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Meta-Analysis
. 2021 Feb 24;2(2):CD008823.
doi: 10.1002/14651858.CD008823.pub2.

Walking for hypertension

Ling-Ling Lee  1 , Caroline A Mulvaney  2 , Yoko Kin Yoke Wong  3 , Edwin Sy Chan  3 , Michael C Watson  4 , Hui-Hsin Lin  5
Affiliations
Meta-Analysis

Walking for hypertension

Ling-Ling Lee et al. Cochrane Database Syst Rev. .

Abstract

Background: Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings.

Objectives: To determine the effect of walking as a physical activity intervention on blood pressure and heart rate.

Search methods: We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions.

Selection criteria: Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings.

Main results: A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times.

Authors' conclusions: Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.

PubMed Disclaimer

Conflict of interest statement

Ling‐Ling Lee: none known

Caroline A Mulvaney: none known

Michael C Watson: none known

Edwin SY Chan: none known

Hui‐Hsin Lin: none known

Yoko Kin Yoke Wong: none known

Figures

1
1
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 Walking versus non‐intervention control (overall), outcome: 1.1 systolic blood pressure [mmHg].
5
5
Funnel plot of comparison: 1 Walking versus non‐intervention control (overall), outcome: 1.2 diastolic blood pressure [mmHg].
1.1
1.1. Analysis
Comparison 1: Walking vs non‐intervention control, Outcome 1: systolic blood pressure
1.2
1.2. Analysis
Comparison 1: Walking vs non‐intervention control, Outcome 2: diastolic blood pressure
1.3
1.3. Analysis
Comparison 1: Walking vs non‐intervention control, Outcome 3: heart rate [beats/min]
2.1
2.1. Analysis
Comparison 2: Walking vs non‐intervention control: subgroup analysis by age, Outcome 1: SBP by Age
2.2
2.2. Analysis
Comparison 2: Walking vs non‐intervention control: subgroup analysis by age, Outcome 2: DBP by Age
3.1
3.1. Analysis
Comparison 3: Walking vs non‐intervention control: subgroup analysis by sex, Outcome 1: SBP by Sex
3.2
3.2. Analysis
Comparison 3: Walking vs non‐intervention control: subgroup analysis by sex, Outcome 2: DBP by Sex
4.1
4.1. Analysis
Comparison 4: Walking vs non‐intervention control: sensitivity analysis for studies at low risk of overall bias, Outcome 1: systolic blood pressure
4.2
4.2. Analysis
Comparison 4: Walking vs non‐intervention control: sensitivity analysis for studies at low risk of overall bias, Outcome 2: diastolic blood pressure
5.1
5.1. Analysis
Comparison 5: Walking vs non‐intervention control: sensitivity analysis for studies at low risk of attrition bias, Outcome 1: systolic blood pressure
5.2
5.2. Analysis
Comparison 5: Walking vs non‐intervention control: sensitivity analysis for studies at low risk of attrition bias, Outcome 2: diastolic blood pressure
6.1
6.1. Analysis
Comparison 6: Walking vs non‐intervention control: sample size per trial ≦30 vs. >30, Outcome 1: SBP
6.2
6.2. Analysis
Comparison 6: Walking vs non‐intervention control: sample size per trial ≦30 vs. >30, Outcome 2: DBP
7.1
7.1. Analysis
Comparison 7: Walking vs non‐intervention control: subgroup analysis (normotensive vs. high normal), Outcome 1: SBP
7.2
7.2. Analysis
Comparison 7: Walking vs non‐intervention control: subgroup analysis (normotensive vs. high normal), Outcome 2: DBP
8.1
8.1. Analysis
Comparison 8: Walking vs non‐intervention control: subgroup analysis (normotensive vs. hypertensive), Outcome 1: SBP
8.2
8.2. Analysis
Comparison 8: Walking vs non‐intervention control: subgroup analysis (normotensive vs. hypertensive), Outcome 2: DBP
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Stanton 1996 {published data only}
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    1. Stanton JM, Arroll B. The effect of moderate exercise on mood in mildly hypertensive volunteers: a randomized controlled trial. Journal of Psychosomatic Research 1996;40(6):637-42. [DOI: 10.1016/0022-3999(95)00643-5] [PMID: ] - DOI - PubMed
Stutzman 2010 {published data only}
    1. Stutzman SS, Brown CA, Hains SM, Godwin M, Smith GN, Parlow JL, et al. The effects of exercise conditioning in normal and overweight pregnant women on blood pressure and heart rate variability. Biological Research for Nursing 2010;12(2):137-48. [DOI: 10.1177/1099800410375979] [PMID: ] - DOI - PubMed
Tudor‐Locke 2004 {published data only}
    1. Tudor-Locke C, Bell RC, Myers AM, Harris SB, Ecclestone NA, Lauzon N, et al. Controlled outcome evaluation of the first step program: a daily physical activity intervention for individuals with type II diabetes. International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity 2004;28(1):113-9. [DOI: 10.1038/sj.ijo.0802485] [PMID: ] - DOI - PubMed
Tudor‐Locke 2020 {published data only}
