Table 2.

List of accepted items

No	Item description
Safety
1	In general, leg IRT employed at an appropriate training intensity (e.g., 20% MVC) causes blood pressure responses of >30 mmHg in SBP or 20 mmHg in DBP.
2	IRT at an appropriate training intensity (e.g., 30% MVC for handgrip or 20% MVC for leg) causes smaller increases in rate pressure product (SBP x HR) compared to moderate intensity aerobic exercise.
3	An appropriate IRT program is safe for people with pre-hypertension.
4	An appropriate IRT program is safe for people with stage 1 hypertension.
5	In general, an appropriate IRT program is safe for people with cardiovascular diseases.
6	An appropriate IRT program is safe for people with peripheral artery disease.
Efficacy
1	A program of IRT of 8 weeks or longer elicits statistically significant reductions in SBP in healthy individuals.
2	A program of IRT of 8 weeks or longer elicits statistically significant reductions in DBP in healthy individuals.
3	A program of IRT of 8 weeks or longer elicits statistically significant reductions in SBP in cardiovascular disease patients.
4	A program of IRT of 8 weeks or longer elicits statistically significant reductions in DBP in cardiovascular disease risk patients.
5	A program of IRT of 8 weeks or longer elicits clinically meaningful reductions (i.e., ≥2 mmHg reduction) in SBP in healthy individuals.
6	A program of IRT of 8 weeks or longer elicits clinically meaningful reductions (i.e., ≥2 mmHg reduction) in DBP in healthy individuals.
7	A program of IRT of 8 weeks or longer elicits clinically meaningful reductions (i.e., ≥2 mmHg reduction) in SBP in cardiovascular disease patients.
8	A program of IRT of 8 weeks or longer elicits clinically meaningful reductions (i.e., ≥2 mmHg reduction) in DBP in cardiovascular disease patients
9	A program of IRT of 8 weeks or longer elicits SBP and DBP reductions of similar size to those observed with taking one anti-hypertensive medication.
10	A program of IRT of 8 weeks or longer elicits SBP and DBP reductions that are likely to reduce the risk of a serious event related to poor blood pressure control such as stroke and myocardial infarction.
11	An appropriate IRT program may potentially be beneficial for people with heart disease as it elicits an ischaemic pre-conditioning response.
Programming
1	A typical handgrip IRT program is 4 × 2 min effort at 30% MVC with 1–3 min rest periods in between efforts.
2	A typical leg IRT program is 4 × 2 min effort at 20% MVC with 1–3 min rest periods in between efforts.
3	A typical IRT protocol performed at a minimum frequency of 3 sessions per week for 8 weeks or longer is enough to obtain a clinically meaningful anti-hypertensive response.
4	Prior to IRT programming an individual should be pre-screened including appropriate risk assessment by an appropriate health professional.
5	Ideally, MVC should be measured before every IRT session and training intensity adjusted accordingly to ensure relative effort remains constant.
6	IRT can be used as an alternative form of exercise to lower blood pressure in people with hypertension who are unable to perform other types of exercise (aerobic or dynamic resistance).
7	IRT is relatively simple to perform compared to some other forms of exercise.
8	The handgrip IRT exercise device is portable and simple to transport.
9	Besides walking an IRT program is relatively inexpensive compared to some other forms of exercise.
10	An IRT program takes less time to perform and to elicit anti-hypertensive benefits than other types of exercise.
Delivery
1	Handgrip IRT is simple to deliver as one can measure MVC and then prescribe IRT at 30% MVC and this may also reduce barriers to dynamic exercise training.
2	Handgrip IRT below 5% MVC is unlikely to elicit anti-hypertensive benefits.
3	Leg IRT is more difficult to prescribe as opposed to handgrip IRT as sophisticated laboratory/gym equipment is required to determine MVC for leg IRT.
4	Handgrip IRT performed at MVC above 30% is sub-optimal as it increases the risk of exaggerated blood pressure responses and reduces the ability of people to complete their handgrip program.
5	Handgrip IRT employed at an appropriate training intensity can be prescribed by a qualified exercise specialist for home-based training with little or no supervision – using the appropriate risk assessment prior to training.
6	Leg IRT employed at an exact training intensity of 20% MVC can be prescribed by a qualified exercise specialist for home-based training with little or no supervision.
7	Prescription of handgrip IRT is preferred to leg IRT for home-based delivery as the former is inexpensive and easier to use compared to the later which requires sophisticated laboratory/gym equipment to determine precise MVC.
Mechanism of action
1	A possible mechanism for IRT to work is via repeated exposure to blood vessel occlusion that causes shear stress on the arterial wall with a resultant increase in nitric oxide release triggering vasodilation.
2	Repeated exposure of IRT may cause permanent changes in blood vessels (e.g., diameter) with time. Longer term (i.e., ≥6 months) might lead to more consistent blood pressure adaptations.
3	IRT generates reactive hyperaemia which is facilitated by vasodilation.
4	Repeated exposure to IRT increases baroreflex sensitivity which may improve cardiac autonomic modulation.
5	Depending on the length of the protocol, the anti-hypertensive effects of IRT are reversed within 2–5 weeks detraining.
6	The anti-hypertensive effects of IRT are transient if the individual discontinues the training.
7	The anti-hypertensive effects of IRT are semi-permanent (e.g., lasting up to 4 weeks) if training is discontinued.

Note: Two items that negated a previous statement have been excluded from accepted items