Effect Of Isometric Exercise On Blood Pressure – Effect of isometric exercise on blood pressure in prehypertensive and hypertensive individuals: protocol for systematic review and meta-analysis of randomized controlled trials.

Systemic arterial hypertension (HTN) is the major risk factor for death from cardiovascular disease. Lifestyle changes are important for the prevention and management of HTN. Regular aerobic exercise training is recommended as part of the management of HTN, and dynamic resistance exercise should be prescribed as an adjunct to aerobic training. Recent evidence points to the potential benefits of isometric resistance training in reducing blood pressure (BP). Nevertheless, the hypotensive effect of isometric exercise in prehypertensive and hypertensive individuals is not fully understood. Thus, we will examine the effect of isometric exercise in prehypertensive and hypertensive individuals through a systematic review and meta-analysis.

Effect Of Isometric Exercise On Blood Pressure

Our systematic review studies will include randomized controlled trials (RCTs) selected from the electronic databases MEDLINE (PubMed), Cochrane, LILACS, EMBASE, Web of Science and PEDro, published in English, Spanish and Portuguese languages. We will follow the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol) and PICOS framework. Our search will include studies of both male and female participants aged 18 years or older with prehypertension or HTN who received either isometric exercise (acute effects) or isometric exercise training (chronic effects) compared to a control group (no exercise). ) will do a session of. We will use the Cochrane Risk of Bias 2 (ROB2) tool to evaluate the quality of the studies and RStudio software (v1.3.959 for Windows) for statistical analyses.

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A meta-analysis of a homogeneous sample of prehypertensive and hypertensive individuals involving isometric handgrip exercise alone may support previous findings and improve our understanding and recommendations for the management of these populations.

The prevalence of systemic arterial hypertension (HTN) is estimated to be 30% of the worldwide population, affecting approximately 1.4 billion adults [1, 2]. The World Health Organization (WHO) estimates that this number will increase to 1.6 billion people by 2025 [1, 3]. This is a worrying scenario because a 10-mmHg increase in systolic blood pressure (SBP)/diastolic blood pressure (DBP) levels is strongly associated with an increased rate of deaths from ischemic heart disease [4, 5]. HTN is the leading risk factor for cardiovascular diseases (13%) compared to other risk factors including smoking (9%), high blood glucose (6%), physical inactivity (6%), and excess body weight (5%). represents. 6].

The practice of regular aerobic exercise has traditionally been recommended as first-line non-pharmacological management of cardiovascular diseases. Dynamic resistance exercise involving joint movement is recommended as an adjunctive intervention to aerobic training [7, 8, 9]. Interestingly, isometric resistance exercise (not involving joint movement) is clearly effective in reducing blood pressure (BP) levels, as evidenced in meta-analyses published over the last 10 years [10, 11, 12, 13, 14, 15, 16]. A meta-analysis by Cornelissen et al. [12] evaluated the hypotensive effects of aerobic, dynamic resistance, and isometric resistance training. They found that isometric training led to greater reductions in BP compared to the control group and other exercise modalities [12]. Nevertheless, this meta-analysis included only four studies of isometric training.

In addition to including a small number of randomized controlled trials (RCTs), the samples of study participants included in these meta-analyses are not completely representative of the prehypertensive or hypertensive population [10, 11, 12, 17]. They are usually heterogeneous samples of normotensive, prehypertensive, and/or hypertensive individuals, making it difficult to generalize the results to each group. Additionally, some studies included participants with other comorbidities, which may have affected their results. It is important to examine restricted samples of hypertensive individuals because they show higher BP levels in response to exercise and require longer recovery intervals between resistance exercise sets compared to normal individuals [18].

Pdf) Effect Of Isometric Handgrip Exercise Training On Resting Blood Pressure In Normal Healthy Adults

Furthermore, most meta-analyses [10, 12, 13, 16, 17] evaluated the effect of isometric exercise from studies with combined exercise interventions involving upper and lower limbs, and since the amount of active muscle mass involved Additionally, hemodynamic responses to these types of exercise may also differ [19,20]. From our understanding, if handgrip exercise alone proves to be effective for the prevention and management of HTN, it may be prescribed as an alternative exercise approach for those who are unable to control HTN due to physical limitation, peripheral artery disease, or any other reason. Are not capable of isometric leg exercises. Other limiting conditions. Although recently published meta-analyses [14, 15] showed good methodological quality, Jin et al. [14] evaluated a very small number of studies (only seven) in their meta-analysis (four with hypertensive individuals, two with normal individuals, and one with prehypertensive individuals). Loaiza et al. [15] conducted a more consistent metaanalysis with 11 articles of prehypertensive and hypertensive individuals; Nevertheless, three RCTs [21, 22, 23] did not use a control group to compare the analyses.

