Feasibility study to assess the delivery of a novel isometric exercise intervention for people with stage 1 hypertension

Objective:

Adherence is low to the lifestyle changes recommended by NICE for patients with hypertension. More easily adopted, effective and manageable exercise interventions are needed. This study determined the feasibility of personalised isometric exercise (IE) for patients with Stage (grade) 1 hypertension in the National Health Service (NHS) in England.

Design and method:

We conducted a multicentre randomised controlled feasibility study delivered through NHS primary/secondary care. Patients included were 18+, with clinic systolic BP (SBP)140-159mmHg, not on anti-hypertensive medication and without significant medical contraindications. Participants were randomised to standard lifestyle advice (control) or standard lifestyle advice plus wall squat IE for a 6-month period (intervention). After excluding people with average home systolic <135mmHg, 41 participants were included (control n=19, IE n=22) (aged 57 ± 15.15yrs). Participants were followed up at 4-weeks, 3-months, and 6-months.

Results:

Healthcare professionals were able to deliver the intervention with high fidelity (100% passed independent delivery check and 84.6% of participants recorded at least 2/3 of exercise heart rates within their target range over 6 months). A sample size for an efficacy trial (primary objective), was determined n= 542, based upon the 35% attrition rate and 14.4mmHg SD of change of SBP from baseline. Qualitative work provided valuable insights into acceptability, feasibility, delivery, and implementation in an NHS setting and for improved follow-on studies. Whilst the study was not powered to detect BP changes, reductions in SBP were observed at all time points.