    1. Tudor-Locke C, Schuna J M, Swift DL, Dragg AT, Davis AB, Martin CK, et al. Walkmore: a randomized controlled trial of pedometer-based interventions differing on intensity messages. BMC Public Health 2014;14(1):168. [DOI: 10.1186/1471-2458-14-168] - DOI - PMC - PubMed
    1. Tudor-Locke C, Schuna J M, Swift DL, Dragg AT, Davis AB, Martin CK et al. Evaluation of step-counting interventions differing on intensity messages. Journal of physical activity & health 2020;17:21-8. [DOI: 10.1123/jpah.2018-0439] [PMID: ] - DOI - PubMed
Tully 2005 {published data only}
    1. Tully MA, Cupples ME, Chan WS, McGlade K, Young IS. Brisk walking, fitness, and cardiovascular risk: a randomized controlled trial in primary care. Preventive Medicine 2005;41(2):622-8. [DOI: 10.1016/j.ypmed.2004.11.030] [PMID: ] - DOI - PubMed
Tully 2007a {published data only}
    1. Tully MA, Cupples ME, Hart ND, McEneny J, McGlade KJ, Chan WS, et al. Randomised controlled trial of home-based walking programmes at and below current recommended levels of exercise in sedentary adults. Journal of Epidemiology & Community Health 2007;61(9):778-83. [DOI: 10.1136/jech.2006.053058] [PMID: 17699531]] - DOI - PMC - PubMed
Tully 2011 {published data only}
    1. Tully MA, Cupples ME. Unistep (university students exercise and physical activity) study: a pilot study of the effects of accumulating 10,000 steps on health and fitness among university students. Journal of Physical Activity and Health 2011;8:663-7. [DOI: 10.1123/jpah.8.5.663] [PMID: ] - DOI - PubMed
Venturelli 2011 {published data only}
    1. Venturelli M, Scarsini R, Schena F. Six-month walking program changes cognitive and ADL performance in patients with alzheimer. American Journal of Alzheimer's Disease & Other Dementias 2011;26(5):381-8. [DOI: 10.1177/1533317511418956] [PMID: ] - DOI - PMC - PubMed
Wallis 2017 {published data only}
    1. Wallis JA, Webster KE, Levinger P, Singh PJ, Fong C, Taylor NF. A walking program for people with severe knee osteoarthritis did not reduce pain but may have benefits for cardiovascular health: a phase II randomised controlled trial. Osteoarthritis and Cartilage 2017;25:1969-79. [DOI: 10.1016/j.joca.2016.12.017] [PMID: ] - DOI - PubMed
Wang (王正斌) 2014 {published data only}
    1. Wang ZB, Qiu CG, Huang ZW, Han ZY, Sun GJ, Sun H. The effects of walking exercise on glyeometabolism，dynamic blood pressure and the quality of life of patients with hypertension and type 2 diabetes [步行運動對高血壓合并糖尿病患者糖代謝、動態血壓及生活質量的影響]. Chinese Journal of Physical Medicine and Rehabilitation 2014;36(8):609-13. [DOI: 10.3760/cma.j.issn.0254-1424.2014.08.010] - DOI
Wang (王聰) 2016 {published data only}
    1. Wang C, Huang JJ, Ren ZY, Sun CM, Wang T. The effect of walking and health education on blood pressure in hypertensive patients of datong coal mine group [健步走與健康教育相結合對同煤職工高血壓患者血壓的影響]. Chinese Journal of Disease Control & Prevention 2016;20(2):134-45. [DOI: 10.16462/j.cnki.zhjbkz.2016.02.007] - DOI
Wang 2014 {published data only}
    1. Wang CH, Chung MH, Chan P, Tsai JC, Chen FC. Effects of endurance exercise training on risk components for metabolic syndrome, interleukin-6, and the exercise capacity of postmenopausal women. Geriatric Nursing 2014;35(3):212-8. [DOI: 10.1016/j.gerinurse.2014.02.001] [PMID: ] - DOI - PubMed
Westhoff 2007 {published data only}
    1. Westhoff TH, Franke N, Schmidt S, Vallbracht-Israng K, Meissner R, Yildirim H, et al. Too old to benefit from sports? The cardiovascular effects of exercise training in elderly subjects treated for isolated systolic hypertension. Kidney & Blood Pressure Research 2007;30(4):240-7. [DOI: 10.1159/000104093] [PMID: ] - DOI - PubMed
Xiao (肖卉) 2010 {published data only}
    1. Xiao H, Wang JH, Zhang YW, Tian Y. Effects of exercise on blood glucose and blood pressure in elderly diabetes patients [運動對中老年糖尿病患者血糖及血壓的影響]. Chinese Journal of Physical Medicine and Rehabilitation 2010;38(10):843-5.
Yan (嚴華) 2010a {published data only}
    1. Yan H, Fu CH, Zou EF, Fu YH, Chen LY, He DM, et al. Walk exercise training produces rehabilitation effects on heart function for patients with chronic heart failure [步行運動訓練對慢性充血性心力衰竭患者心臟的康復]. Chinese Journal of Cardiovascular Rehabilitation Medicine 2010;19(1):2-4 and 30. [DOI: 10.3969/j.issn.1008-0074.2010.01.01] - DOI
    1. Yan H, Fu CH, Zou EF, Fu YH, Chen LY, He DM, et al. Walking training improves heart function in aged patients with chronic heart failure [步行訓練對老年慢性心力衰竭患者心臟功能康復的影響]. Chinese Journal of Cardiovascular Rehabilitation Medicine 2010b;19(5):456-9. [DOI: 10.3969/j.issn.1008-0074.2010.05.02] - DOI
Yu (余冰清) 2018 {published data only}
    1. Yu BC. The effect of different exercise intensity on the cardioVascularevents and its risk factors in phlegm dampness elderly patients with isolated systolic hypertension [thesis] [不同運動強度對痰濕質老老年ISH患者心腦血管事件及危險因素的影響]. Fujian University of Traditional Chinese Medicine 2018:1-67.

