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Review article                                                       DOI: https://doi.org/10.35469/ak.2023.389
received: 2023-04-20                   UDC: 796.015:616.12-008.33-053.9
THE INFLUENCE OF PHYSICAL ACTIVITY ON THE 
ARTERIAL BLOOD PRESSURE OF THE ELDERLY: 
A SYSTEMATIC REVIEW
Doroteja RANČIĆ
1
, Tamara ILIĆ
1
, Stefan STOJANOVIĆ
1
1
Faculty of sport and physical education, University of Niš
Corresponding author:
Doroteja RANČIĆ
1
Faculty of Sport and Physical Education, University of Niš
Čarnojevića 10A, 18000 Niš, Serbia
Telephone number: +381652644224
Email: doroteja.r@yahoo.com
ABSTRACT
Purpose: The aim of this review was to determine the influence of physical activity 
on the arterial blood pressure of the elderly through a review of previous research.
Methods: The search was performed on the Web of Science, Google Scholar and 
PubMed databases. The first search identified 1112 articles. In the initial assessment 
carried out in accordance with the inclusion and exclusion criteria, 15 articles were 
found suitable and were included in the study, while 1097 studies were excluded. The 
search was limited to articles published in period of 2002–2022.
Results: After the applied exercise programs and evaluation at the final measure-
ments, the mean values of systolic blood pressure, on the total sample, were 131 mmHg, 
while the values of diastolic blood pressure were 77 mmHg, which indicates that physi-
cal activity (regardless of whether swimming, walking, yoga, resistance training, high 
interval training, Tai Chi) have a positive effect on the arterial blood pressure of the 
elderly.
Conclusion: All studies, except one, showed a positive influence of physical activity 
on the arterial blood pressure of elderly people. In this regard, it can be concluded that 
physical activity, regardless of the type of activity, has a positive effect on the arterial 
blood pressure of the elderly, in the form of a reduction in blood pressure values.
Keywords: physical activity, arterial blood presure, elderly.

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VPLIV TELESNE DEJA VNOSTI NA ARTERIJSKI KRVNI TLAK 
PRI STAREJŠIH OSEBAH: SISTEMATIČNI PREGLED
IZVLEČEK
Namen: Namen te analize je bil s pregledom dosedanjih raziskav ugotoviti vpliv 
telesne dejavnosti na arterijski krvni tlak pri starejših osebah.
Metode: Iskanje je potekalo v podatkovnih zbirkah Web of Science, Google Scholar 
in PubMed. Pri prvem iskanju je bilo opredeljenih 1112 člankov. Pri začetni presoji, 
opravljeni v skladu z merili za vključitev in izključitev, se je 15 člankov izkazalo za 
primerne in so bili vključeni v študijo, medtem ko je bilo 1097 študij izključenih. Iskanje 
je bilo omejeno na članke, objavljene v obdobju 2002–2022.
Rezultati: Po izvedenih vadbenih programih in oceni ob končnih meritvah so bile 
povprečne vrednosti SKT na celotnem vzorcu 131 mmHg, vrednosti DKT pa 77 mmHg, 
kar kaže, da imajo telesne dejavnosti (ne glede na to, ali gre za plavanje, hojo, jogo, 
vadbo vzdržljivosti, visoko intervalni trening, tai chi) pozitiven učinek na arterijski 
krvni tlak starejših oseb.
Sklep: Vse študije, razen ene, so pokazale pozitiven vpliv telesne dejavnosti na ar-
terijski krvni tlak starejših oseb. V zvezi s tem lahko sklepamo, da ima telesna de-
javnost, ne glede na vrsto dejavnosti, pozitiven učinek na arterijski krvni tlak starejših, 
in sicer v obliki zmanjšanja vrednosti krvnega tlaka.
Ključne besede: telesna dejavnost, arterijski krvni tlak, starejše osebe.

