Hayley V. MacDonald

Exercise for Hypertension: A Prescription Update Integrating Existing Recommendations with Emerging Research

Hypertension is the most common, costly, and preventable cardiovascular disease risk factor. Numerous professional organizations and committees recommend exercise as initial lifestyle therapy to prevent, treat, and control hypertension. Yet, these recommendations differ in the components of the Frequency, Intensity, Time, and Type (FITT) principle of exercise prescription (Ex Rx); the evidence upon which they are based is only of fair methodological quality; and the individual studies upon which they are based generally do not include people with hypertension, which are some of the limitations in this literature. The purposes of this review are to (1) overview the professional exercise recommendations for hypertension in terms of the FITT principle of Ex Rx; (2) discuss new and emerging research related to Ex Rx for hypertension; and (3) present an updated FITT Ex Rx for adults with hypertension that integrates the existing recommendations with this new and emerging research.

Methodological quality of meta-analyses on the blood pressure response to exercise: a review.

&NA; Numerous meta-analyses have been conducted to summarize the growing numbers of trials addressing the effects of exercise on blood pressure (BP), yet it is unclear how well they have satisfied contemporary methodological standards. We applied an augmented version of the Assessment of Multiple Systematic Reviews (AMSTARExBP) scale to 33 meta-analyses retrieved from searches of electronic databases. Qualifying reports used meta-analytic procedures; examined controlled exercise training trials; had BP as a primary outcome; and had exercise or physical activity interventions independently or combined with other lifestyle interventions. AMSTARExBP scores averaged near the middle of the scale (Mean = 56.0% ± 21.4% of total items possible); co-authored and more recent meta-analyses had higher quality scores. Common deficits were failures to disclose full search details (30% did), gauge the quality of included trials (48% did), use duplicate study selection and data extraction (55% did), or incorporate study quality in formulating results (35% did). Nearly all (91%) meta-analyses observed that exercise significantly lowered BP; fewer (58%) found that such effects depended on exercise or patient characteristics but these patterns often conflicted. Meta-analyses are often pillars of clinical recommendations and guidelines, yet only 58% addressed the clinical translations of their findings. In sum, meta-analyses have contributed less than ideally to our understanding of how exercise may impact BP, or how these BP effects may be moderated by patient or exercise characteristics. Future meta-analyses that better satisfy contemporary standards offer considerable promise to understand how and for whom exercise impacts BP. Video abstract http://links.lww.com/HJH/A368

Panning for the gold in health research: incorporating studies' methodological quality in meta-analysis.

Background: Systematic reviews now routinely assess methodological quality to gauge the validity of the included studies and of the synthesis as a whole. Although trends from higher quality studies should be clearer, it is uncertain how often meta-analyses incorporate methodological quality in models of study results either as predictors, or, more interestingly, in interactions with theoretical moderators. Objective and methods: We survey 200 meta-analyses in three health promotion domains to examine when and how meta-analyses incorporate methodological quality. Results: Although methodological quality assessments commonly appear in contemporary meta-analyses (usually as scales), they are rarely incorporated in analyses, and still more rarely analysed in interaction with theoretical determinants of the success of health promotions. The few meta-analyses (2.5%) that did include such an interaction analysis showed that moderator results remained significant in higher quality studies or were present only among higher quality studies. We describe how to model quality interactively with theoretically derived moderators and discuss strengths and weaknesses of this approach and in relation to current meta-analytic practice. Conclusions: In large literatures exhibiting heterogeneous effects, meta-analyses can incorporate methodological quality and generate conclusions that enable greater confidence not only about the substantive phenomenon but also about the role that methodological quality itself plays.

Antihypertensive Effects of Exercise Among Those With Resistant Hypertension

Dimeo et al1 tested the hypothesis that aerobic exercise training reduces ambulatory blood pressure (ABP) among individuals with resistant hypertension and found that daytime systolic (6 mm Hg) and diastolic (3 mm Hg) ABPs were reduced after an 8- to 12-week aerobic exercise training program. Their findings indicate that exercise is effective antihypertensive therapy in a clinical population that is not responsive to drug therapy. Nonetheless, they should be interpreted with caution for the reasons below. Daytime ABP was the primary outcome. A complete description of the ABP methods including the timing when ABP was taken and procedures for handling missing …

Is Concurrent Training Efficacious Antihypertensive Therapy? A Meta-analysis.

