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Cited by 284Cardiovascular and exercise physiologyBlood Pressure and Hypertension StudiesPhysical Activity and Health

Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials

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Edwards, Jamie J, Deenmamode, Algis H P, Griffiths, Megan, Arnold, Oliver, Cooper, Nicola J, Wiles, Jonathan D, O'Driscoll, Jamie M·2023·British Journal of Sports Medicine
DOI 10.1136/bjsports-2022-106503
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Abstract

Objective: To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal antihypertensive exercise prescription practices. Design: Systematic review and network meta-analysis. Data sources: PubMed (Medline), the Cochrane library and Web of Science were systematically searched. Eligibility criteria: Randomised controlled trials published between 1990 and February 2023. All relevant work reporting reductions in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) following an exercise intervention of ≥2 weeks, with an eligible non-intervention control group, were included. Results: 270 randomised controlled trials were ultimately included in the final analysis, with a pooled sample size of 15 827 participants. Pairwise analyses demonstrated significant reductions in resting SBP and DBP following aerobic exercise training (−4.49/–2.53 mm Hg, p<0.001), dynamic resistance training (–4.55/–3.04 mm Hg, p<0.001), combined training (–6.04/–2.54 mm Hg, p<0.001), high-intensity interval training (–4.08/–2.50 mm Hg, p<0.001) and isometric exercise training (–8.24/–4.00 mm Hg, p<0.001). As shown in the network meta-analysis, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for SBP were isometric exercise training (SUCRA: 98.3%), combined training (75.7%), dynamic resistance training (46.1%), aerobic exercise training (40.5%) and high-intensity interval training (39.4%). Secondary network meta-analyses revealed isometric wall squat and running as the most effective submodes for reducing SBP (90.4%) and DBP (91.3%), respectively. Conclusion: Various exercise training modes improve resting blood pressure, particularly isometric exercise. The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of arterial hypertension.

