Walking for hypertension

Abstract

Background

Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low‐cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings.

Objectives

To determine the effect of walking as a physical activity intervention on blood pressure and heart rate.

Search methods

We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions.

Selection criteria

Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non‐intervention control on blood pressure and heart rate were included.

Data collection and analysis

We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings.

Main results

A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias.

Primary outcome

We found moderate‐certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD ‐4.11 mmHg, 95% CI ‐5.22 to ‐3.01; 73 studies, n = 5060). We found moderate‐certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD ‐4.41 mmHg, 95% CI ‐6.17 to ‐2.65; 14 studies, n = 491), and low‐certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD ‐3.79 mmHg, 95% CI ‐5.64 to ‐1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD ‐4.30 mmHg, 95% CI ‐6.17 to ‐2.44, 24 studies, n = 2610). We also found low certainty‐evidence suggesting that walking reduces SBP in both females (MD ‐5.65 mmHg, 95% CI ‐7.89 to ‐3.41; 22 studies, n = 1149) and males (MD ‐4.64 mmHg, 95% CI ‐8.69 to ‐0.59; 6 studies, n = 203).

Secondary outcomes

We found low‐certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD ‐1.79 mmHg, 95% CI ‐2.51 to ‐1.07; 69 studies, n = 4711) and heart rate (MD ‐2.76 beats per minute (bpm), 95% CI ‐4.57 to ‐0.95; 26 studies, n = 1747). We found moderate‐certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD ‐3.01 mmHg, 95% CI ‐4.44 to ‐1.58; 14 studies, n = 491) and low‐certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD ‐1.74 mmHg, 95% CI ‐2.95 to ‐0.52; 32 studies, n = 1730) and those aged 60 years and over (MD ‐1.33 mmHg, 95% CI ‐2.40 to ‐0.26; 23 studies, n = 2490). We found moderate‐certainty evidence that suggests walking reduces DBP for males (MD ‐2.54 mmHg, 95% CI ‐4.84 to ‐0.24; 6 studies, n = 203) and low‐certainty evidence that walking reduces DBP for females (MD ‐2.69 mmHg, 95% CI ‐4.16 to ‐1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times.

Authors' conclusions

Moderate‐certainty evidence suggests that walking probably reduces SBP. Moderate‐ or low‐certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low‐certainty evidence suggests that walking may reduce DBP and heart rate. Moderate‐ and low‐certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.

Plain language summary

The effect of walking on blood pressure control

Review question

Can walking lower blood pressure?

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.

Background

Description of the condition

Hypertension is responsible for approximately nine million deaths worldwide each year (Lim 2012) and an estimated 1.13 billion people globally have hypertension, with two‐thirds living in low‐ and middle‐income countries (WHO 2019). The premature death and disability caused by hypertension can have a considerable financial toll on families, health services, and national finances (WHO 2013). Hypertension is also a risk factor for various health problems, such as myocardial infarction, heart failure, chronic kidney disease, stroke, peripheral artery disease, and atrial fibrillation (Qamar 2018). Epidemiologic studies show that cardiovascular disease (CVD) events, such as coronary heart disease, stroke, and heart failure, are associated with elevated blood pressure levels (Amici 2009; Pini 2008; Rodriguez 2014). Observational studies document a progressive increase in heart disease risk as blood pressure rises above 115/75 mmHg ( Lawes 2008; Lewington 2002). A recent meta‐analysis of prospective cohort studies demonstrates that even just a stage I hypertension (systolic blood pressure (SBP) 130 to 139  mmHg or diastolic blood pressure (DBP) 80 to 89  mmHg) is associated with those CVD events and its morbidity and mortality (Han 2019).

Lowering blood pressure to standard targets has been found to be effective in reducing the risks of coronary artery disease and stroke (Lewington 2002; Staessen 2001; Vargas‐Urocoechea 2019), and effective control of stage 1 hypertension was found to prevent more than 10% of CVD (Han 2019). The report to the Eighth Joint National Committee for Detection, Evaluation, and Treatment of High Blood Pressure (JNC‐8) recommends that individuals achieve a target SBP <140 mmHg and DBP lower than 90 mmHg (James 2014; Lawes 2008; Lewington 2002). SBP is suggested as a better predictor of adverse health events than DBP (Ettehad 2016; Haider 2003).

Hypertension control through pharmacological treatment has led to substantial benefits in the primary prevention of morbidity and mortality from cardiovascular diseases (Ettehad 2016; Law 2009; Li 2019; Musini 2019; Blood Pressure Lowering Treatment Trialists 2000; Blood Pressure Lowering Treatment Trialists 2008; Wright 2018). Given some of the drawbacks to the pharmacological treatment of hypertension, such as discontinuation of the drug treatment due to potential adverse effects and the level of adherence with prescribed medication, non‐pharmacological interventions play an important role in controlling hypertension (Bonilla Ocampo 2018; Hagberg 2000).

There are several non‐modifiable risk factors for hypertension including a family history of hypertension, age over 65 years and co‐existing diseases (e.g. kidney disease and diabetes), but modifiable risk factors for hypertension include use of tobacco and consumption of alcohol, high fat diet, excessive salt consumption, physical inactivity and obesity (WHO 2002; WHO 2019). These modifiable risk factors for hypertension are related to lifestyle.

As hypertension is associated with lifestyle factors, all of the current guidelines highlight the role of non‐pharmacological interventions in hypertension management (James 2014; Whelton 2002; WHO 2003; Williams 2004). When most people with hypertension fall into the categories of high‐normal to stage 1 blood pressure elevations, which are lower than the level at which physicians often begin to prescribe antihypertensive medications (Wang 2004), lifestyle modifications maybe even more important than pharmacological treatment to control blood pressure.

Description of the intervention

Lifestyle physical activity interventions have been recommended as a way of lowering blood pressure and reducing the risk of heart disease (James 2014; Williams 2004). Some randomised controlled trials have provided evidence of the benefits of physical activity on reduction in SBP (Duru 2010; Murphy 2006), however, other studies found no such benefits (Elley 2003; Lawton 2008; Liira 2014). These contradictory data could result from methodological differences in the type of physical activity used in the intervention (frequency, duration, intensity, mode of supervision), target population, or overall study design. In addition, many people may find it difficult to fit physical exercise into their daily lives. Walking is one of the easiest forms of low‐cost physical activity and one which many people can do.

How the intervention might work

Evidence from randomised and non‐randomised trials suggests that walking may lead to improvements in SBP and DBP (Kelley 2001; Lee 2006). Walking, as an everyday activity for most people, is likely to be the most relevant low‐to‐moderate‐intensity activity, and brisk walking is a common and feasible form of sustainable dynamic aerobic exercise (Mabire 2017; Tschentscher 2013). For adults aged 18 and over, walking is the most popular physical activity (Afonso 2001; Australian Bureau of Statistics 2003; National Institutes of Health 1996), and the most common leisure activity among both men and women (Australian Bureau of Statistics 2003; Crespo 1996; Office for National Statistics 2003).

Why it is important to do this review

Results from previous studies examining the effect of walking interventions on blood pressure have been inconsistent. A meta‐analysis of walking programs for blood pressure management found beneficial effects either from various study designs (Kelley 2001); limited in a specific population, such as inactive adults (Oja 2018) or those with type 2 diabetes (Cai 2014); complex interventions, such as combining walking, jogging and/or running (Nieman 2013, Shabaaninia 2017, Sijie 2012); or compared a walking intervention with participants in the control group who also received an intervention, such as active pedometer‐based walking intervention (Vetrovsky 2018) or lifestyle modification, such as health education (Zhang (張舒) 2012) or salt reduction (Subramanian 2011). More evidence from randomised controlled trials in the general population and investigation of the effect of walking alone on blood pressure is needed. The purpose of this review is to examine whether walking is effective in controlling blood pressure.

Objectives

To determine the effect of walking as a physical activity intervention on blood pressure and heart rate.

Methods

Criteria for considering studies for this review

Types of studies

We included individually‐randomised parallel group controlled trials. We excluded cluster‐randomised studies due to the risk of contamination and we did not include cross‐over trials due to possible carry‐over effects of the intervention.

Types of participants

Both hypertensive and normotensive adults aged 16 years and over.

Types of interventions

Walking interventions including community, laboratory‐based (e.g. treadmill), or non‐stair and non‐uphill treadmill walking were included. Mixed interventions of walking with other modes of physical activity, such as jogging, or other forms of lifestyle modification, such as dietary salt reduction, were excluded.

The comparison was non‐exercising and non‐intervention controls.

Types of outcome measures

All outcome measures of: systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) as continuous data.

Primary outcomes

Systolic blood pressure (SBP) (continuous): measured by any standard devices, such as electronic or traditional mercury sphygmomanometer, or 24 hours ambulatory blood pressure measurement in millimetres of mercury (mmHg) pressure units.

Secondary outcomes

1. Diastolic blood pressure (DBP) (continuous): measured by any standard devices, such as electronic or traditional mercury sphygmomanometer, or 24 hours ambulatory blood pressure measurement in mmHg.

2. Heart rate (HR) (continuous): measured by any standard devices in beats per minute (bpm).

Search methods for identification of studies

Electronic searches

The Cochrane Hypertension Information Specialist conducted systematic searches in the following databases for randomised controlled trials without language, publication year, or publication status restrictions:

• Cochrane Hypertension Specialised Register via the Cochrane Register of Studies (CRS‐Web) (searched 8 March 2020);

• Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies (CRS‐Web) (2020, Issue 2);

• MEDLINE Ovid (from 1946 onwards), MEDLINE Ovid Epub Ahead of Print, and MEDLINE Ovid In‐Process & Other Non‐Indexed Citations (searched 7 March 2020);

• Embase Ovid (searched 7 March 2020);

• CINAHL EBSCO (searched 9 March 2020);

• SPORTDiscus EBSCO (searched 11 March 2020);

• PsycINFO EBSCO (searched 9 March 2020);

• Physiotherapy Evidence Database (PEDro) (searched 11 March 2020);

• ClinicalTrials.gov (www.clinicaltrials.gov) (searched 11 March 2020);

• World Health Organization International Clinical Trials Registry Platform (https://apps.who.int/trialsearch) (searched 11 March 2020).

Databases were searched from the date of inception. The Information Specialist modelled subject strategies for databases on the search strategy designed for MEDLINE. Where appropriate, they were combined with subject strategy adaptations of the sensitivity‐ and precision maximising search strategy designed by Cochrane for identifying randomised controlled (as described in Chapter 4 of the Cochrane Handbook for Systematic Reviews of Interventions Version 6 (Lefebrve 2019). We present the search strategies for major databases in Appendix 1.

The review authors also searched the following databases from the date of inception:

• Index to Taiwan Periodical Literature System (searched 18 May 2020);

• National Digital Library of Theses and Dissertations in Taiwan (searched 18 May 2020);

• China National Knowledge Infrastructure (CNKI)‐Journals, Theses & Dissertations (searched 18 May 2020);

• Wanfang Medical Online (searched 18 May 2020).

Searching other resources

• The Cochrane Hypertension Information Specialist searched the Hypertension Specialised Register segment (which includes searches of MEDLINE and Epistemonikos for systematic reviews) to retrieve existing systematic reviews relevant to this systematic review, so that we could scan their reference lists for additional trials. The Specialised Register also includes searches of CAB Abstracts & Global Health, CINAHL, ProQuest Dissertations & Theses and Web of Knowledge.

We checked the bibliographies of included studies and any relevant systematic reviews identified for further references to relevant trials. Where necessary, we contacted authors of key papers and abstracts to request additional information about their trials. We did not perform a separate search for adverse effects of interventions used for the treatment of hypertension. We considered adverse effects described in the included studies only.

Data collection and analysis

Selection of studies

All titles and abstracts identified through the searches were scanned by two review authors (LLL and HHL) independently for eligibility of inclusion. Abstracts that did not meet all the inclusion criteria were rejected. Any discrepancies were discussed and resolved by a third review author (CM). Full‐text articles for all included titles and abstracts were then retrieved and assessed by two review authors (LLL and HHL) to determine whether they met the inclusion criteria. Uncertainties concerning the appropriateness of studies for inclusion in the review were discussed and resolved through consultation with a third review author (CM). We have produced a PRISMA flow chart (Figure 1) showing how we selected our studies for inclusion in the review.

1.

Data extraction and management

A data extraction form was used to extract data on population, study methods, intervention, and outcomes. Two review authors independently extracted data (CM and LLL; EC and YW) and then compared the data. Any discrepancies were identified and resolved via discussion. We extracted data on study aim, inclusion and exclusion criteria, description of the intervention and control, and outcomes of interest. Special care was taken to avoid the inclusion of multiple reports pertaining to the same individuals, for example in trials reporting outcomes over multiple time periods. Where data were not available in the published trial reports, we contacted authors requesting missing information, and studies were excluded when data were not available.

Assessment of risk of bias in included studies

Using the Cochrane 'Risk of bias' tool (RoB1), two review authors (CM and LLL; EC and YW) independently assessed each study by examining randomisation procedure; allocation concealment; blinding of participants, intervention providers, and outcome assessors; incomplete outcome and losses to follow‐up. Discrepancies were resolved by discussion between the two review authors and, if needed, by consulting a third review author.

Measures of treatment effect

The mean blood pressure and heart rate differences from baseline to follow‐up in the intervention and control groups were compared and pooled using the weighted mean difference (WMD) approach (see Cochrane Collaboration: http://www.epi.bris.ac.uk/cochrane/stats3.html). The appropriateness of conducting meta‐analysis was checked by assessing clinical, methodological, and statistical homogeneity. Where insufficient information about the variance has been provided in trial reports, we calculated variances and took the correlation of baseline and final blood pressure measurements (Follmann 1992) into account. We contacted trial authors to collect the data insufficiently reported in the original trial, such as systolic or diastolic blood pressure readings at either baseline or follow‐up, and trials were excluded when the requested data were not available.

Unit of analysis issues

The unit of analysis was each participant. For studies with more than two arms, we included only arms that met the inclusion criteria of the review.

Dealing with missing data

We addressed the issue of missing data by requesting information from the original study authors. Where such attempts were unsuccessful and data could not be obtained, or estimates had to be derived by making further assumptions, the robustness of the overall findings was assessed through sensitivity analyses.

Assessment of heterogeneity

We used forest plots, Chi² tests, and I²to test for heterogeneity between the results of the studies in the review. We regarded a level of heterogeneity above 50% as substantial or high, as explained in the Cochrane Handbook for Systematic Reviews of Interventions, Section 9.5.2 (Higgins 2011). Where significant heterogeneity existed, explanations were sought for the sources of heterogeneity such as differences in the design or methodological characteristics.

Assessment of reporting biases

The possibility of publication bias was examined using funnel plots. If there was evidence that publication bias did exist, the trim‐and‐fill method (Duval 2000; Peters 2007) was used. This method estimates and adjusts for the numbers and outcomes of studies estimated as being missing and provides a sensitivity analysis to assess the robustness of the results to the likely degree of publication bias in the literature.

Data synthesis

We checked the appropriateness of conducting meta‐analysis by assessing for clinical and design homogeneity and presented the pooled results of SBP and DBP, and heart rate as mean differences (MDs) between groups and 95% Confidence Intervals (CIs). Random‐effects models were used to take account of statistical heterogeneity between combinable studies. We used Cochrane Review Manager 5.4 (RevMan 2014 [Computer program]) for data synthesis.

Subgroup analysis and investigation of heterogeneity

Subgroup analyses according to age and sex were carried out among the studies with sufficient information. Pooled results for SBP and DBP and heart rate were presented as MDs between groups and 95% CIs. Statistical heterogeneity was quantified by I². Random‐effects models were used to allow for statistical heterogeneity present between studies.

Sensitivity analysis

We performed sensitivity analyses to assess the effect of walking on blood pressure in studies we assessed at low risk of overall bias. We also performed a sensitivity analysis for studies assessed at low risk of attrition bias.

Summary of findings and assessment of the certainty of the evidence

We used the GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) (Guyatt 2011) to assess the certainty of the evidence for each estimate of intervention effect (Schünemann 2019a; Schünemann 2019b). We rated the certainty of the evidence by assessing the 'Risk of bias' evaluation, indirectness of evidence, inconsistency (considering I² and P value), imprecision of effect estimates (95%CI or small size of effect), and potential publication bias. We rated the certainty of the evidence as high, moderate, low or very low. We downgraded the evidence from 'high certainty' by one level for serious limitations or by two levels for very serious study limitations. We present key findings of the review in the 'Summary of findings' tables, including a summary of the amount of data, the magnitude of the effect size and the overall certainty of the evidence.

Results

Description of studies

Results of the search, included and excluded studies are described as follows.

Results of the search

Our initial searches identified 51,195 potentially relevant papers. After the removal of duplicates and initial screening, 7565 records remained. After conducting a further assessment on the basis of title and abstract, we excluded 7166 records and obtained the full text of 399 studies. After screening the full text of these 399 studies, 73 studies remained (Figure 1). Three studies are ongoing and will be considered in updates of this review when needed (Characteristics of ongoing studies).

Included studies

Seventy‐three randomised controlled trials involving 6473 participants met our inclusion criteria and were included in the review. Of the 6473 participants randomised into the 73 trials, 5763 received the eligible intervention and 5060 were analysed. The details of the methods, participants, intervention, comparison group, and outcome measures for each of the included trials are shown in the Characteristics of included studies. Further study details are presented in Table 4. The trials were published over a 30‐year period between 1991 and 2020, with 10 published during the 1990s, 23 during the 2000s, and 40 in 2010 to 2020.

1. Baseline characteristics of included studies.

Study ID	Participants randomised n	Country	Study population	Mean age (SD) or range	Male/total (%)	Mean baseline SBP (SD)(mmHg)	Mean baseline DBP (SD)(mmHg)	Mean baseline HR (SD)(beats/min)
Araiza 2006	30	USA	type 2 diabetes mellitus, free from advanced secondary complications of diabetes.	Range 33 to 69; IG: 49 (SD 11); CG:51 (SD 10)	NR	IG: 140.6 (SD 21.4); CG: 136.6 (SD 19.3)	IG: 80.7 (SD 12.2); CG: 77.6 (SD 8.9)	NR
Arija 2017	419	Spain	Older primary health‐care patients (attending primary health care facilities)	IG: 64.5 (SD 9.2); CG: 66.99 (SD 10.28)	84/364 (23.2%)	IG: 131.06 (SD 15.94); CG: 135.32 (SD 16.62)	IG: 76.75 (SD 9.09); CG: 75.96 (SD 9.86)	NR
Baker 2008	80	UK	Sedentary general population	Range 18 to 65; IG: 47.3 (SD9.3); CG: 51.2 (SD7.9)	16/79 (20.3%)	IG: 118.2 (SD 17.9); CG: 119.9 (SD 15.9)	IG: 75.1(SD 11.4); CG: 75.5 (SD 11.8)	IG: 68.6 (SD 7.2); CG: 67.9 (SD 8.6)
Bang 2016	60	Korea	General population (Office workers)	IG: 42.22 (SD 11.44); CG: 37.37 (SD 9.32)	3/45 (6.67%)	IG: 121.39 (SD 16.02); CG: 112.52 (SD 12.49)	IG: 79.00 (SD 9.37); CG: 72.85 (SD 9.35)	NR
Baross 2017	24	UK	Sedentary young adults	IG: 20.9 (SD 2.0); CG: 21.3 (SD 2.0)	13 (54%)	IG: 126.7 (SD 3.7); CG: 127.9 (SD 4.2)	IG: 77.7 (SD 3.0); CG: 77.0 (SD 1.8)	IG: 66.0 (SD 3.1); CG: 67.4 (SD 2.7)
Bayat 2018	120	Iran	Woman with Type 2 Diabetes	IG: 53.77 (SD 6.52); CG: 52.06 (SD 6.28)	0 (0%)	IG: 126.04 (SD 16.69), CG: 130.9 (SD 15.64)	IG: 74.9 (SD 10.85); CG: 85.0 (SD 10.0)
Bell 2010	140	Canada	Sedentary general population	Male: 49 (SD 11); Female: 50 (SD 9)	NR	IG: 124 (SD 14); CG: 125 (SD 13)	IG: 78 (SD 9); CG: 80 (SD 9)	IG: 73 (SD 9); CG: 76 (SD 11)
Braith 1994	30	USA	Normotensive elderly adults	Range 60 to 79; IG: 66 (SD 5); CG: 66 (SD 5)	NR	IG: 121 (SD 10); CG: 121 (SD 12)	IG: 72 (SD 8); CG: 74 (SD 5)	IG: 71 (SD 8); CG: 65 (SD 8)
Brandon 2006	52	USA	Obese sedentary adults	(total: 37.93; AAE: 34.0 (SD 7.2); AAC: 36.0 (SD 8.4); WE: 40.5 (SD 7.1); WC: 42.0 (SD 9.7)	0 (0%)	AAE: 110.0 (SD 11.9); AAC: 103.9 (SD 15.6); WE: 111.0 (SD 14.9); WC: 115.0 (SD 18.1)	AAE: 69.7 (SD 8.9); AAC: 63.8 (SD 14.6) WE: 67.0 (SD 10.3); WC: 68.5 (SD 10.2)	NR
Brenner 2020	48	Canada	Patients with vascular problems	IG 68.6 (SD 6.87); CG 63.7 (SD 8.47)	21/33 (63.6%)	IG: 124 (SD 15); CG: 132 (SD 14)	IG: 67 (SD 8); CG: 69 (SD 11)	IG: 63 (SD 12); CG: 66 (SD 13)
Brown 2014	94	UK	General population (Office workers)	IG1: 46.3 (SD 9.4); IG2: 39.3 (SD 10.3); CG: 40.2 (SD 11.0)	74 (78.7%)	IG1: 135.1 (SD 12.3); IG2: 128.9 (SD 15.1); CG: 133.3 (SD 10.5)	IG1: 86.0 (SD 7.6); IG2: 81.5 (SD 11.9); CG: 79.5 (SD 7.1)	IG1: 67.1 (SD 10.0); IG2: 63.6 (SD 10.1); CG: 64.6 (SD 12.5)
Chan 2018	164	Hong Kong	Hypertensive patients	IG: 63.22 (SD 11.11); CG: 65.13 (SD 10.22)	80 (48.8%)	IG: 138.15 (SD17.39); CG: 142.49 (SD19.12)	IG: 79.74 (SD 10.51); CG: 82.59 (SD 10.68)	NR
Chiang 2019	32	Taiwan	College students with obesity	IG1: 19.17 (SD 1.03); IG2: 20.64 (SD 1.80); CG: 19.36 (SD 1.12)	NR	IG1: 121.92 (SD 15.70); IG2: 121.36 (SD 11.48); CG: 127.00 (SD 17.18)	IG1: 76.92 (SD 12.06); IG2: 79.55 (SD 8.85); CG: 74.33 (SD 11.06)	IG1: 75.92 (SD 10.13) IG2: 78.3 (SD 10.02) CG: 79.78 (SD 7.85)
Coghill 2008	67	UK	Hypercholesterolaemic men	Range 45 to 65	67 (100%)	IG: 138.04 (SD 15.61); CG: 140 (SD 15.63)	IG: 89.90 (SD 9.93); CG: 88.32 (SD 9.52)	NR
Cooper 2000	90	UK	Sedentary adults with unmedicated hypertension 150‐180 mmHg	Range 25 to 63; IG: 46.2 (SD 9.4); CG: 49.4 (SD 8.9)	72 (80%)	IG: 139.8 (SD 12.7); CG: 135.7 (SD 9.3)	IG: 89.5 (SD 9.6); CG: 87.6 (SD 8.5)	NR
Dong 2007	120	China	Patients with chronic heart failure	IG: 61.7 (SD 12.3); CG: 61.9 (SD 12.1)	66 (55%)	IG: 149.10 (SD 44.50); CG: 147.2 (SD 44.1)	NR	IG: 104 (SD 25); CG: 105 (SD 21)
Dong 2012	51	China	White coat hypertension patients	Range 45 to 71; IG: 53.75 (SD 16.42); CG: 54.26 (SD 17.18)	29 (56.9%)	IG: 129.51 (SD 25.42); CG: 127.96 (SD 23.13)	IG: 82.09 (SD 17.23); CG: 83.46 (SD 18.52)	NR
Duncan 1991	102	USA	Sedentary pre‐menopausal women	Range 20 to 40	0 (0%)	IG1: 105 (SD 8); IG2: 109 (SD 9); IG3: 108 (SD 6); CG: 108 (SD 8)	IG1: 70 (SD 7); IG2: 74 (SD 8); IG3: 73 (SD 9); CG: 74 (SD 7)	NR
Dureja 2014	10	India	Young adults (post‐graduate students)	Range 19 to 25	10 (100%)	IG: 116 (SD 5.47); CG: 123 (SD 10.36)	IG: 79 (SD 8.94); CG: 82.0 (SD 11.51)	NR
Foulds 2014	90	Canada	General population	Range 20 to 65; total: 44 (SD 13)	21/58 (36.2%)	IG1: 116 (SD 16.11); IG2: 111.22 (SD 11.39); IG3: 108.28 (SD 11.58); IG4: 115.15 (SD 11.31);CG: 114.6 (SD 16.97)	IG1: 75.2 (SD 10.3); IG2: 72.3 (SD 7.14); IG3: 68.2 (SD 9.17); IG4: 74.9 (SD 11);CG: 69.2 (SD 8.6)	NR
Fritz 2013	213	Sweden	Overweight general population, & individuals with IGT or T2DM	Range 45 to 69; total: 60 (SD 5.3)	95 (44.6%)	IG1_NGT: 138 (SD 12.5); IG2_IGT: 141 (SD 14.0); IG3_T2DM: 143 (SD 13.2);CG1_NGT: 137 (SD 15.0); CG2_IGT: 141 (SD 13.0); CG3_T2DM: 144 (SD 12.6)	IG1_NGT: 85 (SD 7.9); IG2_IGT: 84 (SD 7.8); IG3_T2DM: 85 (SD 7.6);CG1_NGT: 84 (SD 8.8); CG2_IGT: 86 (SD 9.4); CG3_T2DM: 83 (SD 7.4)	NR
Geddes 2009	15	USA	Multiple sclerosis adults	IG: Range 40 to 64; CG: Range 22 to 50	3/12 (25%)	NR baseline SBP	NR baseline DBP	NR
Gilson 2007	70	UK	General population (University employees office workers)	Male: 41 (SD 11); Female: 42 (SD 11)	7 (10%)	IG1: 121.7 (SD 17.3); IG2: 119.0 (SD 7.4); CG: 121.6 (SD 9.9)	IG1: 85.6 (SD 12.1); IG2: 85.7 (SD 10); CG: 82.9 (SD 7.3)	NR
Gradidge 2018	132	South Africa	Obese women (university staff)	IG: 44.4 (SD 11.5); CG: 37.4 (SD 8.78)	0 (0%)	IG: 127 (SD 14.7); CG: 122 (SD 15.6)	NR	NR
Hamdorf 1999	49	Australia	Elderly sedentary women	Range 79 to 91; IG: 82.4 (SEM 0.66); CG: 83.1 (SEM 0.69)	0 (0%)	IG: 144.6 (SEM 4.9); CG: 149.3 (SEM 5.1)	IG: 72.6 (SEM 2.2); CG: 77.7 (SEM 2.5)	IG: 74.4 (SEM 2.1) CG: 72.7 (SEM 1.7)
Headley 2017	49	USA	Stage 3 chronic kidney disease adults	IG: 58 (SD 8.0); CG: 57.1 (SD 9.0)	30/46 (65.2%)	IG: 126.4 (SD 17.8); CG: 133.7 (SD 19.2)	IG: 79.5 (SD 10.2); CG: 79.1 (SD 10.7)	IG: 64.3 (SD 8.9); CG: 65.5 (SD 12.3)
Herzig 2014	78	Finland	Impaired fasting glucose/ glucose tolerance adults	IG: 58.1 (SD 9.9); CG: 59.5 (SD 10.8)	18/68 (26.5%)	IG: 138.5 (SD 16.4); CG: 150.4 (SD 20.2)	IG: 83.8 (SD 8.0); CG: 85.4 (SD 9.5)	NR
Higashi 1999b	27	Japan	Essential hypertensive adults	IG: 53 (SD 10); CG: 51 (SD 8)	20 (74%)	IG: 155.0 (SD 6.6); CG: 155.4 (SD 8.3)	IG: 96.0 (SD 4.9); CG: 97.6 (SD 4.3)	IG: 71.8 (SD 9.7); CG: 73.1 (SD 6.4)
Holloway 1997	102	USA	Sedentary middle‐aged	Range 20 to 50	unknown	IG1_XS: 113.6 (SD 9.8); IG2_T: 113.4 (SD 11.1); IG3_S: 116.7 (SD 10.0); CG: 114.5 (SD 12.3)	IG1_XS: 80.0 (SD 7.3); IG2_T: 81.9 (SD 9.1); IG3_S: 83.5 (SD 8.7); CG: 82.7 (SD 6.0)	IG1_XS: 76.4 (SD 9.0) IG2_T:77.0 (SD 8.8) IG3_S: 75.9 (SD 6.3) CG:78.6 (SD 10.1)
Hua 2006	47	Canada	Hypertensive adults	IG‐Male:55.8 (SD 9.5); IG‐Female: 56.3 (SD 9.6) CG‐Male: 55.9 (SD 10.2) CG‐Female:58.5 (SD 11.3)	20/40 (50%)	IG‐Male: 140 (SD 11); IG‐Female: 141 (SD 16); CG‐Male: 142 (SD 15); CG‐Female: 141 (SD 17)	IG‐Male: 92 (SD 7); IG‐Female: 87 (SD 9); CG‐Male: 91 (SD 11); CG‐Female: 88 (SD 9)	IG‐Male: 69 (SD 7); IG‐Female: 75 (SD 12); CG‐Male: 75 (SD 15); CG‐Female: 70 (SD 12)
Karstoft 2013	34	Denmark	Type 2 diabetes adults	IG_CWT: 60.8 (SD 2.2); IG_IWT: 57.5 (SD 2.4); CG: 57.1 (SD 3.0)	20/32 (62.5%)	IG_CWT: 155 (SD 5.4); IG_IWT: 138 (SD 3.3); CG: 142 (SD 4.3)	IG_CWT: 90.0 (SD 1.8); IG_IWT: 85.0 (SD 2.8); CG: 86.6 (SD 3.5)	NR
Khalid 2013	30	Egypt	Hypertensive post‐menopausal women	Range 40 to 50; IG: 52.9 (SD 2.6); CG: 52.7 (SD 2.2)	0 (0%)	IG: 148 (SD 5.6); CG: 154 (SD 6.7)
Koh 2010	43	Australia	Long‐term haemodialysis patients	IG: 52.1 (SD 13.6); CG: 51.3 (SD 14.4)	19/31 (61.3%)	IG: 143 (SD 32) CG: 145 (SD 18)	IG: 78 (SD 16); CG: 80 (SD 9)	IG: 73 (SD 9); CG: 74 (SD 10)
Kukkonen‐Harjula 1998	116	Finland	Healthy middle‐aged adults	Range 30 to 55; IG: 42.1 (SD 5.1); CG: 40.3 (SD 4.5)	55 (47.4%)	IG: 118 (SD 12)	CG: 75 (SD 11)	NR
Kurban 2011	60	Turkey	Type 2 diabetes adults	IG: 53.77 (SD 8.2); CG: 53.57 (SD 6.6)	29 (48%)	IG: 129.17 (SD 12.1); CG: 124.83 (SD 14.59)	IG: 78.83 (SD 6.78); CG: 77.88 (SD 10.53)	NR
Lee 2007	202	Taiwan	Hypertensive adults (mild / moderate)	IG: 71.3 (SD 6.4); CG: 71.3 (SD 5.7)	118 (58.4%)	IG: 152.0 (SD 10.5); CG: 152.4 (SD 11.1)	IG: 83.5 (SD 11.2); CG: 80.6 (SD 8.8)	NR
Li 2018	100	China	University teachers	IG: 42.26 (SD 8.63); CG: 42.39 (SD 8.35)	48/100 (48%) (22+26)	IG: 112.69 (SD 13.74); CG: 118.95 (SD 14.99)	NR	NR
Li 2003	48	USA	Elderly sedentary adults	Range 60 and above; IG: 72 (SD 6.4); CG: 73.3 (SD 7.3)	9/40 (22.5%)	IG: 133.64 (SD 9.68); CG: 132.17 (SD 13.62)	IG: 81.5 (SD 9.41); CG: 81.22 (SD 8.59)	NR
Lin 2000	22	Taiwan	Borderline hypertensive adolescents / students	Range 16 to 18	22 (100%)	IG1: 140 (SD 11.14); IG2: 137.75 (SD 6.69); CG: 145.67 (SD 10.33)	IG1: 92.25 (SD 3.45); IG2: 91.75 (SD 4.06); CG: 93.67 (SD 4.27)	NR
Ming 2018	64	China	Elderly patients with Coronary Heart Disease and Hypertension	IG: 63.18 (SD 5.42); CG: 62.76 (SD 5.54)	40 (62.5%)	IG: 136.79 (SD 7.03); CG: 137.32 (SD 7.44)	IG: 95.88 (SD 4.10); CG: 96.30 (SD 4.52)	IG: 83.18 (SD 8.14); CG: 83.55 (SD 8.09)
Moreau 2001	24	USA	Postmenopausal women with borderline stage 1 hypertension	IG: 53 (SE 2); CG: 55 (SE 1)	0 (0%)	IG: 142 (SE 3); CG: 142 (SE 3)	IG: 84 (SE 1); CG: 86 (SE 2)	IG: 77 (SE 3); CG: 77 (SE 3)
Murphy 1998	47	UK	Sedentary middle‐aged women	IG1: 44.8 (SD 8.4); IG2: 48.0 (SD 5.5); CG: 47.3 (SD 4.1)	0 (0%)	IG1_short bout: 125.5 (SD10.8); IG2_long bout: 124.2 (SD11.1); CG: 128.6 (SD13.3)	NR	NR
Murphy 2006	37	UK	Sedentary general population (civil servants)	IG: 41.4 (SD 7.5); CG: 40.8 (SD 10.0)	13 (35%)	IG: 120.4 (SD 19.7); CG: 116.5 (SD 1 3)	IG: 77.2 (SD 9.4); CG: 74.6 (SD 9.0)	NR
Murtagh 2005	48	UK	Sedentary general population (university staff/students)	45.7 (SD 9.4)	17 (35%)	IG1_single bout: 117.9 (SD 12.0); IG2_accumulated bout: 121.7 (SD 11.2); CG: 117.5 (SD 18.1)	IG1_single bout: 74 (SD 9.8) IG2_accumulated bout: 75.4 (SD 6.6); CG: 73.1 (SD 10.6)	NR
Nemoto 2007	246	Japan	General population adults	Range 44 to 78; 63 (SD 6)	60 (24%)	Wcnt_male: 141 (SE 2); Wcnt_female: 135 (SE 3); Wint_male: 146 (SE 2); Wint_female: 140 (SE 3); CG_male: 143 (SE 2); CG_female: 142 (SE 3)	Wcnt_male: 85 (SE 2); Wcnt_female: 81 (SE 2); Wint_male: 87 (SE 3); Wint_female; 85 (SE 2); CG_male: 84 (SE 2); CG_female: 83 (SE 2)	Wcnt_male: 81 (SE 3); Wcnt_female: 78 (SE 1); Wint_male: 75 (SE 3); Wint_female; 81 (SE 2); CG_male: 80 (SE 3); CG_female: 79 (SE 1)
Neumann 2006	25	USA	Older adults with Silent Myocardial Ischaemia	Range 56 to 83; IG: 71 (SE 2); CG: 63 (SE 2)	17 (68%)	IG: 134 (SE 3); CG: 140 (SE 6)	IG: 76 (SE 3); CG: 80 (SE 2);	IG: 71 (SE 3); CG: 71 (SE 3)
Pagonas 2014	72	Germany	Hypertensive outpatients	IG: Range 42 to 79CG: Range 43 to 77	31 (43.1%)	IG: 137.9 (SD 12.3); CG: 133.1 (SD 12.1)	IG: 78.1 (SD 8.9); CG: 73.8 (SD 6.4)	NR
Palmer 1995b	27	USA	Sedentary middle‐aged premenopausal women	Range 29 to 50; 37.4	0 (0%)	IG: 117.1 (SD 14); CG: 122.6 (SD 13.8)	IG: 80.9 (SD 10.6); CG: 77.6 (SD 11.2)	IG: 74 (SD 10.8); CG: 71 (SD 6.5)
Pernar 2017	41	Sweden	Prostate cancer patients	Range 54.5 to 81.7	41 (100%)	IG: 170; CG: 162	IG: 93; CG: 89	NR
Pospieszna 2017	39	Poland	Postmenopausal women (healthy volunteers)	Range 52 to 72; IG: 62 (SD 3.79); CG: 62 (SD 1.12)	0 (0%)	IG: 134.7 (SD 21.23); CG: 132.16 (SD 3.8)	IG: 75.8 (SD 7.06); CG: 78.58 (SD 1.96)	NR
Ready 1996	79	Canada	Sedentary postmenopausal women	Range 50 and above; 61.3 (SD 5.8)	0 (0%)	IG1_3D: 134 (SD 18); IG2_5D: 131 (SD 20); CG: 131 (SD 16)	IG1_3D: 77 (SD 11); IG2_5D: 76 (SD 9) CG: 77 (SD 10)	NR
Romero 2019	55	USA	Sedentary elderly female	Range 60 to 75	0 (0%)	IG: 143.67 (SD 21.91); CG: 146.07 (SD 24.18)	IG: 84.41 (SD 15.19); CG: 82.96 (SD 10.29)	NR
Sakuragi 2006	20	Japan	Sedentary general population (female college students)	Range 20 to 22; IG: 19.4 (SD 1.4); CG: 20.1 (SD 1.2)	0 (0%)	IG：93.324(SD17.55);CG：100.13(SD18.09)	IG：43.779(SD14.18);CG：50.054(SD11.72)	Figure 2
Salesi 2014	32	Iran	Elderly women	Range 50 to 55	0 (0%)	IG: 136.0 (SD 12.1); CG: 131.1 (SD 8.7)	IG: 83.1 (SD 10.1); CG: 80.3 (SD 3.8)	NR
Saptharishi 2009	58	India	Confirmed hypertensive / pre‐hypertensive patients	IG: 22.4 (SD 1.3); CG: 22.5 (SD 1.4)	39 (67.2%)	IG: 128.6 (SD 7.7); CG: 123.1 (SD 10.2)	IG: 87.4 (SD 4.8); CG: 82.9 (SD 7.1)	NR
Serwe 2011	60	USA	Sedentary office women	Range 18 to 50; IG1: 37.1 (SD 7.2); IG2: 38.2 (SD 7.3); CG: 36.3 (SD 8.1)	0 (0%)	IG1: 115.1 (SD 10.5); IG2: 117.7 (SD 12.1); CG: 120.9 (SD 9.2)	IG1: 73.4 (SD 8.1); IG2: 73.2 (SD 8.7); CG: 72.7 (SD 7.2)	IG1: 68.4 (SD 10.4); IG2: 65.8 (SD 6.0); CG: 72.7 (SD 9.5)
Shenoy 2010	40	India	T2DM patients	Range 40 to 70; IG: 53.15 (SD 4.4); CG: 51 (SD 5.4)	29 (73%)	IG: 122 (SD 13.8); CG: 131 (SD 12.7)	IG: 85.6 (SD 16.1); CG: 86.0 (SD 7.2)	IG: 82.7 (SD 10.6); CG: 81.0 (SD9.7)
Stanton 1996	102	New Zealand	Sedentary, essential hypertension volunteers	IG: 55.2 (SE 1.4); CG:53.8 (SE 1.5)	42/89 (47.2%)	IG: 142.9 (SE 2.5); CG: 145.3 (SE 2.6)	IG: 88.4 (SE 1.4); CG: 94.0 (SE 1.4)	NR
Stutzman 2010	25	Canada	Sedentary normal & overweight 20 weeks pregnant women	IG_normal weight: 30.4 (SD 4.2); IG_overweight: 28.8 (SD 6.9); CG_normal weight: 25.8 (SD 3.0); CG_overweight: 26.2 (SD 5.6)	0 (0%)	IG_normal weight: 111 (SD 12); IG_overweight: 114 (SD 14); CG_normal weight: 109 (SD 7); CG_overweight: 107 (SD 8)	IG_normal weight: 76 (SD 11); IG_overweight: 75 (SD 10); CG_normal weight: 74 (SD 4); CG_overweight: 72 (SD 4)	NR
Tudor‐Locke 2004	60	Canada	Sedentary overweight T2DM patients	Range 40 to 60; total: 52.7 (SD 5.2); IG: 52.8 (SD 5.7) CG: 52.5 (SD 4.8)	26/47 (55.3%)	IG: 138.2 (SD 17.2); CG: 130.1 (SD 15.9);	IG: 81.5 (SD 9.5); CG: 78.9 (SD 8.0)	IG: 76.4 (SD 11.8) CG: 77.0 (SD 9.7)
Tudor‐Locke 2020	120	USA	Sedentary overweight/obese and postmenopausal women	Range 45 to 75; IG1: 62.6 (SD 6.5); IG2: 61.7 (SD 6.2); CG: 58.4 (SD 5.8)	0 (0%)	IG1: 127.6 (SD 16.6); IG2: 125.2 (SD 12.7); CG: 122.5 (SD 13.9)	IG1: 78.7 (SD 8.0); IG2: 75.5 (SD 7.6); CG: 77.3 (SD 7.3)	NR
Tully 2005	31	UK	Sedentary middle‐aged adults	Range 50 to 65; IG: 55.52 (SD 3.99); CG: 57.75 (SD 4.64)	13 (42%)	IG: 129.94 (SD 8.61); CG: 125.78 (SD 14.02)	IG: 78.47 (SD 4.16); CG: 77.22 (SD 7.74)	NR
Tully 2007a	106	UK	Sedentary middle‐aged adults (civil servants)	Range 40 to 61; IG1_3D: 47.8 (SD 5.97); IG2_5D: 46.37 (SD 4.76); CG: 49.05 (SD 6.31)	42 (39.6%)	IG1_3‐Day: 134 (SD 15); IG2_5‐Day: 133 (SD 15); CG: 128 (SD 15)	IG1_3‐Day: 87 (SD 11); IG2_5‐Day: 87 (SD 11); CG: 83 (SD 10)	IG1_3‐Day: 69 (SD 12); IG2_5‐Day: 72 (SD 10); CG: 75 (SD 11)
Tully 2011	12	UK	Sedentary university students	21.16 (SD 6.17)	2 (16.7%)	IG: 120 (SD 15.62); CG: 131.67 (SD 11.85)	IG: 79.00 (SD 8.23); CG: 86.33 (SD 8.50)	NR
Venturelli 2011	24	Italy	Late stage Alzheimer's disease patients	Range 65 and above; IG: 83 (SD 6); CG: 85 (SD 5);	0 (0%)	IG: 132 (SD 10); CG: 133 (SD 6)	IG: 84 (SD 5); CG: 84 (SD 3)	NR
Wallis 2017	46	Australia	Severe OA patients rated as grade III or IV affecting at least one of the tibiofemoral compartments	Range 50 to 84; IG: 68 (SD 8); CG: 67 (SD 7)	26 (56.5%)	IG: 142 (SD 10); CG: 138 (SD 24)	IG: 82 (SD 10); CG: 81 (SD 11.1)	NR
Wang (王正斌) 2014	62	China	Patients with hypertension and Diabetes Mellitus	Range 40 to 70; IG: 55.8 (SD 9.3); CG: 57.4 (SD 8.9)	39 (62.9%)	IG: 143 (SD 11); CG: 141 (SD 14)	IG: 81 (SD 11); CG: 88 (SD 9)	NR
Wang 2014	53	Taiwan	Sedentary postmenopausal women	Range 45 to 70; IG: 56.9 (SD 6.2) CG: 55.1 (SD 7.8)	0 (0%)	IG: 124.6 (S D9.2); CG: 127 (SD 10.1)	IG: 76.8 (SD 8.1) CG: 79 (SD 9.4)	NR
Wang 2016	61	China	Hypertensive coal miners	Range 18 to 64; IG: 49.61 (SD 4.91); CG: 48.50 (SD 6.31)	31/48 (64.6%)	IG: 134.83 (SD 17.43); CG: 143.97 (SD 20.91)	IG: 82.39 (SD 12.94); CG: 87.63 (SD 10.48)	NR
Westhoff 2007	54	Germany	Sedentary Isolated Systolic Hypertension elderly patient	Range 60 and above; IG: 67.2 (SD 4.8); CG: 68.9 (SD 5.2)	26 (48.1%)	IG: 136.6 (SD 12.7); CG: 134.8 (SD 11)	IG: 76.3 (SD 7.3); CG: 72.8 (SD 7.2)	Figure 2
Xiao 2010	124	China	Elderly Type 2 Diabetes Mellitus patients	IG: 65.84 (SD 6.32); CG 65.82 (SD 6.39)	36/112 (32.1%)	IG: 141.82 (SD 16.23); CG 141.05 (SD 20.06)	IG: 82.91 (SD 9.94); CG 84.04 (SD 10.15)	NR
Yan 2010	418	China	Patients with Congestive Heart Failure	IG: 61.2 (SD 11.8); CG: 62.5 (SD 11.6)	261 (62.4%)	IG: 123.1 (SD 21.9); CG: 125.6 (SD 20.2)	IG: 68.6 (SD 10.8); CG: 68.5 (SD 10.6)	IG: 74.2 (SD 15.7) CG: 77.1 (SD 15.2)
Yu 2018	231	China	Elderly patients with Isolated Systolic Hypertension	IG1: 82.96 (SD 2.06); IG2: 83.01 (SD 2.09); CG: 83.44 (SD 1.99)	139/211 (65.9%)	IG1: 141.67 (SD 5.95); IG2: 140.87 (SD 6.45); CG: 141.94 (SD 5.22)	IG1: 63.2 (SD 3.59); IG2: 62.36 (SD 2.84); CG: 63.43 (SD 3.11)	NR

CG: control group; CWT: continuous walking training; IG: intervention group; IGT: impaired glucose tolerance; IWT: intermittent walking training; NGT: normal glucose tolerance; NR: not reported; OA: Osteoarthritis; SD: standard deviation; SE: standard error; T2DM: type 2 diabetes mellitus; W_cnt: moderate‐intensity continuous walking training group; W_int: high‐intensity interval walking training group

Study and participant characteristics

The mean age of participants ranged from 16 to 84 years; and there were approximately 1.5 times as many female participants as male ones (3122 versus 2075). Among the trials that reported data about sex, the majority recruited both male and female participants (n = 49 trials), 20 recruited only women and four only men. Hua 2006 and Nemoto 2007 recruited both male and female participants and provided outcome data for each. Sample sizes ranged from 10 to 396. The majority of the trials were conducted in the USA (n = 14) and the UK (n = 12); with nine in China; seven in Canada; four in Taiwan; three each in Australia, India, and Japan; two each in Finland, Germany, Iran, and Sweden; and one each in Denmark, Egypt, Iran, Italy, Korea, Poland, New Zealand, Poland, Spain, and Turkey (Table 4). Among the 73 trials included in the current review, nearly one quarter (n = 17, 23%) reported that they recruited hypertensive participants, while 15 reported that they recruited non‐hypertensive participants (21%).

