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

Document Type : Review Article

Authors

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

Abstract

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. 
 
 

Keywords


##Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. Journal of the American Heart Association. 2013;2(1):e004473.##Millar PJ, McGowan CL, Cornelissen VA, Araujo CG, Swaine IL. Evidence for the role of isometric exercise training in reducing blood pressure: potential mechanisms and future directions. Sports Medicine. 2014;44(3):345-56.##Brook RD, Jackson EA, Giorgini P, McGowan CL. When and how to recommend ‘alternative approaches’ in the management of high blood pressure. The American journal of medicine. 2015;128(6):567-70.##Ghadieh AS, Saab B. Evidence for exercise training in the management of hypertension in adults. Canadian Family Physician. 2015;61(3):233-9.##Johnson B, MacDonald H, Bruneau Jr M, Goldsby T, Brown J, Huedo-Medina T, et al. Methodological quality of meta-analyses on the blood pressure response to exercise: a review. Journal of hypertension. 2014;32(4):706.##MacDonald HV, Pescatello LS. Exercise Prescription for Hypertension: New Advances for Optimizing Blood Pressure Benefits.  Lifestyle in Heart Health and Disease: Elsevier; 2018. p. 115-36.##Harris-Packer T, Forehand J, Hodges T, Leigh K. The Implementation of an Exercise by Prescription Program in Middle-aged Hypertensive African American Women. 2015.##O'Neil S, Thomas A, Pettit-Mee R, Pelletier K, Moore M, Thompson J, et al. Exercise Prescription Techniques in Cardiac Rehabilitation Centers in Midwest States. Journal of Clinical Exercise Physiology. 2018;7(1):8-14.##Pescatello LS, MacDonald HV, Lamberti L, Johnson BT. Exercise for hypertension: a prescription update integrating existing recommendations with emerging research. Current hypertension reports. 2015;17(11):1-10.##Pescatello LS, MacDonald HV, Lamberti L, Johnson BT. Exercise for hypertension: a prescription update integrating existing recommendations with emerging research. Current hypertension reports. 2015;17(11):87.##Alamdari KA. Influence of metabolic risk on adaptation of mean arterial pressure with endurance training and detraining: study of males with mild hypertension. Majallah-i pizishki-i Danishgah-i Ulum-i Pizishki va Khadamat-i Bihdashti-i Darmani-i Tabriz. 2017;39(1):6.##Moker EA, Bateman LA, Kraus WE, Pescatello LS. The Relationship between the Blood Pressure Responses to Exercise following Training and Detraining Periods. PLoS ONE. 2014;9(9).##Igarashi Y, Nogami Y. The effect of regular aquatic exercise on blood pressure: A meta-analysis of randomized controlled trials. European journal of preventive cardiology. 2018;25(2):190.##Sosner P, Guiraud T, Grémeaux V, Arvisais D, Herpin D, Bosquet L. The ambulatory hypotensive effect of aerobic training: a reappraisal through a meta-analysis of selected moderators. Scandinavian journal of medicine & science in sports. 2017;27(3):327-41.##Wen H, Wang L. Reducing effect of aerobic exercise on blood pressure of essential hypertensive patients: A meta-analysis. Medicine. 2017;96(11).##Gkaliagkousi E, Gavriilaki E, Douma S. Effects of acute and chronic exercise in patients with essential hypertension: benefits and risks. American journal of hypertension. 2015;28(4):429.##Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Australian Journal of Physiotherapy. 2002;48(1):43-9.##Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. Journal of the American Heart Association. 2013;2(1):e004473.##Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: Wiley Online Library; 2008.##Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. Journal of clinical epidemiology. 1992;45(7):769-73.##Borenstein M. Introduction to metaanalysis. JSTOR; 2008.