Advertisement

Running to Lower Resting Blood Pressure: A Systematic Review and Meta-analysis

  • Yutaka IgarashiEmail author
  • Yoshie Nogami
Systematic Review

Abstract

Background

According to previous epidemiological studies, there are pros and cons for the relationship between running regularly and changes in resting blood pressure (RBP), and the changes may depend on the form of exercise.

Objective

The aims of the current systematic review were to summarize the effects of running regularly on RBP and to investigate the most efficacious form of running in reducing RBP for this purpose.

Methods

The inclusion criteria were: randomized controlled trials, involving healthy adults or adults with hypertension, the exercise group only performed regular running and the control group did not exercise, and the study reported the mean resting systolic blood pressure (RSBP) and/or diastolic blood pressure (RDBP). The mean difference (MD) in RBP in each trial was defined as follows: (mean value at post-intervention in the exercise group − mean value at baseline in the exercise group) − (mean value at post-intervention in the control group − mean value at baseline in the control group) and was calculated. The weighted MD (WMD) was defined as the synthesis of all MD. A linear meta-regression analysis, exercise intensity [the percentage of maximum heart rate] (%) and total exercise time throughout the intervention (hours) were selected as explanatory variables and the MD in RBP served as the objective variable.

Results

Twenty-two trials (736 subjects) were analyzed. When trials were limited to those involving healthy subjects, the WMD in RBP decreased significantly [RSBP: − 4.2 mmHg (95% confidence intervals (95% CI) − 5.9 to − 2.4); RDBP: − 2.7 mmHg (95% CI − 4.2 to − 1.1)] and did not contain significant heterogeneity (RSBP: P = 0.67, I2 = 0.0%; DBP: P = 0.38, I2 = 7.2%). When trials were limited to those involving subjects with hypertension, the WMD in RBP decreased significantly [RSBP: − 5.6 mmHg (95% CI − 9.1 to − 2.1); RDBP: − 5.2 mmHg (95% CI − 9.0 to − 1.4)] but contained significant heterogeneity (RSBP: P = 0.01, I2 = 62.2%; DBP: P < 0.01, I2 = 87.7) and a meta-regression analysis showed that the percentage of maximum heart rate was significantly associated with the WMD in RSBP [slope: 0.56 (95% CI 0.21 to 0.92), intercept: − 48.76 (95% CI − 76.30 to − 21.22), R2 = 0.88] and RDBP [slope: 0.45 (95% CI 0.01 to 0.87), intercept: − 38.06 (95% CI − 72.30 to − 4.08), R2 = 0.41]. When trials were limited to those involving subjects with hypertension and a mean age ≥ 40 years, a meta-regression analysis showed that total exercise time throughout the intervention was significantly associated with the WMD in RDBP [slope: 0.82 (95% CI 0.54 to 1.09), intercept: − 22.90 (95% CI − 29.04 to − 16.77), R2 = 0.99].

Conclusions

Running regularly decreases RBP, but the changes in subjects with hypertension may differ depending on exercise intensity or total exercise time. Therefore, running regularly at moderate intensity and at a restrained volume is recommended to lower RBP in subjects with hypertension.

Notes

Acknowledgements

The authors wish to sincerely thank the staff of Osaka University of Health and Sports Sciences Library for collecting the articles used in this analysis and to thank the staff of International Studies Library in Osaka University, National Institute of Public Health, and Chukyo University Library for facilitating a search of the literature in electronic databases.

Compliance with Ethical Standards

Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Yutaka Igarashi and Yoshie Nogami have no conflicts of interest relevant to the content of this article.

Supplementary material

40279_2019_1209_MOESM1_ESM.pdf (382 kb)
Supplementary material 1 (PDF 381 kb)