References to studies excluded from this review

Ades 1995 {published data only}
    1. Ades PA, Waldmann ML, Gillespie C. A controlled trial of exercise training in older coronary patients. Journals of Gerontology Series A-Biological Sciences & Medical Sciences 1995;50A(1):M7-11. [DOI: 10.1093/gerona/50a.1.m7] [PMID: ] - DOI - PubMed
Adragna 1985 {published data only}
    1. Adragna NC, Chang JL, Morey MC, Williams RS. Effect of exercise on cation transport in human red cells. Hypertension 1985;7(1):132-9. [DOI: 10.1161/01.hyp.7.1.132] [PMID: ] - DOI - PubMed
Albright 1992 {published data only}
    1. 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. Journal of Psychosomatic Research 1992;36(1):25-36. [DOI: 10.1016/0022-3999(92)90111-e] [PMID: ] - DOI - PubMed
Aldred 1995 {published data only}
    1. Aldred HE, Hardman AE, Taylor S. Influence of 12 weeks of training by brisk walking on postprandial lipemia and insulinemia in sedentary middle-aged women. Metabolism 1995;44(3):390-7. [DOI: 10.1016/0026-0495(95)90172-8] [PMID: ] - DOI - PubMed
Andersen 2013 {published data only}
    1. Andersen LL, Sundstrup E, Boysen M, Jakobsen MD, Mortensen OS, Persson R. Cardiovascular health effects of internet-based encouragements to do daily workplace stair-walks: randomized controlled trial. Journal of Medical Internet Research 2013;15(6):e127. [DOI: 10.2196/jmir.2340] [PMID: ] - DOI - PMC - PubMed
Anderson 2015a {published data only}
    1. Anderson DR. Thesis. US: ProQuest Information & Learning, 2015.
Anderson 2015b {published data only}
    1. Anderson DR, Harris KM, Landers J, Emery CF. Lower anxiety associated with greater physical activity in a pedometer-based intervention among cardiac patients. Psychosomatic Medicine 2015;77(3):A17-A18.
Aoike 2012 {published data only}
    1. Aoike DT, Baria F, Rocha ML, Kamimura MA. Home-based vs in center aerobic exercise: Impact on cardiorespiratory (CR) and functional capacities (FC) of nondialysis dependent overweight CKD patients. Kidney Research and Clinical Practice 2012;31(2):A27.
Arakawa 1993 {published data only}
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Arija 2018a {published data only}
    1. Arija V, Villalobos F, Pedret R, Vinuesa A, Jovani D, Pascual G, et al. Physical activity, cardiovascular health, quality of life and blood pressure control in hypertensive subjects: randomized clinical trial. Health and Quality of Life Outcomes 2018;16(1):184. [DOI: 10.1186/s12955-018-1008-6] [PMID: ] - DOI - PMC - PubMed
Arija 2018b {published data only}
    1. Arija V, Martinez FV, Pedret Llaberia R, Vinuesa Fernandez A, Jovani D, Reche A, et al. Effectiveness of a physical activity program on cardiovascular disease risk in adult with overweight and obesity: the "Pas-a-Pas" community intervention trial. Obesity Facts 2018;11(Supplement 1):38.
Asbury 2008 {published data only}
    1. Asbury EA, Slattery C, Grant A, Evans L, Barbir M, Collins P. Cardiac rehabilitation for the treatment of women with chest pain and normal coronary arteries.. Menopause 2008;15(3):454-60. [DOI: 10.1097/gme.0b013e31815982eb] [PMID: ] - DOI - PubMed
Asikainen 2002aStudyII {published data only}
    1. Asikainen TM, Miilunpalo S, Oja P, Rinne M, Pasanen M, Uusi-Rasi K, et al. Randomised, controlled walking trials in postmenopausal women: the minimum dose to improve aerobic fitness? Sports Medicine 2002a;36:189-94. [DOI: 10.1136/bjsm.36.3.189] [PMID: ] - DOI - PMC - PubMed
Asikainen 2002bStudy I {published data only}
    1. Asikainen TM, Miilunpalo S, Kukkonen-Harjula K, Nenonen A, Pasanen M, Rinne M, et al. Walking trials in postmenopausal women: effect of one vs two daily bouts on aerobic fitness. British Journal of Sports Medicine 2002;12(2):99-105. [DOI: 10.1034/j.1600-0838.2002.120206.x] [PMID: ] - DOI - PubMed
Asikainen 2003 {published data only}
    1. Asikaine TM, Miilunpalo S, Kukkonen-Harjula K, Nenonen A Pasanen M, Rinne M et al. Walking trials in postmenopausal women: effect of low doses of exercise and exercise fractionization on coronary risk factors. Scandinavian Journal of Medicine & Science in Sports 2003;13(5):284-92. [DOI: 10.1034/j.1600-0838.2003.00331.x] [PMID: ] - DOI - PubMed
Baraas 2011 {published data only}
