A Systematic Review of the Impact of Physical Activities in the Prevention and Control of High Blood Pressure Among Adults in Africa

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Physical activity has been recognised as a cost-effective, non-pharmacological approach for the management of hypertension. Nonetheless, evidence from African populations continues to be disjointed. This study aimed to assess the impact of physical activity in the prevention and control of high blood pressure in adults in Africa. Methods A comprehensive review was performed utilising studies published from 2010 to 2025 sourced from PubMed, Scopus, CINAHL, Web of Science, and African Index Medicus. Retrieved studies were screened based on pre-determined eligibility criteria. Data were extracted according to key variables, including study design, intervention type, duration, outcome measures, and key findings. The CASP checklist for randomised controlled trials was employed to assess the methodological quality of the studies that were included. Studies were synthesised using a narrative synthesis approach. Results Five studies satisfied the inclusion criteria. The results repeatedly demonstrated that moderate-intensity aerobic exercises, especially brisk walking and aerobic dance, substantially reduced systolic blood pressure, with lesser albeit favourable impacts on diastolic blood pressure. Interventions lasting 12 to 16 weeks or longer and those that included medication led to the most significant results. Conclusion Consistent, moderate-intensity physical activity significantly reduces blood pressure and ought to be included in hypertension care and preventive programs in Africa. The results show that there is a need for national policies that encourage community-based fitness programs and more large-scale studies to look at long-term and gender-specific impacts. PROSPERO Registration Number: CRD420251131467. Physical activity hypertension blood pressure aerobic exercise Africa prevention lifestyle intervention Figures Figure 1 Introduction The World Health Organisation ( 1 ) defines hypertension as systolic blood pressure ≥ 140 mmHg and/or diastolic pressure ≥ 90 mmHg. The criteria agree with global clinical thresholds, although the American Heart Association (AHA) proposed a stricter categorisation, defining hypertension at ≥ 130/80 mmHg, which lowers the diagnostic threshold and raises concerns about overdiagnosis versus early care ( 2 ). Mills et al. ( 3 ) proposed that this adjustment by the AHA may overstate prevalence figures, whereas WHO's criteria are considered pragmatic for global surveillance. According to reports, hypertension affects around 1.28 billion adults worldwide, with Africa having the highest prevalence at approximately 46% of the adult population, exceeding the global average of 31% ( 4 ). Ampofo et al. ( 5 ) and Kayima et al. ( 6 ) argue that hypertension in Africa is frequently undetected and undertreated, highlighting a systemic deficiency in preventive healthcare, and physical activity has been largely accepted as a key component of non-pharmacological intervention for addressing modifiable risk factors. WHO ( 1 ) defines physical activity as any skeletal muscle movement that results in energy expenditure, and recommends that adults engage in at least 150–300 minutes of moderate-intensity aerobic activity each week. In contrast, "exercise" refers to structured, repetitive, and goal-oriented physical activity ( 7 ). Sedentary behaviour, on the other hand, refers to waking activities like sitting or reclining that require little energy expenditure, often less than 1.5 METs ( 8 ). Bashir et al. ( 9 ) and Blair et al. ( 10 ) discussed that a clear knowledge of these distinctions is critical, as even light-to-moderate exercises like brisk walking or home chores have considerable cardiovascular benefits, particularly in low-resource African contexts where gym-based routines are less accessible. Palatini and Cornelissen ( 11 ) found that aerobic exercise lowers systolic and diastolic blood pressure by 5–7 mmHg, a result comparable to medication in moderate hypertension, and as a result, the role of physical activity encompasses both prevention and control, which must be defined. Friedenreich et al. ( 12 ) argued that primary prevention tries to prevent illness beginning through lifestyle changes before risk factors emerge, whereas secondary prevention focuses on early detection and care to slow progression. In hypertension, prevention comprises community awareness, food restriction, and physical exercise, whereas control includes medication adherence, periodic screening, and behaviour adjustment ( 8 , 13 ). In line with this, lifestyle change acts as both an intervention and a management strategy, especially in African contexts where pharmacological availability is limited and exercise is widely accepted ( 3 ). Thus, there is a significant confluence between public health education and behavioural change, as highlighted by WHO ( 14 ) in its Global NCD Action Plan, which includes physical exercise as a key behavioural risk reduction approach. The rationale for performing this systematic analysis stems from important gaps in the available research on the function of physical activity in preventing and managing hypertension in African adult