Review
The effect of walking intervention on blood pressure control: A systematic review

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Abstract

Background

Hypertension is a major public health problem and a key risk factor of cardiovascular diseases. Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. However the optimal characteristics for a physical activity programme remain open to debate. Walking is recommended by healthcare professionals as a form of exercise for controlling hypertension and nurses find it difficult to provide advice about this form of physical activity. Studies testing the effect of walking on blood pressure have produced inconsistent findings.

Objectives

To systematically review the evidence for the effectiveness of walking intervention on blood pressure.

Methods

A systematic search of the literature was conducted using a range of electronic and evidence-based databases to identify studies. Criteria for study inclusion were a randomised controlled trial design with a non-intervention control group; study samples were aged 16 years and over; the intervention was predominantly focused on walking and blood pressure was an outcome. Data extraction and quality appraisal were carried out independently by two reviewers; a third reviewer was consulted when needed.

Results

A total of 27 randomised controlled trials were included and nine of the 27 trials found an effect of walking intervention on blood pressure control. Walking intervention tends to be effective from studies with larger sample size. A beneficial effect of walking on blood pressure tended to employ moderate to high-intensity walking and a longer intervention period than those trials not showing the effect.

Conclusions

The results of this review provide evidence of the beneficial effects of walking on lowering blood pressure. Recommendations on lowering blood pressure with a walking activity should address the issue of walking intensity to achieve a beneficial effect on lowering blood pressure. Future research investigating the effect of walking intensity on blood pressure levels and rigorous design of walking interventions to achieve better adherence and methodological quality is required.

Section snippets

Background

Hypertension is a major public health problem (National Institute for Clinical Excellence NICE, 2004, World Health Organisation, 2002, World Health Organisation, 2003) and a major risk factor for cerebrovascular and ischaemic heart disease (World Health Organisation, 2002). Increased physical activity has been recommended as an important lifestyle modification for the prevention and management of hypertension (Chobanian et al., 2003, Guidelines Committee of European Society of Hypertension, 2003

Study criteria

Studies were included if they met the following criteria: (1) a randomised controlled trial design; (2) the intervention group was compared with a non-exercising control group; (3) the study samples were restricted to adults aged 16 and over; (4) the intervention focused on walking with no lower limit placed on the length of the intervention period; and (5) blood pressure was an outcome. Studies that included a combination of walking and other activities were not included as we were interested

Results

Our searches identified 3483 potentially relevant papers. A further 62 potentially relevant papers were identified from other sources (websites, referenced lists, own archives, experts). Of these 3545, 3447 were excluded based on a review of title or abstract (Fig. 1). Of the 98 potentially relevant studies, 71 were excluded following review of the full paper. Thus 27 trials met our inclusion criteria (Table 1).

Discussion

This review found that there is evidence showing beneficial effects of walking on lowering either systolic or diastolic blood pressure or both. Trial interventions which showed a beneficial effect on blood pressure tended to have larger sample size, higher baseline blood pressure level and employed moderate to high-intensity walking compared to those trials not showing a beneficial effect. These interventions were also of slightly longer duration although on average, the minutes per session and

Conclusion

In this review, about one third of trials found an effect of walking intervention on blood pressure control. The trials that generated beneficial results on blood pressure reduction were those that had longer mean intervention period, larger sample size and higher walking intensity. This review, with no language limitation and from good quality evidence, found the effect of walking interventions on controlling either systolic or diastolic blood pressure, or both. Although walking is a

Acknowledgment

We acknowledge the financial support from Tzu-Chi College of Technology, Hualien, Taiwan (Project number: TCCT-952A08).
Conflict of interest

We declare that there is no any conflicts of interest.
Ethical approval

Ethical approval was not sought for this systematic review.

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