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Methodological quality of meta-analyses on the blood pressure response to exercise: a review

Johnson, Blair T.a,b; MacDonald, Hayley V.a,c; Bruneau, Michael L. Jrf; Goldsby, TaShauna U.a,e; Brown, Justin C.g; Huedo–Medina, Tania B.a,d; Pescatello, Linda S.a,c

doi: 10.1097/HJH.0000000000000097

Numerous meta-analyses have been conducted to summarize the growing numbers of trials addressing the effects of exercise on blood pressure (BP), yet it is unclear how well they have satisfied contemporary methodological standards. We applied an augmented version of the Assessment of Multiple Systematic Reviews (AMSTARExBP) scale to 33 meta-analyses retrieved from searches of electronic databases. Qualifying reports used meta-analytic procedures; examined controlled exercise training trials; had BP as a primary outcome; and had exercise or physical activity interventions independently or combined with other lifestyle interventions. AMSTARExBP scores averaged near the middle of the scale (Mean = 56.0% ± 21.4% of total items possible); co-authored and more recent meta-analyses had higher quality scores. Common deficits were failures to disclose full search details (30% did), gauge the quality of included trials (48% did), use duplicate study selection and data extraction (55% did), or incorporate study quality in formulating results (35% did). Nearly all (91%) meta-analyses observed that exercise significantly lowered BP; fewer (58%) found that such effects depended on exercise or patient characteristics but these patterns often conflicted. Meta-analyses are often pillars of clinical recommendations and guidelines, yet only 58% addressed the clinical translations of their findings. In sum, meta-analyses have contributed less than ideally to our understanding of how exercise may impact BP, or how these BP effects may be moderated by patient or exercise characteristics. Future meta-analyses that better satisfy contemporary standards offer considerable promise to understand how and for whom exercise impacts BP.

Video abstract:

aCenter for Health, Intervention and Prevention

bDepartment of Psychology

cDepartment of Kinesiology

dDepartment of Allied Health Sciences, University of Connecticut, Storrs

eCenter for Metabolic Health, The Hospital of Central Connecticut, New Britain, Connecticut

fDepartment of Exercise Science and Sports Studies, Springfield College, Springfield, Massachusetts

gCenter for Clinical Epidemiology and Biostatistics and Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Correspondence to Blair T. Johnson, PhD, Center for Health, Intervention, and Prevention and Department of Psychology, 2006 Hillside Road Unit 1248, University of Connecticut, Storrs, CT 06269-1248, USA. E-mail:

Abbreviations: AMSTAR, Assessment of Multiple Systematic Reviews; AMSTARExBP, Modified Assessment of Multiple Systematic Reviews; BP, blood pressure; FITT, Frequency, Intensity, Time and Type; PEDro, Physiotherapy Evidence Database; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses; QUOROM, Quality of Reporting of Meta-analyses; RCTs, randomized-controlled trials

Received 18 April, 2013

Accepted 28 November, 2013

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