Interventions and comparators

Among the trials that clearly stated the setting of their interventions (n = 71), the walking interventions were mainly carried out at home/in the community (n = 50) (such as indoor or outdoor walking, nature/city/campus walking, or daily walking), or in the laboratory with the treadmill or stepper (n = 16). There was a total of 36 trials conducting supervised walking programs among the 47 trials reported the information of supervision. The prescription of walking interventions varied widely in the 73 included trials, and included treadmill walking (n = 18), outdoor walking (n = 17), brisk walking (n = 16), and Nordic walking (n = 6). Participants in the control groups received no intervention. In order to be able to compare the length of time of each intervention, we decided to present the time of the intervention in weeks and thus when the length of the intervention was presented as months, we calculated months into weeks using the following formula: number of months*4.33 weeks. On the basis of this calculation, the intervention length ranged from four to 64 weeks, including 12 to 13 weeks in 26 trials and 24 to 26 weeks in 13 trials. Moreau 2001 conducted two outcome measures at both 12 and 24 weeks, respectively and Chan 2018 conducted three at three, six, and nine months, respectively, and we conservatively used the data obtained at the shortest intervention length, which is 12 weeks (three months). The average length of the intervention among all studies was 15 weeks. In terms of frequency and duration of walking, most trials prescribed walking three to five sessions per week and 20 to 40 minutes per session. Among the 77 walking intervention groups that clearly stated the prescription for weekly walking frequency and duration of walking per session, the walking time per week ranged widely from 10 to 845 minutes. The average walking duration per week was 153 minutes (range 150 to 180) prescribed by 22 studies. The second and third most frequently prescribed duration were a walking duration of 90 to 100 minutes per week prescribed by 13 studies and 120 to 149 minutes prescribed by 12 studies.

Among the walking groups that provided information for classifying measures of the walking intensity, 27 intervention groups used maximum heart rate (in the form of either a percentage or calculated heart rate); 24 each reported a walking intensity as VO2max (in the form of either a percentage or calculated VO2max) and walking distance per hour (e.g. 6.5km/hour), per day (e.g. 3 km/day) or per second (e.g. 1.6 to 1.8 metres/second), respectively. Fourteen studies reported the ratings of perceived exertion using the Borg Scale of Perceived Exertion (Borg 1982), and eight used the percentage of heart rate reserve. Of these, 14 walking group intensities were measured using mixed methods, such as walking distance per hour plus the percentage of the maximum heart rate. The intensity of walking varied from minor to high and the majority of the walking groups were moderate intensity (n = 62), with 13 low intensity, 11 self‐paced, and five high intensity.

Funding sources

More than one‐third of the trials included in the current review failed to report their funding sources (n = 32) and studies that clearly reported the funding support received funding from governments (n = 24), private sector (n = 11), both (n = 3), or were self‐funded (n = 3).

Excluded studies

The reasons for study exclusion are mainly due to non randomisation, not just walking but multiple interventions, intervention control groups, or the unavailability of outcome data (see Characteristics of excluded studies).

Risk of bias in included studies

We have summarised our judgments of the risks of bias in Figure 2 and Figure 3. Full details of our judgments of risk of bias are presented in Characteristics of included studies tables.

2.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

3.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Allocation

Random sequence generation

Of the 73 included studies, 27 described a method of random sequence generation that we judged to be at low risk of bias. In most studies, researchers used a computerised random number generator. We judged 45 studies to be at unclear risk of random sequence generation due to insufficient information available to make a judgment. We judged one study (Nemoto 2007)  to be a high risk of bias because there were reassignments after randomisation and it was not defined how many participants were reassigned.

Allocation concealment

Only 13 studies described a method of allocation concealment that we judged to be at low risk of bias. For the majority of studies (n = 59), we were unable to judge the risk of allocation bias as these studies failed to report sufficient information on which to make a judgment. We judged one study (Nemoto 2007) to be a high risk of allocation bias because some participants were moved from their allocated group to be in the same group as their partner or to a more convenient administrative centre.

Blinding

Blinding of participants and personnel

Given the nature of the intervention, it was difficult to blind participants and personnel and thus we judged 42 of the 73 included to be at high risk of performance bias. We judged five studies to be at low risk of performance bias. The authors for the remaining 26 studies failed to provide sufficient information regarding blinding of participants and personnel and we, therefore, judged these studies to be at unclear risk of performance bias.

Blinding of outcomes assessors

Fifty‐two studies failed to report information on the blinding of outcomes assessors and therefore we judged the risk of detection bias to be unclear. Blinding of outcome assessment was deemed appropriate in 19 trials and we judged these trials to be at low risk of bias for this domain. We judged the remaining two trials (Cooper 2000; Koh 2010) to be at high risk of detection bias as both authors clearly stated that outcome assessors were not blinded to group assignment.

Incomplete outcome data

The majority of the included studies provided information regarding withdrawals or losses to follow‐up (n = 64). Among the studies that provided sufficient information, the dropout rate varied substantially from 0 to 37% in the 73 included studies. We judged 21 studies to have a high risk of bias due to incomplete outcome data, i.e. the dropout rate was equal to or greater than 20%. There are 45 studies using per‐protocol (PP) analysis, 17 studies using intention‐to‐treat (ITT), and two studies reported both ITT and PP. In addition, there are three studies that performed more than one randomisation in their trial (Nemoto 2007; Neumann 2006; Stutzman 2010). In Karstoft 2013, a total of three randomisations was carried out and there were five participants entering the trial twice firstly into the control and then into the intervention group.

Selective reporting

We judged all 73 included studies to be at low risk of selective reporting bias because they either reported the data of the primary outcome and/or secondary outcomes in the published paper or provided the outcome data we needed when we contacted them. Ten studies were prospectively registered with a clinical trial registry, and therefore the majority of studies (n = 63) were not.

Other potential sources of bias

In the study by Brenner 2020, participants in both the intervention and control groups received follow‐up phone calls after the first week of the program, and at two‐week intervals during the 12‐week intervention period. Also, in the study by Chan 2018, the participants in all trial arms were encouraged or invited to participate in weekly non‐exercised based community socialisation activities during the three‐month intervention period (Chan 2018). For both studies, these activities are likely to have highlighted the issue regarding the importance of lifestyle modification and thus may have resulted in contamination of the control group participants. This may lead to a dilution in any observed difference between the intervention and control groups in both studies.

To check for publication bias, we produced a funnel plot using the mean difference (MD) for the effects of walking on SBP and DBP against the standard error (SE). An inspection of the two funnel plots shows symmetrical plots, with the effect estimate equally distributed around the mean (Figure 4; Figure 5). This suggests that publication bias is not an issue for this review.

4.

Funnel plot of comparison: 1 Walking versus non‐intervention control (overall), outcome: 1.1 systolic blood pressure [mmHg].

5.

Funnel plot of comparison: 1 Walking versus non‐intervention control (overall), outcome: 1.2 diastolic blood pressure [mmHg].

Effects of interventions

See: Table 1; Table 2; Table 3

Summary of findings 1. Walking compared to no intervention (overall) for control of blood pressure.

Walking compared to no intervention (overall) for hypertension
Patient or population: adults with or without hypertension Setting: general population Intervention: walking Comparison: no intervention (overall)
Outcomes	Anticipated absolute effects* (95% CI)		№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Effect with no intervention mmHg	Effect with Walking mmHg
Systolic blood pressure	The mean systolic blood pressure was ‐1.30	MD 4.11 lower (5.22 lower to 3.01 lower)	5060 (73 RCTs)	⊕⊕⊕⊝ MODERATE 1 2	Walking interventions probably reduce systolic blood pressure.
Diastolic blood pressure	The mean diastolic blood pressure was ‐0.73	MD 1.79 lower (2.51 lower to 1.07 lower)	4711 (69 RCTs)	⊕⊕⊝⊝ LOW 2 3	Walking interventions may reduce diastolic blood pressure.
Heart rate [beats/min]	The mean heart rate [beats/min] was ‐0.41 beats/min	MD 2.76 beats/min lower (4.57 lower to 0.95 lower)	1747 (26 RCTs)	⊕⊕⊝⊝ LOW 2 4	Walking interventions may reduce heart rate.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; DBP: diastolic blood pressure; MD: mean difference; RCT: randomised controlled trial; SBP: systolic blood pressure.
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

¹ Not downgraded one level for risk of bias even though more than half of included studies failed to report details of randomisation and allocation concealment. This is because a sensitivity analysis based on trials judged as being at low risk of bias also showed a statistically significant reduction of SBP: Weighted Mean Difference= ‐4.31, 95% CI: ‐7.99 to ‐0.63, P = 0.02, I² = 0%, n = 235.

² Downgraded one level for inconsistency on the basis of statistically significant heterogeneity.

³ Downgraded one level for risk of bias; More than half of the included studies failed to report details of randomisation and allocation concealment. The sensitivity analysis based on trials judged as being at low risk of bias failed to show a statistically significant reduction of DBP: Weighted Mean Difference = ‐0.47, 95% CI: ‐2.54 to 1.61, P = 0.66, I² = 18%, n = 235.

⁴ Downgraded one level for risk of bias; More than half of included studies failed to report details of randomisation and allocation concealment and there is no data for further sensitivity analysis.

Summary of findings 2. Walking compared to no intervention by age for control of blood pressure.

Patient or population: adults with or without hypertension Setting: general population Intervention: walking Comparison: no intervention, by age
Outcomes	Anticipated absolute effects* (95% CI)		№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Effect with no intervention  mmHg	Effect with Walking mmHg
SBP age <=40	The mean SBP was 1.71	MD 4.41 lower (6.17 lower to 2.65 lower)	491 (14 RCTs)	⊕⊕⊕⊝ MODERATE 1	Walking interventions probably reduce systolic blood pressure in adults aged equal to or less than 40 years.
SBP age 41‐60	The mean SBP was ‐1.88	MD 3.79 lower (5.64 lower to 1.94 lower)	1959 (35 RCTs)	⊕⊕⊝⊝ LOW 1 2	Walking interventions may reduce systolic blood pressure in adults aged 41 to 60 years.
SBP age >60	The mean SBP was ‐2.21	MD 4.30  lower (6.17 lower to 2.44 lower)	2610 (24 RCTs)	⊕⊕⊝⊝ LOW 1 2	Walking interventions may reduce systolic blood pressure in adults aged over 60 years.
DBP   age <=40	The mean DBP was ‐0.24	MD 3.01 lower (4.44 lower to 1.58 lower)	491 (14 RCTs)	⊕⊕⊕⊝ MODERATE 1	Walking interventions probably reduce diastolic blood pressure in adults aged equal to or less than 40 years.
DBP   age 41‐60	The mean DBP by age 41‐60 was ‐0.87	MD 1.74 lower (2.95 lower to 0.52 lower)	1730 (32 RCTs)	⊕⊕⊝⊝ LOW 1 2	Walking interventions may reduce diastolic blood pressure in adults aged 41 to 60 years.
DBP   age >60	The mean DBP  was ‐0.86	MD 1.33 lower (2.40 lower to 0.26 lower)	2490 (23 RCTs)	⊕⊕⊝⊝ LOW 1 2	Walking interventions may reduce diastolic blood pressure in adults aged over 60 years.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; DBP: diastolic blood pressure; MD: mean difference; RCT: randomised controlled trial; SBP: systolic blood pressure.
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

¹ Downgraded one level for risk of bias; the majority of included studies failed to report details of randomisation and allocation concealment.

² Downgraded one level for inconsistency; there was statistically significant heterogeneity.

Summary of findings 3. Walking compared to no intervention by sex for control of blood pressure.

Patient or population: adults with or without hypertension Setting: general population Intervention: walking Comparison: no intervention, by sex
Outcomes	Anticipated absolute effects* (95% CI)			№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Effect with no intervention mmHg	Effect with Walking mmHg
SBP in males	The mean SBP was ‐1.22	MD 4.64 lower (8.69 lower to 0.59 lower)	‐	203 (6 RCTs)	⊕⊕⊝⊝ LOW 1 2	Walking interventions may lower systolic blood pressure in male adults.
SBP in females	The mean SBP was ‐0.48	MD 5.65 lower (7.89 lower to 3.41 lower)	‐	1149 (22 RCTs)	⊕⊕⊝⊝ LOW 2 3	Walking interventions may reduce systolic blood pressure in female adults.
DBP in males	The mean DBP was ‐1.81	MD 2.54  lower (4.84 lower to 0.24 lower)	‐	203 (6 RCTs)	⊕⊕⊕⊝ MODERATE 2	Walking interventions probably reduce diastolic blood pressure in male adults.
DBP in females	The mean DBP was 0.53	MD 2.69 lower (4.16 lower to 1.23 lower)	‐	1000 (20 RCTs)	⊕⊕⊝⊝ LOW 2 3	Walking interventions may reduce diastolic blood pressure in female adults.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

¹ Large 95% confidence intervals.

² Downgraded one level for risk of bias; the majority of included studies failed to report details of randomisation and allocation concealment.

³ Downgraded one level for inconsistency; there was statistically significant heterogeneity.

See Table 1; Table 2; Table 3.

Primary outcome

Overall, we found that walking reduced systolic blood pressure (SBP) compared to the non‐intervention control groups (mean difference (MD) ‐4.11 mmHg, 95% confidence interval (CI) ‐5.22 to ‐3.01, P < 0.00001, I² = 53%) on the basis of 73 trials, 5060 participants (Analysis 1.1). The funnel plot for SBP did not show serious small‐study bias (Figure 4). Using GRADE to assess the certainty of the evidence, we downgraded the evidence by one level for inconsistency because there was significant heterogeneity (moderate‐certainty evidence). We did not downgrade one level for risk of bias even though more than half of the included studies failed to report details of randomisation and allocation concealment. This is because a sensitivity analysis based on trials judged as being at low risk of overall bias showed a reduction of SBP (MD ‐4.31 mmHg, 95% CI ‐7.99 to ‐0.63, P = 0.49, I² = 0%).

1.1. Analysis.

Comparison 1: Walking vs non‐intervention control, Outcome 1: systolic blood pressure

Our analyses showed that walking statistically and significantly lowered SBP in participants in all three age groups. Thus, when comparing participants who received the intervention with those in the control groups, participants aged 40 years and under showed a MD of ‐4.41 mmHg (95% CI ‐6.17 to ‐2.65, P < 0.00001, I² = 0%; 14 studies, n = 491), participants aged 41 to 60 years showed a MD of ‐3.79 mmHg (95% CI ‐5.64 to ‐1.94, P < 0.001, I² = 61%; 35 studies, n = 1959), and those aged 60 years of over showed a MD of ‐4.30 mmHg (95% CI ‐6.17 to ‐2.44, P < 0.001, I² = 60%; 24 studies; n= 2610) (Analysis 2.1). We graded the evidence in the age group of less than or equal to 40 years as moderate due to the concern of risk of bias as the majority of included studies failed to report details of randomisation and allocation concealment; we graded the certainty of the evidence as low in the age groups of 41 to 60 and over 61 due to the two concerns of risk of bias when the majority of included studies failed to report details of randomisation and allocation concealment, and inconsistency when there was statistically significant heterogeneity.

2.1. Analysis.

Comparison 2: Walking vs non‐intervention control: subgroup analysis by age, Outcome 1: SBP by Age

Regarding sex, the outcome data of the subgroup analysis showed that walking interventions statistically lowered SBP in both females (MD ‐5.65 mmHg, 95% CI ‐7.89 to ‐3.41, P < 0.00001, I² = 44%; 22 studies, n = 1149) and males (MD ‐4.64 mmHg, 95% CI ‐8.69 to ‐0.59, P = 0.02, I² = 29%; 6 studies, n = 203) (Analysis 3.1). We graded the evidence for males and females with low certainty as there were risks of bias, imprecision (large 95% confidence interval), and inconsistency, i.e. significant heterogeneity.

3.1. Analysis.

Comparison 3: Walking vs non‐intervention control: subgroup analysis by sex, Outcome 1: SBP by Sex

Regarding intervention characteristics, when we consider only the trials with a statistically significant reduction in SBP in the current review, the average walking duration per week (mean = 151 minutes/week. range: 60 to 220 minutes) was similar to the walking duration per week in the trials with negative results (mean = 157 minutes/week. range: 10 to 845 minutes). In terms of intensity of walking, moderate walking is the major prescription (n = 14 intervention groups) in the trial with a significant reduction in SBP, five were self‐paced; one each was high and low intensity.

Secondary outcomes

see Table 1; Table 2; Table 3

Overall, compared to the non‐intervention control group, we found that walking reduced both diastolic blood pressure (DBP) (MD ‐1.79 mmHg, 95% CI ‐2.51 to ‐1.07, P < 0.00001, I² = 53%; 69 studies, n = 4711) (Analysis 1.2) and heart rate (HR) (MD ‐2.76 bpm, 95% CI ‐4.57 to ‐0.95, P = 0.003, I² = 65%; 26 studies, n = 1747) (Analysis 1.3). We graded the evidence for changes in DBP and HR as low certainty as there were concerns of both inconsistency (statistically significant heterogeneity) and risk of bias as more than half of included studies failed to report details of randomisation and allocation concealment.

1.2. Analysis.

Comparison 1: Walking vs non‐intervention control, Outcome 2: diastolic blood pressure

1.3. Analysis.

Comparison 1: Walking vs non‐intervention control, Outcome 3: heart rate [beats/min]

We found that walking reduced DBP according to subgroup analyses for all three age groups. Our analysis for study participants aged 60 years and over showed an MD of ‐1.33 mmHg (95% CI ‐2.40 to ‐0.26; 23 studies, n = 2490) while our analysis of participants in the age group 41 to 60 years showed an MD of ‐1.74 mmHg (95% CI ‐2.95 to ‐0.52; 32 studies, n = 1730), and participants aged 40 years and under showed a MD of ‐3.01 mmHg (95% CI ‐4.44 to ‐1.58; 14 studies, n = 491) (Analysis 2.2). While these reductions in DBP were statistically significant, the reduction in DBP for each age group was smaller than that seen for reductions in SBP for the corresponding age groups. We graded the certainty of evidence for the analysis for participants aged 40 years and under as moderate because we downgraded one level for risk of bias as the majority of included studies failed to report details of randomisation and allocation concealment. For the analyses of DBP and participants aged 41 to 60 years and 60 years and over we graded the evidence as low because we downgraded one level for risk of bias as the majority of included studies failed to report details of randomisation and allocation concealment and we downgraded one level for inconsistency.

2.2. Analysis.

Comparison 2: Walking vs non‐intervention control: subgroup analysis by age, Outcome 2: DBP by Age

As with SBP, we found that walking reduced DBP for both males and females, however, the reductions in DBP were not as great as those seen in SBP. Thus, walking interventions saw a statistically significant reduction in DBP among females (MD ‐2.69 mmHg, 95% CI ‐4.16 to ‐1.23, P = 0.0003, I² = 43%; 20 studies, n = 1000) and males (MD ‐2.54 mmHg, 95% CI ‐4.84 to ‐0.24, P = 0.03, I² = 0%; 6 studies, n = 203) when compared to females and males in control groups (Analysis 3.2). We graded the evidence for DBP and men as moderate; we downgraded the evidence one level for risk of bias due to the majority of included studies failing to report details of randomisation and allocation concealment. We graded the evidence for DBP and women as low; we downgraded the evidence one level for risk of bias due to the majority of included studies failing to report details of randomisation and allocation concealment and one level for inconsistency as there was statistically significant heterogeneity.

3.2. Analysis.

Comparison 3: Walking vs non‐intervention control: subgroup analysis by sex, Outcome 2: DBP by Sex

We found that walking significantly reduced the HR of participants in the walking groups compared to those in control groups (‐2.76 bpm, 95% CI ‐4.57 to ‐0.95, P < 0.001, I² = 65%).

Sensitivity analyses

Sensitivity analyses were undertaken to assess the effect of walking in high‐quality studies only, where high‐quality studies were defined as those with a low risk of overall bias. Only four studies met our definition of low risk of bias (Baker 2008; Stanton 1996; Venturelli 2011; Wallis 2017). Walking was still found to be effective in lowering SBP by a statistically significant mean of 4.31 mmHg (95% CI ‐7.99 to ‐0.63, P = 0.02, I² = 0%; 4 studies, n = 235) (Analysis 4.1), but did not significantly lower DBP (MD ‐0.43 mmHg, 95% CI ‐2.78 to 1.92, P = 0.72, I² = 18%) (Analysis 4.2).

4.1. Analysis.

Comparison 4: Walking vs non‐intervention control: sensitivity analysis for studies at low risk of overall bias, Outcome 1: systolic blood pressure

4.2. Analysis.

Comparison 4: Walking vs non‐intervention control: sensitivity analysis for studies at low risk of overall bias, Outcome 2: diastolic blood pressure

A sensitivity analysis was also performed to evaluate the effect of the walking interventions in 41 studies (n = 3480) with a low risk of attrition bias. Walking was found to lower SBP by a mean of 4.67 mmHg (95% CI: ‐6.25 to ‐3.09, P < 0.001, I² = 65%) (Analysis 5.1) and significantly lower DBP by a mean of 2.23 mmHg (95% CI ‐3.20 to ‐1.26, P < 0.001, I² = 64%) (Analysis 5.2).

5.1. Analysis.

Comparison 5: Walking vs non‐intervention control: sensitivity analysis for studies at low risk of attrition bias, Outcome 1: systolic blood pressure

5.2. Analysis.

Comparison 5: Walking vs non‐intervention control: sensitivity analysis for studies at low risk of attrition bias, Outcome 2: diastolic blood pressure

Adverse events

Of the 73 included trials, only 21 reported adverse events. Of this 21, 16 reported no adverse events and a total of eight events was reported by the remaining five studies with Kukkonen‐Harjula 1998 reporting two events (one participant with a stress fracture and another one with a knee injury); Li 2003 reporting one participant with a bruised foot; Tudor‐Locke 2020 reporting one participant with knee pain; Wallis 2017 reporting two participants with knee pain and one participant who tripped; and Westhoff 2007 reporting one participant with knee pain and two participants with events considered unrelated to the intervention, namely, acute cholecystitis and a change in medication. Thus, while few studies specifically reported adverse events, knee pain seemed to be the most common adverse event. (see Characteristics of included studies). Several studies reported incidences that occurred during the intervention period. Brenner 2020 reported that two participants dropped out due to hip fracture; one dropped out from the study by Chan 2018 due to health problems, 60 dropped out of the Yan (嚴華) 2010a study due to hospitalisation, and several participants were reported as injured in the studies by Baker 2008 and Karstoft 2013.

Additional analyses

Sample size may impact trial outcomes at different levels. We examined the impact of the study sample size on the effects of walking on blood pressure in the current review. We undertook a post hoc subgroup analysis that entailed comparing studies having a sample size greater than 30 participants with studies having a sample size equal to or less than 30 for the outcomes of SBP and DBP. The analyses showed a statistically significant reduction in SBP in both sample sizes. The group with a study sample size of less than or equal to 30 saw a mean reduction in SBP of 7.06 mmHg (95% CI ‐9.47 to ‐4.66, P < 0.00001, I² = 35%), while the group with trial sample sizes over 30 showed a smaller mean reduction of 3.48 mmHg (95% CI ‐4.69 to ‐2.27, P < 0.00001, I² = 54%) (Analysis 6.1). Similarly, the analyses showed a statistically significant reduction in DBP in both sample sizes. The group with a study sample size of less than or equal to 30 saw a mean reduction in DBP of 2.92 mmHg (95% CI ‐5.02 to ‐0.82, P = 0.006, I² = 61%) while the group with trial sample sizes over 30 showed a smaller mean reduction of 1.57 mmHg (95% CI ‐2.32 to ‐0.82, P < 0.0001, I² = 50%) (Analysis 6.2).

6.1. Analysis.

Comparison 6: Walking vs non‐intervention control: sample size per trial ≦30 vs. >30, Outcome 1: SBP

6.2. Analysis.

Comparison 6: Walking vs non‐intervention control: sample size per trial ≦30 vs. >30, Outcome 2: DBP

We carried out subgroup analyses using baseline SBP and DBP to classify participants into two sets of comparison groups, one is normotensives compared to high normal and hypertensive participants and the other is normotensives compared to hypertensives only. The classification was based on two current hypertension guidelines, American Heart Association (Unger 2020) and European Society of Cardiology (Williams 2018), which defined SBP as normotensives <130 mmHg, high normal ≥130 mmHg, and hypertension ≥140 mmHg; DBP as normotensives <85 mmHg, high normal ≥85 mmHg, and hypertension ≥90 mmHg. Geddes 2009 did not provide baseline SBP and DBP data for us to be able to carry out the classification and therefore was not included in these subgroup analyses.

We found a similar magnitude of walking effect on both normotensive SBP compared to either higher than high normal (MD ‐4.14 mmHg, 95% CI ‐5.28 to ‐3.00, P = 0.45; 72 studies, n = 5048, Analysis 7.1) or higher than hypertensive (MD ‐4.24 mmHg, 95% CI ‐5.52 to ‐2.97, P = 0.29; 54 studies, n = 3630, Analysis 8.1). This is similar when compared normotensive to higher than high normal DBP (MD ‐4.06 mmHg, 95% CI ‐5.24 to ‐2.88, P = 0.65; 68 studies, n = 4699, Analysis 7.2), and compared to higher than hypertensive DBP (MD ‐4.39 mmHg, 95% CI ‐5.67 to ‐3.10, P = 0.03; 60 studies, n = 4223, Analysis 8.2). There was a similar reduction between the two DBP subgroup analyses (‐4.39 versus ‐4.24) but the reduction in DBP comparing normotensive with higher than hypertensive was a statistically significant difference. Additionally, there was significant heterogeneity between the subgroups of normotensive and higher than hypertensive DBP (Chi² = 4.50, df = 1, P = 0.03, I² = 77.8%, n = 4223, Analysis 8.2), but not in other subgroup analyses to this purpose.

7.1. Analysis.

Comparison 7: Walking vs non‐intervention control: subgroup analysis (normotensive vs. high normal), Outcome 1: SBP

8.1. Analysis.

Comparison 8: Walking vs non‐intervention control: subgroup analysis (normotensive vs. hypertensive), Outcome 1: SBP

7.2. Analysis.

Comparison 7: Walking vs non‐intervention control: subgroup analysis (normotensive vs. high normal), Outcome 2: DBP

8.2. Analysis.

Comparison 8: Walking vs non‐intervention control: subgroup analysis (normotensive vs. hypertensive), Outcome 2: DBP

We carried out further statistical analyses to test the association between baseline and change SBP and so for DBP. The association is weak (SBP: r= ‐0.142; DBP: r= ‐0.285) and not statistically significant in the association of baseline and change SBP (P = 0.23) but statistically significant in DBP (P = 0.02).

Discussion

Summary of main results

Our review aimed to determine the effect of a walking intervention on blood pressure. We included 73 randomised controlled trials in the meta‐analysis and revealed that walking alone can lower both systolic and diastolic blood pressure (SBP/DBP) statistically and clinically, regardless of age, sex, or baseline blood pressure. We also found that the effect of walking on lowering blood pressure exists after undertaking sensitivity analyses with just high‐quality studies or those not at risk of attrition bias. Among the four high‐quality studies, which were defined as no risk of biases regarding allocation, performance, attrition, and measurement, our findings suggest that walking can lower SBP by 4.31 mmHg (P = 0.02), but less likely to effectively lower DBP (WMD = ‐0.43, P = 0.71). The effect of walking on lowering blood pressure is also evidenced even when we omitted the studies with a dropout rate greater than 20%. It was found that a walking intervention could significantly lower SBP by 4.67 mmHg (P < 0.00001) and DBP by 2.23 mmHg (P < 0.00001).

Previous research has shown that a reduction in blood pressure is associated with the management of the mortality of the cardiovascular disease. Lowering SBP by 2 mmHg of SBP is related to approximately a 10% decrease in stroke mortality and a 7% decrease in mortality from vascular risks in adults (Lewington 2002). A more recent paper by Ettehad 2016 showed that a reduction in SBP of 10 mmHg reduced the risk of major cardiovascular disease (CVD) events by 20%, coronary heart disease (CHD) by 17%, stroke by 27% and all‐cause mortality by 13%. Our review found that walking interventions could lower SBP from 3.01 to 5.22 mmHg (MD ‐4.11) and DBP from 1.07 to 2.51 (MD ‐1.79), which were of greater magnitude than the reduction of 2 mmHg SBP and could be considered clinically significant. These small reductions in blood pressure are similar to those reported by previous systematic reviews which investigated interventions of walking among the younger population (Hanson 2015; Tschentscher 2013). Walking may also serve as an effective, useful adjunct to pharmacological therapy for controlling hypertension. For those who are normotensive, walking interventions may be useful in further reducing or preventing an increase in blood pressure.

The age of the study participants may mediate the effect of walking on blood pressure reduction (Lee 2010a). It is noteworthy that the result of subgroup analysis by different age groups showed that walking intervention demonstrated a similar reduction of SBP in the age group of over 60 to that observed in the age group of equal to or less than 40. Though previous studies found a tendency of an association between older people and a greater reduction in SBP and DBP (Burt 1995; Lee 2010a), this effect of walking on blood pressure reduction may result from higher baseline blood pressure levels among older adult participants. In the current review, we found a similar effect of walking on both normotensive SBP and DBP compared to either higher than high normal or higher than hypertensive.

When there are no sex differences on the effect of walking on lowering blood pressure, we found that females have slightly more reduction and more precisely than males in both SBP and DBP. This finding is inconsistent with those of previous studies (Carpio‐Rivera 2016; Christou 2005) that have suggested that males appeared to have a greater reduction in blood pressure than females. The menstrual cycle and menopausal impact might confound the acute‐ and long‐term effects of physical activity on the changes in blood pressure among the female population (Christou 2005). This inconsistency might also be due to that, in the current review, the total number of female participants is around 1.5 times compared to that of males. Previous studies argued that researchers have usually neglected adult females (Carpio‐Rivera 2016), but this did not appear to be the case in walking trials. In general, this review supports the finding that age and sex are less likely to change blood pressure response to physical activity.

The sample size could impact the research outcome widely and adequate sample sizes are required to provide sufficient power to generate robust results. According to our post hoc subgroup analyses using sample sizes greater and less than 30 participants per trial for the outcomes of SBP and DBP, there was a statistically significant reduction of both SBP and DBP in the two different sample sizes, whereby the studies with sample sizes equal to or less than 30 showed a much larger effect but less precisely, i.e. wider 95% confidence intervals than those in the studies with sample sizes greater than 30. This differs from a previous systematic review that found that walking interventions are likely to be effective according to studies with larger sample sizes (Lee 2010a). Most of the included studies in the current review did not report the power calculation for estimating adequate sample size. A small sample size could result in greater bias due to variations in the participants or contribute towards a positive result when the observed effects are far larger than the true differences between the groups (Altman 1997). Small sample size could also make the generalisability of the results challenging. Therefore, a proper sample size calculation is crucial for the robust interpretation and generalisation of the effect of the intervention.

There are insufficient data to examine the long‐term effect of walking on blood pressure. As only three studies reported follow‐up data on blood pressure in the months after the intervention ceased, it is unclear whether the benefits can persist or if further intervention is needed to maintain the benefit. The evidence showed that the cessation of exercise may lead to a rapid loss of benefit with regard to blood pressure (Moker 2014). The previous research revealed that the application of behaviour modification theories, such as increased exercise self‐efficacy among older participants might prolong the ongoing benefits of walking with regard to blood pressure management (Chiu 2015).

Overall completeness and applicability of evidence

We searched and screened relevant databases carefully to identify all relevant randomised controlled trials that investigated the effect of walking intervention on blood pressure control compared with a non‐intervention control group. Our searches were carried out across multiple databases and we screened carefully all reference lists of the included studies and relevant systematic reviews, together with a hand search of all articles citing the included studies to enhance the completeness of the systematic review.

We identified 73 studies that met our inclusion criteria and included data from 5060 participants in the meta‐analysis for our primary outcome of change in SBP. We included data from 69 studies and 4711 participants in the meta‐analysis for the secondary outcome of change in DBP. Fewer studies (n = 26) and participants (n = 1747) provided data for the meta‐analysis of the secondary outcome of change in heart rate (HR). These 73 studies included walking interventions only and thus other modes of activity such as jogging or lifestyle modifications such as dietary salt reduction were excluded. There were sufficient participants to undertake subgroup analyses of changes in SBP and DBP by age and sex. Our findings that walking can result in a statistically and clinically significant reduction in SBP and DBP were robust to subgroup analysis according to age and sex.

Walking is the activity that the majority of the population can do and is seen as a low cost, low risk, common and feasible mode of physical activity in different age groups for decades (Asikainen 2004; Kraus 2019; Morris 1997; Mutrie 2004). Therefore, walking is often recommended by healthcare professionals as a form of exercise for health promotion and preventing health problems (Kraus 2019; Pate 1995). The findings from the current meta‐analysis are applicable to blood pressure management among both normotensive and hypertensive populations.

Quality of the evidence

We judged the certainty of the evidence of the effect of walking on SBP as moderate rather than high because of lack of clarity around randomisation procedures, allocation concealment and blinding of participants, study personnel, and outcome assessors. There was also some inconsistency across trials, which was related in part to differences in study populations and to differences in walking interventions. In this circumstance, we decided not to downgrade the certainty of this evidence because that sensitivity analysis on the basis of low risk of bias trials showed a significant reduction of SBP. However, we judged the certainty of the evidence of the effect of walking on DBP and HR as low because of the inconsistency across trials and the lack of clarity around randomisation procedures, allocation concealment, and blinding of participants, study personnel, and outcome assessors. A sensitivity analysis on the basis of low risk of bias trials showed a non‐significant reduction of DBP and there were data for us to carry out a similar sensitivity analysis on HR. While we assessed many of the studies at risk of performance bias, it should be noted that the outcomes of interest for this review are objective so even if participants and assessors are aware of group assignment, this knowledge is less likely to influence the outcome data than if we were analysing subjectively‐assessed outcomes.

Potential biases in the review process

Approximately one quarter (n = 19, 26%) of the 73 included trials were multi‐arm trials. An example is a study by Brown 2014, where one intervention consisted of a nature walking group with participants following a walking route through trees and parks while a second intervention comprised a built walking group(BW) following a route through housing estates, and a third control arm followed normal activities. With such studies, where the walking intervention groups met our inclusion criteria, we combined them and calculated a mean change in outcome measures for the combined group, thus creating a single‐pair wise comparison with the control group. In some multi‐arm trials, one or more of the intervention groups did not meet our inclusion criteria and thus we excluded those findings from our analyses. Where we did combine groups, we were cautious to ensure that combining groups did not result in double‐counting of participants. A number of studies, for example, Chan 2018 and Moreau 2001 collected outcome data at a number of time points. We used the data collected at the shortest intervention period so that the data collection was most similar for the majority of studies. However, our findings may have changed if we used data from the last time period of data collection as it may be that fewer participants continued with the intervention as time went on. For those studies that did not provide sufficient data, we contacted study authors and received responses from approximately 10%. Some study details and data remain missing which may influence the findings of our review.

Agreements and disagreements with other studies or reviews

Our meta‐analysis investigated the effect of a walking intervention compared to a non‐intervention control group on blood pressure control using randomised controlled trials and revealed that walking significantly lowered both systolic and diastolic blood pressure, and heart rate among the adult participants, regardless of their age or sex. The results of the current meta‐analysis support the findings of earlier reviews that a walking intervention can lower either SBP (Bravata 2007) or DBP (Murphy 2007; Qui 2014), or both (Hanson 2015; Herrod 2018; Kelley 2001; Oja 2018; Tschentscher 2013). These findings are also consistent with a previous systematic review, which found that group walking could cause a statistically significant reduction in both SBP (3.72 mmHg, P < 0.001) and DBP (3.14 mmHg, P < 0.001) (Hanson 2015). Herrod 2018 reported that undertaking aerobic exercise regularly over at least three months can lead to 5 mmHg to 6 mmHg reduction in SBP and 2 mmHg to 3.5 mmHg in DBP among participants aged over 65 years (Herrod 2018).

However, one systematic review found no effect of walking on SBP and DBP control (Cai 2014), and two did not find a statistically significant reduction in SBP (Murphy 2007; Qui 2014). One systematic review using standardised mean differences and a random‐effects model found a small but statistically significant reduction in both SBP (‐0.213 mmHg, P = 0.001) and DBP (‐0.166 mmHg, P = 0.006) (Oja 2018). The systematic review undertaken by Bravata 2007 found that the use of pedometers has a similar effect on SBP reduction (‐3.8 mmHg, P < 0.001) as our finding, but a relatively small reduction in DBP (‐0.3 mmHg, P = 0.001). This slightly differs from the findings of Cai 2014 that the use of a pedometer was not statistically effective in reducing neither SBP (‐1.13 mmHg, P = 0.18) nor DBP (‐1.49 mmHg, P = 0.25). Among patients with type 2 diabetes, a recent meta‐analysis by Qui 2014 found that walking was associated with DBP reduction but not a significant reduction in SBP.

Walking prescriptions in the included studies of the current review mainly followed the general recommendations of physical activity for adults (ACSM 2018; US Dept of Health & Human Sciences 2018; US Dept of Health & Human Sciences 2018; Bull 2020), which involved participating in moderate‐intensity aerobic physical activity for a minimum of 30 minutes on five days per week or vigorous‐intensity exercise for a minimum of 20 minutes on three days per week. Walking can be considered as either a low‐intensity activity (e.g. walking at an easy or moderate pace) or moderate exercise (e.g. brisk or very brisk walking) (Hamilton 2008; Tanasescu 2002; US Dept of Health & Human Sciences 2018), and occasionally greater than moderate‐intensity (Murtagh 2002; Tanasescu 2002).

The previous review (Brown 1995) and guideline (ACSM 2018) pointed out that low‐ to moderate‐intensity exercise could have a similar effect on blood pressure reduction as does high‐intensity training among hypertensive people, while low‐ to moderate‐intensity exercise may even have a greater impact on SBP (Hagberg 2000). Among the trials that found a statistically significant reduction in SBP (n = 21 trials) with clearly stated intensity prescription (n = 16 intervention groups), the present review observed that moderate‐intensity walking is the major prescription of walking (n = 14 groups), with only one trial prescribing high‐intensity walking, and one trial prescribing low‐intensity walking. Consistent with this finding, previous studies found a greater, longer‐lasting blood pressure reduction after reaching exercise intensity of 75% VO_2max (Quinn 2000; Huang 2006; Cox 2001), which were seen as the moderate‐intensity level of exercise.

Previous studies have found that higher baseline blood pressure was associated with a greater reduction in blood pressure (Lee 2007; Nemoto 2007). Given the similar reduction in BP we saw among normotensive and hypertensive people and the weak association between baseline and change in blood pressure, we conclude that the effect of walking is similarly beneficial to those defined as normotensive and hypertensive. This is consistent with a later study (Rahman 2019) that found the benefits of medicinal blood pressure treatment, regardless of baseline blood pressure.

Authors' conclusions

Implications for practice.

We found moderate‐ to low‐certainty evidence that walking can lower systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). Our findings suggest that these findings are relevant for all adults of any age, for both men and women and for those defined as normotensive and hypertensive according to baseline blood pressure levels. World Health Organization (WHO) guidelines recommend that aerobic physical activity should be undertaken in moderate‐intensity for 150 to 300 minutes per week; with muscle‐strengthening activities twice a week to have additional health benefits (Bull 2020). Findings from this review suggest that walking of moderate‐intensity, undertaken three to five times per week, of 20 to 40 minutes duration, and 150 minutes per week for approximately three months may lower blood pressure.

Walking is an attractive intervention for the prevention, control, and management of high blood pressure, representing both a cheaper treatment alternative to medication and one with less risk of adverse events and side effects for patients. Furthermore, the consequent reduction in the risk of cardiovascular diseases as a result of controlling blood pressure represents substantial savings in the treatment costs of chronic diseases and relieving the burden of national and global health expenditures.

Implications for research.

Future studies should focus on the impact on blood pressure control of different walking environments, such as walking in the laboratory or gymnasium, and walking in the countryside or city. The neighbourhood, place of work, or peer pressure may also play a crucial role in motivation regarding physical activity. Finding alternatives or phased walking interventions for those who are less able to take up a walking activity are also warranted. Furthermore, studies that focus on those with different co‐morbidity or those with poorly controlled hypertension where medications may have limited effect, are required. Given that we found few studies that had collected data on adverse events, and from those studies that did, knee pain was the most common adverse event, it is essential that future studies collect data on adverse events that might be related to the walking intervention. The long‐term benefits of walking interventions on blood pressure reduction require further research. In terms of study design, future studies should adopt rigorous trial designs aim to reduce the risk of bias by using transparent methods of random sequence generation and allocation concealment, ensuring study attrition is minimised and blinding outcome assessors where possible and then report those properly. Only then, the quality and certainty of published evidence on this topic can be raised. 

What's new

Date	Event	Description
8 March 2021	Amended	Corrected minor typos in the text

History

Protocol first published: Issue 11, 2010
Review first published: Issue 2, 2021

Notes

An earlier version of this review was funded by the Tzu Chi College of Technology (TCCT‐971B31 2007.08.01‐2008.07.31). It was carried out without meta‐analysis and was published in the International Journal of Nursing Studies (New Reference).

