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Am Fam Physician. 2022;105(1):22-23

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

Is routine walking an effective way to lower blood pressure?

Evidence-Based Answer

Walking lowers systolic blood pressure by 4.11 mm Hg (95% CI, 3.01 to 5.22 mm Hg). It lowers diastolic blood pressure by 1.79 mm Hg (95% CI, 1.07 to 2.51 mm Hg) and resting heart rate by 2.76 beats per minute (bpm; 95% CI, 0.95 to 4.57 bpm).1 (Strength of Recommendation: C, based on low- to moderate-certainty disease-oriented evidence.)

Practice Pointers

Hypertension can contribute to heart disease2 and is affected by an individual's physical activity level and lifestyle habits.3 Walking can be a relatively easy and affordable way to incorporate lifestyle changes and potentially lower blood pressure.

The authors of this Cochrane review evaluated studies of walking compared with no physical activity to lower blood pressure.1 This review included 73 randomized controlled trials and 5,763 participants. Participants were 16 to 84 years of age and normotensive or hypertensive men and women with various health conditions—the category “prehypertensive” was not discussed. The primary outcome was change in systolic blood pressure; secondary outcomes included changes in diastolic blood pressure and heart rate.

Walking as an intervention occurred in multiple environments, including at the participant's home, in the local community, or in a laboratory with a treadmill. Participants walked an average of 153 minutes per week for an average of 15 weeks. Although the intensity of activity was described as “moderate,” it varied among groups and was determined in a variety of ways, from heart rate or VO2 max (maximal oxygen consumption during intense exercise) to the speed of walking; in several studies walking intensity was not described at all.

The primary evaluation found moderate-certainty evidence that walking lowered systolic blood pressure (mean difference [MD] = 4.1 mm Hg; 95% CI, 3.0 to 5.2 mm Hg). Secondary evaluation found low-certainty evidence that walking lowered diastolic blood pressure (MD = 1.8 mm Hg; 95% CI, 1.1 to 2.5 mm Hg) and heart rate (MD = 2.8 bpm; 95% CI, 1.0 to 4.6 bpm). A subgroup analysis by age found moderate-certainty evidence that walking lowered systolic blood pressure in participants 40 years or younger (MD = 4.4 mm Hg; 95% CI, 2.7 to 6.2 mm Hg). There was low-certainty evidence that walking lowered systolic blood pressure in patients 41 to 60 years of age (MD = 3.8 mm Hg; 95% CI, 1.9 to 5.6 mm Hg) and in those older than 60 years (MD = 4.3 mm Hg; 95% CI, 2.4 to 6.2 mm Hg). There were only eight total adverse events across the 21 trials that reported them, five of which were knee pain.

The findings of this review suggest that a walking regimen—three to five times a week at a moderate intensity for 20 to 40 minutes per session, with at least 150 total minutes per week for approximately three months—can lower systolic blood pressure, diastolic blood pressure, and heart rate in adult men and women with or without hypertension. These findings support guidelines for the management of hypertension in adults as established by the National Institute for Health and Care Excellence and the American Heart Association and American College of Cardiology, which recommend that lifestyle interventions be included as part of a hypertension treatment plan.4,5

The practice recommendations in this activity are available at http://www.cochrane.org/CD008823.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. government.

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

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