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The required step count for a reduction in blood pressure: a systematic review and meta-analysis

Journal of Human Hypertension volume 32, pages 814–824 (2018)Cite this article

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Abstract

The aim of the current study was to perform a systematic review and meta-analysis to evaluate the relationship between step count and changes in blood pressure (BP). Studies involving healthy adults and an intervention in the form of brisk walking with a pedometer were included. Net changes in BP and step count in each trial were calculated and pooled. In addition, the pooled net changes of two categories (trials that achieved walking 10,000 steps a day and those that did not) were compared. A meta-regression analysis was performed to examine the relationship between net changes in BP and step count. Fourteen trials were analyzed. Pooled net changes in BP improved significantly (systolic BP, −3.1 mm Hg; diastolic BP, −1.6 mm Hg). When the trials were categorized depending on whether they achieved walking 10,000 steps a day, the pooled net change in systolic BP and diastolic BP did not differ significantly between both groups of subjects. The meta-regression analyses indicated that net change in systolic BP was significantly associated with an increased step count (e.g., systolic BP is expected to decrease approximately 4 mm Hg if increased step count by 2000 steps a day). However, net change in systolic BP was not associated with the step count in an intervention group following the intervention. At present, there is presumably no evidence that walking 10,000 steps a day lowers the BP to any marked degree. In order to reduce systolic BP by walking with a pedometer, one should be mindful of increasing one’s step count.

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References

  1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective studies collaboration. 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.

    Article  PubMed  Google Scholar 

  2. Health Statistics Office, Director-General for Statistics and Information Policy, Ministry of Health, Labour and Welfare of Japan. Estimates of National Medical Care Expenditure, FY 2015. Tokyo, Japan: Statistical Surveys conducted by Ministry of Health, Labour and Welfare; 2017. 

  3. He J, Gu D, Chen J, Wu X, Kelly TN, Huang JF, et al. Premature deaths attributable to blood pressure in China: a prospective cohort study. Lancet. 2009;374:1765–72.

    Article  PubMed  Google Scholar 

  4. Takashima N, Ohkubo T, Miura K, Okamura T, Murakami Y, Fujiyoshi A, et al. Long-term risk of BP values above normal for cardiovascular mortality: a 24-year observation of Japanese aged 30 to 92 years. J Hypertens. 2012;30:2299–306.

    Article  CAS  PubMed  Google Scholar 

  5. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–67.

    Article  PubMed  Google Scholar 

  6. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 h urinary sodium and potassium excretion. BMJ. 1988;297:319–28.

    Article  Google Scholar 

  7. Hashimoto T, Fujita Y, Ueshima H, Kagamimori S, Kasamatsu T, Morioka S, et al. Urinary sodium and potassium excretion, body mass index, alcohol intake and blood pressure in three Japanese populations. J Hum Hypertens. 1989;3:315–21.

    CAS  PubMed  Google Scholar 

  8. Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302:401–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Colin BA, Adair LS, Popkin BM. Ethnic differences in the association between body mass index and hypertension. Am J Epidemiol. 2002;155:346–53.

    Article  Google Scholar 

  10. Crump C, Sundquist J, Winkleby MA, Sundquist K. Interactive effects of physical fitness and body mass index on the risk of hypertension. JAMA Intern Med. 2016;176:210–6.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sawada S, Tanaka H, Funakoshi M, Shindo M, Kono S, Ishiko T. Five year prospective study on blood pressure and maximal oxygen uptake. Clin Exp Pharmacol Physiol. 1993;20:483–7.

    Article  CAS  PubMed  Google Scholar 

  12. Ishizaka N, Ishizaka Y, Toda E, Koike K, Yamakado M, Nagai R. Impacts of changes in obesity parameters for the prediction of blood pressure change in Japanese individuals. Kidney Blood Press Res. 2009;32:421–7.

    Article  PubMed  Google Scholar 

  13. Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens. 2006;24:215–33.

    Article  CAS  PubMed  Google Scholar 

  14. Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2001;38:1112–7.

    Article  CAS  PubMed  Google Scholar 

  15. Graudal NA, Hubeck-Graudal T, Jürgens G. Effects of low-sodium diet vs. high-sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride (Cochrane Review). Am J Hypertens. 2012;25:1–15.

    Article  CAS  PubMed  Google Scholar 

  16. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, control trial. Ann Intern Med. 2002;136:493–503.