Due to the lack of strong metaanalysis evidence, only isometric resistance exercise was included as a non-pharmacological intervention for the prevention and management of hypertension in the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines [8] . The European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology (ESC) Council on Hypertension [24] reported that both dynamic and isometric resistance training can be recommended for secondary prevention in individuals with HTN, but the former I am not. -HTN. Canadian [25] and Brazilian [26] guidelines do not mention isometric exercises as an adjunctive or alternative approach to the management of HTN. Furthermore, it has been proposed to differentiate populations for better recommendations: (1) individuals with normal BP but with risk factors for HTN; (2) individuals with normal to high blood pressure; and (3) individuals with HTN.

Thus, given the importance of controlling and maintaining BP within normal levels during exercise and exercise training, and to provide the best evidence to inform guideline recommendations, special attention should be paid to prehypertensive and hypertensive populations. It is valuable to conduct consistent meta-analyses with. To the best of our knowledge, there is no meta-analysis of studies examining the acute effect of handgrip exercise on BP and they have only examined the chronic effect of this type of exercise. Therefore, we developed a study protocol for a systematic review and meta-analysis, including RCTs evaluating the BP-lowering effect of isometric exercise or training in prehypertensive or hypertensive individuals.

The study protocol was developed based on PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol) 2015 [27] and the Cochrane systematic review methodology [28]. The protocol for the systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (“www.crd.york.ac.uk/PROSPERO/”, “CRD42020213081” and registration date 09/10/2020 ). Figure 1 summarizes the study design.

Physical Activity And Hypertension

The PICOS framework was used to formulate eligibility criteria, as follows: population (individuals aged ≥ 18 years diagnosed with pre-HTN or HTN); intervention (a session of isometric resistance exercise or isometric handgrip training); comparison (isometric resistance exercise or training versus [no exercise or training] control group); outcomes (SBP and DBP measurements by auscultation, oscillometry or 24-h ambulatory BP monitoring); study (RCT).

Inclusion criteria for this review studies included “prehypertension” and/or “hypertension” in the title and/or abstract used to describe the main characteristic of the study sample. The body of the article should clearly describe the study population (adults) and the diagnosis of HTN: persistent high BP levels and/or use of antihypertensive medications with medical history and/or skilled medical evaluation. Criteria for “intervention” included a study with two or more arms, either isometric resistance exercise or training using handgrips as a “comparator” versus a control group (no session of exercise or physical training, or receiving only primary care, general care, care while on a waiting list, etc.). For the purpose of performing subgroup analyses, only RCTs of individuals with prehypertensive or hypertensive conditions as defined in each RCT (overall, persistent high BP levels and/or use of antihypertensive medications with medical history and/or skilled medical evaluation) will be selected . For meta-analysis.

We will select all studies of individuals aged 18 years or older in which HTN was measured using auscultation, oscillometry, or 24-h ambulatory BP monitoring (ABPM), including isometric handgrip exercise (acute impact or PEH). or involves one session of isometric handgrip exercise training (chronic). effect) in the form of interference. The following FITT (Frequency, Intensity, Type and Timing of Exercise) principles will be applied to the single session intervention: frequency, single session; Intensity, no limits; Type, isometric handgrip exercise; Time, no limit, and for studies involving exercise training: frequency, at least twice per week; Intensity, no limits; Type, sessions of only isometric handgrip exercises; Time, No time limit per session and minimum duration 4 weeks.

Studies involving other interventions involving exercise, but including a clearly defined isometric resistance group and a control group (no exercise) will be thoroughly reviewed. Studies with participants taking antihypertensive medications were eligible if the medication was given ≥ 4 weeks before the exercise/training intervention or during the intervention and data analysis.

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Studies involving individuals taking medications other than antihypertensive medications or concomitant dietary (or supplemental) interventions, as well as review studies, studies with animal experimentation, and studies that included pre-HTN or a condition other than HTN, were included. Will be kept out. Studies with similar characteristics published in different journals will be carefully

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