References

  1. 1.
    Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011–2012. NCHS Data Brief. 2013;133:1–8.Google Scholar
  2. 2.
    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Kokubo Y. Prevention of hypertension and cardiovascular diseases: a comparison of lifestyle factors in Westerners and East Asians. Hypertension. 2014;63:655–60.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Carey RM, Muntner P, Bosworth HB, Whelton PK. Prevention and control of hypertension: JACC Health Promotion Series. J Am Coll Cardiol. 2018;72:1278–93.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens. 2006;24:215–33.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2001;38:1112–7.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Graudal NA, Hubeck-Graudal T, Jürgens G. Effects of low-sodium diet vs. high-sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride (cochrane review). Am J Hypertens. 2012;25:1–15.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Murtagh EM, Nichols L, Mohammed MA, Holder R, Nevill AM, Murphy MH. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med. 2015;72:34–43.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Igarashi Y, Akazawa N, Maeda S. The required step count for a reduction in blood pressure: a systematic review and meta-analysis. J Hum Hypertens. 2018;32:814–24.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Oja P, Kelly P, Murtagh EM, Murphy MH, Foster C, Titze S. Effects of frequency, intensity, duration and volume of walking interventions on CVD risk factors: a systematic review and meta-regression analysis of randomised controlled trials among inactive healthy adults. Br J Sports Med. 2018;52:769–75.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension. 2011;58:950–8.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Igarashi Y, Nogami Y. The effect of regular aquatic exercise on blood pressure: a meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2018;25:190–9.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Igarashi Y, Akazawa N, Maeda S. Regular aerobic exercise and blood pressure in East Asians: a meta-analysis of randomized controlled trials. Clin Exp Hypertens. 2018;40:378–89.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136:493–503.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Manfredini F, Malagoni AM, Mandini S, Boari B, Felisatti M, et al. Sport therapy for hypertension: why, how, and how much? Angiology. 2009;60:207–16.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, et al. 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–81.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Stamatakis E, Chaudhury M. Temporal trends in adults’ sports participation patterns in England between 1997 and 2006: the Health Survey for England. Br J Sports Med. 2008;42:901–8.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Juraschek SP, Blaha MJ, Whelton SP, Blumenthal R, Jones SR, et al. Physical fitness and hypertension in a population at risk for cardiovascular disease: the Henry Ford ExercIse Testing (FIT) Project. J Am Heart Assoc. 2014.  https://doi.org/10.1161/JAHA.114.001268.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Williams PT, Thompson PD. Walking versus running for hypertension, cholesterol, and diabetes mellitus risk reduction. Arterioscler Thromb Vasc Biol. 2013;33:1085–91.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Pressler A, Suchy C, Friedrichs T, Dallinger S, Grabs V, et al. Running multiple marathons is not a risk factor for premature subclinical vascular impairment. Eur J Prev Cardiol. 2017;24:1328–35.PubMedCrossRefGoogle Scholar
  21. 21.
    Morrison BN, McKinney J, Isserow S, Lithwick D, Taunton J, et al. Assessment of cardiovascular risk and preparticipation screening protocols in masters athletes: the Master Athlete Screening Study (MASS): a cross-sectional study. BMJ Open Sport Exerc Med. 2018.  https://doi.org/10.1136/bmjsem-2018-000370.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Schnohr P, O’Keefe JH, Marott JL, Lange P, Jensen GB. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. 2015;65:411–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Lee DC, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol. 2014;64:472–81.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Kikuchi H, Inoue S, Lee IM, Odagiri Y, Sawada N, et al. Impact of moderate-intensity and vigorous-intensity physical activity on mortality. Med Sci Sports Exerc. 2018;50:715–21.PubMedCrossRefGoogle Scholar
  25. 25.
    Lavie CJ, Lee DC, Sui X, Arena R, O’Keefe JH, et al. Effects of running on chronic diseases and cardiovascular and all-cause mortality. Mayo Clin Proc. 2015;90:1541–52.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Lee DC, Brellenthin AG, Thompson PD, Sui X, Lee IM, Lavie CJ. Running as a key lifestyle medicine for longevity. Prog Cardiovasc Dis. 2017;60:45–55.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Hespanhol Junior LC, Pillay JD, van Mechelen W, Verhagen E. Meta-analyses of the effects of habitual running on indices of health in physically inactive adults. Sports Med. 2015;45:1455–68.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.CrossRefGoogle Scholar
  29. 29.
    University of York, Centre for reviews and dissemination. PROSPERO: international prospective register of systematic reviews. 2011. https://www.crd.york.ac.uk/prospero/. Accessed 25 Jan 2019.
  30. 30.
    Cochrane Skin Group. Data collection forms for intervention reviews: RCTs only, version 3. 2014. https://skin.cochrane.org/resources. Accessed 15 May 2019.
  31. 31.
    Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. 2011. http://handbook.cochrane.org/. Accessed 25 Jan 2019.