    1. Baraas F. The effect of short-term low intensity exercise training on oxygen free radicals and nitric-oxide production in male patients with acute myocardial infarction. Journal of the American College of Cardiology 2011;1:E1032. [DOI: 10.1055/s-0033-1348881] [PMID: ] - DOI - PMC - PubMed
Baraas 2013 {published data only}
    1. Baraas F, Rilantono L, Diniharini S, Kurniawan I, Christian R, Kusmana D. Effect of short-term low-intensity exercise training on association of oxygen free radicals and nitric oxide production in patients with acute myocardial infarction. International Journal of Angiology 2013;22:159-64. [DOI: 10.1055/s-0033-1348881] [PMID: ] - DOI - PMC - PubMed
Baria 2012 {published data only}
    1. Baria F, Kamimura MA, Aoike DT, Rocha ML, Ammirati A, Cuppari L. Impact of aerobic exercise on visceral fat of nondialysis dependent overweight CKD patients: a pilot study. Kidney Research and Clinical Practice 2012;31(2):A27.
Barone 2009 {published data only}
    1. Barone BB, Wang NY, Bacher AC, Stewart KJ. Decreased exercise blood pressure in older adults after exercise training: contributions of increased fitness and decreased fatness. British Journal of Sports Medicine 2009;43(1):52-6. [DOI: 10.1136/bjsm.2008.050906] [PMID: ] - DOI - PMC - PubMed
Barroso 2008 {published data only}
    1. Barroso WK, Jardim PC, Vitorino PV, Bittencourt A, Miquetichuc F. The influence of programmed physical activity on blood pressure of hypertensive elderly patients on non-pharmacological treatment. Revista Da Associacao Medica Brasileira 2008;54(4):328-33. [DOI: 10.1590/s0104-42302008000400018] [PMID: ] - DOI - PubMed
Belli 2011 {published data only}
    1. Belli T, Ribeiro LF, Ackermann MA, Baldissera V, Gobatto CA, da Silva RG. Effects of 12-week overground walking training at ventilatory threshold velocity in type 2 diabetic women. Diabetes Research and Clinical Practice 2011;93(3):337-43. [DOI: 10.1016/j.diabres.2011.05.007] [PMID: ] - DOI - PubMed
Bergstrom 2009 {published data only}
    1. Bergstrom I, Lombardo C, Brinck J. Physical training decreases waist circumference in postmenopausal borderline overweight women. Acta Obstetricia et Gynecologica Scandinavica 2009;88(3):308-13. [DOI: 10.1080/00016340802695942] [PMID: ] - DOI - PubMed
Bhammar 2012 {published data only}
    1. Bhammar DM, Angadi SS, Gaesser GA. Effects of fractionized and continuous exercise on 24-h ambulatory blood pressure. Medicine and Science in Sports and Exercise 2012;44(12):2270-6. [DOI: 10.1249/MSS.0b013e3182663117] [PMID: ] - DOI - PubMed
Bhammar 2017 {published data only}
    1. Bhammar DM, Sawyer BJ, Tucker WJ, Gaesser GA. Breaks in sitting time: effects on continuously monitored glucose and blood pressure. Medicine and Science in Sports and Exercise 2017;49(10):2119-30. [DOI: 10.1249/MSS.0000000000001315] [PMID: ] - DOI - PubMed
Blumenthal 1991 {published data only}
    1. Blumenthal JA, Siegel WC, Appelbaum M. Failure of exercise to reduce blood pressure in patients with mild hypertension. Joumal of the American Medical Association 1991;266(15):2098-104. [PMID: ] - PubMed
Boer 2014 {published data only}
    1. Boer PH, Meeus M, Terblanche E, Rombaut L, Wandele I, Hermans L, et al. The influence of sprint interval training on body composition, physical and metabolic fitness in adolescents and young adults with intellectual disability: a randomized controlled trial. Clinical Rehabilitation 2014;28(3):221-31. [DOI: 10.1177/0269215513498609] - DOI - PubMed
Bonet 2003 {published data only}
    1. Bonet J, Coll R, Rocha E, Romero R. Supervised versus recommended physical exercise in hypertensive women. Is its recommendation enough? Blood Pressure 2003;12(3):139-44. [DOI: 10.1080/08037050310002533] [PMID: ] - DOI - PubMed
Boyne 2011 {published data only}
    1. Boyne J, Vrijhoef HJ, Nieman FH, De Wit R, Kragten J, De Weerd GJ, et al. Telemonitoring in patients with heart failure: Results from a multicenter randomized controlled trial (the TEHAF study). Journal of the American College of Cardiology 2011;1:E389.
Brawley 2000 {published data only}
    1. Brawley LR, Rejeski WJ, Lutes L. A group-mediated cognitive-behavioral intervention for increasing adherence to physical activity in older adults. Journal of Applied Biobehavioral Research 2000;5(1):47-65. [DOI: 10.1016/j.cct.2012.04.012] [PMID: 22575796] - DOI - PMC - PubMed
Brekke 2013 {published data only}