Appendices

Appendix 1. Search strategies

Database: Ovid MEDLINE(R) and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations, Daily and Versions(R) <1946 to March 06, 2020>
Search Date: 7 March 2020
1     exp walking/ 
2     (walk$ or gait or locomot$ or stride$ or stroll$ or treadmill$).tw,kf. 
3     or/1‐2
4     exp hypertension/ 
5     essential hypertension/ 
6     (antihypertens$ or hypertens$ or prehypertens$).tw,kf. 
7     exp blood pressure/ 
8     (blood pressur$ or bloodpressur$).tw,kf. 
9     ((arterial adj2 pressur$) or (diastolic adj2 pressur$) or (systolic adj2 pressur$)).tw,kf.
10     (bp or dbp or sbp).tw,kf. 
11     or/4‐10 
12     randomized controlled trial.pt. 
13     controlled clinical trial.pt.
14     randomized.ab.
15     placebo.ab. 
16     clinical trials as topic/ 
17     randomly.ab. 
18     trial.ti. 
19     or/12‐18 
20     animals/ not (humans/ and animals/) 
21     ((ocular or portal or pulmonary) adj (arterial or hypertens$)).ti. 
22     (eclamp$ or preeclampsi$ or pregnan$).ti. 
23     or/20‐22 
24     19 not 23 
25     3 and 11 and 24

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: Cochrane Hypertension Specialised Register via Cochrane Register of Studies (CRS‐Web)                                                                                                                                                                                                 Search Date: 8 Search Date: March 2020                                                                                                                                                                                                                                                                                                                                                                
#1 (walk* OR gait OR locomot* OR  stride* OR stroll* OR treadmill*) AND INSEGMENT
#2 RCT:DE A ND INSEGMENT
#3 Review:ODE AND INSEGMENT
#4 (#2 OR #3) AND INSEGMENT
#5 #1 AND #4 AND INSEGMENT

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: Cochrane Central Register of Controlled Trials (Issue 2, 2020) via Cochrane Register of Studies (CRS‐Web)                                                                                                                                                                                         Search Date: 8 March 2020                                                                                                                                                                                                                                                                                                                                                  
#1 MESH DESCRIPTOR Walking EXPLODE ALL AND CENTRAL:TARGET
#2 (walk* OR gait OR locomot* OR stride* OR stroll* OR treadmill*) AND CENTRAL:TARGET
#3 (#1 OR #2) AND CENTRAL:TARGET
#4 MESH DESCRIPTOR Hypertension AND CENTRAL:TARGET
#5 MESH DESCRIPTOR Essential Hypertension AND CENTRAL:TARGET
#6 (antihypertens* OR hypertens* OR prehypertens*) AND CENTRAL:TARGET
#7 (blood OR arterial OR diastolic OR systolic) NEAR2 pressur* AND CENTRAL:TARGET
#8 (bp OR dbp OR sbp) AND CENTRAL:TARGET
#9 (#4 OR #5 OR #6 OR #7 OR #8) AND CENTRAL:TARGET
#10 #3 AND #9 AND CENTRAL:TARGET

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: Embase <1974 to 2020 March 05>
Search Date: 7 March 2020
1     exp walking/ 
2     (walk$ or gait or locomot$ or stride$ or stroll$ or treadmill$).tw. 
3     or/1‐2
4     exp hypertension/ 
5     (antihypertens$ or hypertens$ or prehypertens$).tw. 
6     exp blood pressure/ 
7     (blood pressur$ or bloodpressur$).tw.
8     ((arterial adj2 pressur$) or (diastolic adj2 pressur$) or (systolic adj2 pressur$)).tw. 
9     (bp or dbp or sbp).tw. 
10     or/4‐9 
11     randomized controlled trial/ 
12     crossover procedure/
13     double‐blind procedure/ 
14     (randomi?ed or randomly).tw. 
15     (crossover$ or cross‐over$).tw. 
16     placebo.ab. 
17     (doubl$ adj blind$).tw.
18     assign$.ab.
19     allocat$.ab. 
20     or/11‐19 
21     (exp animal/ or animal.hw. or nonhuman/) not (exp human/ or human cell/ or (human or humans).ti.) 
22     ((ocular or portal or pulmonary) adj (arterial or hypertens$)).ti. 
23     (eclamp$ or preeclampsi$ or pregnan$).ti. 
24     or/21‐23 
25     20 not 24
26     3 and 10 and 25 

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: EBSCO CINAHL (1982 to Present)

Search Date: 9 March 2020

S21     S3 AND S12 AND S20   
S20     (S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19)     
S19     (MH "Quantitative Studies")    
S18     (MH "Random Assignment")     
S17     TI (randomi* OR randomly) OR AB (randomi* OR randomly)     
S16     ( TI (singl* blind*) OR (doubl* blind*) ) OR ( AB (singl* blind*) OR (doubl* blind*) )     
S15     TI (clinic* trial*) OR AB (clinic* trial*)     
S14     PT Clinical Trial     
S13     (MH "Clinical Trials+")     
S12     (S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11)   
S11     TI (bp OR dbp OR sbp) OR AB (bp OR dbp OR sbp)     
S10     TI (diastolic N1 pressur*) OR (systolic N1 pressur*) OR AB (diastolic N1 pressur*) OR (systolic N1 pressur*)     
S9     TI (arterial N1 pressur*) OR AB (arterial N1 pressur*)     
S8     TI (blood pressur* OR bloodpressur*) OR AB (blood pressur* OR bloodpressur*)     
S7     MJ Blood Pressure
S6     (MH "Blood Pressure+")     
S5     (TI (antihypertens* OR hypertens* OR prehypertens*) ) OR ( AB (antihypertens* OR hypertens* OR prehypertens*) )     
S4     (MH "Hypertension+")   
S3     S1 OR S2 
S2     TI ( (walk* OR gait OR locomot* OR stride* OR stroll* OR treadmill*) ) OR AB ( (walk* OR gait OR locomot* OR stride* OR stroll* OR treadmill*) )   
S1     (MH "Walking+")    

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: EBSCO PsycINFO (1950 to Present)

Search Date: 9 March 2020
S20     S3 AND S11 AND S19    
S19     (S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18)    
S18     TI blind* OR AB blind*
S17     AB allocat*     
S16     AB assign*    
S15     TI trial* OR AB trial*  
S14     AB control group*  
S13     TI controlled OR AB controlled     
S12     TI (randomi* OR randomly) or AB (randomi* OR randomly)   
S11     (S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10)    
S10     TI (bp OR dbp OR sbp) OR AB (bp OR dbp OR sbp)     
S9     TI ( (diastolic N1 pressur* OR systolic N1 pressur*) ) AND AB ( (diastolic N1 pressur* OR systolic N1 pressur*) )    
S8     TI (arterial N1 pressur*) OR AB (arterial N1 pressur*)    
S7     TI blood pressur* OR AB blood pressur*    
S6     SU Blood pressure    
S5     (TI (antihypertens* OR hypertens* OR prehypertens*) ) or ( AB (antihypertens* OR hypertens* OR prehypertens*) )     
S4     SU Hypertension     
S3     S1 OR S2    
S2     TI ( (walk* OR gait OR locomot* OR stride* OR stroll* OR treadmill*) ) or AB ( (walk* OR gait OR locomot* OR stride* OR stroll* OR treadmill*) )   
S1     SU Walking     
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: EBSCO SPORTDiscus (1949 to Present)

Search Date: 11 March 2020

S20    (S3 AND S11 AND S19)   
S19    (S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18)   
S18    TI blind* OR AB blind*    
S17    AB allocat*    
S16    AB assign*    
S15    TI trial* OR AB trial*  
S14    AB control group*    
S13    TI controlled OR AB controlled  
S12    TI (randomi* OR randomly) OR AB (randomi* OR randomly)  
S11    (S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10)    
S10    TI (bp OR dbp OR sbp) OR AB (bp OR dbp OR sbp)   
S9    TI (diastolic N1 pressur*) OR (systolic N1 pressur*) OR AB (diastolic N1 pressur*) OR (systolic N1 pressur*)    
S8    TI (arterial N1 pressur*) OR AB (arterial N1 pressur*)   
S7    TI (blood pressur*) OR AB (blood pressur*)   
S6    SU Blood pressure   
S5    TI (antihypertens* OR hypertens* OR prehypertens*) OR AB (antihypertens* OR hypertens* OR prehypertens*)    
S4    SU Hypertension   
S3    S1 OR S2    
S2    TI ( (walk* or gait or locomot* or stride* or stroll* or treadmill*) ) or AB ( (walk* or gait or locomot* or stride* or stroll* or treadmill*) )    
S1    SU Walking    

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: PEDro <1929 to Present>

Search Date: 11 March 2020

Abstract & Title: antihypertens*
Therapy: fitness training
Method: clinical trial OR systematic review
Score of at least 7/10

Abstract & Title: blood pressure
Therapy: fitness training
Method: clinical trial OR systematic review
Score of at least 7/10

Abstract & Title: hypertens*
Therapy: fitness training
Method: clinical trial OR systematic review
Score of at least 7/10

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: ClinicalTrials.gov

Search Date: 11 March 2020

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Other terms: randomized 
Study type: Interventional Studies (Clinical Trials)
Study Results: All Studies
Intervention/treatment: treadmill OR walking
Outcome Measure: blood pressure 

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: WHO International Clinical Trials Registry Platform (ICTRP)

Search Date: 11 March 2020

blood pressure AND randomi* AND walk*  
hypertens* AND randomi* AND walk*
blood pressure AND randomi* AND treadmill 
hypertens* AND randomi* AND treadmill 

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: Index to Taiwan Periodical Literature System

Search Date: 18 May 2020

#1 (健走 + 健步 + 踏步 + 快走 + 快步 + 跑走 + 慢走 + 慢步 + 走路 + 步行 + 腳踏 + 滑步 + 跑步機 + 漫步機 + 橢圓機) * (收縮壓 + 舒張壓 + 血壓 + 心跳 + 心律 + 心率 + 心肺) * (實驗 + 試驗 + 隨機 + 對照 + random* + controlled + trial) [Search Fields: Article Title, Keywords, Author, Abstract]

#2 (walking + tread* + “running machine” + “running machines” + “Pedlar inexpensive ergometer” + "elliptical trainer" + "elliptical trainers" + gait* + locomot* + stride*) * (SBP + DBP + BP + pressure + hypertens* + antihypertens* + heart* + HR + rhythm* + cardi*) * (random* + controlled + trial) [Search Fields: Article Title, Keywords, Author, Abstract]

#3 #1 or #2

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: National Digital Library of Theses and Dissertations in Taiwan

Search Date: 18 May 2020

(健走.ti,kw or 健步.ti,kw or 踏步.ti,kw or 快走.ti,kw or 快步.ti,kw or 跑走.ti,kw or 慢走.ti,kw or 慢步.ti,kw or 走路.ti,kw or 步行.ti,kw or 腳踏.ti,kw or 滑步.ti,kw or 跑步機.ti,kw or 漫步機.ti,kw or 橢圓機.ti,kw or walking.ti,kw or tread*.ti,kw or "running machine".ti,kw or "running machines".ti,kw or "Pedlar inexpensive ergometer".ti,kw or "elliptical trainer".ti,kw or "elliptical trainers".ti,kw or stride*.ti,kw) and (收縮壓.ti,kw,ab or 舒張壓.ti,kw,ab or 血壓.ti,kw,ab or 心跳.ti,kw,ab or 心律.ti,kw,ab or 心率.ti,kw,ab or 心肺.ti,kw,ab or SBP.ti,kw,ab or DBP.ti,kw,ab or BP.ti,kw,ab or pressure.ti,kw,ab or hypertens*.ti,kw,ab or antihypertens*.ti,kw,ab or heart*.ti,kw,ab or HR.ti,kw,ab or rhythm*.ti,kw,ab or cardi*.ti,kw,ab) and (實驗.ti,kw,ab or 試驗.ti,kw,ab or 隨機.ti,kw,ab or 對照.ti,kw,ab or random*.ti,kw,ab or controlled.ti,kw,ab or trial.ti,kw,ab)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: China National Knowledge Infrastructure (CNKI): Journals, Theses & Dissertations

Search Date: 18 May 2020

(TI=(健走+健步+踏步+快走+快步+跑走+慢走+慢步+走路+步行+腳踏+滑步+跑步機+漫步機+橢圓機+跑台+跑臺+平板+踏車+walking+ tread+"running machine"+"running machines"+"Pedlar inexpensive ergometer"+"elliptical trainer"+"elliptical trainers"+stride) or KY=(健走+健步+踏步+快走+快步+跑走+慢走+慢步+走路+步行+腳踏+滑步+跑步機+漫步機+橢圓機+跑台+跑臺+平板+踏車+walking+ tread+treadmill+treadmills+"running machine"+"running machines"+"Pedlar inexpensive ergometer"+"elliptical trainer"+"elliptical trainers"+stride)) and (SU=(收縮壓+舒張壓+血壓+心跳+心律+心率+心肺+SBP+DBP+BP+pressure+hypertension+hypertensive+antihypertensive+antihypertension+heart+HR+rhythm+rhythms+cardiopulmonary)) and (SU=(隨機+對照+控制組+random+randomly+randomized+randomised))

(This interface does not support truncation queries)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Database: Wanfang Med Online: Journals, Theses & Dissertations

Search Date: 18 May 2020

((題名=健走 OR 健步 OR 踏步 OR 快走 OR 快步 OR 跑走 OR 慢走 OR 慢步 OR 走路 OR 步行 OR 腳踏 OR 滑步 OR 跑步機 OR 漫步機 OR 橢圓機 OR 跑台 OR 跑臺 OR 平板 OR 踏車) OR (關键词=健走 OR 健步 OR 踏步 OR 快走 OR 快步 OR 跑走 OR 慢走 OR 慢步 OR 走路 OR 步行 OR 腳踏 OR 滑步 OR 跑步機 OR 漫步機 OR 橢圓機 OR 跑台 OR 跑臺 OR 平板 OR 踏車)) AND (收縮壓 OR 舒張壓 OR 血壓 OR 心跳 OR 心律 OR 心率 OR 心肺) AND (隨機 OR 對照 OR 控制組)

Data and analyses

Comparison 1. Walking vs non‐intervention control.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 systolic blood pressure	73	5060	Mean Difference (IV, Random, 95% CI)	‐4.11 [‐5.22, ‐3.01]
1.2 diastolic blood pressure	69	4711	Mean Difference (IV, Random, 95% CI)	‐1.79 [‐2.51, ‐1.07]
1.3 heart rate [beats/min]	26	1747	Mean Difference (IV, Random, 95% CI)	‐2.76 [‐4.57, ‐0.95]

Comparison 2. Walking vs non‐intervention control: subgroup analysis by age.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 SBP by Age	73	5060	Mean Difference (IV, Random, 95% CI)	‐4.12 [‐5.22, ‐3.01]
2.1.1 Age <=40	14	491	Mean Difference (IV, Random, 95% CI)	‐4.41 [‐6.17, ‐2.65]
2.1.2 Age 41‐60	35	1959	Mean Difference (IV, Random, 95% CI)	‐3.79 [‐5.64, ‐1.94]
2.1.3 Age >60	24	2610	Mean Difference (IV, Random, 95% CI)	‐4.30 [‐6.17, ‐2.44]
2.2 DBP by Age	69	4711	Mean Difference (IV, Random, 95% CI)	‐1.79 [‐2.51, ‐1.07]
2.2.1 Age <=40	14	491	Mean Difference (IV, Random, 95% CI)	‐3.01 [‐4.44, ‐1.58]
2.2.2 Age 41‐60	32	1730	Mean Difference (IV, Random, 95% CI)	‐1.74 [‐2.95, ‐0.52]
2.2.3 Age >60	23	2490	Mean Difference (IV, Random, 95% CI)	‐1.33 [‐2.40, ‐0.26]

Comparison 3. Walking vs non‐intervention control: subgroup analysis by sex.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 SBP by Sex	26	1352	Mean Difference (IV, Random, 95% CI)	‐5.49 [‐7.43, ‐3.56]
3.1.1 Male	6	203	Mean Difference (IV, Random, 95% CI)	‐4.64 [‐8.69, ‐0.59]
3.1.2 Female	22	1149	Mean Difference (IV, Random, 95% CI)	‐5.65 [‐7.89, ‐3.41]
3.2 DBP by Sex	24	1203	Mean Difference (IV, Random, 95% CI)	‐2.67 [‐3.85, ‐1.48]
3.2.1 Male	6	203	Mean Difference (IV, Random, 95% CI)	‐2.54 [‐4.84, ‐0.24]
3.2.2 Female	20	1000	Mean Difference (IV, Random, 95% CI)	‐2.69 [‐4.16, ‐1.23]

Comparison 4. Walking vs non‐intervention control: sensitivity analysis for studies at low risk of overall bias.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
4.1 systolic blood pressure	4	235	Mean Difference (IV, Random, 95% CI)	‐4.31 [‐7.99, ‐0.63]
4.2 diastolic blood pressure	4	235	Mean Difference (IV, Random, 95% CI)	‐0.43 [‐2.78, 1.92]

Comparison 5. Walking vs non‐intervention control: sensitivity analysis for studies at low risk of attrition bias.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
5.1 systolic blood pressure	41	3480	Mean Difference (IV, Random, 95% CI)	‐4.67 [‐6.25, ‐3.09]
5.2 diastolic blood pressure	41	3480	Mean Difference (IV, Random, 95% CI)	‐2.23 [‐3.20, ‐1.26]

Comparison 6. Walking vs non‐intervention control: sample size per trial ≦30 vs. >30.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
6.1 SBP	73	5040	Mean Difference (IV, Random, 95% CI)	‐4.12 [‐5.23, ‐3.02]
6.1.1 sample size <= 30	15	321	Mean Difference (IV, Random, 95% CI)	‐7.06 [‐9.47, ‐4.66]
6.1.2 sample size >30	58	4719	Mean Difference (IV, Random, 95% CI)	‐3.48 [‐4.69, ‐2.27]
6.2 DBP	69	4691	Mean Difference (IV, Random, 95% CI)	‐1.79 [‐2.51, ‐1.08]
6.2.1 sample size <= 30	15	321	Mean Difference (IV, Random, 95% CI)	‐2.92 [‐5.02, ‐0.82]
6.2.2 sample size >30	54	4370	Mean Difference (IV, Random, 95% CI)	‐1.57 [‐2.32, ‐0.82]

Comparison 7. Walking vs non‐intervention control: subgroup analysis (normotensive vs. high normal).

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
7.1 SBP	72	5048	Mean Difference (IV, Random, 95% CI)	‐4.14 [‐5.28, ‐3.00]
7.1.1 Normotensive <130	33	2057	Mean Difference (IV, Random, 95% CI)	‐3.68 [‐5.12, ‐2.24]
7.1.2 High normal and Hypertensive ≧130	39	2991	Mean Difference (IV, Random, 95% CI)	‐4.54 [‐6.23, ‐2.85]
7.2 DBP	68	4699	Mean Difference (IV, Random, 95% CI)	‐4.06 [‐5.24, ‐2.88]
7.2.1 Normotensive <85	53	3920	Mean Difference (IV, Random, 95% CI)	‐3.91 [‐5.26, ‐2.55]
7.2.2 High normal and Hypertensive ≧85	15	779	Mean Difference (IV, Random, 95% CI)	‐4.57 [‐7.07, ‐2.07]

Comparison 8. Walking vs non‐intervention control: subgroup analysis (normotensive vs. hypertensive).

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
8.1 SBP	54	3630	Mean Difference (IV, Random, 95% CI)	‐4.24 [‐5.52, ‐2.97]
8.1.1 Normotensive <130	33	2057	Mean Difference (IV, Random, 95% CI)	‐3.68 [‐5.12, ‐2.24]
8.1.2 Hypertensive ≧140	21	1573	Mean Difference (IV, Random, 95% CI)	‐5.21 [‐7.66, ‐2.76]
8.2 DBP	60	4223	Mean Difference (IV, Random, 95% CI)	‐4.39 [‐5.67, ‐3.10]
8.2.1 Normotensive <85	53	3920	Mean Difference (IV, Random, 95% CI)	‐3.91 [‐5.26, ‐2.55]
8.2.2 Hypertensive ≧90	7	303	Mean Difference (IV, Random, 95% CI)	‐7.82 [‐11.16, ‐4.47]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Araiza 2006.

Study characteristics
Methods	Aim: quote: "To determine whether a recommendation to accumulate 10000 steps per day, as documented by use of a pedometer, would result in significant improvements in parameters of glycemic control, insulin sensitivity, cardiovascular risk, lipid profile, and oxidative stress in sedentary patients with type 2 diabetes mellitus." Design: parallel 2‐group RCT (1:1) matched Power/sample size calculation: yes (post hoc)
Participants	No. randomised:30 (15 in IG, 15 in CG) No. completers: 30 Country: USA Study population: Type 2 diabetes mellitus (free from advanced secondary complications of diabetes) Ethnicity: NR Gender: NR Age: mean 51 (SD 10) in IG, 49 (SD 11) in CG; range 33 to 69 Smokers: NR Hypertension: no Mean baseline BP: SBP = 140.6 (SD 21.4) in IG, 136.6 (SD 19.3) in CG; DBP = 80.7 (SD 12.2) in IG, 77.6 (SD 8.9) in CG . Inclusion criteria: participants with type 2 diabetes mellitus with oral therapy, but free from advanced secondary complications of diabetes. Exclusion criteria: pregnant or lactating women, anaemia (haemoglobin <11 g/100 mL for males, haemoglobin <10 g/100 mL for females), cardiovascular disease, hypertension (SBP >180 mmHg and/or DBP >110 mmHg), or orthopedic limitation for walking.
Interventions	IG: Active group: The protocol consisted of a 10‐day baseline period during which the participants were asked not to change their physical activity habits. Duration: (accumulated steps) Intensity: NR Frequency: accumulated 10,000 steps/day, >=5 days/week Intervention period: 6 weeks Pedometer: Yamax Digiwalker step counter, positioned on the waist, in‐line with the right mid‐thigh. Facilitator: NR CG: Control group: quote: "The control group was instructed to maintain their normal activity habits throughout the 6‐week intervention."
Outcomes	Review outcomes reported: SBP, DBP Measurement method: BP (SBP/DBP) was measured with participant in the seated position with an automated monitor at study weeks 0 and 6. Primary/Main outcome of manuscript: BMI, percentage of body fat, BP, waist circumference, and resting energy expenditure (REE) Adherence: the active increased steps per day by an average of 69% to 10410 (SD 4162). Adverse event: NR
Notes	PARTICIPANT Trial registration: NR Funding sources: NIH NCRR GCRC grant 5M01‐RR00997 from the University of New Mexico GCRC.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	No information
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	It is unlikely that the participants and investigators were blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	no dropout ITT analysis
Selective reporting (reporting bias)	Low risk	0nly 1 endpoint measurement at 6 weeks
Other bias	Low risk	No other bias

Arija 2017.

Study characteristics
Methods	Aim: to assess short‐ and medium‐term effectiveness of 9 months supervised physical activity programme including social cultural activities on CVD risk in adults accessing primary healthcare facilities Design: parallel 2‐group RCT (3:1) Power/sample size calculation: yes
Participants	No. randomised: 419 (305 in IG, 114 in CG) No. completers: 364 Country: Spain Study population: primary healthcare patients (attending primary healthcare facilities) Ethnicity: NR Gender: male 23.2% (only can roughly estimated from the following information: "76.8% women" in abstract) Age: mean 64.5 (SD 9.2) in IG, 66.99 (SD 10.28) in CG (mean age: 65.19) Smokers: 7.9% in IG, 4.20% in CG Hypertension: 54.2% in IG, 57.3% in CG Mean baseline BP: SBP = 131.06 (SD 15.94) in IG, 135.32 (SD 16.62) in CG; DBP = 76.75 (SD 9.09) in IG, 75.96 (SD 9.86) in CG, (see manuscript Table 4) Inclusion criteria: adults accessing the primary care facilities Exclusion criteria: Quote: "an episode of ischemic heart disease (<6 months previously), or an acute episode of arthritis which would limit the ability to walk, or having a lung or heart disease with dyspnea (mild to moderate effort dyspnea) which would limit the individual’s ability to undertake the proposed exercise regimen"
Interventions	IG: walking group: Walking itineraries and cultural activities were pre‐set. Walking itineraries were, on average, a five‐km circuit in and around the city. Group sizes ranged from 15 to 30 participants. Monthly socio‐cultural activities included: visits to museums and libraries, cultural exhibitions, tourist attractions and dance lessons. Duration: 60‐minute/session Intensity: 396 METs/minutes/week over 120 minutes in 2 walking sessions per week of 60 minutes each Frequency: 1 session/day, 2 days/week, plus monthly socio‐cultural activities Intervention period: 39 weeks (9 month*4.33) Pedometer: NR Facilitator: yes, supervised walking by healthcare professionals; a physical activity specialist was responsible for the standardisation of procedures and for the training of the primary care nurses. CG: control group: received usual care from healthcare personnel, and were recommended to follow their habitual lifestyle.
Outcomes	Review outcomes reported: SBP, DBP; AEs (at 2 years) Measurement method : BP was measured with a manual sphygmomanometer with the participants resting for at least five minutes. Three recordings were taken and the average of the second and third readings was used in the statistical analyses. Primary/Main outcome of manuscript: overall CVD risk Adverse event: NR, cardiovascular event objective outcomes (hospital records)
Notes	Trial registration: NCT02767739 Funding sources: private sector (Department of Health of the Generalitat of Catalonia, the Catalan Society of Family and Community Medicine (CAMFIC) and the Nursing Association Family and Community (AIFICC))
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated random number table Table 1 in manuscript
Allocation concealment (selection bias)	Unclear risk	No information Table 1 in manuscript
Blinding of participants and personnel (performance bias) All outcomes	Low risk	No other co‐interventions Closely supervised by healthcare professionals Closely monitored for adherence
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information about blood pressure assessor
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 13.1% in 9‐month follow‐up 45 out of 305 (14.8%) in IG and 10 out of 114 (8.8%) in CG refer to Figure 1 PP analysis
Selective reporting (reporting bias)	Low risk	only 1 endpoint measurement at 9 months; only 1 analysis. AE: only 1 endpoint measurement at 2 years for CVD events; only 1 analysis.
Other bias	Low risk	no other bias

Baker 2008.

Study characteristics
Methods	Aim: to evaluate short‐term effects of a pedometer‐based walking programme on health outcomes in general population not meeting current physical activity guidelines. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: yes
Participants	No. randomised: 80 (1 withdrawn after randomisation, resulting 39 in IG, 40 in CG) No. completers: 79 Country: UK (Scotland) Study population: general population (from lowest socio‐economic groups surrounding community of a West of Scotland University) Ethnicity: NR Gender: male 20.3% (16/79) Age: mean 47.3 (SD 9.3) in IG, 51.2 (SD 7.9) in CG Smokers: NR Hypertension: NR Mean baseline BP: SBP = 118.2 (SD 17.9) in IG, 119.9 (SD 15.9) in CG; DBP = 75.1 (SD 11.4) in IG, 75.5 (SD 11.8) in CG; HR = 68.6 (SD 7.2) in IG, 67.9 (SD 8.6) in CG Inclusion criteria: independently ambulatory, English speaking, age 18 to 65, self‐classified as not meeting current physical activity recommendation, completed Physical Activity Readiness Questionnaires for readiness, and personal physician's approval of participation. Exclusion criteria: not meeting inclusion criteria
Interventions	IG: walking group: An initial semi‐structured physical activity consultation based on the Transtheoretical Model of exercise behavior change. Followed by a 12‐week walking programme involving a graduated increase in the participants' mean daily step‐count over the first six weeks to a target of 3,000 accumulated steps above their baseline value for 5 days/week. In the following six weeks, participants maintained this intensity for at least 5 days/week. Duration: participants were advised on the nature of the intensity and duration of the desired increases in walking. (gradually increase from 1500 to 3000 steps/day from baseline value) Intensity: moderate brisk walking (100 steps/minute) and 12 to 14 on Borg scale Frequency: 3 to 5 days/week Intervention period: 12 weeks Pedometer: yes Facilitator: yes, researchers for physical activity consultation CG: Control group: maintain normal walking levels for 12 weeks.
Outcomes	Review outcomes reported: SBP, DBP, HR Measurement method: quite: "Blood pressure and HR was measured using an automated blood pressure monitor (Omron HEM‐907, Bannockburn, IL). On each visit blood pressure measurements were performed three times with a rest period of one minute between measurements. Three measurements of resting heart rate were also recorded simultaneously by the blood pressure monitor. The average of these measurements is reported in these results." Primary/Main outcome of manuscript: steps per day measured by Omron HJ‐109E Step‐O‐Meter and International Physical Activity Questionnaire (IPAQ). Compliance/Adherence: 64% (definition: 25 out of 39 participants achieved an increase of 15,000 steps per week) Adverse event: NR (5 were injured, 3 in TG and 2 in CG, but was not identified as adverse event)
Notes	Trial registration: NR note: study name was Walking for Well‐being in the West (WWW) Funding sources: Government(Walking for Well‐being in the West (WWW) study was funded by the Scottish Government (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518560/))
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Independent interactive voice response system (by phone) refer to Table 4
Allocation concealment (selection bias)	Low risk	Quote: "Randomization was carried out via an independent interactive voice response system (IVRS) which concealed all details of the randomization method from the end users." Independent interactive voice response system (by phone) refer to Table 4
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote: "Researchers who conducted the physical activity consultations were not blinded to group assignment in order to implement the physical activity intervention." "Additional researchers...were blinded to group assignment." refer to Table 3 and 4
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Quote:"Additional researchers who performed physiological measurements were blinded to group assignment."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Ddropout 19.0% (15 out of 79 dropouts) was acceptable 7 out of 39 (18%) in IG, 8 out of 40 (20%) in CG. ITT analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Bang 2016.

Study characteristics
Methods	Aim: to determine the physical and psychological effects of an urban forest‐walking program for office workers. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: yes (In order to test the difference between the two groups of the two sides, the significance level was .05, power .80, and the effect size was.80 using G * Power 3.1 program. As a result, the number of subjects required was 26 per group, A total of 52 patients.)
Participants	No. randomised: 60 (30 in IG, 30 in CG) No. completers: 45 Country: Korea Study population: sedentary office workers Ethnicity: NR Gender: male 0% Age: mean age 39.8 ( 42.22 (SD 11.44) in IG, 37.37 (SD 9.32) in CG) Smokers: NR Hypertension: 0% Mean baseline BP: SBP = 121.39 (SD 16.02) in IG, 112.52 (SD 12.49) in CG DBP = 79.00 (SD 9.37) in IG, 72.85 (SD 9.35) in CG Inclusion criteria: 60 school faculty and researchers who voluntarily submitted their application announcements to the campus from 6 September 26 2014 to 8 October 2014 and recruited on a first‐come‐first‐served basis. Exclusion criteria: NR
Interventions	IG: Forest walk: City centre forest walk program ‐ Forest walk at park in lunch time. Lunch of rice ball or sandwich was provided. Duration: 1 hour/day Intensity: 6.5 km/hour Frequency: twice a week Intervention period: 5 weeks Pedometer: monitor was provided and amount of physical activity can be seen by both participants and researchers. Facilitator: NR CG: Control (CON) group: Maintain normal daily routine
Outcomes	Review outcomes reported: SBP, DBP (Table 1 and 2) Measurement method: BP (no HR) was measured using an automated blood pressure monitor after 10‐minute rest. Primary/Main outcome of manuscript: SBP, DBP (no HR), body composition analysis, bone density, depression, quality of life Adverse event: NR
Notes	Trial registration: NR Funding sources: Korean government
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computerised randomisation procedure; refer to Table 1 (baseline information only from completer) ("low risk": because all participants were from a same hospital)
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Co‐interventions: lunch provided to intervention group participants No details provided
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 25% (15 out of 60 dropouts) 12 (36.4%) in TG and 3 (11.1%) in CG PP analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 2 years for CVD events Only 1 analysis
Other bias	Low risk	No other bias

Baross 2017.

Study characteristics
Methods	Aim: to compare the effects on resting SBP, DBP, and mean arterial pressure (MAP) of 6 weeks of training, involving either (i) simultaneous walking and isometric handgrip (WHG), (ii) walking only (WLK), (iii) isometric handgrip only (IHG), or (iv) control conditions (CON). Design: parallel 4‐group RCT (1:1:1:1) Power/sample size calculation: No
Participants	No. randomised: 24 (12 in IG, 12 in CG); (12 in WHG and12 in IHG groups excluded) No. completers: 24 Country: UK Study population: sedentary young adults Ethnicity: NR Gender: male 54% (13/24) Age: mean 20.7 (SD 1.6) for IG, 21.3 (SD 2.0) for CG Smokers: NR Hypertension: 0% Mean baseline BP: SBP = 126.7 (SD 3.7) for IG; 127.9 (SD 4.2) for CG; DBP = 77.7 (SD 3.0) for IG; 77.0 (SD 1.8) for CG Resting HR = 66.0 (SD 3.1) for IG; 67.4 (SD 2.7) for CG Inclusion criteria: healthy sedentary participants, who were university students who had not participated in regular exercise training (3 or more times per week) for 12 months prior to enrolment in our study. Exclusion criteria: if they reported any recent (6 months) history of medical treatment for serious illness such as high blood pressure, orthopaedic injury, viral illness, or surgical procedure, habitually active students
Interventions	IG: Walking (WLK) group: treadmill walking using a mains powered treadmill (GX100, Powerjog, Birmingham, UK). Duration: 30 minute/session Intensity: 6.5 km/hour Frequency: 1 session/day, 4 days/week Intervention period: 6 weeks Pedometer: NR Facilitator: all training sessions were performed in a consistent laboratory environment under supervision. CG: Control (CON) group: maintain normal daily routine Note: WHG (simultaneous walking and isometric handgrip exercise) and IHG (isometric handgrip exercise) groups excluded
Outcomes	Review outcomes reported: SBP, DBP, resting heart rate Measurement method: quote: "resting baseline measures (heart rate and blood pressure) were recorded using a heart rate monitor (Polar Beat, Polar Electro, Kempele, Finland) and an automatic blood pressure monitor (UA‐767 Plus, A&D Company, Ltd., Tokyo, Japan)." Primary/Main outcome of manuscript: Resting HR, SBP, DBP and mean arterial pressure (MAP) Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "were randomly allocated" but no details reported refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Participants not blinded. Quote:"All training sessions were carried out at the University of Northampton in a consistent laboratory environment under supervision."
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Dropout: NR refer to Table 1
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 12 weeks Only 1 analysis
Other bias	Low risk	no other bias

Bayat 2018.

Study characteristics
Methods	Aim: quote: "To evaluate the effect of regular walking for 3 months on some glycemic indexes and blood pressure in women with type 2 diabetes" Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 120 (60 in IG, 60 in CG) No. completers: 100 Country: Iran Study population: Type II diabetic women Ethnic: NR Gender: male 0% Age:mean 53.77 (SD 6.52) in IG, 52.06 (SD 6.28) in CG Smokers: no Hypertension: no Mean baseline BP: SBP = 126.04 (SD 16.69) in IG, 130.9 (SD 15.64) in CG; DBP = 74.9 (SD 10.85) in IG, 85.0 (SD 10.0) in CG. Inclusion criteria: women with type 2 diabetes, aged ranged 50 to 70, none of them used tobacco or drugs, had no history of stroke, heart, kidney disease, proteinuria, or neurological and lumbar disc disease. Exclusion criteria: not specified
Interventions	IG: Walking group: Duration: walked quote: "30 minutes from 7 to 10 am" Intensity: moderate physical activity: quote "According to the recommendation of the European Federation of Sports Medicine Associations (the last edition of 2017), participants involved in moderate physical activity (RPE 10 to 14) at least three times a week." Frequency: (not specified) Intervention period: 3 months Pedometer: no Facilitator: no CG: Control group: quote: "The control group did not have any physical activity during regular study, such as regular walking." "Both groups took 500 mg of metformin and 5 mg of glibenclamide daily."
Outcomes	Review outcomes reported: SBP, DBP Measurement method : quote "A standard mercury brachial barometer was used to measure the blood pressure of type 2 diabetic patients." "Blood pressure of the subjects was taken in the sitting position after 10 minutes of rest, the legs were placed on the floor, and the hand was measured at the heart level. Blood pressure was measured twice in both pre‐test and post‐test, and the mean of these two was recorded as the patient's blood pressure at each turn." Primary/Main outcome of manuscript: glycaemic indexes and BP Compliace/Adherance: walking group completion rate 92% of prescribed walking steps/day Adverse event: NR
Notes	Trial registration: NR Funding sources: Arabian government
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Qquote: "were randomly assigned" but no details reported refer to Table 1 and 2
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1 and 2
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	According to the information author provided: Dropout 20 out of 120 (16.7%) 10 out of 60 (16.7%) in IG and 10 out of 60 (16.7%) in CG drop outs PP analysis
Selective reporting (reporting bias)	Low risk	SBP and DBP were reported at 3 months Only 1 analysis
Other bias	Low risk	No other bias

Bell 2010.

Study characteristics
Methods	Aim: to compare the improvements in fitness and health‐related parameters from aerobic fitness training program and pedometer‐based walking program in sedentary men and women. Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: NR
Participants	No. randomised: 140 (69 in IG and 71 in CG); (71 in Fitness training group excluded) No. completers: 88 Country: Canada Study population: general population from urban city Ethnic: NR Gender: NR Age:mean 49 (SD 11) in men, 50 (SD 9) in women Smokers: NR Hypertension: NR Mean baseline BP: SBP = 124 (SD 14) in IG, 125 (SD 13) in CG; DBP = 78 (SD 9) in IG, 80 (SD 9) in CG. HR = 73 (SD 9) in IG, 76 (SD 11) in CG Inclusion criteria: Quote: “a successful completion of a physical examination by a physician; between the ages of 25 and 65 years; no known cardiorespiratory or other disease (e.g. diabetes mellitus); sedentary (no regular physical activity and less than a mean of 5500 baseline steps per day for a 7‐day period); ability to walk and participate in a moderate physical activity program; and willingness to be randomly assigned to any of the experimental groups.” Exclusion criteria: Quote: “any blood parameter measured during pre‐testing was at a level considered to be clinically unhealthy, if their pre‐exercise heart rate was at or above 100 beat × minute–1, or their resting systolic or diastolic blood pressure was at or above 145 mmHg systolic and 95 mmHg diastolic.”
Interventions	IG: Walking (pedometer‐based walking) group: Accumulated walking steps, progressively overloaded every 3 weeks for the first 12 weeks followed by an additional 4‐ and 8‐week increase in steps over the final 12 weeks, resulting in a progressive increase in the number of steps until 10,000 steps per day were prescribed during the last 8 weeks of the 24‐week program. Participants in the walking group were counselled to attain the target number of daily steps by increasing their walking during the morning, afternoon or evening time periods or during breaks at work. No exercise intensity guidelines or heart‐rate monitors were provided. Duration: 5618 steps/d (week 1 to 3), 6499 steps/d (week 4 to 6), 7379 steps/d (week 7 to 9), 8260 steps/d (week 10 to 12), 9141 steps/d (week 13 to 16), 10,000 steps/d (week 17 to 24) Intensity:1185 kJ/d (week 1 to 3), 1371 kJ/d (week 4 to 6), 1557 kJ/d (week 7 to 9), 1743 kJ/d (week 10 to 12), 1929 kJ/d (week 13 to 16), 2115 kJ/d (week 17 to 24) Frequency: 7 days/week Intervention period: 24 weeks Pedometer: yes Facilitator: no CG: Control group: the control group was requested to not begin nor change their amount of daily physical activity while participating in the study and was offered an activity program after completion of the study as an incentive to adhere to these guidelines. Note: fitness training group excluded from this description.
Outcomes	Review outcomes reported: SBP, DBP, HR Measurement method : submaximal HR, BP, rating of perceived exertion, ventilatory threshold (VT), and peak oxygen uptake (VO2) were determined during a graded exercise test on a treadmill. Primary/Main outcome of manuscript: fitness (ventilatory threshold, peak oxygen uptake) and health‐related parameters (waist circumference, hip circumference, BMI, HR and BP) measured at baseline and week 24. Adverse event: NR
Notes	Trial registration: NR Note: study duration of 6 months was been clearly described as 24 weeks in the original article Funding sources: Governement (Grant from the Canadian Institutes of Health Research. Kerry S. Courneya (4th author) is supported by the Canada Research Chairs Program.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomly assigned to..." but no details reported. refer to Table 2
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 2
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Quote:"were blinded to the name of the subject and the time of the test"
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Oobjective outcomes Quote:"were blinded to the name of the subject and the time of the test"
Incomplete outcome data (attrition bias) All outcomes	High risk	26 out of 69 (37.7%) in IG and 26 out of 71 (36.6%) in CG refer to Figure 1 PP analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 24 weeks only 1 analysis
Other bias	Low risk	No other bias

Braith 1994.

Study characteristics
Methods	Aim: to determine the effects of 6 months of moderate‐ and high‐intensity walking exercise on resting BP in normotensive elderly subjects (60 to 79 years). Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: NR
Participants	No. randomised: 30 (19 in moderate intensity group, 11 in control group) (14 in high intensity group excluded) No. completers: 30 Country: USA Study population: general population (elderly volunteers) Ethnic group: NR Gender: male 45% (20/44*100%) included the group we excluded Age: mean 66 (SD 5) in IG, 66 (SD 5) in CG. Smokers: NR Hypertension: 0% Mean baseline BP: SBP = 121 (SD 10) in IG121 (SD 12) in CG; DBP = 72 (SD 8) in IG74 (SD 5) in CG; HR = 71 (SD 8) in IG65 (SD 8) in CG. Inclusion criteria: Quote: “male and female volunteers aged 60 to 79 years, sedentary but otherwise healthy persons with no contraindications to exercise.” Exclusion criteria: “(1) 2 consecutive resting systolic or diastolic BP measurements >140 or >90 mmHg, respectively; (2) >0.3 mV of horizontal or downsloping ST‐segment depression at 0.08 second from the J point; (3) significant arrhythmias; (4) angina pectoris; and (5) exercise‐induced bundle branch block.”
Interventions	IG: Walking (moderate intensity) group: Duration: increased 5 minutes every 2 weeks until it reached 40 minutes and then to 45 minutes/session (week 14 to 26) Intensity: 70% of maximal heart rate reserve started training by walking for 20 minutes at 50% of their maximal heart rate reserve; progressed to 70% of heart rate reserve by week 8; after completion of the graded exercise test during week 14, the exercise target heart rate was adjusted in accordance with changes in resting heart rate; then continued training at 70% of heart rate reserve for an additional 13 weeks. Frequency: 3 session/week Intervention period: 26 weeks Pedometer: No Facilitator: NR CG: Control group: control group participants were instructed to maintain their usual diet and salt intake during the study period. Note: IG2_high: high intensity walking group that trained with uphill treadmill jogging excluded according to the following description: "all subjects in the high‐intensity group trained by walking uphill on a treadmill."
Outcomes	Review outcomes reported: resting SBP, DBP Measurement method: quote: "subjects did not participate in strenuous physical activity for a minimum of 24 hours before these measurements. Heart rate and BP were measured after 20 minutes of seated rest in a quiet room.The same trained observer made all BP measurements by auscultation using a Hawksley random‐zero sphygmomanometer in the arm with the highest BP during the initial visit. Heart rate was measured by palpitation." Primary/Main outcome of manuscript: resting SBP, DBP (at baseline,week 13 and 26), HR Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomly stratified to 1 of 3 groups" but no details reported. refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and personnel not blinded. refer to Table 2
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	According to the outcome table 1 and 2, the dropout rate was 0% since the participant number was the same in two tables. ITT analysis
Selective reporting (reporting bias)	Low risk	Measurement at 3 months and 6 months (all reported) Both 3‐month and 6‐month analysis reported
Other bias	Low risk	No other bias

Brandon 2006.

Study characteristics
Methods	Aim: the effects of a 16‐week dose if brisk walking on body composition and blood pressure in sedentary and obese African America and White women. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: yes
Participants	No. randomised: 52 (15 in AAE, 13 in WE, 12 in AAC, 12 in WC) No. completers: 36 Country: USA Study population: general population (from urban university and local government agencies.) Ethnicity: African American: 51.92% (27/52), white: 48.08% (25/52) Gender: male 0% (0/52) Age: mean 34.0 (SD 7.2) in AAE, 40.5 (SD 7.1) in WE, 36.0 (SD 8.4) in AAC, 42.0 (SD 9.7) in WC. (mean age 37.93) Smokers: NR Hypertension: NR Mean baseline BP: SBP = 110.0 (SD 11.9) in AAE, 111.0 (SD 14.9) in WE; 103.9 (SD 15.6) in AAC, 115.0 (SD 18.1) in WC; DBP = 69.7 (SD 8.9) in AAE, 67.0 (SD 10.3) in WE; 63.8 (SD 14.6) in AAC, 68.5 (SD 10.2) in WC. Inclusion criteria: Quote: “Sedentary (exercise less than twice a week for the past six months), weight stability, age 18 to 50 years, body fat (>27% body fat).” For the IG: able to successfully walk three miles per session after the first two weeks of orientation. Exclusion criteria: Quote: “past history of cardiovascular disease, present signs or symptoms of cardiovascular disease, resting SBP>160mmHg and resting DBP>100mmHg, or taking blood pressure or other medication that contraindicated exercise. Participants with two or more coronary heart disease risk factors obtained physical approval before participating in the study. Women who were on or had been on diets or weight loss medications affecting body weight within the last six months were excluded from the study.”
Interventions	IG: Walking group (AAE, WE) The first 2 weeks were used for conditioning and providing instruction on the brisk walking, training the ability of walking 3 miles for a session. The last 16 weeks constituted the training intervention. The walking sessions took place outside on courses, or on indoor track or treadmill on rainy day. The participants were instructed for making up and recording missed sessions within a week. Duration: 3 miles/session (single bout) Intensity: self‐paced, as brisk as possible, the goal was to walk at 3.5 mph. Frequency: 1 session/day, 3 days/week Intervention period: 16 weeks Pedometer: NR Facilitator: NR CG: Control group (AAC, WC): were asked not to exercise outside the program All study participants were instructed not to change their present lifestyle and dietary habit.
Outcomes	Review outcomes reported: SBP, DBP Measurement method : all BP values were measured with a calibrated sphygmomanometer and stethoscope on the right arm. The same technician and equipment were used for all BP measurements in this study. Primary/Main outcome of manuscript: body compositions (BMI, waist and hip circumferences, per cent body fat, bone marrow density, body density‐skinfold fatness) and blood pressure measured at baseline and week 18. Compliance/Adherence: 87.6+‐8.9% (Quote:"Only subjects that completed 75% of the training intervention were included in the data analyses.) Adverse event: NR
Notes	Trial registration: NR note: mean baseline BP in Table 1 and table 5 had some differences. Definition: 75% of the completion of the training interventions Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "The women were randomly assigned based on race…” Randomisation method was not clearly described. refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	High dropout rates: 16/52 = 30.8% there was no explanation regarding the high dropout rate in the article refer to Table 2 PP analysis
Selective reporting (reporting bias)	Low risk	Only measurement at 18 weeks only 1 analysis
Other bias	Low risk	No other bias

Brenner 2020.

