Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Isometric handgrip training, but not a single session, reduces blood pressure in individuals with hypertension: a systematic review and meta-analysis

Journal of Human Hypertension volume 37, pages 844–853 (2023)Cite this article

Subjects

Abstract

Aerobic exercise is a leading strategy for the prevention/management of systemic arterial hypertension, but other modalities of exercise have also been explored. Thus, we examined the acute effect of isometric handgrip exercise (IHGE) and the chronic effect of isometric handgrip training (IHGT) on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in individuals with hypertension without comorbid conditions. We conducted a systematic review with meta-analysis of randomized controlled trials (RCTs) involving adults with hypertension. We searched the electronic databases MEDLINE (PubMed), Cochrane, Web of Science, LILACS, EMBASE and PEDro. We used random-effects model for the analyses, RoB2 tool to assess the risk of bias, and GRADE to assess the strength of evidence. A total of 9 RCTs (2 for IHGE and 7 for IHGT) were selected. Compared to a control condition, IHGE did not have any effect on SBP/DBP. Unlike, the pooled mean effect of IHGT showed SBP was reduced by 6.7 mmHg (95% CI –10.3 to –3.4 mmHg) and DBP by 4.5 mmHg (95% CI –7.3 to –1.7 mmHg) in individuals with hypertension. Also, the 95% prediction interval (95% PI) of IGHT was –10.9 to –2.5 mmHg for SBP and –10.2 to +1.2 mmHg for DBP. In conclusion, while IHGE did not produce post-exercise hypotension in the population studied, IHGT reduced SBP/DBP in individuals with hypertension with clinically important reductions in SBP (–6.7 mmHg) and DBP (–4.5 mmHg). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD 42021217958).

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow chart of the study design.
Fig. 2: Effect after isometric handgrip exercise (IHGE) in individuals with hypertension (MVC: 30%).
Fig. 3: Effect after isometric handgrip exercise (IHGE) in individuals with hypertension (MVC: 50%).
Fig. 4: Effect after isometric handgrip training (IHGT) in individuals with hypertension.

Similar content being viewed by others

Data availability

The database used for this meta-analysis is available, as follows: Contributors: GW, PCO, and AML; Year: 2022; https://data.mendeley.com/datasets/4w2vp9bcmn.

References

  1. Malachias MVB, Gomes MAM, Nobre F, Alessi A, Feitosa AD, Coelho EB. 7th Brazilian guideline of arterial hypertension: chapter 2—diagnosis and classification. Arquivos Brasileiros de Cardiologia. 2016;107:7–13.

    CAS  PubMed  Google Scholar 

  2. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Collaboration PS. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13. https://doi.org/10.1016/s0140-6736(02)11911-8

    Article  PubMed  Google Scholar 

  3. Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, et al. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke. 2014;45:315–53. https://doi.org/10.1161/01.str.0000437068.30550.cf

    Article  PubMed  Google Scholar 

  4. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–324. https://doi.org/10.1161/HYP.0000000000000066

    Article  CAS  PubMed  Google Scholar 

  5. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953–2041. https://doi.org/10.1097/HJH.0000000000001940

    Article  CAS  PubMed  Google Scholar 

  6. Hanssen H, Boardman H, Deiseroth A, Moholdt T, Simonenko M, Krankel N et al. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol. 2021. https://doi.org/10.1093/eurjpc/zwaa141

  7. Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association. Hypertension. 2013;61:1360–83. https://doi.org/10.1161/HYP.0b013e318293645f

    Article  CAS  PubMed  Google Scholar 

  8. Pescatello LS, Buchner DM, Jakicic JM, Powell KE, Kraus WE, Bloodgood B, et al. Physical Activity to Prevent and Treat Hypertension: A Systematic Review. Med Sci Sports Exerc. 2019;51:1314–23. https://doi.org/10.1249/MSS.0000000000001943

    Article  PubMed  Google Scholar 

  9. Jin YZ, Yan S, Yuan WX. Effect of isometric handgrip training on resting blood pressure in adults: a meta-analysis of randomized controlled trials. J Sports Med Phys Fit. 2017;57:154–60. https://doi.org/10.23736/S0022-4707.16.05887-4

