Evidence Summary
A meta-analysis conducted in 2021 examined the impact of exercise intervention programs on selected cardiometabolic health indicators including blood pressure. Of the fifty-four articles included thirty-six studies with 1334 subjects in the experimental groups, and 942 subjects in the control groups. The authors found that exercise training programs were effective in reducing systolic blood pressure (MD: −2.95 mmHg [95% CI: −4.22, −1.68], p < 0.00001, I2 = 63%). The authors noted that the decrease in blood pressure appeared to be larger in subjects with hypertension compared with normotensive patients, reaching on average 3 mmHg versus a nonsignificant effect. The authors did not distinguish between overweight and obese patients in the analysis. [1]
A randomised control trial with 404 participants was published in 2012 and aimed to determine the effect of different doses of aerobic exercise training on exercise blood pressure in obese post menopausal women with elevated blood pressure. [2] It was observed that 6 months of aerobic exercise training resulted in a statistically significant reduction in systolic blood pressure compared to control at 50 watts stage of a cycle ergometer maximal exercise test. Resting blood pressure was not altered following any exercise intervention compared to control.
3 studies were published in 2019 and the largest involved 67 sedentary older obese adults . The authors found that morning exercise reduces BP during a period of 8 hours in older overweight/obese adults compared with prolonged sitting. [3] It was concluded that combining exercise with regular breaks in sitting may be of more benefit for lowering BP in women than in men. A randomised control trial involving 28 overweight or obese older women observed a statistically significant reduction in the diastolic blood pressure of participants who undertook a 12 week supervised exercise training at maximal fat oxidation intensity when compared to the control group. [4] One study involving 32 college students with obesity found a non-statistically significant reduction in blood pressure after an 8 week walking group with or without exercise compared to control. [5]
A 2017 randomised control crossover trial involving 27 middle aged obese prehypertensive adults demonstrated a statistically significant reduction in blood pressure following aerobic exercise versus control, but not after isometric hand grip resistance versus control. [6]
Quality of Evidence
B- Evidence from randomised controlled trials has limitations such as inconsistency of findings and concerns about quality
Strength of recommendation
1-On the basis of the existing evidence, clinical opinion is that all or most patients will be best served by following this piece of evidence
Conclusion
Exercise interventions probably result in an improvement in blood pressure for patients with obesity. There is a larger evidence base for the role of exercise to reduce blood pressure for obese women than men and a suggestion that combining exercise with regular breaks in sitting may be of more benefit for lowering BP in women than in men. It is unclear what form of exercise intervention will achieve the greatest improvement in blood pressure for obese individuals.
References
- Battista, F., Ermolao, A., van Baak, M. A., Beaulieu, K., Blundell, J. E., Busetto, L., … & Oppert, J. M. (2021). Effect of exercise on cardiometabolic health of adults with overweight or obesity: Focus on blood pressure, insulin resistance, and intrahepatic fat—A systematic review and meta‐analysis. Obesity Reviews, 22, e13269.
- Swift, D. L., Earnest, C. P., Katzmarzyk, P. T., Rankinen, T., Blair, S. N., & Church, T. S. (2012). The effect of different doses of aerobic exercise training on exercise blood pressure in overweight and obese postmenopausal women. Menopause (New York, N.Y.), 19(5), 503–509. https://doi.org/10.1097/gme.0b013e318238ea66
- Wheeler, M. J., Dunstan, D. W., Ellis, K. A., Cerin, E., Phillips, S., Lambert, G., Naylor, L. H., Dempsey, P. C., Kingwell, B. A., Green, D. G. (2019). Effect of Morning Exercise With or Without Breaks in Prolonged Sitting on Blood Pressure in Older Overweight/Obese Adults. Hypertension. 2019 Apr;73(4):859-867. doi: 10.1161/HYPERTENSIONAHA.118.12373.
- Cao, L., Jiang, Y., Li, Q., Wang, J., & Tan, S. (2019). Exercise Training at Maximal Fat Oxidation Intensity for Overweight or Obese Older Women: A Randomized Study. Journal of sports science & medicine, 18(3), 413–418.
- Chiang TL, Chen C, Hsu CH, Lin YC, Wu HJ. Is the goal of 12,000 steps per day sufficient for improving body composition and metabolic syndrome? The necessity of combining exercise intensity: a randomized controlled trial. BMC Public Health. 2019 Sep 3;19(1):1215. doi: 10.1186/s12889-019-7554-y. PMID: 31481039; PMCID: PMC6724241.
- Ash, G. I., Taylor, B. A., Thompson, P. D., Macdonald, H. V., Lamberti, L., Chen, M., Farinatti, P., Kraemer, W. J., Panza, G. A., Zaleski, A. L., Deshpande, V., Ballard, K. D., Mujtaba, M., White, M., Pescatello, L. S. (2017). The antihypertensive effects of aerobic versus isometric handgrip resistance exercise. J Hypertens. 2017 Feb;35(2):291-299. doi: 10.1097/HJH.0000000000001176.