EXERCISE AND AMBULATORY BLOOD PRESSURE: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS WITH META-ANALYSIS

Abstract

Objective: Hypertension remains the biggest single contributor to the global burden of disease and to the global mortality rate. Lifestyle changes, including exercise therapy, are recommended in the prevention and treatment of high blood pressure (BP). To date, most randomized controlled trials (RCT’s) have evaluated the effect of exercise therapy on resting office blood pressure (BP). Data on the efficacy of exercise on ambulatory BP (AMBP), nowadays considered the gold standard measurement, remain scant. The current systematic review and meta-analysis aimed to summarize the effect of different exercise modalities on AMBP in individuals with a normal, high normal BP or hypertension. Design and method: This systematic review was conducted and reported according to the PRISMA-guidelines. A systematic literature search was conducted in three databases including only RTC’s involving exercise of at least 4 weeks in adults with a normal, high-normal BP or hypertension without concomitant diseases and published as a full-text in a peer-reviewed journal up to October 2021. Random effects models were used for analyses, with data reported as weighted means and 95% CI. We included 30 trials, including 36 study groups (n = 31 aerobic endurance exercise interventions, n = 4 resistance exercise interventions; n = 1 combined exercise intervention) randomizing a total of 1919 participants. Results: Analyses were performed with Comprehensive Meta-Analysis software (CMA 2.0). Aerobic endurance exercise significantly decreased 24 h AMBP (-2.8/-1.7 mmHg; p < 0.05); daytime AMBP (-3.6/-2.8mmHg; p < 0.001), nighttime ABMP (-1.6/-1.1; p < 0.05). Following resistance training, only a decrease in daytime systolic BP (-5.3 mmHg; p> 0.05) was observed without a statistically significant effect on daytime diastolic BP or nighttime BP (p > 0.05 for both). Conclusions: This meta-analysis confirms the BP lowering potential of exercise therapy in the management of BP. Daytime, nighttime and 24 h AMBP were significantly lower following an aerobic exercise intervention. The limited data available on resistance exercise warrants more research to confirm the resistance exercise as a sole exercise therapy to lower AMBP.