Abstract
Uncontrolled hypertension remains the major risk factor for cardiovascular disease. Isometric resistance training (IRT) has been shown to be a useful nonpharmacological therapy for reducing blood pressure (BP); however, some exercise physiologists and other health professionals are uncertain of the efficacy and safety of IRT. Experts’ consensus was sought in light of the current variability of IRT use as an adjunct treatment for hypertension. An expert consensus-building analysis (Delphi study) was conducted on items relevant to the safety, efficacy and delivery of IRT. The study consisted of 3 phases: (1) identification of items and expert participants for inclusion; (2) a two-round modified Delphi exercise involving expert panelists to build consensus; and (3) a study team consensus meeting for a final item review. A list of 50 items was generated, and 42 international experts were invited to join the Delphi panel. Thirteen and 10 experts completed Delphi Rounds 1 and 2, respectively, reaching consensus on 26 items in Round 1 and 10 items in Round 2. The study team consensus meeting conducted a final item review and considered the remaining 14 items for the content list. A final list of 43 items regarding IRT reached expert consensus: 7/10 items on safety, 11/11 items on efficacy, 10/12 items on programming, 8/10 items on delivery, and 7/7 on the mechanism of action. This study highlights that while experts reached a consensus that IRT is efficacious as an antihypertensive therapy, some still have safety concerns, and there is also ongoing conjecture regarding optimal delivery.
Highlights
Chronic disease is the leading cause of death and disability globally, with a disease burden accounting for 71% (41 million) of all deaths each year
Steered by the study team’s (BB, MP, GD and NS) evaluation of the literature on Isometric resistance training (IRT) research and current guidelines for the application of IRT, consensus building was conducted in three phases: 1. Identification of items regarding the safety, efficacy and delivery of IRT and expert participants for inclusion (August–October 2020); 2
A total of 50 items were generated in relation to the safety, efficacy and delivery of IRT
Summary
Chronic disease is the leading cause of death and disability globally, with a disease burden accounting for 71% (41 million) of all deaths each year. Hansen et al [56], in their consensus statement from the Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) working group for exercise prescription in patients with different combinations of CVD risk factors, identified IRT as an adjunct tool to lower blood pressure [56]. They suggested that the paucity of data warranted further research (level of evidence: 2 + ; grade of recommendation: C) according to the grading recommendations in evidence-based guidelines [57] for exercise prescription. In light of this situation, a modified Delphi method was employed to seek expert consensus building with the aim of identifying the relevant issues worth considering for the safety, efficacy, and delivery of IRT as an adjunct therapy in the management of hypertension
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