  32. 32.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992;45:769–73.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Londeree BR, Ames SA. Trend analysis of the % VO2 max-HR regression. Med Sci Sports. 1976;8:123–5.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Kelley GA, Kelley KS. Statistical models for meta-analysis: a brief tutorial. World J Methodol. 2012;2:27–32.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455–63.PubMedCrossRefGoogle Scholar
  39. 39.
    Mathur DN, Toriola AL. Twelve weeks jogging effects on selected cardiovascular risk factors in untrained healthy males. J Sports Med Phys Fitness. 1984;24:259–62.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Duncan JJ, Farr JE, Upton SJ, Hagan RD, Oglesby ME, Blair SN. The effects of aerobic exercise on plasma catecholamines and blood pressure in patients with mild essential hypertension. JAMA. 1985;254(18):2609–13.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Suter E, Marti B, Tschopp A, Wanner HU, Wenk C, Gutzwiller F. Effects of self-monitored jogging on physical fitness, blood pressure and serum lipids: a controlled study in sedentary middle-aged men. Int J Sports Med. 1990;11:425–32.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Blumenthal JA, Siegel WC, Appelbaum M. Failure of exercise to reduce blood pressure in patients with mild hypertension Results of a randomized controlled trial. JAMA. 1991;266:2098–104.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Albright CL, King AC, Taylor CB, Haskell WL. Effect of a six-month aerobic exercise training program on cardiovascular responsivity in healthy middle-aged adults. J Psychosom Res. 1992;36:25–36.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Rogers MW, Probst MM, Gruber JJ, Berger R, Boone JB Jr. Differential effects of exercise training intensity on blood pressure and cardiovascular responses to stress in borderline hypertensive humans. J Hypertens. 1996;14:1369–75.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Tsai JC, Chang WY, Kao CC, Lu MS, Chen YJ, Chan P. Beneficial effect on blood pressure and lipid profile by programmed exercise training in Taiwanese patients with mild hypertension. Clin Exp Hypertens. 2002;24:315–24.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Tsai JC, Liu JC, Kao CC, Tomlinson B, Kao PF, et al. Beneficial effects on blood pressure and lipid profile of programmed exercise training in subjects with white coat hypertension. Am J Hypertens. 2002;15:571–6.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Tsai JC, Yang HY, Wang WH, Hsieh MH, Chen PT, et al. The beneficial effect of regular endurance exercise training on blood pressure and quality of life in patients with hypertension. Clin Exp Hypertens. 2004;26:255–65.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Krustrup P, Nielsen JJ, Krustrup BR, Christensen JF, Pedersen H, et al. Recreational soccer is an effective health-promoting activity for untrained men. Br J Sports Med. 2009;43:825–31.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Knoepfli-Lenzin C, Sennhauser C, Toigo M, Boutellier U, Bangsbo J, et al. Effects of a 12-week intervention period with football and running for habitually active men with mild hypertension. Scand J Med Sci Sports. 2010;20:72–9.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Krustrup P, Hansen PR, Andersen LJ, Jakobsen MD, Sundstrup E, et al. Long-term musculoskeletal and cardiac health effects of recreational football and running for premenopausal women. Scand J Med Sci Sports. 2010;20(Suppl 1):58–71.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Amin-Shokravi F, Rajabi R, Ziaee N. Exercise effects on risk of cardiovascular disease among Iranian women. Asian J Sports Med. 2011;2:37–43.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Beck DT, Martin JS, Casey DP, Braith RW. Exercise training reduces peripheral arterial stiffness and myocardial oxygen demand in young prehypertensive subjects. Am J Hypertens. 2013;26:1093–102.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Foulds HJ, Bredin SS, Charlesworth SA, Ivey AC, Warburton DE. Exercise volume and intensity: a dose-response relationship with health benefits. Eur J Appl Physiol. 2014;114:1563–71.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Hur S, Kim SR. The effects of exercise therapy on CVD risk factors in women. J Phys Ther Sci. 2014;26:1367–70.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Patterson S, Pattison J, Legg H, Gibson AM, Brown N. The impact of badminton on health markers in untrained females. J Sports Sci. 2017;35:1098–106.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Jamnik VK, Warburton DE, Makarski J, McKenzie DC, Shephard RJ, et al. Enhancing the effectiveness of clearance for physical activity participation: background and overall process. Appl Physiol Nutr Metab. 2011;36(Suppl 1):S3–13.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Boutcher YN, Boutcher SH. Exercise intensity and hypertension: what’s new? J Hum Hypertens. 2017;31:157–64.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Annuk M, Zilmer M, Fellström B. Endothelium-dependent vasodilation and oxidative stress in chronic renal failure: impact on cardiovascular disease. Kidney Int Suppl. 2003;63:S50–3.CrossRefGoogle Scholar
  59. 59.
    Korsager LM, Matchkov VV. Hypertension and physical exercise: The role of oxidative stress. Medicina (Kaunas). 2016;52:19–27.CrossRefGoogle Scholar
  60. 60.
    Sachdev S, Davies KJ. Production, detection, and adaptive responses to free radicals in exercise. Free Radic Biol Med. 2008;44:215–23.PubMedCrossRefGoogle Scholar
  61. 61.
    Arakawa K. Antihypertensive mechanism of exercise. J Hypertens. 1993;11:223–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Environmental Physiology for ExerciseOsaka City University Graduate School of MedicineOsakaJapan
  2. 2.Department of Human Environmental Sciences, Faculty of EngineeringShonan Institute of TechnologyFujisawaJapan

Personalised recommendations