Aquatic Training in Upright Position as an Alternative to Improve Blood Pressure in Adults and Elderly: A Systematic Review and Meta-Analysis
Abstract
Background Meta-analyses have shown that land training (LT) reduces blood pressure; however, it is not known whether aquatic training (AT) promotes this same effect.Objective The aim was to conduct a meta-analysis on the effects of AT on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adults and elderly and compare them to those of LT and no training [control group (CG)].Data sources Embase, PubMed, Cochrane and Scopus were searched up to May 2017.Study eligibility criteria Studies that evaluated the effect of upright AT (i.e., AT performed in upright position) on the blood pressure of adult individuals and the elderly who did not present with cardiovascular disease (other than hypertension) were included.Data analysis Two independent reviewers screened search results, performed data extraction and assessed risk of bias. Random effect was used, and the effect size (ES) was calculated by using the standardized mean difference with a 95% confidence interval.Results AT promoted a reduction in SBP (ES - 1.47; 95% CI - 2.23 to - 0.70; p < 0.01) compared to CG. This effect is maintained with training progression (ES - 1.52; 95% CI - 2.70 to - 0.33; p = 0.01) and no progression (ES - 1.43; 95% CI - 2.64 to - 0.23; p = 0.02). These effects were significant only in hypertensive (ES - 2.20; 95% CI - 2.72 to - 1.68; p < 0.01), and not in pre-hypertensive individuals. AT promoted a decrease in DBP (- 0.92; 95% CI - 1.27 to - 0.57; p < 0.01) after training with progression (- 0.81; 95% CI - 1.62 to - 0.001; p = 0.04) and no progression (- 1.01; 95% CI - 1.40 to - 0.62; p < 0.01) in pre-hypertensive (- 1.12; 95% CI - 1.53 to - 0.70; p < 0.01) and hypertensive patients (- 0.69; 95% CI - 1.31 to - 0.06; p = 0.03). AT promoted similar reductions in SBP compared to LT; however, reduction of DBP in hypertensive patients was lower (1.82; 95% CI 0.84 to 2.79; p < 0.01).Conclusion AT promotes blood pressure reduction in adults and elderly. The reduction in SBP in those performing AT is similar to those performing LT, but reduction of DBP is lower in the AT group compared to that in the LT group.Systematic review registration number CRD42016049716.
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Aquatic-based resistance exercises have shown promising results in improving strength and muscle mass in older individuals and metabolic health in patients with non-communicable diseases.
“In such clinical conditions, aquatic-based resistance exercises could also be a low-impact exercise alternative as they have shown promising results in improving strength and muscle mass in older individuals [141,142], as well as metabolic health in patients with non-communicable diseases [143,144].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [143]
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.005 · Cited by 19,575 · see citing works
Goodpaster, B. H., Park, S. W., Harris, T. B., Kritchevsky, S. B., Nevitt, M., Schwartz, A. V., Simonsick, E. M., Tylavsky, F. A., Visser, M., Newman, A. B., et al. (2006) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/61.10.1059 · Cited by 3,083 · see citing works
Resistant Hypertension: Diagnosis, Evaluation, and Treatment
Calhoun, D. A., Jones, D. W., Textor, S. C., Goff, D. C., Murphy, T. P., Toto, R. D., White, A. J., Cushman, W. C., White, W. B., Sica, D. A., et al. (2008) · Circulation · doi:10.1161/circulationaha.108.189141 · Cited by 2,232 · see citing works
