The effects of aerobic and resistance exercise on blood pressure in uncomplicated and at risk pregnancies: A systematic review and meta-analysis

BACKGROUND: Regular exercise performed during pregnancy has been shown to reduce the risk of developing perinatal gestational hypertensive conditions. Further evidence on the exact parameters of exercise needed to explain these beneficial responses is required, within both uncomplicated and at-risk pregnancies. OBJECTIVE: The aim of this systematic review and meta-analysis was to investigate the effects of aerobic and resistance exercise on blood pressure during pregnancy. DESIGN: Systematic review and meta-analysis. DATA SOURCES AND METHODS: An online search of six search engines was conducted up to February 2023. Randomized controlled trials, quasi-experimental, cohort, and longitudinal studies were included. Studies included an acute exercise bout or intervention of land-based aerobic and/or resistance exercise during any trimester in uncomplicated and at-risk pregnancies. Outcomes included mean arterial pressure (MAP), or systolic blood pressure (SBP) and diastolic blood pressure (DBP). RESULTS: Following the removal of duplicates, 1538 articles were screened with 59 studies meeting the inclusion criteria for the review (randomized controlled trials (RCTs) n = 34, clinical trials n = 19, cohort n = 5 and cross-sectional n = 2), and 21 studies included in the meta-analysis. A random effects model was used with mean difference calculated in mmHg. Overall, there were no statistically significant effects of exercise on resting blood pressure (BP) outcomes in pregnant women with normal blood pressure compared to control/usual care populations following intervention (SBP mean diff -1.54 mmHg (favours intervention), p = 0.38; DBP mean diff -2.25 mmHg (favours intervention), p = 0.1; MAP mean diff -1.75 mmHg (favours intervention), p = 0.31). In at-risk pregnant women, both aerobic and combination exercise significantly reduced BP outcomes compared to control (SBP mean diff -3.91 mmHg, p < 0.01; DBP mean diff -2.9 mmHg, p = 0.01; MAP mean diff -2.38 mmHg, p = 0.01). Twenty-seven studies reported an acute increase in SBP and DBP during aerobic exercise, with no difference found between uncomplicated and at-risk pregnancies. CONCLUSIONS: Compared to usual care, aerobic and/or resistance exercise performed throughout uncomplicated pregnancy had no influence on blood pressure. Pregnant women with no diagnosed complications should be encouraged to exercise regularly due to the multitude of known benefits. In women who are at risk of, or diagnosed, with gestational hypertensive conditions during pregnancy, moderate to vigorous exercise during pregnancy improves blood pressure outcomes. Higher risk pregnancies may reduce their risk of future cardiovascular complications through regular exercise training during pregnancy. REGISTRATION: CRD42020159998.