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Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors
Abstract
Previous meta-analyses of randomized controlled trials on the effects of chronic dynamic aerobic endurance training on blood pressure reported on resting blood pressure only. Our aim was to perform a comprehensive meta-analysis including resting and ambulatory blood pressure, blood pressure–regulating mechanisms, and concomitant cardiovascular risk factors. Inclusion criteria of studies were: random allocation to intervention and control; endurance training as the sole intervention; inclusion of healthy sedentary normotensive or hypertensive adults; intervention duration of ≥4 weeks; availability of systolic or diastolic blood pressure; and publication in a peer-reviewed journal up to December 2003. The meta-analysis involved 72 trials, 105 study groups, and 3936 participants. After weighting for the number of trained participants and using a random-effects model, training induced significant net reductions of resting and daytime ambulatory blood pressure of, respectively, 3.0/2.4 mm Hg ( P <0.001) and 3.3/3.5 mm Hg ( P <0.01). The reduction of resting blood pressure was more pronounced in the 30 hypertensive study groups (−6.9/−4.9) than in the others (−1.9/−1.6; P <0.001 for all). Systemic vascular resistance decreased by 7.1% ( P <0.05), plasma norepinephrine by 29% ( P <0.001), and plasma renin activity by 20% ( P <0.05). Body weight decreased by 1.2 kg ( P <0.001), waist circumference by 2.8 cm ( P <0.001), percent body fat by 1.4% ( P <0.001), and the homeostasis model assessment index of insulin resistance by 0.31 U ( P <0.01); HDL cholesterol increased by 0.032 mmol/L −1 ( P <0.05). In conclusion, aerobic endurance training decreases blood pressure through a reduction of vascular resistance, in which the sympathetic nervous system and the renin-angiotensin system appear to be involved, and favorably affects concomitant cardiovascular risk factors.
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“Regular exercise improves blood pressure control and lipid profiles, reduces the incidence of diabetes and myocardial infarction, and increases life expectancy.6–9”
From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [6]
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“Increased cardiorespiratory fitness is associated with a progressive reduction of cardiovascular events, which would seem to be at odds with the aforementioned link between lifelong exercise load and increased coronary atherosclerosis.”
From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [6]
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Cited by
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2007 Guidelines for the Management of Arterial Hypertension
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ResultA systematic review of the evidence for Canada's Physical Activity Guidelines for Adults
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BackgroundImpact of Resistance Training on Blood Pressure and Other Cardiovascular Risk Factors
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Krustrup, P., Nielsen, J., Krustrup, B. R., Christensen, J. F., Pedersen, H. Æ., Randers, M., Aagaard, P., Petersen, A.-M., Nybo, L., & Bangsbo, J. (2008) · British Journal of Sports Medicine · doi:10.1136/bjsm.2008.053124 · Cited by 274
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Fagard, R. (2006) · Clinical and Experimental Pharmacology and Physiology · doi:10.1111/j.1440-1681.2006.04453.x · Cited by 265
“We recently performed meta-analyses of randomized controlled trials on the effects of each type of exercise on blood pressure and, if available, on blood pressure-regulating mechanisms and cardiovascular risk factors.(11,12) Inclusion criteria of the studies were: random allocation to intervention and control; exercis…”