populations. Akinlua et al. ( 15 ) discussed that, despite the fact that hypertension is a primary cause of morbidity and mortality in Africa, most present therapies are biomedical in nature, with insufficient incorporation of culturally relevant, lifestyle-based approaches such as physical activity. While global data strongly support exercise as an effective blood pressure-lowering technique, there is a lack of region-specific syntheses that contextualise these findings within the African sociocultural and infrastructural background. Ainsworth, ( 16 ) opine that physical activity patterns in Africa differ significantly from those in Western contexts; for example, regular walking, subsistence farming, traditional dance, and communal labour are all common but under-represented in global databases, and the lack of comprehensive evaluation of these novel approaches jeopardises their potential inclusion into national noncommunicable disease (NCD) preventive strategies. Furthermore, previous reviews frequently aggregate data across other areas, concealing intra-African heterogeneity in lifestyle, urbanisation, and socioeconomic determinants of health ( 16 ). This systematic review seeks to fill a significant gap by gathering and synthesising empirical evidence relevant to African adults, stratifying findings by nation, activity type, and methodological quality. The major aim of this systematic review is to assess the impact of physical activities in the prevention and control of high blood pressure among adults in Africa Methods Eligibility Criteria In this review, the population consists of persons aged 18 and above who live in African countries, independent of their hypertension status at baseline. The Intervention encompasses all forms of structured or unstructured physical activity, including aerobic exercise, walking, community-based exercise programs, and culturally relevant activities such as farming or dance. Individuals with sedentary lives or those who have received other therapies (e.g., pharmaceutical or nutritional interventions) make up the Comparison group. Changes in systolic and diastolic blood pressure are the major outcomes of interest; additional outcomes include the incidence or prevalence of hypertension, BMI fluctuations, cardiovascular risk, and adherence to physical activity programs. The review will only include quantitative research, such as randomised controlled trials (RCTs), quasi-experimental studies, cohort studies, and case-control studies, with cross-sectional studies omitted unless they provide longitudinal inference. To preserve methodological rigour, only original peer-reviewed studies published in English in the last 10 to 15 years will be considered. Grey literature, such as unpublished reports, short communications, preprints, magazines, and non-empirical papers, is omitted to improve the quality and replicability of results. Table 1.0 shows the inclusion and exclusion criteria for this review Table 1.0 Inclusion and Exclusion Criteria Eligibility Item Inclusion Criteria Exclusion Criteria Population Adults aged ≥ 18 years residing in any African country, with or without hypertension Studies involving children, adolescents (< 18 years), or non-African populations Intervention Any form of structured/unstructured physical activity (e.g., walking, aerobic exercise, farming, dance) Studies not involving physical activity or using only pharmacological/dietary interventions Comparison Sedentary lifestyle or alternative interventions (e.g., medication, no intervention) No comparison or irrelevant comparators (e.g., unrelated behavioural therapies) Outcomes Primary: Changes in systolic/diastolic BP; Secondary: Hypertension incidence, BMI, cardiovascular risk Studies not reporting BP or relevant cardiovascular/anthropometric outcomes Study Design Quantitative studies only: RCTs, quasi-experimental, cohort, case-control (with longitudinal inference) Cross-sectional without longitudinal data, qualitative studies, mixed methods, case reports, editorials, reviews Publication Type Original, peer-reviewed journal articles, dissertations Preprints, unpublished reports, short communications, grey literature, magazines, conference abstracts Study Period Studies published within the past 10–15 years (2010–2025) Studies published before 2010 Language English Non-English language publications Search Strategy The search strategy for this systematic review was broad and structured, and utilised five key databases: PubMed, Scopus, CINAHL, Web of Science, and African Index Medicus ( 17 ). To improve the precision and relevance of retrieved articles, Medical Subject Headings (MeSH) phrases were combined with primary keywords drawn from the review's core themes ( 18 ). The core keywords are "physical activity", "exercise", "aerobic activity", "hypertension", "high blood pressure", "adults", and "Africa". Boolean operators like AND, OR, and NOT were used to link and filter search queries, assuring logical links between concepts. To improve search yield, truncation symbols (e.g., activ to capture activity, activities), wildcards (e.g., wom?n to capture woman and women), and proximity operators (e.g., NEAR/n) were used where allowed by database syntax. This technique assisted in retrieving studies that utilised different terminologies but addressed