Abstract
Moderate intensity aerobic exercise (AE) lowers blood pressure (BP) among most adults with hypertension. New and emerging evidence suggests that greater BP benefits may be achieved with different AE doses for some populations. PURPOSE: Few meta-analyses have identified such patterns; our meta-analysis addresses this gap. METHODS: Electronic databases identified 86 controlled AE trials (105 interventions) that involved adults (≥19yr) and reported BP pre- and post-AE. Analyses followed random-effects assumptions. RESULTS: Participants (n=3581) were White (18% non-White), middle-aged (48.0±12.8yr), overweight (27.7±3.8 kg·m-2) adults with prehypertension (systolic BP [SBP]/diastolic BP [DBP] 130.7±12.7/81.7±9.0 mmHg]. AE performed at moderate to vigorous intensity (6.0±1.7 metabolic equivalents [MET]) for 45.5±26.2 min·session-1, 3.4±1.1 d·wk-1 for 18.3±16.6 wk reduced SBP (d+= -0.35; 95% CI: -0.46, -0.24; -4.1 mmHg) and DBP (d+= -0.33; 95% CI: -0.44, -0.23; -2.9 mmHg) compared to control. Greater SBP reductions occurred among randomized controlled trials (RCTs) (-7.4 mmHg; k=69) versus non-RCTs (-1.7 mmHg; k=36, p<.01); and for non-White (-6.5 mmHg; k=19) versus White samples (-2.6 mmHg; k=86, p<.05). Among RCTs, non-White samples with hypertension achieved the greatest SBP benefit (-12.4 mmHg, p<.01) compared to White samples with hypertension (-3.7 mmHg, p=.02). Greater DBP reductions occurred for samples with higher resting DBP in dose-response fashion: 1.0 mmHg (p=.04) for normal BP (k=43), 3.2 mmHg for prehypertension (k=42), and 5.3 mmHg (ps<.01) for hypertension (k=16). Similar patterns emerged for AE intensity: 1.3 mmHg (p=.08) low to moderate (k=58), 3.8 mmHg for vigorous (k=39), and 6.2 mmHg (ps<.01) for near maximal intensities (k=8); and frequency: 1.6 mmHg (p=.05) for 2 d·wk-1 (k=14), 3.4 mmHg for 4 d·wk-1 (k=70), and 5.2 mmHg (ps<.01) 6 d·wk-1 (k=18). The greatest DBP benefit was observed for samples with hypertension who performed vigorous intensity AE ≥4 d·wk-1 (7.5 mmHg, p<.01). CONCLUSIONS: More vigorous exercise intensity and greater volumes of AE elicited the largest BP reductions indicating a need to re-examine the current exercise recommendations for adults with hypertension. Supported by the University of Connecticut Center for Health, Intervention, and Prevention.
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