BackgroundMethodSelf-citationCiolac, E. G., Bocchi, E. A., Bortolotto, L. A., Carvalho, V. O., Greve, J. M. D., & Guimarães, G. V. (2010) · Hypertension Research · doi:10.1038/hr.2010.72 · Cited by 242
Dose–Response Association Between Physical Activity and Incident Hypertension
Liu, X., Zhang, D., Liu, Y., Sun, X., Han, C., Wang, B., Ren, Y., Zhou, J., Zhao, Y., Shi, Y., et al. (2017) · Hypertension · doi:10.1161/hypertensionaha.116.08994 · Cited by 345
Cornelissen, V. A., Verheyden, B., Aubert, A. E., & Fagard, R. H. (2010) · Journal of Human Hypertension · doi:10.1038/jhh.2009.51 · Cited by 252
Self-citationIntradialytic Exercise in Hemodialysis Patients: A Systematic Review and Meta-Analysis
Sheng, K.-X., Zhang, P., Chen, L.-L., Cheng, J., Wu, C.-C., & Chen, J.-H. (2014) · American Journal of Nephrology · doi:10.1159/000368722 · Cited by 244
Influence of Physical Activity on Hypertension and Cardiac Structure and Function
Hegde, S. M., & Solomon, S. D. (2015) · Current Hypertension Reports · doi:10.1007/s11906-015-0588-3 · Cited by 305
Stavropoulos‐Kalinoglou, A., Metsios, G. S., Zanten, J. V., Nightingale, P., Kitas, G. D., & Koutedakis, Y. (2012) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2012-202075 · Cited by 233
Sympathetic regulation of vascular function in health and disease
Bruno, R. M., Ghiadoni, L., Seravalle, G., Dell’Oro, R., Taddei, S., & Grassi, G. M. (2012) · Frontiers in Physiology · doi:10.3389/fphys.2012.00284 · Cited by 241
“that the effects of exercise training on BP, driven by peripheral vascular resistance reduction, are accompanied by reduction in heart rate and norephinephrine levels (Cornelissen and Fagard, 2005).”
BackgroundMueller, P. J. (2007) · Clinical and Experimental Pharmacology and Physiology · doi:10.1111/j.1440-1681.2007.04590.x · Cited by 227
“Finally, other factors, including the type of training programme, the duration, intensity and frequency of individual bouts and the overall duration of the training programme are all likely to be important factors that warrant further investigation.(6,21)”
BackgroundResultExercise and cardiovascular risk in patients with hypertension
Sharman, J. E., La Gerche, A., & Coombes, J. S. (2015) · American Journal of Hypertension · doi:10.1093/ajh/hpu191 · Cited by 224
Exercise Dose in Clinical Practice
Wasfy, M. M., & Baggish, A. L. (2016) · Circulation · doi:10.1161/circulationaha.116.018093 · Cited by 292
“BP reduction attributable to exercise is generally greater among hypertensive individuals (reductions of 6–8 mm Hg in systolic BP and 5–6 mm Hg in diastolic BP) and slightly less in normotensive individuals (reductions of 2–3 mm Hg in SBP and 1–2 mm Hg in DBP).(49,50,54) There does not appear to be a clear minimal exe…”
BackgroundExercise for Primary and Secondary Prevention of Cardiovascular Disease
Tucker, W. J., Fegers‐Wustrow, I., Halle, M., Haykowsky, M. J., Chung, E. H., & Kovacic, J. C. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2022.07.004 · Cited by 280
Blood Pressure Responses to Acute and Chronic Exercise Are Related in Prehypertension
Liu, S., Goodman, J. M., Nolan, R. P., Lacombe, S. P., & Thomas, S. G. (2012) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31825408fb · Cited by 227
Exercise, Vascular Wall and Cardiovascular Diseases: An Update (Part 1)
Leung, F. P., Yung, L. M., Laher, I., Yao, X., Chen, Z. Y., & Huang, Y. (2008) · Sports Medicine · doi:10.2165/00007256-200838120-00005 · Cited by 219
V Diretrizes Brasileiras de Hipertensão Arterial
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Yates, T. E., Zaccardi, F., Dhalwani, N. N., Davies, M. J., Bakrania, K., Celis-Morales, C. A., Gill, J. M. R., Franks, P. W., & Khunti, K. (2017) · European Heart Journal · doi:10.1093/eurheartj/ehx449 · Cited by 243
Cornelissen, V. A., Buys, R., & Smart, N. A. (2013) · Journal of Hypertension · doi:10.1097/hjh.0b013e32835ca964 · Cited by 209
“The magnitude of change is similar to that previously reported for office or resting BP reductions after dynamic endurance training [4].”
