Introduction
Rationale
Objectives
Methods
Protocol and registration
Eligibility criteria
Information sources and search strategy
Study selection
Data collection process
Data items
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Change in resting diastolic blood pressure (DBP)
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Change in HR
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Change in arterial health and function assessed via pulse wave velocity, arterial distensibility, reactive hyperamic forearm blood flow, or flow mediated vasodilation
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Change in venous health and function assessed via venous compliance
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Change in autonomic nervous system indicators, assessed via muscle sympathetic nerve activity (MSNA), heart rate variability (HRV), BP variability, or cardiovascular (CV) reactivity
Risk of bias in individual studies
Summary measures and additional analyses
Results
Study selection
Study characteristics
Author and country | Study design | Participants | Relevant comorbidities | Exercise frequency and duration | HG training prescription | Total training tension-time product | SBP training response | Secondary outcomes reported | Risk of bias (TESTEX) |
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Allen et al. [59] USA | Cohort | Men (n = 14), young (26 ± 5.7 years) | 5/week for 4 weeks | One contraction every 4 s unilateral (non-dom) at 60% MVC for 20 min | 360,000 | − 4 mmHg (non-sig) | Diastolic BP, Heart rate, Arterial health and function (FMD), Autonomic Nervous system indicators (HRV) | 7/15 | |
Alomari et al. [60] no country noted | Cohort | Men (n = 11), young (24 ± 4.8 years) | 5/week for 4 weeks | 300 × 2 s unilateral (non-dom) HG contractions at 60% MVC, separated by 2-s rest | 720,000 | − 2 mmHg (non-sig) | Diastolic BP, Heart rate, Arterial health and function (reactive hyperamic blood flow + vascular resistance) | 5/15 | |
Badrov et al. [45] Canada | RCT—traditional | Men (n = 6), aged (67 years), Women (n = 6), aged (63 years) | All hypertensive and/or receiving pharmacotherapy for at least 4 months | 3/week for 10 weeks | 4 × 2 min bilateral HG contractions at 30% MVC, separated by 1-min rest | 432,000 | Men: − 7 mmHg (grouped change sig), Women: − 9 mmHg (grouped change sig) | Diastolic BP, Heart rate, Autonomic nervous system indicators (CV reactivity) | 11/15 |
Badrov et al. [38] Canada | RCT—traditional | Women (n = 12), young (23 ± 4 years) | 3/week for 8 weeks | 4 × 2 min unilateral (non-dom) HG contractions at 30% MVC, separated by 4-min rest | 345,600 | − 6 mmHg (sig) | Diastolic BP, Heart rate, Autonomic nervous system indicators (HRV), Arterial health and function (reactive hyperamic blood flow) | 13/15 | |
Women (n = 11), young (27 ± 6 years) | 5/week for 8 weeks | 4 × 2 min unilateral (non-dom) HG contractions at 30% MVC, separated by 4-min rest | 576,000 | − 6 mmHg (sig) | |||||
Badrov et al. [54] Canada | Cohort | Men (n = 9), young (21 ± 2 years), Women (n = 11), young (23 ± 4 years) | 3/week for 8 weeks | 4 × 2 min unilateral (non-dom) HG contractions at 30% MVC, separated by 4-min rest | 345,600 | Men: − 9 mmHg (sig), Women: − 6 mmHg (sig) | Diastolic BP, Arterial health and function (FMD) | 7/15 | |
Baross et al. [44] * United Kingdom | RCT—traditional | Men (n = 6) and women (n = 16), young (20.7 ± 1.6 years) | 4/week for 6 weeks | 3 × 10 s bilateral HG contractions at 20% MVC, separated by 10-min rest | 14,400 | − 4.9 mmHg (sig) | Diastolic BP | 6/15 | |
