Isometric exercise training was found to be the most effective modality for lowering blood pressure in a systematic review and meta-analysis of 270 randomized trials with nearly 16,000 participants.[1]
The findings support the development of new exercise guidelines for blood pressure control, the authors said.
According to the authors, previous research, based on older data that excluded high-intensity interval training and isometric exercise training, led to recommending aerobic exercise training to control blood pressure.
Although aerobic exercise training, high-intensity interval training, dynamic resistance training, and combined training are also effective in reducing both systolic and diastolic blood pressure, the new analysis proposes that isometric exercise training does the best. gets it.
The analysis showed blood pressure reductions of 8.24/4 mm Hg after isometric exercise training, compared to 4.49/2.53 mm Hg after aerobic exercise training; 4.55/3.04 mm Hg after resistance training; 6.04/2.54 mm Hg after combined training; and 4.08/2.50 mm Hg after the high intensity interval.
“These results reflect our smaller scale trials and therefore we anticipated that isometric exercises would be largely effective,” he told Medscape Medical News Jamie O’Driscoll, Ph. D., of the Canterbury Christ Church University from Kent, in the United Kingdom. However, “the magnitude of the difference between isometric exercises and some other modalities was surprising.”
The study was published electronically on July 25 in British Journal of Sports Medicine.[1]
All modalities are effective
The researchers analyzed data from 270 randomized controlled trials involving 15,827 people, published between 1990 and February 2023. For consistency, protocol and intensity in each included study, it was cross-checked with the exercise prescription tool and EXPERT rehabilitative training, to define and categorize them.
All protocols were then stratified as aerobic exercise training, resistance training, combined training, high-intensity intervals, or isometric exercise training.
As appropriate, protocols were subsequently stratified into subgroups: aerobic exercise training included walking, running, and cycling; high-intensity interval training included sprint interval training and aerobic interval training; and isometric exercise training included isometric leg extension and isometric wall squat.
Healthy resting blood pressure was defined as less than 130/85 mm Hg, prehypertension as 130-139/85-89 mm Hg, and hypertension as 140/90 mm Hg or higher.
All exercise modalities led to statistically significant reductions in systolic blood pressure in the normal blood pressure cohorts; however, all reductions were substantially greater in individuals with hypertension.
Pairwise analyzes showed significant reductions in resting systolic and diastolic blood pressure after aerobic exercise training (-4.49/-2.53 mm Hg); resistance training (-4.55/-3.04 mm Hg), combination training (-6.04/-2.54 mm Hg), high intensity interval training (-4.08/-2.50 mm Hg); and training with isometric exercises (-8.24/-4.00 mm Hg).
In the network meta-analysis, the order of effectiveness for systolic blood pressure based on surface under the cumulative ranking curve (SUCRA) values was isometric exercise training (SUCRA: 98.3%), combined training (75, 7%), resistance training (46.1%), aerobic exercise training (40.5%) and high intensity intervals (39.4%).
Secondary network meta-analyses showed that isometric wall squat was the most effective submodality in reducing systolic blood pressure (90.4%), followed by isometric leg extension, isometric hand grip, cycling, running, training combined, sprint interval training, other aerobic exercises, resistance training, aerobic interval training and walking.
Running was the most effective submodality for reducing diastolic blood pressure (91.3%), followed by isometric wall squat, isometric hand grip, isometric leg extension, cycling, sprint interval training, resistance, aerobic interval training, other aerobic exercises, cross-training, and walking.
The authors acknowledged limitations, including variability in exercise interventions, missing data, variable quality of exercise monitoring and analyses, lack of blinding of group assignment, variable participant populations, and bias. of publication.
However, they concluded: “The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of high blood pressure.”
Change in the guides?
“There are numerous organizations involved in the provision and communication of exercise guidelines to the population,” including the World Health Organization (WHO), the American and European exercise guidelines, and the National Institute for Health and Care Excellence (NICE), O’Driscoll listed. “We are currently planning an international collaboration project with other world leaders in the field to develop this line of research.”
Additionally, the team is exploring prescribing isometric exercise training within the National Health Service from England and expanding the study to broader clinical populations.
In his comment to Medscape Medical News about the studyThe doctor. John A. Osborne, Ph. D., founder and director of State of the Heart Cardiology in Southlake, United States, said: “This study lends further credence that other forms of exercise, other than the commonly recommended aerobic exercise promulgated in previous guidelines, have significant value in lowering blood pressure and may potentially offer benefits.” even greater to… control hypertension.
“This study should inform contemporary non-pharmacological approaches to blood pressure control and allow healthcare professionals greater flexibility in different exercise strategies to combat hypertension,” said Dr. Osborne, a volunteer spokesperson for the American Heart Association.
That said, he added: “While this study in itself is extremely interesting, thoughtful and rigorously conducted, it should be used as a hypothesis generator and hopefully followed by direct comparison studies of aerobic exercise versus resistance training to confirm the findings.”
The study did not receive funding. O’Driscoll, Ph. D., and Dr. Osborne have disclosed no relevant financial relationships.
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