Abstract
Background
Low physical activity has been identified as a major risk factor for cardiovascular disease. Medical societies therefore recommend increased physical activity be part of any antihypertensive therapy.
Objective
Focusing on patient-relevant outcomes such as mortality and cardiovascular events, this review was conducted to assess the long-term effects of interventions aiming at increasing physical activity in comparison with no such interventions on adult patients with essential hypertension.
Data sources
We searched for high-quality systematic reviews in MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (Cochrane Reviews), Database of Abstracts of Reviews of Effects (Other Reviews) and Health Technology Assessment Database (Technology Assessments) published between 1997 and February 2009 and for randomized controlled trials (RCTs) in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (Clinical Trials) published before September 2012. Additional studies were identified by hand searching reference lists of reviews.
Study selection
RCTs with at least 24 weeks’ follow-up that evaluated the effect of increased physical activity on the blood pressure of adults with essential hypertension were included in our review. Primary outcomes were all-cause mortality, cardiovascular morbidity and mortality, end-stage renal disease, quality of life and adverse events.
Study appraisal and synthesis methods
When appropriate, we used random effects meta-analyses to determine mean difference with 95 % confidence intervals for each endpoint. All data were analysed using the Review Manager software version 5.0.24 from the Cochrane Collaboration.
Results
None of the included nine trials, covering 891 patients with hypertension, provided sufficient data on patient-relevant outcomes such as mortality, cardiovascular events or injuries related to physical activity. Information on changes in systolic and diastolic blood pressure was provided for all included trials. The majority of the included RCTs reported that increased physical activity led to a decrease in systolic and diastolic blood pressure of 5–10 and 1–6 mmHg, respectively, but due to marked heterogeneity in the meta-analyses both for systolic and diastolic blood pressure (I2 = 70.0 and 73.0 %), no effect estimates were provided.
Limitations
About 50 % of the included trials were small, evaluating at most 20 participants per study group, and more than twothirds were deemed to have a high risk of bias.
Conclusions
Although a decrease in blood pressure is shown to be a consequence of increased physical activity, RCTs of appropriate study size and quality that examine potential patient-relevant benefits or harms still need to be conducted to evaluate whether physical activity really improves the health of patients with essential hypertension.
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Acknowledgments
We thank Anika Maas und Ursula Pueringer for their assistance in reviewing the literature and Phillip Elliott for final editing of the manuscript. This review was for the most part commissioned by and conducted in collaboration with IQWiG, the German Institute for Quality and Efficiency in Health Care. All authors had full access to all the data in the review. Thomas Semlitsch, Klaus Jeitler, Karl Horvath, Eva Nagele, Nicole Pignitter and Andrea Siebenhofer were involved as external experts in the preparation of the report A05-21D, “Benefit Assessment of Non-Drug Treatment Strategies in Patients with Essential Hypertension: Increase of Physical Activity”, for the German Institute for Quality and Efficiency in Health Care (IQWiG). Lars G. Hemkens, Christoph Schuermann, Kirsten H. Herrmann and Siw Waffenschmidt were employees of IQWiG. None of the authors has a financial interest in this manuscript or a conflict of interest to declare. Thomas Semlitsch takes responsibility for the integrity of the data and the accuracy of the data analysis.
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Semlitsch, T., Jeitler, K., Hemkens, L.G. et al. Increasing Physical Activity for the Treatment of Hypertension: A Systematic Review and Meta-Analysis. Sports Med 43, 1009–1023 (2013). https://doi.org/10.1007/s40279-013-0065-6
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DOI: https://doi.org/10.1007/s40279-013-0065-6