    Article  Google Scholar 

  10. Loaiza-Betancur AF, Chulvi-Medrano I. Is low-intensity isometric handgrip exercise an efficient alternative in lifestyle blood pressure management? a systematic review. Sports Health. 2020;12:470–7. https://doi.org/10.1177/1941738120943882

    Article  PubMed  PubMed Central  Google Scholar 

  11. López-Valenciano A, Ruiz-Pérez I, Ayala F, Sánchez-Meca J, Vera-Garcia FJ. Updated systematic review and meta-analysis on the role of isometric resistance training for resting blood pressure management in adults. J Hypertens. 2019;37:1320–33. https://doi.org/10.1097/HJH.0000000000002022

    Article  CAS  PubMed  Google Scholar 

  12. Hansford HJ, Parmenter BJ, McLeod KA, Wewege MA, Smart NA, Schutte AE et al. The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis. Hypertens Res. 2021. https://doi.org/10.1038/s41440-021-00720-3.

  13. Farah BQ, Germano-Soares AH, Rodrigues SLC, Santos CX, Barbosa SS, Vianna LC et al. Acute and chronic effects of isometric handgrip exercise on cardiovascular variables in hypertensive patients: a systematic review. Sports (Basel). 2017;5. https://doi.org/10.3390/sports5030055

  14. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. https://doi.org/10.1136/bmj.b2700

    Article  PubMed  PubMed Central  Google Scholar 

  15. Higgins JPTTJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). 2022. Available from: https://training.cochrane.org/handbook/current.

  16. de Oliveira PC, Lehnen AM, Waclawovsky G. Effect of isometric exercise on blood pressure in prehypertensive and hypertensive individuals: protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev. 2022;11:100. https://doi.org/10.1186/s13643-022-01974-9

    Article  PubMed  PubMed Central  Google Scholar 

  17. Robinson KA, Dickersin K. Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol. 2002;31:150–3. https://doi.org/10.1093/ije/31.1.150

    Article  PubMed  Google Scholar 

  18. Glanville J, Foxlee R, Wisniewski S, Noel-Storr A, Edwards M, Dooley G. Translating the Cochrane EMBASE RCT filter from the Ovid interface to Embase.com: a case study. Health Info Libr J. 2019;36:264–77. https://doi.org/10.1111/hir.12269

    Article  PubMed  Google Scholar 

  19. Galvez JM, Alonso JP, Sangrador LA, Navarro G. Effect of muscle mass and intensity of isometric contraction on heart rate. J Appl Physiol (1985). 2000;88:487–92. https://doi.org/10.1152/jappl.2000.88.2.487

    Article  CAS  PubMed  Google Scholar 

  20. Mohebbi H, Rohani H, Ghiasi A. Effect of involved muscle mass in resistance exercise on post exercise blood pressure and rate pressure product. Apunts Med de l’Esport. 2016;51:123–9.

    Article  Google Scholar 

  21. Polito MD, Farinatti PT. The effects of muscle mass and number of sets during resistance exercise on postexercise hypotension. J Strength Cond Res. 2009;23:2351–7. https://doi.org/10.1519/JSC.0b013e3181bb71aa

    Article  PubMed  Google Scholar 

  22. Silvester MD. The acute impact of large and small muscle mass isometric exercise on post-exercise blood pressure. Kingston, Ontario, Canada: Queen’s University; 2017. https://qspace.library.queensu.ca/handle/1974/22914

    Google Scholar 

  23. MacDonald JR, MacDougall JD, Hogben CD. The effects of exercising muscle mass on post exercise hypotension. J Hum Hypertens. 2000;14:317–20. https://doi.org/10.1038/sj.jhh.1000999

    Article  CAS  PubMed  Google Scholar 

  24. Balk EM, Earley A, Patel K, Trikalinos TA, Dahabreh IJ. Empirical assessment of within-arm correlation imputation in trials of continuous outcomes. 2012. Report No.: 12(13)-EHC141-EF.

