlations between the health statuses (i.e., hypertension, diabetes, thyroid conditions, cholesterol levels, chronic pain, and medications) and ethnicity (African Canadians and South Asians) during exercise. Finally, a p-value < 0.05 was considered significant for each test. All statistical procedures were performed using the Statistical Package for Social Sciences (SPSS) software (Version 21, IBM).

3. Results

There were 160 participants in the study: 80 African Canadians and 80 South Asians. At baseline, all subjects had hypertension or high blood pressure (140/90 mmHg). We found that most of the participants were prescribed medication. Some of the drugs included various blood pressure prescriptions, such as beta blockers, and diabetes medications (e.g., metformin). All 160 completed the required 10 exercise sessions. As shown in

Table 1. Main characteristics of the participants, including age, weight, BMI, fat, weight and body fat%.

Variables	African Descendants (G1)	South Asians (G2)	p-Value *
	Baseline Median ± Range	Baseline Median ± Range
Age (year)	66 ± 58	66 ± 41	0.362
Weight (kg)	71.89 ± 60	66 ± 57	0.003
BMI (kg/m2) **	30 ± 28	27 ± 26	0.002
Body fat (%)	40 ± 57	38 ± 42	0.106
Male (%)	7 (8.8%)	5 (6.3%)
Female (%)	73 (91.3%)	75 (93.8%)

* p values < 0.05 indicate a significant association. p values > 0.05 indicate no significant association. ** BMI = body mass index.

, the median age for the two groups was 66. There was also no significant difference between the groups in terms of age (p > 0.05). Baseline body composition results were significantly different, p < 0.05, with African Canadians exhibiting higher body weight and BMI (30) and range of (28) than South Asians (27) and range of 26) (Table 1).

3.1. Difference Between the Pre and Postconditions

3.1.1. Difference Between Pre and Post in the African Canadian Population

According to the American Heart Association (AHA, 17) chart, the BP levels of the African Canadian group were categorized as stage 2 hypertension, defined as SBP of 140 mmHg or higher or DBP of 90 mmHg or higher. Pre median values described were SBP (143), DBP (88), HR (75), RPP (10,740), MAP (105), PP (55), BMI (30), weight (72 kg), and fat% (40) with small effect sizes (

Table 2. Mann U Whitney test—pre, post and pre-post, range, effect size and p-value for cardiovascular markers.

Categorical Variables	Ethnicity	Pre-Median ± Range	Post Median ± Range	Pre–Post Median ± Range	Pre-Effect Size	Post Effect Size	Pre-Post Effect Size	Pre p-Value *	Post p-Value *	Pre-Post p-Value *
systolic blood pressure (SBP)	South Asians	138 ± 72	127 ± 58	10 ± 48	0.120	0.078	0.000	0.003	0.012	0.822
	African Canadians	143 ± 50	133 ± 51	9 ± 37
diastolic blood pressure (DBP)	South Asians	80 ± 55	77 ± 55	3 ± 47	0.181	0.067	0.000	0.000	0.020	0.835
	African Canadians	88 ± 38	81 ± 46	8 ± 42
Heart Rate (HR)	South Asians	78 ± 55	81 ± 55	9 ± 42	0.006	0.001	0.029	0.482	0.711	0.127
	African Canadians	75 ± 61	82 ± 62	7 ± 34
Rate Pressure Product (RPP)	South Asians	10,397 ± 10,045	10,269 ± 7503	1346 ± 14,562	0.000	0.011	0.012	0.890	0.329	0.312
	African Canadians	10,740 ± 1183	10,768 ± 9068	56 ± 7874
Pulse Pressure (PP)	South Asians	57 ± 59	50 ± 75	9 ± 48	0.144	0.000	0.002	0.282	0.898	0.647
	African Canadians	55 ± 55	50 ± 63	8 ± 35
Mean Arterial Pressure (MAP)	South Asians	98 ± 40	95 ± 49	9 ± 3	0.155	0.113	0.011	0.000	0.003	0.344
	African Canadians	105 ± 35	99 ± 37	8 ± 35

* p values < 0.05 indicate a significant association. * p values > 0.05 indicate no significant association. SBP = systolic blood pressure, DBP = diastolic blood pressure, HR = heart rate, RPP = rate pressure product. All BP (SBP, DBP, MAP, PP) unit is expressed in mmHg, RPP in mmHg · bpm. Effect size are interpreted based on Cohen (1988) criteria of 0.1 = small effect, 0.3 = medium effect, 0.5 = large effect.

