The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis

Hansford, Harrison J; Parmenter, Belinda; McLeod, Kelly A.; Wewege, Michael A; Smart, Neil A.; Schutte, Aletta E.; Jones, Matthew D

doi:10.1038/s41440-021-00720-3

Cited by 23 publications

(21 citation statements)

References 70 publications

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“…Similarly, a recently updated Exercise & Sport Science Australia (ESSA) position statement on exercise and hypertension recommends IRT as an adjunct antihypertensive therapy [ 52 ]. This is supported by a recent meta-analysis that shows no significant increase in risk when IRT is performed [ 53 ]. However, some guidelines do not mention IRT [ 17 , 23 , 26 , 54 , 55 ] or do not recommend it [ 24 , 25 ] as a result of the perceived acute increase in BP during exercise.…”

Section: Introductionsupporting

confidence: 54%

“…The results are also supported by Lopez-Valenciano et al [ 43 ] and Punia et al [ 86 ] concerning the potential use of IRT as an adjunct to lowering BP. Likewise, larger and more robust meta-analyses [ 42 , 44 ] and current empirical studies [ 45 , 46 , 53 , 59 – 61 ] demonstrate the safety and effectiveness of IRT in preventing hypertension. In addition, the findings show that the set of items is comprehensive, as the panelists suggested no additional items.…”

Section: Discussionmentioning

confidence: 97%

“…More importantly, an official document of the American College of Sports Medicine, recently published by Pescatello et al [ 58 ], suggested that there is no conclusive evidence for the antihypertensive benefit of IRT, basing this statement solely on a previous meta-analysis [ 41 ]. There are more recent and robust meta-analyses [ 42 , 44 ] as well as several recent empirical studies [ 45 , 46 , 53 , 59 , 60 ] that demonstrate the safety and effectiveness of IRT in managing hypertension. Similarly, recent work by Fu et al [ 61 ] identified IRT as an effective antihypertensive therapy.…”

Section: Introductionmentioning

confidence: 99%

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Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study

et al. 2022

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Uncontrolled hypertension remains the major risk factor for cardiovascular disease. Isometric resistance training (IRT) has been shown to be a useful nonpharmacological therapy for reducing blood pressure (BP); however, some exercise physiologists and other health professionals are uncertain of the efficacy and safety of IRT. Experts’ consensus was sought in light of the current variability of IRT use as an adjunct treatment for hypertension. An expert consensus-building analysis (Delphi study) was conducted on items relevant to the safety, efficacy and delivery of IRT. The study consisted of 3 phases: (1) identification of items and expert participants for inclusion; (2) a two-round modified Delphi exercise involving expert panelists to build consensus; and (3) a study team consensus meeting for a final item review. A list of 50 items was generated, and 42 international experts were invited to join the Delphi panel. Thirteen and 10 experts completed Delphi Rounds 1 and 2, respectively, reaching consensus on 26 items in Round 1 and 10 items in Round 2. The study team consensus meeting conducted a final item review and considered the remaining 14 items for the content list. A final list of 43 items regarding IRT reached expert consensus: 7/10 items on safety, 11/11 items on efficacy, 10/12 items on programming, 8/10 items on delivery, and 7/7 on the mechanism of action. This study highlights that while experts reached a consensus that IRT is efficacious as an antihypertensive therapy, some still have safety concerns, and there is also ongoing conjecture regarding optimal delivery.

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Section: Introductionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study

et al. 2022

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“…We examined baseline imbalance for the outcomes of SBP, DBP, and age. We selected SBP and DBP because we observed baseline imbalance in these variables in our previous review, and they are often the primary outcomes in the management of hypertension [ 11 ]. We also selected age because it is a commonly reported variable, and an imbalance in this variable has been noted in previous research from other fields [ 2 , 17 ].…”

Section: Methodsmentioning

confidence: 99%

“…Recently, we observed baseline imbalance in our meta-analysis examining the antihypertensive effects of isometric exercise compared to nonexercise controls in adults with elevated blood pressure [ 11 ]. The pooled baseline systolic blood pressure (SBP) was 4.78 mmHg higher (95% CI 4.03 to 5.52) in the exercise group than the control group, and the pooled baseline diastolic blood pressure (DBP) was 5.48 mmHg higher (95% CI 5.10 to 5.68) in the exercise group than the control group.…”

Section: Introductionmentioning

confidence: 99%

Baseline imbalance and heterogeneity are present in meta-analyses of randomized clinical trials examining the effects of exercise and medicines for blood pressure management

et al. 2022

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Randomized clinical trials attempt to reduce bias and create similar groups at baseline to infer causal effects. In meta-analyses, baseline imbalance may threaten the validity of the treatment effects. This meta-epidemiological study examined baseline imbalance in comparisons of exercise and antihypertensive medicines. Baseline data for systolic blood pressure, diastolic blood pressure, and age were extracted from a network meta-analysis of 391 randomized trials comparing exercise types and antihypertensive medicines. Fixed-effect meta-analyses were used to determine the presence of baseline imbalance and/or inconsistency. Meta-regression analyses were conducted on sample size, the risk of bias for allocation concealment, and whether data for all randomized participants were presented at baseline. In one exercise comparison, the resistance group was 0.3 years younger than the control group (95% confidence interval 0.6 to 0.1). Substantial inconsistency was observed in other exercise comparisons. Less data were available for medicines, but there were no occurrences of baseline imbalance and only a few instances of inconsistency. Several moderator analyses identified significant associations. We identified baseline imbalance as well as substantial inconsistency in exercise comparisons. Researchers should consider conducting meta-analyses of key prognostic variables at baseline to ensure balance across trials.

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Increasing muscular strength to improve cardiometabolic risk factors

López‐Jaramillo

López‐López

Tole

et al. 2023

Clínica e Investigación en Arteriosclerosis (English Edition)

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The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis

Cited by 23 publications

References 70 publications

Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study

Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study

Baseline imbalance and heterogeneity are present in meta-analyses of randomized clinical trials examining the effects of exercise and medicines for blood pressure management

Increasing muscular strength to improve cardiometabolic risk factors

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