Are home-based exercises effective to reduce blood pressure in hypertensive adults? A systematic review

Abstract

Sedentarism and chronic non-communicable diseases have been a worldwide health problem that is drastically exacerbated by the COVID-19 pandemic social impacts. Home-based exercises are widely encouraged during social isolation to counterbalance the physical inactive impacts. Although, in the context of hypertension, are home-based exercises effective in blood pressure controlling? Our objective is to conduct a systematic review of high-quality controlled trials comparing the possible effects of different types of home-based exercises in hypertensive patients. The literature search was carried out in three scientific databases: Medline, Europe PMC, and Lilacs. Articles were included following three criteria: analyzing the effect of home-based exercise programs on blood pressure in treated and untreated hypertensive patients; exercises must perform at home and on the frequency, intensity, time, and type (FITT) principle, and the articles were published in English. From the qualitative analysis of 27 original trials screened through 451 identified studies, the main results are the following: 1) both endurance, isometric strength, and respiratory home-based exercise programs were efficient to decrease blood pressure in hypertensive patients; 2) differences in methodological approaches regarding FITT components, distinct blood pressure values at baseline and specific underlying mechanisms must be considered as a potential bias of each home-based interventions. In conclusion, endurance, isometric strength, and breathing home-based programs seems to be effective to reduce blood pressure in hypertensive patients. However, further randomized controlled trials and mechanistic studies must be performing to guide evidence-based recommendations of home-based exercises as antihypertensive therapy.

Keywords: Breathing Exercises; Endurance Training; Hypertension; Resistance Training; Social isolation.

Fig. 1

Flowchart of the systematic review process according to PRISMA model [18]

Fig. 2

Summary of main effects and putative mechanisms from home-based exercise programs on blood pressure in hypertensive. Target HR should be compatible as the end of each stage from the isometric exercise test in visit 1 [46]. HR, heart rate; HR_max, maximal heart rate; HRR, heart rate recovery; HRV, heart rate variability; MVC, maximal voluntary contraction; MIP, maximal inspiratory pressure; RPE, relative perception of effort; BRS, baroreflex sensitivity; SBP, systolic blood pressure; DBP, diastolic blood pressure; (?), represents the unknowing mechanisms