ResultSelf-citationMillar, P. J., McGowan, C. L. M., Cornelissen, V., de Araújo, C. G. S., & Swaine, I. (2013) · Sports Medicine · doi:10.1007/s40279-013-0118-x · Cited by 225
Self-citationRossi, A., Dikareva, A., Bacon, S. L., & Daskalopoulou, S. S. (2012) · Journal of Hypertension · doi:10.1097/hjh.0b013e3283544669 · Cited by 203
“Meta-analyses have indicated that regular aerobic exercise [13,14,49] and resistance training [15,16] decrease blood pressure between 2 and 6mmHg.”
BackgroundSmith, D. L. (2011) · Current Sports Medicine Reports · doi:10.1249/jsr.0b013e31821a9fec · Cited by 206
CPAP and measures of cardiovascular risk in males with OSAS
Kohler, M., Pepperell, J. C. T., Casadei, B., Craig, S., Crosthwaite, N., Stradling, J. R., & Davies, R. J. O. (2008) · European Respiratory Journal · doi:10.1183/09031936.00026608 · Cited by 197
Hanssen, H., Boardman, H., Deiseroth, A., Moholdt, T. T., Simonenko, M., Kränkel, N., Niebauer, J., Tiberi, M., Abreu, A., Solberg, E. E., et al. (2020) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaa141 · Cited by 233
Chiang, C., Wang, T., Ueng, K.-C., Lin, T., Yeh, H., Chen, C.-Y., Wu, Y.-J., Tsai, W., Chao, T., Chen, C.-H., et al. (2014) · Journal of the Chinese Medical Association · doi:10.1016/j.jcma.2014.11.005 · Cited by 203
Hansen, D., Niebauer, J., Cornelissen, V., Barna, O., Neunhäuserer, D., Stettler, C., Tonoli, C., Greco, E., Fagard, R., Coninx, K., et al. (2018) · Sports Medicine · doi:10.1007/s40279-018-0930-4 · Cited by 191
Self-citationLeiter, L. A., FITCHETT, D. H., Gilbert, R. E., Gupta, M., Mancini, G. B. J., McFarlane, P. A., Ross, R., Teoh, H., Verma, S., Anand, S. S., et al. (2011) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2010.12.054 · Cited by 195
Evidence on the effects of exercise therapy in the treatment of chronic disease
Kujala, U. M. (2009) · British Journal of Sports Medicine · doi:10.1136/bjsm.2009.059808 · Cited by 172
Drca, N., Wolk, A., Jensen‐Urstad, M., & Larsson, S. C. (2014) · Heart · doi:10.1136/heartjnl-2013-305304 · Cited by 178
The pilocarpine model of epilepsy: what have we learned?
Scorza, F., Arida, R., Naffah-Mazzacoratti, M. D. G., Scerni, D. A., Calderazzo, L., & Cavalheiro, E. (2009) · Anais da Academia Brasileira de Ciências · doi:10.1590/s0001-37652009000300003 · Cited by 175
“Amado and Cavalheiro (1998), studying the establishment of this experimental model in female rats, observed that the oestrus cycle was dramatically altered during the acute period of pilocarpine-induced status epilepticus.”
BackgroundKEMMLER, W. K. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.499 · Cited by 161
The Anti-Hypertensive Effects of Exercise
Hamer, M. (2006) · Sports Medicine · doi:10.2165/00007256-200636020-00002 · Cited by 168
Uncomplicated Resistance Training and Health-Related Outcomes: Evidence for a Public Health Mandate
Phillips, S. M., & Winett, R. A. (2010) · Current Sports Medicine Reports · doi:10.1249/jsr.0b013e3181e7da73 · Cited by 157
Miyashita, M., Burns, S. F., & Stensel, D. J. (2008) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2008.26493 · Cited by 127
“Physical activity is effective for lowering postprandial triacylglycerol concentrations (8, 9) and resting blood pressure (10, 11).”