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INTRODUCTION
Aging is a natural process of life characterized by specific physical, psy-
chological, and social changes (Hamidizadeh, Ahmadi & Fallahi, 2004). In 
addition, aging refers to irreversible degenerative changes that are generally 
progressive, in which the physical condition of an older individual deteriorates, 
along with their ability and motivation to engage in physical activity (Fiori, 
Smith & Antonucci, 2007). As a result, practically all organs in most elderly 
people experience some degree of degradation/atrophy in their morphologi-
cal forms or in the tasks they perform in the body. As a result, various chronic 
diseases appear in older individuals, including cardiovascular diseases such as 
hypertension, coronary artery diseases, and skeletal diseases such as arthritis, 
osteoporosis, and cancer (Hamidizadeh et al., 2004).
Arterial blood pressure (BP) is an important indicator of cardiovascular health, 
and hypertension (high blood pressure) is a major risk factor for the development 
of cardiovascular disease in the elderly (Chobanian et al., 2003). The risk of hy -
pertension tends to be greater in elderly, and it is one of the diseases that can be 
treated. Physical activity is a well-established lifestyle factor that can lower blood 
pressure levels and reduce the risk of hypertension in older adults (Cornelissen & 
Smart, 2013; Pescatello, MacDonald, Lamberti, & Johnson, 2015). However, the 
relationship between physical activity levels and blood pressure in older adults 
is complex, and the optimal amount and intensity of physical activity required to 
achieve blood pressure reduction is still unclear (Pescatello et al., 2015). In addi-
tion, other factors such as age, gender, body mass index, and comorbidities such 
as diabetes and chronic kidney disease may influence the relationship between 
physical activity levels and blood pressure in the elderly. Therefore, it is impor -
tant to investigate the effect of physical activity on blood pressure in the elderly 
while controlling for these confounding variables.
Several studies have examined the impact of physical activity levels on BP 
in older adults, with some showing a significant association between higher 
physical activity levels and lower BP (Pescatello et al., 2015), while others have 
reported mixed or non-significant findings (Cornelissen & Smart, 2013; Graca 
et al., 2022 ). Moreover, some studies suggest that a sedentary lifestyle increases 
the risk of hypertension, while increased physical activity at work or leisure is 
associated with lower blood pressure values (Kokkinos, Papademetriou, 2000). 
The effect of aerobic exercise on hypertension was mainly tested in long-term 
exercise programs (at least three months) with high intensity and a large num-
ber of sessions per week (5 days per week). In a study by Moraes et al. (2012), 
the intervention group’s mean systolic and diastolic blood pressure decreased 

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by 3 mmHg and 1 mmHg, respectively, after three days of aerobic exercise per 
week for three months, but the control group’s mean blood pressure showed no 
significant change. The short-term program had no effect on lowering systolic 
blood pressure, but it did lower diastolic blood pressure, according to a study 
by Tabara et al. (2007) comparing aerobic short-term and long-term exercise 
programs with mild and moderate intensities on cardiovascular indicators of 
older adults. Mean systolic and diastolic blood pressure decreased throughout 
time, from 136 mmHg to 129 mmHg, and 87 mmHg to 83 mmHg, respectively. 
Based on a review of the literature, we can conclude that the previous studies 
are not sufficiently balanced and that there are many dilemmas about the influ -
ence of physical activity on the arterial pressure of the elderly. This study investi-
gated the effects of multiple types of physical activity on arterial blood pressure in 
the elderly. Knowing the effect of physical activity on the arterial blood pressure 
of the elderly, this paper contributes by sublimating the evidence and showing the 
effect of physical activity on blood pressure.  In this context, we assume that in-
dividuals who had higher level of physical acitivity would have preferable, that is 
lower SBP and DBP, BP values. Although the work is not unique, it represents ev -
idence-based evidence of the importance of physical activity for blood pressure. 
Also, most systematic reviews focus on the study of one type of physical activity, 
while showing the importance of multiple types of physical activity gives impor-
tance in planning physical activity programs in order to regulate blood pressure, 
where it is possible to make the program more flexible. 
Therefore, the aim of this study was to determine the influence of physical 
activity on the arterial blood pressure of the elderly through a review of previ-
ous research.
METHODS
This study was designed using the systematic review technique. Research 
data was collected considering the inclusion and exclusion criteria of the stud-
ies published, as a result of the search made by using the keywords “physical 
activity, artirial blood presure, eldery” in English. The search was performed 
on the Web of Science, Google Scholar and PubMed databases. In accordance 
with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 
(PRISMA) guidelines, a systematic review of the available literature was un-
dertaken (Moher, Liberati, Tetzlaff & Altman, 2009) (Figure 1.). The first search 
identified 1112 articles. In the initial assessment carried out in accordance with 
the inclusion and exclusion criteria, 15 articles were found to be suitable and 

