Effects of exercise training on blood pressure : an overview of reviews

Abstract

ABSTRACT: Background: This overview of reviews aimed to identify, appraise, and synthesize findings from high-quality systematic reviews on the benefits and harms of different exercise training modalities on blood pressure in adults who either are normotensive, pre-hypertensive, or have high blood pressure. Methods: This review was reported according to the PRISMA Statement. We searched MEDLINE, EMBASE, Epistemonikos, and PROSPERO to identify systematic reviews of randomized controlled trials (RCTs) in adults diagnosed with high blood pressure, other diseases, or cardiovascular risk factors, that compared exercise training with either active interventions or no exercise. Our major outcomes were blood pressure and adverse events. Pairs of reviewers independently screened the systematic reviews for inclusion, extracted data, and appraised the methodological quality. We assessed the certainty of the evidence by using the GRADE approach. Results: We included seventeen reviews, who reported on 17 comparisons (290 RCTs; 19 232 adults). Any aerobic training probably resulted in a large reduction in SBP in adults with either type II diabetes, metabolic syndrome, end-stage renal disease, or kidney transplantation at short to long-term follow-up (moderate-certainty evidence). Walking aerobic training probably resulted in a large reduction in DBP at short to long-term follow-up in adults with high blood pressure (moderate-certainty evidence). Combined training probably resulted in a large reduction in DBP in adults who either are normotensive, or have high blood pressure, kidney failure, metabolic syndrome, or end-stage renal disease at short to long-term follow-up (moderate-certainty evidence). The body of evidence for the remaining comparisons was rated as low to very low. Eight reviews provided little to no information on safety data. Discussion: We found very low to moderate evidence supporting the benefits of exercise training compared with no interventions or placebo for blood pressure in adults with or without comorbidities or risk factors. Scarce safety data were identified. Our certainty in the evidence was downgraded due to methodological limitations, inconsistency, and imprecision. Before drawing more solid conclusions, further well-conducted and well-reported randomized controlled trials are warranted in order to strengthen the evidence base underlying this research question.