). The score observed in MAP was considered abnormal (according to the MAP assessment chart), whereas the PP was considered normal (based on the PP chart). In contrast, a significant difference was detected between post and pre in SBP (132) and DBP (80), while a slight increase in HR (82) and RPP (10,796) was noted under the exercise condition, with all effect sizes being small. The pattern of change also extended to MAP (99) and PP (50), where a decrease from baseline was observed, with both having a small effect size (Table 2).

3.1.2. Difference Between Pre and Post in the South Asian Population

The baseline results indicate that the South Asian group was at stage 1 hypertension, as defined by SBP levels of 131–139 mmHg or DBP of 80–89 mmHg. The pre-median scores from the Mann–Whitney U test were as follows: SBP (138), DBP (80), HR (78), RPP (10,397), MAP (98), PP (57), BMI (27), weight (66 kg), and body fat percentage (38%). These results were associated with small effect sizes. The BMI of the South Asian group was also classified as overweight according to the BMI chart, again with a small effect size. These findings provide valuable insights into the cardiovascular health and physical characteristics of the South Asian group in the study.

When comparing post training versus pre training differences among South Asians, we observed a decrease in SBP (127), DBP (77), and RPP (10,268), with a slight increase in HR (81) and small effect sizes after the training (Table 2). Changes were also noted in MAP (95) and PP (50) from the precondition, with small effect sizes, which were considered normal according to each evaluation chart. All pre- and post-continuity variable ranges, effect size, and p-values are presented in Table 2.

3.1.3. Difference Between Pre and Post in the All Population

The pre and post analyses revealed significant between-group differences in SBP (p 0.003), DBP (p 0.000), and MAP (p 0.000); all p < 0.05. No significant differences were observed for HR (p 0.482), RPP (p 0.890), or PP (p 0.282); all p > 0.05. At post-intervention, there remained no significant differences between groups in HR (p 0.711), RPP (p 0.329), or PP (p 0.889). Although both groups showed slight shifts in RPP values from pre- to post-intervention, these differences were not statistically significant (Pre p 0.890, Post p 0.329, Pre–Post p 0.312). However, significant reductions in SBP and DBP were observed at p < 0.05 after training.

3.2. Difference Between the Two Groups

3.2.1. The Difference in Pre-Exercise

The Wilcoxon signed-rank test was used to compare the differences between the two groups in terms of pre and post exercise outcomes. The median scores noted for pre cardiovascular measures were as follows: SBP (140), DBP (83), HR (76), and RPP (10,611), indicating variations before the initiation of the exercise intervention. The recorded value for the SBP assessment also indicated stage 2 hypertension between the two groups. The results of all the Wilcoxon tests are presented in

Table 3. Wilcoxon test—pre, post median, effect size (r) and p-value for cardiovascular profiles.

Categorical Variables	Ethnicity	Pre Median	Post Median	Effect Size	p Value *
systolic blood pressure (SBP)	South Asians	138	127	0.554	0.000
	African Canadians	143	133	0.576	0.000
	All	140	129	0.565	0.000
diastolic blood pressure (DBP)	South Asians	80	77	0.226	0.041
	African Canadians	88	81	0.403	0.000
	All	83	78	0.317	0.000
Heart Rate (HR)	South Asians	78	81	0.183	0.199
	African Canadians	75	82	0.001	0.025
	All	76	82	0.214	0.001
Rate Pressure Product (RPP)	South Asians	10,397	10,269	0.132	0.937
	African Canadians	10,740	10,768	0.066	0.924
	All	10,611	10,578	0.066	0.239
Pulse Pressure (PP)	South Asians	57	50	0.354	0.000
	African Canadians	55	50	0.343	0.000
	All	56	50	0.364	0.000
Mean Arterial Pressure (MAP)	South Asians	98	95	0.351	0.000
	African Canadians	105	99	0.380	0.000
	All	101	97	0.035	0.000

