Plain language conclusions:

Background

Hypertension or elevated blood pressure is a major risk factor for cardiovascular diseases, such as coronary heart disease, stroke, and heart failure. Lowering blood pressure to normal levels is effective in reducing the risks of these diseases. Many of the risk factors relating to hypertension, such as physical inactivity, a diet high in salt and fat, or cigarette smoking, are related to lifestyle. Physical activity is recognised as an essential component of a healthy lifestyle. However many people may find it difficult to undertake exercise that fits into their daily lives. Walking is a low‐cost activity and one which many people can do. Previous studies have shown inconsistent results of the effect of walking on blood pressure control.

Study Characteristics

We included 73 trials involving 5763 participants from 22 countries, published up to March 2020. These trials included both males and females; with an age range from 16 to 84 years with approximately half aged over 60 (51%) and 39% aged 41 to 60 years with various health conditions. The types of walking activity varied, including home‐, community‐, school‐, or gym‐based walking several times a week with different intensity levels.

Key Results

We found moderate‐certainty evidence suggesting that walking reduces systolic blood pressure (SBP). We found moderate‐certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under and low‐certainty evidence that walking reduces SBP in participants aged 41 and over. We also found low certainty‐evidence suggesting that walking reduces SBP in females and males. We found low‐certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) and heart rate. Only 21 studies reported a total of eight adverse events, with knee injury reported five times as an adverse event. Many studies did not report how participants were allocated to the walking and control groups and whether those who assessed outcomes knew to which group a participant belonged. However, our outcomes of blood pressure and heart rate are objective measures and thus are less likely to be influenced by knowledge of whether a participant was in a walking or control group. Our findings suggest that moderate‐intensity walking, three to five times per week, of 20 to 40 minutes duration, and 150 minutes per week for approximately three months could have an effect on lowering blood pressure.