title: The effect of walking intervention on blood pressure control: a systematic review.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Nursing, Tzu Chi College of Technology, and School of Nursing, Tzu Chi University, Hualien, Taiwan. lllee666@gmail.com
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Lee
authors.forename: Michael C
authors.initials: MC
authors.lastname: Watson
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Mulvaney
authors.forename: Chin-Chueh
authors.initials: CC
authors.lastname: Tsai
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Lo
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016138:Walking