ﺗﺎﺛﯿﺮ ﺗﻤﺮﯾﻦ ورزﺷﯽ ﻫﻮازي ﺑﺮ ﻓﺸﺎرﺧﻮن ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﭘﺮﻓﺸﺎر ﺧﻮﻧﯽ: ﻣﻄﺎﻟﻌﻪ ﻓﺮاﺗﺤﻠﯿﻠﯽ

Effect of Aerobic Training on Blood Pressure in Hypertensive Patients: A Meta-Analysis Study

ﺳﺎﺑﻘﻪ و ﻫﺪف: در ﺣﺎل ﺣﺎﺿﺮ در ﻣﻮرد اﺛﺮ ﺣﺠﻢ ﺗﻤﺮﯾﻦ و وﯾﮋﮔﯽﻫﺎي ﻓﺮدي ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﭘﺮﻓﺸﺎرﺧﻮﻧﯽ )ﺳﻦ، ﺟﻨﺴﯿﺖ، ﯾﺎﺋﺴﮕﯽ، ﻣﺼﺮف دارو و ...( ﺑﺮ ﻣﻘﺪار ﮐﺎﻫﺶ ﻓﺸﺎر ﺳﯿﺴﺘﻮﻟﯽ و دﯾﺎﺳﺘﻮﻟﯽ ﻧﺎﺷﯽ از ﺗﻤﺮﯾﻦ ﻫﻮازي اﻃﻼﻋﺎت اﻧﺪﮐﯽ وﺟﻮد دارد. ﺑﻨﺎﺑﺮاﯾﻦ ﻫﺪف اﯾﻦ ﻓﺮاﺗﺤﻠﯿﻞ ﺗﻌﯿﯿﻦ و ﻣﻘﺎﯾﺴﻪ ﻣﻘﺪار ﺗﻐﯿﯿﺮات ﻓﺸﺎر ﺧﻮن ﭘﺲ از ﺗﻤﺮﯾﻦ ﻫﻮازي و ﺗﻔﮑﯿﮏ اﺛﺮات در ﺑﯿﻦ زﯾﺮﮔﺮوهﻫﺎي ﻣﺨﺘﻠﻒ ﻣﺮﺑﻮط ﺑﻪ ﺗﻤﺮﯾﻦ و ﺑﯿﻤﺎران ﺑﻮد. ﻣﻮاد و روﺷﻬﺎ: ﮐﺎرآزﻣﺎﯾﯽﻫﺎي ﺑﺎﻟﯿﻨﯽ ﺑﺮرﺳﯽﮐﻨﻨﺪه ﺗﺎﺛﯿﺮ ﺗﻤﺮﯾﻦ ﻫﻮازي ﺑﯿﺶ از ﭼﻬﺎرﻫﻔﺘﻪ ﺑﺮ روي ﺑﯿﻤﺎران ﭘﺮﻓﺸﺎرﺧﻮﻧﯽ ﻣﻨﺘﺸﺮ ﺷﺪه در ﻣﺠﻼت ﭘﮋوﻫﺸﯽ اﻧﮕﻠﯿﺴﯽ و ﻓﺎرﺳﯽ ﺗﺎ آﮔﻮﺳﺖ 2018 از ﺳﺎﯾﺘﻬﺎي sid ،google و magiran و Pubmed ﺳﺮچ ﺷﺪه و ﻣﻮرد ﻓﺮاﺗﺤﻠﯿﻞ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﻣﺪﻟﻬﺎي اﺛﺮات ﺗﺼﺎدﻓﯽ و ﺛﺎﺑﺖ ﺑﺮاي ﻓﺮاﺗﺤﻠﯿﻞ اﻧﺪازه اﺛﺮ(ﺗﻔﺎوت در ﻣﯿﺎﻧﮕﯿﻦ ﺑﺎ ﺗﻨﺎوب اﻃﻤﯿﻨﺎن %95) ﺑﻪ ﺗﺮﺗﯿﺐ در 20 و 21 ﭘﮋوﻫﺶ ﻣﺮﺑﻮط ﺑﻪ ﻓﺸﺎرﺧﻮن ﺳﯿﺴﺘﻮﻟﯽ و دﯾﺎﺳﺘﻮﻟﯽ ﺑﺎ I2 ﮐﻤﺘﺮ از %50 ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮماﻓﺰار CMA2 اﺳﺘﻔﺎده ﺷﺪ. زﯾﺮﮔﺮوهﻫﺎي ﻃﺒﻘﻪاي ﺷﺎﻣﻞ ﺟﻨﺴﯿﺖ، ﯾﺎﺋﺴﮕﯽ، ﻣﺼﺮف دارو، ﺗﻌﺪاد ﺟﻠﺴﺎت ﺗﻤﺮﯾﻦ ﻫﻔﺘﻪ، ﺷﺪت و ﻣﺪت ﻫﺮ ﺟﻠﺴﻪ، ﮐﻞ زﻣﺎن ﺗﻤﺮﯾﻦ در ﻫﻔﺘﻪ و ﮐﻞ ﻣﺪت اﺟﺮاي ﺗﻤﺮﯾﻦ ﺑﺎ ANOVA ﻣﻘﺎﯾﺴﻪ ﺷﺪﻧﺪ و ﻫﻤﺒﺴﺘﮕﯽ ﺑﯿﻦ ﺳﻦ و ﭘﺎﺳﺦ ﻓﺸﺎرﺧﻮن ﺑﻪ ﺗﻤﺮﯾﻦ ﻫﻮازي ﺑﺎ ﻓﺮا رﮔﺮﺳﯿﻮن ﺗﺼﺎدﻓﯽ ﺳﺎده ﺑﺮرﺳﯽ ﺷﺪ. ﯾﺎﻓﺘﻪﻫﺎ: اﺛﺮ ﮐﻠﯽ ﺗﻤﺮﯾﻨﺎت ﻫﻮازي ﺑﺮ ﻓﺸﺎرﺧﻮن ﺳﯿﺴﺘﻮﻟﯽ و دﯾﺎﺳﺘﻮﻟﯽ ﺑﻪ ﺗﺮﺗﯿﺐ ﺑﺮاﺑﺮ ﺑﺎ 8/72- و 3/88- ﻣﯿﻠﯽﻣﺘﺮﺟﯿﻮه ﮐﺎﻫﺶ ﺑﻪ دﺳﺖ آﻣﺪ)0/001=P(. ﺑﺎ اﯾﻨﮑﻪ اﻧﺪازه اﺛﺮ ﺗﻤﺮﯾﻦ ﻫﻮازي ﺑﺮ ﻓﺸﺎر ﺳﯿﺴﺘﻮﻟﯽ و دﯾﺎﺳﺘﻮﻟﯽ در ﻣﻮرد ﺗﻤﺎم زﯾﺮﮔﺮوﻫﻬﺎي ﻃﺒﻘﺎت (ﺑﻪ ﺟﺰ در ﻣﻮرد ﻓﺸﺎر ﺳﯿﺴﺘﻮﻟﯽ ﺗﻤﺮﯾﻨﺎت ﮐﻢﺷﺪت و ﻓﺸﺎر دﯾﺎﺳﺘﻮﻟﯽ زﻧﺎن ﯾﺎﺋﺴﻪ) ﻣﻌﻨﯽدار ﺑﻮد(0/05