  25. Simmonds M. Quantifying the risk of error when interpreting funnel plots. Syst Rev. 2015;4:24. https://doi.org/10.1186/s13643-015-0004-8

    Article  PubMed  PubMed Central  Google Scholar 

  26. Farah BQ, Rodrigues SLC, Silva GO, Pedrosa RP, Correia MA, Barros MVG, et al. Supervised, but not home-based, isometric training improves brachial and central blood pressure in medicated hypertensive patients: a randomized controlled trial. Front Physiol. 2018;9:961. https://doi.org/10.3389/fphys.2018.00961

    Article  PubMed  PubMed Central  Google Scholar 

  27. Badrov MB, Horton S, Millar PJ, McGowan CL. Cardiovascular stress reactivity tasks successfully predict the hypotensive response of isometric handgrip training in hypertensives. Psychophysiology. 2013;50:407–14. https://doi.org/10.1111/psyp.12031

    Article  PubMed  Google Scholar 

  28. Stiller-Moldovan C, Kenno K, McGowan CL. Effects of isometric handgrip training on blood pressure (resting and 24 h ambulatory) and heart rate variability in medicated hypertensive patients. Blood Press Monit. 2012;17:55–61. https://doi.org/10.1097/MBP.0b013e32835136fa

    Article  PubMed  Google Scholar 

  29. Gordon BDH, Thomas EV, Warren-Findlow J, Marino JS, Bennett JM, Reitzel AM, et al. A comparison of blood pressure reductions following 12-weeks of isometric exercise training either in the laboratory or at home. J Am Soc Hypertens. 2018;12:798–808. https://doi.org/10.1016/j.jash.2018.09.003

    Article  PubMed  Google Scholar 

  30. Taylor AC, McCartney N, Kamath MV, Wiley RL. Isometric training lowers resting blood pressure and modulates autonomic control. Med Sci Sports Exerc. 2003;35:251–6. https://doi.org/10.1249/01.MSS.0000048725.15026.B5

    Article  PubMed  Google Scholar 

  31. Punia S, Kulandaivelan S. Home-based isometric handgrip training on RBP in hypertensive adults-Partial preliminary findings from RCT. Physiother Res Int. 2020;25:e1806. https://doi.org/10.1002/pri.1806

    Article  PubMed  Google Scholar 

  32. Palmeira AC, Farah BQ, Silva GOD, Moreira SR, Barros MVG, Correia MA, et al. Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare: a randomized controlled trial. Sao Paulo Med J. 2021;139:648–56. https://doi.org/10.1590/1516-3180.2020.0796.R1.22042021

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https://doi.org/10.1136/bmj.l4898

    Article  PubMed  Google Scholar 

  34. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328:1490. https://doi.org/10.1136/bmj.328.7454.1490

    Article  PubMed  Google Scholar 

  35. IntHout J, Ioannidis JP, Rovers MM, Goeman JJ. Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open. 2016;6:e010247. https://doi.org/10.1136/bmjopen-2015-010247

    Article  PubMed  PubMed Central  Google Scholar 

  36. Dias S, Sutton AJ, Welton NJ, Ades AE. Evidence synthesis for decision making 3: heterogeneity–subgroups, meta-regression, bias, and bias-adjustment. Med Decis Mak. 2013;33:618–40. https://doi.org/10.1177/0272989X13485157

    Article  Google Scholar 

  37. Pedralli ML, Eibel B, Waclawovsky G, Schaun MI, Nisa-Castro-Neto W, Umpierre D, et al. Effects of exercise training on endothelial function in individuals with hypertension: a systematic review with meta-analysis. J Am Soc Hypertens. 2018;12:e65–e75. https://doi.org/10.1016/j.jash.2018.09.009

    Article  PubMed  Google Scholar 

  38. Schwarzer G, Carpenter, James R, Rücker, Gerta, Guido Schwarzer, James R Carpenter, Gerta Rück er, James R. Carpenter. Meta-Analysis with R. 2015. Available from: https://cran.r-project.org/web/packages/meta/meta.pdf.

  39. Cahu Rodrigues SL, Farah BQ, Silva G, Correia M, Pedrosa R, Vianna L et al. Vascular effects of isometric handgrip training in hypertensives. Clinical and experimental hypertension 2019. https://doi.org/10.1080/10641963.2018.1557683.

