مقاله انگلیسی رایگان در مورد اثربخشی مداخله های فعالیت فیزیکی بر فشارخون در کودکان و نوجوانان – الزویر 2024

Abstract

Background
High blood pressure (BP) is a major contributor to mortality and cardiovascular diseases. Despite the known benefits of exercise for reducing BP, it is crucial to identify the most effective physical activity (PA) intervention. This systematic review and network meta-analysis (NMA) aimed to evaluate the available evidence on the effectiveness of various PA interventions for reducing BP and to determine their hierarchy based on their impact on BP.

Methods
A search of PubMed, SPORTDiscus, PsycINFO, Web of Science, CINAHL, Cochrane, and Eric databases was conducted up to December 2022 for this systematic review and NMA. Randomized controlled trials and quasi-experimental studies targeting healthy children and adolescents aged 6–12 years old were included in this study. Only studies that compared controlled and intervention groups using PA or exercise as the major influence were included. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent investigators performed the literature screening, data extraction, and risk of bias assessment. We used Bayesian arm-based NMA to synthesize the data. The primary outcomes were systolic BP and diastolic BP. We calculated the mean differences (MDs) in systolic BP and diastolic BP before and after treatment. Mean treatment differences were estimated using NMA and random-effect models.

Results
We synthesized 27 studies involving 15,220 children and adolescents. PA combined with nutrition and behavior change was the most effective intervention for reducing both systolic BP and diastolic BP ((MD: –8.64, 95% credible interval (95%CI):–11.44 to –5.84); (MD: –6.75, 95%CI: –10.44 to –3.11)), followed by interventions with multiple components ((MD: –1.39, 95%CI: –1.94 to –0.84); (MD: –2.54, 95%CI: –4.89 to –0.29)).

Conclusion
Our findings suggest that PA interventions incorporating nutrition and behavior change, followed by interventions with multiple components, are most effective for reducing both systolic blood pressure and diastolic blood pressure in children and adolescents.

Introduction

High blood pressure (HBP), or hypertension, occurs when the blood exerts too much pressure against the walls of blood vessels due to systolic and diastolic forces.1 It is a significant risk factor for cardiovascular diseases, contributing to 10.1 million deaths and 208.1 million cases of overall disease burden worldwide in the past 2 decades.2 The death rate attributable to HBP increased to 34.2% between 2009 and 2019,3, 4, 5 with hypertension projected to affect 41% of US adults by 2030.6,7 The economic burden of hypertension is expected to rise significantly, with direct costs projected to triple to USD 389.9 billion and indirect costs to double to USD 42 billion by 2030.6,8,9 Around 50% of reported cases of hypertension have a genetic component,10, 11, 12 while modifiable factors like lifestyle, diet, and physical activity (PA) contribute to the other half.13,14

The American Heart Association highlighted that the significance of HBP in children was previously underestimated. Recent studies show that many children and adolescents in the United States face hypertension risks. Data reveals that 5% of this demographic has HBP, while 18% exhibit elevated BP.15 Similarly, the Centers for Disease Control and Prevention reported that among youth aged 12–19, 1 in 25 has hypertension, and 1 in 10 experiences elevated BP.16 Considering these findings, both American Heart Association and Centers for Disease Control and Prevention emphasize the increasing incidence of HBP in young individuals, which could lead to health complications in adulthood. As a result, it’s imperative to implement preventive measures to counteract the rising trend of HBP in this age group. While medical research explores various approaches for monitoring and controlling genetically-based hypertension, non-medical approaches may be more feasible and effective in the interim.

Conclusion

Although medication-based treatments are essential for young individuals with hypertension, non-drug strategies have demonstrated effectiveness for lowering BP among healthy youth. Thus, integrating PA with other alterable factors early on can serve as a protective shield against future health issues. Notably, interventions that amalgamate PA, nutrition, and behavioral adjustments tend to be notably superior at decreasing both SBP and DBP compared to interventions focused solely on PA. Moreover, further investigation is required to classify PA modalities in terms of content, length, and intensity before concluding that PA-only intervention is the least effective approach for reducing BP.