Chow, C. K. (2013) · JAMA · doi:10.1001/jama.2013.184182 · Cited by 2,000 · see citing works
Effect of Aerobic Exercise on Blood Pressure: A Meta-Analysis of Randomized, Controlled Trials
Whelton, S. P., Chin, A., Xin, X., & He, J. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-136-7-200204020-00006 · Cited by 1,970 · see citing works
Pescatello, L. S., Franklin, B. A., Fagard, R. H., Farquhar, W. B., Kelley, G. A., & Ray, C. A. (2004) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000115224.88514.3a · Cited by 1,918 · see citing works
Exercise Training for Blood Pressure: A Systematic Review and Meta‐analysis
Cornelissen, V. A., & Smart, N. A. (2013) · Journal of the American Heart Association · doi:10.1161/jaha.112.004473 · Cited by 1,683 · see citing works
Mancia, G., Laurent, S., Agabiti-Rosei, E., Ambrosioni, E., Burnier, M., Caulfield, M. J., Cifkova, R., Clément, D., Coca, A., Dominiczak, A., et al. (2009) · Journal of Hypertension · doi:10.1097/hjh.0b013e328333146d · Cited by 1,643 · see citing works
Whelton, P. K. (2002) · JAMA · doi:10.1001/jama.288.15.1882 · Cited by 1,466 · see citing works
Resistant Hypertension: Diagnosis, Evaluation, and Treatment
Calhoun, D. A., Jones, D. W., Textor, S. C., Goff, D. C., Murphy, T. P., Toto, R. D., White, A. J., Cushman, W. C., White, W. B., Sica, D. A., et al. (2008) · Hypertension · doi:10.1161/hypertensionaha.108.189141 · Cited by 1,404 · see citing works
A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women
Frontera, W. R., HUGHES, V. A., Lutz, K. J., & Evans, W. J. (1991) · Journal of Applied Physiology · doi:10.1152/jappl.1991.71.2.644 · Cited by 1,011 · see citing works
Seravalle, G., & Grassi, G. (2017) · Pharmacological Research · doi:10.1016/j.phrs.2017.05.013 · Cited by 909 · see citing works
Mancia, G., Laurent, S., Agabiti‐Rosei, E., Ambrosioni, E., Burnier, M., Caulfield, M. J., Cífková, R., Clement, D. L., Coca, A., Dominiczak, A. F., et al. (2009) · Blood Pressure · doi:10.3109/08037050903450468 · Cited by 893 · see citing works
Dynapenia and aging: an update
Manini, T. M., & Clark, B. C. (2012) · The Journals of Gerontology: Series A · doi:10.1093/gerona/glr010 · Cited by 875 · see citing works
Hypertension: Renin–Angiotensin–Aldosterone System Alterations
te Riet, L., van Esch, J. H. M., Roks, A. J. M., van den Meiracker, A. H., & Danser, A. H. J. (2015) · Circulation Research · doi:10.1161/circresaha.116.303587 · Cited by 706 · see citing works
Kelley, G. A., & Kelley, K. S. (2000) · Hypertension · doi:10.1161/01.hyp.35.3.838 · Cited by 555 · see citing works
Impact of Resistance Training on Blood Pressure and Other Cardiovascular Risk Factors
Cornelissen, V., Fagard, R. H., Coeckelberghs, E., & Vanhees, L. (2011) · Hypertension · doi:10.1161/hypertensionaha.111.177071 · Cited by 548 · see citing works
Aging, Arterial Stiffness and Hypertension
Sun, Z.-J. (2014) · HYPERTENSION · doi:10.1161/hypertensionaha.114.03617 · Cited by 545 · see citing works
Jiang, S.-Z., Lu, W., Zong, X.-F., Ruan, H., & Liu, Y. (2016) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2016.3667 · Cited by 458 · see citing works
Pescatello, L. S., MacDonald, H. V., Lamberti, L., & Johnson, B. T. (2015) · Current Hypertension Reports · doi:10.1007/s11906-015-0600-y · Cited by 431 · see citing works
Water-based exercise improves health-related aspects of fitness in older women
TAKESHIMA, N., ROGERS, M. E., WATANABE, E., BRECHUE, W. F., OKADA, A., YAMADA, T., ISLAM, M. M., & HAYANO, J. (2002) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200203000-00024 · Cited by 329 · see citing works