similar issues. Furthermore, the reference lists of relevant papers were manually inspected to discover possibly eligible studies that were not found during the original computerised database search, assuring data saturation and reducing selection bias. Table 2.0 below illustrates the detailed search strategy. Table 2.0 Search Strategy Primary Keywords Search Strings Boolean Operator Databases Searched Physical activity, Exercise (“Physical activity” OR “Exercise” OR “Aerobic activity”) OR PubMed, Scopus, CINAHL, Web of Science, AIM Hypertension, High blood pressure (“Hypertension” OR “High blood pressure”) OR PubMed, Scopus, CINAHL, Web of Science, AIM Adults (“Adults” OR “middle-aged” OR “older adults” OR “≥18 years”) OR PubMed, Scopus, CINAHL, Web of Science, AIM Africa (“Africa” OR “Nigeria” OR “Kenya” OR “South Africa” OR “Ghana” OR “Sub-Saharan Africa” OR “North Africa”) OR PubMed, Scopus, CINAHL, Web of Science, AIM Combined strategy (“Physical activity” OR “Exercise” OR “Aerobic activity”) AND (“Hypertension” OR “High blood pressure”) AND (“Adults”) AND (“Africa” OR countries) AND PubMed, Scopus, CINAHL, Web of Science, AIM Study Selection The study selection process is an essential component of systematic reviews, since it ensures that included research is thoroughly checked for relevance and methodological suitability. The references retrieved from the database search were exported to EndNote reference management software (version X9), which automatically removed duplicates. The initial title and abstract screening were performed, followed by the full text screening. Two independent reviewers screened and selected the studies, and discrepancies were addressed through discussion. However, to ensure transparency and methodological integrity, the entire selection process was monitored and displayed using the PRISMA flow diagram ( 19 ), which visually sums up the number of studies identified, screened, excluded, and eventually included. Data Extraction In this review, data extraction was carried out using Microsoft Excel, which proved to be a solid platform for systematically arranging and managing study-specific information. A standardised data extraction form was created in Excel and tested on a subset of papers to ensure consistency, accuracy, and completeness among reviewers. Extracted data items included the author(s) name, year of publication, country of study, study design, target population characteristics (e.g., age, gender, health status), sample size, type and duration of physical activity intervention, comparison or control group, outcome measures such as changes in systolic and diastolic blood pressure, and, where reported, effect size or statistical significance of findings. Two independent reviewers performed the data extraction of the included studies, and discrepancies were addressed through discussion. This organised extraction technique simplified the synthesis of comparable evidence from various research and guaranteed that all included articles were appraised using a consistent set of metrics. Risk of Bias The Critical Appraisal Skills Programme (CASP) checklist was employed for this review because it can be used for a variety of study types, including RCTs, cohorts, and quasi-experimental studies ( 20 ). It enables organised judgement without requiring substantial statistical knowledge, making it both accessible and replicable. The CASP checklist is divided into three sections: study validity (e.g., clarity of the research aim, appropriateness of design, recruitment strategy), methodological rigour, and results relevance (e.g., data analysis, precision of findings, and applicability to context). Two independent reviewers assessed the quality of the included studies, and discrepancies were addressed through discussion. This approach is consistent with the primary purpose of this review: to synthesise strong, context-specific evidence on the impact of physical exercise in hypertension prevention among African adults, while critically evaluating the methodological strength of each included study. Data Synthesis Data synthesis in systematic reviews is the act of combining findings from individual studies to reach relevant conclusions about a research subject. Narrative synthesis, also known as textual or topic synthesis, is a non-statistical approach that works well with a variety of study designs and outcomes. Also, narrative synthesis enables researchers to investigate relationships, contexts, and methodological variations, resulting in a more comprehensive and nuanced understanding of findings. For this review, a narrative synthesis approach was used. This choice was made due to methodological and contextual heterogeneity among included research, such as differences in physical activity kinds, outcome measures, and African regional contexts, which disallowed statistical meta-analysis. Narrative synthesis was used to systematically assess and thematically organise data across studies, emphasising trends, contradictions, and knowledge gaps. Results Overview of Search Process A search through electronic databases such as PubMed, Scopus, CINAHL, Web of Science, AIM yielded a total of 1114 studies. Following record de-duplication and study screening, 198 studies were eligible for full text screening, and studies were excluded based on the predetermined eligibility criteria leaving 5 studies which met the review’s inclusion criteria. Figure 1 depicts the PRISMA flow chart, which shows the study selection process and reasons for exclusion of studies. 