Rocha, J, Cunha, FA, Cordeiro, R, Monteiro, W, Pescatello, LS, and Farinatti, P. Acute effect of a single session of Pilates on blood pressure and cardiac autonomic control in middle-aged adults with hypertension. J Strength Cond Res 34(1): 114-123, 2020-We investigated the blood pressure (BP) and heart rate variability (HRV) responses to a single session of Pilates among adults with hypertension. Thirteen participants (7 women), aged 44-66 years, underwent Pilates and nonexercise control sessions separated by 48-72 hours in a randomized counterbalanced order. Blood pressure and HRV indices were simultaneously assessed 10 minutes before and 60 minutes after all sessions in the supine position: root mean square of successive differences (rMSSD), percentage of successive normal sinus RR intervals >50 ms (pNN50), SD of all normal sinus RR intervals over 24 hours (SDNN), and low-frequency (LF) and high-frequency (HF) bands. After an acute session of Pilates, the mean values for area under the curve for systolic BP (p = 0.004, corresponding to -7.4 +/- 8.2 mm Hg) and mean arterial pressure (p = 0.023, corresponding to -5.3 +/- 5.4 mm Hg) were significantly lower compared to the control session. No significant difference was detected for diastolic BP (-4.2 +/- 4.7 mm Hg, p = 0.106). Concomitant to BP reduction, significant lowering of parasympathetic HRV indices occurred: RR intervals (-64.1 +/- 69.9 ms.min, p = 0.043), rMSSD (-8.3 +/- 15.4 ms.min, p = 0.013), pNN50 (-3.6 +/- 13%.min, p = 0.028), and total power (-3,089.4 +/- 5,938 m.min, p = 0.037). No difference was found for sympathetic markers: SDNN (-17.7 +/- 34.6 ms.min, p = 0.100), LF (-5.2 +/- 21,6 n.u..min, p = 0.417), and LF:HF ratio (-0.3 +/- 5.2 ratio.min, p = 0.422). In conclusion, a single session of Pilates reduced BP by approximately 5-8 mm Hg in adults with hypertension during the first 60 minutes of post-exercise recovery. Acute BP reduction was concomitant to lowered cardiac parasympathetic activity. Our findings are promising for the use of Pilates as an alternative exercise modality to lower BP.