Influence of Modality on the Antihypertensive Effects of Exercise: A Meta-Analysis

The general consensus is that aerobic exercise training (AET) and dynamic resistance training (RT) lowers blood pressure (BP) 5-7 and 2-3 mmHg among adults with hypertension. However, there is significant variability in the BP response to exercise, ranging from ~0-9 mmHg. Patient and exercise characteristics may explain these differences; yet, what patient profile and exercise features elicits optimal BP benefit remains unclear. Therefore, we performed two high-quality meta-analyses to determine the effectiveness of AET and RT as stand-alone antihypertensive therapy and identify what patient profile and exercise ‘dose’ elicited optimal BP-benefit. Methods: 84 and 64 controlled AET and RT trials were analyzed following random-effects assumptions. Results: White, middle-aged, overweight adults with prehypertension that performed AET and RT ~3-4d·wk-1 for 14-18wks reduced systolic BP (SBP)/diastolic BP (DBP) ~4/3 and ~3/2 mmHg versus controls (ps<0.01). Greater BP reductions occurred among AET and RT samples with higher resting BP: ~7/6 and ~6/5 mmHg for hypertension, ~5/4 and ~3/3 mmHg for prehypertension, ~3/1 and ~0/1 mmHg for normal BP (ps≤0.03). AET reduced BP to the greatest extent among non-White samples with hypertension that achieved large fitness gains and performed high AET volume (‑12.0/-12.2 mmHg), twice the magnitude among White samples (‑6.8/-6.3 mmHg). RT reduced BP to the greatest extent among non-White samples with hypertension (‑14.3/‑10.3 mmHg). Discussion: These results highlight the critical need for more precise exercise prescriptions that maximize the effectiveness of AET and RT as viable stand-alone or combined antihypertensive therapeutic exercise options among racially/ethnically diverse samples with hypertension.