تاثیر تمرین ورزشی هوازی بر فشارخون بیماران مبتلا به پرفشار خونی: مطالعه فراتحلیلی

نوع مقاله : مقاله مروری

نویسندگان

1 استادیار فیزیولوژی ورزشی، گروه فیزیولوژی ورزشی، پژوهشگاه تربیت بدنی و علوم ورزشی، تهران

2 دانشیار فیزیولوژی ورزشی، دانشکده علوم تربیتی و روانشناسی، دانشگاه شهید مدنی آذربایجان، تبریز

چکیده

سابقه و هدف: در حال حاضر در مورد اثر حجم تمرین و ویژگی‌های فردی بیماران مبتلا به پرفشارخونی (سن، جنسیت، یائسگی، مصرف دارو و ...) بر مقدار کاهش فشار سیستولی و دیاستولی ناشی از تمرین هوازی اطلاعات اندکی وجود دارد. بنابراین هدف این فراتحلیل‌ تعیین و مقایسه مقدار تغییرات فشار خون پس از تمرین هوازی و تفکیک اثرات در بین زیرگروه‌های مختلف مربوط به تمرین و بیماران بود.
مواد و روشها: کارآزمایی‌های بالینی بررسی‌کننده تاثیر تمرین هوازی بیش از چهارهفته بر روی بیماران پرفشارخونی منتشر شده در مجلات پژوهشی انگلیسی و فارسی تا آگوست 2018 از سایتهای google، sid و magiran و Pubmed سرچ شده و مورد فراتحلیل قرار گرفتند. مدلهای اثرات تصادفی و ثابت برای فراتحلیل‌ اندازه‌ اثر(تفاوت در میانگین با تناوب اطمینان %95) به ترتیب در 20 و 21 پژوهش مربوط به فشارخون سیستولی و دیاستولی با I2 کمتر از %50 با استفاده از نرم‌افزار CMA2 استفاده شد. زیرگروه‌های طبقه‌ای شامل جنسیت، یائسگی، مصرف دارو، تعداد جلسات تمرین هفته، شدت و مدت هر جلسه، کل زمان تمرین در هفته و کل مدت اجرای تمرین با ANOVA مقایسه شدند و همبستگی بین سن و پاسخ فشارخون به تمرین هوازی با فرا رگرسیون تصادفی ساده بررسی شد.
یافته‌ها: اثر کلی تمرینات هوازی بر فشارخون سیستولی و دیاستولی به ترتیب برابر با 72/8-­ و 88/3-­ میلی‌متر‌جیوه کاهش به دست آمد(001/0=P). با اینکه اندازه اثر تمرین هوازی بر فشار سیستولی و دیاستولی در مورد تمام زیرگروههای طبقات (به جز در مورد فشار سیستولی تمرینات کم‌شدت و فشار دیاستولی زنان یائسه) معنی‌دار بود(05/0>P)، ولی فقط در بین زیرگروههای طبقه "کل مدت اجرای تمرین" مقدار کاهش فشارخون سیستولی متفاوت بود(002/0=P).
نتیجه‌گیری: تمرین‌هوازی بی‌اعتنا به تاثیر تعدیل‌کننده طبقه سنی، وضعیت یائسگی، ‌مصرف دارو و یا دوز تمرین، سبب کاهش خفیف فشارخون بیماران پرفشارخون می‌شود که در تمرینات بین هشت تا 10 هفته، بیشترین فواید را گزارش شده‌ است. ولی به دلیل محدودیتهای بسیار زیاد تحقیقات موجود، هنوز باید منتظر انجام کارآزمایی‌های دارای تعداد آزمودنی‌های بیشتر و مدت تمرینی طولانی‌تر بود.

کلیدواژه‌ها


عنوان مقاله [English]

Effect of Aerobic Training on Blood Pressure in Hypertensive Patients: A Meta-Analysis Study

نویسندگان [English]

  • Hadi Rohani 1
  • Karim Azali -Alamdari 2
1 Department of Exercise Physiology, Sport Sciences Research Institute, Tehran, Iran
2 Department of Exercise Physiology, Faculty of Education and Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran
چکیده [English]

Background &purpose: A low information is available concerning the effects of the training volume subgroups and also hypertensive patients’ characteristics (e.g. age, gender, menopause, medication use and etc.) on the amount of aerobic training induced decreases in systolic and also diastolic blood pressures. Therefore, this meta-analysis aimed to determine and compare the amount of blood pressure changes after aerobic training and also to separate the effects in between patients and training subgroups
Methods: Clinical trials (CTs) that investigated the effect of, at least, 4 weeks of aerobic training in hypertensive patients, published in a peer reviewed journals up to Aug 2018 were selected from Google, PubMed, SID and Magiran databases and included in the meta-analysis. Random-and fixed-effect models were used for analyzing the effect sizes were reported as difference in mean between 95% confidence intervals (CIs) of the respectively 20 and 21 studies concerned with SBP and DBP with I2 values less than 50% using CMA2 software. For each trial subgroup (gender, menopause, medication use, exercise frequency, intensity and duration, total weekly exercise time and study duration), statistical significance was tested by using one-way analysis of variance and a multivariate meta-regression analysis were performed to assess correlations between the participants’ age subgroup and the both SBP and DBP response to aerobic training.  
Results: The overall pooled net effect of aerobic training on both the systolic and diastolic blood pressures were -8.72 mm Hg and -3.88 mm Hg (P=0.001), respectively.
In spite of the significant effect sizes observed for all the trial subgroups (in exception for SBP in low intensity training and DBP in post menopause women), a significantly different SBP reduction was only observed among the three subgroups of the “study duration” category.
Conclusion: Aerobic training leads to a mild suppression of blood pressure in hypertensive patients regardless to the moderating effects from study subgroups (age group, gender, menopause status, and medication use or training dosage) with the greater reductions reported for eight to 10 weeks of training. However; a larger and longer term CTs still remains to be done because of a very large number of limitations in the conducted trials. 
 
 

کلیدواژه‌ها [English]

  • Aerobic training
  • Systolic Blood Pressure
  • Diastolic Blood Pressure
  • Hypertension
  • Meta-Analysis
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