BackgroundPescatello, L., Macdonald, H. V., Ash, G. I., Lamberti, L. M., Farquhar, W., Arena, R., & Johnson, B. T. (2015) · Mayo Clinic proceedings · doi:10.1016/j.mayocp.2015.04.008 · Cited by 152
The additive blood pressure lowering effects of exercise intensity on post‐exercise hypotension
Eicher, J. D., Maresh, C. M., Tsongalis, G. J., Thompson, P. D., & Pescatello, L. S. (2010) · American Heart Journal · doi:10.1016/j.ahj.2010.06.005 · Cited by 151
“Habitual physical activity is also associated with other health benefits that favorably modulate HTN and CVD.(5,6) Aerobic exercise training reduces BP by 5 to 7 mm Hg.”
BackgroundResultSassen, B., Cornelissen, V., Kiers, H., Wittink, H. M., Kok, G., & Vanhees, L. (2009) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e3283312e94 · Cited by 161
Self-citationIs weight loss the optimal target for obesity-related cardiovascular disease risk reduction?
Ross, R., & Janiszewski, P. M. (2008) · Canadian Journal of Cardiology · doi:10.1016/s0828-282x(08)71046-8 · Cited by 141
“The lipid improvements independent of significant weight reduction may also be mediated by improvements in body composition, such as reductions in visceral fat (60), but apparently are not due to improvements in CRF (51).”
BackgroundInfluentialDietary Nitrate, Nitric Oxide, and Cardiovascular Health
Bondonno, C. P., Croft, K. D., & Hodgson, J. M. (2016) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2013.811212 · Cited by 141
Lifelong endurance exercise and its relation with coronary atherosclerosis
De Bosscher, R., Dausin, C., Claus, P., Bogaert, J., Dymarkowski, S., Goetschalckx, K., Ghekiere, O., Van De Heyning, C. M., Van Herck, P., Paelinck, B., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad152 · Cited by 140
Heart rate, lifespan, and mortality risk
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Pattyn, N., Coeckelberghs, E., Buys, R., Cornelissen, V., & Vanhees, L. (2014) · Sports Medicine · doi:10.1007/s40279-014-0158-x · Cited by 154
Self-citationHecksteden, A., Grütters, T., & Meyer, T. (2013) · Clinical Journal of Sports Medicine · doi:10.1097/jsm.0b013e31825b6974 · Cited by 132
Randers, M., Nielsen, J., Krustrup, B. R., Sundstrup, E., Jakobsen, M., Nybo, L., Dvořák, J., Bangsbo, J., & Krustrup, P. (2010) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/j.1600-0838.2010.01091.x · Cited by 132
“In a meta-analysis of 61 prospective studies, the risk of cardiovascular death was shown to decrease linearly with decreasing blood pressure to a systolic pressure of 115mmHg and a diastolic pressure of 75mmHg (Cornelissen & Fagard, 2005).”
BackgroundLevels of physical activity among adults 18–64 years old in 28 European countries
Gerovasili, V., Agaku, I. T., Vardavas, C. I., & Filippidis, F. T. (2015) · Preventive Medicine · doi:10.1016/j.ypmed.2015.08.005 · Cited by 139
Exercise improves cardiac autonomic function in obesity and diabetes
Voulgari, C., Pagoni, S., Vinik, A. I., & Poirier, P. (2012) · Metabolism · doi:10.1016/j.metabol.2012.09.005 · Cited by 118
“morphological amelioration of the capillary network relevant to tissue oxygenation, increased muscle chemoreflex activation with decreased right atrial pressure) [46].”
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Medical comorbidity in bipolar disorder: The link with metabolic-inflammatory systems
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“…2007), although antidepressant properties of exercise might be beneficial in the management of BD, in addition to effects in improvement of metabolic parameters and cardiorespiratory status (Abdelhafiz and Sinclair, 2015; Church et al., 2007; Cornelissen and Fagard, 2005; Sari-Sarraf et al., 2015).”