Study characteristics
Methods	Aim: to determine the circulatory and autonomic effects, as well as the effects on walking performance of a progressive, 12‐week, home‐based, low‐intensity (pain‐free walking) exercise program in patients with PAD. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised:48 (27 in IG, 21 in CG) No. completers: 33 Country: Canada Study population: patients with vascular problems (from a cohort study held at a vascular clinic at an acute care hospital) Ethnicity: NR Gender: male 63.6% (21/33), [66.7% (12/18) in IG, 60% (9/15) in CG] Age: mean 68.56 (SD 6.87) in IG, 63.67 (SD 8.47) in CG. Smokers: 48.5% (16/33) in total, [44.4% (8/18) in IG, 53.3% (8/15) in CG] Hypertension: NR Mean baseline BP: SBP = 124 (SD 15) in IG, 132 (SD 14) in CG. DBP = 67 (SD 8) in IG, 69 (SD 11) in CG HR = 63 (SD 12) in IG, 66 (SD 13) in CG Inclusion criteria: 18 years or older diagnosed with stable PAD, expressing symptoms of IC, and having an ankle‐brachial index (ABI) 0.9 Exclusion criteria: unable to read or write English resided in a nursing home already involved in an exercise program wheelchair dependent had angina, congestive heart failure, chronic obstructive pulmonary disease, severe arthritis, or limb amputation had non‐compressible arteries (ABI > 1.2) cognitively impaired
Interventions	IG: Walking group: Verbal and written instructions regarding Borg Ratings of Perceived Exertion (RPE) Scale and the Borg CR‐10 Pain Scale were offered. Logbooks rather than activity monitors were applied due to funding limitations. Both groups received follow‐up phone calls after the first week of the program and at 2‐week intervals to address any concerns. For members of the exercise group, to address any questions about the exercise intervention and to ensure compliance with the program. Duration: mean 33.7‐minute/session (to begin walking 0.4 km per day with a gradual increase every 2 weeks to reach 3.2 km per day at the end of 12 weeks) Intensity: low Intensity. Less than 40% of HRR and an RPE between 11 and 13 until they felt minimal claudication pain (Borg CR‐10 score 2) then to record time, distance, HR, RPE, and pain score in their activity log Frequency: 5 days per week (mean 4.3 (SD 2.1) days/week Intervention period: 12 weeks Pedometer: no Facilitator: no CG: Control group: Continue with normal lifestyle and record in an activity log the type and amount of physical activity during the week, the duration of activity, and HR.
Outcomes	Review outcomes reported: HR and BP Measurement method: at rest in the supine position and during upright standing at baseline and after 12 weeks. Participants rested comfortably in the supine position in a quiet, dimly lit room. HR and BP were measured using a BpTRU machine (Model BPM‐300, VSM Medtech Ltd., Coqitlam, BC). The upright standing data were measured following an adaptation period of 3 minutes in the upright, free‐standing position. Primary/Main outcome of manuscript: HR, BP, heart rate variability (HRV), and heart rate reserve Compliance/Adherence: duration, mean 33.7 minute/session with 95 ± 11% compliance; frequency, mean 4.3 (SD 2.1) days/week with 97 ± 37% compliance; and walking distance, mean 74 + 9% compliance. Adverse event: NR
Notes	Trial registration: NR Funding sources: Queen’s University, School of Nursing Freda Paltiel Award and a Southeastern Ontario Academic Health Sciences Innovation Grant
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Rrandom assignment, participants randomly selected a sealed envelope that contained an assignment to groups. However, quote: "for each participant who did not complete testing following the exercise program," a new participant was recruited. There is no information for how the new participant was recruited.
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants were not blinded and personnel was unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 31.3% (15 out of 48 dropouts) 9 out of 27 (33.3%) in IG, 6 out of 21 (28.6%) in CG refer to Table 1, 3, 4. PP analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 12 weeks Only 1 analysis
Other bias	Unclear risk	The follow‐up phone calls to both intervention and control groups after the first week of the program and at 2‐week intervals during the 12‐week intervention period may increase the awareness of the need of lifestyle modification among participants in the control group and may cause the concern of information contamination.

Brown 2014.

Study characteristics
Methods	Aim: to measure the impact of lunchtime walking on employee's physical activity levels and health markers. Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: yes
Participants	No. randomised: 94 (32 in IG1, 33 in IG2, 29 in CG) No. completers: 73 Country: UK Study population: general population (office workers) Ethnicity: white 98% (92/94), Indian 2% (2/94) Gender: male 78.7% (74/94) Age: mean 42 years (SD 10.6) Smokers: 0% Hypertension: NR Mean baseline BP: SBP = 135.1 (SD 12.3) in IG1, 128.9 (SD 15.1) in IG_built; 133.3 (SD 10.5) in CG; DBP = 86.0 (SD 7.6) in IG1; 81.5 (SD 11.9) in IG2, 79.5 (SD 7.1) in CG HR = 67.1 (SD 10.0) in IG1; 63.6 (SD 10.1) in IG_built; 64.6 (SD 12.5) in CG Inclusion criteria: 18 to 65 years office workers, consider themselves healthy and able to undertake fairly intense exercise. Exclusion criteria: Quote: "known cardiovascular and/or neurological conditions or taking of medication that affects these systems."
Interventions	IG1_nature : Nature Walking (NW) group: The walking route provided for the NW group consisted of trees, spaces of maintained grass, public footpaths, and country lanes. They are able to walk individually or with others. Duration: 20‐minute/session (approximately 2 km; i.e. 6km/hour) Intensity: 12 on the Rate of Perceived exertion (RPE) scale (Borg 6–20) Frequency: 2 lunchtime sessions/week Intervention period: 8 weeks Pedometer: yes (ActiPed) Facilitator: NR IG2_built : built walking (BW) group: The walking route for the BW group primarily composed of paved footpaths adjacent to roads, housing estates, and industrial areas. They are able to walk individually or with others. Duration: 20‐minute/session (approximately 2 km; i.e. 6km/hour) Intensity: 12 on the Rate of Perceived exertion (RPE) scale (Borg 6–20) Frequency: 2 lunchtime sessions/week Intervention period: 8 weeks Pedometer: yes (ActiPed) Facilitator: NR CG: Control (waiting) group: normal level of activities. Pedometer: yes (ActiPed) for monitoring physical activity
Outcomes	Review outcomes reported: SBP, DBP, HR Measurement method : a Polar HR monitor (Polar Electro UK Ltd, Warwick, UK) was used to view HR throughout the testing procedure. Resting BP measurement was taken using an electronic BP monitor (MX3 basic, Omron, Lake Forest, IL, USA) with the cuff placed on the participant’s upper right arm. Primary/Main outcome of manuscript: HR and HR variability Adverse event: NR
Notes	Trial registration: ISRCTN005716448 Funding sources: Governement(The British Heart Foundation (non‐clinical PhD studentship FS/10/32/28204) and Economic and Social Research Council as part of UK Research and Innovation (project number RES‐064‐27‐0019) supported this study.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Randomisation for the grouping of the participants was generated by a computer program" refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 21 out of 94 = 22.3% 5 out of 32 in Nature walking (15.6%), 6 out of 33 in Built walking (18.2%), 10 out of 29 in control group (34.5%) dropouts refer to Figure 1, Table 2 PP analysis
Selective reporting (reporting bias)	Low risk	Only measurement at 8 weeks Only 1 analysis
Other bias	Low risk	No other bias

Chan 2018.

Study characteristics
Methods	Aim: to compare Tai Chi with brisk walking in effects of reducing cardiovascular disease risk factors and improving psychosocial well‐being. Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: yes
Participants	No. randomised: 164 (82 in IG, 82 in CG); (82 in Tai Chi group excluded) No. completers: 144 Country: Hong Kong Study population: hypertensive adults Ethnicity: NR Gender: male 48.8% ((42+38)/164) Age: mean 63.22 (SD 11.11) in IG, 65.13 (SD 10.22) in CG. Smokers: Yes, 11.0% (5+13)/164) Hypertension: 100% Mean baseline BP: SBP = 138.15 (SD 17.39) in IG, 142.49 (SD 19.12) in CG. DBP = 79.74 (SD 10.51) in IG, 82.59 (SD 10.68) in CG. Inclusion criteria: hypertension, at least two but not more than three CVD risk factors, defined by the American Heart Association (American Heart Association, 2017a) as diabetes, dyslipidaemia, hypertension, overweight, physical inactivity and smoking." Exclusion criteria: NR
Interventions	IG: Brisk walking group: To ensure intervention fidelity, a pulse oximeter was provided to each participant to measure HR during brisk walking. Self‐reported logbooks were provided for the participants to record heart rate, frequency and duration of brisk walking. The research assistant collected the logbooks weekly and encouraged the participants’ adherence to the intervention. Weekly non‐exercise community activities were arranged for 3 months as attention control activities to balance the socialiSation among groups. Duration: 30 minutes/day, 150 minutes/week Intensity: moderate, 5 to 6 km/30 minutes/day; participants were advised to reach an individualised HR equal to a moderate‐intensity exercise, which was based on their age. Frequency: ≧5 days/week Intervention period: 13 weeks (3 months*4.33) Pedometer: NR Facilitator: NR CG: Control group: Usual activity without self‐report log books, but weekly non‐exercise community activities for 12 weeks as attention control activities to balance the socialisation among three groups. Note: Tai Chi group excluded
Outcomes	Review outcomes reported: SBP and DBP Measurement method: the participants were asked to sit for at least 10 minutes in a quiet location. BP was then measured twice at 5‐minute intervals using a digital BP monitor (CARESCAPEV100, GE Healthcare). The average of the two BP readings was used for analysis. Data were collected at baseline, 3, 6, and 9 months. Primary/Main outcome of manuscript: BP Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: Health Medical Research Fund, Food and Health Bureau, Hong Kong SAR (No. 12130041).
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "The randomisation list was stored in a password‐protected computer only accessible by the research staff responsible for participant allocation."
Allocation concealment (selection bias)	Low risk	Quote: "The randomisation list was stored in a password‐protected computer only accessible by the research staff responsible for participant allocation."
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "The research assistants responsible for data collection were blinded to group assignment."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 12.2% (20 out of 164 dropouts) 6 out of 82 (7.3%) in IG, 14 out of 82 (17.1%) in CG refer to Fig. 1 GEE models used for accommodating missing data ITT analysis
Selective reporting (reporting bias)	Low risk	only 1 endpoint measurement at 3 months only 1 analysis
Other bias	Unclear risk	The participants in the brisk walking and control groups were arranged to participate in non‐exercise community socialisation activities weekly during the 3‐month intervention period. These activities may cause information contamination between groups and may increase awareness of lifestyle modification among control group participants.

Chiang 2019.

Study characteristics
Methods	Aim: to investigate the differences in body composition and metabolic syndrome (MS) under a daily 12,000‐step strategy with or without moderate‐intensity walking exercise in college students with obesity Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: NR
Participants	No. randomised:32 (12 in IG1, 11 in IG2, 9 in CG) No. completers: 32 Country: China Study population: college students with obesity and did not regularly engage in physical activity (≥18 years) Ethnicity: NR Gender: NR Age: mean 19.17 (SD 1.03) in IG1, 20.64 (SD 1.80) in IG2, 19.36 (SD 1.12) in CG Smokers: NR Hypertension: NR Mean baseline BP: SBP = 121.92 (SD 15.70) in IG1, 121.36 (SD 11.48) in IG2, 127.00 (SD 17.18) in CG. DBP = 76.92 (SD 12.06) in IG1, 79.55 (SD 8.85) in IG2, 74.33 (SD 11.06) in CG. HR = 75.92 (SD 10.13) in IG1, 78.3 (SD 10.02) in IG2, 79.78 (SD 7.85) in CG Inclusion criteria: participants with obesity aged 18 years or older who did not regularly engage in physical activity were recruited. The inclusion criterion for participants were no diabetes or other chronic diseases. Exclusion criteria: NR
Interventions	All three groups were required to attend a procedure instruction session on different day before the intervention and were issued a smartwatch (ZenWatch 3, ASUSTeK Computer Inc. Taipei, Taiwan) for step monitoring during the 8‐week intervention. Participants from WEG and WSG must report back to the lab weekly for verification of any missing or incorrect data recording on the exercise log. IG1: Walking Step Goal (WSG) group: Duration: NR Intensity: 12,000 steps/day from Monday to Friday Frequency: 5 days/week Intervention period: 8 weeks Pedometer: Smartwatch (ZenWatch 3, ASUS TeK Computer Inc., Taipei, Taiwan) for step monitoring Facilitator: No IG2: Walking Exercise (WEG) group: Duration: NR but request to complete 30 minutes of continuous moderate‐intensity on 3 days per week Intensity: 12,000 step/day from Monday to Friday + moderate‐intensity (i.e., 103 steps per minute) on 3 days per week Frequency: 5 days/week including 30 minutes of continuous moderate‐intensity on 3 days per week Intervention period: 8 weeks Pedometer: Smartwatch (ZenWatch 3, ASUS TeK Computer Inc., Taipei, Taiwan) Facilitator: yes (participants were monitored by professional instructors during the exercises in order to maintain a steady brisk walking pace) CG: Control group: not given any instructions regarding exercise during the intervention and was asked to maintain a similar daily routine including diet. A smartwatch (ZenWatch 3, ASUSTeK Computer Inc., Taipei, Taiwan) was offered for step monitoring
Outcomes	Review outcomes reported: SBP and DBP, resting HR Measurement method: prior to measuring resting HR, SBP, DBP, and blood biomarkers, participants were asked to refrain from intense activity, smoking, caffeine consumption, and avoid the foods rich in sugar and fat for 24 hours and to fast for 12 hours before blood sampling. All resting values were obtained after a 10 minutes seated resting. Primary/Main outcome of manuscript: Weight (wt), BMI, body fat (FAT), visceral fat area (VFA), skeletal muscle mass (SMM), waist circumference (WC), hip circumference (HIP), HDL‐C, HR, DBP, SBP and blood biomarkers (fasting glucose (FG), and TG levels). Compliance/Adherence: WSG 94.5% (11340.46/12000*100%; mean 11340.46 (SD 743) steps per day. WEG 102.4% (12288/12000*100%; mean 12288 (SD 721) steps per day. Adverse event: NR
Notes	Trial registration: Australian New Zealand Clinical Trials Registry, (ACTRN12618001237279) Funding sources: Chinese Culture University and Ministry of Science and Technology, Republic of China (Taiwan) (No. 105–2815‐C‐034‐028‐H).
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Participants "were randomly assigned" but no details reported.
Allocation concealment (selection bias)	Unclear risk	The "grouping methods" for assigning study groups "was confidential to the participants" but not sure what kind of methods has been confidential to study participants.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	No information
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 8 weeks Only 1 analysis
Other bias	Low risk	No other bias

Coghill 2008.

Study characteristics
Methods	Aim: to investigate whether a home‐based physical activity program meeting current guidelines was effective in improving the lipid profile in hypercholesterolaemic men. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: yes
Participants	No. randomised:67 (38 in IG, 29 in CG) No. completers: 67 Country: UK Study population: middle‐aged hypercholesterolaemic men Ethnicity: NR Gender: male 100% Age: range 45 to 65 years Smokers: 0% Hypertension: NR Mean baseline BP: SBP = 138.04 (SD 15.61) in IG, 140 (SD 15.63) in CG; DBP = 89.90 (SD 9.93) in IG, 88.32 (SD 9.52) in CG Inclusion criteria: middle‐aged (45 to 65 years) male non‐smokers, with hypercholesterolaemia defined as TC6.2mmol/L (NCEP III, 2001) and/or a TC/HDLC ratio≥6; who were not receiving pharmacological treatment for hypercholesterolaemia or other conditions related to CHD, including both type 1 and 2 diabetes; sedentary (defined as no regular moderate or vigorous physical activity in excess of 30 minutes a day on at least five days a week over the last three months) and able to undertake a program of walking. Exclusion criteria: NR
Interventions	IG: Brisk Walking group: Wear times of accelerometer, total activity energy expenditure, and any bout of moderate activities ≥30 minutes or high intensity activity ≥20 minutes were recorded in a diary by participants. Duration: walk briskly for at least 30 minutes/session Intensity: 12 to 14 RPE (= energy expenditure 5 to 7.5kcal/minute) Frequency: at least 5 days/week Intervention period: 12 weeks Pedometer: accelerometer was worn during walking hours. Facilitator: NR CG: Control group: control group participants were requested to maintain their current activities of daily living
Outcomes	Review outcomes reported: SBP, DBP Measurement method: quote: "Blood pressure and resting heart rate were measured with a Spacelabs 90207 monitor." Primary/Main outcome of manuscript: SBP, DBP Adverse event: NR
Notes	Trialregistration: NR Funding sources: Private sector (Frenchay Hospital Trustees, Bristol funded the blood assays for this project.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "randomization group inside a sealed opaque envelope"
Allocation concealment (selection bias)	Low risk	Quote:"Participants were allocated by a researcher blinded to the randomisation process who selected and opened each envelope with the participant at the point of randomisation." refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded. Personnel not blinded. refer to Figure 1
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	No dropout refer to figure 1, table 1, 2 ITT analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Cooper 2000.

Study characteristics
Methods	Aim: Quote:“The effect of a six‐week programme of moderate intensity exercise on daytime ambulatory blood pressure (10.00am to 10.00pm) among unmedicated, sedentary adults aged 25 years to 63 years with office blood pressure of 150 mmHg to 180 mmHg systolic and/or 91 mmHg to 110 mmHg diastolic.” Hypertensive adults Design: Parallel 2‐group RCT (1:1) Power/sample size calculation: yes
Participants	No. randomised: 90 (48 in IG, 42 in CG) No. completers: 86 Country: UK Study population: unmedicated hypertensive patients adults (recruited from general practices and workplaces of two large companies) Ethnicity: NR Gender: male 80% (72/90) Age: mean 46.2 (SD 9.4) in IG, 49.4 (SD 8.9) in CG. Smokers: NR Hypertension: 100% hypertensive patients (SBP 150 to 180, DBP 91 to 110) Mean baseline BP: SBP = 139.8 (SD 12.5) in IG, 137.0 (SD 10.9) in CG; DBP = 89.5 (SD 9.6) in IG, 88.4 (SD 9) in CG. Inclusion criteria: Quote:“be aged 18 years to 64 years, not be receiving pharmacological blood pressure or lipid lowering treatment, be sedentary, and have a resting office blood pressure of 150 mmHg to 180 mmHg (systolic) and/or 91 mmHg to 110 mmHg (diastolic).” Exclusion criteria: NR
Interventions	IG: Walking group: Participants were asked to expend a daily 150 kcal to 200 kcal in 30 minutes of physical activity (equivalent to 30 minutes of brisk walking) in addition to their normal levels of activity for at least 5 days a week. Duration: 30 minutes/session Intensity: Moderate physical activity, 150 to 200 kcal expenditure daily Frequency: 1 session/day, 5 days/week Intervention period: 6 weeks Pedometer: Wore an accelerometer on each exercising day Facilitator: Yes, biweekly; participants met with the researchers after two and four weeks to replace diaries and to resolve problems encountered in achieving the exercise target. CG: Control group: Participants were asked to maintain their usual levels of physical activity over the subsequent six weeks. All participants were requested not to change other aspects of their lifestyle during the intervention period.
Outcomes	Review outcomes reported: SBP, DBP Measurement method : daytime ambulatory blood pressure was measured using SpaceLabs 90207 monitors programmed to record a reading every 15 minutes between 9.00 am and 10.00 pm. Primary/Main outcome of manuscript: Office and ambulatory SBP, DBP, and weight measured at baseline and week‐6. Compliance/Adherence: 89% compliance 100% compliance was defined as recording that exercise was undertaken on 30 of 42 days Adverse event: NR
Notes	Trial registration: NR Funding sources: Government (This study was funded by the NHS Executive South and West Research and Development Directorate. The Department of Social Medicine at the University of Bristol is the main centre for the MRC Health Services Research Collaboration.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote:"Block randomisation within strata defined by sex was used to generate the allocation, with six intervention and five control conditions within each block of 11." refer to Table 1
Allocation concealment (selection bias)	Low risk	Opaque envelope prepared by others Quote:"…, an opaque envelope with the treatment allocation was opened to reveal the participant’s treatment allocation. Randomisation envelopes were prepared by a member of the research team not involved in data collection and researchers collecting data were unaware of the allocation of participants until opening each envelope." refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded. Personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	High risk	"The researcher responsible for administering the collection of data at six‐week follow‐up was not blinded to treatment allocation."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 4.4% (4 out of 90) 1 out of 48 (2.1%) in IG, 3 out of 42 (7.1%) in CG Planned ITT, but excluded dropouts in analysis refer to Table 2 PP analysis
Selective reporting (reporting bias)	Low risk	Only measurement at 6 weeks Only 1 analysis
Other bias	Low risk	No other bias

Dong (董兆強) 2007.

Study characteristics
Methods	Aim: to investigate the effect of physical training on insulin resistance among the patients with chronic heart failure (CHF). Design: parallel 2‐group RCT (65:55) Power/sample size calculation: NR
Participants	No. randomised: 120 (65 in IG, 55 in CG) No. completers: 120 Country: China Study population: hospitalised congestive heart failure (CHF) patients (NYHA Ⅱ‐Ⅲ) Ethnicity: Chinese Gender: male 55% ((36+30)/120) Age: mean 61.7 (SD 12.3) in IG; 61.9 (SD 12.1) in CG Smokers: NR Hypertension: 20.8% (25 primary hypertension with 14 in IG and 11 in CG) Mean baseline BP: SBP = 149.10 (SD 44.50) in IG, 147.2 (SD 44.1) in CG. HR = 104 (SD 25) in IG, 105 (SD 21) in CG Inclusion criteria: ① Hospitalised NYHA Ⅱ‐Ⅲ CHF patients with stable condition for at least 2 months; age between 43 to 75; no lung disease or limb disability was noted. Exclusion criteria: diabetes mellitus, obesity, uncontrolled HTN, endocrine disease, cerebral stroke, peripheral vessel disease, degenerative joint disease, active pericarditis or myocarditis, moderate to severe aortic stenosis, impending surgery for valve regurgitation and severe insufficiency of liver/kidney function.
Interventions	IG: Training group: Participants were encouraged to walk to and from on a relatively stable 40‐metre hallway for 6 minutes per session. Routine medication treatment and the 6‐minute walking distance exercise were continued till 20 weeks. HR, BP and EKG were monitored during each session. Duration: 6‐minute/session Intensity: (6‐minute walking distance) Frequency: twice a day/week, 7 days/week = 14 sessions/week Intervention period: 20 weeks Pedometer: no Facilitator: NR CG: Routine therapy group: routine medication treatment
Outcomes	Review outcomes reported: meanBP and HR Measurement method: before and after the 20‐week intervention Primary/Main outcome of manuscript: homeostasis model assessment‐insulin resistance (HOMA‐IR), insulin resistance index (ISI), left ventricular ejection fraction (LEVF), left ventricular fractional shortening (LVFS), 6‐minute walking distance, HR and mean BP Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote:"randomly divided" using "random table" but no details reported
Allocation concealment (selection bias)	Unclear risk	NR, study groups allocator
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Dropout: NR 65 completers in training group, 55 completers in control group refer to table 2, 3 Unsure ITT or PP analysis
Selective reporting (reporting bias)	Unclear risk	Only 1 endpoint measurement at 20 weeks Only 1 analysis Only provided SBP but not DBP without reason, DBP data could not obtained from author contact
Other bias	Low risk	no other bias

Dong (董雅娟) 2012.

Study characteristics
Methods	Aim: to observe influence of aerobic exercise on blood pressure in patients with white coat hypertension (WCH). Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 51 (26 in IG, 25 in CG) No. completers: 51 Country: China Study population: white coat hypertensive patients Ethnicity: Chinese Gender: male 56.9% ((16+13)/51) Age: mean 53.75 (SD 16.42) in IG, 54.26 (SD 17.18) in CG Smokers: NR Hypertension: 100% (white coat hypertension) Mean baseline BP: 24 hours mean SBP (mSBP) = 129.51 (SD 25.42) in IG, 127.96 (SD 23.13) in CG; 24 hour mean DBP (mDBP) = 82.09 (SD 17.23) in IG, 83.46 (SD 18.52) in CG Inclusion criteria: diagnostic standard of WCH; volunteered to participate in the present study. Exclusion criteria: diagnosed hypertension; could not walk properly because of bone and joint diseases; diagnosed with severe disease
Interventions	IG: Walking group: Adopted WHO recommendation of “mild hypertension exercise plan”: Exercise was done in the morning and evening. Duration: continuing for 50 to 80 minutes/session; warming‐up and cooling down for 5 to 10 minutes each Intensity: walking on flat ground with constant speed every day, adjusting the velocity according to self‐measured HR controlled below 100 beats/minute for about 50 to 60% maximum oxygen consumption Frequency: >=5 days/week, 10 to 16 sessions/week Intervention period: 3 months Pedometer: no Facilitator: NR CG: Control group: not undergoing exercise
Outcomes	Review outcomes reported: Office SBP (OSBP), Office DBP(ODBP), Ambulatory 24‐hour mean SBP (mSBP). Ambulatory 24‐hour mean DBP (mDBP), Ambulatory daytime SBP (dSBP) and Ambulatory daytime DBP (dDBP). We used mSBP and mDBP only. Measurement method: office BP: after resting for 30 minutes in sitting position, OSBP and ODBP were measured at right upper arm by mercury standard cuff sphygmomanometer. Ambulatory BP: non‐invasive portable (America type AMR4) ambulatory blood pressure monitor was used for measurement. Cuff (22 cm 12 cm) was tied to right upper arm of participant automatically aerated and measured every 30 minutes in daytime (6:00 to 22:00) and every 60 minutes at night (22:00 to 6:00 of second day), effective was de fined as recorded monitoring times ≥80% within 24 hours. Primary/Main outcome of manuscript: Office SBP(OSBP), Office DBP(ODBP), Ambulatory 24‐hour mean SBP (mSBP) DBP (mDBP), ambulatory daytime SBP (dSBP) and DBP (dDBP) Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote:"randomly divided" mentioned in abstract but no detail reported
Allocation concealment (selection bias)	Unclear risk	NR
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 0% (0/51) 26 in exercise group, 25 in control group refer to table 1, 2 ITT analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 3 months Only 1 analysis
Other bias	Low risk	No other bias

Duncan 1991.

Study characteristics
Methods	Aim: the effects of a 24‐week walking program with different exercise intensity on the risk of cardiovascular disease in sedentary premenopausal women. Design: parallel 4‐group RCT (1:1:1:1) Power/sample size calculation: Yes
Participants	No. randomised: 102 (29 in IG1, 26 in IG2, 26 in IG3, 21 in CG) No. completers: 59 (16 in IG1, 12 in IG2, 18 in IG3, 13 in CG) Country:USA Study population: general population (premenopausal female volunteers) Ethnicity: 81% White, 17% black, and 2% Hispanic. Gender: male 0% (0/102) Age: range 20 to 40 Smokers: 0% Hypertension: NR Mean baseline BP: (data only reported for 59 study completers) SBP = 105 (SD 8) in IG1, 109 (SD 9) in IG2, 108 (SD 6) in IG3, 108 (SD 8) in CG; DBP = 70 (SD 7) in IG1, 74 (SD 8) in IG2, 73 (SD 9) in IG3, 74 (SD 7) in CG Inclusion criteria: 20 to 40 years of age, sedentary menopausal women with blood pressure below 160/90mmHg, total serum cholesterol levels below 6.59 mmol/L, and serum triglyceride levels below 2.25 mmol/L;"if they: did not smoke; consumed fewer than three alcoholic drinks per day; did not currently receiver dietary interventions; did not have cardiopulmonary and/or musculoskeletal diseases; and did not regularly exercise more than 1 day per week in the previous 6 months.” Exclusion criteria: NR
Interventions	IG1_aerobic: walking (aerobic walkers) group: Duration: gradually increase to 4.8 km/session (by week 7 and maintain) (start with 2.4 km) Intensity: initially 70% of 8.0 km/hour, and gradually increasing to 100% (week 14 to week 24). Frequency: 5 days/week Intervention period: 24 weeks IG2_brisk: walking (brisk walkers) group: Duration: gradually increase to 4.8 km/session (by week 7 and maintain) (start with 2.4 km) Intensity: Initially 70% of 6.4 km/hr, and gradually increasing to 100% (week 14 to week 24). Frequency: 5 days/week Intervention period: 24 weeks IG3_stroller: walking (strollers) group: Duration: gradually increase to 4.8 km/session (by week 7 and maintain) (start with 2.4 km) Intensity: Initially 70% of 4.8 km/hour, and gradually increasing to 100% (week 14 to week 24). Frequency: 5 sessions/week Intervention period: 24 weeks Walking on a tartan‐surfaced 1.6‐km track, starting at 2.4 km, and gradually increasing to 4.8 km by the week 7, till the completion of the study. Subsequently from week 8 to 24, the walking intensity depends on the allocated group. Pedometer: NR Facilitator: yes, an exercise physiologist CG: Control group: remaining sedentary for the duration of the study and were not contacted except to schedule follow‐up testing. All groups advised not to change dietary, exercise (other than prescribed) or other life style habits
Outcomes	Review outcomes reported: resting BP (at baseline and week‐24) Measurement method: the same trained observer made all measurements with a mercury sphygmomanometer. The mean of the three readings on the third day was used as baseline and follow‐up values. SBP andDBP were recorded at the first and fifth phases of Korotkoffs sounds. Primary/Main outcome of manuscript:sSerum lipid and lipoprotein levels, maximal oxygen uptake (VO2 max), nude body weight, and percentage of body fat measured at baseline and week‐24. Adverse event: no
Notes	Trial registration: NR Funding sources: private sector (This study was supported by a grant from the Naturalizer division of Brown Shoe Co, St Louis, Mo)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote:"random assignment" but no details reported Table 1 results only from 59 completers, not all 102 randomised
Allocation concealment (selection bias)	Unclear risk	No information Table 1 results only from 59 completers, not all 102 randomised
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded and personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	0bjective outcomes Quote:"All baseline and posttest‐dependent variables (except percentage of body fat) were measured by personnel who were blinded to individual participant group assignments."
Incomplete outcome data (attrition bias) All outcomes	High risk	13 out of 29 (44.8%) in IG (aerobic), 14 out of 26 (53.8%) in IG (brisk), 8 out of 26 (30.8%) in IG (strollers), 8 out of 21 (38.1%) in CG. refer to Table 3 PP analysis
Selective reporting (reporting bias)	Low risk	Only measurement at 24 weeks Only 1 analysis
Other bias	Low risk	No other bias

Dureja 2014.

Study characteristics
Methods	Aim: to investigate the effect of treadmill training on blood pressure among young post‐graduate students. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised:10 (5 in IG, 5 in CG) No. completers: 10 Country: India Study population: post graduate students Ethnicity: NR Gender: male 100% Age: range 19 to 25 years Smokers: NR Hypertension:NR Mean baseline BP: SBP = 116 (SD 5.47) in IG, 123 (Sd10.36) in CG DBP = 82.0 (SD 11.51) in IG, 79 (SD 8.94) in CG Inclusion criteria:19 to 25 years, college students Exclusion criteria:NR
Interventions	IG: Walking (experimental) group: treadmill walking with increasing intensity Duration: 10 minutes (week 1), 15 minutes (week 2), 20 minutes (week 3), 25 minutes (week 4) per session Intensity: 5 km/hour (week 1), 7 km/hour (week 2), 8 km/hour (week 3), 10 km/hour (week 4) Frequency: 1 session/day, 6 days/week Intervention period:4 weeks Pedometer: no Facilitator: all participants completed a 4‐week training program.  CG: Control group: NR
Outcomes	Review outcomes reported: SBP, DBP Measurement method: not mentioned Primary/Main outcome of manuscript: Pre‐test, post‐test SBP, DBP Adverse event: NR
Notes	Trialregistration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Participants were randomly assigned to" but no details reported
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	no dropout refer to Tables 2, 3, 4,5 ITT analysis
Selective reporting (reporting bias)	Low risk	Only measurement at 4 weeks Only 1 analysis
Other bias	Low risk	No other bias

Foulds 2014.

Study characteristics
Methods	Aim: to examine the dose–response relationship between exercise volume and intensity with derived health benefits including volumes and intensity of activity well below international recommendations. Design: parallel 6‐arm RCT (1:1:1:1:1:1) (1 control + 4 brisk walking groups + 1 running group) Power/sample size calculation: NR
Participants	No. randomised:90 (75 in walking group, 15 in CG). (17 in running group excluded) No. completers: 58 Country: Canada Study population: general population (healthy and active) Ethnicity: NR Gender: male 36% (21/58) Age: mean 44 (SD13), range 20 to 65 years Smokers: NR Hypertension: 0% Mean baseline BP: NR Inclusion criteria: Quote: "participants represented a range of ages, from 20 to 65 years of age, who were not previously diagnosed with diabetes or cardiovascular disease. All participants were cleared using the Physical Activity Readiness Questionnaire for Everyone (PAR‐Q+) (Warburton et al. 2011). Participants in this training program include only individuals who responded ‘No’ to each of the PAR‐Q+ questions." Exclusion criteria: NR
Interventions	IG1: walking (10‐minute brisk walking once/week) group Duration: 10 minute/session Frequency: once/week Intervention period: 13 weeks IG2: Walking (10‐minute brisk walking 3 times/week) group Duration: 10 minutes/session Frequency: 3 times/week Intervention period: 13 weeks IG3: Walking (30‐minute brisk walking 3 times/week) group Duration: 30 minutes/session Frequency: 3 times/week Intervention period: 13 weeks IG4: Walking (60‐minute brisk walking 3 times/week) group Duration: 60 minutes/session Frequency: 3 times/week Intervention period: 13 weeks Intensity: brisk walking Pedometer: NR Facilitator: yes, a qualified exercise professional CG: Control group: control group prescribed no additional exercise training. Note: the group of 30‐minute running 3 times/week was excluded
Outcomes	Review outcomes reported: SBP, DBP Measurement method: resting BP was evaluated following 3 minutes of seated rest (BP‐TRU, VSM Medical, Vancouver, BC). Primary/Main outcome of manuscript: body composition and exercise capacity (VO2 max) Adverse event: No
Notes	Trialregistration: NR running group (N = 17) outcome was not extracted Funding sources :private sector (This research was supported by the Physical Activity Support Line, the Canada Foundation for Innovation, the BC Knowledge Development Fund, the Canadian Institutes of Health Research (CIHR), the Michael Smith Foundation for Health Research (MSFHR), and the Natural Sciences and Engineering Research Council of Canada (NSERC))
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote:"were assigned randomly" but no details reported refer to Table 1 (72 completers, 114 randomised)
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded. Personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	7 out of 114 did not start 32 out of 90 drop outs (35.6%) (25% to 47% in each group) Quote:"Attrition rates (18 to 47 %)" no reasons given for drop outs PP analysis
Selective reporting (reporting bias)	Low risk	Only measurement at 13 weeks Only 1 analysis
Other bias	Low risk	No other bias

Fritz 2013.

Study characteristics
Methods	Aim: The effects of Nordic walking on cardiovascular risk factors were determined in overweight individuals with normal or disturbed glucose regulation. Design: Parallel 6‐arm RCT Power/sample size calculation: Yes
Participants	No. randomised:213 [87 in IG (53 in NGT, 14 in IGT, 20 in T2DM),126 in CG (75 in NGT, 21 in IGT, 30 in T2DM)] No. completers: 203 Country: Sweden Study population: overweight individuals with IGT or T2DM, and normal OGTT Ethnicity: Caucasian Gender: male 44.6% (95/213) Age: mean 60 (SD 5.3), range 45 to 69 years. Smokers: NR Hypertension: NR Mean baseline BP: SBP = NGT: 138 (SD12.5) in IG, 137 (SD 15.0) in CG; IGT: 141 (SD 14.0) in IG, 141 (SD 13.0) in CG; T2DM: 143 (SD13.2) in IG, 144 (SD 12.6) in CG DBP = NGT: 85 (SD 7.9) in IG, 84 (SD 8.8) in CG: IGT: 84 (SD 7.8) in IG, 86 (SD 9.4) in CG; T2DM: 85 (SD7.6) in IG, 83 (SD 7.4) in CG Inclusion criteria: Quote: "age 45–69 years, body mass index (BMI) >25 kg/m2 and HbA1c for individuals with T2DM between 7.4% and 9.3% of the National Glycohemoglobin Standardization Program standard (57–78 mmol/mol of the International Federation of Clinical Chemistry standard)" Exclusion criteria: Quote: "physical impairments, symptoms of angina pectoris (i.e. chest pain on physical strain), atrial fibrillation determined by electrocardiogram, systolic blood pressure (SBP) or diastolic blood pressure (DBP) >160 or >100 mmHg, respectively, and insulin treatment."
Interventions	Intervention group: IG1_NGT: Walking (NGT) group: Normal glucose tolerance IG2_IGT:Walking (IGT) group: Impaired glucose tolerance IG3_T2DM:Walking (T2DM) group: type 2 diabetes mellitus Duration: additional 5 hours walking with poles (Nordic walking)/week Intensity: prescribed as a pace that caused slight shortness of breath and perspiration Frequency: NR Intervention period: 17 weeks (4 months) After 2 months, the participants in the intervention group received a supportive telephone call from an assisting nurse. Pedometer: 25 consecutive participants ( 11 controls and 14 Nordic walkers) wore an accelerometer in a belt around the waist for 7 days from morning to bedtime, recording physical activity was recorded as total activity counts per minute, minutes per day of inactivity, low, moderate or vigorous activity. Facilitator: an exercise physiologist provided instructions for Nordic walking. Control group:Quote: "The participants in the control group were instructed to maintain their habitual physical activity." CG1_NGT:Control (NGT) group CG2_IGT:Control (IGT) group CG3_T2DM:Control (T2DM) group Quote: "All participants were also instructed not to change their usual eating habits."
Outcomes	Review outcomes reported: SBP, DBP Measurement method: SBP and DBP (Speidell & Keller Tonometer) Primary/Main outcome of manuscript: BMI, waist circumference, blood pressure, glucose tolerance, clinical chemistry, maximal oxygen uptake (peak VO2) and self‐reported physical activity (questionnaire) Adverse event: No
Notes	Trialregistration: NR Funding sources: Government and private sector (This study was supported by the Strategic Research Programme in Diabetes at Karolinska Institutet, the Stockholm County Council, the Swedish Heart Lung Foundation and the Swedish Research Council, Stockholm)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote:"For the randomisation procedure, blinded labels with the participants' names were drawn from a box and assigned to either the control or intervention group "
Allocation concealment (selection bias)	Low risk	Quote:"..drawn from a box and assigned to either the control or intervention group." refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded. Personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 4.7% (10 out of 213) 6 as 6.9% in TG and 4 as 3.2% in CG refer to Table 2 (ITT analysis) Quote:"Follow‐up data were missing for ten participants, and the principle of last‐observation‐carried‐forward was applied in those cases. Analysis was performed as intention‐to‐treat."
Selective reporting (reporting bias)	Low risk	Only measurement at 4 months Only 1 analysis
Other bias	Low risk	No other bias

Geddes 2009.

Study characteristics
Methods	Aim: to investigate the effects of a 12‐week home walking program on cardiovascular parameters, fatigue perception, and walking distance in persons with multiple sclerosis (MS). Design: parallel 2‐group RCT (2:1) Power/sample size calculation: NR
Participants	No. randomised:15 (9 in IG, 6 in CG) No. completers: 12 Country: USA Study population: adult multiple sclerosis patients (18 to 65 years) Ethnicity: NR Gender: male 25% (3/12) Age: mean 51.3 in IG (range 40 to 64 years), 34.7 in CG (22 to 50 years) (mean age 45.83) Smokers: NR Hypertension: NR Mean baseline BP: NR Inclusion criteria: adults between the ages of 18 and 65 with a diagnosis of MS greater than 1 year, no history of exacerbation within 6 months prior to the study, no regular participation in an aerobic exercise program within 6 months prior to the study, the ability to walk independently 100 metres with or without resting (may use intermittent or constant unilateral assistance such as a cane, crutch, or a brace), and an Expanded Disability Status Score (EDSS) < 6.0. Exclusion criteria: if they had cardiovascular, pulmonary, or orthopaedic conditions that precluded them from participating in an aerobic conditioning program.
Interventions	IG: Walking group: home walking program; participants maintained weekly exercise log including RPE values and received biweekly telephone calls to monitor compliance. Duration: gradually increased from 15 minutes/session for week 1 to 2, 20 to 30 minutes/session for weeks 3 to 12 For the first 2 weeks, the participants walked 5 minutes below the lower limits of their THR range, followed by 15 minutes of walking within their THR range, and then a 5‐minute cool down below their THR range. During weeks 3 through 12, participants increased their training time in the THR range to 20 to 30 minutes. Intensity: individualised based on the results of the 6MWT Frequency: 1 session/day, 3 days/week Intervention period: 12 week Pedometer: NR Facilitator: NR CG: Control group: the control group was asked to refrain from any regular exercise during the 12‐week period. Control group participants were offered the opportunity to participate in the home walking program with monitoring upon completion of the study.
Outcomes	Review outcomes reported: SBP, DBP, resting HR Measurement method: the sphygmomanometer cuff, Polar Fitwatch Heart Rate Monitor Primary/Main outcome of manuscript: 6 min walk test, Physiological Cost Index (PCI) Compliance/Adherence: NR Adverse event: no
Notes	Trialregistration: NR Funding sources: private sector (This study was partially supported by the New York Chapter Research Designated Fund)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Coin toss Table 1 is only for completers
Allocation concealment (selection bias)	Unclear risk	Coin toss Table 1 is only for completers
Blinding of participants and personnel (performance bias) All outcomes	High risk	Quote: "Neither the researchers nor participants were blinded in the study."
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 20.0% (3 out of 15) 1 out of 9 (11.1%) in IG, 2 out of 6 (33.3%) in CG PP analysis,Three participants (2 control and 1 experimental) were excluded from data analysis due to poor compliance refer to p.3, Table 2
Selective reporting (reporting bias)	Low risk	Only measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Gilson 2007.

Study characteristics
Methods	Aim: the impact of two walking interventions, 15‐minute brisk walking and accumulated walking steps, on work day step counts and health status. Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: NR
Participants	No. randomised: 70 (23 in IG1, 23 in IG2, 24 in CG) No. completers: 64 Country: UK Study population: university employees (volunteers of the UK academic and administrative) Ethnicity: NR Gender: male 10% (7/70) Age: mean 42 (SD 11) in female, and 41 yrs (SD 11) in male Smokers: NR Hypertension: NR Mean baseline BP: SBP = 121.7 (SD 17.3) in IG1, 119.0 (SD 7.4) in IG2, 121.6 (SD 9.9) in CG; DBP = 85.6 (SD 12.1) in IG1, 85.7 (SD 10) in IG2, 82.9 (SD 7.3) in CG Inclusion criteria: NR (convenience sample) Exclusion criteria: NR (convenience sample)
Interventions	IG1_route: Walking ("working routes") group: Brisk and continuous walking; at least 15‐minute walking around campus; participants received detailed guidance of expectations and goals prior the study, and reinforced by weekly group emails through the intervention phase. Duration: at least 15‐minute/session Intensity: continuous brisk walking Frequency: 1 session/day, 5 days/week Intervention period: 10 weeks IG2_task: Walking ("walking in task") group: The accumulation of step counts through work day; participants received detailed guidance of expectations and goals prior the study, and reinforced by weekly group emails through the intervention phase. Duration: Accumulated step counts through the working day Intensity: NR Frequency: 5 days/week Intervention period: 10 weeks Pedometer: yes, only in 1st, 5th, 10th week Facilitator: no CG: Control group: received no intervention and continued with normal behaviour.
Outcomes	Review outcomes reported: SBP, DBP were measured at baseline and week‐10 Measurement method: SBP/DBP (Accoson sphygmomanometer) Primary/Main outcome of manuscript: per cent body fat, waist circumference, and BP Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: “randomly assigned” “based on random number tables”
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Quote: "pretest and posttest measures were administered by trained instructors who …. were blind to the intervention status."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 6 out of 70 (8.6%) 2 in working routes TG (8.7%), 2 in Walking in task TG (8.7%), 2 in CG (8.3%) dropout refer to Tables PP analysis
Selective reporting (reporting bias)	Low risk	Only measurement at week 10 only 1 analysis
Other bias	Low risk	No other bias

Gradidge 2018.

Study characteristics
Methods	Aim: to determine if an intervention of walking, a primary form of physical activity amongst African populations, could influence the body composition and blood pressure of a cohort of African women employed at a rural‐based South African university. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 132 (66 in IG, 66 in CG) No. completers: 115 Country: South Africa Study population: obese women Ethnicity: NR Gender: male 0% Age: Mean 44.4 (SD 11.5) in IG, 37.4 (SD 8.78) in CG. Smokers: NR Hypertension: NR Mean baseline BP: SBP= 127 (SD 14.7) in IG, 122 (SD 15.6) in CG. Inclusion criteria: women aged ≥18 years and employed at the university. Exclusion criteria: pregnant, illiterate or injured women
Interventions	IG: Walking group: Using treadmills (Jkexer Sprint 9875A), the walking intervention took place during lunch breaks at the Human Movement Sciences gymnasium, University of Venda. Hydration with water was encouraged and the ambient room temperature was kept at 18 degrees Celsius. Duration: 30 minutes/session; light stretching before the 30‐minute walking programme Intensity: moderate intensity with walking speed 5 to 5.5 km/hour, rating of perceived exertion score of 4 to 8/10, and gradient (0.5 to 1.5 degrees) throughout the intervention Frequency: 3 days/week Intervention period: 12 weeks Pedometer: NR Facilitator: yes, qualified research assistants; the participants were monitored throughout the activity for any exaggerated physiological changes, including increasing angina, drop in SBP >10 mmHg from baseline, fatigue, dyspnoea, wheezing, leg cramps, by qualified research assistants. CG: Control group: did not receive any treatment
Outcomes	Review outcomes reported: BP Measurement method: BP was measured on the right arm with the participant in a seated position using the Omron BP monitor (M6, Europe). The average of the latter two of three measurements was recorded after the participants had rested for at least 10 minutes Primary/Main outcome of manuscript:bBody mass, stature, waist and hip circumference, BP Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "distance randomisation", "49 of these participants were randomly selected into an intervention group" but not sure how the random sequence was generated
Allocation concealment (selection bias)	Low risk	Quote: "the researchers were blinded to the assignment sequence, as the research assisstants allocated the participants into either the intervention or control group."
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 12.9% (17 out of 132 dropouts) 17 out of 66 (25.8%) in IG, 0 out of 66 (0%) in CG High dropout rate in intervention group without reason refer to Table 1 PP analysis
Selective reporting (reporting bias)	Unclear risk	Only 1 endpoint measurement at 12 weeks Only 1 analysis DBP measured but not reported and could not obtained data from author contact
Other bias	Low risk	No other bias

Hamdorf 1999.