  40. Olher RRV, Bocalini DS, Bacurau RF, Rodriguez D, Figueira A, Pontes FL, et al. Isometric handgrip does not elicit cardiovascular overload or post-exercise hypotension in hypertensive older women. Clin Inter Aging. 2013;8:649–55. https://doi.org/10.2147/CIA.S40560

    Article  Google Scholar 

  41. Silva GO, Farah BQ, Germano-Soares AH, Andrade-Lima A, Santana FS, Rodrigues SL et al. Acute blood pressure responses after different isometric handgrip protocols in hypertensive patients. Clinics. 2018;73:e373. https://doi.org/10.6061/clinics/2018/e373

  42. Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288:1882–8. https://doi.org/10.1001/jama.288.15.1882

    Article  PubMed  Google Scholar 

  43. Millar PJ, McGowan CL, Cornelissen VA, Araujo CG, Swaine IL. Evidence for the role of isometric exercise training in reducing blood pressure: potential mechanisms and future directions. Sports Med. 2014;44:345–56. https://doi.org/10.1007/s40279-013-0118-x

    Article  PubMed  Google Scholar 

  44. Eguchi K, Hoshide S, Hoshide Y, Ishikawa S, Shimada K, Kario K. Reproducibility of ambulatory blood pressure in treated and untreated hypertensive patients. J Hypertens. 2010;28:918–24. https://doi.org/10.1097/HJH.0b013e3283378477

    Article  CAS  PubMed  Google Scholar 

  45. Loaiza-Betancur AF, Pérez Bedoya E, Montoya Dávila J, Chulvi-Medrano I. Effect of isometric resistance training on blood pressure values in a group of normotensive participants: a systematic review and meta-analysis. Sports Health. 2020;12:256–62. https://doi.org/10.1177/1941738120908070

    Article  PubMed  PubMed Central  Google Scholar 

  46. Carlson DJ, Dieberg G, Hess NC, Millar PJ, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis. Mayo Clin Proc. 2014;89:327–34. https://doi.org/10.1016/j.mayocp.2013.10.030

    Article  PubMed  Google Scholar 

  47. Inder JD, Carlson DJ, Dieberg G, McFarlane JR, Hess NC, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit. Hypertens Res. 2016;39:88–94. https://doi.org/10.1038/hr.2015.111

    Article  PubMed  Google Scholar 

  48. Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension. 2011;58:950–8. https://doi.org/10.1161/HYPERTENSIONAHA.111.177071

    Article  CAS  PubMed  Google Scholar 

  49. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2:e004473. https://doi.org/10.1161/JAHA.112.004473

    Article  PubMed  PubMed Central  Google Scholar 

  50. Millar PJ, Bray SR, McGowan CL, MacDonald MJ, McCartney N. Effects of isometric handgrip training among people medicated for hypertension: a multilevel analysis. Blood Press Monit. 2007;12:307–14. https://doi.org/10.1097/MBP.0b013e3282cb05db

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Carla Finger for her help with English language. Also, we thank Garrett Ash for critical review of this article and suggestions.

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

Author information

Authors and Affiliations

  1. Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Brazil

    Patrícia C. Oliveira, Marcondes R. Silva, Alexandre M. Lehnen & Gustavo Waclawovsky

Authors
  1. Patrícia C. Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcondes R. Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandre M. Lehnen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gustavo Waclawovsky
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PCO, AML, and GW contributed to the study concept and design. PCO, MRS, and GW collected the data. PCO, MRS, and GW organized the database. GW conducted the statistical analyses. PCO, AML, and GW drafted the manuscript. GW and AML conducted the critical review, and all authors provided input and approved the final manuscript.

Corresponding author

Correspondence to Alexandre M. Lehnen.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oliveira, P.C., Silva, M.R., Lehnen, A.M. et al. Isometric handgrip training, but not a single session, reduces blood pressure in individuals with hypertension: a systematic review and meta-analysis. J Hum Hypertens 37, 844–853 (2023). https://doi.org/10.1038/s41371-022-00778-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-022-00778-7

Search

Advanced search

Quick links