The Rising Challenge of Pediatric Hypertension
As rehabilitation professionals, we are increasingly encountering pediatric and adolescent populations presenting with comorbidities traditionally associated with adults, such as hypertension and metabolic syndrome. While physical activity remains the cornerstone of physiotherapy interventions for cardiovascular health, dietary behaviors play an equally critical role. A recent cluster-randomized controlled trial, published in Clinical and Experimental Hypertension, investigates a novel non-pharmacological approach: Time-Restricted Eating (TRE). For physiotherapists involved in holistic lifestyle management, understanding the nuances of meal timing could offer a potent adjunctive strategy to exercise prescription.
Investigating the 12-Hour Eating Window
The study, conducted by Wu et al. (2026), utilized a cluster-randomized design involving 91 classes across two schools. The researchers aimed to evaluate the safety and efficacy of TRE in reducing blood pressure (BP) among 192 children and adolescents diagnosed with elevated BP. The participants were allocated into three distinct arms:
- TREa: A 12-hour eating window where the last meal must be consumed before 8:00 PM.
- TREb: A 12-hour eating window with no restriction on the timing of the last meal.
- Control: No time restrictions on eating.
The intervention spanned 12 months, analyzing data under an intention-to-treat framework using mixed-effects models to account for the clustering effect of the school classes.
Timing Matters: Key Hemodynamic Outcomes
The results of this trial offer compelling data for lifestyle medicine. After 12 months, both TRE groups demonstrated significant reductions in blood pressure compared to baseline. However, the timing of the final meal appeared to be a differentiating factor. The TREa group (last meal before 8:00 PM) showed the most robust improvements:
- Systolic Blood Pressure (SBP): Decreased by -7.03 mmHg (95% CI, -10.77 to -3.29 mmHg; P < 0.001).
- Diastolic Blood Pressure (DBP): Decreased by -4.09 mmHg (95% CI, -6.80 to -1.38 mmHg; P < 0.001).
While the TREb group also saw significant reductions in SBP (-5.29 mmHg), the strict evening cut-off in the TREa group resulted in superior outcomes, particularly regarding DBP, which was significantly different compared to the control group.
Critical Appraisal: Attrition and Interpretation
While the hemodynamic improvements are clinically significant—potentially rivaling monotherapy outcomes in similar populations—physiotherapists must interpret these findings with caution regarding adherence. The trial experienced high attrition rates, with a loss-to-follow-up rate of 40.6% at the 12-month mark. This suggests that while a 12-hour eating window is effective, maintaining this behavioral change in adolescents over the long term presents a substantial compliance challenge.
Clinical Implications for Rehabilitation
For the physiotherapist, this study underscores the importance of circadian biology in rehabilitation. The reduction in BP associated with finishing meals before 8:00 PM suggests that aligning nutrient intake with circadian rhythms may enhance cardiovascular recovery. When counseling families on lifestyle modifications to support physical therapy goals, suggesting a “kitchen closed at 8 PM” rule may be a simple, quantifiable, and effective strategy to manage elevated blood pressure alongside prescribed exercise programs.
References
Wu, X., Miao, J., Peng, Z., An, X., Liu, Q., Chen, L., & Liang, X. (2026). Effects of time-restricted eating on blood pressure in children: A cluster randomized controlled trial. Clinical and Experimental Hypertension, 48(1). https://pubmed.ncbi.nlm.nih.gov/41736499/