Study characteristics
Methods	Aim: investigate the effect of a progressive, twice‐weekly walking programme on habitual activity patterns, body composition and functional/social characteristics among previously sedentary 79‐ to 91‐year old females Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised:49 (25 in IG, 24 in CG) No. completers: 38 Country: Australia Study population: community dwelling women (sedentary yet participating in community life and not functionally impaired) Ethnicity: NR Gender: male 0% (0/49) Age: mean 82.4 (SEM 0.66) in IG, 83.1 (SEM 0.69) in CG Smokers: NR Hypertension: NR Mean baseline BP: SBP = 144.6 (SEM 4.9) in IG, 149.3 (SEM 5.1) in CG; DBP = 72.6 (SEM 2.2) in IG, 77.7 (SEM 2.5) in CG HR = 74.4 (SEM2.1) in IG, 72.7 (SEM1.7) in CG Inclusion criteria: sedentary women in their age of ninth decade; sedentary level determined from each participant's response to an activity questionnaire. Exclusion criteria: contraindications to the exercise testing, medication usage and ECG irregularities.
Interventions	IG: Walking (training) group: outdoor walking with free transportation for each session. Duration: graduated increase to 25 minutes/session @ week 22 (5 minutes/day @ week 1) Intensity: 40% heart rate reserve and 72.9% maximum heart rate. Frequency: 1 session/day, 2 days/week Intervention period: 26 weeks Pedometer: NR Facilitator: yes, by two experienced fitness instructors. CG: Control group: asked not to engage in any physical activity outside the study
Outcomes	Review outcomes reported: SBP, DBP, HR Measurement method: Resting SBP and DBP were measured using a random zero sphygmomanometer after 10 minutes of rest in a seated position. Primary/Main outcome of manuscript: resting SBP/DBP, recovery SBP/DBP, spirometry, skinfolds, habitual activity profiles Adverse event: No
Notes	Trial registration: NR Funding sources: Government and private sector (This research was supported by grant No. 944042 from the National Health and Medical Research Council of Australia and from a Special Purposes fund from the Royal Adelaide Hospital.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Coin toss refer to Table 2
Allocation concealment (selection bias)	Unclear risk	Quote: "toss coin" and no other details refer to Table 2
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded. Personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 22.4% (11 out of 49) 7 out of 25 in IG (28%), 4 out of 24 in CG (16.7%) Completers only analysis Quote: "Two dropped out of the control group on medical advice while three withdrew due to family commitments. Drop out in the training group was due to medical reasons (n=2), overseas travel (n=1) and family commitments (n=3)" refer to Tables PP analysis
Selective reporting (reporting bias)	Low risk	Measurement at 3 and 6 months Only 1 analysis
Other bias	Low risk	No other bias

Headley 2017.

Study characteristics
Methods	Aim: To determine whether a relationship exists between post‐exercise hypotension (PEH) prior to training and changes in resting blood pressure values following 16 weeks of training in stage 3 CKD patients. Design: Parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 49 (27 in IG, 22 in CG) No. completers; 46 Country: USA Study population: chronic kidney disease patients Ethnicity: NR Gender: male 65.2% (30/46) Age: 58 (SD 8.0) in IG; 57.1 (SD 9.0) inCG Smokers: 0% Hypertension: 95.7% Mean baseline BP: SBP = 126.4 (SD 17.8) in IG; 133.7 (SD 19.2) in CG DBP = 79.5 (SD 10.2) in IG; 79.1 (SD 10.7) in CG resting HR = 64.3 (SD 8.9) in IG; 65.5 (SD 12.3) in CG Inclusion criteria: ageD 35–70 years, had a glomerular filtration rate of 30–59 mL/minute per 1.73m2 and had either diabetes mellitus or hypertension as the primary cause of their kidney disease. Patients with both diabetes and hypertension were also included. Exclusion criteria: cigarette smoking, current involvement in an exercise programme, atrial fibrillation. and the presence of any absolute contraindication to exercise as defined by the American College of Sports Medicine.
Interventions	IG: Walking group: participants who were randomised to T were asked to attend three supervised training sessions per week for 16weeks. Participants initially trained at 50% to 60% VO2peak for 15 to 30 minutes and then gradually increased to a total of 55 minutes.The average weekly duration of exercise was 129.2 ± 8.6 minutes. If a participant missed a session, they were given a 2‐week period during which they could make up that session. Duration: gradually from 15 to 30 minutes to 55 minutes/session Intensity: 50% to 60% VO2peak Frequency: 1 session/day, 3 days/week Intervention period: 16 weeks Pedometer: NR Facilitator: yes CG: Control group: control group participants were told to continue as physician told them and not start any new exercise routine.
Outcomes	Review outcomes reported: SBP, DBP, HR Measurement method: Quote: "SBP and DBP blood pressure readings were taken with a calibrated automated sphygmomanometer (Tango; Sun Tech Medical, Morrisville, NC, USA)." "Subjects were fitted with a 24h ambulatory blood pressure monitor (ABPM; Spacelabs Healthcare, Issaquah, WA, USA) that they wore on the nondominant arm for the next 24h period." Primary/Main outcome of manuscript: BP, HR Compliance/Adherence: adherence to the programme was computed by taking the total number of sessions completed and dividing it by 48 sessions and expressing this as a percentage. Adverse event: NR
Notes	Trial registration: NR Funding sources: Government(This study was supported by the National Heart, Lung and Blood Institute of grant no. 1R15HL096097‐01)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "... randomized to the treatment group (T) or to the control group (C) but no details reported. refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded. Personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	0bjective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	3 out of 49drop outs (6.1%) 2 in TG (7.4%) and 1 in CG (4.5%) drop outs PP analysis
Selective reporting (reporting bias)	Low risk	Measurement at 16 weeks Only 1 analysis
Other bias	Low risk	No other bias

Herzig 2014.

Study characteristics
Methods	Aim: to investigate the effects of a 3‐month structured aerobic walking exercise on fasting and 2‐hour glucose and insulin concentrations and lipid homeostasis in sedentary overweight people with impaired fasting glucose and/or impaired glucose tolerance. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: Yes
Participants	No. randomised: 78 (38 in IG, 40 in CG) No. completers: 68 Country: Finland Study population: outpatients at high‐risk for T2DM Ethnicity: Caucasian Gender: male 26.5% (18/68) Age: mean 58.1 (SD 9.9) for IG; 59.5 (SD 10.8) for CG [68 completers only] Smokers: NR Hypertension: 52.9 % (36/68) Mean baseline BP: SBP = 138.5 (SD 16.4) for IG; 150.4 (SD 20.2) for CG; DBP = 83.8 (SD 8.0) for IG; 85.4 (SD 9.5) for CG Inclusion criteria: with the FINDRISC questionnaire for T2D scores >15 were selected for the study, the WHO criteria for impaired fasting glucose (>=5.6 and <7.0 and 2‐h glucose <7.8 mmol/L) or impaired glucose tolerance (fasting glucose <7.8 and 2‐h glucose >=7.8 and <11.1 mmol/L). Exclusion criteria: exclusion criteria were any functional limitation or chronic disease that might have limited the training and testing of the cardiovascular and respiratory systems, any medication for diabetes or current vigorous PA for more than 75 minutes per week as revealed by a questionnaire or physician’s examination.
Interventions	IG: Walking group: the training sessions of the intervention group were carried out in an indoor sports hall. Duration: graduated increase to 45‐minute/session (starting two x 20 minutes in first 6 weeks + stretching) Walking was followed by a 5‐minute stretching and balance training, a 20‐minute walk and a 10‐minute stretching and balance exercise. After 1.5 months the 5‐minute stretching and balance training between the two 20‐minute walks were eliminated, and walking time was increased to 45 minutes. Intensity: low (speed: 3km/hour, 2 MET) Frequency: 1 session/day, 3 days/week Intervention period: 13 weeks (3 months) Pedometer: accelerometer data were recorded through the whole 3‐month study Facilitator: yes, athletic instructor and a physician 3 times/week during the structured exercises CG: Control group: the control group participants met research assistants once a week for downloading the data from the accelerometers.
Outcomes	Review outcomes reported: SBP, DBP Measurement method: Quote: "Heart rate was recorded using a heart rate monitor (M61, Polar Electro, Kempele, Finland)" "Blood pressure and blood lactic acid (Lactate Pro, Argray Inc., Kojo, Japan) were measured at each resistance level." Primary/Main outcome of manuscript: metabolic parameters (e.g. fasting glucose, total cholesterol, insulin etc) (see Table 2) Adverse event: NR
Notes	Trial registration: NCT01649219 Funding sources: Government and private sector(The Finnish Diabetes Foundation and EVO funds from Pohjois‐Pohjanmaa Hospital District and Oulu University Hospital)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computerised random number generation refer to Table 1 (SBP imbalance)
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded. Personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 12.8% (10 out of 78) 5 out of 38 (13.2%) in IG & 5 out of 40 (12.5%) in CG dropouts 33/35 and 35/40 included in analysis PP analysis
Selective reporting (reporting bias)	Low risk	Measurement at 12 weeks only 1 analysis
Other bias	Low risk	No other bias

Higashi 1999b.

Study characteristics
Methods	Aim: the effects of a 12‐week, 30‐minute brisk walking program on endothelial function and forearm haemodynamics in patients with essential hypertension Design: parallel 2‐group RCT (3:1) Used for sample size calculation: NR
Participants	No. randomised:27 (20 in IG, 7 in CG) No. completers: 27 Country: Japan Study population: mild to moderate hypertension patients Ethnicity: Japanese Gender: male 74% (20/27) Age: mean 53 (SD 10) in IG, 51 (SD 8) in CG Smokers: 29.6% (8/27) Hypertension: 100% Mean baseline BP: SBP = 155.0 (SD 6.6) in IG, 155.4 (SD 8.3) in CG; DBP = 96.0 (SD 4.9) in IG, 97.6 (SD 4.3) in CG Heart rate =71.8 (SD 9.7) in IG, 73.1 (SD 6.4) in CG Inclusion criteria: BP between 140 to 170 or 90 to 110mmHg. Quote: “No patient had a history of cardiovascular or cerebrovascular disease, diabetes mellitus, hypercholesterolemia, liver disease, or renal disease. All patients were essentially sedentary and did not exercise regularly.” Exclusion criteria: Quote: “alcohol intake greater than ethanol 30 mL/day.”
Interventions	IG: Walking (exercise) group: Participants were asked not to change their original behavioral and dietary habits, especially the intake of sodium, potassium, calories, and alcohol. Exercise performance sheet, recorded by the participants, and 24‐hour urinary excretion of sodium and potassium were checked by the investigators every four weeks during the interview. Duration: 30 minutes/session Intensity: brisk walking Frequency: 5 to 7 sessions/week Intervention period: 12 weeks Pedometer: NR Facilitator: NR CG: Control group: participants were asked not to engage in any physical activity outside the study.
Outcomes	Review outcomes reported: SBP, DBP, HR Measurement method: not mentioned Primary/Main outcome of manuscript: endothelial function Adverse event: NR
Notes	Trial registration: NR note: data from Protocol 2 only Funding sources: government This study was supported in part by a grant‐in‐aid for Scientific Research from the Ministry of Education, Science and Culture of Japan and Japan Heart Foundation grant for research on hypertension and vascular metabolism and a grant from Research Foundation for Community Medicine)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomised" but no details reported refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded. Personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Dropout: NR At start of study? Intervention arm n = 20, Control arm n = 7; At follow up? Intervention arm n = 20, Control arm n = 7 refer to table 2 Unsure ITT or PP analysis
Selective reporting (reporting bias)	Low risk	Only 1 analysis
Other bias	Low risk	No other bias

Holloway 1997.

Study characteristics
Methods	Aim: to compare psychological state, resting heart rate, and resting blood pressure of sedentary adults among different walking intervention groups. Design: parallel 5‐group RCT (4 interventions + 1 control groups) Power/sample size calculation: No
Participants	No. randomised:83 (8 dropouts, resulting 58 in IG [22 in XC, 21 in T, 15 in S], 17 in CG) (19 in stationary bicycle excluded) No. completers: 75 Country: USA Study population: general population (volunteers) Ethnicity: NR Gender: male 47.9% [45/(45 + 49), 94 completers only] [this 94 include bicycle] Age: range 23 to 49 years (only in abstract), male range 20 to 40), female range 20 to 50 Smokers: NR Hypertension: NR Mean baseline BP SBP = 113.6 (SD 9.8) in IG1_XS, 113.4 (SD 11.1) in IG2_T, 116.7 (SD 10.0) in IG3_S, 114.5 (SD 12.3) in CG. DBP = 80.0 (SD 7.3) in IG1_XS, 81.9 (SD 9.1) in IG2_T, : 83.5 (SD 8.7) in IG3_S, 82.7 (SD 6.0) in CG HR = 76.4 (SD 9.0) in IG1_XS, 77.0 (SD 8.8) in IG2_T, 75.9 (SD 6.3) in IG3_S, 78.6 (SD 10.1) in CG Inclusion criteria: men between 20 and 40 years of age, women between 20 and 50 years Exclusion criteria: Quote: "anyone who responded NO to any of the PAR‐Q questions, or YES to 2 or more of the Major Coronary Risk Factors questions" "Those on mood altering or blood pressure altering medications, and those who had been regular exercises within the 6 months preceding the study"
Interventions	Participants signed up for a practice session and orientation held at the LaCross YMCA, where training took place. The training site was chosen due to its convenience for accessibility, childcare, and open hours. In the last 4 weeks, interval training was added to add variety and further improve conditioning. Self‐selected intensity level (HR and 15‐points Borg scale) was recorded in personal exercise logs, which was used to verify attendance of unsupervised sessions. Duration: graduated from 20 minutes in week 1, 25 minutes in week 2, 30 minutes in week 3, 40 minutes in week 4, 35 to 45 minutes in weeks 5 to 12 Intensity: self‐selected intensity level (65% to 90%HRmax and 15‐points Borg scale) Frequency: 1 session/day, 3 days/week Intervention period: 12 weeks Pedometer: NR Facilitator: No Compliance/Adherence: NR. Participants who missed more than 3 sessions were eliminated from the study. IG1_XC: Walking (XC, Cross‐country ski simulator) group: participants exercised only on NordicTrack Achiever model (NordicTrack, Inc., Chaska, MN) and only at LaCrosse YMCA. IG2_T: Walking (T, Treadmill) group: participants exercised only on Trimline1100 motorised treadmill (Roadmaster Corporation, Irving, TX) and only at LaCrosse YMCA. IG3_S: Walking (S, Stepper) group: participants exercised only on Precor 721E hydraulic steepper (Precor, Inc., Bothell, WA) and only at LaCrosse YMCA. CG: Control group: not to alter activity levels or modify diet. Note: stationary bicycle excluded from analysis
Outcomes	Review outcomes reported: SBP, DBP, resting HR Measurement method:quote: "Resting blood pressure was measured with the occluding cuff, auscultation method, all pressures were taken with a mercury sphygmomanometer..." Primary/Main outcome of manuscript: psychological state, resting heart rate, resting blood pressure. Compliance/Adherence: NR. Participants who missed more than 3 sessions were eliminated from the study. Adverse event: NR
Notes	Trial registration: No Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "...were randomly assigned to..." and no details reported completers only
Allocation concealment (selection bias)	Unclear risk	Quote:"...were randomly assigned to..." and no details reported completers only
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded, research personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	8 out of 102 drop outs (7.8%) Completers PP analysis
Selective reporting (reporting bias)	Low risk	Measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Hua 2006.

Study characteristics
Methods	Aim: to determine the effects of a low‐intensity exercise conditioning programme on BP, HR, and cardiac autonomic function in men and women with mild hypertension Design: parallel 2‐group RCT Power/sample size calculation: yes
Participants	No. randomised: 47 (7 dropouts, 20 in IG [male = 10, female = 10], 20 in CG [male = 10, female = 10]) No. completers: 40 Country: Canada Study population: sedentary hypertensive men and women Ethnicity: NR Gender: male 50% (20/40) Age: range 56 to 59 Smokers: non‐smokers Hypertension: hypertensive participants Baseline BP: SBP = 140 (SD 11) in IG1‐male, 141 (SD16) in IG2‐female, 142 (SD 15) in CG1‐male, 141(SD17) in CG2‐female; DBP = 92 (SD 7) in IG1‐male, 87 (SD 9) in IG2‐female, 91 (SD 11) in CG1‐male, 88 (SD 9) in CG2‐female;; resting HR = 69 (SD 7) in IG1‐male, 75 (SD 12) in IG2‐female, 75 (SD15) in CG1‐male, 70 (SD 12) in CG2‐female Inclusion criteria: "age>35 years; diagnosed with mild hypertension with BP>135/85 mmHg; the approval of the physician to participate if participants answered YES to one of the seven questions on the Physical Activity Readiness Questionnaire (PAR‐Q)." Exclusion criteria: "smoker; on hormone replacement therapy; previous diagnosis of stroke, heart failure, ischemic heart disease, myocardial infarction, vascular disease and/or renal disease; currently participating in more than two aerobic physical activity sessions per week; co‐morbid conditions that limited exercise activity; or did not have appropriate family physician's approval."
Interventions	IG1_M / IG2_F: Walking group It was suggested that not to exercise within 2 hours of consuming a large meal, alcohol or caffeine, and not to make any dietary change, but encouraged to begin each walking session with a 5 to 10 minutes warm‐up and end with a 5 to 10 minute cool‐down. Participants were also instructed recording walking sessions and reasons from stopping in the exercise log. All the participants received a phone call or email from the researcher every 3 weeks to monitor their progress and to answer any questions. They returned to the lab by the end of week 12 for re‐assessment and logs were collected. Duration: graduated from 0.8 km/day in week 1and 2, added 0.4 km per week to 4.8 km/day in week 12 Intensity: low, 40% maximal heart rate reserve; 11 to 13 RPE on Borg’s scale and self‐monitor HR by radial artery palpation with verbal and written instructions. Frequency: 4 days/week Intervention period: 12 weeks Pedometer: NR Facilitator: NR CG1_M / CG2_F: Control group: maintaining current level of activity. An activity log was used to obtain weekly activities.
Outcomes	Review outcomes reported: SBP, HR Measurement method: Quote: "A BpTRU (Model BPM‐300, VSM MedTech Ltd., Coquitlam, BC) automated, non‐invasive BP monitor was used to measure BP and HR." Primary/Main outcome of manuscript: BP, HR, cardiac autonomic function Compliance/Adherence: Quote:"3.75 sessions/week, a minimum of three sessions per week were considered compliance" IG1_M: Walking (male) group Compliance/Adherence: 3.52 (SD 1.00) sessions/week IG2_F: Walking (female) group Compliance/Adherence: 3.97 (SD 0.52) sessions/week Compliance/Adherence: a minimum of three sessions per week were considered compliance Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote:"... were randomized to ... " (p.29) but no details reported refer to Table 4 in thesis (p.42)
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	dropout 14.9% (7 out of 47) 6 in TG (23.1%) and 1 in CG (4.8%) drop outs refer to Table 5 (p.45) PP analysis
Selective reporting (reporting bias)	Low risk	Measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Karstoft 2013.

Study characteristics
Methods	Aim: to test the feasibility of free‐living walking training in patients with type 2 diabetes Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: a priori power calculations indicated that n = 12 in each training group would be sufficient to detect significant changes in glycaemic control.
Participants	No. randomised: 32 (total 3 rounds of randomisation; final 12 in IG1, 12 in IG2, 8 in CG) No. completers: 32 Country: Denmark Study population:T2DM patients Ethnicity: NR Gender: male 62.5% (20/32) Age: mean 60.8 (SD 2.2) in IG1; 57.5 (SD 2.4) in IG2; 57.1 (SD 3.0) in CG Smokers: NR Hypertension: NR Mean baseline BP: SBP = 155 (SD 5.4) in IG1; 138 (SD 3.3) in IG2; 142 (SD 4.3) in CG; DBP = 90.0 (SD 1.8) in IG1; 85.0 (SD 2.8) in IG2, 86.6 (SD 3.5) in CG Inclusion criteria: confirmed T2DM by OGTT and sedentary Exclusion criteria: Quote: “The use of exogenous insulin, weight instability (>2 kg/6 months), physical activity (>150 min/week), and evidence of liver, renal, and cardiopulmonary disease and diseases contraindicating physical activity.”
Interventions	IG1_CWT: Walking (continuous‐walking training) group: Walking above the target intensity, obtained from VO2 peak test. Duration: 60 minutes/session Intensity: 55% of peak energy expenditure rate according to VO2 peak test Frequency: 1 session/day, 5 days/week Intervention period: 17 weeks (4 months) IG2_IWT: Walking (interval‐walking training) group: Walking cycles of 3 minutes of the fast walking (above the target intensity) and 3 minutes of slow walking (below the target intensity). Duration: 60 minutes/session Intensity: 70% of the peak energy‐expenditure rate, and were instructed to perform IWT consisting of cycles of 3 minutes of fast walking(above the target) and 3minutes of slow walking (below the target) Frequency: 1 session/day, 5 days/week Intervention period: 17 weeks (4 months) Pedometer: yes, JD Mate pedometer. Facilitator: no CG: Control group: continue habitual lifestyle for 4 months and had their JD Mate pedometer data uploaded monthly.
Outcomes	Review outcomes reported: SBP, DBP Measurement method: not mentioned Primary/Main outcome of manuscript: physical activities and energy intake expenditure parameters (Table 1 and 2) Adverse event: NR (one participant in continuous walking group dropped out due to a knee injury was reported but not identified as adverse event)
Notes	Trial registration: NR Funding sources: Government(This study was primarily funded by DD2 (The Danish Centre for Strategic Research in Type 2 Diabetes, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469283/) supported by the Danish Agency for Science (grants 09‐067009 and 09‐075724 to B.K.P.).)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	A total 3 randomisations done, first 24 to 8/8/8, then the 5 out of 8 from control randomised to 2 IG, then additional randomisation of 5 to the 2 IG. There were five participants entering the trial twice as control then intervention. refer to Table 1 (SBP difference between IG and CG)
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Nature of intervention cannot be blinded 5 participants contributed to both CG and IG. Quote: "Subjects in the CON group were offered re‐randomisation into a training group after the CON period. Five subjects accepted, adding n = 3 to the CWT group and n = 2 to the IWT group."
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Dropout 6.9% (2 out of 29) 2 in TG and 0 in CG A total 3 randomisation done: first 24 to 8/8/8, then the 5 out of 8 from control randomised to 2 IG, then additional randomisation of 5 to the 2 IG. There were five participants entering the trial twice as control then intervention. PP analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 12 weeks only 1 analysis
Other bias	Low risk	No other bias

Khalid 2013.

Study characteristics
Methods	Aim: to investigate the effects of moderate exercise training on nitric oxide levels in postmenopausal hypertension. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: no
Participants	No. randomised: 30 (15 in IG, 15 in CG) No. completers: 25 Country: Egypt Study population: postmenopausal, hypertensive & overweight/obese women Ethnicity: NR Gender: male 0% (0/25) Age: mean 52.9 (SD 2.6) in IG, 52.7 (SD 2.2) in CG, range 40 to 50. Smokers: NR Hypertension: 100% (SBP 140 to 160 mmHg, DBP over 90 to 100 mmHg) Mean baseline BP: SBP = 148 (SD 5.6) in IG; 154 (SD 6.7) in CG; DBP = 94 (SD 4.1) in IG; 95 (SD 4.2) in CG Inclusion criteria: experienced at least one year of postmenopausal hypertension, their ages ranged from 40 to 50 years; Body Mass Index (BMI) ranged from 30 to 36 Kg/m2, their Blood Pressure (BP) ranged from 140 to 160 mmHg (systolic ‐ SBP) over 90 to 100 mmHg (diastolic ‐ DBP) Exclusion criteria: on any postmenopausal hormone therapy such as oestrogen, previous history of hypertension or receiving any anti‐hypertensive drugs, history of diabetes or any other pathology within the spectrum of metabolic syndrome, orthopedic or neuromuscular disorders that could have interfered with the training program.
Interventions	IG: Walking group: electric treadmill walking. The program consisted of three phases followed by a relaxation period. These phases were: 1‐warming up phase, 2‐ conditioning stimulus phase, 3‐cooling down phase. Duration: 20‐minute/session at least Intensity: 60% to 70% of maximum HR Frequency: 1 session/day, 3 days/week, a total of 24 sessions Intervention period: 8 weeks Pedometer: NR Facilitator: NR CG: Control group: NR
Outcomes	Review outcomes reported: SBP, DBP Measurement method: not mentioned Primary/Main outcome of manuscript: SBP, DBP, NO Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "A computer‐generated, simple randomisation procedure was used" refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "the medics who measured the blood pressure and all other variables incorporated in this study were blinded as to the allocation of the participants to both groups (exercise and control)."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 16.7% (5 out of 30) 3 out 15 (20%) in IG, 2 out of 15 (13.3%) in CG dropouts PP analysis on completers only (Figure 1)
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 8 weeks Only 1 analysis
Other bias	Low risk	No other bias

Koh 2010.

Study characteristics
Methods	Aim: to compare the effects of 6 months of supervised intradialytic or unsupervised home‐based exercise training and usual care on physical function, arterial stiffness, and self‐reported health. Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: yes
Participants	No. randomised:43 (21 in IG, 22 in CG ) (27 in Intradialytic‐exercise group trained on a cycle ergometer excluded) No. completers: 31 Country: Australia Study population: adult haemodialysis patients Ethnicity: NR Gender: male: 61.3% (19/31) Age: mean 52.1 (SD 13.6) in IG; 51.3 (SD 14.4) in CG Smokers: NR Hypertension: 38.7% (12/31) (Table 2) Mean baseline BP: SBP = 143 (SD 32) in IG, 145 (SD 18) in CG; DBP = 78 (SD 16) in IG, 80 (SD 9) in CG; HR = 73 (SD 9) in IG, 74 (SD 10) in CG. Inclusion criteria: “Patients aged >18 years on stable adequate dialysis therapy with urea reduction ratio >70% for >3 months”. Exclusion criteria: Quote:“Patients with unstable angina, those with lower‐limb amputation, or those who met or exceeded the exercise recommendation of 120 minutes of moderate intensity physical activity per week”.
Interventions	IG: Walking (home‐based exercise) group: Fortnightly telephone contacts were given by investigators to provide encouragement and allow feedback. Duration: graduated increase to 45 minutes/session by week 24 (starting from 15 minutes) Intensity: self‐reported RPE 12 to 13 on Borg scale; to increase intensity by walking faster or on an incline Frequency: 1 session/day, 3 days/week Intervention period: 26 weeks Facilitator: yes Pedometer: NR CG: Control (Usual care) group: brochures about exercise benefits were given while participants were requested to maintain usual lifestyle. Note: intradialytic‐exercise group trained on a cycle ergometer excluded
Outcomes	Review outcomes reported: SBP, DBP, HR Measurement method: central blood pressures and AIx were estimated using radial applanation tonometry performed on the non‐fistula arm using customized software (SphygmorCor 7.01). Primary/Main outcome of manuscript: physical function (6‐minute walk distance) and arterial stiffness (aortic pulse wave velocity) and self‐reported health Adverse event: No
Notes	Trial registration: ACTRN12608000247370 Intrdialytic‐exercise group (ID) is excluded in this analysis (n = 27) because intervention is not walking Funding sources: private sector (This project was funded by the Clifford Craig Medical Research Trust.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote:"...unrestricted computer‐generated random numbers." refer to Table 1 (completers only)
Allocation concealment (selection bias)	Low risk	Assigned by staff not associated with trial
Blinding of participants and personnel (performance bias) All outcomes	High risk	Quote:"It was not possible to blind participants or researchers to group assignment." refer to Table 1 (some did not receive home‐base exercise)
Blinding of outcome assessment (detection bias) All outcomes	High risk	0bjective outcomes Quote:"It was not possible to blind participants or researchers to group assignment."
Incomplete outcome data (attrition bias) All outcomes	High risk	dropout 27.9% (12 out of 43) Start of study: home‐based exercise n = 21, Control n = 22; At follow up: home‐based exercise n = 15/21 = 71.4%, Control n = 16/22 = 72.7% PP analysis (completers only)
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 26 weeks Only 1 analysis
Other bias	Low risk	No other bias

Kukkonen‐Harjula 1998.

Study characteristics
Methods	Aim: to study the effects of walking training on maximal aerobic power, serum lipoproteins, and plasma fibrinogen as indicators of health‐related fitness in healthy middle‐aged men and women. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: Yes
Participants	No. randomised: 117 (1 excluded after randomisation, 58 in IG, 58 in CG) (one woman in the exercise group was excluded because of arrhythmia during maximal exercise testing, n = 116.) No. completers: 108 Country: Finland Study population: healthy middle‐aged adults Ethnicity: NR Gender: male 47.4% (55/116)*100%; completers only Age: mean 42.1 (SD 5.1) in IG, 40.3 (SD 4.5) in CG; range 30‐55 years. Smokers: 0% Hypertension: 0% Mean baseline BP: SBP = 118 (SD 12) in IG, DBP = 75 (SD 11) in IG Inclusion criteria: 30 to 55 years old, non‐smokers, premenopausal (women), and clinically healthy with no disabilities precluding exercise training. Exclusion criteria: regular medication (except for hormonal contraception in women) physical exercise more than twice weekly; BMI > 33 kg/m2.
Interventions	IG: Walking group: the target intensity of exercise for 50 minutes was 74% to 81% of HRmax, which is equivalent to 65% to 75% of VO2max. Duration: 50 minutes (+5 to 10‐minute warm‐up and cool‐down) Intensity: 65% to 75%VO2max or 74% to 81% HRmax Frequency: 1 session/day, 4 days/week Intervention period: 15 weeks Pedometer: yes Facilitator: yes CG: Control group: were told not to change their eating or physical activity habits.
Outcomes	Review outcomes reported: exercise heart rate, (SBP, DBP ‐> pending from author) Measurement method: blood pressure measurements were taken after the participants had been resting in a sitting position for 5 minutes, using a random zero sphygmomanometer (Hawksley & Sons Ltd, Lancing, Sussex, England). Primary/Main outcome of manuscript: exercise capacity, lipid biomarkers Adverse event: 2 (one stress fracture and one knee injury leading to surgery) Quote:"Two severe injuries resulted from the training (one stress fracture and one knee injury leading to surgery). Other reasons for discontinuation were not related to training."
Notes	Trial registration: NR Funding sources: Government. The study was supported by grants from the Finnish Ministry of Education and Polar Electro Oy (Kempele, Finland).
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Randomization was stratified according to sex and submaximal oxygen consumption (divided into thirds)" but no details of randomisation refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 6.8% (8 out of 116) 5 out of 58 in IG (8.6%), 3 out of 58 (5.2%) in CG dropouts PP analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 15 weeks oOnly 1 analysis
Other bias	Low risk	No other bias

Kurban 2011.

Study characteristics
Methods	Aim: to determine the effect of chronic regular exercise on ischaemia‐modified albumin levels and oxidative stress in T2DM. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: no
Participants	No. randomised:60 (30 in IG, 30 in CG) No. completers: 60 Country: Turkey Study population: T2DM patients Ethnicity: NR Gender: male 48% (29/60) Age: mean 53.77 (SD8.2) in IG; 53.57 (SD 6.6) in CG. Smokers: NR Hypertension: NR Mean baseline BP: SBP = 129.17 (SD 12.1) in IG, 124.83 (SD 14.59) in CG; DBP = 78.83 (SD 6.78) in IG, 77.88 (SD 10.53) in CG. Inclusion criteria: sedentary, T2DM patients with blood pressure ≧ 140/90mmHg. None of the patients had macro‐ or microvascular complication including retinopathy and proteinuria. Exclusion criteria: Quote:“Malignant disease, infectious disease, chronic obstructive lung disease, liver disease, kidney disease, and patients with joint or muscle disease.”
Interventions	IG: Walking group: Duration: 50 minutes/session (10‐minute warm‐up + 30‐minute walking + 10‐minute cool‐down exercise) Intensity: moderate, aerobic exercise Frequency: 1 session/day, 3 days/week Intervention period: 13 weeks (3 months) Pedometer: NR Facilitator: yes, an certified exercise instructor. CG: Control group: participants remained sedentary throughout the study period.
Outcomes	Review outcomes reported: SBP, DBP Measurement method: not reported Primary/Main outcome of manuscript: ischaemia‐modified albumin levels and oxidative stress (total antioxidant status and total oxidant status) Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote:"randomly divided" but no details reported refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Unlikely that research personnel and participants blinded
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Dropout: NR Start of study? Intervention n = 30, Control n = 30; At follow up, no mention of dropouts; not sure if Intervention n = 30/30 = 100%? Control n = 30/30 = 100%? refer to Table 1 Unsure ITT or PP analysis
Selective reporting (reporting bias)	Low risk	Only measurement at 3 months Only 1 analysis
Other bias	Low risk	No other bias

Lee 2007.

Study characteristics
Methods	Aim: the effect of a community‐based walking intervention on blood pressure among older people aged 60. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: yes
Participants	No. randomised:202 (102 in IG, 100 in CG) No. completers: 184 Country: Taiwan Study population: elderly mild‐to‐moderate hypertensive patients (60+ years) Ethnicity: NR Gender: male 58% (118/202) Age: mean 71.3 (SD 6.4) in IG, 71.3 (SD 5.7) in CG Smokers: 21.8% (44/202) Hypertension: 100% Mean baseline BP: SBP = 152.0 (SD 10.5) in IG, 152.4 (SD 11.1) in CG; DBP = 83.5 (SD 11.2) in IG, 80.6 (SD 8.8) in CG Inclusion criteria: Quote:“Being resident in a local township, aged 60 years and over and with a resting systolic blood pressure between 140 mmHg and 179 mmHg and thereby classified as having mild to moderate hypertension” Exclusion criteria: NR
Interventions	IG: Walking (community‐based walking intervention) group: based on the self‐efficacy theory, participants were telephone‐contacted or in‐person interviewed by one of the research members to reinforce motivation and solve barriers to promote increased walking. A median of 6 contacts was given, it was more frequent in the first 3 months than the last 3 months. Duration: NR (individualised) Intensity: NR (individualised) Frequency: NR (individualised) Intervention period: 26 weeks Pedometer: yes; pedometers were provided as a motivator to facilitate participants' walking Facilitator: no CG: Control (usual care) group: participants received usual primary health care involving self‐initiated contact with health services as required.
Outcomes	Review outcomes reported: SBP, DBP Measurement method: BP measured quote:"using a traditional mercury sphygmomanometer Primary/Main outcome of manuscript: change in SBP, exercise self‐efficacy score, self reported walking frequency, DBP Adverse event: NR
Notes	Trial registration: no Funding sources: self‐funded
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "A series of numbered, opaque, sealed envelopes were used to randomly allocate participants to one of the two arms of the trial. To prevent an imbalance in size of study groups, blocks of 12 were used. The randomisation list and the block size were concealed..." refer to Table 1
Allocation concealment (selection bias)	Low risk	Quote:" A series of numbered, opaque, sealed envelopes were used to randomly allocate participants to one of the two arms of the trial. To prevent an imbalance in size of study groups, blocks of 12 were used. The randomisation list and the block size were concealed..." refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and personnel were not blinded
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Quote: "All outcome measures were recorded during face‐to‐face interviews by four trained interviewers who were blinded to study group allocation and trained in questionnaire administration and blood pressure measurement."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 8.9% (18 out of 202) 11 out of 102 in IG (10.8%), 7 out of 100 in CG (7%) dropouts refer to Table 2 and figure 1 PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 6 months Only 1 analysis
Other bias	Low risk	no other bias

Li (李虎) 2018.

Study characteristics
Methods	Aim: to investigate the effect of long‐term walking on health status. Design: Parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised:100 (50 in IG, 50 in CG) No. completers: 80 Country: China Study population: university teachers Ethnicity: Chinese Gender: male 48% (22+26) Age: mean 43.63 (SD 8.26) in IG; 43.24 (8.67) in CG Smokers: NR Hypertension: yes Mean baseline BP: SBP = 118.95 (SD 14.99) in IG, 112.69 (SD 13.74) in CG (DBP was not reported.) Inclusion criteria: volunteers agreed with randomisation, signed informed consent and were willing to provide daily step count and health profile data; no contraindication for walking; not allergic or having skin problem with sport bracelet for long‐term use. Exclusion criteria: NR
Interventions	IG: Walking group:health seminar with positive feedback each month. Duration: NR Intensity: 10,000 steps per day using Xioami bracelet for step count Frequency: 7 sessions/week Intervention period: 64.3 weeks (450 days) Pedometer: yes (Xioami bracelet) Facilitator: NR CG: Control group: no bracelet for step count, neither seminars nor feedback; measurement for health profile twice before and after intervention.
Outcomes	Review outcomes reported: SBP Measurement method: SBP was obtained from regular health examination data from belonged universities. Primary/Main outcome of manuscript: questionnaire including height, BMI, waist‐hip ratio, sleeping condition, perceived pressure level, and history with hypertension, diabetes mellitus and hyperlipidaemia. Health profile measured SBP, blood sugar, LDL, cholesterol, TG, and HDL. Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: Office of Research, Beijing Jiaotong University (016JB00050), National Natural Science Foundation of China(81641175), Peking University People's Hospital(RDB2015—10, RDY2016—15), 2015 Osteoarthritis Research Society International (OARSI), 2016 International Cartilage Regeneration & Joint Preservation Society (ICRS), 2016 Beijing love Joint Health Community Foundation
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote:"randomly divided" but no detail reported
Allocation concealment (selection bias)	Unclear risk	NR
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 20% (20 out of 100 dropouts) 42 completers in walking group, 38 completers in control group refer to table 1 PP analysis
Selective reporting (reporting bias)	Unclear risk	Only 1 endpoint measurement at 450 days Only 1 analysis Only provided SBP but not DBP without reason, DBP data could not obtained from author contact
Other bias	Low risk	no other bias

Li 2003.

Study characteristics
Methods	Aim: to evaluate the efficacy of cobblestone‐mat walking as a physical activity to improve selected health‐related outcomes. Design: Parallel 2‐group RCT (1:1) Power/sample size calculation: yes
Participants	No. randomised: 48 (24 in IG, 24 in CG) (2 did not receive intervention, 6 declined, leaving 40 in study) No. completers; 40 Country: USA Study population: sedentary elderly adult (60+ years, general population) Ethnicity: white 90% (36/40) Gender: male 22.5% (9/40) Age: mean 72 (SD 6.4) in IG, 73.3 (SD 7.3) in CG Smokers: NR Hypertension: NR Mean baseline BP: SBP = 133.64 (SD 9.68) in IG, 132.17 (SD 13.62) in CG; DBP = 81.5 (SD 9.41) in CG, 81.22 (SD 8.59) in CG Inclusion criteria: Quote:“being 60 years of age or older, not participating in regular physical activity (i.e., in the previous 2 months, no more than 90 min of structured group exercise per week), being an independent ambulator able to walk without the use of aids, having no progressive or debilitating conditions that would limit participation in moderate‐intensity exercise, having a physician’s approval for participation, and having no severe foot or ankle problems.” Exclusion criteria: NR
Interventions	IG: walking (cobblestone‐mat walking) group: Walk on cobblestone mat for 12 to 25 minutes/session over the 8‐week study period. Foot‐rolling activity was provided between sets, and each participant was also given a pair of cotton socks to be worn Duration: 45‐minute/session (starting from 12‐minute/session) Intensity: NR Frequency: 1 session/day, 3 days/week Intervention period: 8 weeks Pedometer: NR Facilitator: yes CG: Control group: participants were instructed to continue their usual physical activities and were also invited to four meetings to meet one another. A cobblestone‐mat walking program was provided at the end of the study.
Outcomes	Review outcomes reported: SBP, DBP Measurement method: a trained and experienced research assistant used an aneroid sphygmomanometer to measure resting SBP and DBP. Primary/Main outcome of manuscript: HRQoL (SF‐12 IADL) and self‐care activities Compliance/Adherence: n = 18 (79%), compliance was defined by attending 15 or more sessions (24 sessions in total). 22/24 IG & 18/24 CG received intervention Adverse event: 1 (oOne had a bruise on the ball of her foot and Cobblestone‐Mat Walking subsequently dropped out of the study)
Notes	Trial registration: NR Funding sources: Government(Preparation of this manuscript was supported in part by Grant No. AG18394 from the National Institute on Aging.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "computer program to generate random numbers " refer to Table 1 & 2
Allocation concealment (selection bias)	Low risk	Quote:"Before enrolment of the first study participant, a research statistician not working on the study used a computer program to generate random numbers for group assignment."
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Participants not blinded. Quote:"The principle investigators were blinded to the assignment"
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes Quote:"The principle investigators were blinded to the assignment" but not use if it included outcome assessor(s).
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout: not in final analysis 16.7% (8 out of 48) 2 out of 24 in TG (8.3%) and 6 out of 24 in CG (25.0%) dropout Dropout: non completer 27.1% (13 out of 48) 7 out of 24 in IG (29.2%) & 6 out of 24 in CG (25%) dropout refer to Figure 1 PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 8 weeks Only 1 analysis
Other bias	Low risk	no other bias

Lin 2000.

Study characteristics
Methods	Aim: to examine the effects of brisk walking on blood pressure in teenagers with higher blood pressure. Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: no
Participants	No. randomised:22 (8 in IG1, 8 in IG2, 6 in CG) No. completers: 22 Country: Taiwan Study population: borderline hypertensive adolescents (students) Ethnicity: Chinese Gender: male 100% (22/22) Age: range 16 to 18 years Smokers: NR Hypertension: 100% borderline Mean baseline BP: SBP = 140 (SD 11.14) in IG1, 137.75 (SD 6.69) in IG2, 145.67 (SD 10.33) in CG; DBP = 92.25 (SD 3.45) in IG1, 91.75 (SD 4.06) in IG2, 93.67 (SD 4.27) in CG Inclusion criteria: 16 to 18 male teenagers with resting SBP≥140 mmHg and resting DBP≥90 mmHg. Deny use of anti‐hypertensives. Exclusion criteria: NR
Interventions	IG: Walking group: Duration: 30 minutes/session Intensity: brisk walking with Maximal heart rate: 130 to 140 bpm (monitor by Polar) Frequency: 1 session/day, 3 days/week Intervention period: 12 weeks IG: Walking group: Duration: 10 minutes/session Intensity: brisk walking with maximal heart rate: 130 to 140 bpm (monitor by Polar) Frequency: 3 sessions/day, 3 days/week Intervention period: 12 weeks Pedometer: NR Facilitator: Yes CG: Control group:maintaining current activity and dietary habit
Outcomes	Review outcomes reported:SBP, DBP Measurement method: resting blood pressure assessed by Sanken model SM‐301, Tokyo Japan Primary/Main outcome of manuscript: blood pressure and blood composition (refer to Table 1) Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote:"randomised" but no details reported refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes no information
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Dropout: NR refer to Table 1
Selective reporting (reporting bias)	Low risk	Reported measurement at 12 weeks only 1 analysis
Other bias	Low risk	No other bias

Ming (明輝) 2018.

Study characteristics
Methods	Aim: to examine the effect of long‐distance brisk walking on haemodynamics and cardiopulmonary function in elderly patients with coronary heart disease complicated with hypertension. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 64 (32 in IG, 32 in CG) No. completers: 64 Country: China Study population: hospitalised patients with percutaneous coronary intervention (PCI) Ethnicity: Chinese Gender: male 62.5% ((21+19)/64) Age: mean 63.18 (SD 5.42) in IG; 62.76 (SD 5.54) in CG Smokers: No Hypertension: 100% Mean baseline BP: SBP = 136.79 (SD 7.03) in IG, 137.32 (SD 7.44) in CG. DBP = 95.88 (SD 4.10) in IG,96.30 (SD 4.52) in CG. HR=83.18 (SD 8.14) in IG, 83.55 (SD 8.09) in CG Inclusion criteria: age between 60 to 80; Confirmed diagnosis with coronary heart disease complicated with hypertension; caregiver or family were informed with the study details and signed consent; patients successfully survived from the PCI surgery. Exclusion criteria: mental problem refrained from cooperation and intervention; mobile restriction from long‐distance brisk walking; ③transmissible disease such as AIDS and TB; noted cancer or malignant tumour mass.
Interventions	IG: Walking group: During the long‐distance brisk walking, participants were asked to keep head up high and straight, open arms and keep shoulders and hips in vertical line along with the ground, and breathe in accordance with steps. Duration: 30 to 70 minutes/session Intensity: brisk walking 120 to 140 steps/minute (participants could adjust their own speed in the beginning and gradually increased to the preferred speed; If any palpitation, dizziness or discomfort was noted, participants were able to gradually speed down to stop walking; participants were also free to decrease some level of intensity if fatigue or tiredness was noted.) Frequency: 1 to 2 session/day, 7 to 14 session/week or daily distance of 4.5 to 6.0 km Intervention period: 40 weeks Pedometer: NR Facilitator: NR CG: Control group: routine medication treatment.
Outcomes	Review outcomes reported: SBP, DBP, mean arterial pressure, and heart rate Measurement method: before and after 40 weeks. Primary/Main outcome of manuscript: SBP, DBP, mean arterial pressure, heart rate, left ventricular ejection fraction, mitral velocity and late flow velocity ratio, cardiopulmonary function and life quality. Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "random‐number method" but no details reported
Allocation concealment (selection bias)	Unclear risk	NR
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Dropout: NR 32 completers in walking group, 32 completers in control group This study requested elderly patients with coronary heart disease to walk briskly 20 to 140 steps for 30 to 70 minutes per session and 7 to 14 sessions/week for around 10 months. There is not sufficient information to judge the attrition. refer to table 1 to 3 Unsure ITT or PP analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 10 months Only 1 analysis
Other bias	Low risk	No other bias

Moreau 2001.