    1. Brekke HK, Bertz F, Rasmussen KM, Bosaeus I, Ellegard L, Win Kvist A. Dietary behavior modification, with or without exercise, improves risk factors for CVD over one year in overweight and obese lactating women. The Federation of American Societies for Experimental Biology Journal 2013;27(S1):225.5.
Bronas2011 {published data only}
    1. Bronas UG, Treat-Jacobson D, Leon AS. Comparison of the effect of upper body-ergometry aerobic training vs treadmill training on central cardiorespiratory improvement and walking distance in patients with claudication. Journal of Vascular Surgery 2011;53(6):1557-64. [DOI: 10.1016/j.jvs.2011.01.077] [PMID: ] - DOI - PubMed
Brun 2008 {published data only}
    1. Brun JF, Bordenave S, Ghanassia E, Picot MC, Jaussent A, Mercier J, et al. One year endurance training at the level of the ventilatory threshold in type-2 diabetics reduces by 50% health costs: a randomized trial. [French]. Science and Sports 2008;23(3-4):193-7.
Calfas 2001 {published data only}
    1. Calfas KJ, Criqui MH, Sallis JF, Langer RD, Rupp JW, Kashani IA, et al. Six-month patient outcomes in a preventive cardiology center. Preventive Cardiology 2001;4(1):16-27. [PMID: ] - PubMed
Carrier 2008 {published data only}
    1. Carrier J. Aerobic plus resistance training was more effective than either alone for glycaemic control in type 2 diabetes. Evidence-Based Nursing 2008;11(2):48. [PMID: ] - PubMed
Carroll 1995a {published data only}
    1. Carroll JF, Convertino VA, Pollock ML, Graves JE, Lowenthal DT. Effect of 6 months of exercise training on cardiovascular responses to head-up tilt in the elderly. Clinical Physiology 1995a;15(1):13-25. [DOI: 10.1111/j.1475-097x.1995.tb00426.x] [PMID: ] - DOI - PubMed
Carroll 1995b {published data only}
    1. Carroll JF, Convertino VA, Wood CE, Graves JE, Lowenthal DT, Pollock ML. Effect of training on blood volume and plasma hormone concentrations in the elderly. Medicine and Science in Sports and Exercise 1995;27(1):79-84. [PMID: ] - PubMed
Casal 1984 {published data only}
    1. Casal DC. Effects of 2000 kilocalories per week of treadmill walking and stair climbing on physical fitness and coronary risk factors of obese young men (exercise, disease, preventive medicine). Minnesota: University of Minnesota, 1984.
Cashin 2008 {published data only}
    1. Cashin A, Potter E, Stevens W, Davidson K, Muldoon D. Fit for prison: special population health and fitness programme evaluation. International Journal of Prison Health 2008;4(4):208-16. [DOI: 10.1080/17449200802473131] [PMID: ] - DOI - PubMed
Castello 2011 {published data only}
    1. Castello V, Simoes RP, Bassi D, Catai AM, Arena R, Borghi-Silva A. Impact of aerobic exercise training on heart rate variability and functional capacity in obese women after gastric bypass surgery. Obesity Surgery 2011;21:1739-49. [DOI: 10.1007/s11695-010-0319-4] [PMID: ] - DOI - PubMed
Chan 2013 {published data only}
    1. Chan L, Chin LM, Kennedy M, Woolstenhulme JG, Nathan SD, Weinstein AA. Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest 2013;143:333-43. [DOI: 10.1378/chest.12-0993] [PMID: ] - DOI - PMC - PubMed
Chanruengvanich 2006 {published data only}
    1. Chanruengvanich W, Kasemkitwattana S, Charoenyooth C, Towanabut S, Pongurgsorn C. RCT: self-regulated exercise program in transient ischemic attack and minor stroke patients. Thai Journal of Nursing Research 2006;10(3):165-79.
Chen (陳佳萍) 2016 {published data only}
    1. Chen JP, Mao LH. Effect of health education combined with vigorous walking on blood pressure and quality of life of elderly hypertension patients [健康教育結合健步走對高校老年高血壓患者血壓及生活質量的影響]. Chinese Journal of Gerontology 2016;36(16):4024-6.
Chen ( 陳宣蘭) 2015 {published data only}
    1. Chen Xl, Jiang H, Zhong YM, Wang XP, Wei XJ, Qiu YQ. Clinical value of walking exercise in patients with coronary artery disease combining heart failure [步行運動訓練在冠心病心力衰竭患者中的臨床價值]. Chinese Circulation Journal 2015;30(12):1170-2. [DOI: 10.3969/j.issn.1000-3614.2015.12.009] - DOI
Chen (陳美娟) 2017 {published data only}
    1. Chen MJ, Dong B, Li L, Zeng LZ, Shen DP. The effect of walking exercise on the IMT in elderly patients with hypertension and anxiety [步行運動對老年高血壓并焦慮患者頸動脈內膜中層厚度及焦慮狀態的作用]. Chinese Journal of Geriatric Care 2017;15(5):39-41. [DOI: 10.3969/j.issn.1672-4860.2017.05.012] - DOI
