BackgroundWe conducted meta‐analyses examining the effects of endurance, dynamic resistance, combined endurance and resistance training, and isometric resistance training on resting blood pressure (BP) in adults. The aims were to quantify and compare BP changes for each training modality and identify patient subgroups exhibiting the largest BP changes.Methods and ResultsRandomized controlled trials lasting ≥4 weeks investigating the effects of exercise on BP in healthy adults (age ≥18 years) and published in a peer‐reviewed journal up to February 2012 were included. Random effects models were used for analyses, with data reported as weighted means and 95% confidence interval. We included 93 trials, involving 105 endurance, 29 dynamic resistance, 14 combined, and 5 isometric resistance groups, totaling 5223 participants (3401 exercise and 1822 control). Systolic BP (SBP) was reduced after endurance (−3.5 mm Hg [confidence limits −4.6 to −2.3]), dynamic resistance (−1.8 mm Hg [−3.7 to −0.011]), and isometric resistance (−10.9 mm Hg [−14.5 to −7.4]) but not after combined training. Reductions in diastolic BP (DBP) were observed after endurance (−2.5 mm Hg [−3.2 to −1.7]), dynamic resistance (−3.2 mm Hg [−4.5 to −2.0]), isometric resistance (−6.2 mm Hg [−10.3 to −2.0]), and combined (−2.2 mm Hg [−3.9 to −0.48]) training. BP reductions after endurance training were greater (P<0.0001) in 26 study groups of hypertensive subjects (−8.3 [−10.7 to −6.0]/−5.2 [−6.8 to −3.4] mm Hg) than in 50 groups of prehypertensive subjects (−2.1 [−3.3 to −0.83]/−1.7 [−2.7 to −0.68]) and 29 groups of subjects with normal BP levels (−0.75 [−2.2 to +0.69]/−1.1 [−2.2 to −0.068]). BP reductions after dynamic resistance training were largest for prehypertensive participants (−4.0 [−7.4 to −0.5]/−3.8 [−5.7 to −1.9] mm Hg) compared with patients with hypertension or normal BP.ConclusionEndurance, dynamic resistance, and isometric resistance training lower SBP and DBP, whereas combined training lowers only DBP. Data from a small number of isometric resistance training studies suggest this form of training has the potential for the largest reductions in SBP.

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The TESTEX scale is a new, reliable tool, specific to exercise scientists, that facilitates a comprehensive review of exercise training trials.

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The objective of our study was to examine the effects of isometric resistance training (IRT) on resting blood pressure in adults. We conducted a systematic review and meta-analysis of randomized-controlled trials lasting ⩾2 weeks, investigating the effects of isometric exercise on blood pressure in healthy adults (aged ⩾18 years), published in a peer-reviewed journal between 1 January 1966 to 31 January 2015. We included 11 randomized trials, totaling 302 participants. The following reductions were observed after isometric exercise training; systolic blood pressure (SBP) mean difference (MD) -5.20 mm Hg (95% confidence interval (CI) -6.08 to -4.33, P<0.00001); diastolic blood pressure (DBP) MD -3.91 mm Hg (95% CI -5.68 to -2.14, P<0.0001); and mean arterial blood pressure (MAP) MD -3.33 mm Hg (95% CI -4.01 to -2.66, P<0.00001). Sub-analyses showed males tended to reduce MAP MD -4.13 mm Hg (95% CI -5.08 to -3.18) more than females. Subjects aged ⩾45 years demonstrated larger reductions in MAP MD -5.51 mm Hg (95% CI -6.95 to -4.06) than those <45 years. Subjects undertaking ⩾8 weeks of IRT demonstrated a larger reduction in SBP MD -7.26 mm Hg (95% CI -8.47 to -6.04) and MAP MD -4.22 mm Hg (95% CI -5.08 to -3.37) than those undertaking<8 weeks. Hypertensive participants in IRT demonstrated a larger reduction in MAP MD -5.91 mm Hg (95% CI -7.94 to -3.87) than normotensive participants MD -3.01 mm Hg (95% CI -3.73 to -2.29). Our study indicated that IRT lowers SBP, DBP and MAP. The magnitude of effect may be larger in hypertensive males aged ⩾45 years, using unilateral arm IRT for >8 weeks.

Context Membranous urethral length (MUL) measured prior to radical prostatectomy (RP) has been identified as a factor that is associated with the recovery of continence following surgery. Objective To undertake a systematic review and meta-analysis of all studies reporting the effect of MUL on the recovery of continence following RP. Evidence acquisition A comprehensive search of PubMed, EMBASE, and Scopus databases up to September 2015 was performed. Thirteen studies comprising one randomized controlled trial and 12 cohort studies were selected for inclusion. Evidence synthesis Four studies (1738 patients) that reported hazard ratio results. Every extra millimeter (mm) of MUL was associated with a faster return to continence (hazard ratio: 1.05; 95% confidence interval [CI]: 1.02–1.08, p < 0.001). Eleven studies (6993 patients) reported the OR (OR) for the return to continence at one or more postoperative time points. MUL had a significant positive effect on continence recovery at 3 mo (OR: 1.08, 95% CI: 1.03–1.14, p = 0.004), 6 mo (OR: 1.12, 95% CI: 1.09–1.15, p <0.0001). and 12 mo (OR: 1.12, 95% CI: 1.03–1.22, p = 0.006) following surgery. After adjusting for repeated measurements over time and studies with overlapping data, all OR data combined indicated that every extra millimeter of MUL was associated with significantly greater odds for return to continence (OR: 1.09, 95% CI: 1.05–1.15, p <0.001). Conclusions A greater preoperative MUL is significantly and positively associated with a return to continence in men following RP. Magnetic resonance imaging measurement of MUL is recommended prior to RP. Patient summary We examined the effect that the length of a section of the urethra (called the membranous urethra) had on the recovery of continence after radical prostatectomy surgery. Our results indicate that measuring the length of the membranous urethra via magnetic resonance imaging before surgery may be useful to predict a longer period of urinary incontinence after surgery, or to explain a delay in achieving continence after surgery.

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