Effect of Intensity of Aerobic Training on V˙O2max
GORMLEY, S. E., SWAIN, D. P., HIGH, R., SPINA, R. J., DOWLING, E. A., KOTIPALLI, U. S., & GANDRAKOTA, R. (2008) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31816c4839 · Cited by 307 · see citing works
Renal effects of head-out water immersion in humans: a 15-year update
Epstein, M. (1992) · Physiological Reviews · doi:10.1152/physrev.1992.72.3.563 · Cited by 198 · see citing works
Elliott, K. J., Sale, C., & Cable, N. T. (2002) · British Journal of Sports Medicine · doi:10.1136/bjsm.36.5.340 · Cited by 180 · see citing works
Human Physiology in an Aquatic Environment
Pendergast, D. R., Moon, R. E., Krasney, J. J., et al. (2015) · Comprehensive physiology · doi:10.1002/cphy.c140018 · Cited by 164 · see citing works
The underwater environment: cardiopulmonary, thermal, and energetic demands
Pendergast, D. R., & Lundgren, C. E. (2008) · Journal of Applied Physiology · doi:10.1152/japplphysiol.90984.2008 · Cited by 162 · see citing works
Effects of aquatic resistance training on health and fitness in postmenopausal women
Colado, J. C., Triplett, N. T., Tella, V., Saucedo, P., & Abellán, J. (2009) · European Journal of Applied Physiology · doi:10.1007/s00421-009-0996-7 · Cited by 157 · see citing works
Beneficial effects of water-based exercise in patients with chronic kidney disease
lle, P., Ots, M., Mesikepp, S., Zilmer, K., Kullisaar, T., Vihalemm, T., Zilmer, M., & Maaroos, J. (2003) · International Journal of Rehabilitation Research · doi:10.1097/00004356-200306000-00013 · Cited by 128 · see citing works
Exercise intensity and hypertension: what’s new?
Boutcher, Y. N., & Boutcher, S. H. (2016) · Journal of Human Hypertension · doi:10.1038/jhh.2016.62 · Cited by 116 · see citing works
Guimarães, G. V., Cruz, L. G. D. B., Fernandes-Silva, M. M., Dórea, E. L., & Bocchi, E. A. (2014) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.01.100 · Cited by 103 · see citing works
Epstein, M. (1976) · Circulation Research · doi:10.1161/01.res.39.5.619 · Cited by 102 · see citing works
Effects of eccentric and concentric resistance training on arterial stiffness
Okamoto, T., Masuhara, M., & Ikuta, K. (2006) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001979 · Cited by 101 · see citing works
Kanitz, A. C., Delevatti, R. S., Reichert, T. L., Liedtke, G. V., Ferrari, R., Almada, B. P., Pinto, S. S., Alberton, C. L., & Kruel, L. F. M. (2015) · Experimental Gerontology · doi:10.1016/j.exger.2015.02.013 · Cited by 74 · see citing works
Self-citationArca, E. A., Martinelli, B., Martín, L. C., Waisberg, C. B., & Franco, R. J. D. S. (2013) · Physiotherapy Research International · doi:10.1002/pri.1565 · Cited by 65 · see citing works
Brixius, K., Schoenberger, S., Ladage, D., Knigge, H., Falkowski, G., Hellmich, M., Graf, C., Latsch, J., Montie, G. L., Prede, G. L., et al. (2007) · British Journal of Sports Medicine · doi:10.1136/bjsm.2007.035188 · Cited by 60 · see citing works
Delevatti, R. S., Kanitz, A. C., Alberton, C. L., Marson, E. C., Lisboa, S. C., Pinho, C. D. F., Lovatel, G. A., Korb, A., Bertoldi, K., Macedo, R. C. O., et al. (2015) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2015.10.008 · Cited by 45 · see citing works
Self-citationBrown, R. E., Riddell, M. C., Macpherson, A., Canning, K. L., & Kuk, J. L. (2013) · American Journal of Hypertension · doi:10.1093/ajh/hpt063 · Cited by 44 · see citing works
Reichert, T. L., Kanitz, A. C., Delevatti, R. S., Bagatini, N. C., Barroso, B. M., & Kruel, L. F. M. (2016) · AGE · doi:10.1007/s11357-016-9882-5 · Cited by 39 · see citing works