    Article  PubMed  Google Scholar 

  17. Kelley GA, Kelley KS, Tran ZV. Walking and resting blood pressure in adults: a meta-analysis. Prev Med. 2001;33:120–7.

    CAS  PubMed  Google Scholar 

  18. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2:e004473.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hanson S, Jones A. Is there evidence that walking groups have health benefits? A systematic review and meta-analysis. Br J Sports Med. 2015;49:710–5.

    Article  PubMed  Google Scholar 

  20. Murtagh EM, Nichols L, Mohammed MA, Holder R, Nevill AM, Murphy MH. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med. 2015;72:34–43.

    Article  PubMed  Google Scholar 

  21. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–81.

    Article  PubMed  Google Scholar 

  22. Williams PT. Advantage of distance- versus time-based estimates of walking in predicting adiposity. Med Sci Sports Exerc. 2012;44:1728–37.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–59.

    Article  PubMed  Google Scholar 

  24. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007;298:2296–304.

    Article  CAS  PubMed  Google Scholar 

  25. Qiu S, Cai X, Chen X, Yang B, Sun Z. Step counter use in type 2 diabetes: a meta-analysis of randomized controlled trials. BMC Med. 2014;12:36.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Baskerville R, Ricci-Cabello I, Roberts N, Farmer A. Impact of accelerometer and pedometer use on physical activity and glycaemic control in people with type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2017;34:612–20.

    Article  CAS  PubMed  Google Scholar 

  27. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.

    Article  Google Scholar 

  28. Higgins JPT, Green S (eds). Cochrane handbook for systematic reviews of interventions version 5.1.0. [updated March 2011]. London, UK: The Cochrane Collaboration; 2011. Available from http://handbook.cochrane.org/ 

  29. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  PubMed  Google Scholar 

  30. Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992;45:769–73.

    Article  CAS  PubMed  Google Scholar 

  31. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.

    Article  PubMed  Google Scholar 

  32. Cooper H, Hedges LV. The handbook of research synthesis. New York, NY: Russell Safe Foundation; 1994.

    Google Scholar 

  33. Egger M, Davey G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455–63.

    Article  CAS  PubMed  Google Scholar 

  35. Moreau KL, Degarmo R, Langley J, McMahon C, Howley ET, Bassett DR, et al. Increasing daily walking lowers blood pressure in postmenopausal women. Med Sci Sports Exerc. 2001;33:1825–31.

    Article  CAS  PubMed  Google Scholar 

  36. Tudor-Locke C, Bell RC, Myers AM, Harris SB, Ecclestone NA, Lauzon N, et al. Controlled outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type II diabetes. Int J Obes Relat Metab Disord. 2004;28:113–9.

    Article  CAS  PubMed  Google Scholar 

  37. Araiza P, Hewes H, Gashetewa C, Vella CA, Burge MR. Efficacy of a pedometer-based physical activity program on parameters of diabetes control in type 2 diabetes mellitus. Metabolism. 2006;55:1382–7.

    Article  CAS  PubMed  Google Scholar 

  38. Murphy MH, Murtagh EM, Boreham CA, Hare LG, Nevill AM. The effect of a worksite based walking programme on cardiovascular risk in previously sedentary civil servants [NCT00284479]. BMC Public Health. 2006;6:136.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Baker G, Gray SR, Wright A, Fitzsimons C, Nimmo M, Lowry R, et al. The effect of a pedometer-based community walking intervention “Walking for Wellbeing in the West” on physical activity levels and health outcomes: a 12-week randomized controlled trial. Int J Behav Nutr Phys Act. 2008;5:44.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bell GJ, Harber V, Murray T, Courneya KS, Rodgers W. A comparison of fitness training to a pedometer-based walking program matched for total energy cost. J Phys Act Health. 2010;7:203–13.

    Article  PubMed  Google Scholar 

  41. Uchikawa Y, Miyai N, Ito K, Yabu M, Ishii A, Shibata M, et al. Effects of walking exercise on cardiovascular risk parameters and arterial stiffness in middle-aged and elder subjects. Jpn J Appl Physiol. 2010;40:185–92. (Japanese)

    Google Scholar 

  42. Serwe KM, Swartz AM, Hart TL, Strath SJ. Effectiveness of long and short bout walking on increasing physical activity in women. J Women’s Health (Larchmt). 2011;20:247–53.