* p values < 0.05 indicate a significant association. * p values > 0.05 indicate no significant association. SBP = systolic blood pressure, DBP = diastolic blood pressure, HR = heart rate, RPP = rate pressure product. All BP (SBP, DBP, MAP, PP) unit is expressed in mmHg, RPP in mmHg · bpm. The effect sizes can be interpreted based on Cohen (1988) criteria of 0.1 = small effect, 0.3 = medium effect, 0.5 = large effect.

.

3.2.2. The Difference in Post Exercise

As displayed in Table 3, the median numbers for SBP (129), DBP (78), HR (82), RPP (10,578), MAP (97) and PP (50) were lower at the post conditions, indicating a significant difference from baseline. This suggested that the 10 exercise training sessions were adequate to see changes in the cardiovascular measures. The data also showed a significant change in the post-to-pre condition for SBP (p 0.000), DBP (p 0.000), HR (p 0.001), MAP (p 0.000), and PP (0.000); all p < 0.05, but not in RPP (p 0.2387); p > 0.05. Outcomes for effect size were SBP * r = 0.565), DBP (r = 0.317), HR (r = −0.214), RPP (r = 0.066), MAP (r = 0.364), PP (r = 0.350), ranging from 0.1 (small effect), 0.3 (moderate effects) and 0.5 (large effect) (Table 3).

Concerning medication and ethnicity, the Parson’s Chi-Squared test yielded no significant results (p > 0.05), demonstrating no association between medication usage and ethnic background in the context of exercise training. However, a significant relationship was observed between thyroid conditions and ethnic background (χ² = 7.828, p 0.005144) and the drug levothyroxine and race (χ² = 6.782, p 0.009208). These findings suggest a connection between thyroid conditions, ethnicity, and the use of levothyroxine within the studied population.

4. Discussion

This study investigated the effects of low impact aerobic dance sessions on key cardiovascular metrics in diverse groups (i.e., African Canadians and South Asians). The results showed significant differences in cardiovascular characteristics between pre and post exercise periods for both African Canadians and South Asians. Post exercise improvements were observed in SBP and DBP within each group, corroborating outcomes from similar studies [18,19,20]. In the current study, significant improvements were observed within each group, in addition to the differences noted. For example, South Asians showed a slight reduction in BP, with an −11 mm Hg drop compared to a −10 mm Hg decline among African Canadians. Beyond the clinical significance, these positive outcomes, backed up by multiple studies, including the current one, reinforce the evidence that acute reductions in BP with physical activity, in this case, dance aerobics, may predict long-term cardiovascular improvement with continued exercise training. Even as an acute response, this represents a meaningful enhancement in overall cardiovascular health [21] and in the absence of large statistical effect. This also supports the potential impact of the observed BP changes on long term cardiovascular risk.

An interesting observation from the present study was that the RPP values were small and differed from those reported in other research. For instance, a study performed by Lamina and co-authors evaluated the impact of an 8 week moderate intensity interval training program on the RPP consisting of predominantly African American male participants. The authors measured clinical stress levels and baroreflex sensitivity and found significant reductions in SBP, DBP, HR, and RPP in the training group compared to the control group [22]. An increase in VO₂max was also noted in the training group, indicating improved cardiovascular fitness. Whereas, a strong positive correlation was found between RPP and SBP (87% variance), emphasizing the relationship between BP and myocardial workload [22]. Another study, though, by Chaturvedi, investigated post-exercise BP response and myocardial oxygen uptake across ethnic differences and documented suboptimal recovery of the RPP in the South Asian group [23]. The findings also showed that South Asians exhibited a slower return to baseline cardiovascular workload during post exercise, suggesting a higher risk for cardiovascular complications. This advocates that it is important to take an assessment of post exercise RPP in both African Canadian and South Asian groups, even after short-term exercise bouts, to better know and understand their cardiovascular recovery as well as their post exercise risk profiles.

