THE EFFECTS OF ADDING EXERCISE TO USUAL CARE ON BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION, TYPE II DIABETES MELLITUS, AND/OR CARDIOVASCULAR DISEASE (PRELIMINARY RESULT)

Abstract

Objective: Exercise is one of the most commonly recommended interventions for hypertension, type II diabetes, and/or cardiovascular disease. However, previous reviews have shown conflicting evidence on the effects of exercise and especially the effects in low- and middle-income countries (LMICs) is debated. Our objective was to assess the beneficial and harmful effects of adding exercise to usual care for people with hypertension, type II diabetes, and/or cardiovascular disease in high-income countries (HICs) and LMICs. Design and method: We searched CENTRAL, MEDLINE, EMBASE, LILACS from inception to present time, and further searched the bibliography of retrieved articles and reviews. We included relevant randomised clinical trials and cluster randomised trials irrespective of trial duration, publication status, publication year, and language. Two independent investigators assessed each trial for methodological quality. A random-effects model was used to meta-analyse data, we used test of interaction to compare the effects of exercise in HIC and LMIC, and heterogeneity (I2) was assessed by the χ2 test on Cochran's Q statistic. Our protocol was registered with PROSPERO, number CRD42019142313 and published before our literature search was conducted. Results: We included 96 trials randomising 6002 participants with type II diabetes (34 trials), hypertension (26 trials), and rest were trials on CVDs. The mean follow-up for the trials was 5.21 (SD: ± 4.07) months. Meta-analysis including all trials showed that exercise compared with control decreased the systolic blood pressure (SBP) 4.66 mmHg (95% CI: -6.24 -3.07; I2 93.6, p < 0.001). Test of interaction showed that the decrease in SBP was higher in LMICs (-8.69; 95% CI -11.95 -5.43; I2 89.73, p < 0.001) compared to HICs (-3.315; 95% CI -5.002 -1.62; I2 93.05, p = 0.000) and the difference was significant (Q = 8.25 p < 0.001). Likewise, exercise decreased the overall diastolic blood pressure (DBP) 2.98 (95% CI; -4.04 -1.93; I2 = 93.35, p < 0.001) however the difference was not significant between LMICs and HICs (Q = 1.66 p = 0.198). Conclusions: This reiterates the possibility of implementing exercise on population level as a cheap, low risk, non-pharmacological cardiovascular prevention.