Many exercise modalities are effective treatments for hypertension

1. In this systematic review and network meta-analysis, aerobic exercise training, dynamic resistance training, combined training, high-intensity interval training, and isometric exercise training were all associated with significant reductions in resting systolic and diastolic blood pressure.

2. However, isometric wall squatting was the most effective exercise for reducing systolic blood pressure, while running was most effective for lowering diastolic blood pressure.

Evidence Rating Level: 1 (Excellent)

It is well known that exercise is an effective non-pharmacological treatment for hypertension. Aerobic exercise remains the main form of physical activity that is suggested for the treatment of hypertension. However, there is limited data on the effects of different exercise modalities on the management of high blood pressure. Therefore, the present study aimed to identify the optimal exercise intervention for reducing resting blood pressure to better inform hypertension management guidelines.

Of 14,553 identified records, 270 randomized controlled trials (n = 15,827 participants) published between 1990 and February 2023 were included in the review. Studies were included if they investigated an exercise intervention in adults and reported pre- and post-intervention systolic and diastolic blood pressure. Studies were excluded if they used concurrent interventions with exercise, such as medications. The risk of bias was evaluated using the TESTEX scale. The study was performed following PRISMA guidelines. The primary outcome was the impact of a given intervention on resting systolic and diastolic blood pressure.

The results demonstrated that aerobic exercise, dynamic resistance, combined, high-intensity interval, and isometric exercise training were all associated with significant reductions in resting blood pressure. Isometric exercise training and combined training were the most effective for lowering systolic blood pressure. Meanwhile, the most effective exercises for reducing blood pressure were isometric wall squats for systolic blood pressure and running for diastolic blood pressure. However, the study was limited by the publication bias in some exercise modalities, such as aerobic and isometric exercise training, over other modalities, such as sprint interval training, which may have influenced the results. Nonetheless, the present study identified optimal exercise modalities for managing hypertension.

Click to read the study in British Journal of Sports Medicine

Image: PD

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