Dynamic Resistance Training as Stand‐Alone Antihypertensive Lifestyle Therapy: A Meta‐Analysis

Abstract

BackgroundAerobic exercise (AE) is recommended as first‐line antihypertensive lifestyle therapy based on strong evidence showing that it lowers blood pressure (BP) 5 to 7 mm Hg among adults with hypertension. Because of weaker evidence showing that dynamic resistance training (RT) reduces BP 2 to 3 mm Hg among adults with hypertension, it is recommended as adjuvant lifestyle therapy to AE training. Yet, existing evidence suggests that dynamic RT can lower BP as much or more than AE.Methods and ResultsWe meta‐analyzed 64 controlled studies (71 interventions) to determine the efficacy of dynamic RT as stand‐alone antihypertensive therapy. Participants (N=2344) were white (57%), middle‐aged (47.2±19.0 years), and overweight (26.8±3.4 kg/m2) adults with prehypertension (126.7±10.3/76.8±8.7 mm Hg); 15% were on antihypertensive medication. Overall, moderate‐intensity dynamic RT was performed 2.8±0.6 days/week for 14.4±7.9 weeks and elicited small‐to‐moderate reductions in systolic BP (SBP; d+=−0.31; 95% CIs, −0.43, −0.19; −3.0 mm Hg) and diastolic BP (DBP; d+=−0.30; 95% CIs, −0.38, −0.18; −2.1 mm Hg) compared to controls (Ps<0.001). Greater BP reductions occurred among samples with higher resting SBP/DBP: ≈6/5 mm Hg for hypertension, ≈3/3 mm Hg for prehypertension, and ≈0/1 mm Hg for normal BP (Ps<0.023). Furthermore, nonwhite samples with hypertension experienced BP reductions that were approximately twice the magnitude of those previously reported following AE training (−14.3 mm Hg [95% CIs, −19.0, −9.4]/−10.3 mm Hg [95% CIs, −14.5, −6.2]).ConclusionsOur results indicate that for nonwhite adult samples with hypertension, dynamic RT may elicit BP reductions that are comparable to or greater than those reportedly achieved with AE training. Dynamic RT should be further investigated as a viable stand‐alone therapeutic exercise option for adult populations with high BP.

Can Exercise Improve Cognitive Symptoms of Alzheimer's Disease?

“…The standardized mean difference effect size ( d ) was used to quantify the influence of exercise on cognitive function in adults at risk of or diagnosed with AD and has been described previously . Briefly, d values were calculated for exercise and control within‐group comparisons and exercise versus control between‐group comparisons, correcting for small sample size bias and, for the between‐group comparisons only, baseline differences . Multiple d values were calculated for 4 studies that involved more than 1 exercise intervention group (e.g., aerobic exercise training vs resistance training) and analyzed as independent studies .…”

“…In addition, 2 studies that reported AD severity reported mild to severe AD, indicating a range of AD severity in their sample, and only 4 studies clearly indicated a sample with mild to moderate (k = 3) or severe (k = 1) AD. The moving constant technique was applied to estimate the magnitude of weighted mean effect sizes (d + ) and their CIs at different levels of interest for individual study–level moderators, including extreme values and other observations, within that range (see references for greater detail). Effects of continuous variables were held constant at their sample means by mean‐centering them and for categorical variables using contrast codes …”

Increased Muscle Mass Protects Against Hypertension and Renal Injury in Obesity

“…Exercise has been long documented to improve blood pressure in obese individuals, even in the absence of weight loss 31, 32, 33. In 2004, studies from our institution indicated that blood pressure control, specifically recovery of poststress pressor increases, was correlated with high lean body mass in overweight subjects, arguing the skeletal muscle was an unappreciated determination of blood pressure control 34.…”

Pathophysiological mechanisms underlying the beneficial effects of physical activity in hypertension

“…Several studies demonstrate that the effects of physical exercise on blood pressure are dose‐dependent . Moreover, the beneficial effects depend on the type of exercise training . Importantly, resistance training is contraindicated in the presence of instable cardiovascular conditions, including uncontrolled severe hypertension .…”

“…[49][50][51] Moreover, the beneficial effects depend on the type of exercise training. [52][53][54][55][56][57][58] Importantly, resistance training is contraindicated in the presence of instable cardiovascular conditions, including uncontrolled severe hypertension. 59,60 Therefore, it is imperative to emphasize that a specific training plan including the specific type and dose of exercise training has to be delineated for each individual.…”