3.2 Characteristics of Included Studies A total of five studies were included for the synthesis of this review. These studies were conducted across different African countries. Table 3.0 details the characteristics of the five included studies. Table 3.0 Characteristics of Included Studies Author (Year) Country of Study Study Aim(s) Sample Size and Population Characteristics Study Design and Methodology Intervention (Type and Duration of Physical Activity) Comparison or Control Group Outcome Measures Main Findings Nahwera et al. ( 21 ) Uganda (Kyambogo University Medical Centre, Kampala) To evaluate the effect of a 12-week supervised aerobic dance exercise programme on systolic blood pressure among adults diagnosed with stage-one hypertension. n = 36 randomized (18 intervention, 18 control); adults with stage-one hypertension; mixed gender (~ 50% female in intervention group); age range: 30–59 years. Open-label randomized parallel-group trial; allocation by coin toss with sealed-envelope concealment; standardized blood pressure measurement using mercury sphygmomanometer; pre- and post-intervention assessments. Supervised moderate-intensity aerobic dance programme for 12 weeks, 3 sessions per week, 45 minutes per session (warm-up, 30-minute aerobic phase, cool-down). Control group maintained usual activities (no organized exercise) with weekly follow-up contact. Primary: Systolic blood pressure (mmHg). Secondary: Sex- and age-stratified changes in systolic blood pressure. Systolic blood pressure significantly reduced in the intervention group (143.83 ± 6.38 → 136.33 ± 9.19 mmHg; Δ − 7.50; p = 0.002) compared to the control group (137.61 ± 6.40 → 139.56 ± 9.95 mmHg; Δ + 1.95; ns). Both males and females improved, with slightly greater reduction among females. Nahwera et al. ( 22 ) Uganda (Kyambogo University Medical Centre, Kampala) To determine whether a 12-week supervised aerobic dance programme leads to reductions in diastolic blood pressure and whether gender influences the effect among adults with stage-one hypertension. n = 36 completed (18 intervention, 18 control); adults with stage-one hypertension; intervention: 9 females/9 males; control: 6 females/12 males; age range: 30–59 years. Randomized parallel-group trial; blood pressure assessed using standardized sphygmomanometer; paired and independent-samples t-tests applied for analysis. Supervised aerobic dance at 40–60% heart-rate reserve, for 12 weeks, 3 sessions/week, 45 minutes/session, including warm-up, aerobic, strengthening, and relaxation phases; intensity monitored using heart-rate checks. Usual daily activities (no exercise intervention) with weekly follow-up phone calls. Primary: Diastolic blood pressure (mmHg). Secondary: Gender-stratified differences in diastolic blood pressure. The aerobic-dance programme led to a non-significant overall reduction in diastolic blood pressure (− 1.50 ± 8.59 mmHg) compared to control (− 0.33 ± 6.59 mmHg; p = 0.275). Female participants showed a larger mean reduction than males. Maruf et al. ( 23 ) Nigeria (Ibadan/Nnewi) To investigate whether the addition of supervised aerobic dance exercise to standard antihypertensive drug therapy enhances blood-pressure control and reduces the number of required medications in adults with mild-to-moderate hypertension. n = 120 newly-diagnosed mild-to-moderate hypertensives randomized; 88 completed (45 intervention + drugs; 43 drugs-only control); participants had uncontrolled hypertension on two antihypertensive drugs. 12-week double-blind randomized clinical trial; intervention group received coamilozide + amlodipine plus aerobic dance; control received drug therapy only; data analyzed on an intention-to-treat basis. Supervised aerobic dance added to drug therapy; 12 weeks, sessions spaced ≥ 24 hours apart with progressively increased tempo (session duration not reported). Drug therapy alone (coamilozide + 5/10 mg amlodipine). Primary: Systolic and diastolic blood pressure (mmHg). Secondary: Rate of blood-pressure control (< 140/90 mmHg); number of drugs required post-intervention. Aerobic dance combined with drug therapy achieved greater blood-pressure reduction (SBP − 7.1 mmHg; DBP − 1.7 mmHg) and higher control rates (53.9% vs 35.3%) than drug-only treatment. More participants reduced to a single antihypertensive drug (20.3% vs 11.1%). Daimo et al. ( 24 ) Ethiopia (Hawassa & Mekelle) To examine the effects of a 16-week moderate-intensity aerobic exercise programme on systolic and diastolic blood pressure among adult males with stage-one hypertension. n = 24 male participants with stage-one hypertension; mean age = 38 ± 4 years; randomized to exercise (n = 12) or control (n = 12). Randomized controlled parallel-group study; baseline and post-intervention (16 weeks) measurements; analysis by paired and independent t-tests using SPSS v20. Supervised moderate-intensity brisk walking for 16 weeks, 3 sessions/week. Control group continued usual daily routines (no physical-activity intervention). Resting systolic and diastolic blood pressure (mmHg). Exercise group achieved significant reductions