Study characteristics
Methods	Aim: the effects of daily walking on lowering blood pressure in postmenopausal women with borderline to stage 1 hypertension. Design: parallel 2‐group RCT (3:2) Power/sample size calculation: NR
Participants	No. randomised: 24 (15 in IG, 9 in CG) No. completers: 24 Country: United States Study population: postmenopausal women with borderline stage 1 hypertension Ethnicity: NR Gender: male: 0% (0/24) Age: mean 53 (SE 2) in IG; 55 (SE 1) in CG Smokers: 0% Hypertension:100% borderline Mean baseline BP: SBP = 142 (SE 3) in IG, 142 (SE 3) in CG; DBP = 84 (SE 1) in IG, 86 (SE 2) in CG HR = 77 (SE 3) in IG, 77 (SE 3) in CG Inclusion criteria: postmenopausal (for at least 1 year) women with borderline to stage 1 hypertension (SBP of 130 to 159 mmHg and/or DBP of 85 to 99 mmHg, determined on the basis of repeated seated BP recordings at rest on two separate days), were not participating in regular physical activity (< 2 days/week ) within the past year. Non‐smokers, had no orthopaedic limitations to walking, and were absent of known CVD as assessed with a health history questionnaire. Exclusion criteria: NR
Interventions	IG: Walking (exercise) group: self‐reported daily log sheets with any additional physical activity was collected biweekly. Participants were asked not to change any lifestyle activity other than walking. Duration: graduated increase, initially 1.4 km/day above individual baseline walking steps, which was measured in the first week; increased 0.5 km/day until 3 km/day by the 3rd week when the desired walking steps were achieved; accumulated walking steps. Frequency: 7 sessions/week Intensity: self‐selected, comfortable pace Intervention period: 24 weeks Pedometer: yes Facilitator: no CG: Control group: not to change daily activity and subsequently wore a pedometer 1 week each month to document their walking.
Outcomes	Review outcomes reported: SBP, DBP, resting HR Measurement method: blood pressure was measured in the left arm by brachial artery sphygmomanometer with at least 3 minutes separating each measurement. Primary/Main outcome of manuscript: blood pressure Adverse event: NR
Notes	Trial registration: NR Funding sources: private sector(research was supported by an American College of Sports Medicine Foundation Research Grant.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote:"randomised" but no details reported refer to Figure 1 and 2
Allocation concealment (selection bias)	Unclear risk	no information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants not blinded. Personnel not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	objective outcomes Quote:"Blood pressure and heart rate were measured at rest in triplicate by the same trained observer who was blinded to the group assignment as previously described"
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Dropout: NR At start of study: Intervention n = 15, Control arm n = 9; At follow up: data not reported? Intervention n = 15/15 = 100%?, Control arm n = 9/9 = 100%? refer to table 1 Unsure ITT or PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 24 weeks Only 1 analysis
Other bias	Low risk	No other bias

Murphy 1998.

Study characteristics
Methods	Aim: to compare the effects of short and long bouts of brisk walking in sedentary women Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: NR
Participants	No. randomised:47 (16 in IG1, 16 in IG2, 15 in CG) No. completers: 34 Country: UK Study population: sedentary middle‐aged women Ethnicity: NR Gender: male 0% (0/47) Age: mean 44.4 (SD 6.2); 44.8 (SD 8.4) in IG1, 48.0 (SD 5.5) in IG2, 47.3 (SD 4.1) in CG Smokers: NR Hypertension: 0% Mean baseline BP: SBP = 125.5 (SD 10.8) in IG1_SB; 124.2 (SD 11.1) in IG2_LB; 128.6 (SD 13.3) in CG Inclusion criteria: Quote: "None was employed in manual work and none had engaged in regular physical activity (defined as more than one 20‐min bout per week) during the preceding 6 months. " Exclusion criteria: Quote: "history of cardiovascular disease; resting arterial blood pressure >150 mmHg systolic or >95 mmHg diastolic; body mass index >= 30 kg·m‐2; diabetes; musculoskeletal condition or injury; taking any pharmacotherapeutic drug."
Interventions	IG_SB: walking (Short‐bout: 3*10 minutes) group: participants in the short‐bout group split this into three 10‐minutes sessions at intervals of ≧4 hours. Training was performed outdoors on the campus of the University of Ulster. Duration: 10 minutes/session Frequency: 3 sessions/day, 5 days/week Intensity: 70% to 80% of maximal heart rate Intervention period: 10 weeks IG_LB: Walking (long‐bout: 30minutes) group: participants in the long‐bout group were free to select the time of day at which they did their one 30‐minute bout. Training was performed outdoors on the campus of the University of Ulster. Duration: 30 minutes/session Frequency: 1 session/day, 5 days/week Intensity: 70% to 80% of maximal heart rate Intervention period: 10 weeks Pedometer: NR Facilitator: yes, one of the five training days each week training CG: Control group: usual lifestyle
Outcomes	Review outcomes reported: SBP only Measurement method: blood pressure measured by mercury‐in‐glass sphygmomanometer Primary/Main outcome of manuscript: exercise capacity, SBP, anthropometric variables Adverse event: 0
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomly assigned" but no details reported refer to Table 1 (completers only)
Allocation concealment (selection bias)	Unclear risk	No information Completers only
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	no information
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Quote: "Duplicate measurements of arterial blood pressures were made by an observer who was blinded to subjects' group assignment "
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 27.7% (13 out of 47) 4 out of 16 long IG (25%), 4 out of 16 short IG (25%), 5 out of 15 CG (33.3%) dropouts PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 10 weeks Only 1 analysis
Other bias	Low risk	No other bias

Murphy 2006.

Study characteristics
Methods	Aim: to examine the effects of 45 minutes walking, 2 days/week on fitness, BP, body composition, lipids and C‐reactive protein (CRP). Design: parallel 2‐group RCT (3:2) Power/sample size calculation: NR
Participants	No. randomised: 37 (23 in IG, 14 in CG) No. completers: 33 Country: UK Study population: general population adults (sedentary civil servants) Ethnicity: NR Gender: male 35% (13/37) Age: mean 41.5 (SD 9.3); 41.4 (SD 7.5) in IG, 40.8 (SD 10.0) in CG Smokers: 0% Hypertension: 0% Mean baseline BP: SBP=120.4 (SD 19.7) in IG, 116.5 (SD 13) in CG; DBP=77.2 (SD 9.4) in IG, 74.6 (SD 9.0) in CG Inclusion criteria: NR Exclusion criteria: Quote: "physically active lifestyle, age > 65 years, resting BP > 159/99 mmHg, total cholesterol > 6.2 mmol· L‐1, fasting blood glucose > 7.0 mmol· L‐1, body mass index (BMI) > 34.9 kg· m‐2, current cigarette smokers, individuals with cardiovascular, pulmonary or metabolic disease, pain or discomfort in the chest, dizziness or heart murmur. In addition, individuals taking medication known to interfere with lipid metabolism, and females who were pregnant or planning to become pregnant in the following five months were excluded from taking part in the study."
Interventions	IG: Walking group: single bout and outdoors walking; Only 12 walkers wore pedometer to record steps in week 0, 4 and 8. Duration: graduated increase to 45 min/session (25 min @ week 1; 35 min @ week 2; 45 minutes for week 3 to week 8) Intensity: moderate; self‐paced Frequency: 2 days/week Intervention period: 8 weeks Pedometer: yes, 12 walkers and all controls wore pedometer on weeks 0, 4 and 8. Facilitator: NR CG: Control group: wore pedometer to record steps in weeks 0, 4 and 8.
Outcomes	Review outcomes reported: SBP, DBP Measurement method: duplicate measurements of BP were taken two minutes apart using an automated device (Omron 705 CP; Omron Matsusaka Co. Ltd., Japan) Primary/Main outcome of manuscript: blood pressure, lipids, CRP and body composition Compliance/Adherence: % of prescribed sessions (16 sessions in total) were completed. Compliance was high with walkers completing 83.9 ± 18.9% of prescribed sessions. Adverse event: 0
Notes	Trial registration: NCT00284479 Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	C‐reactive protein "randomised controlled study" but no details reported refer to Table 1 (completers only)
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1 (completers only)
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 10.8% (4 out of 37) 2 out of 23 IG (8.7%), 2 out of 14 CG (14.3%) dropouts refer to Table 3 Quote: "Four individuals dropped out of the study due to: illness (1 control), moving job (1 control), family circumstances (1 walker) and lack of interest (1 walker)." PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 8 weeks only 1 analysis
Other bias	Low risk	No other bias

Murtagh 2005.

Study characteristics
Methods	Aim: to evaluate the effectiveness of instructing sedentary individuals to undertake 20‐minute brisk walking (in one continuous bout or two 10‐minute bouts) 3 days per week, on fitness and other cardiovascular disease (CVD) risk factors in previously sedentary adults. Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: NR
Participants	No. randomised: 48 (19 in IG1_Single bout, 18 in IG2_Acumulated bout, 11 in CG) No. completers: 32 Country: UK Study population: sedentary general population (University staff or students) Ethnicity: NR Gender: male 35% (17/48) Age: mean 45.7 (SD 9.4) Smokers: NR Hypertension: 0% Mean baseline BP: SBP = 117.9 (SD 12.0) in IG1_Single bout, 121.7 (SD 11.2) in IG2_Acumulated bout, and 117.5 (SD 18.1) in CG; DBP = 74 (SD 9.8) in IG1_Single bout, 75.4 (SD 6.6) in IG2_Acumulated bout, and 73.1 (SD 10.6) in CG. Inclusion criteria: NR Exclusion criteria: Quote: "History of cardiovascular or metabolic disease, resting blood pressure > 140/90 mmHg, body mass index > 30 kg m‐2, musculoskeletal condition or injury, taking medications known to interfere with lipid metabolism, or a physically active lifestyle (Defined as engaging in more than 20 min of planned exercise per week during the preceding 4‐week period)."
Interventions	IG_SB: Walking (single‐bout) group: Treadmill walking: treadmills at the university were free of use. During one session each week, walking was supervised and heart rate and walking speed were monitored continuously. A self‐reported training diary recoding walking duration, speed, distance and all walking notes was collected in week 12. Duration: 20 minutes/session Frequency: 1 session/day, 3 days/week Intensity: moderate (walk briskly) Length: 12 weeks Pedometer: NR Facilitator: yes, once a week IG_AB: walking (accumulated‐bout) group: Treadmill walking: treadmills at the university were free of use. During one session each week, walking was supervised and heart rate and walking speed were monitored continuously. A self‐reported training diary recoding walking duration, speed, distance and all walking notes was collected in week 12. Duration: 10 minutes/session Frequency: 2 session/day, 3 days/week Intensity: moderate (briskly) Pedometer: NR Facilitator: yes, once a week CG: Control group: no training
Outcomes	Review outcomes reported: SBP, DBP Measurement method: blood pressure measured by validated automated device (Omron 705CP; Omron Matsusaka Co. Ltd., Japan) Primary/Main outcome of manuscript: body composition, blood pressure and lipids Compliance/Adherence: compliance was defined as completing at least 60% of prescribed sessions [7] and, as a result, two subjects were excluded (1 single‐bout walker, 1 accumulated‐bout walker) Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomised" but no details reported refer to Results (32 completers only)
Allocation concealment (selection bias)	Unclear risk	No information refer to Results (32 completers only)
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 33.3% (16 out of 48) 4 out of 19 single IG (21%), 9 out of 18 accumulated IG (50%), 3 out of 11 CG (27.3%) dropouts Quote: "Fourteen subjects dropped out of the study due to: time pressures with work/study (2 single‐bout walkers, 3 accumulated‐bout walkers); personal circumstances (1 single‐bout walker, 2 accumulated‐bout walkers, 1 control); lack of interest (1 accumulated‐bout walker); starting medication (1 accumulated‐bout walker); moving job (1 accumulated‐bout walker); and starting a personal exercise programme (2 control)." Quote: "Compliance was defined as completing at least 60% of prescribed sessions [7] and, as a result, two subjects were excluded (1 single‐bout walker, 1 accumulated‐bout walker)." Data are therefore presented for 32 subjects (17 women) who completed the study. Data were from completers only refer to Result PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Nemoto 2007.

Study characteristics
Methods	Aim: whether the high‐intensity interval walking training increased thigh muscle strength and peak aerobic capacity and reduced blood pressure more than moderate‐intensity continuous walking training. Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: the statistical power to detect their significant changes after training in the continuous and interval walking groups was >0.8 at α of 0.05 except for SBP in men from the continuous walking group (0.74) and DBP in men from the interval walking group (0.53).
Participants	No. randomised: 246 (16 in Wcnt_male, 59 in Wcnt_female, 19 in Wint_male, 68 in Wint_female, 25 in CG_male, 59 in CG_female.) Wint: high‐intensity interval walking training group Wcnt: moderate‐intensity continuous walking training group No. completers: 139 Country: Japan Study population: general population adults Ethnicity: NR Gender: male: 24% (60/246) Age: mean 63 (SD 6), range 44 to 78 Smokers: 0% Hypertension: 0% Mean baseline BP: SBP=141 (SE 2) in Wcnt_male, 135 (SE 3) in Wcnt_female, 146 (SE 2) in Wint_male, 140 (SE 3) in Wint_female, 143 (SE 2) in CG_male, 142 (SE 3) in CG_female; DBP=85 (SE 2) in Wcnt_male, 81 (SE 2) in Wcnt_female, 87 (SE 3) in Wint_male, 85 (SE 2) in Wint_female; 84 (SE 2) in CG_male, 83 (SE 2) in CG_female. HR=81 (SE 3) in Wcnt_male, 78 (SE 1) in Wcnt_female, 75 (SE 3) in Wint_male, 81 (SE 2) in Wint_female, 80 (SE 3) in CG_male, 79 (SE 1) in CG_female. Inclusion criteria: Quote: “Nonsmoking middle‐aged and older adults (44 to 78 years) with no history of cardiovascular or pulmonary diseases” Exclusion criteria: NR
Interventions	WCNT: walking (continuous moderate‐intensity training) group: Participants were instructed to walk more than 8000 steps per day for a minimum of 4 days a week. Pedometers were given and returned to administration centre once a month to review the compliance. Only 18 participants in this group wore accelerometer to monitor intensity and steps. Duration: 8000 steps/day Intensity: 50%VO2peak Frequency: min 4 days/week Intervention period: 22 weeks (Training between 18 May and 15 Oct. 2004) WINT: walking (high‐intensity interval walking) group: Participants were divided into 5 subgroups and invited to a community office near their homes. Instruction of repeating the following regimen 4 or more times per week: 5 or more sets of 2 to 3‐minute low‐intensity walking intervals (at approximately 40% of the pre‐training VO2peak), followed by a 3‐minute interval of high‐intensity walking (70% to 85% VO2peak for walking) was given. Participants were instructed to reach target levels every 2 weeks, and needed to return to local office to review compliance and load the pedometer/accelerometer data. Duration: 25 to 30 minutes/day Intensity: 5 or more sets of 2‐ to 3‐minute low‐intensity walking intervals (at approximately 40% of the pre‐training VO2peak); followed by a 3‐minute interval of high‐intensity walking (>70% but <85% VO2peakfor walking). Frequency: minimum 4 days/week Intervention period: 22 weeks (5 months*4.33) (Training between 18 May and 15 Oct 2004) Pedometer: Yes, Omron, JH‐005, Kyoto, Japan Facilitator: NR CG: Control (no walking training) group: Remaining sedentary life.
Outcomes	Review outcomes reported: SBP, DBP, resting HR Measurement method: SBP and (DBP were measured by auscultation after the participant had been sitting for 10 minutes in a room Primary/Main outcome of manuscript: VO2peak (by graded cycling exercise and by graded walking exercise), isometric knee extension and flexion forces were measured at baseline and week‐20. Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: Government (This study was supported in part by grants from the Ministry of Health, Labor, and Welfare (Comprehensive Research on Aging and Health), the Japan Society for Promotion of Science, and the Ministry of Economy, Trade, and Industry of Japan.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Quote: "a few of the participants were married couples and wanted to join the same group, and others, who lived a distance from an administrative center, wished to be assigned to the interval walking group so that they could visit a local community office nearer their homes. For these reasons, minor reassignments were made..." There were "minor" reassignments after randomisation and it was not defined how many participants were reassigned. refer to Table 4
Allocation concealment (selection bias)	High risk	Quote: "a few of the participants were married couples and wanted to join the same group, and others, who lived a distance from an administrative centre, wished to be assigned to the interval walking group so that they could visit a local community office nearer their homes. For these reasons, minor reassignments were made..." In this case, the information of allocation is unlikely to be concealed. refer to Table 4
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	High dropout (total 107 out of 246 randomised, 43.5%) 24 out of 75 (32.0%) in Moderate intensity TG, 45 out of 87 (51.7%) in High intensity TG, and 38 out of 84 (45.2%) in CG drop outs refer to Figure 1 PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 5 months Only 1 analysis
Other bias	Low risk	No other bias

Neumann 2006.

Study characteristics
Methods	Aim: the potential attenuating effects of 6 months of walking (aerobic exercise) versus control on cardiovascular reactivity (CVR) to anger‐provoking stressors in sedentary older adults who manifest exercise‐induced silent myocardial ischaemia (SI) and have no history of overt coronary artery disease (CAD). Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 25 (14 in IG, 11 in CG) No. completers: 20 (9 dropouts, 4 CG re‐enter as IG) Country:USA Study population: adults with Silent Myocardial Ischemia (Baltimore‐Washington metropolitan area and the Charlestown Retirement Community) Ethnicity: NR Gender: male 68% (17/25) Age: mean 71 (SE 2) in IG, 63 (SE 2) in CG Smoker: 0% Hypertension: NR Mean baseline BP: SBP = 134 (SE 3) in IG, 140 (SE 6) in CG; DBP = 76 (SE 3) in IG, 80 (SE 2) in CG; resting HR = 71 (SE 3) in IG, 71(SE 3) in CG Inclusion criteria: older (age 56–83 years), nonsmokers with at least a high school education and without a history of symptomatic CAD. Exclusion criteria: Quote: “history of overt CAD, resting‐ECG evidence of CAD as defined by significant Q waves, major ST segment abnormalities, left‐bundle‐branch block, complex arrhythmias, poorly controlled hypertension (blood pressure >180/105 mmHg), stroke, peripheral arterial disease, poorly controlled hyperlipidaemia (low‐density lipid concentrations >190 mg/dl or plasma triglycerides >400mg/dl), diabetes mellitus, dementia (Mini‐Mental State Examination score <24), history of psychiatric disorders, current smoking, history of heavy alcohol consumption (>14 drinks per week), or other comorbid diseases that would interfere with the ability to participate in the study. Participants were also excluded if they had severe hypertension requiring multiple antihypertensive medications (3+) because of potential safety concerns of temporarily discontinuing their medications during the measurements of CVR.”
Interventions	IG: Walking (exercise) group: The duration and intensity of sessions were gradually increased until participants were walking for 40 minutes at 70% of their heart rate reserve or at their ischaemic threshold as determined during their exercise‐treadmill test. Duration: graduated increase to 40 minutes/sessions Intensity: 70% of their heart rate reserve; aiming at increasing the participants’ VO2max by 10% or more, without changing their weight. Frequency: 1 session/day, 3 days/week Intervention period: 26 weeks (6 months) Pedometer: no Facilitator: yes, by exercise physiologists CG: Control (wait‐list) group: the wait‐list controls received no further contact for 6 months before post‐control testing.
Outcomes	Review outcomes reported: SBP, DBP, resting HR Measurement method: all BP and HR data were collected oscillometrically at 60‐s intervals during rest and task periods with an automated vital‐signs monitor (Dinamap Model # 1846SX, Critikon, Tampa, FL). Primary/Main outcome of manuscript: cardiovascular reactivity (SBP, DBP, HR), Spielberger’s State‐Trait Personality Inventory questionnaires, lipoprotein lipids and glucose levels Compliance/Adherence: attended >75% of the exercise sessions Adverse event: NR
Notes	Trial registration: NR Funding sources: Government (This work was supported by National Institute on Aging (NIA) K24 AG 00930, NIA R29 AG15112, a Department of Veteran Affairs Geriatric Research, Education and Clinical Center Grant (GRECC), a VA Merit Grant, and the University of Maryland Claude D.Pepper Older Americans Independence Center (P60‐AG12583).)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomised" but no details reported a total of two randomisation performed: 25 randomised to 14/11, the 6 and 3 lost, then the controls randomised again to become intervention (+4). Turn out become 12 in IG and 8 in CG. refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 36.0% (9 out of 25) 6 out of 14 in IG (42.9%), 3 out of 11 in CG (27.3%) dropouts refer to Figure 1 Quote: "Four participants dropped out of the exercise‐training protocol because of time conflicts, and 2 participants experienced adverse health events not associated with study participation but precluding them from further participation. During the 6‐month waiting period, 1 participant from the control group experienced an adverse health event not associated with study participation but precluding the individual from further participation in the study, and 2 participants refused to return for post‐control assessment." PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 6 months Only 1 analysis
Other bias	Low risk	No other bias

Pagonas 2014.

Study characteristics
Methods	Aim: to investigates the impact of an aerobic exercise program on BPV Design:Parallel 2‐group RCT (1:1) Power/sample size calculation: yes
Participants	No. randomised:72 (36 in IG, 36 in CG) No. completers: 66 Country: Germany Study population: hypertensive outpatients (hypertension clinic or press) Ethnicity: NR Gender: male 43.1% (31/72) Age: mean 65.3 (range 42 to 79) in IG, 67.7 (range 43 to 77) in CG Smokers: ex‐smokers 15.3% (11/72) Hypertension: 100% Mean baseline BP: daytime ambulatory SBP = 137.9 (SD 12.3) in IG, 133.1 (SD 12.1) in CG daytime ambulatory DBP = 78.1 (SD 8.9) in IG, 73.8 (SD 6.4) in CG Inclusion criteria: current antihypertensive treatment with at least one antihypertensive drug and/or office blood pressure >=140/90 mmHg. Exclusion criteria: Quote: "regular engagement in physical exercise training in the past 4 weeks prior to inclusion in the study, symptomatic peripheral arterial occlusive disease, aortic insufficiency or stenosis >stage I, hypertrophic obstructive cardiomyopathy, congestive heart failure (>NYHA II), uncontrolled cardiac arrhythmia with haemodynamic relevance, systolic office BP >=180mmHg, signs of acute ischemias in exercise ECG, change of antihypertensive medication in the past 4 weeks prior to inclusion in the study or during follow‐up period."
Interventions	IG: Walking (exercise) group: Walking on a treadmill according to an interval‐training pattern; training was performed in the hospital. Training sessions were carried out with a target‐lactate concentration of 2.0±0.5 mmol/L in capillary blood slightly above the aerobic threshold. Duration: graduated increase to 36 minutes/session (3 minutes/day x 5 times (week 1); 5 minutes/day x 4 times (week 2), 8 minutes/day x 3 times (week 3), 10 minutes/day x 3 times (week 4), 15 minutes/day x 2 times (week 5). In the sixth and further weeks, exercise was progressively increased to 30, 32 and 36 minutes and carried out without interruption.) Intensity: NR Frequency: 1 session/day, 3 days/week Intervention period: 10 weeks ((8+12)/2) Pedometer: NR Facilitator: yes, by a study nurse and a physician CG: Control (sedentary) group: NR
Outcomes	Review outcomes reported: SBP, DBP Measurement method: assessment of 24‐hour‐ABP monitoring and physical performance were conducted before and after the observation period. 24‐hour‐ABP monitoring was performed using Spacelabs 90 207 monitors (Spacelabs, Redmond, WA, USA). Primary/Main outcome of manuscript: a change in systolic BPV measured as the CV of systolic daytime ABP. Compliance/Adherence: minimum of 8 weeks Adverse event: NR
Notes	Trial registration: NR Note: included Dimeo study participants, not separately analysed resistant hypertension subset. Funding sources: private sector (The study was supported by the Gertrud und Hugo Adler Stiftung, Georgensgmu¨ nd, Germany.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Participants were randomly assigned to an exercise program or sedentary control." Quote: "A total of 72 patients, who met the inclusion criteria, were randomized by lot to either the exercise group (36 patients) or the control group (36 patients, Figure 1)." No details about the randomisation procedure refer to Table 1 & 2
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Quote: "The aerobic exercise program consisted of walking on a treadmill according to an interval‐training pattern. Training was performed in the hospital. Patients were supervised during training by a study nurse and a physician." Insufficient information about control group and not sure if the nurse and physician had any opportunity to care participants in control group.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Measurement of 24‐hour ambulatory blood pressure was used.
Incomplete outcome data (attrition bias) All outcomes	Low risk	dropout 8.3% (6 out of 72) 3 out of 36 in IG (8.3%) & 3 out of 36 in CG (8.3%) dropouts refer to Figure 1 (dropout) PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 8 to 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Palmer 1995b.

Study characteristics
Methods	Aim: the psychological effects of an 8‐week walking program on attributional style, scores of depression, self‐esteem, and physical fitness in females. Design: Parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 27 (16 in IG, 11 in CG) No. completers: 27 Country: USA Study population: non‐exercising, premenopausal, female volunteers (recruited from the general public via radio and newspaper) announcements. Ethnicity: NR Gender: male 0% (0/27) Age: mean 37.4; range 29 to 50 Smokers: NR Hypertension:0% Mean baseline BP: SBP = 117.1 (SD 14) in IG, 122.6 (SD 13.8) in CG; DBP = 80.9 (SD 10.6) in IG, 77.6 (SD 11.2) in CG; HR = 74 (SD 10.8) in IG, 71 (SD 6.5) in CG Inclusion criteria: non‐exercising, premenopausal women Exclusion criteria: Quote: "history of heart disease or other significant health problems and those who reported having been highly fit in the past 3 years were not eligible for participation."
Interventions	IG: Walking group: walking in university coliseum. Duration: gradually increase to 55 minutes/session (starting from 20 minutes) Intensity: 60% to 70% of estimated maximum heart rate, participants were instructed to measure their carotid halfway the walking to ensure the intensity reached 60% to 70% of estimated maximum heart rate Frequency: lacking data of walking frequency per week Intervention period: 8 weeks Pedometer: NR Facilitator: yes CG: Control group: non walking, wait‐list
Outcomes	Review outcomes reported: SBP, DBP, resting heart rate Measurement method: resting heart rate and blood pressure were measured by digital blood‐pressure cuff Primary/Main outcome of manuscript: psychological outcomes Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Participants were randomly assigned to either a walking group...... or nonwalking, ......" and no other details about randomisation. refer to Table 2
Allocation concealment (selection bias)	Unclear risk	No information There is no information about control group participants.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	No dropout refer to table 2 ITT analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 8 weeks Only 1 analysis
Other bias	Low risk	No other bias

Pernar 2017.

Study characteristics
Methods	Aim: the feasibility of a randomised walking group intervention to improve quality of life, circulating biomarkers, and morbidity among men with newly diagnosed prostate cancer. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised:41 (21 in IG, 20 in CG) No. completers: 36 Country: Sweden Study population: newly diagnosed prostate cancer patients Ethnicity: NR Gender: male 100% (41/41) Age: range 61.7 to 81.7 years in IG; 54.5 to 81.6 years in CG Smokers: 48% in IG; 50% in CG Hypertension: NR Mean baseline BP: SBP = 170 in IG, 162 in CG; DBP = 93 in IG, 89 in CG Inclusion criteria: histological diagnosis of prostate cancer without evidence of distant metastases, had completed initial treatment at least 1 month prior to study enrolment, and had a life expectancy of at least 5 years, the ability to speak Swedish and be mentally and physically able to complete the questionnaires and clinical exam and to participate in group walking sessions. Exclusion criteria: physical or mental impairment
Interventions	IG: Walking group: participants were assigned to groups of 6 to 8 men, based on the participants’ availability for walking on specific times of the day. For the 11‐week intervention, the men walked together weekly in their groups for 1 hour along with a research nurse who answered patients’ questions about prostate cancer and led discussions. On other days, the men were instructed to wear pedometers to monitor the number of steps they took on a given day. In addition, they recorded their daily number of steps in a diary. Duration: self‐paced, encouraged to maintain 10,000 steps per day. Frequency: 7 sessions/week Intensity: NR Intervention period: 11 weeks Pedometer: Yes, Timex W‐180 US 621 095000 Facilitator: yes. CG: Control (usual care) group: received no intervention other than their usual medical care
Outcomes	Review outcomes reported: SBP, DBP Measurement method: not mentioned, only physical exam by research nurse Primary/Main outcome of manuscript: quality of life and circulating biomarker Compliance/Adherence: walked within 1000 steps of the study goal of 10,000 steps per day on average over the 11 weeks Adverse event: NR
Notes	Trial registration: NR 1. Convert % Difference in mean change in column 7 of Table 2 into Difffference in mean change score by dividing by 100. E.g. for SBP ‐8.51 = ‐8.51/100 = ‐0.0851 = mean difference of change scores = MD 2. Similarly covert 95%CI limits i.e. ‐21.23 and 4.21 become ‐0.2123 and 0.0421 3. Now use Revman Claculator, enter N, MD and 95%CI limits into the bottom set of boxes to get the SE of the mean diff of change score. 4. Use the MD and this SE to enter into GIV data type for meta‐analysis. 5. For SBP, MD = ‐0.085, SE (MD) = 0.0638 6. For DBP, MD = ‐0.0002, SE (MD) = 0.0321 Funding sources: Private sector(C.H. Pernar and S.C. Markt are supported by National Institutes of Health (NIH) training grants (T32 ES 007069, T32 CA 09001). This project was supported in part by funding from the Prostate Cancer Foundation (PCF). L.A. Mucci and J.R. Rider are PCF Young Investigators.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "randomised to the study through a random number generator... "
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 12.2% (5 out of 41) 4 out of 21 (19.0%) in walking group, 1 out of 20 usual care group (5.0%) dropouts refer to Figure 1 and author provided information PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 11 weeks Only 1 analysis
Other bias	Low risk	No other bias

Pospieszna 2017.

Study characteristics
Methods	Aim: to test if Nordic walking training would be increased endothelial nitric oxide synthase (eNOS) activity and, consequently, greater capacity for nitric oxide (NO) formation in the vascular endothelium. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: no
Participants	No. randomised: 39 (20 in IG, 19 in CG) No. completers: 39 Country: Poland Study population: healthy postmenopausal women (recruited through public advertisement) Ethnicity: NR Gender: male 0% (0/39) Age: mean 62 (SD 3.79) in IG, 62 (SD 1.12) in CG; range: 52 to 72 Smokers: data collected but NR Hypertension: no Mean baseline BP: SBP = 134.7 (SD 21.23) in IG, 132.16 (SD 3.8) in CG; DBP = 75.8 (SD 7.06) in IG, 78.58 (SD 1.96) in CG. Inclusion criteria: postmenopausal volunteers; good health status; aged between 52 and 72. Exclusion criteria: Quote: "exclusion criteria for volunteers included inflammatory disorders, recent infections, renal or hepatic insufficiency, active coronary artery disease, diabetes, hypertension (>160/100 mmHg), heart failure, the use of hormonal replacement therapy, and supplementation with antioxidants within 3 months prior to enrolment."
Interventions	Training group: Nordic walking Duration: 60 minutes/session Frequency: 3 times/week Intensity: 90% of ventilatory threshold (VT) intensity Intervention period: 12 weeks Pedometer: no Facilitator: yes Control group: were asked to continue their daily routines, without any major changes, especially in the level of everyday physical activity
Outcomes	Review outcomes reported: SBP, DBP, HR Measurement method: after the participants spent a further 5 minutes resting in the supine position, the level of blood pressure and heart rate at rest were measured. Primary/Main outcome of manuscript: endothelial NOS activity, TAC and oLAb concentration Compliance/Adherence: quote: "Participants in the training group performed a 12‐week supervised NW training, preceded by individual demonstrations of the proper walking technique. Each physical workout took place outdoors and consisted of 60‐minute sessions of exercise (50 minutes of walk with 90% of ventilatory threshold [VT]intensity, 5‐minute warm‐up, and 5‐minute stretching), repeated three times per week." Adverse event: NR
Notes	Trial registration: NR Funding sources: Government (This work was partially financed by the City of Poznan as part of the "Academic and Scientific Poznari" strategy)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomly divided into a training group ... and a control group" "Both groups were similar with regard to anthropometric parameters, such as body mass, BMI, or height. None of the accepted women changed their nutritional approach during the analysed 12‐week period. In particular, the levels of salt and alcohol intake were unchanged. Women assigned to the control group were asked to continue their daily routines, without any major changes, especially in the level of everyday physical activity." No other details about randomisation
Allocation concealment (selection bias)	Unclear risk	Quote: "randomly divided into a training group ... and a control group" "Both groups were similar with regard to anthropometric parameters, such as body mass, BMI, or height. None of the accepted women changed their nutritional approach during the analysed 12‐week period. In particular, the levels of salt and alcohol intake were unchanged. Women assigned to the control group were asked to continue their daily routines, without any major changes, especially in the level of everyday physical activity." No other details about allocation concealment
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	39 randomised but the number of participants at outcome measures was not reported Unsure ITT or PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Ready 1996.

Study characteristics
Methods	Aim: the effect of walking volume on aerobic fitness, serum lipids, and body composition in women post‐menopause, a population at risk for coronary artery disease. Design: Parallel 3‐group RCT (1:1:1) Power/sample size calculation: yes
Participants	No. randomised: 79 (27 in IG1_3D, 27 in IG2_5D, 25 in CG) No. completers: 56 Country: Canada Study population: sedentary postmenopausal women (50+) Ethnicity: NR Gender: male 0% (0/79) Age: mean 61.3 (SD 5.8) (56 completers) Smokers: 0% Hypertension: NR Mean baseline BP: SBP = 134 (SD 18) in IG1_3D, 131 (SD 20) in IG2_5D, 131 (SD 16) in CG; DBP = 77 (SD 11) in IG1_3D, 76 (SD 9) in IG2_5D, 77 (SD 10) in CG. Inclusion criteria: Quote: “post‐menopausal status (no menstrual periods in the past 12 months), over 50 yrs of age, absence of hormone replacement therapy or medication to lower serum cholesterol, nonsmoker status, a sedentary lifestyle (exercising less than 30 min/wk), physical ability to exercise, and a body mass index of 34 or less. Total serum cholesterol levels less than 8.0 mmol/l and serum triglyceride less than 4.2 mmol/l" Exclusion criteria: Quote: "of these 30 were screened out for medical reasons, including medications that interfere with serum lipids, or presence of disease that would preclude unsupervised walking (e.g., known heart disease)."
Interventions	IG_3D: Walking (3 days/week) group: Duration: 60 minutes/session Frequency: 1 session/day, 3 days/week Intensity: 60% VO2peak Intervention period: 24 weeks IG_5D: Walking (5 days/week) group: Duration: 60 minutes/session Frequency: 1 session/day, 5 days/week Intensity: 60% VO2peak Intervention period: 24 weeks Participants were instructed to walk a complete 60 minutes first, and then gradually increased the intensity thereafter. Walkers were requested to attend at least 4 supervised session at the university track (5 times per week) in the first 2 week, and at least one per week thereafter. Unsupervised sessions took place in a variety of settings including community tracks, fitness facilities, parks, and public roads. Pedometer: no Facilitator: yes, 4 supervised walking classes in first 2 weeks, and at least 1/week thereafter CG: Control group: participants were asked to maintain sedentary lifestyle
Outcomes	Review outcomes reported: SBP, DBP Measurement method: no mention on blood pressure measurement. Heart rate was monitored with an ECG (Cardio Tracer, Birtcher Medical Systems) using a CM5lead. Primary/Main outcome of manuscript: aerobic fitness, serum lipids, and body composition Compliance/Adherence:walkers must walk an average of at least 150 minutes/week and 240 minutes/week to successfully complete the study. Adverse event: NR
Notes	Trial registration: NR Funding sources: private sector (This study was supported by the Canadian Fitness and Lifestyle Research Institute (https://www.cflri.ca/who‐we‐are, project #931R014), the Manitoba Medical Service Foundation, and the Centre on Aging at the University of Manitoba.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomly assigned" but no details reported Completers only
Allocation concealment (selection bias)	Unclear risk	No information Completers only
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 29.1% (23 out of 79) 8 out of 27 (29.6%) in 3‐day walking, 10 out of 27 5‐day walking (37.0%), 5 out of 25 (20.0%) in CG dropouts Unspecific reasons for each group refer to Figure 1 PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 24 weeks Only 1 analysis
Other bias	Low risk	No other bias

Romero 2019.

Study characteristics
Methods	Aim: to investigate the effects of a pedometer on motivating Mexican‐American female participants, ages sixty to seventy‐five years old, to increase their physical activity to lower weight and /or blood pressure. Design: Parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 55 (27 in IG, 28 in CG) No. completers: 55 Country: USA Study population: general population (women) Ethnicity: Mexican‐American Gender: male 0% Age: range 60 to 75 Smokers: NR Hypertension: NR Mean baseline BP: SBP = 143.67 (SD 21.91) in IG. 146.07 (SD 24.18) in CG; DBP = 84.41 (SD 15.19) in IG, 82.96 (SD 10.29) in CG. Inclusion criteria: Mexican‐American females aged 60 to 75 years Exclusion criteria: NR
Interventions	IG: Walking group: the treatment group participants completed simple entry logs to record the number of steps and facilitate the evaluation of the program. Each participant in the treatment group was contacted once a week via telephone to remind recording daily steps. Duration: NR Intensity: NR Frequency: 7 days/week Intervention period: 12 weeks Pedometer: yes as a motivational tool (brand unknown) Facilitator: NR CG: Control group: participants did not receive a pedometer or entry logs, only education on the importance of diet and exercise on the pretest meeting. They were instructed to return at the end of the twelve weeks to complete a posttest.
Outcomes	Review outcomes reported: BP Measurement method: weight, systolic and diastolic blood pressure were measured at baseline and a follow‐up meeting 12 weeks later. Primary/Main outcome of manuscript: weight, systolic and diastolic blood pressure Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Randomly assigned but no detailed information provided
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 0% (0/55) refer to Table 3 ITT analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Sakuragi 2006.

Study characteristics
Methods	Aim: the effects of daily walking on subjective symptoms as well as on mood and autonomic nervous function in people who take no medication but have some general physical complaints. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: no
Participants	No. randomised: 20 (12 in IG,8 in CG) No. completers: 15 Country: Japan Study population: healthy college students from general population Ethnicity: NR Gender: male 0% (0/20) Age: range 20 to 22 Smokers: 0% Hypertension: 0% Mean baseline BP: figure 2. Inclusion criteria: normotensive nonsmokers Exclusion criteria: Quote: "exercised regularly two or more times per week for at least 30 min during the preceding 12 months and those who took medication on a regular basis"
Interventions	IG: Walking group: without altering other habitual activities during the study period Duration: 60 minutes/session Frequency: 1 session/day, 6 days/week Intensity: 6 km/hour (rapid walk) Intervention period: 4 weeks Pedometer: wore lifestyle record machine (Lifecorder, Suzuken, Japan) to record motor activities by acceleration sensors Facilitator: NR CG: Control group: wore lifestyle record machine from the previous week to the end of the study to ensure a level of daily activity.
Outcomes	Review outcomes reported: SBP, DBP, HR Measurement method: an occlusion cuff of appropriate size was attached to the left arm with a tonometry sensor on the radial artery at the wrist to measure blood pressure (BP) waveform (Colin, Japan). Primary/Main outcome of manuscript: psychological indices (Cornell medical index questionnaire, profile of mood states, and frontal alpha laterality ratio) and autonomic indices (Blood pressure and ECG variance under orthostatic condition) measured at baseline and week 4. Compliance/Adherence: walkers whose average amount of exercise calculated from the Lifecorder data did not increase by more than 1.2 kcal/kg/day would be excluded. Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	No information ‐ Quote: "All subjects were normotensive non‐smokers and were randomly assigned into two groups: a walking group (n=12) and a control group (n=8)." Completers only
Allocation concealment (selection bias)	Unclear risk	Completers only
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 25% (5 out of 20) Completer‐only analysis refer to table 1 PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 4 weeks Only 1 analysis
Other bias	Low risk	No other bias

Salesi 2014.

Study characteristics
Methods	Aim: to investigate the effect of 8‐week walking program on metabolic syndrome indexes in non‐athlete menopausal women Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 32 (16 in IG, 16 in CG) No. completers: 32 Country: Iran Study population : elderly women Ethnicity: NR Gender: male 0% Age: range 50 to 55 years Smokers: NR Hypertension: NR Mean baseline BP: SBP=136.0 (SD 12.1) in IG, 131.1 (SD 8.7) in CG; DBP = 83.1 (SD 10.1) in IG, 80.3 (SD 3.8) in CG Inclusion criteria: aged 50 to 55, healthy inactive, fulfilling at least three criteria of ATPIII, at least 2 years of menopause, physical health, no regular exercise (at least 3 sessions a week) over the last 6 months before the study, not using hormone therapy Exclusion criteria: NR
Interventions	IG: walking group: walking with 60% heart rate reserve and for 30 minutes for the first two weeks. From the third week, every 2‐week sessions increased by 10 minutes and intensity increased by 5%. So that the session was with 75% heart rate reserve and 60 minutes at last week. Walking at own time (not treadmill) Duration: gradually increase from 30 minutes to 60 minutes Intensity: gradually increase from 60% heart rate reserve to 75% heart rate reserve Frequency: 3 sessions per week Intervention period: 8 weeks Pedometer: not mentioned Facilitator: not mentioned CG: Control group: everyday normal activities with no physical exercise
Outcomes	Review outcomes reported: SBP, DBP Measurement method:. measure by sphygmomanometer Primary/Main outcome of manuscript: SBP, DBP Compliance/Adherence: completed all session Adverse event: NR
Notes	Trial registration: NR Funding sources: Egyptain government
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	The randomisation method was not described, the sample size is equal at the two groups. Based on Table 1, weight, BMI, fat% and waist to hip ratio seems to be comparable at the two groups before the program.
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	There was no missing value for the outcomes before and after the program at the two groups. refer to table 1, 2 According to the outcome table 1 and 2, the dropout rate was 0% since the participant number was the same in tables. ITT analysis
Selective reporting (reporting bias)	Low risk	Only 1 analysis
Other bias	Low risk	No other bias

Saptharishi 2009.

Study characteristics
Methods	Aim: to measure the efficacy of physical exercise, reduction in salt intake, and yoga, in lowering BP among young (20 to 25) pre‐hypertensives and hypertensives, and to compare their relative efficacies. Design: parallel 4‐group RCT (1:1:1:1) Power/sample size calculation: NR
Participants	No. randomised:58 (28 in IG, 30 in CG); (27 in Yoga group and 28 in Salt intake reduction excluded) No. completers: 56 Country: India Study population: confirmed hypertensives/pre‐hypertensives Ethnicity: NR Gender: male 69.6% ((20+19)/56) Age: mean 22.4 (SD 1.3) in IG; 22.5 (SD 1.4) in CG Smokers: NR Hypertension: 100% pre‐hypertensive and hypertensive Mean baseline BP: SBP = 128.6 (SD 7.7) in IG, 123.1 (SD 10.2) in CG; DBP = 87.4 (SD 4.8) in IG, 82.9 (SD 7.1) in CG Inclusion criteria: pre‐hypertensives (SBP130 to 139 mmHg and/or DBP 85 to 89 mmHg) and hypertensives. Exclusion criteria: severe hypertension
Interventions	IG: walking (physical exercise) group: Duration: 50 to 60 minutes/session Intensity: brisk walking Frequency: 1 session/day, 4 days/week Intervention period: 8 weeks Pedometer: NR Facilitator: yes, the investigator accompanied walkers on several occasions CG: Control group: NR Note: yoga and salt intake reduction groups excluded
Outcomes	Review outcomes reported: SBP, DBP Measurement method: blood pressure was measured using the mercury sphygmomanometer. Primary/Main outcome of manuscript: SBP, DBP Adverse event: NR
Notes	Trial registration: NR Funding sources: Government (This study was sponsored by the Indian Council of Medical research (ICMR), New Delhi under the Short Term Studentship scheme (STS‐2007).)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "using a standardized randomization process, with a random number generator (SPSS 13.0)." refer to Table 1 (completers only)
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 3.4% (2 out of 58) 1 out of 28 in walking group (3.6%) & 1 out of 30 in control group (3.3%) dropouts refer to Table 1 Both ITT and PP done
Selective reporting (reporting bias)	Low risk	Reported measurement at 8 weeks only 1 analysis
Other bias	Low risk	No other bias

Serwe 2011.