: Aerobic exercise training and, to a lesser degree, dynamic resistance training, are recommended to lower blood pressure (BP) among adults with hypertension. Yet the combined influence of these exercise modalities, termed concurrent exercise training (CET), on resting BP is unclear. PURPOSE This study aimed to meta-analyze the literature to determine the efficacy of CET as antihypertensive therapy. METHODS Electronic databases were searched for trials that included the following: adults (>19 yr), controlled CET interventions, and BP measured pre- and postintervention. Study quality was assessed with a modified Downs and Black Checklist. Analyses incorporated random-effects assumptions. RESULTS Sixty-eight trials yielded 76 interventions. Subjects (N = 4110) were middle- to older-age (55.8 ± 14.4 yr), were overweight (28.0 ± 3.6 kg·m), and had prehypertension (systolic BP [SBP]/diastolic BP [DBP] = 134.6 ± 10.9/80.7 ± 7.5 mm Hg). CET was performed at moderate intensity (aerobic = 55% maximal oxygen consumption, resistance = 60% one-repetition maximum), 2.9 ± 0.7 d·wk for 58.3 ± 20.1 min per session for 19.7 ± 17.8 wk. Studies were of moderate quality, satisfying 60.7% ± 9.4% of quality items. Overall, CET moderately reduced SBP (db = -0.32, 95% confidence interval [CI] = -0.44 to -0.20, -3.2 mm Hg) and DBP (db = -0.35, 95% CI = -0.47 to -0.22, -2.5 mm Hg) versus control (P < 0.01). However, greater SBP/DBP reductions were observed among samples with hypertension in trials of higher study quality that also examined BP as the primary outcome (-9.2 mm Hg [95% CI = -12.0 to -8.0]/-7.7 mm Hg [95% CI = -14.0 to -8.0]). CONCLUSIONS Among samples with hypertension in trials of higher study quality, CET rivals aerobic exercise training as antihypertensive therapy. Because of the moderate quality of this literature, additional randomized controlled CET trials that examine BP as a primary outcome among samples with hypertension are warranted to confirm our promising findings.

The antihypertensive effects of aerobic versus isometric handgrip resistance exercise

Background: Aerobic exercise reduces blood pressure (BP) on average 5–7 mmHg among those with hypertension; limited evidence suggests similar or even greater BP benefits may result from isometric handgrip (IHG) resistance exercise. Method: We conducted a randomized controlled trial investigating the antihypertensive effects of an acute bout of aerobic compared with IHG exercise in the same individuals. Middle-aged adults (n = 27) with prehypertension and obesity randomly completed three experiments: aerobic (60% peak oxygen uptake, 30 min); IHG (30% maximum voluntary contraction, 4 × 2 min bilateral); and nonexercise control. Study participants were assessed for carotid-femoral pulse wave velocity pre and post exercise, and left the laboratory wearing an ambulatory BP monitor. Results: SBP and DBP were lower after aerobic versus IHG (4.8 ± 1.8/3.1 ± 1.3 mmHg, P = 0.01/0.04) and control (5.6 ± 1.8/3.6 ± 1.3 mmHg, P = 0.02/0.04) over the awake hours, with no difference between IHG versus control (P = 0.80/0.83). Pulse wave velocity changes following acute exercise did not differ by modality (aerobic increased 0.01 ± 0.21 ms, IHG decreased 0.06 ± 0.15 ms, control increased 0.25 ± 0.17 ms, P > 0.05). A subset of participants then completed either 8 weeks of aerobic or IHG training. Awake SBP was lower after versus before aerobic training (7.6 ± 3.1 mmHg, P = 0.02), whereas sleep DBP was higher after IHG training (7.7 ± 2.3 mmHg, P = 0.02). Conclusion: Our findings did not support IHG as antihypertensive therapy but that aerobic exercise should continue to be recommended as the primary exercise modality for its immediate and sustained BP benefits.

The Effects of Aerobic Exercise on Hypertension: Current Consensus and Emerging Research

Hypertension is one of the most important cardiovascular disease risk factors due to its high prevalence and significant medical costs. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the American College of Sports Medicine recommend lifestyle modifications such as habitual physical activity as initial therapy to prevent, treat, and control hypertension. The purposes of this chapter are to: (1) overview the current consensus on the effects of acute (immediate, short-term, or postexercise hypotension) and chronic (long-term or training) aerobic exercise on blood pressure among individuals with hypertension; (2) discuss new and emerging research on the effects of acute and chronic aerobic exercise on blood pressure that has the potential to alter the way in which aerobic exercise is prescribed to prevent, treat, and control hypertension in the future; and (3) present exercise prescription recommendations and special considerations for individuals with hypertension that consider this new and emerging research.

Evaluating exercise prescription and instructional methods used in tai chi studies aimed at improving balance in older adults: a systematic review

To develop an evaluation instrument to determine to what extent Tai Chi interventions aimed at improving the balance of older adults disclosed their exercise prescription (Ex Rx) and instructional methods and met best‐practice exercise recommendations for balance improvement.

Effects of Concurrent Exercise on Hypertension: Current Consensus and Emerging Research

Hypertension is one of the most important cardiovascular disease risk factors due to its high prevalence and significant medical costs. The Eighth Report of the Joint National Committee guideline on the management of adult hypertension and the American College of Sports Medicine recommend aerobic exercise supplemented by dynamic resistance training as initial therapy to prevent, treat, and control hypertension despite the lack of clear recommendations on how to perform these exercises in combination, which is termed concurrent exercise. The purposes of this chapter are: (1) to overview the literature about the effects of acute (immediate, short-term, or postexercise hypotension) and chronic (long-term or training) concurrent exercise on blood pressure among individuals with hypertension; (2) to evaluate how the existing, new, and emerging research regarding acute and chronic concurrent exercise may alter the way in which exercise programs are designed to prevent, treat, and control hypertension in the future; and (3) to present formal recommendations and special considerations of the concurrent exercise prescription for individuals with hypertension that considers the current and emergent research for this exercise modality as antihypertensive therapy.