Bentley et al. [49] Canada | Cohort | Women (n = 17), aged (61.6 ± 4 years) | At least pre-hypertensive or receiving pharmacotherapy | 4/week for 8 weeks | 32 × 5 s unilateral (non-dom) HG contractions at max MVC, separated by 5-s rest | 512,000 | − 5.2 mmHg (sig) | Diastolic BP, Heart rate, Autonomic nervous system indicators (HRV and CV reactivity), Arterial health and function (PWV and AIx) | 9/15 |
Carlson et al. [41] * Australia | RCT—“sham” | Men and women (n = 18), aged (52 ± 8 years) | At least pre-hypertensive or receiving pharmacotherapy | 3/week for 8 weeks | 4 × 2 min unilateral (non-dom) HG contractions at 30%MVC, separated by 3-min rest | 345,600 | − 7 mmHg (sig) | Diastolic BP, Heart rate | 11/15 |
Men and women (n = 20), aged (54 ± 8 years) | At least pre-hypertensive or receiving pharmacotherapy | 3/week for 8 weeks | 4 × 2 min unilateral (non-dom) HG contractions at 5%MVC, separated by 3-min rest | 57,600 | − 2 mmHg (non-sig) | ||||
Dawson et al. [42] no country noted | RCT—traditional | Men (n = 8), aged (65 years), Women (n = 1), young (47 years) | All patients required transradial catheterization for upcoming coronary angiography/angioplasty | 3/week for 6 weeks | 900 × 1 s unilateral (catheterized arm) HG contractions at 40% MVC, separated by 1-s rest | 648,000 | Men: + 1 mmHg (grouped change non-sig), Women: + 16 mmHg (grouped change non-sig) | Heart rate, Arterial health and function (FMD) | 5/15 |
Dobrosielski et al. [51] USA | Cohort | Men (n = 12), aged (81 ± 5 years) | 4/week for 4 weeks | 300 × 1 s unilateral (non-dom) HG contractions at 60% MVC, separated by 3-s rest | 288,000 | − 2 mmHg (non-sig) | Diastolic BP, Heart rate, Arterial health and function (brachial artery reactivity and FMD) | 8/15 | |
Garg et al. [39] * India | Cohort | Men (n = 16) and women (n = 14), young (29.8 ± 6.3 years) | 3/week for 10 weeks | 5 × 3 min unilateral (dominant) HG contractions at 30% MVC, separated by 5-min rest | 810,000 | − 9.87 mmHg (sig) | Diastolic BP | 3/15 | |
Goessler et al. [52] * Belgium | RCT—traditional | Men and women (n = 19), young (33.1 ± 2.1 years) | 7/week for 8 weeks | 4 × 2 min bilateral contractions at 30% MVC, separated by 1-min rest | 806, 400 | − 5.5 mmHg (sig) | Diastolic BP | 8/15 | |
Hess et al. [61] * Australia | RCT—“sham” | Men (n = 6) and women (n = 4), young (38.8 ± 10.5 years) | 3/week for 6 weeks | 4 × 2 min unilateral (non-dom) contractions at 5% MVC, separated by 1-min rest | 43,200 | − 4.04 mmHg (non-sig) | Diastolic BP, Heart rate | 11/15 | |
Men (n = 6) and Women (n = 4), young (38.7 ± 12.6 years) | 3/week for 6 weeks | 4 × 2 min unilateral (non-dom) contractions at 10% MVC, separated by 1-min rest | 86,400 | − 5.62 mmHg (non-sig) | |||||
Kumar et al. [39] United Kingdom | Cohort | Men (n = 10), aged (avg: 63 years), Women (n = 13), aged (avg: 66 years) | Stable (stage 3–4) chronic kidney disease | 7/week for 4 weeks | 600 × 1 s unilateral (self-selected arm) HG contractions at max effort, separated by 2-s rest | 1,680,000 | Men: − 2.2 mmHg (grouped change non-sig) Women: 0 mmHg (grouped change non-sig) | Diastolic BP, Arterial health and function (brachial and radial resting diameters) | 7/15 |
McGowan et al. [55] Canada | Cohort | Men (n = 8), young (avg: 23 years), Women (n = 3), young (avg: 39 years) | 3/week for 8 weeks | 4 × 2 min unilateral (non-dom) HG contractions at 30% MVC, separated by 4-min rest | 345,600 | Men: − 6 mmHg (grouped change sig) Women: − 3 mmHg (grouped change sig) | Diastolic BP, Arterial health and function (FMD) | 9/15 | |
McGowan et al. [46] Canada | Cohort | Men (n = 12), aged (avg: 63 years) | Medicated hypertensive | 3/week for 8 weeks | 4 × 2 min unilateral (non-dom, n = 9) or bilateral (n = 7) HG contractions at 30% MVC, separated by 4-min rest | 345,600 | − 12 mmHg (grouped change sig) | Diastolic BP, Arterial health and function (FMD) | 9/15 |