in systolic (− 7.1 mmHg) and diastolic (− 5.6 mmHg) blood pressure (p < 0.001 for both); control group showed no significant changes. Opoku ( 25 ) Ghana (Korle Bu Teaching Hospital – National Diabetes Management and Research Centre, Accra) To assess the impact of an 8-week brisk-walking exercise programme on blood-pressure control, fasting blood-glucose levels, and functional fitness among adults with type 2 diabetes mellitus and co-existing hypertension. n = 60 adults (52 females, 8 males) diagnosed with type 2 diabetes mellitus and hypertension. Single-arm controlled (participants served as their own controls) pre–post intervention study; supervised sessions conducted for 8 weeks; pre- and post-assessments of physiological and functional parameters. Brisk walking programme, 8 weeks, 3 sessions/week, 45 minutes/session, including ≈ 5-minute warm-up and cool-down. No separate control group; baseline served as within-participant control. Fasting blood glucose, systolic blood pressure, diastolic blood pressure, and functional fitness (6-minute walk, 30-second chair-stand, 3-minute step test). Significant reductions in fasting blood glucose and both systolic and diastolic blood pressure were observed. Functional-fitness performance improved across all tests after the intervention. Quality Assessment The CASP Randomised Controlled Trial checklist was employed to assess the quality of the included studies, and they had moderate to high methodological quality. Studies were appraised using yes, no, and can’t tell in each domain. “Yes” was awarded 1 point, “No” was given 0, while “Not clear” was given 0.5. Studies that scored 9–11 were graded “High quality”, Studies that scored below 7 were graded “Low quality”, while studies scoring 7–8 were graded “Medium quality”. According to Table 4.0 below, the studies scored from 7 to 10.5 indicate a moderate to high quality. Four trials were appropriately randomised, explicitly articulated their objectives, and included all participants; however, the majority lacked blinding, hence presenting a possible risk of bias. The Nigerian study conducted by Maruf et al. ( 23 ) was the only study to implement double blinding. Although the effect sizes were explicitly provided, the majority of studies failed to include confidence intervals, hence constraining the precision of the results. The interventions and outcomes were suitable and clinically significant, with findings applicable to local populations. The Opoku ( 25 ) study, due to its non-randomised design, exhibited a higher risk of bias. Overall, the studies provide reliable evidence that physical activity effectively lowers blood pressure among the African population, although the methodological shortcomings, such as the lack of blinding and insufficient statistical reporting, reduce their rigour. Table 4.0 Critical Appraisal of Included Studies Study Q1 Focused issue? Q2 Randomisation? Q3 Accounted for all participants? Q4 Blinding (patients, staff, assessors)? Q5 Groups similar at start? Q6 Equal treatment aside from intervention? Q7 Size of effect clear? Q8 Precision (e.g., CIs reported)? Q9 Applicability to local population? Q10 All clinically important outcomes considered? Q11 Benefits worth costs/harms? Overall Quality Nahwera et al. ( 21 ) – Uganda Yes Yes Yes No Can't tell Yes Yes Can't tell Yes Yes Yes 9/11 (High quality) Nahwera et al. ( 22 ) – Uganda Yes Yes Yes No Can't tell Yes Yes Can't tell Yes Yes Yes 9/11 (High quality) Maruf et al. ( 23 ) – Nigeria Yes Yes Yes Yes Yes Yes Yes Can't tell Yes Yes Yes 10.5/11 (High quality) Daimo et al. ( 24 ) – Ethiopia Yes Yes Yes No Yes Yes Yes Can't tell Yes Yes Yes 9.5/11 (High quality) Opoku ( 25 ) – Ghana (non-RCT) Yes No Yes No No Can't tell Yes Can't tell Yes Yes Yes 7/11 (Moderate quality) Findings Effectiveness of Physical Activity Interventions in Reducing Blood Pressure The five included studies showed that physical activity interventions, especially aerobic dance and brisk walking, can reduce blood pressure in African adults with hypertension. However, the advantages are not always the same or as strong. In a randomised controlled trial conducted in Nigeria, Maruf et al. ( 23 ) discovered that participants who engaged in aerobic dance alongside pharmacological therapy attained a mean reduction of 7.1 mmHg in systolic blood pressure (SBP) and 1.7 mmHg in diastolic blood pressure (DBP), surpassing the drug-only control group and demonstrating high blood pressure control rates. This shows that exercise and medications work better together than either one alone. Likewise, Nahwera et al. ( 21 ) documented a notable reduction of 7.5 mmHg in systolic blood pressure (SBP) following a 12-week supervised aerobic dance program, compared to a marginal increase in the control group (p = 0.002). This underscores the efficacy of moderate-intensity exercise as a standalone non-pharmacological intervention. Conversely, Nahwera et al. ( 22 ), investigating the identical intervention with an emphasis on diastolic blood pressure (DBP), reported a non-significant mean reduction of 1.5 mmHg, indicating that enhancements in diastolic measures may necessitate prolonged or more rigorous exercise procedures. Daimo et al. ( 24 ) corroborated this interpretation, documenting significant intra-group decreases of 7.1 mmHg (SBP) and 5.6 