Previous research undertaken by White underlined that RPP values below 12,000, accompanied by HR ranging from 60 to 120 beats per minute (bpm) and SBP between 100 and 140 mmHg, are considered within the normal range [24]. An RPP below this threshold suggested increased parasympathetic activity, contributing to a cardioprotective effect and optimal vascular tone [24]. It is possible that the exercise stimulus, while enhancing vascular tone and parasympathetic modulation, also elicited mild sympathetic activation in some participants. Although the training program may have positively influenced vascular function and parasympathetic balance as reflected by improvement in RPP during rest or submaximal exertion (as indicated by RPP), its effect on resting HR appears to be more multifaceted. In this study, baseline and post exercise RPP for both African Canadians and South Asians remained within a moderate range and did not show significant elevations. However, the African Canadian group presented a slight increase, whereas the South Asian group showed a modest decrease from baseline levels to the exercise response. Genetic variations in genes related to cardiac function, BP regulation, or autonomic nervous system activity could also cause the observed differences in RPP responses during rest and exercise [25]. However, the specific genetic factors that influence cardiovascular responses to exercise remain poorly understood and require further in-depth investigation due to the complexity of the underlying mechanisms. The inclusion of participants with pre existing health conditions and cardiovascular issues in this study may have also influenced their exercise capacity, potentially contributing to the observed variations in RPP.

Several investigations have begun studying the impact of age and sex on MVO₂ and RPP. In a 2012 study, investigators explored the connection between left ventricular mass, the aging process, and disparities in hormonal profiles. Their findings corroborated those of other studies, which identified a decrease in MVO2 and RPP associated with aging [25]. Interestingly, the decline was comparatively smaller in women than men, suggesting possible variations in cardiac output, heart rate, or stroke volume [25]. While this may be the case for the RPP difference, the current study did not account for age-related or gender differences between the two groups. This is partly due to an imbalance in the number of women and men. Future research investigations could address this limitation by examining the potential impact of age and gender on MVO2 and RPP, including an equal representation of both genders. Expanding research efforts are essential for uncovering and validating critical insights into the mechanisms driving these differences and their impacts on cardiovascular health outcomes. Additionally, conducting studies that prioritize a balanced gender distribution would provide a more comprehensive understanding of how age-related changes and gender specific factors influence MVO2 and RPP.

Regarding HR responses to the exercise training, each group exhibited a slight increase in recovery. Observing a modest HR response is unsurprising, given that many participants had pre-existing chronic conditions. Some earlier studies highlighted HR in cardiac patients from exercise training and yielded positive outcomes where HR varied. For instance, the study by Meyer et al. found a decreased RPP in the trained group following submaximal exercise [26]. In the study they evaluated three interval exercise modes on a cycle ergometer, each with distinct work-to-recovery ratios and intensities: (1) 30 s work/60 s recovery at 50% of maximum work rate, (2) 15 s work/60 s recovery at 70% of maximum work rate and (3) 10 s work/60 s recovery at 80% of maximum work rate. These protocols were compared against continuous exercise performed at 75% of peak VO₂. It was noted that the 10/60 s interval mode led to significant increases in HR compared to the other modes [26]. The author suggested this was likely due to a few physiological and exercise science principles, such as the higher workload intensity [26]. Another study by May and Nagle investigated the impact of regular aerobic exercise on the RPP in patients diagnosed with coronary artery disease (CAD) [27]. Their findings indicated that consistent aerobic exercise leads to beneficial adaptations in both the myocardium and skeletal muscles of individuals with CAD. These physiological changes contribute to symptomatic relief and improve maximal exercise capacities, recognizing the importance of structured physical training in the management of CAD.