Background &purpose: A low information is available concerning the effects of the training volume subgroups and also hypertensive patients’ characteristics (e.g. age, gender, menopause, medication use and etc.) on the amount of aerobic training induced decreases in systolic and also diastolic blood pressures. Therefore, this meta-analysis aimed to determine and compare the amount of blood pressure changes after aerobic training and also to separate the effects in between patients and training subgroups Methods: Clinical trials (CTs) that investigated the effect of, at least, 4 weeks of aerobic training in hypertensive patients, published in a peer reviewed journals up to Aug 2018 were selected from Google, PubMed, SID and Magiran databases and included in the meta-analysis. Random-and fixed-effect models were used for analyzing the effect sizes were reported as difference in mean between 95% confidence intervals (CIs) of the respectively 20 and 21 studies concerned with SBP and DBP with I2 values less than 50% using CMA2 software. For each trial subgroup (gender, menopause, medication use, exercise frequency, intensity and duration, total weekly exercise time and study duration), statistical significance was tested by using one-way analysis of variance and a multivariate meta-regression analysis were performed to assess correlations between the participants’ age subgroup and the both SBP and DBP response to aerobic training. Results: The overall pooled net effect of aerobic training on both the systolic and diastolic blood pressures were -8.72 mm Hg and -3.88 mm Hg (P=0.001), respectively. In spite of the significant effect sizes observed for all the trial subgroups (in exception for SBP in low intensity training and DBP in post menopause women), a significantly different SBP reduction was only observed among the three subgroups of the “study duration” category. Conclusion: Aerobic training leads to a mild suppression of blood pressure in hypertensive patients regardless to the moderating effects from study subgroups (age group, gender, menopause status, and medication use or training dosage) with the greater reductions reported for eight to 10 weeks of training. However; a larger and longer term CTs still remains to be done because of a very large number of limitations in the conducted trials.