mmHg (DBP) after 16 weeks of brisk walking, suggesting that extended interventions may produce more profound diastolic effects. Finally, Opoku ( 25 ) reported substantial pre-post reductions in both SBP and DBP following an eight-week brisk-walking program for people with type-2 diabetes and hypertension; however, the lack of a control group limits causal inferences. The findings indicate that moderate-intensity aerobic exercise, conducted three times weekly for 12–16 weeks, significantly lowers systolic blood pressure, with more consistency than diastolic outcomes. The efficacy of integrated pharmaceutical and exercise therapies ( 23 ) and the duration-dependent outcomes ( 24 ) highlight the necessity of organised, prolonged physical activity programs for optimum hypertension control in African populations. Influence of Intervention Type, Intensity, and Duration on Blood Pressure Outcomes The studies showed that the type, intensity, and duration of physical activity interventions had a significant impact on blood pressure outcomes in African adults. Nahwera et al. ( 21 ) showed that a 12-week moderate-intensity aerobic dance program caused a statistically significant drop of − 7.5 mmHg in systolic blood pressure (SBP) compared to a small rise in the control group (p < 0.002). This suggests that exercises based on culture and rhythm can yield cardiovascular benefits. Nonetheless, intensity and program duration were critical factors influencing the outcome. In Nahwera et al. ( 22 ), the same 12-week aerobic dance intervention resulted in a reduction of DBP by merely − 1.5 mmHg, with no statistical significance, indicating that diastolic enhancements may necessitate greater intensity or extended interventions. On the other hand, Daimo et al. ( 24 ) found that 16 weeks of supervised brisk walking led to significant drops in both SBP (− 7.1 mmHg) and DBP (− 5.6 mmHg). This means that longer and more progressive programs help the body adapt to changes in blood flow. Opoku ( 25 ) noted substantial reductions in both SBP and DBP after an eight-week brisk walking regimen for persons with diabetes and hypertension, however its short duration constrained their sustainability. The data together indicates that moderate-intensity aerobic therapies, particularly those with a length of 12 weeks or more, are the most successful, with duration being more significant than intensity alone. Dance-based routines, particularly those incorporating local music ( 21 ), enhanced adherence and enjoyment, whereas extended walking programs ( 24 ) yielded enduring decreases in pressure. These findings highlight the necessity of culturally appropriate, prolonged, and progressive exercise treatments for effective hypertension management in African adults. Gender and Age Differences in the Response to Physical Activity Gender and age were identified as significant, but inconsistently reported, factors influencing blood pressure responses to physical exercise in the examined studies. The Ugandan studies conducted by Nahwera et al. ( 21 , 22 ) yielded the most definitive sex-stratified assessments. In the 2025 trial, both males and females engaged in a 12-week moderate-intensity aerobic dancing intervention had reductions in systolic blood pressure (SBP), with females demonstrating a slightly higher mean decrease (− 9.00 ± 10.81 mmHg) compared to males (− 6.00 ± 5.59 mmHg). The Nahwera et al. ( 22 ) companion study also revealed that females exhibited a more pronounced, albeit statistically non-significant, decrease in diastolic blood pressure (DBP) relative to males, indicating possible physiological or behavioural disparities affecting cardiovascular responses. These findings suggest that women may demonstrate more vascular compliance and more reliable adherence to supervised exercise programs, hence improving their responsiveness to aerobic training. In contrast, Daimo et al. ( 24 ) studied solely male participants in Ethiopia, documenting substantial decreases in both SBP (− 7.1 mmHg) and DBP (− 5.6 mmHg) following a 16-week brisk walking regimen. Even while this sample's homogeneity makes it hard to compare genders, the size of the reduction was similar to or higher than what was seen in research with both men and women. This suggests that exercise benefits men as long as they stick to it and the program lasts long enough. Maruf et al. ( 23 ) did not separate outcomes by sex or age; nonetheless, their sample of middle-aged individuals (mean age ≈ 40 years) demonstrated clinically significant improvements, highlighting that adults of all ages can get decreases in blood pressure through structured aerobic activity. Overall, the results show that both men and women benefit from moderate-intensity exercise, but women may see bigger or earlier improvements. Age-related variables were inadequately examined; nonetheless, the convergence of results among people aged 30 to 59 suggests that middle-aged populations experience consistent advantages, with responsiveness appearing to correlate more with program adherence and length than with chronological age. Integration of Physical Activity with Pharmacological and Lifestyle Management Three studies elucidated the synergistic effects of exercise on antihypertensive treatment and lifestyle modification. The most compelling evidence comes from