Self-citationVasheghani‐Farahani, A., Mansournia, M. A., Asheri, H., Fotouhi, A., Yunesian, M., Jamali, M., & Ziaee, V. (2010) · Asian Journal of Sports Medicine · doi:10.5812/asjsm.34854 · Cited by 37 · see citing works
Gabrielsen, A., Pump, B., Bie, P., et al. (2002) · Acta Physiologica Scandinavica · doi:10.1046/j.1365-201x.2002.00932.x · Cited by 36 · see citing works
Effect of head-out water immersion on response to exercise training
Sheldahl, L. M., Tristani, F. E., Clifford, P. S., et al. (1986) · Journal of Applied Physiology · doi:10.1152/jappl.1986.60.6.1878 · Cited by 34 · see citing works
Boidin, M., Lapierre, G., Paquette-Tannir, L., Nigam, A., Juneau, M., Guilbeault, V., Latour, É., & Gayda, M. (2015) · Annals of Physical and Rehabilitation Medicine · doi:10.1016/j.rehab.2015.07.002 · Cited by 32 · see citing works
Katz, J., & Wilson, B. R. (1992) · PubMed · Cited by 29 · see citing works
Effect of aquatic exercise training on lipids profile and glycaemia: A systematic review
Delevatti, R. S., Marson, E. C., & Kruel, L. F. M. (2015) · Revista Andaluza de Medicina del Deporte · doi:10.1016/j.ramd.2014.08.003 · Cited by 29 · see citing works
Self-citationThe effects of a 24-week deep water aerobic training program on cardiovascular fitness
Piotrowska-Całka, E. (2010) · Biology of Sport · doi:10.5604/20831862.913074 · Cited by 25 · see citing works
Aquatic Treadmill Training Reduces Blood Pressure Reactivity to Physical Stress
Lambert, B. S., Greene, N. P., Carradine, A. T., Joubert, D. P., Fluckey, J. D., Riechman, S. E., & Crouse, S. F. (2013) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000167 · Cited by 23 · see citing works
Filho, C., Carvalheira, J. B. C., Velloso, L. A., & Saad, M. J. A. (2007) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302007000200008 · Cited by 12 · see citing works
Yoo, Y., Kim, S.-K., & Song, M.-S. (2013) · Physical Activity and Nutrition · doi:10.5717/jenb.2013.17.4.133 · Cited by 11 · see citing works
Gonzaga, C. C., & Calhoun, D. A. (2008) · Polskie Archiwum Medycyny Wewnętrznej · doi:10.20452/pamw.428 · Cited by 8 · see citing works
Kamalakkannan, K., & Kumar, S. (2014) · Journal of Physical Education and Sport · Cited by 2 · see citing works
Kaddissy, G., & Lattouf, N. A. (2011) · Kinésithérapie la Revue · doi:10.1016/s1779-0123(11)75197-x · Cited by 1 · see citing works
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- Authors
- Reichert, T., Costa, R. R., Barroso, B. M., da Rocha, V. D. M. B., Delevatti, R. S., & Kruel, L. F. M.
- Affiliations
- Universidade Federal do Rio Grande do Sul (BR)
- Corresponding author
- Reichert, Thaís
- ORCID
- Venue
- Sports Medicine
- Published
- 2018-04-12
- Volume
- 48
- Issue
- 7
- Pages
- 1727-1737
- ISSN
- 0112-1642 (ISSN-L)
- 1179-2035
- OpenAlex
- W2797573411
- Cited by
- 34
- References
- 56
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 7 · 2023: 4 · 2022: 7 · 2020: 6 · 2019: 1
- FWCI
- 0.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- aquatic exercise, upright posture, blood pressure reduction, systolic blood pressure, diastolic blood pressure, hypertension, prehypertension, older adults, adults, exercise progression, land-based training, cardiovascular risk reduction, antihypertensive therapy, cardiovascular risk factors, body mass index, physical activity, sedentary lifestyle, physical fitness
- MeSH terms
- Adult, Aged, Blood Pressure, Blood Pressure Determination, Female, Humans, Hypertension, Male, Exercise, Treatment Outcome
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