Women (n = 4), aged (avg: 68) | − 13 mmHg (grouped change sig) | ||||||||
Millar et al. [47] Canada | Cohort | Men (n = 11), aged (avg: 66 years), Women (n = 2), aged (avg: 73 years) | Medicated Hypertensive | 3/week for 8 weeks | 4 × 2 min unilateral (non-dom) HG contractions at 30% MVC, separated by 4-min rest | 345,600 | Men: − 2 mmHg (grouped change sig) Women: − 15 mmHg (grouped change sig) | Diastolic BP, Heart rate, Autonomic nervous system indicators (HRV) | 9/15 |
Millar et al. [53] Canada | RCT—traditional | Men (n = 14), aged (avg: 68 years), Women (n = 11), aged (avg: 63 years) | 3/week for 8 weeks | 4 × 2 min bilateral HG contractions at 30–40% MVC, separated by 1-min rest | 345,600–460,800 | Men: − 7 mmHg (grouped change sig) Women: − 11 mmHg (grouped change sig) | Diastolic BP | 4/15 | |
Pagonas et al. [50] * Germany | RCT—“sham” | Men and women (n = 24), aged (58.8 ± 10.6 years) | Hypertensive | 5/week for 12 weeks | 4 × 2 min bilateral HG contractions at 30% MVC, separated by 1-min rest | 864,000 | 0 mmHg | Diastolic BP, Arterial health and function (PWV) | 8/15 |
Men and women (n = 23), aged (62.1 ± 7.1 years) | Hypertensive | 5/week for 12 weeks | 4 × 2 min bilateral HG contractions at 5% MVC, separated by 1-min rest | 144,000 | + 1.4 mmHg (non-sig) | ||||
Peters et al. [37] * USA | Cohort | Men (n = 8) and women (n = 2), aged (52 ± 5) | Hypertensive | 3/week for 6 weeks | 4 × 45 s bilateral HG contractions at 50% MVC, separated by 1-min rest | 162,000 | − 13 mmHg (sig) | Diastolic BP | 3/15 |
Ray et al. [56] * USA | RCT—traditional | Men and women (n = 9), young (19 to 35 years) | 4/week for 5 weeks | 4 × 3 min unilateral (non-dom) contractions at 30% MVC separated by 5-min rest | 432,000 | − 3 mmHg (non-sig) | Diastolic BP, Heart Rate, Autonomic Nervous System Indicators (MSNA) | 6/15 | |
Somani et al. [40] Canada | Cohort | Men (n = 13), young (24 ± 4 years), Women (n = 13), young 25 ± 5 years | 3/week for 10 weeks | 4 × 2 min bilateral HG contractions at 30% MVC, separated by 1-min rest | 432,000 | Men: − 5 mmHg (sig) Women: − 3 mmHg (sig) | Diastolic BP, Heart rate, Autonomic nervous system indicators (CV reactivity) | 10/15 | |
Stiller-Moldovan et al. [48] * Canada | RCT—traditional | Men (n = 7) and women (n = 3), aged (60 ± 8.5 years) | Medicated hypertensive | 3/week for 8 weeks | 4 × 2 min bilateral HG contractions at 30–40% MVC, separated by 1-min rest | 345,600 | − 1.9 mmHg (non-sig) | Diastolic BP, Heart rate, Autonomic nervous system indicators (HRV) | 10/15 |
Taylor et al. [43] * Canada | RCT—traditional | Men (n = 5) and women (n = 4), aged (69.3 ± 6 years) | Hypertensive | 3/week for 10 weeks | 4 × 2 min bilateral HG contractions at 30% MVC, separated by 1-min rest | 432,000 | − 19 mmHg (sig) | Diastolic BP, Heart rate, Autonomic nervous system indicators (HRV) | 6/15 |
Thijssen et al. [58] United Kingdom | Cohort | Men (n = 11), young (22 ± 2 years) | 4/week for 8 weeks | 30 contractions/min bilateral contractions for 30 min at 30% MVC for 4 weeks, 40% MVC for 2 weeks and 50% MVC final 2 weeks | 1,080,000 | 0 mmHg (non-sig) | Diastolic BP, Heart rate, Arterial health and function (wall-to-lumen ration) | 7/15 | |
Wiley et al. [57] * USA | Cohort | Men or women (n = 8), young (20–35 years) | 3/week for 8 weeks | 4 × 2 min unilateral (dom) contractions at 30% MVC separated by 3-min rest | 345,600 | − 13 mmHg (sig) | Diastolic BP, Heart rate | 6/15 | |
Men or women (n = 10), young (29 to 52 years) | 5/week for 5 weeks | 4 × 45 s bilateral contractions at 50% MVC, separated by 1-min rest | 216,000 | − 9.5 mmHg (sig) |
Risk of bias within studies
Synthesis of results
Participant details
