Benefits of exercise training on blood pressure and beyond in cardiovascular diseases

Considerable evidence has emphasized that despite the substantial recommendations for major societies, sedentary behavior and physical inactivity remain high and physical activity (PA) and exercise training (ET) remains low in the US and much of the world.1–6 Therefore, greater efforts are needed to improve PA/ET in the primary and secondary prevention of cardiovascular disease (CVD) risk factors, including hypertension (HTN), and CVD. Although the European Society of Cardiology did not adopt the lower blood pressure (BP) guidelines that are now present in the US guidelines, still in Europe, the US and most of the world HTN is extremely prevalent and it contributes to markedly increased the risk of CVD and CVD-related morbidity and mortality.7–9 Studies have emphasized the potential for ET to reduce BP and HTN and to improve overall CVD prognosis. In the current issue of the European Journal of Preventive Cardiology, Noone et al.10 performed perhaps the largest and most thorough meta-analysis to date on the impact of ET on BP in people with HTN, while also comparing the anti-HTN effects of ET versus modern-day pharmacological intervention for HTN. In an analysis of 93 randomized controlled trials (RCTs), in 32 of those trials (404 patients with HTN), both ET and medications, together, effectively lowered BP compared to controlled conditions. Although the point estimate suggested that the anti-HTN medications were more effective than ET, there was insufficient evidence to suggest that first-line anti-HTN medications (including angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), calcium-channel blockers (CCBs) and thiazide-like diuretics) significantly reduced BP to a greater extent than ET intervention did, supporting the idea that vigorous non-pharmacologic therapy, including ET, should be considered as first-line therapy for at least mild HTN.