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  1. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990- 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2224-60. · DOI · Paper page
  2. Murray CJL, Aravkin AY, Zheng P, et al. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1223-49. · DOI · Paper page
  3. Yusuf S, Joseph P, Rangarajan S, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low- income countries (PURE): a prospective cohort study. Lancet 2020;395:795-808. · DOI · Paper page
  4. Whelton PK, Carey RM, Aronow WS, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: A report of the American college of cardiology/American heart Association task F. J Am Soc Hypertens 2018;12:S1933-1711(18)30189-X. · DOI
  5. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol 2020;16:223-37. · DOI
  6. Zhou B, Carrillo-Larco RM, Danaei G, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021;398:957-80. Protected by copyright. on September 10, 2023 at University of Texas Rio Grande Valley. http://bjsm.bmj.com/ Br J Sports Med: first published as 10.1136/bjsports-2022-106503 on 25 July 2023. Downloaded from Systematic review · DOI · Paper page
  7. Rahimi K, Bidel Z, Nazarzadeh M, et al. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 2021;397:1625-36. · DOI · Paper page
  8. Vrijens B, Vincze G, Kristanto P, et al. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ 2008;336:1114-7. · DOI
  9. Burnier M, Egan BM. Adherence in hypertension. Circ Res 2019;124:1124-40. · DOI · Paper page
  10. Cohen JS. Adverse drug effects, compliance, and initial doses of antihypertensive drugs recommended by the joint national committee vs the physicians' desk reference. Arch Intern Med 2001;161:880. · DOI
  11. Wang G, Grosse SD, Schooley MW. Conducting research on the economics of hypertension to improve cardiovascular health. Am J Prev Med 2017;53:S115-7. · DOI
  12. Cernota M, Kroeber ES, Demeke T, et al. Non-pharmacological interventions to achieve blood pressure control in African patients: a systematic review. BMJ Open 2022;12:e048079. · DOI
  13. Valenzuela PL, Carrera-Bastos P, Gálvez BG, et al. Lifestyle interventions for the prevention and treatment of hypertension. Nat Rev Cardiol 2021;18:251-75. · DOI
  14. Lear SA, Hu W, Rangarajan S, et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet 2017;390:2643-54. · DOI · Paper page
  15. Leitzmann MF, Park Y, Blair A, et al. Physical activity recommendations and decreased risk of mortality. Arch Intern Med 2007;167:2453-60. · DOI
  16. Blond K, Brinkløv CF, Ried-Larsen M, et al. Association of high amounts of physical activity with mortality risk: a systematic review and meta-analysis. Br J Sports Med 2020;54:1195-201. · DOI · Paper page
  17. Naci H, Salcher-Konrad M, Dias S, et al. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. Br J Sports Med 2019;53:859-69. · DOI · Paper page
  18. Edwards J, De Caux A, Donaldson J, et al. Isometric exercise versus high-intensity interval training for the management of blood pressure: a systematic review and meta-analysis. Br J Sports Med 2022;56:506-14. · DOI
  19. Cornelissen VA, Fagard RH, Coeckelberghs E, et al. Impact of resistance training on blood pressure and other cardiovascular risk factors. Hypertension 2011;58:950-8. · DOI
  20. Lee L-L, Mulvaney CA, Wong YKY, et al. Walking for hypertension. Cochrane Database Syst Rev 2021;2:CD008823. · DOI
  21. Ashton RE, Tew GA, Aning JJ, et al. Effects of short-term, medium-term and long-term resistance exercise training on cardiometabolic health outcomes in adults: systematic review with meta-analysis. Br J Sports Med 2020;54:341-8. · DOI
  22. Xi H, He Y, Niu Y, et al. Effect of combined aerobic and resistance exercise on blood pressure in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Exp Gerontol 2021;155:S0531-5565(21)00342-9. · DOI
  23. Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 2015;162:777-84. 10.7326/M14-2385 Available: https://doi.org/107326/M14-2385 · DOI · Paper page
  24. Hansen D, Dendale P, Coninx K, et al. The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: a digital training and decision support system for optimized exercise prescription in cardiovascular disease. concept, definitions and construction methodology. Eur J Prev Cardiol 2017;24:1017-31. · DOI
  25. Campbell WW, Kraus WE, Powell KE, et al. High-intensity interval training for cardiometabolic disease prevention. Med Sci Sports Exerc 2019;51:1220-6. · DOI
  26. Egger M, Smith GD, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34. · DOI · Paper page
  27. Owen RK, Bradbury N, Xin Y, et al. MetaInsight: an interactive web-based tool for analyzing, interrogating, and visualizing network meta-analyses using R-Shiny and Netmeta. Res Synth Methods 2019;10:569-81. · DOI
  28. Dias S, Welton NJ, Sutton AJ, et al. Evidence synthesis for decision making 4: inconsistency in networks of evidence based on randomized controlled trials. Med Decis Making 2013;33:641-56. · DOI