Study design details including exercise intervention information
Age and sex introduction
Young (< 55 years) | Aged (> 55 years) | ||
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Men n = 139 | − 2 mmHg (n = 11) [60] 0 mmHg (n = 11) [58] − 4 mmHg (n = 14) [59] | − 2 mmHg (n = 12) [51] − 2.2 mmHg (n = 10) [39] + 1 mmHg (n = 8) [42] | Weighted mean (young and aged men): − 4.43 mmHg |
Weighted mean: − 4.12 mmHg (n = 66) | Weighted mean: − 4.71 mmHg (n = 73) | ||
Women n = 104 | + 16 mmHg (n = 1) [42] | 0 mmHg (n = 13) [39] | Weighted mean (young and aged women): − 5.59 mmHg |
Weighted mean: − 4.63 mmHg (n = 51) | Weighted mean: − 6.52 mmHg (n = 53) | ||
Men + women n = 222 (at least 96 women) | − 4.04 mmHg (n = 10, 4 women) [61] *sham − 5.62 mmHg (n = 10, 4 women) [61] − 3 mmHg (n = 9) [56] − 4.9 mmHg (n = 12, 6 women) [44] | − 1.9 mmHg (n = 11, 4 women) [48] − 2 mmHg (n = 20, 12 women) [41] *sham 0 mmHg (n = 24, 15 women) [50] + 1.4 mmHg (n = 23, 12 women) [50] *sham | |
Weighted mean: −7.26 mmHg (n = 107) | Weighted mean: − 3.96 mmHg (n = 115) | ||
Weighted mean (young men and women): −5.73 mmHg | Weighted mean (aged men and women): − 4.75 mmHg |
Young (< 55 years) | Aged (> 55 years) | ||
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Men n = 139 | − 0.2 mmHg (n = 11) [60] + 1 mmHg (n = 11) [58] 0 mmHg (n = 14) [59] 0 mmHg (n = 13) [40] | − 1 mmHg (n = 12) [51] − 0.9 mmHg (n = 10) [39] − 4 mmHg (n = 12) [46] 0 mmHg (n = 11) [47] − 2 mmHg (n = 8) [42] | Weighted mean (young and aged men): − 1.21 mmHg |
Weighted mean: − 0.26 mmHg (n = 66) | Weighted mean: − 2.07 mmHg (n = 73) | ||
Women n = 104 | − 3 mmHg (n = 12) [38] 0 mmHg (n = 11) [38] 0 mmHg (n = 3) [55] + 8 mmHg (n = 1) [42] − 1 mmHg (n = 13) [40] | − 0.8 mmHg (n = 13) [39] − 5 mmHg (n = 4) [46] − 11 mmHg (n = 2) [47] − 1.7 mmHg (n = 17) [49] | |
Weighted mean: − 1.45 mmHg (n = 51) | Weighted mean: − 2.40 mmHg (n = 53) | Weighted mean (young and aged women): − 1.94 mmHg | |
Men + women n = 222 (at least 96 women) | − 0.97 mmHg (n = 10, 4 women) [61] + 1.8 mmHg (n = 10, 4 women) [61] − 1.8 mmHg (n = 18, 8 women) [52] − 2.4 mmHg (n = 12, 6 women) [44] | − 1.6 mmHg (n = 1, 4 women) [48] − 7 mmHg (n = 9, 4 women) [43] − 2 mmHg (n = 18, 11 women) [41] − 3 mmHg (n = 20, 12 women) [41] − 0.7 mmHg (n = 24, 15 women) [50] 2.8 mmHg (n = 23, 12 women) [50] − 2 mmHg (n = 10, 2 women) [37] | |
Weighted mean: − 4.33 mmHg (n = 107) | Weighted mean: − 1.30 mmHg (n = 115) | ||
Weighted mean (young men and women): − 2.47 mmHg | Weighted mean (aged men and women): − 1.77 mmHg |
Young (< 55 years) | Aged (> 55 years) | ||
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Men n = 83 | + 0.1 bpm (n = 11) [60] 0 bpm (n = 11) [58] − 4 bpm (n = 14) [59] + 1 bpm (n = 13) [40] | − 2 bpm (n = 12) [51] + 2 bpm (n = 8) [42] + 1 bpm (n = 14) [53] | Weighted mean (young and aged men): − 0.59 bpm |
Weighted mean: − 0.86 bpm (n = 49) | Weighted mean: − 0.18 bpm (n = 34) | ||
Women n = 65 | −1 bpm (n = 12) [38] 0 bpm (n = 11) [38] + 14 bpm (n = 1) [42] − 3 bpm (n = 13) [40] | − 1.1 bpm (n = 17) [49] 0 bpm (n = 11) [53] | Weighted mean (young and aged women):− 0.86 bpm |
Weighted mean: − 1.0 bpm (n = 37) | Weighted mean: − 0.67 bpm (n = 28) | ||
Men + Women n = 130 (at least 47 women) | − 2 bpm (n = 8) [57] 0 bpm (n = 10) [57] 0 bpm (n = 10, 4 women) [61] 0 bpm (n = 10, 4 women) [61] − 1 bpm (n = 9) [56] | − 0.7 bpm (n = 11, 4 women) [48] − 2 bpm (n = 9, 4 women) [43] − 2 bpm (n = 13, 2 women) [47] 0 bpm (n = 12, 6 women) [45] + 2 bpm (n = 18, 11 women) [41] − 1 bpm (n = 20, 12 women) [41] | |
Weighted mean: − 0.53 bpm (n = 47) | Weighted mean: − 0.43 bpm (n = 83) | ||
Weighted mean (young men and women): − 0.59 bpm | Weighted mean (aged men and women): − 0.33 bpm |