BackgroundIs Bone Tissue Really Affected by Swimming? A Systematic Review
Gómez‐Bruton, A., González‐Agüero, A., Gómez‐Cabello, A., Casajús, J. A., & Vicente‐Rodríguez, G. (2013) · PLoS ONE · doi:10.1371/journal.pone.0070119 · Cited by 125
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“It is therefore not surprising that, in a meta-analysis of 72 trials, Cornelissen and Fagard (2005) showed that endurance training for 4 weeks induced significant net reductions of resting and daytime ambulatory blood pressure of 3.”
BackgroundExercise capacity and mortality in hypertensive men with and without additional risk factors.
Kokkinos, P., Manolis, A., Pittaras, A., Doumas, M., Giannelou, A., Panagiotakos, D. B., Faselis, C., Narayan, P., Singh, S., & Myers, J. (2009) · Hypertension · doi:10.1161/hypertensionaha.108.127027 · Cited by 120
Physical activity, visual impairment, and eye disease
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Effects of short‐term endurance exercise on gut microbiota in elderly men
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“Although the underlying mechanisms have not been fully elucidated, it has been welldocumented that increased CRF due to regular exercise reduces the risks for hypertension (Cornelissen and Fagard 2005) and cardiovascular diseases (Kodama et al. 2009).”
BackgroundSoccer improves fitness and attenuates cardiovascular risk factors in hypertensive men.
Krustrup, P., Randers, M., Andersen, L. J., Jackman, S., Bangsbo, J., & Hansen, P. (2013) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3182777051 · Cited by 118
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Physical Inactivity and Mortality Risk
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“The average exercise-related blood pressure is about 7–10 mm Hg for systolic and 4– 8 mm Hg for diastolic blood pressure [41, 42].”
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Effect of isometric exercise on resting blood pressure: a meta analysis
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Cornelissen, V., Arnout, J., Holvoet, P., & Fagard, R. H. (2009) · Journal of Hypertension · doi:10.1097/hjh.0b013e328322cf60 · Cited by 112
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Sveaas, S., Berg, I., Provan, S., Semb, A., Hagen, K., Vøllestad, N., Fongen, C., Olsen, I. C., Michelsen, A., Ueland, T., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0108688 · Cited by 105
“Two different meta-analyses concluded that exercise interventions have beneficial effects on BP, HDL-c and to some extend TC in the general population [41,42].”
Background
Metadata
- Authors
- Cornelissen, V. A., & Fagard, R. H.
- Affiliations
- From the Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, Catholic University of Leuven, Belgium.
- UCLouvain (BE)
- Venue
- Hypertension
- Published
- 2005-10
- Volume
- 46
- Issue
- 4
- Pages
- 667-675
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2163161539
- Cited by
- 1,005
- References
- 0
- Citations by year
- 2026: 28 · 2025: 47 · 2024: 33 · 2023: 38 · 2022: 52 · 2021: 41 · 2020: 49 · 2019: 46 · 2018: 47 · 2017: 52 · 2016: 49 · 2015: 63 · 2014: 76 · 2013: 79 · 2012: 58
- FWCI
- 64.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion)
- Funders
- Fonds Wetenschappelijk Onderzoek
- Vlaamse regering
- Topics
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Keywords
- aerobic endurance training, blood pressure, ambulatory blood pressure, systemic vascular resistance, plasma norepinephrine, plasma renin activity, renin-angiotensin system, sympathetic nervous system, cardiovascular risk factors, insulin resistance, HDL cholesterol, body weight, waist circumference, fat mass
- MeSH terms
- Blood Pressure, Cardiovascular Diseases, Hemodynamics, Humans, Norepinephrine, Physical Education and Training, Physical Endurance, Regression Analysis, Renin, Rest, Risk Factors, Vascular Resistance, Randomized Controlled Trials as Topic, Cross-Over Studies, Blood Pressure Monitoring, Ambulatory
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