Isometric Exercise Training and Arterial Hypertension: An Updated Review

Jamie J Edwards¹, Damian A Coleman¹, Raphael M Ritti-Dias², Breno Q Farah³, David J Stensel^{4

5

6

7}, Sam J E Lucas⁸, Philip J Millar⁹, Ben D H Gordon¹⁰, Véronique Cornelissen¹¹, Neil A Smart¹², Debra J Carlson¹³, Cheri McGowan¹⁴, Ian Swaine¹⁵, Linda S Pescatello¹⁶, Reuben Howden¹⁷, Stewart Bruce-Low¹⁸, Christopher K T Farmer¹⁹, Paul Leeson²⁰, Rajan Sharma²¹, Jamie M O'Driscoll^{22

23}

Affiliations

¹ School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK.
² Graduate Program in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil.
³ Department of Physical Education, Universidade Federal Rural de Pernambuco, Recife, Brazil.
⁴ National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
⁵ NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK.
⁶ Faculty of Sport Sciences, Waseda University, Tokyo, Japan.
⁷ Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China.
⁸ School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
⁹ Human Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, ON, Canada.
¹⁰ Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA.
¹¹ Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
¹² School of Science and Technology, University of New England, Armidale, NSW, Australia.
¹³ School of Health, Medical and Applied Sciences, CQ University, North Rockhampton, QLD, Australia.
¹⁴ Department of Kinesiology, University of Windsor, Windsor, ON, Canada.
¹⁵ Sport Science, University of Greenwich, London, UK.
¹⁶ Department of Kinesiology, University of Connecticut, Storrs, CT, 06269, USA.
¹⁷ Department of Applied Physiology, Health and Clinical Sciences, UNC Charlotte, Charlotte, NC, 28223, USA.
¹⁸ Department of Applied Sport and Exercise Science, University of East London, London, UK.
¹⁹ Centre for Health Services Studies, University of Kent, Canterbury, UK.
²⁰ Oxford Clinical Cardiovascular Research Facility, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK.
²¹ Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
²² School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK. jamie.odriscoll@canterbury.ac.uk.
²³ Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK. jamie.odriscoll@canterbury.ac.uk.

PMID: 38762832
PMCID: PMC11239608
DOI: 10.1007/s40279-024-02036-x

Review

Isometric Exercise Training and Arterial Hypertension: An Updated Review

Jamie J Edwards et al. Sports Med. 2024 Jun.

. 2024 Jun;54(6):1459-1497.

doi: 10.1007/s40279-024-02036-x. Epub 2024 May 19.

Authors

Affiliations

¹ School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK.
² Graduate Program in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil.
³ Department of Physical Education, Universidade Federal Rural de Pernambuco, Recife, Brazil.
⁴ National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
⁵ NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK.
⁶ Faculty of Sport Sciences, Waseda University, Tokyo, Japan.
⁷ Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China.
⁸ School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
⁹ Human Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, ON, Canada.
¹⁰ Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA.
¹¹ Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
¹² School of Science and Technology, University of New England, Armidale, NSW, Australia.
¹³ School of Health, Medical and Applied Sciences, CQ University, North Rockhampton, QLD, Australia.
¹⁴ Department of Kinesiology, University of Windsor, Windsor, ON, Canada.
¹⁵ Sport Science, University of Greenwich, London, UK.
¹⁶ Department of Kinesiology, University of Connecticut, Storrs, CT, 06269, USA.
¹⁷ Department of Applied Physiology, Health and Clinical Sciences, UNC Charlotte, Charlotte, NC, 28223, USA.
¹⁸ Department of Applied Sport and Exercise Science, University of East London, London, UK.
¹⁹ Centre for Health Services Studies, University of Kent, Canterbury, UK.
²⁰ Oxford Clinical Cardiovascular Research Facility, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK.
²¹ Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
²² School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK. jamie.odriscoll@canterbury.ac.uk.
²³ Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK. jamie.odriscoll@canterbury.ac.uk.

PMID: 38762832
PMCID: PMC11239608
DOI: 10.1007/s40279-024-02036-x

Abstract

Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest relevant to the content of this review.

Figures

**Fig. 1**
Pathophysiological mechanisms of hypertension. *Ang* angiotensin, *ANP* atrial natriuretic peptide, *BNP* brain natriuretic peptide, CA calcium, CO cardiac output, *Epi* epinephrine, HR heart rate, NE norepinephrine, NO nitric oxide, *PGI* prostacyclin, *RAAS* renin–angiotensin–aldosterone system, *SNS* sympathetic nervous system, SV stroke volume, *TPR* total peripheral resistance

**Fig. 2**
Modes of isometric exercise training. *dBP* diastolic blood pressure, HR_peak peak heart rate, *IET* isometric exercise training, *MVC* maximal voluntary contraction, *sBP* systolic blood pressure

**Fig. 3**
Acute physiological responses post-isometric exercise. *ATP* adenosine triphosphate, *BEI* baroreflex effectiveness index, *BRS* baroreflex sensitivity, *EDHF* endothelium-derived hyperpolarising factor, *IET* isometric exercise training, K potassium, LV left ventricular, *NTS* nucleus tractus solitarius, *TPR* total peripheral resistance

**Fig. 4**
Chronic mechanistic changes seen with isometric exercise training. *BRS* baroreflex sensitivity, *dBP* diastolic blood pressure, *GLS* global longitudinal strain, HR heart rate, *mBP* mean blood pressure, Q̇ cardiac output, *sBP* systolic blood pressure, SV stroke volume, *TPR* total peripheral resistance

See this image and copyright information in PMC

References

1. Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet [Internet]. 2018;392:1736–88. - PMC - PubMed
1. WHO. Cardiovascular diseases (CVDs) [Internet]. 2017. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases.... Cited 8 May 2021.
1. Amini M, Zayeri F, Salehi M. Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017. BMC Public Health [Internet]. 2021;21:1–12. 10.1186/s12889-021-10429-0. - PMC - PubMed
1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–2260. doi: 10.1016/S0140-6736(12)61766-8. - DOI - PMC - PubMed
1. Allen M. The SAGE encyclopedia of communication research methods. Milwaukee: SAGE Publications Inc.; 2017.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- PubMed Central
- Springer
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Isometric Exercise Training and Arterial Hypertension: An Updated Review

Affiliations

Isometric Exercise Training and Arterial Hypertension: An Updated Review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical