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Isometric exercise versus high-intensity interval training for the management of blood pressure: a systematic review and meta-analysis
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  • Published on:
    Comment on: ‘Isometric exercise versus high-intensity interval training for the management of blood pressure: a systematic review and meta-analysis’ by Edwards et al.
    • Michael A Wewege, PhD Candidate University of New South Wales; Neuroscience Research Australia
    • Other Contributors:
      • Harrison J Hansford, PhD Candidate
      • Matthew D Jones, Lecturer

    In their systematic review and meta-analysis, Edwards et al. (1) aimed to ‘directly compare’ the efficacy of isometric exercise and high-intensity interval training (HIIT) for the management of resting blood pressure. They included 38 randomised controlled trials (18 for isometric, 20 for HIIT) in their pairwise meta-analysis and concluded that isometric exercise appears to be superior to HIIT for improving both systolic blood pressure (mean difference between exercise types = 5.29 mmHg, 95% confidence interval 3.97 to 6.61) and diastolic blood pressure (mean difference between exercise types = 3.25 mmHg, 95% confidence interval 2.53 to 3.96). We were interested in these marked differences because they contrast previous findings (2) and, if correct, may necessitate important changes to guidelines. However, in further examining the article, we identified some issues that we believe require attention as they may invalidate the results and are relevant to readers of this journal.

    None of the included trials in this review appear to contain both isometric and HIIT interventions; therefore, the authors are unable to ‘directly compare’ the interventions. Instead, by analysing the differences between isometric and HIIT subgroups in the meta-analysis, Edwards et al. (1) are making an inference based on the indirect effect, which assumes that the differences between exercise types can be inferred via a common comparator (in this case, the control group) (3). This is, in effe...

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    Conflict of Interest:
    We have published systematic reviews evaluating exercise for blood pressure management. Michael Wewege was supported by a Postgraduate Scholarship from the National Health and Medical Research Council of Australia, a School of Medical Sciences Top-Up Scholarship from the University of New South Wales, and a PhD Top-Up Scholarship from Neuroscience Research Australia.