Previous studies studying exercise-induced heart rates have documented delayed recovery among patients with cardiac conditions and, in rare cases, identified additional cardiac complications (e.g., myocardial infarction) associated with inadequate monitoring during training [28,29,30]. While such adverse events are infrequent and the overall risk remains low, these findings highlight the importance of structured and supervised exercise. The results also confirm that prolonged physical activity can improve fitness and significantly enhance RPP responses while lowering post-exercise HR. It is then appropriate to encourage exercise, particularly in individuals with cardiovascular disease. The use of proper monitoring and indirect tools, such as RPP, supports safety and the optimization of positive outcomes. One additional variable that could have affected the HR different outcome responses of African Canadians and South Asians during the exercise is their consumption of beta-adrenergic drugs, which are otherwise referred to as beta-blockers (BBs). These hypertension drugs reduce HR and BP, and they help to decrease oxygen demand and lower RPP [31,32]. Such effects can be beneficial for individuals with conditions like angina, as they help ease adverse cardiovascular events in addition to hypertension. Interestingly, recent evidence found that BBs may not be universally recommended for all individuals with CVD. For instance, under certain conditions, beta blockers are more effective for patients with atrial fibrillation or heart failure [32]. It is also suggested that BBs are more useful for post-myocardial infarction management [32]. The selective uses reflect the need to balance RPP reduction with maintaining adequate myocardial perfusion, which can be supported through exercise. Although Tesch’s work in 1985 highlighted the potential of RPP as a valuable indicator of myocardial oxygen demand, its adoption in clinical practice has remained limited [33]. Several factors may contribute to this, including the preference for more direct measures of cardiac function, such as echocardiography, or biomarkers like troponin levels, which provide detailed insights into heart health [33]. Additionally, the complexity of calculating and interpreting RPP in diverse patient populations may have hindered its widespread use. Recent studies, however, suggest that RPP could offer unique predictive value for long-term outcomes in certain cardiovascular conditions, warranting renewed attention to its clinical applications [32]. It is also important to mention that no correlation was found between post-exercise heart rate recovery and BBs use in this study.

The Parson’s Chi-square analysis found no significant differences in medication usage between the two groups, indicating that the effects of medications did not differ significantly between them. Additionally, a significant relationship between the thyroid, the drug levothyroxine, and ethnicity was reported, demonstrating that participants’ prescriptions can be considered when designing exercise interventions for specific populations. Of course, further inquiry would be necessary to better understand this correlation and how levothyroxine or other medications could impact different ethnicities’ exercise responses.

The pre BMI measurements between the two groups saw the African Canadians with a higher score for preconditions, suggestive of obesity, while the South Asians were identified as overweight. BMI is a known predictor of cardiovascular risks, with higher values associated with hypertension, heart disease, or stroke [34]. However, regular exercise has consistently decreased the risk of these cardiovascular conditions, even in individuals with higher BMI levels. A difference in body weight at pre-assessment was also found, whereby the African Canadians had higher measurements. The African Canadian group’s greater body weight and BMI observed could be linked to their hypertension prevalence, perhaps reflecting the slight rise in RPP recovery.

Beyond the RPP results, the MAP for the South Asian group was within the normal range before and after exercise, as indicated by the standard evaluation chart (MAP 70–100 mmHg). The African Canadians’ MAP scores were slightly above the normal range at the start but showed improvement post exercise. This enhancement can likely be attributed to the exercise intervention, which appears to have helped control blood pressure in this group after just 10 sessions. The PP values for each group also fell within the normal range (PP 40–60 mmHg) pre and post exercise. This suggests that even short-term or acute exercise (10 sessions) could effectively maintain healthy arterial compliance and elasticity across different ethnic groups [35]. Additionally, a study demonstrated differences in PP between ethnic groups, with Africans exhibiting higher PP, while South Asians had lower PP values [36]. In the present study, PP was relatively comparable across the groups. This similarity could potentially influence their respective risks of developing cardiovascular disease and the higher incidence of hypertension reported in the African Canadian group. The sustained normal levels of MAP and PP following the 10-session exercise program indicate a positive trajectory towards improved cardiovascular health and a reduced risk of adverse cardiac events. Although participants’ assessment to test arterial stiffness was not evaluated, it is safe to say that this condition was improved, given the many benefits of exercise training [35,36,37]. It is reasonable to hypothesize that a longer-term application of such exercise protocols would yield even more substantial and enduring benefits in reducing these risks. This expectation is supported by evidence that cumulative exposure to regular exercise leads to more significant structural and functional adaptations in the vasculature, thereby offering greater protection against the development of arterial stiffness.

