Hypertension is a common comorbidity we encounter in the clinic. Unfortunately, the standard approach for treating hypertension is limited to medication. Patients may be instructed to make some lifestyle changes (often consume less salt and exercise more) but education alone often fails to support meaningful and sustained behavior change. We have mounds of data that show exercise is one of the best interventions for eliciting sustained improvements in blood pressure. But how much exercise is the right amount?
This meta-analysis provides some guidance for patients and clinicians. It assessed the effects of aerobic training with and without progression on systolic blood pressure and diastolic blood pressure of adults with hypertension.
The authors compared studies that contained clear progression in frequency, duration, or intensity (% of HR max or RPE) of aerobic training with studies that contained no progression. The final analysis included 24 papers (12 with progression and 12 without). There was no difference in improvements in SBP (110.67 vs. -10.17) or DBP (-5.49 vs -6.51). The nonprogressive aerobic training primarily consisted of continuous moderate-intensity training (only 2 used interval training). One study was 4 sessions per week and the rest were 3. The exercise sessions lasted 20 to 60 minutes and the programs were 6 to 12 weeks long.
Does this mean progressive exercise is unnecessary? Hardly. This study was limited to 12-week programs and only assessed blood pressure. Does this study mean patients can improve their blood pressure without complex programs? Absolutely.