Chen 2007 {published data only}
    1. Chen D, Yuan Y, Yang H. Effect of exercise on coagulation and fibrinolytic system in the elderly. [Chinese]. Journal of Clinical Rehabilitative Tissue Engineering Research 2007;11(42):8545-8.
Chen 2014 {published data only}
    1. Chen II, Lai CF, Chan WC, Hsu TF, Huang WL, Wang IG. The effects of regular exercise training on risk factors and mood states in subjects with metabolic syndrome. Diabetes Research and Clinical Practice 2014;106:S72-3.
Chomiuk 2013 {published data only}
    1. Chomiuk T, Folga A, Mamcarz A. The influence of systematic pulse-limited physical exercise on the parameters of the cardiovascular system in patients over 65 years of age. Archives of Medical Science 2013;9(2):201-9. [DOI: 10.5114/aoms.2013.34559] [PMID: ] - DOI - PMC - PubMed
Clark 2017 {published data only}
    1. Clark IN, Baker FA, Peiris CL, Shoebridge G, Taylor NF. Participant-selected music and physical activity in older adults following cardiac rehabilitation: a randomized controlled trial. Clinical Rehabilitation 2017;31(3):329-39. [DOI: 10.1177/0269215516640864] [PMID: ] - DOI - PubMed
Collins 2003 {published data only}
    1. Collins EG, Langbein WE, Orebaugh C, Bammert C, Hanson K, Reda D, et al. Polestriding exercise and vitamin for management of peripheral vascular disease. Medicine and Science in Sports and Exercise 2003;35(3):384-93. [DOI: 10.1249/01.MSS.0000053658.82687.FF] [PMID: ] - DOI - PubMed
Collins 2005 {published data only}
    1. Collins EG, Langbein WE, Orebaugh C, Bammert C, Hanson K, Reda D, et al. Cardiovascular training effect associated with polestriding exercise in patients with peripheral arterial disease. Journal of Cardiovascular Nursing 2005;20(3):177-85. [DOI: 10.1097/00005082-200505000-00009] [PMID: ] - DOI - PubMed
Collins 2007 {published data only}
    1. Collins TC, Johnson SL, Souchek J. Unsupervised walking therapy and atherosclerotic risk-factor management for patients with peripheral arterial disease: a pilot trial. Annals of Behavioral Medicine 2007;33(3):318-24. [DOI: 10.1007/bf02879914] [PMID: ] - DOI - PubMed
Collins 2010a {published data only}
    1. Collins T, Lunos S. Home-based walking therapy improves walking ability and quality of life in patients with diabetes mellitus and peripheral arterial disease. Journal of General Internal Medicine 2010a;25:S296-7.
Collins 2010b {published data only}
    1. Collins T, Lunos S. Home-based walking therapy improves walking ability and quality of life in persons with diabetes mellitus and peripheral arterial disease. Vascular Medicine 2010b;15(2):155. - PubMed
Collins 2011a {published data only}
    1. Collins T, Ghidei W, Ahluwalia J. Benefits of walking therapy in patients with diabetes mellitus and peripheral arterial disease who are limited by leg pain or fatigue. Journal of General Internal Medicine 2011a;26:S176-7.
Collins 2011b {published data only}
    1. Collins T, Lunos S, Hodges J. Effects of a walking intervention on systemic inflammation in persons with diabetes mellitus and peripheral arterial disease. Journal of General Internal Medicine 2011b;26:S174-5.
Collins 2011c {published data only}
    1. Collins TC, Lunos S, Carlson T, Henderson K, Lightbourne M, Nelson B, et al. Effects of a home-based walking intervention on mobility and quality of life in people with diabetes and peripheral arterial disease: a randomized controlled trial. Diabetes Care 2011c;34:2174-9. [DOI: 10.2337/dc10-2399] [PMID: ] - DOI - PMC - PubMed
Cononie 1991 {published data only}
    1. Cononie CC, Graves JE, Pollock ML, Phillips MI, Sumners C, Hagberg JM. Effect of exercise training on blood pressure in 70- to 79-yr-old men and women. Medicine and Science in Sports and Exercise 1991;23(4):505-11. [PMID: ] - PubMed
Cooper 2001 {published data only}
    1. Cooper AR, Goff F. Does a single bout of brisk walking reduce ambulatory blood pressure in normotensives or hypertensives? Cardiovascular Reviews and Reports 2001;22(4):213-216+222.
Cotes 1963 {published data only}
    1. Cotes JE, Pisa Z, Thomas AJ. Effect of breathing oxygen upon cardiac output, heart rate, ventilation, systemic and pulmonary blood pressure in patients with chronic lung disease. Clinical Science 1963;25:305-21. [PMID: ] - PubMed
Coulon 2013 {published data only}