    Article  Google Scholar 

  43. Tully MA, Cupples ME. UNISTEP (university students exercise and physical activity) study: a pilot study of the effects of accumulating 10,000 steps on health and fitness among university students. J Phys Act Health. 2011;8:663–7.

    Article  PubMed  Google Scholar 

  44. Uchikawa Y, Nakamura C, Miyai N, Ito K, Ishii A, Utsumi M, et al. Effects of walking in sand-beach on novel risk factors of cardiovascular disease in metabolic syndrome - randomized control design. Heart. 2012;44:799–804. (Japanese)

    Google Scholar 

  45. Suboc TB, Strath SJ, Dharmashankar K, Coulliard A, Miller N, Wang J, et al. Relative importance of step count, intensity, and duration on physical activity’s impact on vascular structure and function in previously sedentary older adults. J Am Heart Assoc. 2014;3:e000702.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ohta Y, Kawano Y, Minami J, Iwashima Y, Hayashi S, Yoshihara F, et al. Effects of daily walking on office, home and 24-h blood pressure in hypertensive patients. Clin Exp Hypertens. 2015;37:433–7.

    Article  PubMed  Google Scholar 

  47. Phing CH, Saad HA, Nisak MYB, Nasir MTM. Effectiveness of physical activity intervention among government employees with metabolic syndrome. J Exerc Sci Fit. 2017;15:55–62.

    Article  Google Scholar 

  48. Laverty AA, Mindell JS, Webb EA, Millett C. Active travel to work and cardiovascular risk factors in the United Kingdom. Am J Prev Med. 2013;45:282–8.

    Article  PubMed  Google Scholar 

  49. Sun Q, Townsend MK, Okereke OI, Franco OH, Hu FB, Grodstein F. Physical activity at midlife in relation to successful survival in women at age 70 years or older. Arch Intern Med. 2010;170:194–201.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Huang B, Wu X. Pedometer algorithm research based-matlab. Adv Comput Sci Inform Eng. 2012;168:81–6.

    Article  Google Scholar 

  51. Health Service Division, Health Servuce Bureau, Ministry of Health, Labour and Welfare of Japan. National Health and Nutrition Survey. Tokyo, Japan: Statistical Surveys conducted by Ministry of Health, Labour and Welfare; 2016. 

  52. Tudor-Locke C, Bassett DR Jr. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med. 2004;34:1–8.

    Article  PubMed  Google Scholar 

  53. Yates T, Haffner SM, Schulte PJ, Thomas L, Huffman KM, Bales CW, et al. Association between change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance (NAVIGATOR trial): a cohort analysis. Lancet. 2014;383:1059–66.

    Article  PubMed  Google Scholar 

  54. Franklin SS, Gustin W 4th, Wong ND, Larson MG, Weber MA, Kannel WB, et al. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1997;96:308–15.

    Article  CAS  PubMed  Google Scholar 

  55. Avolio AP, Chen SG, Wang RP, Zhang CL, Li MF, O’Rourke MF. Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community. Circulation. 1983;68:50–8.

    Article  CAS  PubMed  Google Scholar 

  56. Igarashi Y, Akazawa N, Maeda S. Regular aerobic exercise and blood pressure in East Asians: A meta-analysis of randomized controlled trials. Clin Exp Hypertens. 2018;40:378–89.

    Article  PubMed  Google Scholar 

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Acknowledgements

A special thanks to the staff of Osaka University of Health and Sports Sciences Library collecting literatures for our analysis.

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Authors and Affiliations

  1. Graduate School of Sport and Exercise Sciences, Osaka University of Health and Sport Sciences, 1-1 Asashirodai, Kumatori-cho, Sennan-gun, Osaka, 590-0496, Japan

    Yutaka Igarashi

  2. Japan Institute of Sports Sciences, 3-15-1 Nishiga-oka, Kita-ku, Tokyo, 115-0056, Japan

    Nobuhiko Akazawa

  3. Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan

    Nobuhiko Akazawa & Seiji Maeda

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Igarashi, Y., Akazawa, N. & Maeda, S. The required step count for a reduction in blood pressure: a systematic review and meta-analysis. J Hum Hypertens 32, 814–824 (2018). https://doi.org/10.1038/s41371-018-0100-z

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