##Ades PA, Gunther PG, Meyer WL, Gibson TC, Maddalena J, Orfeo T. Cardiac and skeletal muscle adaptations to training in systemic hypertension and effect of beta blockade (metoprolol or propranolol). The American Journal of Cardiology. 1990;66(5):591-6.##Anderssen S, Holme I, Urdal P, Hjermann I. Diet and exercise intervention have favourable effects on blood pressure in mild hypertensives: the Oslo Diet and Exercise Study (ODES). Blood Pressure. 1995;4(6):343-9.##Collier SR, Frechette V, Sandberg K, Schafer P, Ji H, Smulyan H, et al. Sex differences in resting hemodynamics and arterial stiffness following 4 weeks of resistance versus aerobic exercise training in individuals with pre-hypertension to stage 1 hypertension. Biology of sex differences. 2011;2(1):9.##Collier S, Kanaley J, Carhart Jr R, Frechette V, Tobin M, Hall A, et al. Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre-and stage-1 hypertensives. Journal of human hypertension. 2008;22(10):678.##Cozza IC, Di Sacco TH, Mazon JH, Salgado MCO, Dutra SG, Cesarino EJ, et al. Physical exercise improves cardiac autonomic modulation in hypertensive patients independently of angiotensin-converting enzyme inhibitor treatment. Hypertension Research. 2012;35(1):82.##Damorim IR, Santos TM, Barros GWP, Carvalho PRC. Kinetics of Hypotension during 50 Sessions of Resistance and Aerobic Training in Hypertensive Patients: a Randomized Clinical Trial. Arquivos Brasileiros de Cardiologia. 2017;108(4):323.##De Meirelles L, Mendes‐Ribeiro A, Mendes M, Da Silva M, John Clive Ellory J, Mann G, et al. Chronic exercise reduces platelet activation in hypertension: upregulation of the l‐arginine‐nitric oxide pathway. Scandinavian journal of medicine & science in sports. 2009;19(1):67-74.##Duncan J, Farr J, Upton S, Hagan R, Oglesby M, Blair S. The effects of aerobic exercise on plasma catecholamines and blood pressure in patients with mild essential hypertension. JAMA. 1985;254(18):2609.##Farzaneg P, Habibian M, Fazeli M, Moosavi SJ. Effect Of Aerobic Training On Markers Of Endothelial Function In Hypertensive Postmenopausal Women. Urmia Medical Journal. 2013;24(8):624-32.##Galdino G, Silva AM, Bogão Jr JA, de Oliveira MPB, de Oliveira Araújo HAG, Oliveira MS, et al. Association between respiratory muscle strength and reduction of arterial blood pressure levels after aerobic training in hypertensive subjects. Journal of Physical Therapy Science. 2016;28(12):3421.##Georgiades A, Sherwood A, Gullette EC, Babyak MA, Hinderliter A, Waugh R, et al. Effects of exercise and weight loss on mental stress–induced cardiovascular responses in individuals with high blood pressure. Hypertension. 2000;36(2):171-6.##Hakimi M, Ali-Mohammadi M, Baghaiee B, Siahkouhian M, Bolboli L. Comparing The Effects Of 12-Weeks Of Resistance And Endurance Training On Anp, Endothelin-1, Apelin And Blood Pressure In Hypertensive Middle-Aged Men. URMIA MEDICAL JOURNAL. 2016;26(12):1080-9.##He L, Wei Wr, Can Z. Effects of 12-week brisk walking training on exercise blood pressure in elderly patients with essential hypertension: a pilot study. Clinical and Experimental Hypertension. 2018:1-7.##Higashi Y, Sasaki S, Sasaki N, Nakagawa K, Ueda T, Yoshimizu A, et al. Daily aerobic exercise improves reactive hyperemia in patients with essential hypertension. Hypertension. 1999;33(1):591-7.##Hua L, Brown C, Hains S, Godwin M, Parlow J. Effects of low-intensity exercise conditioning on blood pressure, heart rate, and autonomic modulation of heart rate in men and women with hypertension. Biological research for nursing. 2009;11(2):129.##Hagberg J, Montain S, Martin 3rd W, Ehsani A. Effect of exercise training in 60-to 69-year-old persons with essential hypertension. The American journal of cardiology. 1989;64(5):348.##Ishikawa-Takata K, Ohta T, Tanaka H. How much exercise is required to reduce blood pressure in essential hypertensives: a dose–response study. American journal of hypertension. 2003;16(8):629-33.