According to a large-scale systematic review and meta-analysis of 270 previous studies, aerobic exercise training, dynamic resistance training, combined training, high-intensity interval training and isometric exercise training are significantly effective in reducing resting systolic and diastolic blood pressure; static isometric exercise training — the sort that involve engaging muscles without movement, such as wall sits and planks — is the most effective mode.
Various exercise training modes improve resting blood pressure, particularly isometric exercise. Image credit: Viktor Ristic.
“Hypertension is a leading modifiable risk factor for morbidity and mortality,” said Dr. Jamie O’Driscoll and colleagues from Canterbury Christ Church University and the University of Leicester.
“While differences in diagnostic cut-off points exist in guidelines, blood pressure above optimal levels is lineally associated with an escalated risk of cardiovascular disease.”
“With the prevalence of hypertension increasing, particularly in low- and middle-income countries, research into effective antihypertensive interventions remains critical.”
“Medical therapy is an effective means of reducing blood pressure; however, poor adherence, adverse side effects and economic expenditure are important limitations.”
“As such, non-pharmacological approaches are favored,” they said.
“Exercise elicits conclusive cardiovascular health benefits and improves long-term survival, with a longitudinal association between physical activity and reduced mortality well documented.”
“We aimed to provide an updated large-scale systematic review and network meta-analysis of randomized controlled trials on the effects of exercise training on resting systolic and diastolic blood pressure.”
The researchers trawled research databases looking for clinical trials reporting the effects of an exercise training intervention lasting 2 or more weeks on resting blood pressure.
The initial systematic search identified 14,553 trials, with an additional 138 trials discovered through screening of previous meta-analyses and their respective reference lists.
Following all exclusions, 270 trials were ultimately included, constituting an analyzed sample of 15,827 (7,632 controls) participants.
The exercise interventions were classified as aerobic (‘cardio’), dynamic resistance training, a combination of these, high-intensity interval training (HIIT), and isometric exercises.
Healthy resting blood pressure was defined as a reading below 130/85 mmHg; pre-high blood pressure as 130-139/85-89 mmHg; and high blood pressure as 140/90 mmHg or more.
The pooled data analysis showed significant reductions in resting systolic and diastolic blood pressure after all the various categories of exercise, but with the largest falls in both systolic and diastolic blood pressure after isometric exercise training.
The reductions in blood pressure after aerobic exercise training amounted to 4.49/ 2.53 mmHg; 4.55/3.04 mm Hg after dynamic resistance training; 6.04/2.54 mmHg after combined training; 4.08/2.50 mmHg after HIIT; and 8.24/4 mmHg after isometric exercise training.
The rank order of effectiveness values for reducing systolic blood pressure were isometric exercise training (98%), combined training (76%), dynamic resistance training (46%), aerobic exercise training (40.5%) and HIIT (39%).
Secondary analyses revealed wall squats (isometric) and running (aerobic) as the most effective individual exercises for reducing systolic blood pressure (90.5%) and diastolic blood pressure (91%), respectively, with isometric exercise, overall, the most effective for reducing both blood pressure elements.
“Overall, isometric exercise training is the most effective mode in reducing both systolic and diastolic blood pressure,” Dr. O’Driscoll said.
“These findings provide a comprehensive data driven framework to support the development of new exercise guideline recommendations for the prevention and treatment of arterial hypertension.”
The findings were published in the British Journal of Sports Medicine.
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J.J. Edwards et al. Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. British Journal of Sports Medicine, published online July 25, 2023; doi: 10.1136/bjsports-2022-106503