Beyond the RPP results, the MAP for the South Asian group was within the normal range before and after exercise, as indicated by the standard evaluation chart (MAP 70–100 mmHg). The African Canadians’ MAP scores were slightly above the normal range at baseline but improved post exercise. PP values for both groups also remained within the normal range (40–60 mmHg) pre and post intervention, suggesting that even short-term aerobic dance sessions can support healthy arterial compliance and elasticity. Importantly, regarding BP, clinical significance is context dependent. For example, a reduction of ≥5 mmHg in systolic BP is often considered clinically meaningful, even when effect sizes are small or statistical significance is limited. This highlights that the observed improvements, though modest, may still carry significant implications for cardiovascular risk reduction in these populations. Further research is warranted to define such thresholds more clearly within community-based exercise interventions.

These findings from the study collectively indicate that culturally tailored, community-based programs can elicit positive cardiovascular adaptations across diverse ethnic groups. While the short-term nature of the intervention limits conclusions about long-term outcomes, the improvements in BP, maintenance of RPP, and favorable MAP and PP responses support the value of exercise in high-risk populations. Future studies with larger, more diverse, and age-stratified samples are essential to confirm these results and strengthen the evidence base for targeted exercise prescriptions.

5. Limitations

There are several limitations to this study. The most critical were: (1) reliance on self-reported medication use, and it is possible that some participants may not have accurately reported their medication use which may also introduced reporting bias and affected cardiovascular responses; (2) a gender imbalance, as the majority of participants were female, which may have influenced cardiovascular responses and restricted the ability to generalize findings to men; and (3) the absence of direct VO₂max assessment restricted the evaluation of aerobic capacity. Additional limitations include the short duration of the intervention (10 sessions), lack of dietary control, and the relatively small sample size. Regarding the limited session, a study performed by Katyal and colleagues showed that short-duration exercise programming can be effective in improving cardiac function in older women [38]. The 10 sessions showed improvement, although not that significant. Furthermore, the study focused only on African Canadian and South Asian participants, which limits generalizability to other ethnic groups. However, these populations were prioritized due to their higher cardiovascular risk and underrepresentation in research. Finally, unmeasured confounding factors such as age-related differences, older adults’ variability in vital signs, and baseline physical activity levels may also have influenced outcomes. Future studies should address these issues by including larger and more diverse samples, stratifying analyses by age and sex, and incorporating standardized measures of aerobic fitness.

6. Conclusions

In this community-based study, 10 sessions of aerobic dance led to a reduction in systolic blood pressure from a median of 140 mmHg to 129 mmHg and diastolic blood pressure from 83 mmHg to 78 mmHg in both African Canadian and South Asian participants with hypertension and related conditions. Although RRP changes were modest (10,611 to 10,578) and not statistically significant, maintaining stable values may nonetheless reflect improved cardiovascular efficiency and reduced myocardial oxygen demand. Importantly, reductions of p ≥ 5 mmHg in SP, as seen in each group, are considered clinically meaningful and predictive of lower cardiovascular risk. These findings highlight the feasibility and cultural significance of tailored exercise programs for enhancing cardiovascular health in high risk ethnic groups, supporting their inclusion as accessible community based strategies for BP management. Larger, multicentre studies with more diverse and possible age stratified participant population samples are needed to further expand on the outcome of this study.