Several exercise training modes improved resting BP, but isometric exercise was the most effective, according to a systematic review and meta-analysis published in the British Journal of Sports Medicine.
“With the prevalence of hypertension increasing, particularly in low- and middle-income countries, research into effective antihypertensive interventions remains critical,” Jamie J. Edwards, MSc, a PhD researcher and instructor at Canterbury Christ Church University, and colleagues wrote.
Although medical therapy is effective in reducing BP, the researchers noted that there are “important limitations” like costs, adverse events and poor adherence rates.
“As such, nonpharmacological approaches are favored,” they wrote. “Exercise elicits conclusive cardiovascular health benefits and improves long-term survival, with a longitudinal association between physical activity and reduced mortality well documented.”
Edwards and colleagues conducted a systematic review and network meta-analysis of 270 randomized controlled trials published from 1990 to February 2023 to identify the optimal antihypertensive exercise that physicians can prescribe. The analysis included 15,827 participants who were assigned to an exercise intervention for at least 2 weeks or a nonintervention control group.
Edwards and colleagues found that several exercise training modes, but especially isometric exercise — contracting a specific muscle or muscle group in exercises like wall sits, squats and planks — improved resting BP.
There were significant reductions in resting systolic BP and diastolic BP after aerobic exercise training (4.49 mm Hg for SBP and –2.53 mm Hg for DBP, combined training (–6.04 and –2.54 mm Hg), dynamic resistance training (–4.55 and –3.04 mm Hg), high-intensity interval training (–4.08 and –2.50 mm Hg) and isometric exercise training (–8.24 and –4 mm Hg).
They found that isometric wall squat and running were the most effective submodes for reducing systolic BP, with a surface under the cumulative ranking curve (SUCRA) of 90.4%, and diastolic BP, with a SUCRA of 91.3%, respectively.
The rank order of effectiveness based on the SUCRA values for systolic BP were:
“These findings provide a comprehensive data-driven framework to support the development of new exercise guideline recommendations for the prevention and treatment of arterial hypertension,” Edwards and colleagues concluded.