Effects of combined exercise training with or without nutritional counseling on cardiovascular risk factors in older adults with hypertension: a pragmatic randomized trial.

High blood pressure and elevated glycemia increase cardiovascular risk in older adults. Physical activity and diet are cornerstone non-pharmacological strategies to manage these risk factors. However, interventions in community settings focusing on the combination of exercise and nutrition are scarce. This pragmatic randomized controlled trial compared combined exercise training with versus without nutritional counseling on fasting blood glucose (primary outcome), blood pressure, body composition, and cardiorespiratory fitness in older adults with hypertension. Thirty-two participants (50-80 years) were randomly assigned to exercise training alone (EX; n = 16), comprising walking/jogging and calisthenics (60 min per session, twice weekly), or exercise training plus nutritional counseling based on the Brazilian Dietary Guidelines (EX + N; n = 16; six biweekly group sessions emphasizing food quality and reduction of ultra-processed foods without energy restriction). The 12-week combined training was conducted in outdoor athletics track. Data were analyzed using generalized estimating equations with intention-to-treat principle. Between-group differences used Bonferroni correction, effect sizes used Hedges' g, and significance was α < 0.05. Twenty-nine participants completed the intervention. Fasting blood glucose was lower in EX + N than EX (-10 mg/dL; P = 0.004; g = 1.07). Systolic blood pressure decreased within EX + N (-10 mmHg; P = 0.034; g = 0.89) but not within EX, with no between-group difference (P = 0.220; g = 0.43). No between-group differences for diastolic blood pressure, body composition, or cardiorespiratory fitness. Nutritional counseling added to a community-based exercise program reduced fasting blood glucose compared with exercise alone, supporting the addition of nutritional counseling to exercise as a pragmatic strategy.