title: Isometric exercise training for blood pressure management: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To conduct a systematic review and meta-analysis quantifying the effects of isometric resistance training on the change in systolic blood pressure(SBP), diastolic blood pressure (DBP), and mean arterial pressure in subclinical populations and to examine whether the magnitude of change in SBP and DBP was different with respect to blood pressure classification.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of randomized controlled trials lasting 4 or more weeks that investigated the effects of isometric exercise on blood pressure in healthy adults (aged ≥18 years) and were published in a peer-reviewed journal. PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials were searched for trials reported between January 1, 1966, and July 31, 2013. We included 9 randomized trials, 6 of which studied normotensive participants and 3 that studied hypertensive patients, that included a total of 223 participants (127 who underwent exercise training and 96 controls).
  
  
  RESULTS
  The following reductions were observed after isometric exercise training: SBP-mean difference (MD), -6.77 mm Hg (95% CI, -7.93 to -5.62 mm Hg; P<.001); DBP-MD, -3.96 mm Hg (95% CI, -4.80 to -3.12 mm Hg; P<.001); and mean arterial pressure-MD, -3.94 mm Hg (95% CI, -4.73 to -3.16 mm Hg; P<.001). A slight reduction in resting heart rate was also observed (MD, -0.79 beats/min; 95% CI, -1.23 to -0.36 beats/min; P=.003).
  
  
  CONCLUSIONS
  Isometric resistance training lowers SBP, DBP, and mean arterial pressure. The magnitude of effect is larger than that previously reported in dynamic aerobic or resistance training. Our data suggest that this form of training has the potential to produce significant and clinically meaningful blood pressure reductions and could serve as an adjunctive exercise modality.
authors.affiliation: School of Science and Technology, University of New England, Armidale, New South Wales, Australia.
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Carlson
authors.affiliation: School of Science and Technology, University of New England, Armidale, New South Wales, Australia.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Dieberg
authors.affiliation: School of Science and Technology, University of New England, Armidale, New South Wales, Australia.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Hess
authors.affiliation: Division of Cardiology, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Millar
authors.affiliation: School of Science and Technology, University of New England, Armidale, New South Wales, Australia. Electronic address: nsmart2@une.edu.au.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Smart
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D015444:Exercise / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000517:prevention & control*; D015233:Models, Statistical; D016032:Randomized Controlled Trials as Topic