##Lamina S, Okoye G. Therapeutic effect of a moderate intensity interval training program on the lipid profile in men with hypertension: a randomized controlled trial. Nigerian journal of clinical practice. 2012;15(1):42.##Martin J, Dubbert P, Cushman W. Controlled trial of aerobic exercise in hypertension. Circulation. 1990;81(5):1560.##mokhtari m, daryanoush f, koushki jahroumi m. Effect of the Comparison 12 weeks aerobic and Resistance exercise on levels of Omentin-1 plasma and Blood pressure in hypertensive elderly women. Journal of Applied Health Studies in Sport Physiology. 2015;2(2):66-75.##Sakai T, Ideishi M, Miura S, Maeda H, Tashiro E, Koga M, et al. Mild exercise activates renal dopamine system in mild hypertensives. Journal of human hypertension. 1998;12(6):355.##Sardroudian M, Hamedi nia MR, Haghighi A. The Effect of Elementary Swimming Training on Vascular Cell Adhesion Molecule and Blood Pressure in Hypertensive Postmenopausal Women. Scientific Journal Management System. 2012;8(16):55-68.##Meisam S, Shahidi F, Rajabi H, Nazar I. Study of L-Arginine to Asymmetric Dimethylarginine Ratio in Middle Aged Hypertensive Men and Effect of Aerobic Training on this Variable. Jundishapur Scientific Medical Journal 2017;15(6):745-56.##Staffileno B, Braun L, Rosenson R. The accumulative effects of physical activity in hypertensive post-menopausal women. Journal of cardiovascular risk. 2001;8(5):283.##Tanabe Y, Urata H, Kiyonaga A, Ikeda M, Tanaka H, Shindo M, et al. Changes in serum concentrations of taurine and other amino acids in clinical antihypertensive exercise therapy. Clinical and Experimental Hypertension Part A: Theory and Practice. 1989;11(1):149-65.##Tsai J-C, Chang W-Y, Kao C-C, Lu M-S, Chen Y-J, Chan P. Beneficial effect on blood pressure and lipid profile by programmed exercise training in Taiwanese patients with mild hypertension. Clinical and experimental hypertension. 2002;24(4):315-24.##Tsuda K, Yoshikawa A, Kimura K, Nishio I. Effects of mild aerobic physical exercise on membrane fluidity of erythrocytes in essential hypertension. Clinical and experimental pharmacology and physiology. 2003;30(5‐6):382-6.##Westhoff TH, Schmidt S, Gross V, Joppke M, Zidek W, van der Giet M, et al. The cardiovascular effects of upper-limb aerobic exercise in hypertensive patients. Journal of hypertension. 2008;26(7):1336-42.##Zaros PR, Pires CER, Bacci Jr M, Moraes C, Zanesco A. Effect of 6-months of physical exercise on the nitrate/nitrite levels in hypertensive postmenopausal women. BMC Women's Health. 2009;9:17.##      Hosseiny s, Farahani z, Shiri h, AbedSaeidi z, AlaviMajd h, Hamidizadeh s. The effects of low intensity aerobic exercise on blood pressur. Journal of Shahrekord Uuniversity of Medical Sciences. 2007;9(2):14-9.##Zouhal H, Jacob C, Delamarche P, Gratas-Delamarche A. Catecholamines and the effects of exercise, training and gender. Sports medicine. 2008;38(5):401-23.##Martinez DG, Nicolau JC, Lage RL, Toschi-Dias E, de Matos LD, Alves MJN, et al. Effects of long-term exercise training on autonomic control in myocardial infarction patients. Hypertension. 2011;58(6):1049-56.##Winterfeld H, Siewert H, Bohm J, Möbes R, Bauer U, Reisinger J, et al. Hemodynamics in arterial hypertension treated with running endurance training or nifedipine therapy. Zeitschrift fur Kardiologie. 1996;85(3):171.##Hansen AH, Nyberg M, Bangsbo J, Saltin B, Hellsten Y. Exercise training alters the balance between vasoactive compounds in skeletal muscle of individuals with essential hypertension. Hypertension. 2011;58(5):943-9.##Black JM, Stöhr EJ, Shave R, Esformes JI. Influence of exercise training mode on arterial diameter: A systematic review and meta-analysis. Journal of science and medicine in sport. 2016;19(1):74-80.##James P, Oparil S, Carter B, Cushman W, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507.