Study characteristics
Methods	Aim: to compare changes in PA between participants assigned to walk daily in accumulated shorter bouts, one continuous session and control group. Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: Yes
Participants	No. randomised: 60 (20 in IG_LB, 20 in IG_SB, 20 in CG) No. completers: 53 Country: USA Study population: sedentary office women Ethnicity: NR Gender: male: 0% (0/60) Age: mean 37.1 (SD 7.2) in IG_LB, 38.2 (SD 7.3) in IG_SB, 36.3 (SD 8.1) in CG; range 18 to 50 Smokers: NR Hypertension: 0% Mean baseline BP: SBP = 115.1 (SD 10.5) in IG_LB, 117.7 (SD 12.1) in IG_SB, and 120.9 (SD 9.2) in CG; DBP = 73.4 (SD 8.1) in IG_LB, 73.2 (SD 8.7) in IG_SB, 72.7 (SD 7.2) in CG Resting HR = 68.4 (SD 10.4) in IG_LB, 65.8 (SD 6.0) in IG_SB,72.7 (SD 9.5) in CG Inclusion criteria: Quote: “premenopausal healthcare workers between the ages of 18 and 50 years, inactive (i.e., did not engage in ≥30 minutes of daily physical activity either continuous or accumulated on >2 days/week for the past 3 months, per self‐report), free of cardiovascular, pulmonary, neurological, metabolic, or orthopedic disorders that could interfere with safe walking without an assistive device.” Exclusion criteria: participants who averaged >7500 steps/day, postmenopausal, taking medication known to affect blood pressure or being pregnant.
Interventions	IG_LB: walking (long bout) group: Duration: 30 minutes/session Frequency: 1 session/day, 5 days/week Intensity: moderate walking pace, 60% to 70% heart rate reserve Intervention period: 8 weeks IG_SB: Walking (short bout) group: Duration: 10 minutes/session, Frequency: 3 sessions/day, 5 days/week Intensity: moderate walking pace, 60% to 70% heart rate reserve Intervention period: 8 weeks Pedometer: Yes Facilitator: NR CG: Control group: maintaining normal physical activity levels and diet during the 8‐week intervention period.
Outcomes	Review outcomes reported: SBP, DBP, resting HR Measurement method: participants measures of resting blood pressure with a mercury sphygmomanometer and stethoscope. Primary/Main outcome of manuscript: physical activity assessed via steps=day obtained by pedometer. Fitness (6MWT) Compliance/Adherence: completed ≥80% of the prescribed walking bouts Adherence to prescribed intensity: Quote: "During week 8 of the walking program, 51.6% of the participants were in the recommended heart rate range of 60%–70% HRR, 38.7% of participants averaging below the recommended range and 9.7% of participants averaging above the recommended heart rate range. Average heart rate from week 4 of the intervention was not significantly different from the week 8 average heart rate (t=‐0.481, p=0.636). Week 4 and week 8 heart rate averages were positively correlated (r=0.564, p=0.015). The LB group followed recommended heart rate ranges with greater consistency than did the SB group (Table 3)." Adverse event: NR
Notes	Trial registration: NR Funding sources: Government (This work was supported by funding from a College of Health Sciences Research Award and from a Career Development Award from the National Institute on Aging (K01AG025962))
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "participants deemed eligible were randomized to one of three study groups (control, LB, or SB group) and underwent initial pre‐intervention assessments." but no other details. refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Quote: "All educational materials, assessments, and follow‐up calls were scripted to have each participant receive the same information and treatment." but Unlikely that research personnel and participants blinded
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 11.7% (7 out of 60) Quote: "Of the 60 women enrolled, 53 completed the study" "Of the 7 who did not complete the study, 1 was from the control group" (1/20, 5%), "3 were from the Short Bout group" (3/20, 15%), "and 3 were from the Long Bout group." (3/20, 15%) refer to Table 1 ITT analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 8 weeks Only 1 analysis
Other bias	Low risk	No other bias

Shenoy 2010.

Study characteristics
Methods	Aim: to analyse the effects of 8 weeks of aerobic walking using a heart rate monitor (HRM) and pedometer for monitoring exercise intensity on glycaemic outcomes, fasting blood glucose (FBG), cardiovascular fitness and well‐being in type 2 diabetes patients. Design: Parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 40 (20 in IG, 20 in CG) No. completers: 40 Country: India Study population: T2DM patients Ethnicity: NR Gender: male 73% (29/40) Age: mean 53.15 (SD 4.4) in IG; 51.00 (SD 5.4) in CG Smokers: NR Hypertension: excluded if uncontrolled hypertension Mean baseline BP: SBP = 122 (SD 13.8) in IG, 131 (SD 12.7) in CG; DBP = 85.6 (SD 16.1) in IG, 86.0 (SD 7.2) in CG; Resting HR = 82.7 (SD 10.6) in IG; 81.0 (SD 9.7) in CG Inclusion criteria: Quote: “Diagnosed with type 2 diabetes, aged between 40 and 70 years, not taking insulin, without physical limitation, were not enrolled in other physical activity program previously or simultaneously and with the duration of diabetes between 1 and 10 years.” Exclusion criteria: Quote: "Evidence of coronary artery disease, uncontrolled hypertension, advanced retinopathy or neuropathy, severe orthopedic/cardiovascular/respiratory conditions restricting physical activity"
Interventions	IG: Walking group: a pilot study was conducted to estimate an average steps they could walk at 50% to 60% of maximum heart rate in 30 minutes, counted for 3000 steps for most participants. Participants were informed and trained to be familiar with the intensity and the body work until they can self‐monitor the exercise intensity.A self‐recorded diary log reported steps count and RHR. Participants were asked to maintain their diet habit during the program and advised regarding eating 1 to 2 hours before exercise avoiding hypoglycaemia and maintaining hydration level. Duration: 30‐minute/session Intensity: moderate, 50% to 70% of maximum heart rate (at least 4000 steps in 35 to 40 min duration, up to 70% max HR in 8 weeks) Frequency: 1 session/day, 5 days/week Intevention period: 8 weeks Pedometer: yes Facilitator: yes CG: Control group: no training but continued with medication as before and not engaged in any kind of active exercise intervention during the entire study period
Outcomes	Review outcomes reported: SBP, DBP, resting HR Measurement methods: blood pressure: Sphygmomanorneter‐Lifecare (N and B Medical Products Co.). Heart rate: Polar S410™ heart rate monitor (CE0537, Finland). Primary/Main outcome of manuscript: glycaemic outcomes, fasting blood glucose, cardiovascular fitness parameters and general well‐being Adverse event: NR
Notes	Trial registration: NCT01293253 Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomly assigned to one of the following two groups by a random lottery approach: the experimental group (group A) or control group (group B)" but no further details
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Unlikely that research personnel and participants blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	No dropout ITT analysis; Start of study: Intervention n = 20, Control n = 20; At follow‐up: Intervention n = 20/20 = 100%, Control n = 20/20 =100% refer to Table 2
Selective reporting (reporting bias)	Low risk	Reported measurement at 8 weeks Only 1 analysis ITT analysis
Other bias	Low risk	No other bias

Stanton 1996.

Study characteristics
Methods	Aim: the effect of moderate exercise (three 40‐minute sessions of brisk walking a week for 6 months) on mood state in sedentary, mildly hypertensive volunteers. Design: parallel 4‐group RCT Power/sample size calculation: yes (Thesis 7.1.10 Statistical Power)
Participants	No. randomised: 102 (53 in IG, 49 in CG); (55 in exercise + salt restriction and 51 in Salt restriction only excluded) No. completers: 89 Country: New Zealand Study population: mild hypertensive adults (recruited through participants’ general practitioners and through advertisements in community newspapers) Ethnicity: European (n = 179, 99%), Pacific Island (n = 1, 1%), Chinese (n = 1, 1%) (from Thesis Table 8.3) Gender: male: 52% (95/181; 181 refers to the overall completers only from four groups) Age: mean 55.2 (SE 1.4) in IG, CG:53.8 (SE 1.5) in CG, range 26 to 71) Smokers: 13/181 (181 refers to the overall completers from four groups; from thesis Table 8.3) Hypertension: 100% essential hypertension Mean baseline BP: (From Thesis Table 8.8) SBP = 142.9 (SE 2.5) in IG, 145.3 (SE 2.6) in CG; DBP = 88.4 (SE 1.4) in IG, 94.0 (SE 1.4) in CG. Inclusion criteria: Quote: “Essential hypertension, aged between 20 and 69 inclusive, a sedentary lifestyle, and being managed by a primary care doctor.” Exclusion criteria: Quote: “Symptomatic coronary heart disease, immobility that restricted walking, current diastolic blood pressure greater than 105 mmHg or a systolic blood pressure greater than 180 mmHg, and currently performing regular moderate activity. This excluded persons who were involved in more than 2 hours of moderate leisure time activity per week other than housework or gardening.”
Interventions	Extracted from Thesis: IG: Walking (exercise) group (Group B): brisk walking. A weekly diary was used to note health problems experienced during the week as well as compliance with medication. Duration: 40 minutes/session Intensity: moderate (Table 2) Frequency: 1 session/day, 3 days/week Intervention period: 26 weeks Pedometer: NR Facilitator: NR CG: Control group (Group D) Note: Group A Exercise + salt restriction and Group C Salt restriction excluded
Outcomes	Review outcomes reported: SBP, DBP Measurement methods: blood measured with Hawksley random zero sphygmomanometer Primary/Main outcome of manuscript: mood state (measured at baseline and week‐26) Adverse event: NR
Notes	Trial registration: Auckland Blood Pressure Control Study Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Participants were randomised at the time of the baseline interview..." Thesis section 7.1.3 Randomisation Balance baseline characteristics in Thesis Table 8.8
Allocation concealment (selection bias)	Low risk	Quote: "Participants were randomised at the time of the baseline interview..." Thesis section 7.1.3 Randomisation Balance baseline characteristics in Thesis Table 8.8
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote: "Therefore the doctors were unblinded ..." Thesis 7.1.3 Randomisation "The participants in the four intervention sub‐groups were thus blind to each other's intervention." p.152
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes BP measured blindly
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 12.7% (13 out of 102) 181 (87%) completed the study, 177 (85%) completed the primary outcome measurement Group B. Exercise only: 46/53, 87% completed Group D. Control: 43/49, 88% completed refer to thesis and table I, II PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 26 weeks Only 1 analysis
Other bias	Low risk	No other bias

Stutzman 2010.

Study characteristics
Methods	Aim: to measure the effects of a 16‐week low‐intensity walking program in healthy, normal weight, and overweight/obese pregnant women on BP, heart rate variability (HRV), and BRS. Design: Parallel 2‐group RCT Power/sample size calculation: Yes
Participants	No. randomised: 25 (2 excluded & 1 withdraw after randomisation; 11 in IG [normal = 5, overweight = 6], 11 in CG [normal = 5, overweight = 6]) No. completers: 22 Country: Canada Study population: healthy women who were 20 weeks pregnant Ethnicity: NR Gender: male 0% (0/22) Age: mean 30.4 (SD 4.2) in IG_norm, 28.8 (SD 6.9) in IG_overweight; 25.8 (SD 3.0) in CG_norm, 26.2 (SD 5.6) in CG_overweight, ranged between 20 and 69 inclusive Smokers: non‐smoker during pregnancy Hypertension: 0% Mean baseline BP: SBP = 111 (SD 12) in IG_norm, 114 (SD 14) in IG_overweight; 109 (SD 7) in CG_norm, 107 (SD 8) in CG_overweight, DBP = 76 (SD 11) in IG_norm, 75 (SD 10) in IG_overweight; 74 (SD 4) in CG_norm, 72 (SD 4) in CG_overweight Inclusion criteria: healthy pregnant women at 20 (+ 2) weeks gestational age met the inclusion criteria of: (a) singleton pregnancy, (b) sedentary lifestyle (defined as ≤ 2 sessions of aerobic exercise per week, and (c) approval of the attending physician. Exclusion criteria: "(a) alcohol or drug dependence, (b) hypertension, diabetes, or comorbid medical conditions, or reasons that contraindicated exercise, (c) cigarette smoking during pregnancy, and (d) medical reasons or treatments that would confound the measurement of HRV and BRS."
Interventions	1. Walking group: IG_overweight: overweight, IG_norm: Normal weight Walking groups received verbal and written instructions for a 16‐week, progressive, low‐intensity walking program, an walking log, and the Borg 15‐point (6 to 20) RPE scale. Single bout. Activity log was collected at completion of the 16‐week period, and biweekly call or email from the researcher was provided to answer any questions and to assess/promote compliance. Duration: self‐paced, graduated from 0.6km/day to 3.0km/day by week 16 Intensity: low, <40% of the heart rate reserve with RPE 11 to 13 on Borg scale; taught participants how to monitor their HR response to exercise by radial artery palpation Frequency: 5 sessions/week Intervention period: 16 weeks Pedometer: no Facilitator: yes, on the first day of the walking program. 2. Control group: CG_overweight : overweight CG_norm: normal weight An activity log to record daily physical activity was given and collected at completion of the 16‐week period. Biweekly call or email from the researcher was provided to answer any questions and to assess/promote compliance.
Outcomes	Review outcomes reported: SBP, DBP Measurement method: maternal BP (arm) and HR were measured using a BpTRU (Model BPM‐300, VSM MedTech Ltd., Coquitlam, BC, Canada) BP monitor. Primary/Main outcome of manuscript: BP pressure, HRV, and baroreflex sensitivity (BRS) Compliance/Adherence: at least three exercise sessions per week. Adverse event: NR
Notes	Trial registration: NR Funding sources: None
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	By minimization method: quote: "Participants were assigned to one of four groups based on exercise group and BMI category. The first two subjects within each weight group, normal or overweight/obese, were randomized by coin toss to either an exercise (walking) group or a non‐exercise control group. Subsequent participants were then assigned to either the exercise (walking) group (n=11) or the non‐exercise control group (n=11) based on BMI so that the weight categories were equally represented in each exercise group." refer to Table 1
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Unlikely that research personnel and participants blinded
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 12% (3 out of 25) refer to table 1, 2 PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 16 weeks Only 1 analysis
Other bias	Low risk	No other bias

Tudor‐Locke 2004.

Study characteristics
Methods	Aim: examining the effectiveness of the FSP (First Step Program) with a larger sample and a control group, also examining whether increased PA (Physical activity) was related to improvements in cardiovascular health, glycaemic control and lipid profiles. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised:60 (30 in IG, 30 in CG) No. completers: 47 Country: Canada Study population: sedentary overweight T2DM patients Ethnicity: NR Gender: male 55% (26/47) Age: range 40 to 60; mean 52.7 (SD 5.2); 52.8 (SD 5.7) in IG, 52.5 (SD 4.8) in CG Smokers: 68% quote: "17% of the participants smoked cigarettes regularly, 13% smoked occasionally, 38% were former smokers " Hypertension: quote: "55% of total sample" Mean baseline BP: SBP = 138.2 (SD 17.2) in IG, 130.1 (SD 15.9) in CG; DBP = 81.5 (SD 9.5) in IG, 78.9 (SD 8.0) in CG; Resting HR = 76.4 (SD 11.8) in IG, 77.0 (SD 9.7) in CG. (n = 47 completers) Inclusion criteria: “(1) aged 40 to 60 years; (2) minimum 3 months post diagnosis of type II diabetes; (3) treated by diet alone or by oral hypoglycaemic medications (not insulin); (4) no PA limitations or documented heart conditions; (5) not currently in an exercise program; and (6) < 8800 steps/day (defined as insufficiently active determined via a 3‐day, blinded pedometer protocol)” Exclusion criteria: NR
Interventions	IG: walking (FSP) group: Four weekly group meetings were held during the adoption phase (initial 4 weeks), participants were given pedometers and the program manual containing goal‐setting and problem‐solving exercises, as well as calendars for self‐monitoring steps/day. During the adherence phase (subsequent 12 weeks), participants were asked to use their pedometers and calendars for goal‐setting and self‐monitoring. No specific advise concerning diet or glycerol control was given. Thanking postcards were mailed at 6 and at 10 weeks. Pedometers and calendars were returned at the 16‐week assessment. Accumulated walking steps per day were calculated. Duration: self‐set goal of daily step and walking time Intensity: NR Frequency: 7 days/week Intervention period: 16 weeks Pedometer: yes Facilitator: yes, PA experts CG: Control group: wait‐list control group
Outcomes	Review outcomes reported: resting HR, SBP, DBP Measurement method: resting HR and BP were measured by a registered nurse. (method not mentioned) Primary/Main outcome of manuscript: daily PA assessed by pedometer (steps/day). Adverse event: quote: "No FSP participants reported having noteworthy musculoskeletal pain or problems during the intervention."
Notes	Trial registration: NR note: adoption phase (week 1 to 4), adherence phase (week 5 to 16) Funding sources: private sector (This project was supported by a grant from the Canadian Diabetes Association. Additional support for the development of First Step Program educational resources was provided by a Canadian Diabetes Association Award supported by Bayer Corporation.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Those individuals who agreed to participate were randomly assigned to either the First Step Program (FSP) group or the wait‐list control group (CONTROL)" but no further details about randomisation.
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding of participants and personnel not possible
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 21.7% in 16‐week follow‐up (13 out of 60), 6 as 20.0% in TG and 7 as 23.3% in CG Dropout 36.7% in 24‐week follow‐up (22 out of 60), 14 as 46.7% in TG and 8 as 26.7% in CG 47 completers analysis only 47/60 = 78.3% randomised (baseline/outcome) PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 16 weeks Only 1 analysis
Other bias	Low risk	No other bias

Tudor‐Locke 2020.

Study characteristics
Methods	Aim: to evaluate these potential effects in sedentary/low‐active postmenopausal women randomised to a usual behaviour control group or one of the 2 lifestyle step‐counting walking interventions (basic vs enhanced; differing only on their discrepant emphases on physical activity intensity) Design: parallel 3‐group RCT (50:50:20) Power/sample size calculation: yes
Participants	No. randomised: 120 (50 in IG1, 50 in IG2, 20 in CG) No. completers: 115 Country: USA Study population: non‐exercising, overweight/obese and postmenopausal women (45 to 75 years) Ethnicity: white 75.5% in IG1, 76.6% in IG2, and 52.6% in CG. Black 22.5% in IG1, 19.2% in IG2, and 47.4% in CG. Other 2.0% in IG1, 4.3% in IG2, and 0% in CG Gender: male 0% Age: mean 62.6 (SD 6.5) in IG1, 61.7 (SD 6.2) in IG2, 58.4 (SD 5.8) in CG Smokers: yes (0% in IG1, 6.4% in IG2, and 0% in CG) Hypertension: yes (26.5% in IG1, 12.8% in IG2, and 15.8% in CG.) Mean baseline BP: SBP = 127.6 (SD 16.6) in IG1, 125.2 (SD 12.7) in IG2, 122.5 (SD 13.9) in CG. DBP = 78.7 (SD 8.0) in IG1,75.5 (SD 7.6) in IG2, 77.3 (SD 7.3) in CG Inclusion criteria: non‐exercising (assessed initially via self‐report of regular exercise habits over the past 6 months), overweight/obese ([BMI], 25 kg/m2 to 45 kg/m2 or waist circumference, > 88 cm), postmenopausal women, aged 45 to75 years, Taking less than 7500 steps per day during a screening assessment with an NL‐1000 was indicative of a sedentary lifestyle, BP <180/< 100 mmHg, type 2 diabetes, who were not currently taking insulin, had glucose control within acceptable limits Exclusion criteria: significant cardiovascular disease/disorders (including diabetes) or other significant medical conditions considered life‐threatening, potentially interfering with or being aggravated by exercise, donating blood before 6 weeks of study, losing ≥ 20 kg in the previous year of study, having been hospitalised for mental illness within the previous 5 years of study, or planning to be out of the area for more than 3 weeks over the next 3 months after study commenced.
Interventions	All intervention participants monitored their daily step counts and walking behaviour using the NL‐1000 accelerometer (New Lifestyle Inc, Lee's Summit, MO) and calendars (to record steps per day). Steps per day and active minutes derived from the NL‐1000 are reported as process variables for both intervention arms, indicative of program adherence. IG1: Basic walking group: In addition to the walking step goal, participants also attended weekly meetings to engage in intervention‐supported behavioural feedback, reflection, and goal setting for the subsequent week. Duration: at least 10,000 step/day Intensity: (no direction provided with regard to walking intensity/speed/cadence) Frequency: 7 days/week and mean 3.5 (SD 2.2) days per week as a result Intervention period: 12 weeks Pedometer: yes, NL‐1000 accelerometer (New Lifestyle Inc, Lee's Summit, MO) and used calendars to record steps per day; Facilitator: NR IG2: Enhanced walking group: Participants were instructed on how to count their cadence while walking a set time and experience what walking at a cadence of at least 100 steps per minute felt like. Duration: at least 10,000 steps per day + a daily goal of 30 active minutes by taking at least 3,000 to 4,000 of their 10,000 steps per day + at least 100 steps per minute to reach a moderate intensity. Intensity: (please see above) Frequency: 7 days/week and mean 3.4 (SD 2.1) days per week as a result Intervention period: 12 weeks Pedometer: yes, NL‐1000 accelerometer (New Lifestyle Inc, Lee's Summit, MO) Facilitator: NR CG: Control group: continued with normal routines and lifestyle, and participated to the baseline and 3‐month assessments.
Outcomes	Review outcomes reported: SBP and DBP Measurement method: NR, outcomes were measured at baseline and after 12‐week intervention. Primary/Main outcome of manuscript: BP, anthropometric measurements (height, weight, and waist circumference), fasting blood glucose and insulin, flow‐mediated dilation and gait speed. Compliance/Adherence: defined by average weekly values for steps per day and/or active minutes. 96.0% (9,602/10,000*100%) in basic walking group and 100.0% (10,508/10,000*100%) in enhanced walking group. Adverse event: 1 dropout due to knee pain, in Consort chart
Notes	Trial registration: ClinicalTrials.gov (NCT01519583) Funding sources: American Heart Association and National Institutes of Health (center grants: P30 DK072476 and U54 GM104940)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Enrolled participants were randomly assigned" on the basis of "computer‐generated program". A biostatistician oversees the computer‐generated program that were used to randomly assign participants to groups.
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	The Principal Investigator were blinded to participants' randomised allocation status but participants were unlikely to be blinded to their allocation status.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	The assessment staff were blinded to participants' randomised allocation status.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 4.2% (5 out of 120 dropouts) 4 out of 100 (4.0%) in IG, 1 out of 20 (5%) in CG refer to Table 1 PP analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 3 months Only 1 analysis
Other bias	Low risk	No other bias

Tully 2005.

Study characteristics
Methods	Aim: to examine the effects of 30‐minute self‐paced, non‐supervised, brisk walking, 5 days per week on traditional cardiovascular risk factors (BP, BMI, cholesterol), Framingham risk score, and fitness in people aged 50–65 years. Design: parallel 2‐group RCT (2:1) Power/sample size calculation: NR
Participants	No. randomised: 31 (21 in IG, 10 in CG) No. completers: 26 Country: UK Study population: sedentary middle‐aged adults from urban GP Ethnicity: NR Gender: male 42% (13/31) Age: mean 55.52 (SD 3.99) in IG; 57.75 (SD 4.64) in CG; range 50 to 65. Smokers: NR Hypertension: no quote:"severe, uncontrolled hypertension" Mean Baseline BP: SBP = 129.94 (SD 8.61) in IG,125.78 (SD 14.02) in CG; DBP = 78.47 (SD 4.16) in IG, 77.22 (SD 7.74) in CG Inclusion criteria: quote:“Individuals aged between 50 and 65 years, with no history of (1) coronary heart disease, (2) peripheral vascular disease, (3) musculoskeletal disease, (4) pulmonary disease, (5) diabetes mellitus, or (6) severe, uncontrolled hypertension.” Exclusion criteria: Quote:“Individuals who were currently prescribed lipid lowering medication, had a body mass index (BMI) over 35 kg/m2, or blood pressure (BP) greater than 140/90 mmHg were excluded. Females who were postmenopausal (no menstrual period in the last 12 months) and had begun taking hormone replacement therapy in the previous 3 months were excluded.”
Interventions	IG: Brisk walking group: Duration: 30‐minute/session, or multiple at least 10‐minute/session (accumulated 30 minutes/day) Intensity: slightly breathless but still able to converse Frequency: 5 days/week Intervention period: 12 weeks Pedometer: yes, Oregon Scientific PE316CA Facilitator: No CG: Control group: participants were asked to maintain their habitual lifestyle and not change their activity. They were also given a diary and asked to record any exercise they performed over the 12 weeks.
Outcomes	Review outcomes reported: SBP, DBP Measurement method: blood pressure was measured using a standardised auscultation procedure Primary/Main outcome of manuscript: body composition, blood pressure, functional capacity, blood lipids, and Framingham risk score. Compliance/Adherence: defined by expressing the number of minutes walked as a percentage of the number of minutes prescribed by the protocol Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote:"using computer‐generated random numbers on a 2:1 basis. "
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding of participants and personnel not possible
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Quote:"Baseline anthropometric and functional capacity measurements were made by observers blinded to individual's group allocation."
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Dropout 16.1% (5 out of 31) 4 out of 21 (19%) in IG, 1 out of 10 (10%) in CG dropouts based on 26 completers analysis only 26 out of 31 randomised (baseline/outcome) PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Tully 2007a.

Study characteristics
Methods	Aim: to determine the effects of unsupervised home‐based walking at and below the current recommended level of exercise on cardiovascular risk factors and functional capacity in healthy sedentary adults, using pedometers for self‐monitoring. Design: parallel 3‐group RCT (2:2:1) Power/sample size calculation: Yes
Participants	No. randomised: 106 (44 in IG1_3D, 42 in IG2_5D, 20 in CG) No. completers: 93 Country: UK Study population: sedentary middle‐aged adults (civil servants) (aged 40 to 61) (email invitation to employees from Northern Ireland Civil Service <NICS> departments.) Ethnicity: NR Gender: male 39.6% (42/106) Age: mean 47.8 (SD 5.97) in IG1_3D, 46.37 (SD 4.76) in IG2_5D, 49.05 (SD 6.31) in CG Smokers: NR Hypertension: 0% Mean baseline BP: SBP = 134 (SD 15) in IG1_3D, 133 (SD 15) in IG2_5D, 128 (SD 15) in CG; DBP = 87 (SD 11) in IG1_3D, 87 (SD 11) in IG2_5D, 83 (SD 10) in CG HR = 69 (SD 12) in IG1_3D, 72 (SD 10) in IG2_5D, 75 (SD 11) in CG Inclusion criteria: aged 40 and order, quote:“sedentary (defined by self‐reported as not having undertaken more than one session of moderate intensity exercise each week over the past six months), blood pressure less than 140/90 mmHg; no history of musculoskeletal, pulmonary, or cardiac disease that would limit the ability to exercise; and taking no drugs with effects on lipid metabolism” Exclusion criteria: NR
Interventions	IG_3D: Walking (3‐day) group Duration: 30‐minute/session, or multiple at least 10‐minute/session (accumulated 30 minutes/day) Intensity: mild shortness of breath (Borg scale 0 to 10) Frequency: 3 days/week Intervention period: 12 weeks IG_5D: walking (5‐day) group Duration: 30‐minute/session, or multiple at least 10‐minute/session (accumulated 30 minutes/day) Intensity: mild shortness of breath (Borg scale 0 to 10) Frequency: 5 days/week Intervention period: 12 weeks Pedometer: yes Facilitator: no CG: Control group: participants were asked to maintain their current lifestyle for 12 weeks, and a self‐reported diary recording any exercise taken above what they would normally do.
Outcomes	Review outcomes reported: SBP, DBP,HR Measurement method: arterial blood pressure and heart rate were measured in the seated position after three minutes of rest, using a validated automatic sphygmomanometer (Omron Devices M5I, USA) Primary/Main outcome of manuscript: BP, serum lipids, BMI, waist:hip ratio, and functional capacity Compliance/Adherence: adherence was similar within the three day (89%) and the five day (83%) groups Adverse event: NR
Notes	Trial registration: NR Funding sources: Government(The researcher (MT) was supported by funding from the Department of Education and Learning NI.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote:"using computer generated random numbers" refer to Table 1
Allocation concealment (selection bias)	Low risk	Quote:"The allocation was determined at a remote location..."
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding of participants and personnel is not possible.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Quote:"Baseline and 12 week samples were analysed at the same time, with blinding to the group allocation."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 12.3% (13 out of 106) 5 out of 44 (11.4%) in IG3d, 6 out of 42 (14.3%) in IG5d, 2 out of 20 (10%) in CG dropouts refer to Figure 1 and Table 2 ITT analysis: quote:"Data were analysed using an intention to treat procedure, substituting baseline data for those at 12 weeks for the participants who withdrew during the study."
Selective reporting (reporting bias)	Low risk	Reported measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Tully 2011.

Study characteristics
Methods	Aim: to determine the effects of taking 10,000 steps per day on fitness and cardiovascular risk factors in sedentary university students. Design: parallel 2‐group RCT (2:1) Power/sample size calculation: Yes
Participants	No. randomised: 12 (8 in IG, 4 in CG) No. completers: 12 Country:UK Study population: sedentary Queen’s University Belfast students Ethnicity: NR Gender: male 16.7% (2/12) Age: mean 21.16 (SD 6.17) Smokers: NR Hypertension: NR Mean baseline BP: SBP = 120 (SD 15.62) in IG, 131.67 (SD 11.85) in CG; DBP = 79.00 (SD 8.23) in IG, 86.33 (SD 8.50) in CG Inclusion criteria: sedentary students who were willing to participate in a walking program. Exclusion criteria: any known disease that would prevent from taking regular exercise.
Interventions	All intervention and control group participants were asked to complete weekly diaries recording the number of steps they took per day, and returned to the researcher biweekly. The researcher would post new ones and phone or email participants to resolve any difficulties. IG: walking (10,000 step) group: Duration: accumulated 10,000 step/day Intensity: NR Frequency: 7 sessions/week Intervention period: 6 weeks Pedometer: yes Facilitator: no CG: Control group: wearing pedometer without modifying any aspect of lifestyle.
Outcomes	Review outcomes reported: SBP, DBP Measurement method:BP and HR were using a Digital Sphygmomanometer (Omron M5‐I, Japan). Primary/Main outcome of manuscript: BP, exercise capacity, body composition. Compliance/Adherence: measured as the number of days of data that was returned on the diaries as a percentage of the total number of days in the program Adverse event: NR
Notes	Trial registration: NR Funding sources: Government (Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, Research and Development Office for the Northern Ireland Health and Social Services and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote:"using computer generated random numbers..." refer to Table 1 (small sample size)
Allocation concealment (selection bias)	Unclear risk	Quote:"using computer generated random numbers by a researcher not involved in the day‐to‐day running of the trial."
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Quote:"Measurements were made at baseline (pre‐intervention) and after 6 weeks (postintervention) in the university Physical Education Centre by the same researcher, who was blinded to the group allocation."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Quote:"All participants completed the trial." "All participants in the 10,000 step group met their daily goal and significantly increased their daily step count over the course of the study (Table 2)." ITT analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 6 weeks Only 1 analysis
Other bias	Low risk	No other bias

Venturelli 2011.

Study characteristics
Methods	Aim: the feasibility of an institution‐based walking program carried out together with family member caregivers could reduce the functional, cognitive, and physical decline of nursing home residents in the later stages of Alzheimer disease. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: no
Participants	No. randomised: 24 (12 in IG, 12 in CG) No. completers: 21 Country: Italy Study population: late stage Alzheimer's disease patients (65+) in nursing home Ethnicity: NR Gender: male 0% (based on the inclusion criteria, 35 participants (5 men and 30 women) were selected; three caregivers declined and were excluded from the study; a multidisciplinary diagnostic evaluation team reviewed the clinical files of the 32 selected residents and excluded 7 (5 men and 2 women) because of severe heart disease, and another 1 due to reduced oxygen saturation during the walking test. Therefore all 24 participants are women.) Age: mean 83 (SD 6) in IG, 85 (SD 5) in CG. Smokers: NR Hypertension: 16.7% (4/24) Mean baseline BP: SBP = 132 (SD 10) in IG; 133 (SD 6) in CG; DBP = 84 (SD 5) in IG; 84 (SD 3) in CG. Inclusion criteria: quote:“65 years of age or older, dependent on assistance in 2 or more personal ADLs according to the Barthel index, Mini‐Mental State Examination (MMSE) maximum score of 15 and minimum of 5, and absence of mobility limitations, minimum score of 23, according to the Performance Oriented Mobility Assessment (POMA) index, and constant oxygen saturation during walking (SpO2 > 85%).” Exclusion criteria: severe heart disease and reduced oxygen saturation during the walking test.
Interventions	IG: Walking group: Single bout walking alone the hallway in the Alzheimer’s care unit (ACU). Cookie were offered after walking as positive psychological reinforcement. A walking log recording session times and number of laps was checked before and after each visit. Duration: 30 minutes/session Intensity: moderate Frequency: 1 session/day, 4 days/week Intervention period: 24 weeks Pedometer: NR Facilitator: yes, caregivers (Participants walked arm in arm with their caregivers (husbands, wives, sons, or daughters), and encouraged to walk with the fastest speed, while the caregivers were trained to walk in accordance to the participants' pace.) CG: Control group: routine care. Nursing home residents in the control group participated in the daily organized activities like bingo, patchwork sewing, and music therapy.
Outcomes	Review outcomes reported: SBP, DBP Measurement method:DBP and SBP were measured using a standard sphygmomanometer device (Heine G7, Germany) Primary/Main outcome of manuscript: cognitive function (MMSE), Barthel Index Adverse event: 0 Quote: "No adverse events related to the exercise program were observed during the experiment period nor did any event influence participation in the sessions. One woman in the walking group left the study after 6 weeks due to a serious medical condition (stroke); 2 people in the control group (reduced from 12 to 10 participants) also left the program because of serious health problems (heart failure and stroke)."
Notes	Trial registration: NR Funding sources: none
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "using StatPlus for Macintosh, version 2009 (AnalystSoft Inc, Alexandria, Virginia)" refer to Table 1 and 2
Allocation concealment (selection bias)	Low risk	Quote:"...The head nurse of the ACU (not involved in the residents' assessments) did the participants' randomization using StatPlus for Macintosh, version 2009 (AnalystSoft Inc, Alexandria, Virginia)."
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote:"...the members of the research team did not know to which group each participant had been assigned." "No‐one on the research team was present during the walking exercise (afternoon); however, the head nurse of the ACU was always present. Before each intervention she checked the participants' health status and their ability to walk that day (exclusion criteria were fever, constipation treatment, low blood pressure, or other serious medical conditions)."
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Quote: "an evaluation was done before and after the experiment period in a blind way and the members of the research team did not know to which group each participant had been assigned.);"
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 12.5% (3 out of 24) 1 as 8.3% in TG and 2 as 16.7% in CG Quote: "The walking group had a 93.4% + 3.2% presence at the 96 scheduled training sessions (90 + 2 training days); individual numbers of visits during the 24 weeks of the program are shown in Figure 2, panel B."‐ " PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 24 weeks Only 1 analysis
Other bias	Low risk	No other bias

Wallis 2017.

Study characteristics
Methods	Aim: to evaluate the effect of a dosed walking program on knee pain for patients with severe knee osteoarthritis (OA). Design: parallel 2‐group RCT (1:1) Power/sample size calculation: yes
Participants	No. randomised:46 (23 in IG, 23 in CG) No. completers: 39 Country: Australia Study population: severe OA patients rated as grade III or IV affecting at least one of the tibiofemoral compartments (50+) Ethnicity: NR Gender: male 56.5% (26/46) Age: mean 68 (SD 8) in IG; 67 (SD 7) in CG Smokers: 12 (26%) were current smokers Hypertension: 60.9% (28/46) Mean baseline BP: SBP = 142 (SD 10) in IG, 138 (SD 24) in CG; DBP = 82 (SD 10) in IG, 81 (SD 11.1) in CG Inclusion criteria: aged at least 50 years and living independently in the community; diagnosed with severe knee OA rated as grade III or IV affecting at least one of the tibiofemoral compartments determined radiographically; a cardiovascular risk profile with 2 total risk factors using stage 2 of the Adult Exercise Screening Tool; able to participate safely in the moderate‐intensity physical activity trial using stage 1 of the Adult Exercise Screening Tool; able to communicate in English. Exclusion criteria: lived in supported accommodation such as a nursing home; reported daily resting level of pain to be 9 or 10 on a 0 (no pain) to 10 (worst possible pain) Numerical Pain Rating Scale as this level of pain may be indicative of a more serious pathology; had high levels of psychological distress as measured by the Kessler 10 questionnaire with a K10 score >29; had a cognitive impairment measured by the Short Portable Mental Status Questionnaire with a score of 7 or less; had a systemic arthritic condition such as rheumatoid arthritis; had a neurological condition that affected walking; had knee surgery or intra‐articular corticosteroid injection within past six months; had used oral corticosteroids within 4 weeks.
Interventions	IG: walking group: No formal instructions on warming up or stretching were provided. Participants continued taking their usual medications and other non‐surgical treatments to manage their knee osteoarthritis and used normal assistive devices such as a cane. Duration: in bouts of at least 10‐minute/sessions Intensity: moderate intensity (Rate of Perceived Exertion Scale level 3 out of a 0 to 10) Frequency: 7 sessions/week (70 minutes/week) Intervention period: 12 weeks in the community Pedometer: yes Facilitator: quote: "...there was regular physiotherapy supervision and monitoring each week, including one‐to‐one supervised walking sessions or group supervised walking sessions based on patient preference..." CG: Control group: usual care. Participants and their health professionals were advised with written information not to include a prescription of physical activity in the 12‐week study period.
Outcomes	Review outcomes reported: SBP, DBP Measurement method: resting SBP and DBP (mmHg) was measured using an electronic blood pressure machine in sitting. Primary/Main outcome of manuscript: average knee pain Compliance/Adherence: participants completed at least 9 out of 12 of the weekly dose of 70 minutes. Adverse event: quote: "Three participants in the walking group had minor adverse events; two reported increased knee pain and were not able to continue the program after week 1, and one tripped during a supervised walking session and had to seek medical management due to knee pain. This participant continued the program following 2 days of rest. There were no serious adverse events." 3 knee pain were defined as minor adverse events as a short‐term exacerbation of a knee pain levels up to a week after the sessions, trips or falls without any serious sequelae or hospital admission.
Notes	Trial registration: yes (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367588) Funding sources: private sector (The research received $24,704 from La Trobe University's research focus area on Sport, Exercise and Rehabilitation.)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote:"using a permuted block design with a computer random number generator " refer to Table 1
Allocation concealment (selection bias)	Low risk	Quote:"Participants were randomly assigned using a permuted block design with a computer random number generator using sealed opaque envelopes prepared by an independent researcher with no role in recruitment or assessment." refer to Table 1
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote:"Intervention and control participants were non‐blinded to their group allocation" but possibly all participants were treated independently by their physicians who would not have knowledge of group allocation.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Quote:"The primary and secondary outcomes were collected at baseline and post‐intervention (week 13) by an assessor blinded to group allocation."
Incomplete outcome data (attrition bias) All outcomes	Low risk	1 out of 23 withdrew after randomisation Dropout 15.2% (7/46) 7 out of 23 in IG (30.4%) , 0 out of 23 in CG dropouts refer to Fig. 1 Both ITT and PP analysis done
Selective reporting (reporting bias)	Low risk	Reported measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Wang (王正斌) 2014.

Study characteristics
Methods	Aim: to explore the effects of walking exercise on glycometabolism, dynamic blood pressure and the quality of life of patients with both hypertension and type 2 diabetes on the basis of conventional drug treatment. Design: Parallel 2‐group RCT (1:1) Power/sample size calculation: no
Participants	No. randomised: 62 (32 in IG, 30 in CG) No. completers: 62 Country: China Study population: cardiovascular clinic or hospitalised patients with both hypertension and type 2 diabetes (medicated) Ethnicity: Chinese Gender: male 62.9% ((20+19)/62) Age: mean 55.8 (SD 9.3) in IG; 57.4 (SD 8.9) in CG Smokers: No Hypertension: 100% Mean baseline BP: SBP = 143 (SD 11) in IG, 141 (SD 14) in CG; DBP = 81 (SD11) in IG, 88 (SD 9) in CG Inclusion criteria: age between 40 to 70 years old; primary hypertension; diabetic mellitus (DM), basic step counts less then 5000 steps/day. Exclusion criteria: secondary hypertension; moderate to severe hypertension with BP> 160/110 mmHg; uncontrolled DM; atrial or ventricular arrhythmia, tachycardia (HR> 100 bpm); acute myocarditis of pericarditis; acute coronary syndrome; thromboembolism; skeletomuscular disorders such as fracture, osteoarthritis, or joint injury refrained from exercise; complex diagnosis with CVA, malignant tumour, or predicted lifespan less than 1 year.
Interventions	IG: walking exercise group: Participants had to walk more than 10,000 steps per day regardless of duration or intensity, but should avoid arduous exercise that could result in fatigue in the next day. Diabetes reminder with personal information and sugar products or chocolate should be carried at all time. When hypoglycaemic syndrome such as dizziness, palpitation, and hunger was occurred, participants should suspend walking and have some sugar. Another situation to suspend walking was when blood pressure was elevated, and participants should undergo medical treatment immediately. When chest tightness and asthma were happened during walking, participants should take rest and decrease walking intensity in accordance with their health situation. Duration: more than 10,000 steps/day Intensity: NR Frequency: 7 sessions/week Intervention period: 12 weeks Pedometer: Yes, Omron HJ‐005 (wore everyday and return to the researcher for recording data monthly) Facilitator: NR CG: Control group: conventional drug treatment and community care
Outcomes	Review outcomes reported: dynamic blood pressure parameters Measurement method: blood pressure was taken by CB2300A (Wusih) ambulatory blood pressure monitor before and after 3‐month intervention. Blood pressure monitor cuff belt was tightened on right upper arm, measure interval was 20 minutes in the daytime (0600 to 2200) and 30 minutes at night (2201 to 0559). On measurement day, there was no activity restriction but participants should record any activity of that day and avoid smoke as well as alcohol beverage. Effective data of SBP 70 to 220 mmHg, DBP 40 to 130 mmHg, and pulse pressure 20 to 110mmHg were recorded, otherwise were taken as ineffective and abandoned. Primary/Main outcome of manuscript: fasting plasma glucose, glycated haemoglobin‐A1C, fasting insulin, the homeostasis model of assessment for insulin resistance index, the homeostasis model of assessment for insulin sensitivity, dynamic blood pressure parameters and quality of life. Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"Quote:randomly divided" using "random number table" but no detail reported
Allocation concealment (selection bias)	Unclear risk	NR
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 0% (0/62) 32 completers in exercise group, 30 completers in control group refer to table 1 to 3 ITT analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 3 months Only 1 analysis
Other bias	Low risk	No other bias

Wang (王聰) 2016.

Study characteristics
Methods	Aim: to discuss the influences of 8 weeks of walking and health education on blood pressure.. Design: parallel 4‐group RCT (1:1:1:1) Power/sample size calculation: yes
Participants	No. randomised: 61 (31 in IG, 30 in CG) (31 in Health Education only and 32 in Walking+Health Education groups excluded) No. completers: 48 Country: China Study population: hypertensive patients (from Datong Coal Mine Group central factory) Ethnicity: Chinese Gender: male 64.6% ((21+10)/48) Age: Range 18 to 64; mean 49.61 (SD 4.91) in IG, 48.50 (SD 6.31) in CG. Smokers: yes (44.5% in IG; 46.6% in CG) Hypertension: 100% Mean baseline BP: SBP = 134.83 (SD 17.43) in IG, 143.97 (SD 20.91) in CG. DBP = 82.39 (SD 12.94) in IG, 87.63 (SD 10.48) in CG Inclusion criteria: hypertension class Ⅰ (140 to 159/90 to 99 mmHg) and class Ⅱ (160 to 179/110 to 109 mmHg) patients, age between 18 to 64, working above the well Exclusion criteria: hypertension class Ⅲ patients with resting BP 180/110 mmHg, hypertension complications including cerebrovascular disease, heart failure, chronic renal failure and severe retinopathy; or hypertension comorbidity such as diabetes and coronary syndrome, skeletomuscular injuries as jointitis or muscle soreness.
Interventions	IG: walking group: Duration: mean 55.74 (SD 4.34) minutes/session Intensity: 70% HRmax by heart rate monitor watch to keep heart rate at target intensity during walk Frequency: 5 sessions/week (total: 42 sessions) Intervention period: 8 weeks Pedometer: yes Facilitator: NR CG: Control group: no intervention control Note: a total of four groups and two groups excluded: 1.walking + health education on exercise and diet 2.health education on exercise and diet only
Outcomes	Review outcomes reported: BP Measurement method: participants were sitting and resting for at least 10 minutes, and Omron HEM‐1000 electronic sphygmograph was used to measure twice with interval of 1 to 2 minutes. The average of the two measurement was taken for analysis, but if the difference of the two measurement was more than 5mmHg, whether SBP or DBP, the third measurement was taken and averaged with the two for analysis. Primary/Main outcome of manuscript:BP Compliance/Adherence: adherence rate to 42 walking session: 76.9% (mean 32.28 (SD 7.97)) in walking IG and 87.6% (mean 36.78 (SD 5.79)) in walking plus health education IG. Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote:"randomly divided" but no detail reported
Allocation concealment (selection bias)	Unclear risk	NR
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	High risk	Dropout 21.31%, 13/61: 13/31 in walking group (41.94%), 0 (30/30) in control group dropouts 18 out of 31 completers in walking group, 30 completer in control group refer to table 1, 2 PP analysis High risk due to high attrition rate in walking group
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 8 weeks Only 1 analysis
Other bias	Low risk	No other bias

Wang 2014.

