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Aerobic exercise interventions reduce blood pressure in patients after stroke or transient ischaemic attack: a systematic review and meta-analysis
  1. Cheng Wang1,
  2. Jessica Redgrave2,
  3. Mohsen Shafizadeh3,
  4. Arshad Majid1,4,
  5. Karen Kilner5,
  6. Ali N Ali1,6
  1. 1Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK
  2. 2Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  3. 3Sheffield Hallam University, Academy of Sport and Physical Activity, Sheffield, UK
  4. 4Sheffield NIHR Biomedical Research Centre, Sheffield, UK
  5. 5Sheffield Hallam University, Centre for Health and Social Care Research, Sheffield, UK
  6. 6Sheffield Teaching Hospitals NHS Foundation Trust, Geriatrics and Stroke Medicine, Sheffield, UK
  1. Correspondence to Dr Ali N Ali, Department of Geriatrics and Stroke Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; ali.ali{at}


Objective Secondary vascular risk reduction is critical to preventing recurrent stroke. We aimed to evaluate the effect of exercise interventions on vascular risk factors and recurrent ischaemic events after stroke or transient ischaemic attack (TIA).

Design Intervention systematic review and meta-analysis.

Data sources OVID MEDLINE, PubMed, The Cochrane Library, Web of Science, The National Institute for Health and Care Excellence, TRIP Database, CINAHL, PsycINFO, SCOPUS, UK Clinical Trials Gateway and the China National Knowledge Infrastructure were searched from 1966 to October 2017.

Eligibility criteria Randomised controlled trials evaluating aerobic or resistance exercise interventions on vascular risk factors and recurrent ischaemic events among patients with stroke or TIA, compared with control.

Results Twenty studies (n=1031) were included. Exercise interventions resulted in significant reductions in systolic blood pressure (SBP) −4.30 mm Hg (95% CI −6.77 to −1.83) and diastolic blood pressure −2.58 mm Hg (95% CI −4.7 to −0.46) compared with control. Reduction in SBP was most pronounced among studies initiating exercise within 6 months of stroke or TIA (−8.46 mm Hg, 95% CI −12.18 to −4.75 vs −2.33 mm Hg, 95% CI −3.94 to −0.72), and in those incorporating an educational component (−7.81 mm Hg, 95% CI −14.34 to −1.28 vs −2.78 mm Hg, 95% CI −4.33 to −1.23). Exercise was also associated with reductions in total cholesterol (−0.27 mmol/L, 95% CI −0.54 to 0.00), but not fasting glucose or body mass index. One trial reported reductions in secondary vascular events with exercise, but was insufficiently powered.

Summary Exercise interventions can result in clinically meaningful blood pressure reductions, particularly if initiated early and alongside education.

  • exercise
  • cardiovascular
  • risk factor
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  • Contributors ANA conceived the review. ANA and CW led the research team in undertaking the systematic review and meta-analysis. ANA, CW and MS were involved in study selection and quality appraisal. All authors were involved in manuscript development.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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