Maruf et al. ( 23 ) in Nigeria, where the addition of supervised aerobic dance to co-amilozide and amlodipine therapy resulted in more significant reductions in systolic (− 7.1 mmHg) and diastolic blood pressure (− 1.7 mmHg) compared to pharmacological treatment alone, along with higher control rates (53.9% vs 35.3%) and a reduced necessity for multiple medications. This underscores the supplementary function of physical activity as a non-pharmacological supplement to conventional therapy. Likewise, the Ethiopian study conducted by Daimo et al. ( 24 ) demonstrated that participants on stable monotherapy who participated in 16 weeks of moderate-intensity brisk walking (three sessions per week) exhibited significant reductions in both systolic (− 7.1 mmHg) and diastolic blood pressure (− 5.6 mmHg) compared to non-exercising controls. This supports the idea that exercise may be beneficial with medicine, but the lack of information on dose changes or adherence makes it harder to say for sure that this is the case. The Ethiopian intervention was longer and more structured than the Nigerian one, which may explain why it had greater effects on diastolic blood pressure. Conversely, the Ghanaian single-arm trial conducted by Opoku ( 25 ), which included adults with type 2 diabetes and hypertension, exhibited substantial reductions in both blood pressure after eight weeks of brisk walking, suggesting potential advantages for comprehensive chronic disease management. Nevertheless, in the absence of a control group or drug-use monitoring, the impact of treatment remains conjectural. In summary, Maruf et al. ( 23 ) presents the most compelling evidence of pharmacologic-exercise synergy, whereas Daimo et al. ( 24 ) and Opoku ( 25 ) highlight the need for continuous physical activity in maintaining blood pressure stability in medicated individuals. Overall, the studies indicate that exercise improves medication effectiveness and may decrease drug dependence, although more robust trials with adherence monitoring are necessary. Discussion This review found that structured, moderate-intensity aerobic exercise performed three times a week for 8 to 16 weeks consistently lowered blood pressure in African adults. The effects were most significant and most consistent on systolic blood pressure (SBP) in randomised controlled settings ( 21 , 23 , 24 ). The direction and intensity of these effects roughly correspond with international syntheses. For instance, meta-analyses of randomised studies indicate average training-induced reductions of approximately 3–5 mmHg in systolic blood pressure (SBP) and 2–3 mmHg in diastolic blood pressure (DBP) across various locations and modalities ( 26 , 27 ). Several African trials in this study notably achieved significant SBP decreases at the upper end ( ≈ − 7 mmHg), possibly indicating a higher baseline risk and robust supervision/adherence. The Nigerian double-blind RCT by Maruf et al. ( 23 ) showed that exercise had an additive impact when taken with co-amilozide and amlodipine, which improved blood pressure control rates and made it possible to reduce the daily dosage of the drugs. This adds to the growing body of evidence that exercise can be just as beneficial as some pharmacological treatments for specific outcomes and that it argues for regular care ( 28 ). In contrast, the Ethiopian RCT (with male participants on stable monotherapy) employed a longer, progression-based brisk-walking protocol (16 weeks) and recorded significant reductions in both SBP and DBP ( 24 ). This underscores duration and progressive overload as critical factors for diastolic responsiveness, an observation supported by meta-analytic subgroup patterns indicating that longer endurance programs produce greater effects ( 26 ). The Ugandan studies utilising culturally tailored aerobic dance over 12 weeks showed a considerable reduction in SBP ( 21 ), although they exhibited only a little, statistically insignificant change in DBP in a concurrent study ( 22 ). These contradictory DBP results are consistent with global evidence indicating that decreases in DBP are generally lower and occasionally less stable than changes in SBP, particularly over shorter interventions ( 27 , 29 ). Mechanistically, endurance exercise decreases blood pressure by reducing sympathetic tone and enhancing endothelial function; the impact magnitude is influenced by dosage (minutes per week), intensity (moderate versus vigorous), and development ( 29 , 30 ). The Ghana single-arm study ( 25 ) demonstrated significant pre–post reductions in blood pressure and fasting glucose levels in patients with type 2 diabetes mellitus and hypertension. However, the lack of a control group prevents causal inference; nonetheless, its pragmatic, supervised brisk-walking model highlights real-world feasibility. When compared to guideline-level recommendations, the observed BP deltas align with the American College of Sports Medicine's recommendations for moderate-intensity aerobic exercise for at least 150 minutes per week, which is expected to lower BP by about 5–7 mmHg in hypertensive adults and maintain post-exercise hypotension ( 29 ). Additionally, prospective epidemiology indicates a dose-response preventive benefit of regular physical exercise on the onset of hypertension ( 31 , 32 ), underscoring