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were included in the study, while 1097 studies were excluded. In order for a 
study to be included in the analysis, it had to meet the following criteria: year 
of publication (2002–2022), participants were eldery people (≥50 yrs), also the 
studies that were included in this review had to be based on the influence of 
physical activity on the arterial blood pressure of the elderly. References from 
all papers were reviewed in order to find more studies that dealt with topics that 
were of interest and related to our review paper.
Figure 1. PRISMA flow chart of article selection process
RESULTS
In this part, 15 original scientific studies are presented on the topic of the 
influence of physical activity on the arterial blood pressure of the elderly in 
Table 1.
Included Analysis Identification Eligibility
Artcles identified through a 
database search 
n = 1112
Articles (duplicates) removed
n = 510 
Articles included in systematic 
review  
n = 15 
Excluded (no full text 
available) 
n = 538
Eliminated articles 
for non-compliance to 
including criteria 
n = 49
Articles analyzed 
n = 602
Full text articles assessed for 
eligibility 
n = 64

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Table 1. Systematic review of the studies
Аuthors Participants Experimental program
Mean SBP 
(Before 
intervention)
Mean DBP
(After 
intervention)
Results
Tabara et al. 
(2007)
n = 139
2 groups
Age 67±6 
Mild to moderate aerobic 
exercise for 30 minutes 2/week 
for 6 months
136 mmHg
75 mmHg
129 mmHg
70 mmHg
Both SBP and DBP were 
significantly reduced 
Kawasaki et al. 
(2011)
n = 35
2 groups
Age 57–73 
6-month exercise program 
(swimming) 2/week
136 mmHg
81 mmHg
132 mmHg
77 mmHg
The exercise program 
significantly improved SBP and 
DBP, as did lipid and glucose 
metabolism
Pitsavos et al. 
(2011)
n = 42
2 groups
Age 53 ± 7
Aerobic exercise program for 
16 weeks, 3/week, with 60 to 80 
max. heart rate
131 mmHg
83 mmHg 
 119 mmHg
76 mmHg 
This study showed a positive 
effect of regular exercise on 
SBP and DBP
Habib et al. 
(2014)
n = 92
2 groups
Age 65–75 
4-week period of walking, 3/
week, each time for 20–30 
minutes
149 mmHg
94 mmHg
144 mmHg
85 mmHg
The findings showed that 
walking is effective in reducing 
blood pressure in the elderly
Miura et al. 
(2015)
n = 200
2 groups
Age 60–88 
12-week program (90 minutes 
2/week), 6–8 resistance 
exercises, circuit training and 
chair exercises for the lower 
body
150 mmHg
84 mmHg
145 mmHg
80 mmHg
Both groups had reductions in 
SBP and DBK (group doing 
circuit training and group doing 
lower body chair exercises)
Patil et al.(2015) n = 60
2 groups
Age ≥60 
Yoga training and brisk walking 
with stretching exercises 1 hour 
in the morning 6/week for 12 
weeks
146 mmHg 
74 mmHg
133 mmHg
73 mmHg
Yoga was more effective than 
brisk walking in reducing SBP 
and DBP