  29. Lunn DJ, Thomas A, Best N, et al. WinBUGS -A Bayesian modelling framework: concepts, structure, and extensibility. Stat Comput 2000;10:325-37. · DOI
  30. Nevill CR, Cooper NJ, Sutton AJ. A multifaceted graphical display, including treatment ranking, was developed to aid interpretation of network meta-analysis. J Clin Epidemiol 2023;157:83-91. · DOI
  31. Hanssen H, Boardman H, Deiseroth A, et al. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a consensus document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol 2022;29:205-15. · DOI
  32. Carlson DJ, Dieberg G, Hess NC, et al. Isometric exercise training for blood pressure management: a systematic review and meta-analysis. Mayo Clin Proc 2014;89:327-34. · DOI
  33. Kelley GA, Kelley KS. Isometric handgrip exercise and resting blood pressure: a meta- analysis of randomized controlled trials. J Hypertens 2010;28:411-8. · DOI
  34. Corso LML, Macdonald HV, Johnson BT, et al. Is concurrent training efficacious antihypertensive therapy? A meta-analysis. Med Sci Sports Exerc 2016;48:2398-406. · DOI · Paper page
  35. Goessler K, Polito M, Cornelissen VA. Effect of exercise training on the renin- angiotensin-aldosterone system in healthy individuals: a systematic review and meta-analysis. Hypertens Res 2016;39:119-26. · DOI
  36. Ekkekakis P, Biddle SJH. Extraordinary claims in the literature on high-intensity interval training (HIIT): IV. is HIIT associated with higher long-term exercise adherence Psychology of Sport and Exercise 2023;64:102295. · DOI · Paper page
  37. Millar PJ, McGowan CL, Cornelissen VA, et al. Evidence for the role of Isometric exercise training in reducing blood pressure: potential mechanisms and future directions. Sports Med 2014;44:345-56. · DOI
  38. Edwards JJ, Taylor KA, Cottam C, et al. Ambulatory blood pressure adaptations to high-intensity interval training: a randomized controlled study. J Hypertens 2021;39:341-8. · DOI
  39. MacInnis MJ, Gibala MJ. Physiological adaptations to interval training and the role of exercise intensity. J Physiol 2017;595:2915-30. 10.1113/JP273196 Available: http:// doi.wiley.com/10.1113/tjp.2017.595.issue-9 · DOI
  40. O'Driscoll JM, Edwards JJ, Coleman DA, et al. One year of Isometric exercise training for blood pressure management in men: a prospective randomized controlled study. J Hypertens 2022;40:2406-12. · DOI
  41. Edwards JJ, Wiles J, O'Driscoll J. Mechanisms for blood pressure reduction following Isometric exercise training: a systematic review and meta-analysis. J Hypertens 2022;40:2299-306. · DOI
  42. López-Valenciano A, Ruiz-Pérez I, Ayala F, et al. Updated systematic review and meta-analysis on the role of Isometric resistance training for resting blood pressure management in adults. J Hypertens 2019;37:1320-33. · DOI
  43. Sánchez-Meca J, Marín-Martínez F. Confidence intervals for the overall effect size in random-effects meta-analysis. Psychol Methods 2008;13:31-48. · DOI
  44. Paz MA, de-La-Sierra A, Sáez M, et al. Treatment efficacy of anti-hypertensive drugs in monotherapy or combination: ATOM systematic review and meta-analysis of randomized clinical trials according to PRISMA statement. Medicine (Baltimore) 2016;95:e4071. · DOI
  45. Pagonas N, Vlatsas S, Bauer F, et al. Aerobic versus Isometric handgrip exercise in hypertension: a randomized controlled trial. J Hypertens 2017;35:2199-206. · DOI
  46. Goessler KF, Buys R, VanderTrappen D, et al. A randomized controlled trial comparing home-based Isometric Handgrip exercise versus endurance training for blood pressure management. J Am Soc Hypertens 2018;12:285-93. · DOI

Cited by

Sorted by citations

Authors
Edwards, J. J., Deenmamode, A. H. P., Griffiths, M., Arnold, O., Cooper, N. J., Wiles, J. D., & O'Driscoll, J. M.
Affiliations
  • Canterbury Christ Church University (GB)
  • University of Leicester (GB)
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2023-07-25
Volume
57
Issue
20
Pages
1317-1326
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2022-106503
OpenAlex
W4385254327
Cited by
284
References
17
Citations by year
2026: 117 · 2025: 100 · 2024: 57 · 2023: 10
FWCI
16.64
Type
journal article
Language
en
Open access
Locations
  • British Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by)
  • HighWire Press Open Archive (submittedVersion)
  • UEL Research Repository (University of East London) (submittedVersion, cc-by)
Funders
  • National Institute for Health and Care Research (14/178/29)
  • Department of Health and Social Care
Topics
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
exercise training, resting blood pressure, hypertension, aerobic exercise, resistance training, high-intensity interval training, isometric exercise, wall squat, running, systolic blood pressure, diastolic blood pressure, exercise prescription
MeSH terms
Network Meta-Analysis, Antihypertensive Agents, Blood Pressure, Humans, Hypertension, Exercise, Randomized Controlled Trials as Topic

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