Methodological quality of meta-analyses on the blood pressure response to exercise

Abstract

Numerous meta-analyses have been conducted to summarize the growing numbers of trials addressing the effects of exercise on blood pressure (BP), yet it is unclear how well they have satisfied contemporary methodological standards. We applied an augmented version of the Assessment of Multiple Systematic Reviews (AMSTARExBP) scale to 33 meta-analyses retrieved from searches of electronic databases. Qualifying reports used meta-analytic procedures; examined controlled exercise training trials; had BP as a primary outcome; and had exercise or physical activity interventions independently or combined with other lifestyle interventions. AMSTARExBP scores averaged near the middle of the scale (Mean = 56.0% ± 21.4% of total items possible); co-authored and more recent meta-analyses had higher quality scores. Common deficits were failures to disclose full search details (30% did), gauge the quality of included trials (48% did), use duplicate study selection and data extraction (55% did), or incorporate study quality in formulating results (35% did). Nearly all (91%) meta-analyses observed that exercise significantly lowered BP; fewer (58%) found that such effects depended on exercise or patient characteristics but these patterns often conflicted. Meta-analyses are often pillars of clinical recommendations and guidelines, yet only 58% addressed the clinical translations of their findings. In sum, meta-analyses have contributed less than ideally to our understanding of how exercise may impact BP, or how these BP effects may be moderated by patient or exercise characteristics. Future meta-analyses that better satisfy contemporary standards offer considerable promise to understand how and for whom exercise impacts BP.

Assessing the Existing Professional Exercise Recommendations for Hypertension: A Review and Recommendations for Future Research Priorities

“…In contrast, Johnson et al, 32 included meta-analyses that examined the BP response to exercise as a primary outcome. Johnson et al, identified and later excluded 4 of the reviews included by the Lifestyle Work Group because it was a systematic review (not a meta-analysis) 30 and 3 did not focus on BP as the primary outcome 22,27,28 ; in addition to the reviews included in the Lifestyle Work Group's sample, Johnson et al, identified 10 additional meta-analyses, 2 of which were excluded for "poor" quality.…”

“…32 The full search details have been reported elsewhere, 32 but briefly, our literature search was inclusive, encompassing all meta-analyses from the earliest coverage until 2013, a search that yielded 33 meta-analyses. On average, the study quality of this literature was fair, with numerous methodological deficiencies including (1) detail of the search strategies was insufficient for replication of the search, (2) only half of the meta-analyses integrated duplicate study selection and data extraction, and (3) the majority failed to document the quality of the included studies or examine whether study quality influenced the primary result (ie, magnitude of the BP change).…”

“…23,24,26,29 These 4 meta-analyses achieved only low to moderate quality on our review's methodological quality scale. 32 Another important deficiency within the exercise and hypertension literature is that despite its volume, examinations of the antihypertensive effects of exercise are often limited by small sample sizes that include a relatively large number of people without hypertension. [5][6][7]32 Because the magnitude of BP reductions in response to exercise is a function of initial values such that adults with the highest resting BP experience the largest BP reductions following exercise, 38 inclusion of individuals without hypertension to make Ex R x recommendations for those with hypertension would serve to underestimate the effectiveness of exercise as antihypertensive lifestyle therapy.…”

“…32 Another important deficiency within the exercise and hypertension literature is that despite its volume, examinations of the antihypertensive effects of exercise are often limited by small sample sizes that include a relatively large number of people without hypertension. [5][6][7]32 Because the magnitude of BP reductions in response to exercise is a function of initial values such that adults with the highest resting BP experience the largest BP reductions following exercise, 38 inclusion of individuals without hypertension to make Ex R x recommendations for those with hypertension would serve to underestimate the effectiveness of exercise as antihypertensive lifestyle therapy. In addition, important moderators such as medication use, body mass index, or the level of exercise supervision were underreported in the studies we reviewed or were not examined for their potential influence on the BP outcomes.…”

Treinamento da musculatura ventilatória combinado com treinamento aeróbio: efeitos sobre a pressão arterial, capacidade funcional, função endotelial e controle autonômico cardiovascular em pacientes hipertensos

“…Além de prevenir o desenvolvimento da HAS (43), o aumento da atividade física, seja ela por treinamento ou por mudança dos hábitos de vida diária, reduz os níveis de pressão arterial de pacientes hipertensos, guardadas as devidas proporções de cada uma das práticas (44).…”