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Аuthors Participants Experimental program
Mean SBP 
(Before 
intervention)
Mean DBP
(After 
intervention)
Results
Ardakani et al. 
(2018) n = 24
2 groups
Age 67.37
8 weeks of resistance training, 
3/week with 40–65% intensity 
+ one max. repetition
143 mmHg 
72 mmHg
138mmHg
70mmHg
Resistance training for 8 weeks 
reduced SBP to a greater extent 
than DBP
Wong et al. 
(2018)
n = 100
2 groups
Age~74 
Swimming 3–4/week for a 
period of 20 weeks
147 mmHg
92 mmHg
143mmHg
86 mmHg
Swimming led to a decrease in 
blood pressure while increasing 
strength and aerobic capacity in 
women
Amooali et al. 
(2019)
n = 40
2 groups
Age 50–70 
Aerobic exercises performed 3 
times a week for 12 weeks
145 mmHg
86 mmHg
140 mmHg
81 mmHg
Aerobic exercise for 12 weeks 
was effective in reducing SBP 
and DBP
Ruangthai & 
Phoemsapthawee 
(2019)
n = 54
3 groups
Age 67±5.8 
Supervised exercise training (1-
hour sessions, 3 times a week 
for 12 weeks),
(strength and endurance training 
+ combined)
146 mmHg
84 mmHg
141mmHg
76 mmHg
Both types of training, as well 
as the combination of the two, 
led to a decrease in SBP and 
DBP
Herrod et al. 
(2020)
n = 48
4 groups
Age 71.0
HIIT on a cycle ergometer; 
isometric handgrip training 
(IHG); unilateral, upper 
limb remote ischemic 
preconditioning (RIPC) or non
intervention control
HIIT 
142 mmHg
85 mmHg
IHG
139 mmHg
83 mmHg
HIIT
131 mmHg
82 mmHg
IHG
131 mmHg
75 mmHg
6 weeks of fully supervised 
HIIT or IHG can reduce the 
resting SBP of older adults by 
an average of 9 mmHg

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Аuthors Participants Experimental program
Mean SBP 
(Before 
intervention)
Mean DBP
(After 
intervention)
Results
Choi et al. 
(2020)
n = 27
2 groups
Age 72–77
Elastic band exercises 
(EBE) for 60 min, 3/week 
for 3 months. The exercises 
consisted of incremental 
resistance and aerobic 
exercises.
126 mmHg 
78 mmHg
121 mmHg
75 mmHg 
Resting SBP and DBP were 
significantly reduced by ~5.0 
mmHg after the 12-week EBE 
program
Iellamo et al. 
(2021)
n = 36
3 groups
Age ≥ 60
Aerobic continuous exercise 
(ACE), HIIT, and combined 
(aerobic and resistance) 
exercise (CE)
ACE
121 mmHg
81 mmHg
CE      
121 mmHg
82 mmHg
      ACE    
     115 mmHg
78 mmHg
CE      
114 mmHg
78 mmHg
SBP lowering significant in the 
ACE and CE groups but not in 
the HIIE group. In all groups, 
DBP decreased to a similar 
level, although not significantly.
Wen & Su (2021) n = 66
2 groups
Age 50–75
60 minutes of simplified Tai 
Chi (STC) 3/week for 6 weeks 
or 60 min
of Wu-style Tai Chi (WTC) 3/
week for 6 weeks
STC
134 mmHg
80 mmHg
WTC
136 mmHg
80 mmHg
STC
124 mmHg
77 mmHg
WTC
123 mmHg
76 mmHg
Results showed that compared 
with
simplified Tai Chi, Wu-style Tai 
Chi had a better effect on BP in 
the elderly −5.80 (mmHg)
Graça et al. 
(2022)
n = 32
2 groups
Age 55–72
Resistance training followed 
by HIIT or vice versa
(8 weeks)
119 mmHg
80 mmHg
114 mmHg
74 mmHg
 Blood pressure did not change 
significantly following the 
intervention for either group
Legend: Mean BP – arterial blood pressure before the exercise program (mean values); Mean BP – arterial blood pressure after the exercise program 
(mean values); n – number of participants; SBP – systolic blood pressure; DBP – diastolic blood pressure.