Study characteristics
Methods	Aim: to explore the overall effects of a supervised endurance‐exercise training program on the risk components of MS, serum IL‐6 levels, and exercise capacity of postmenopausal women Design: parallel 2‐group RCT (1:1) Power/sample size calculation: yes
Participants	No. randomised:53 (7 withdrawn, resulting23 in IG, 23 in CG) No. completers: 46 Country: Taiwan Study population: sedentary postmenopausal women from general population (aged 45 to 70) Ethnicity: Chinese Gender: male 0% Age: mean 56.9 (SD6.2) in IG, 55.1 (SD7.8) in CG, range 45 to 70 (46 completers only) Smokers: 0% Hypertension: 0% Mean baseline BP: SBP =124.6 (SD 9.2) in IG, 127 (SD 10.1) in CG; DBP = 76.8 (SD8.1) in IG, 79 (SD 9.4) in CG (46 completers only) Inclusion criteria: postmenopausal women aged 45 to 70 years; a sedentary lifestyle (not exercising > 30 minutes on >3 days/week) for the past 6 months; and not taking any medication including lipid‐lowering agents, nonsteroidal antiinflammatory drugs, antihypertension drugs, and hormone‐replacement therapy. Exclusion criteria: the presence of chronic heart failure; a positive history or clinical signs of ischaemic heart disease; diabetes mellitus (fasting glycaemia > 126 mg/dL); systolic blood pressure (SBP) > 160 mmHg or diastolic blood pressure (DBP) > 100 mmHg; and orthopedic limitations.
Interventions	IG: walking group: Treadmill walking 3 times/week for 12 weeks in a laboratory near the metabolic and cardiovascular outpatient department of the study hospital. Exercise training began with 10 min of warming up and ended with 10 minutes of cooling down. Duration: 30 minutes/session Intensity: 60% to 80% of HRR Frequency: 1 session/day, 3 days/week Intervention period: 12 weeks Pedometer: NR Facilitator: yes, by one of research staff members CG: Control group: maintain customary lifestyle
Outcomes	Review outcomes reported: SBP, DBP Measurement method: BP was measured using a calibrated automated oscillometric blood‐pressure monitor (Datascope, Mahwah, NJ, USA). Primary/Main outcome of manuscript: exercise capacity, interleukin‐6 level Compliance/Adherence: dividing the number of attendances by the total of 36 training sessions Adverse event: NR
Notes	Trial registration: NR Funding sources: none
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	refer to Table 1, 46 completers only Quote: "No statistically significant differences were observed in basic characteristics or in the data on the study variables between the exercise and control groups at baseline (Table 1)."
Allocation concealment (selection bias)	Unclear risk	No information refer to Table 1, 46 completers only
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Quote: "The individual‐based exercise training program was supervised by one of our research staff members." Not sure if the research staff had other role in the trial.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes Quote: "Study variables were measured by one of the members of our research staff, who was unaware of the group allocation of the participants."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 7 out of 53 (13.2%). Quote: "Those who withdrew said they were too busy (n=3),had to care for family members (n=3), or had fallen ill (n=1)." "The adherence rate of exercise participants was calculated by dividing the number of attendances by the total of 36 training sessions; the mean adherence rate was measured to be 98% in the exercise group." PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Westhoff 2007.

Study characteristics
Methods	Aim: the impact of pulse pressure on the cardiovascular effects of a 12‐week aerobic physical exercise program in elderly hypertensives. Design: Parallel 2‐group RCT (1:1) Power/sample size calculation: yes
Participants	No. randomised: 54 (27 in IG, 27 in CG) No. completers: 51 Country: Germany Study population: sedentary Isolated Systolic Hypertension elderly patient (aged 60+) (hypertensive outpatient clinic) Ethnicity: NR Gender: male 48% (26/54) Age: mean 67.2 (SD 4.8) in IG, 68.9 (SD 5.2) in CG. Smokers: 7.4% (4/54) Hypertension: 100% Mean baseline BP: systolic ABP = 136.6 (SD 12.7) in IG, 134.8 (SD 11) in CG; diastolic ABP = 76.3 (SD 7.3) in IG, 72.8 (SD 7.2) in CG. Inclusion criteria: Quote: "current antihypertensive treatment, diastolic ambulatory blood pressure (ABP) ≤ 90 mmHg, age of ≥ 60 years." Exclusion criteria: Quote: "regular engagement in physical exercise training in the past 12 weeks prior to inclusion in the study, symptomatic peripheral arterial occlusive disease, aortic insufficiency or stenosis >stage I, hypertrophic obstructive cardiomyopathy, congestive heart failure (>NYHA II), uncontrolled cardiac arrhythmia with haemodynamic relevance, systolic office BP≥180 mmHg, signs of acute ischaemia in exercise ECG, change of antihypertensive medication in the past 6 weeks prior to inclusion in the study or during follow‐up period"
Interventions	IG: walking (exercise) group: treadmill walking. During the first week, training consisted of 5 workloads of 3 minutes; between workloads, patients walked with half‐speed for 3 minutes. Exercise duration was gradually increased and reached 30, 32, and 36 minutes in the sixth and further weeks and was carried out without interruption. As exercise heart rate decreased by more than 5/minute as a result of training adaptation, treadmill speed was increased by 0.5 km/hour or elevation was increased by 3% to maintain training intensity. Duration: exercise duration was gradually increased and reached 30, 32, and 36 minutes in the sixth and further weeks and was carried out without interruption Intensity: Lactate concentration of 2.5 ±0.5 mmol/L in capillary blood slightly above the aerobic threshold Frequency: 1 session/day, 3 days/week Intervention period: 12 weeks Pedometer: NR Facilitator: yes, by a physician CG: Control group: sedentary activity and usual care of accurate drug intake.
Outcomes	Review outcomes reported: 24‐hour ABP, exercise BP Measurement method: 24‐Hour ABP monitoring was performed using Spacelabs 90207 monitors (Spacelabs, Redmond, Wash., USA). Primary/Main outcome of manuscript: 24‐hour ABP, pulse pressure, arterial compliance and endothelial function Adverse event: Quote:"One patient stopped within the first session due to knee pain, 1 patient discontinued the program after 4 weeks due to acute cholecystitis, and 1 patient had a change of medication within the observation period." Quote: "In the control group, 4 patients denied to redo the treadmill stress test. In these cases, the last observations of the treadmill test were carried forward."
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "According to these criteria, 54 patients (27 male, 27 female) were enrolled and randomized to exercise and control group by lot ( fig. 1 )." but no other details about randomisation. Characteristics of study groups are identical (Table 1)
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding of participants and personnel not possible Quote: "During training, patients were continuously supervised by a physician." Not sure if there was other co‐intervention provided in the training process.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Objective outcomes: ambulatory blood pressure monitoring Quote: "The American College of Sports Medicine criticizes that in most studies on endurance training, BP was not measured by a blinded observer or an automated device and emphasizes the need for studies using 24‐hour ABP monitoring [28]. We complied with this recommendation” Quote: "The computer‐assisted calculation of vessel diameters was conducted in a blinded fashion as published previously [21, 22]”
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 5.6% (3 out of 54) 3/27=11.1% in exercise group and 0/27 = 0% in control group PP analysis
Selective reporting (reporting bias)	Low risk	Reported measurement at 12 weeks Only 1 analysis
Other bias	Low risk	No other bias

Xiao (肖卉) 2010.

Study characteristics
Methods	Aim: to investigate the effects of exercise on blood glucose and blood pressure in elderly diabetes patients. Design: parallel 2‐group RCT (1:1) Power/sample size calculation: NR
Participants	No. randomised: 124 (62 in IG, 62 in CG) No. completers: 112 Country: China Study population: elderly diabetes residents Ethnicity: Chinese Gender: male 32.1% ((17+19)/112) Age: mean 65.84 (SD 6.32) in IG, 65.82 (SD 6.39) in CG. Smokers: NR Hypertension: NR Mean baseline BP: SBP = 141.82 (SD 16.23) in IG, 141.05 (SD 20.06) in CG. DBP = 82.91 (SD 9.94) in IG, 84.04 (SD 10.15) in CG. Inclusion criteria: live in Tianjin Shi ≧5 years; age≧50 and retired; diagnosis with Type 2 DM. Exclusion criteria: severe ischaemia; diabetic kidney disease; ketonuria; proliferative diabetic retinopathy; severe hypertension; limitation of activity.
Interventions	IG: walking group: Duration: 30 minute/session (walking in the morning at 09:00) Intensity: target heart rate 170‐age; participants were taught to measure radial artery after walking to confirm walking intensity at target heart rate; self perceived adequate sweating, feeling relaxed and happy as well as good appetite after walking were also indicators for proper intensity.) Frequency: 3 sessions/week Intervention period: 24 weeks Pedometer: no Facilitator: NR CG: Control group: usual care and lifestyle.
Outcomes	Review outcomes reported: BP Measurement method: before and after intervention. Primary/Main outcome of manuscript: total physical activity metabolic equivalent, fasting serum glucose, 2‐hour postprandial blood glucose, BP. Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomly divided" using "random table" but no detail reported
Allocation concealment (selection bias)	Unclear risk	NR
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 9.7% (12 out of 124 dropouts) 55/62 completers in intervention group, 57/62 completers in control group refer to table 2 to 3 PP analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 6 months Only 1 analysis
Other bias	Low risk	No other bias

Yan (嚴華) 2010a.

Study characteristics
Methods	Aim: to evaluate the rehabilitation effects of walking training based on medicine therapy on heart function in patients with congestive heart failure (CHF). Design: parallel 3‐group RCT (1:1:1) Power/sample size calculation: NR
Participants	No. randomised: 418 (212 in IG, 206 in CG) (203 in unscheduled exercise group excluded) No. completers: 396 Country: China Study population: CHF (LVEF ≦45%) patients (clinic and hospitalised) Ethnicity: Chinese Gender: male 62.4% ((132+129)/418) Age: mean 61.2 (SD 11.8) in IG, 62.5 (SD 11.6) in CG Smokers: NR Hypertension: NR Mean baseline BP: SBP = 123.1 (SD 21.9) in IG, 125.6 (SD 20.2) in CG. DBP = 68.6 (SD 10.8) in IG, 68.5 (SD 10.6) in CG. HR= 74.2 (SD 15.7) in IG, 77.1 (SD 15.2) in CG Inclusion criteria: CHF (LVEF≦ 45%). Exclusion criteria: asthma; COPD; abnormal liver function; severe A‐V block; severe bradycardia (HR< 60 bpm, cardiogenic shock, sick sinus syndrome including sinoatrial block, and hypotension SBP< 90 mmHg); dyspnoea refrained from exercise.
Interventions	IG: Exercise group: Participants walked slowly as warming‐up and cool‐down. In consideration of temperature, the walking time was day or night in summer and at noon in winter. Walking training was based on individual 6‐minute walking test. Starting from 10% to 20% 6‐minute walking distance, heart rate was kept at 5 to 10 bpm more than resting HR; BP, ECG and self‐perceived fatigue were also monitored. Participants felt energised normally after each session and the intensity and frequency were gradually increased. Duration: from 25 to 40 to 40 to 60 minutes/session; walked on flat square such as leisure square or pavement; 5 to 10 minutes of slow walking as warming‐up and cool‐down; rest for 3 to 5 minutes according to individual condition. Intensity: from 2000 to 3000 to 3000 to 5000 steps (2 to 3km) lasting for 20 minutes Frequency: 4 to 6 days/week Intervention period: 26 weeks (6 months); followed‐up at least every 2 weeks by phone or clinic visit for 6 months to record exercise training, medication, cardiovascular events, reasons for hospitalisation and frequency of re‐hospitalisation) Pedometer: no Facilitator: yes CG: Control group: usual lifestyle Note: a total of 3 groups and only exercise (walking) and control groups included
Outcomes	Review outcomes reported: BP and HR Measurement method: participants were lying for at least 10 minutes and measured with right upper arm. Korotkoff maneuver was applied and the average of three measurements was taken for analysis. Heart rate was detected by stethoscope through chest auscultation. Primary/Main outcome of manuscript: resting HR, BP, 6‐minute walking test and echocardiography were measured before and after exercise training. Compliance/Adherence: NR Adverse event: NR
Notes	Trial registration: NR Funding sources: Guangxi Science and Technology Development Program (0592007‐2)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "randomly divided" but no detail reported
Allocation concealment (selection bias)	Unclear risk	NR
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and investigators were unlikely to be blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Objective outcomes No information
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 5.26% (22 out of 418 dropouts) 203 out of 212 completers in group A (walking group), 193 out of 206 completers in group C (control group) refer to table 1, 2 PP analysis
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 6 months Only 1 analysis
Other bias	Low risk	No other bias

Yu (余冰清) 2018.

Study characteristics
Methods	Aim: to explore the effect of low‐ and moderate‐intensity exercise on the cardiovascular events and risk factors in phlegm dampness elderly patients with isolated systolic hypertension, and to determine the suitable exercise intensity for the elderly. Design: Parallel 3‐group RCT (1:1:1) Power/sample size calculation:yes
Participants	No. randomised: 231 (77 in IG1, 77 in IG2, 77 in CG) No. completers: 211 Country: China Study population: phlegm dampness elderly population with isolated systolic hypertension Ethnicity: Chinese Gender: male 65.9% ((44+52+43)/211) Age: mean 82.96 (SD 2.06) in IG1, 83.01 (SD 2.09) in IG2, 83.44 (SD 1.99) in CG Smokers: yes (43.1% in IG1, 43.5% in IG2, 41.4% in CG) Hypertension: 100% Mean baseline BP: SBP = 141.67 (SD 5.95) in IG1, 140.87 (SD 6.45) in IG2, 141.94 (SD 5.22) in CG; DBP = 63.20 (SD 3.59) in IG1, 62.36 (SD 2.84) in IG2, 63.43 (SD 3.11) in CG Inclusion criteria: diagnosed hypertension (SBP≧140mmHg, DBP<90mmHg) according to 2010 Chinese guidelines for the management of hypertension, but under adequate control; phlegm dampness≧40 according to Constitution in Chinese Medicine Questionnaire; Age≧ 80; New York Heart Association Classification Ⅰ or Ⅱ; Global Initiative for Chronic Obstructive Lung Disease Classification Ⅰ or below; muscle power for extremities grade Ⅳ and able to follow study protocol; no regular exercise within 6 months (regular exercise was taken as duration≧20 minutes/session, ≧2 sessions/week); both participants and caregivers agreed to join and signed informed consent. Exclusion criteria: secondary hypertension; aortic dissection, cardiomyopathy, moderate to severe valve disease, and malignant arrhythmia; severe liver and kidney disease; acute and chronic respiratory failure; acute and chronic gastrointestinal bleeding; Type 1 and 2 DM with severe complications; malignant tumour with predicted lifespan< 1 year; newly diagnosed acute coronary syndrome within 6 months and hemorrhagic stroke accompanied with neuromuscular syndrome; any disease In combination with skeleton and joints problems refrained from exercise; use beta‐blockers or drugs for heart rate maintenance; unable to communicate due to cognitive problems or geriatric organic mental disorders.
Interventions	Adaptive training was performed one week before formal training. Participants walked on a treadmill with EKG monitor, so that participants could experience the target intensity by heart rate and self‐perceived level of moderate intensity in Borg scale, and the EKG abnormality could be detected at the same time. The formal training was carried out in the rest room for retired military cadres. Participants were free to talk during walk; adequate sweating and fatigue after walk could be alleviated from rest. Overall participants should feel good and there should be no dizziness, headache, nausea or vomit. The walk should be suspended when the following situation occurred: ①signs for insufficient perfusion: paleness, cyanosis, and cold sweating; ②unchanged or even decreased heart rate during walk; ③angina pectoris; ④participants asked for stop; ⑤other occasional events. IG1: Lo‐ intensity group: Duration: 60 minutes/session (warm‐up 10 to 15 minutes + reach target heart rate for 30 minutes + cool‐down for 10 to 15 minutes); in consideration of age, the 30‐minute of target heart rate was divided into three 10‐minute walking, thus there were two intervals of 10 to 15 minutes resting in between the 10‐minute walk. Intensity: 50% maximum heart rate; participants wore WeLoop now 2 (Guangdong YF Technology Limited) to monitor heart rate during walking. Frequency: 3 sessions/week Intervention period: 24 weeks Pedometer: NR Facilitator: physicians and nurses in the rest room facilitated the whole process. IG2: Moderate‐intensity group Duration: 60 minutes/session (warm‐up 10 to 15 minutes + reach target heart rate for 30 minutes + cool‐down for 10 to 15 minutes); in consideration of age, the 30‐minute of target heart rate was divided into three 10‐minute walking, thus there were two intervals of 10 to 15 minutes resting in between the 10‐minute walk. Intensity: 70% maximum heart rate; participants wore WeLoop now 2 (Guangdong YF Technology Limited) to monitor heart rate during walking. Frequency: 3 sessions/week Intervention period: 24 weeks Pedometer: NR Facilitator: physicians and nurses in the rest room facilitated the whole process. CG: Control group: maintaining the original lifestyle
Outcomes	Review outcomes reported: blood pressure and blood pressure variability (24h SSD and 24h DSD) Measurement method: ①BP was detected by Microlife BP 3BTO and taken in the 900th Hospital of Joint Logistics Support Force before intervention by researchers; afterwards it was taken in the rest room for retired military cadres by the physicians or nurses one hour before each session, but only data measured in the sixth month were used for analysis. For each measurement, participants were sitting in a quiet room and resting for mood stabilisation for at least 5 minutes. Right upper arm was exposed and kept at the same level of heart with hand palm up when stretch into the BP monitoring device. There were three data in each measurement but only took average of the last two for analysis. ②24‐hour ambulatory BP measurement was detected by MQY‐ABPⅠ. The BP cuff belt was tightened at the right upper arm of the participants, and measured every 30 minutes in the daytime (0600 to 2200), every 60 minutes at night (2200 to 0600). Effective measurement was defined as >80% of effective data. The data were counted for SD of 24‐hour ambulatory mean SBP and SD of 24‐hour ambulatory mean DBP. Primary/Main outcome of manuscript: vascular function(ankle brachial index, pulse wave velocity), blood pressure, blood pressure variability (SD of 24‐hour ambulatory mean SBP and SD of 24‐hour ambulatory mean DBP), Homocysteine, blood glucose (fasting blood glucose,glycated haemoglobin), blood lipid (total cholesterol, triglycerides, LDL‐C, HDL‐C), BMI waist‐hip ratio and phlegm dampness constitution score. Compliance/Adherence: participants who attended less than 80% were ceased to be included in the trial. Adverse event: NR
Notes	Trial registration: NR Funding sources: NR
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random sequence generation and randomisation procedure was clearly stated (p.3)
Allocation concealment (selection bias)	Unclear risk	NR
Blinding of participants and personnel (performance bias) All outcomes	High risk	Quote: "...participants and investigators were not blinded..."
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcome assessors were blinded to participants' randomised allocation status.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Dropout 8.7% (20 out of 231 dropouts) 141 out of 154 completers in intervention group, 70 out of 77 completers in control group refer to table 2.1 to 2.3 and figure 2.1 PP analysis (211 completers only)
Selective reporting (reporting bias)	Low risk	Only 1 endpoint measurement at 6 months Only 1 analysis
Other bias	Low risk	There is no other bias

ABI: ankle‐brachial index; ABP: ambulatory blood pressure; AE(s): adverse event(s); BMI: body mass index;BP: blood pressure; BPM: beat per minute; BRS: baroreflex sensitivity; CAD: coronary artery disease; CG: control group;CHF: congestive heart failure; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; CRP: C‐reactive protein; CRV: heart rate variability; CVD: cardiovascular disease; DBP: diastolic blood pressure; HDL‐C: high‐density lipoprotein cholesterol; HR: heart rate;HRQoL: health‐related quality of life; HRT: hormone replacement therapy;IC: intermittent claudication; IG: intervention group;IGT: impaired glucose tolerance; IPAQ: International Physical Activity Questionnaire; ITT: intention‐to‐treat; LDL‐C: low‐density lipoprotein; LEVF: left ventricular ejection fraction; MET: metabolic equivalent of task; MMSE: Mini‐Mental State Examination; NGT: normal glucose tolerance; NI: no information;No.: number;NR: not reported;OA: osteoarthritis;OGTT: oral glucose tolerance test; PAD: peripheral arterial disease; PCI: percutaneous coronary intervention; PP: per protocol; RCT: randomised controlled trial;RPE: rating of perceived exertion; SBP: systolic blood pressure;SD: standard deviation; SE: standard error; SEM: standard error of the mean; SF‐12 IADL: Short Form 12 instrumental activities of daily living; TC: total cholesterol; TG: triglyceride; T2DM: type 2 diabetes mellitus; 6MWT: six‐minute walk test.

The following studies converted results from SE (reported) to SD [SD=SE*sqrt(n)]:

Hamdorf 1999; Karstoft 2013; Moreau 2001; Nemoto 2007; Stanton 1996.

Characteristics of excluded studies [ordered by study ID]

Study	Reason for exclusion
Ades 1995	Not a randomised controlled trial
Adragna 1985	Not just walking intervention
Albright 1992	Not just walking intervention
Aldred 1995	Excluded after contacting author
Andersen 2013	Stair climbing
Anderson 2015a	Outcome data were not available
Anderson 2015b	Outcome data were not available
Aoike 2012	Not just walking intervention
Arakawa 1993	Not walking intervention
Arija 2018a	Not just walking intervention
Arija 2018b	Not just walking intervention
Asbury 2008	Not just walking intervention
Asikainen 2002aStudyII	Active control
Asikainen 2002bStudy I	Active control
Asikainen 2003	Active control
Baraas 2011	Not just walking
Baraas 2013	Blood pressure was not measured
Baria 2012	Excluded after contacting author
Barone 2009	Not just walking intervention
Barroso 2008	Non walking intervention
Belli 2011	Not just walking intervention
Bergstrom 2009	Not just walking intervention
Bhammar 2012	Intervention only on one exercise session (1 day)
Bhammar 2017	Intervention only on one exercise session (1 day)
Blumenthal 1991	Not just walking intervention
Boer 2014	Not just walking intervention
Bonet 2003	Active control
Boyne 2011	Non walking intervention
Brawley 2000	Excluded after contacting author
Brekke 2013	Non walking intervention
Bronas2011	Not just walking and active control
Brun 2008	Non‐walking intervention, walking is just a test
Calfas 2001	Active control
Carrier 2008	Not just walking intervention
Carroll 1995a	Not just walking intervention
Carroll 1995b	Outcome data not reported separately for the treadmill walking intervention group
Casal 1984	Abstract, insufficient information for outcome extraction
Cashin 2008	Not just walking intervention
Castello 2011	Not a usual blood pressure measurement
Chan 2013	No blood pressure data
Chanruengvanich 2006	Non‐walking intervention, walking is just a test
Chen (陳佳萍) 2016	Active control
Chen ( 陳宣蘭) 2015	No blood pressure data
Chen (陳美娟) 2017	No blood pressure data
Chen 2007	Not a randomised controlled trial
Chen 2014	Insufficient information for data extraction
Chomiuk 2013	Not a randomised controlled trial
Clark 2017	Not just walking intervention and active control
Collins 2003	Excluded after contacting author
Collins 2005	Excluded after contacting author
Collins 2007	Not just walking intervention
Collins 2010a	Active control
Collins 2010b	No blood pressure data
Collins 2011a	Excluded after contacting author
Collins 2011b	Excluded after contacting author
Collins 2011c	Excluded after contacting author
Cononie 1991	Not just walking intervention but walking plus jogging
Cooper 2001	Active control
Cotes 1963	Active control
Coulon 2013	Not just walking intervention and not a a randomised controlled trial
Crowther 2008	Non walking intervention
Cui 2010	Non walking intervention
Dahllof 1976	Not just walking
Dasgupta 2014	Author contacted excluded because of insufficient information
da Silva 2002	Not just walking intervention
Davey 2000	Non walking intervention
Dean 1989	No blood pressure data
Deligiannis 1999	Non walking intervention
De Vito 1999	Not just walking intervention
Devonish 2007	No blood pressure data
Digenio 1999	Non walking intervention
Di Loretoc 2005	Non walking intervention
Dimeo 2012	Part of Pagonas 2014
Dowman 2013	Non walking intervention
Dressendorfer 1995	Not just walking intervention but walking and cycling
Duncan 1985	Not just walking itnervention
Dunn 1997	Not just walking intervention
Duyur 2006	Iinsufficient information for data extraction
Elley 2006	Due to intervention period being too short, less than one week (4 days)
Ettinger 1997	Excluded after contacting author
Fan 2018	Not a randomised controlled trial
Figueroa 2007	Not a randomised controlled trial
Filho 2013	Not just walking intervention
Finkelstein 2016	Intervention of this study was incentive to exercise
Flo 2011	Blood pressure was not measured
Fox 2011	Not a randomised controlled trial
Fukahori 1999	Author contacted, excluded
Gettman 1976	Active control
Giannuzzi 2003	Not just walking intervention
Gibellini 2000	Not a randomised controlled trial
Gill 1984	Non walking intervention
Goldstein 1977	Non walking training
Gram 2010	Active control
Grant 2004	Non walking intervention
Grosse 2001	Not just walking intervention
Guo 2011	Active control
Hagberg 1989a	Non walking intervention
Hagberg 1989b	Not a randomised controlled trial
Halbert 2000	Non walking intervention and another intervention control
Hambrecht 2000	Not just walking intervention
Hamdorf 1992	No tandard deviation (SD) data for outcome data extraction
Hamdorf 1993	Insufficient information for outcome data extraction
Hardman 1994	Not a randomised controlled trial
Hass 2001	Not a randomised controlled trial
Havlik 2005	Active control
Headley 2008	Just tested acute aerobic effect
Hiatt 1994	Not just walking intervention
Higashi 1999a	Duplicated with the other 1999 paper, used the other paper
Hinkleman 1993	From outcome extraction Excel file
Hu 2016	No pure control group
Huang 2006	Non walking intervention
Huiskes 2009	Not a randomised controlled trial
Hurley 2019	From outcome extraction Excel file
Iida 2011	Active control: control was slow walking
Isaacs 2007	Non walking intervention
Jennings 1997	Not a randomised controlled trial
Jerome 2012	Active control
Jessup 1994	Not just walking
Jessup 1996	Blood pressure was not measured
Jette 1988	Outcome data were not available
Jiang 2004	Active control
Jiang 2007	Non walking intervention
Jiang 2013	No controls
Jo 1989	Not a randomised controlled trial and not just walking intervention
Johnson 2007	Non walking intervention
Kaltsatou 2011	Non walking intervention
Katz‐Leurer 2007	Non walking intervention
Kerse 2005	Non walking intervention
Kim 2010	insufficient information for data extraction
King 1991	Not just walking intervention
Kingwell 1993	Not just walking intervention
Kinoshita 1988	Non walking tervention
Klonizakis 2009a	Excluded after contacting author
Klonizakis 2009b	Blood pressure was not measured
Kobayashi 2001	Not a randomised controlled trial
Koh 2009	Protocol
Kolbe‐Alexander 2006	Active control
Kolt 2009	Protocol
Lamb 2002	Control group got advice on physical activity
Larsen 1969	Not just walking intervention
Lee 2001	Not a randomised controlled trial
Leehey 2009	Not just walking intervention
Leon 1996	Not just walking intervention
Ley 2013	Unspecific exercise intervention
Li (李合) 2018	Not a randomised controlled trial
Li 2005	Active control
Liang ( 梁曉琳) 2015	N blood pressure data
Liao 1987	Non walking intervention
Lima 2009	Tested acute effect of walking
Lin (林麗娟) 2010	Not a randomised controlled trial
Lin 2009	Active control
Liu (劉彥平) 2019	Active control
Llaberia 2013	Llaberia 2013 is the abstract of Arija 2017 and therefore was excluded.
Look Ahead Research Group 2010	Non walking intervention
Low 2007	Active control
Lunde 2012	Walking is a test
Mackey 2011	Author contacted excluded previously
Mackey 2011	Author contacted excluded previously
Marceau 1993	Not just walking
Martins 2010	Resistence training
Mason 1977	Not a randomised controlled trial
McAuley 2003	Active control
McDermott 2004	No blood pressure outcome data
McDermott 2013	Blood pressure was not measured
Mentz 2013	Multiple exercise interventions
Mereles 2006	Non walking intervention, walking is a test
Milecki 2013	Non‐RCT nor walking intervention
Miller 1993	Not a randomised controlled trial
Minus‐Grimes 2013	Insufficient information for data extraction
Miyashita 2008	Not a resting or accumulated blood pressure but quotw: "Blood pressure was measured in a seated position immediately after each bout of walking"
Mohammed 2016	Not just walking, not a usual way to measure blood pressure.
Molmen‐Hansen 2012	Walking/running
Monteiro 2010	Active control
Motlagh 2017a	Not just walking intervention
Motlagh 2017b	Blood pressure was not an outcome
Motoyama 1995	No blood pressure data
Motoyama 1998	Non walking intervention
Moul 1993	Active control
Mucha 2007	Excluded after contacting author
Muda 2006	Not just walking intervention
Myers 1999	Not just walking intervention but walking and diet restriction
Nam 2012	Multiple exercise interventions:treadmill walking, stationary cycle, stair‐stepper
Neto 2010	Not a randomised controlled trial
Newton 2002	Active control
Ngomane 2019	Only a 30‐minute intervention
Nieman 2013	Not just walking intervention
Nomura 1984	Not a randomised controlled trial
Norris 1990	Not a randomised controlled trial
Nussbaum 2013	Not a randomised controlled trial, non walking intervention
Oberman 1999	Not a randomised controlled trial
Obesity 2007	Not a randomised controlled trial
Oerkild 2012	Unspecific exercise intervention
Ogata 2012	Walking is a test but not an intervention
Ohta 2012	Intervention is bench‐step exercise
Okamoto 2013	Walking is a test but not an intervention
Oldroyd 2001	Non walking intervention
Osbak 2011	Multiple exercise interventions: treadmill walking, stationary cycling
Özdirenç 2004	Non walking intervention
Pal 2011	Active control
Paolillo 2013	Not a randomised controlled trial
Park 2005	Not a randomised controlled trial
Park 2006a	Active/treatment control
Park 2006b	Active control
Park 2014b	Not a randomised controlled trial
Pascoalino 2015	Walking and jogging
Peel 1999	Non walking intervention
Pereira 2015	Abstract, not enough information for risk of bias and outcome extraction
Petersen 2013	Abstract, not enough information for ridsk of bias and outcome extraction
Petrella 1998	Not a randomised controlled trial
Piette 2011	Active control
Pinto 2006	Not a randomised controlled trial
Pitsavos 2011	Non walking intervention
Pollock 1971	Not a randomised controlled trial
Povoa 2010	Active control
Probart 1991	Blood pressure was not measured
Puggaard 2000	Not just walking intervention
Puig‐Ribera 2015	Cluster randomisation (n = 6)
Purzycka 2011	Not a randomised controlled trial
Qi 2011	Excluded after contacting author
Qiu (邱方) 2016	Non‐human study
Quinn 2006	Active control
Rauramaa 1986	Walking + jogging
Ready 1995	No outcome data
Reeder 2008	Not just walking intervention
Ren (任強) 2015	No blood pressure data
Ressl 1977	Non walking intervention
Richter 2010	Not just walking
Rogers 1996	Not a randomised controlled trial and a non walking intervention
Roghani 2012	Control group data was not collected in the study
Romain 2019	The 30‐second sprint is probably like a running and therefore twas excluded
Rosety‐Rodriguez 2011	Not a randomised controlled trial
Ross 2000	Walking + jogging
Roviaro 1984	Not just a walking intervention
Rudd 1967	Not a randomised controlled trial and not a walking intervention
Sandroff 2016	Blood pressure was not measured
Santana 2016	Not a walking intervention
Santiago 1995	Excluded after contacting author
Saremi 2010	Not a randomised controlled trial
Sari‐Sarraf 2015	Intervention is not pure walking but walking plus running
Saxena 2016	Intervention only on one exercise session
Seals 1991	Active control
Seals 1997	Not a randomised controlled trial
Seminario 1999	Not just a walking intervention
Seo 2010	Multiple aerobic and resistence exercise
Shabaaninia 2017	Not just walking intervention but quote: " treadmill interval aerobic running"
Shin 1999	Not a randomised controlled trial
Shvedko 2019	Active control
Sijie 2012	Not just walking intervention
Simons 2006	Active control and not just walking intervention
Sims 2012	Not a randomised controlled trial
Sivarajan 1981	Not just walking intervention
Sivarajan 1982	Not just walking intervention
Skvortsova 2010	Not a randomised controlled trial
Skvortsova 2011	Not a randomised controlled trial
Sohn 2007	Walking plus sodium reduction
Song 2017a	Tthe main focus of the study is steps but not blood pressure
Song 2017b	Not just walking intervention
Sousa 2013	Not just walking intervention
Staffileno 2001	Multiple interventions
Staffileno 2007	Not just walking
Staudter 2011	Excluded after contacting author
Stefanick 1998	Not just walking intervention
Stensel 1993	Excluded after contacting author
Stensel 1994	Blood pressure was not measured
Steptoe 1990	Non walking intervention
Subramanian 2011	Not just walking intervention
Svacinova 2003	Blood pressure was not measured, active control. Not a randomised controlled trial
Talakad 2011	Non walking intervention
Talbot 2011	Active control
Tanaka 1998a	No mention of randomisation
Tang 2019	Walking + medication
Tao 2004	Not just walking
ter Bogt 2011	Not just walking
Thomas 2010	Not just walking intervention
Thompson 1988	Non walking intervention
Tian (田野) 2014	No blood pressure data
Tjonna 2008	Non walking intervention study
Toledano‐Zarhi 2011	Not just walking intervention
Torrente 2017	This study excluded the control arm and keeping only the park‐walking group and relaxation exercise group, and using the days they were not exercising (before training, and 1 & 3 weeks after training) as their “own” control. The author did not analyse the data in the way that they randomised participants.
Tsai 2002a	Not just walking but walking + jogging
Tsai 2002b	Not just walking but walking + jogging
Tsoukas 1995	Not just walking intervention
Tsuji 1990	Not a randomised controlled trial
Tully 2004	Reference could not be found
Tully 2007	Not a randomised controlled trial
Ubels 1999	Not a randomised controlled trial
Uemura 2012	Not just walking
Van Dyck 2013	Excluded after contacting author
van Sluijs 2005a	Non walking intervention
van Sluijs 2005b	Non walking intervention
Venojarvi 2013	No biood pressure data
Verity 1989	Pseudo‐randomised controlled trial
Vetrovsky 2018	Active control
Vicente‐Campos 2012	Non walking intervention
Waib 2011	Non walking intervention
Wanderley 2010	Blood pressure was not measured
Wanderley 2013	Not just walking intervention
Wang (王漫卓) 2017	Not just walking
Wang (王磊) 2016	Not just walking intervention
Wang (王純) 2007	Not a randomised controlled trial
Wang (王錦雲) 2005	Not a randomised controlled trial
Wang 2011	Not a randomised controlled trial
Wang 2012	Not just walking intervention
Weinstein 2013	Blood pressure was not measured and active control
Welsh 1985	Not a randomised controlled trial
Whitehurst 1991	Not a randomised controlled trial
Whitney 1991	Non walking intervention
Whitney 1993	Non walking intervention
Wijnen 1994	Non walking intervention
Wilmore 1970	Non walking intervention
Wilson 2010	Excluded after contacting author
Wing 1998	Non walking intervention
Wong 2018	Stair‐climbing exercise
Woolf‐May 1999	Not a randomised controlled trial, and no blood pressure measurement
Wu 2007	Not a randomised controlled trial
Xie 2015	Insufficient information for outcome extraction
Yates 2009	Active control
Yeater 1990	Excluded after contacting author
Yu (于進) 2003	No blood pressure data
Yuenyongchaiwat 2018	Not a randomised controlled trial
Zeng (曾玉萍) 2014	No blood pressure data
Zhang (張舒) 2012	No blood pressure data
Zhang 2015	Insufficient information for outcome extraction, refer to Zhang 2016 full‐text paper
Zhang 2016	Active control and only provided percentage of change score but the parameters are unclear
Zhou (周玉萍) 2015	Active control
Zoellner 2011	Not a randomised controlled trial and active control

Characteristics of ongoing studies [ordered by study ID]

Actrn 2015.

Study name	Prescribing the maximum tolerated dose of walking for people with severe knee osteoarthritis: a Phase II, randomised controlled trial
Methods	Aim: to test the effects of a prescribed walking program of 70 minutes per week for 12 weeks Design: a Phase II, randomised controlled trial
Participants	People with severe knee osteoarthritis and at least moderate risk of cardiovascular disease 44 participants in total Both male and female Inclusion criteria Adult aged at least 50 years and living independently in the community. Diagnosed with severe knee osteoarthritis rated as grade III or IV determined radiogaphically. Have a cardiovascular risk profile with at least 2 total risk factors using stage 2 of the Adult Exercise Screening Tool. Able to participate safely in the moderate‐intensity physical activity trial using stage 1 of the Adult Exercise Screening Tool. Able to understand English. Exclusion criteria Live in supported accommodation such as a nursing home. Report daily resting level of pain to be 9 or 10 on a 0 (no pain) to 10 (worst possible pain) Numerical Pain Rating Scale. Have very high levels of psychological distress as measured by the Kessler 10 questionnaire with a K10 score > 29. Have an intellectual impairment as measured by the Short Portable Mental Status Questionnaire with a score of 7 or less. Have a systemic arthritic condition such as rheumatoid arthritis. Have a neurological condition that affects walking. Had knee surgery or intra‐articular corticosteroid injection within past six months. sing oral corticosteroids within four weeks.
Interventions	Intervention group standard care+prescription "of a walking dose of 70 minutes per week, of at least moderate intensity using the rate of perceived exertion scale with a score of at least 3/10, in bouts of at least 10 minutes. The weekly dose will be completed for 12 weeks in the community. The walking doses will be completed in the community using normal assistive devices, such as a walking stick if required. Participants will continue taking their usual medications and other normal strategies to manage their knee osteoarthritis." "To increase the likelihood of adherence to the intervention and maximise the effectiveness of the intervention, we will use the following behavioural change techniques and strategies: Single planning session of up to 30 minutes with goal setting ‐ a physiotherapist will assist the participant to determine when and where to complete the dose of walking; Supervision ‐ physiotherapist supervision of one session of walking weekly; Monitoring ‐ each participant will wear a pedometer to self monitor the number of steps each week. They will also complete a logbook to record number of steps and time spent walking each week. A physiotherapist will monitor their progress with a weekly phone call or send weekly SMS reminders; Engaging social supports ‐ each participant will be encouraged to walk with a friend, or family member or other research participant." Control group standard care only for pain, cardiovascular risk, function and quality of life
Outcomes	Primary outcome: average knee pain over the previous week measured by a 0 to 10 Numerical Pain Rating Scale. [Baseline and post intervention (Week 12)] Secondary outcomes: Resting blood pressure ‐ systolic and diastolic (mmHg) using a blood pressure monitor[Baseline and post intervention (week 12)] 30‐second chair stand test as per OARSI functional performance measure guidelines [Baseline and post intervention (week 12)] 40 metre (4 x 10 metres) fast paced walk test as per OARSI functional performance measure guidelines[Baseline and post intervention (week 12)] Body mass index (kg/m2) using scales for weight and tape measure for height[Baseline and post intervention (week 12) various other irrelevant outcomes
Starting date	14 January 2015
Contact information	Mr Jason Wallis jason.wallis@easternhealth.org.au +61 3 9895 3715 Box Hill Hospital Building B, Level 3 8 Arnold Street Box Hill VIC 3128, Australia
Notes	Trial registration: ACTRN12615000015549

Actrn 2017.

Study name	Activity for Wellbeing: promoting well‐being through physical activity in aged care workers
Methods	Aim: to study the efficacy of using a need‐supportive, person‐centred physical activity program for improving and maintaining physical activity participation and psychological well‐being in frontline aged care workers Design: cross‐over study with block randomisation
Participants	Aged: 18 years or over Sex: males and females 25 participants in total Inclusion criteria • Current employee of ACH group • Able to speak fluent English • At least 18 years of age • Ability to engage in moderate physical activity (as defined by the American College of Sports Medicine (ACSM)) and complete all outcome measures (including the Six Minute Walk) • Not currently meeting ASCM recommendations for physical activity (greater than or equal to 30 minutes of moderate cardio‐respiratory exercise per day, 5 days per week) Exclusion criteria: no exclusion criteria, but volunteers who have previously diagnosed conditions or signs or symptoms of disease as indicated on the Adult Pre‐exercise Screening System will need to provide medical clearance prior to participation in the study.
Interventions	Intervention Pedometer‐based intervention with person‐centred activity plan aimed at assisting the participant to meet ACSM recommendations for physical activity Participants will also be taught how to use affect and ratings of perceived exertion to regulate exercise intensity, and the use of a pedometer and interactive website for monitoring step counts Weekly contacts via the dashboard page of the program website for providing feedback on goal‐setting, motivational statements and active encouragement and support (12 contacts over the course of 12‐weeks), or email contacts Wait‐list control
Outcomes	Primary outcome: 2‐day activity recall Secondary outcomes: resting blood pressure at baseline, 12 weeks (post‐intervention) and 6‐month follow‐up (9 months post baseline); 6 minute Walk distance; BMI etc.
Starting date	21/09/2017
Contact information	Ms Merilyn Lock merilyn.lock@mymail.unisa.edu.au +61 8 8302 1752 Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences. Playford Bldg. City East Campus, University of South Australia, Adelaide, SA, 5001, Australia
Notes	Trial registration: ACTRN12617001395325

Nct 2009.

Study name	Diabetic Kidney Disease: influence of Exercise therapy on Physical and Vascular Function. (DKD‐EXT)
Methods	Aim: to investigate the effect of a 12‐week walking exercise program on vascular endothelial function, arterial stiffness/compliance, and vascular health biomarkers in men and women with pre‐dialysis type 2 diabetic kidney disease (DKD) Design: parallel RCT 2 arms
Participants	Men and women with pre‐dialysis type 2 diabetic kidney disease (DKD) 122 enrolled
Interventions	Experimental: exercise blended supervised‐home‐based exercise training 3 to 4 times/week for 12 weeks. Intervention: behavioral: exercise No Intervention: control group asked to continue usual activities
Outcomes	Primary outcomes Eendothelial function measured by brachial artery flow mediated vasodilation [Time Frame: at week 0 and at week 12] Endothelium‐mediated change in vascular tone Secondary outcomes Arterial stiffness measured by pulse wave velocity [Time Frame: at week 0 and at week 12] Circulating markers of vascular health [Time Frame: at week 0 and at week 12] C‐reactive protein, isoprostane F2, Asymmetric dimethylarginine Aerobic capacity [Time Frame: at week 0 and at week 12] Peak oxygen consumption Blood pressure [Time Frame: at week 0 and at week 12] 24‐hour albuminuria [Time Frame: at week 0 and at week 12] assessed in 30 participants measured inmg/g creatinine
Starting date	October 2009
Contact information	No information
Notes	Trial registration: ClinicalTrials.gov Identifier: NCT02112071; 0905M66282 K23DK082638-04 ( U.S. NIH Grant/Contract ) 22275 ( Other Identifier: University of Minnesota )

BMI: body mass index; RCT: randomised controlled trial.

Differences between protocol and review

Since considerable time passed from the publication of the protocol (Lee 2010b) and the completion of the review, a number of differences arose between protocol and review.

1. We refined our definition of walking to include flat walking only and to not include stair walking and uphill treadmill walking.

2. We updated the background section to include more recently published references.

3. We included data on adverse events where it was provided by included studies.

4. We undertook a post‐hoc analysis of the effect of walking intervention on blood pressure control by study sample size.

5. We undertook a post hoc analysis of the effect of walking intervention on blood pressure control by the baseline blood pressure.

6. Hui‐Hsin Lin and Yoko Kin Yoke Wong are authors on the review but were not authors on the protocol. They undertook screening of papers, data extraction and analysis.

7. Douglas Salzwedel was author on the protocol but is not author on the review. His contribution was acknowledged under Acknowledgements.

Contributions of authors

Ling‐Ling Lee (LLL) formulated the idea for the review and developed the basis for the protocol.

LLL, Caroline A Mulvaney (CM), Michael C Watson (MW) drafted the protocol.

Hui‐Hsin Lin (HHL), LLL, CM independently screened articles for inclusion or exclusion.

Yoko Kin Yoke Wong (YW), HHL, CM, LLL, MW extracted data and checked data entry.

CM, YW, Edwin SY Chan (EC), LLL, MW assessed the risk of bias of all included studies.

LLL, YW, CM conducted data analysis and interpretation of the study result.

LLL, CM, MW contributed to drafting and editing of the final draft of the review.

LLL, CM drafted and edited the final review.

All review authors reviewed and approved the final version.

Sources of support

Internal sources

• Tzu Chi College of Technology, Taiwan

  TCCT‐971B31

External sources

• National Science Council of Taiwan, Taiwan

  NSC 100‐2410‐H‐277‐005

Declarations of interest

Ling‐Ling Lee: none known

Caroline A Mulvaney: none known

Michael C Watson: none known

Edwin SY Chan: none known

Hui‐Hsin Lin: none known

Yoko Kin Yoke Wong: none known

Edited (no change to conclusions)