    1. Coulon SM, Wilson DK, Egan BM. Associations among environmental supports, physical activity, and blood pressure in African-American adults in the path trial. Social Science & Medicine 2013;87:108-15. [DOI: 10.1016/j.socscimed.2013.03.018] [PMID: ] - DOI - PMC - PubMed
Crowther 2008 {published data only}
    1. Crowther RG, Spinks WL, Leicht AS, Sangla K, Quigley F, Golledge J. Effects of a long-term exercise program on lower limb mobility, physiological responses, walking performance, and physical activity levels in patients with peripheral arterial disease. Journal of Vascular Surgery 2008;47(2):303-9. [DOI: 10.1016/j.jvs.2007.10.038] [PMID: ] - DOI - PubMed
Cui 2010 {published data only}
    1. Cui F, Ren Y, Wang H, Mu X, Ma H. Effects of rehabilitation training on exercise tolerance of patients with coronary heart disease after percutaneous coronary intervention. In: Circulation. 2010:e319.
Dahllof 1976 {published data only}
    1. Dahllof AG, Holm J, Schersten T, Sivertsson R. Peripheral arterial insufficiency, effect of physical training on walking tolerance, calf blood flow, and blood flow resistance. Scandinavian Journal of Rehabilitation Medicine 1976;8(1):unknown. [PMID: ] - PubMed
Dasgupta 2014 {published data only}
    1. Dasgupta K, Rosenberg E, Daskalopoulou SS for the SMARTER collaborators. Step monitoring to improve arterial health (smarter) through step count prescription in type 2 diabetes and hypertension: trial design and methods. Cardiovascular Diabetology 2014;13(1):7. [DOI: 10.1186/1475-2840-13-7] [PMID: ] - DOI - PMC - PubMed
da Silva 2002 {published data only}
    1. da Silva MS, Bocchi EA, Guimaraes GV, Padovani CR, Silva MH, Pereira SF, et al. Benefits of exercise training in the treatment of heart failure: study with a control group. Arquivos Brasileiros de Cardiologia 2002;79(4):351-62. [DOI: 10.1590/s0066-782x2002001300003] [PMID: ] - DOI - PubMed
Davey 2000 {published data only}
    1. Davey GJ, Roberts JD, Patel S, Pierpoint T, Godsland IF, Davies B, et al. Effects of exercise on insulin resistance in South Asians and Europeans. Journal of Exercise Physiology Online 2000;3(2):6-11.
Dean 1989 {published data only}
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Deligiannis 1999 {published data only}
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Digenio 1999 {published data only}
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Klonizakis 2009b {published data only}
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Llaberia 2013 {published data only}
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Look Ahead Research Group 2010 {published data only}
    1. Look Ahead Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look ahead trial. Archives of Internal Medicine 2010;170(17):1566-75. [DOI: 10.1001/archinternmed.2010.334.] [PMID: ] - DOI - PMC - PubMed
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Martins 2010 {published data only}
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McAuley 2003 {published data only}
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Mentz 2013 {published data only}
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Mereles 2006 {published data only}
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Milecki 2013 {published data only}
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Miyashita 2008 {published data only}
    1. Miyashita M, Burns SF, Stensel DJ. Accumulating short bouts of brisk walking reduces postprandial plasma triacylglycerol concentrations and resting blood pressure in healthy young men. American Journal of Clinical Nutrition 2008;88(5):1225-31. [DOI: 10.3945/ajcn.2008.26493.] [PMID: ] - DOI - PubMed
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Molmen‐Hansen 2012 {published data only}
    1. Molmen-Hansen HE, Stolen T, Tjonna AE, Aamot IL, Ekeberg IS, Tyldum GA, et al. Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. European Journal of Preventive Cardiology 2012;19:151-60. [DOI: 10.1177/1741826711400512.] [PMID: ] - DOI - PubMed
Monteiro 2010 {published data only}
    1. Monteiro LZ, Vaz Fiani CR, Freitas MC, Zanetti ML, Foss MC. Decrease in blood pressure, body mass index and glycemia after aerobic training in elderly women with type 2 diabetes. Arquivos Brasileiros de Cardiologia 2010;95(5):563-70. [DOI: 10.1590/s0066-782x2010005000135. ] [PMID: ] - PubMed
