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Evidence summaries

Exercise Training and Hypertension

Exercise training to improve physical fitness reduces both systolic and diastolic blood pressure. Level of evidence: "A"

A systematic review 1 including 36 studies (21 RCTs, 15 controlled trials) was abstracted in DARE. The net weighted mean changes associated with exercise training were as follows: systolic blood pressure -5.3 mmHg (95% CI -7.2 to -3.4); diastolic blood pressure -4.7 (95% CI -6.2 to -3.4); heart rate -6.1/min (95% CI -7.3 to -4.8); weight -0.84 kg (95% CI -1.16 to -0.53); physical work capacity +15.1% (95% CI +13.4 to +16.9).

Another systematic review 3 including 9 studies on normotensive adults (6 RCTs, 3 non-randomised controlled studies) was abstracted in DARE. Statistically significant reductions of 9 (95% CI 1.30 to 5.11) and 3 (95% CI 0.05 to 4.82) mmHg were found in exercise groups for resting systolic and diastolic blood pressure, respectively. Significant correlations were found between changes in resting blood pressure an duration of training.

Comment: The meta-analysis combined results separately for the intervention group and the control group, making the combination of treatment effect from the primary studies flawed.

A third systematic review 5 including 29 RCTs with a total of 1533 subjects was abstracted in DARE. Data from 27 studies showed that aerobic exercise resulted in decreases of 4.7 mmHg (95% CI 4.4 to 5.0) for systolic blood pressure and 3.1 mmHg (95% CI 3.0 to 3.3) for diastolic BP.

Comment: The funnel plot indicates that publication bias may be present. There was heterogeneity between trials.

A fourth systematic review 7 including 6 studies with a total of 167 subjects was abstracted in DARE. During a 24 hour period, ambulatory and systolic blood pressure decreased by 1.72 mmHg (95% CI 3.10 to 0.34) and 2.56 mmHg (95% CI 4.01 to 1.06). During sleeping hours, ambulatory and systolic blood pressure decreased by 1.76 (95% CI 4.94 to -1.42) and 3.04 (95% CI 5.82 to 0.26) mmHg respectively.

A fifth systematic review 9 including 10 RCTs with a total of 504 women in exercise groups and 228 control women was abstracted in DARE. Overall, an approximate 2% decrease in resting systolic and 1% decrease in resting diastolic blood pressure were observed (systolic -2 mmHg, bootstrap CI -3 to -1 mmHg; diastolic -1 mmHg, 95% bootstrap CI -2 to -1 mmHg).

    References

    • Brodde OE, Zerkowski HR, Schranz D, Broede-Sitz A, Michel-Reher M, Schäfer-Beisenbusch E, Piotrowski JA, Oelert H. Age-dependent changes in the beta-adrenoceptor-G-protein(s)-adenylyl cyclase system in human right atrium. J Cardiovasc Pharmacol 1995 Jul;26(1):20-6. [PubMed][DARE]
    • Kelley GA. Effects of aerobic exercise in normotensive adults: a brief meta-analytic review of controlled clinical trials. South Med J 1995 Jan;88(1):42-6. [PubMed][DARE]
    • Halbert JA, Silagy CA, Finucane P, Withers RT, Hamdorf PA, Andrews GR. The effectiveness of exercise training in lowering blood pressure: a meta-analysis of randomised controlled trials of 4 weeks or longer. J Hum Hypertens 1997 Oct;11(10):641-9. [PubMed][DARE]
    • Kelley G. Effects of aerobic exercise on ambulatory blood pressure: a meta-analysis. Sports Medicine Training and Rehabilitation 1996;7:115-131. [DARE]
    • Kelley GA. Aerobic exercise and resting blood pressure among women: a meta-analysis. Prev Med 1999 Mar;28(3):264-75. [PubMed][DARE]

Primary/Secondary Keywords