##Rankinen T, Pérusse L, Rauramaa R, Rivera M, Wolfarth B, Bouchard C. The human gene map for performance and health-related fitness phenotypes. Medicine and science in sports and exercise. 2001;33(6):855.##Pescatello LS, Blanchard BE, Van Heest JL, Maresh CM, Gordish-Dressman H, Thompson PD. The Metabolic Syndrome and the immediate antihypertensive effects of aerobic exercise: a randomized control design. BMC Cardiovascular Disorders. 2008;8(1):12.##Pedralli ML, Waclawovsky G, Camacho A, Markoski MM, Castro I, Lehnen AM. Study of endothelial function response to exercise training in hypertensive individuals (SEFRET): study protocol for a randomized controlled trial. Trials. 2016;17.##Lelbach A, Koller A. Mechanisms underlying exercise-induced modulation of hypertension. 2017.##Devan AE, Eskurza I, Pierce GL, Walker AE, Jablonski KL, Kaplon RE, et al. Regular aerobic exercise protects against impaired fasting plasma glucose-associated vascular endothelial dysfunction with aging. Clinical science (London, England: 1979). 2013;124(5):325.##Roque FR, Briones AM, García‐Redondo AB, Galán M, Martínez‐Revelles S, Avendaño MS, et al. Aerobic exercise reduces oxidative stress and improves vascular changes of small mesenteric and coronary arteries in hypertension. British journal of pharmacology. 2013;168(3):686-703.##Nyberg M, Jensen LG, Thaning P, Hellsten Y, Mortensen SP. Role of nitric oxide and prostanoids in the regulation of leg blood flow and blood pressure in humans with essential hypertension: effect of high‐intensity aerobic training. The Journal of physiology. 2012;590(6):1481-94.##Montero D, Roche E, Martinez-Rodriguez A. The impact of aerobic exercise training on arterial stiffness in pre-and hypertensive subjects: a systematic review and meta-analysis. International journal of cardiology. 2014;173(3):361-8.##Taddei S, Galetta F, Virdis A, Ghiadoni L, Salvetti G, Franzoni F, et al. Physical activity prevents age-related impairment in nitric oxide availability in elderly athletes. Circulation. 2000;101(25):2896.##Molmen-Hansen HE, Stolen T, Tjonna AE, Aamot IL, Ekeberg IS, Tyldum GA, et al. Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. European journal of preventive cardiology. 2012;19(2):151-60.##Franklin S, Larson M, Khan S, Wong N, Leip E, Kannel W, et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation. 2001;103(9):1245.##Avolio A, Deng F-Q, Li W-Q, Luo Y-F, Huang Z-D, Xing L, et al. Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China. Circulation. 1985;71(2):202-10.##Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA. Exercise and Hypertension. Medicine & Science in Sports & Exercise. 2004;36(3):533-53.##Ingul C. Low volume, high intensity: Time-efficient exercise for the treatment of hypertension. European journal of preventive cardiology. 2018;25(6):569.##White DW, Fernhall B. Effects of Exercise on Blood Pressure and Autonomic Function and Other Hemodynamic Regulatory Factors.  Effects of Exercise on Hypertension: Springer; 2015. p. 203-25.##Viera AJ, Kshirsagar AV, Hinderliter AL. Lifestyle modification advice for lowering or controlling high blood pressure: who's getting it? The Journal of Clinical Hypertension. 2007;9(11):850-8.##Izumi Y, Matsumoto K, Ozawa Y, Kasamaki Y, Shinndo A, Ohta M, et al. Effect of Age at Menopause on Blood Pressure in Postmenopausal Women. American Journal of Hypertension. 2007;20(10):1045-50.##Dubey R, Oparil S, Imthurn B, Jackson E. Sex hormones and hypertension. Cardiovascular research. 2002;53(3):688.##Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2013:01. cir. 0000441139.02102. 80.##Rice T, An P, Gagnon J, Leon A, Skinner J, Wilmore J, et al. Heritability of HR and BP response to exercise training in the HERITAGE Family Study. Medicine and science in sports and exercise. 2002;34(6):972.##Gupta SK. Intention-to-treat concept: a review. Perspectives in clinical research. 2011;2(3):109.##