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Motlagh 2017b {published data only}
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Moul 1993 {published data only}
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Muda 2006 {published data only}
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Myers 1999 {published data only}
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Newton 2002 {published data only}
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Ngomane 2019 {published data only}
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Oberman 1999 {published data only}
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Paolillo 2013 {published data only}
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Petersen 2013 {published data only}
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Ross 2000 {published data only}
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Santana 2016 {published data only}
    1. Santana M, Pina J, Duarte G, Neto M, Machado A, Dominguez-Ferraz D. Nintendo Wii effects on cardiorespiratory fitness in older adults: A randomized clinical trial. A pilot trial [Efectos de la Nintendo wii sobre el estado cardiorrespiratorio de adultos mayores: ensayo clínico aleatorizado. Estudio piloto]. Fisioterapia 2016;38(2):71-7. [DOI: 10.1016/j.ft.2015.03.003] - DOI
Santiago 1995 {published data only}
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Seals 1997 {published data only}
    1. Seals DR, Silverman HG, Reiling MJ, Davy KP. Effect of regular aerobic exercise on elevated blood pressure in postmenopausal women. American Journal of Cardiology 1997;80(1):49-55. [DOI: 10.1016/s0002-9149(97)00282-8.] [PMID: ] - DOI - PubMed
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Shabaaninia 2017 {published data only}
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Shin 1999 {published data only}
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Shvedko 2019 {published data only}
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Tao 2004 {published data only}
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Tsai 2002a {published data only}
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Wang (王純) 2007 {published data only}
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Wang (王錦雲) 2005 {published data only}
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Wang 2011 {published data only}
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Weinstein 2013 {published data only}
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Welsh 1985 {published data only}
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Whitehurst 1991 {published data only}
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Whitney 1993 {published data only}
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Wilmore 1970 {published data only}
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Wing 1998 {published data only}
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Yuenyongchaiwat 2018 {published data only}
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    1. Zeng YP, Wu Y, Tao XB, Zhu JW, Mou XY, Liang D, et al. The effect of walking exercise on patients with type 2 diabetes and peripheral vascular disease [步行運動對2型糖尿病合并外周血管病變患者的改善作用]. Journal of Nursing（China） 2014;21(7):44-6.
Zhang (張舒) 2012 {published data only}
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Zhang 2015 {published data only}
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Zhang 2016 {published data only}
    1. Zhang HJ, He J, Pan LL, Ma ZM, Han CK, Chen CS, et al. Effects of moderate and vigorous exercise on nonalcoholic fatty liver disease a randomized clinical trial. Journal American Medical Association Internal Medicine 2016;176(8):1074-82. [DOI: 10.1001/jamainternmed.2016.3202] [PMID: ] - DOI - PubMed
Zhou (周玉萍) 2015 {published data only}
    1. Zhou YP, Wang Y, Zhang ZQ. The effect of 6-minute walking test on improving endurance in breast cancer patients with chemotherapy [6 min步行試驗改善乳腺癌化療患者活動耐力的效果觀察]. International Journal of Nursing 2015;34(23):3299-302. [DOI: 10.3760/cma.j.issn.1673-4351.2015.23.053] - DOI
Zoellner 2011 {published data only}
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References to ongoing studies

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