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DISSCUSION
Hypertension is a serious public health challenge worldwide, being quan-
titatively the major risk factor for premature cardiovascular disease (Angeli, 
Reboldi & Verdecchia, 2013). If the underlying problem is not prevented or 
treated, many patients with hypertension die from hypertension-related diseas-
es. Therefore, the aim of this review was to determine the influence of physi-
cal activity on the arterial blood pressure of the elderly, regardless of gender, 
through a review of previous research. 
In the selected studies, there was usually one group that had to fulfill the 
conditions (the elderly population) in order to participate in the study. The num-
ber of participants varied from study to study, the smallest number of partici-
pants was included in our study (Ardakani, Qassemian, Koushki, Shakour & 
Mehrez, 2018) had a sample of only 24 elderly people, and the largest number 
(Miura, Takahashi, Maki, & Sugino, 2015) as many as 200 elderly people. The 
total number of participants in the present study amounted to 995 elderly peo-
ple between the ages of 50 and 88. 
Data from all the studies presented show that the mean values of systolic 
blood pressure (SBP) before exercise, in the total sample, were 138 mmHg, 
while the mean values of diastolic blood pressure (DBP) before exercise were 
82 mmHg. After the exercise programs and evaluation at the final measure-
ments, the mean values of SBP, on the total sample, were 131 mmHg, while 
the values of DBP were 77 mmHg, which indicates that physical activities (re-
gardless of whether swimming, walking, yoga, resistance training, high interval 
training or Tai Chi) have a positive effect on the arterial blood pressure of the 
elderly.
When it comes to physical activity, people who exercised more frequently 
and for a longer period of time had better improvements in the mean values of 
arterial blood pressure compared to people who did not exercise, i.e. sedentary 
individuals from control groups in the presented studies (Habib, Fariba, Fari-
deh, Navideh & Saeed, 2014; Kawasaki, Sullivan, Ozoe, Higaki & Kawasaki, 
2011; Wong et al., 2019; Ardakani et al., 2018; Pitsavos et al., 2011; Patil, 
Aithala & Das, 2015; Amooali, Daryanoosh, Baigi & Mohamadi, 2019). It is 
clear that all forms of physical activity have a positive effect on arterial blood 
pressure, with significant improvements observed after the swimming program 
(Kawasaki et al., 2011; Wong et al., 2019), walking / brisk walking program 
(Amooali et al., 2019; Pitsavos et al., 2011; Patil et al., 2015; Habib et al., 2014; 
Tabara et al., 2007; Iellamo et al., 2021), and resistance training (Ruangthai & 
Phoemsapthawee 2019; Miura et al., 2015; Ardakani et al., 2018; Choi, Hurr & 

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Kim, 2020), with the same positive effects being observed in the study by Wen 
& Su (2021) that implemented simplified Tai Chi and Wu-style Tai Chi and 
Patil et al. (2015) who implemented yoga sessions (Patil et al., 2015). Only one 
study did not find significant changes in SBP or DBP after intervention (Graça 
et al., 2022), in which they implemented resistance traning and high-intensity 
interval training for 8 weeks. A total of 14 out of 15 studies shown in the table 
showed positive results of physical activity on arterial blood pressure and in 
this connection we can conclude that physical activity, in general, has a positive 
effect on the arterial blood pressure of the elderly.
CONCLUSION
Physical activity (regardless of whether swimming, walking, yoga, resis-
tance training, high interval training or Tai Chi) has a positive effect on the 
arterial blood pressure of the elderly. 
With the exception of one study, all the other studies reviewed demonstrated 
a beneficial impact of physical activity on the arterial blood pressure of elderly 
individuals. In light of this, it can be concluded that physical activity, regardless 
of type of activity, yields favorable results by lowering blood pressure values 
in the elderly population.
Limitations of the study
This study has potential limitations. The study’s stringent inclusion and ex-
clusion criteria may have limited the amount of literature gathered. Addition-
ally, the heterogenity of studies included in this systematic review indisposed 
us of performing meta-analysis. Also, there are numerous internal and external 
factors, such as gender, age, level of metabolical health, stress etc., that can 
affect BP values, but the analyzed studies did not take into account all these 
variables. 
Acknowledgement 
All authors equally contributed in preparation of this manuscript.

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Conflict of interest 
The authors declare that there is no conflict of interest. 
Future research 
For future research, it is recommended to use a larger number of studies 
included in systematic review. Also, it is desirable to include studies based on 
only one type of physical activity.
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