EFFECTS OF EXERCISE TRAINING ON ARTERIAL STIFFNESS IN PATIENTS WITH HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Objective: This review aims to determine the effects of exercise training on arterial stiffness, namely Pulse Wave Velocity (PWV), in patients with hypertension. The identification of possible moderator variables of the effect of exercise on PWV was defined as a secondary objective. Design and Methods: For this systematic review and meta-analysis (PROSPERO CRD42019138658), MEDLINE, Scopus, Cochrane and Web of Science were searched up until July 2019. Randomized controlled trials assessing the effect of exercise interventions lasting 4 or more weeks on PWV in (pre)hypertensive subjects were included. The standardized mean difference between the pre-post of the intervention group versus the control group was calculated for PWV using the Cohen's d index as the effect size statistic. The type of exercise, PWV assessment site, use of medication, baseline PWV and study quality assessment score were used to perform subgroup analysis. Design and method: Fourteen trials, involving 15 exercise groups (5 aerobic, 2 dynamic resistance, 6 combined, and 2 isometric resistance groups), totaling 694 subjects with pre- and hypertension (374 exercise). Exercise program duration ranged from 4 to 26 weeks, with a mean duration of 13.1 ± 6.1 weeks. The overall effect size showed statistically significant differences in PWV [(d (95% CI) = 1.35 (0.72, 1.98)] in favor of the exercise group. Aerobic exercise [d (95% CI) = 1.93 (0.31, 3.55)], combined exercise [d (95% CI) = 0.79 (0.09, 1.49)] and isometric resistance exercise [d (95% CI) = 2.23 (1.66, 2.81)] reduced PWV for the exercise group when compared to the control group. There was no significant reduction in PWV in subjects undertaking dynamic resistance training [d (95% CI) = 0.69 (-2.32, 3.69)]. Subgroup analysis demonstrated that the positive effects of exercise training on PWV are independent of medication use, PWV assessment site, study quality assessment score and baseline PWV, although higher baseline PWV values presented a more significant reduction with exercise. Results: Aerobic, combined and isometric resistance exercise significantly decreased PWV in (pre)hypertensive patients. Despite the small number of studies, data from the isometric resistance exercise has the potential for the largest reductions in PWV.