the public health significance of scalable programs (e.g., walking, culturally rooted dancing). There are still some important methodological gaps. First, blinding was infrequent (except Maruf et al. ( 23 ), which introduced the possibility of performance/detection bias; second, precision reporting (confidence intervals) was frequently inadequate, hindering cross-study comparisons; third, adherence and implementation metrics (session attendance, progression achieved) were inconsistently reported, restricting external validity. These flaws are not exclusive to African trials and reflect those noted in the international literature ( 27 , 30 ). Future African trials would benefit from CONSORT-conformant reporting, uniform intensity quantification (e.g., heart-rate reserve or rating of perceived exertion), and explicit medication/adherence objectives to clarify de-prescribing potential. In summary, the African randomised evidence aligns directionally with international meta-analyses and guidelines: supervised, moderate-intensity aerobic programs (≥ 12 weeks) consistently reduce SBP and variably decrease DBP, with more pronounced effects when duration and progression are sufficient and when exercise is combined with pharmacotherapy. Scaling culturally customised, supervised models may optimise adherence and real-world impact. Implications of Findings to Practice and Policy The results of this review have important effects on both public health policy and clinical practice in Africa. The continuous evidence demonstrates that moderate-intensity physical activity, especially aerobic dance and brisk walking, lowers blood pressure, highlighting the necessity of including structured exercise programs in hypertension therapy regimens at the primary healthcare level. Healthcare professionals, such as nurses and community health workers, must be educated in recommending and monitoring exercise as a non-pharmacological intervention in conjunction with medication, particularly for individuals with mild to moderate hypertension. From a policy standpoint, Ministries of Health and local governments ought to formulate national guidelines that advocate for physical exercise as both a preventive and therapeutic approach, in accordance with World Health Organisation (WHO) recommendations for non-communicable disease (NCD) management. Policies should also promote the creation of community-based exercise programs, such as walking groups or aerobics sessions that are tailored to different cultures, to make it easier for adults to become involved and stick with it. Working with groups like education, urban planning, and sports can help create a supportive environment, including safe walking pathways and places to play, that make physical activity a normal part of daily life. Lastly, public health campaigns and workplace wellness programs that encourage people to be active could reduce the number of hypertensive-related morbidities, lower healthcare expenditures, and help Africa reach Sustainable Development Goal (SDG) 3 on health and well-being. Recommendations for Future Research Subsequent study should concentrate on extensive, multicenter randomised controlled trials involving various African communities to enhance the evidence about the long-term efficacy of physical activity in managing blood pressure. Research should utilise standardised exercise protocols, explicitly defined intensity levels, and extended follow-up periods (exceeding 16 weeks) to assess persistent alterations in blood pressure and patterns of adherence. Future research should investigate gender and age disparities in physiological responses to exercise and analyse the impact of socio-cultural factors, such as beliefs, motivation, and environmental constraints, on participation and outcomes. Researchers should also look into how exercise works with other lifestyle modifications, such as dietary changes, stress management, and quitting smoking, to see if they have any synergistic effects. Importantly, future research should utilise mixed-method techniques, incorporating qualitative views to elucidate patient experiences and obstacles to exercise adherence. Lastly, there is an urgent need for economic evaluations to find out how cost-effective it is to put physical activity programs in place at the community and primary healthcare levels. This will give policymakers in African countries with limited resources the information they need to make decisions. Limitations Even though this systematic review followed the PRISMA guidelines for reporting and used the CASP checklist to ensure the methods were sound, there were still limitations with its structure and implementation. First, the review was confined to quantitative studies published in English from 2010 to 2025, potentially introducing language and publication bias by omitting pertinent studies conducted in other languages or found in other grey literature, including conference proceedings and institutional reports. This limitation may have constrained the thoroughness of the evidence base, particularly as numerous African studies are disseminated in local or French-language journals. Second, only publications that had been peer-reviewed and dissertations were included. This may have left out important research on interventions in specific areas or communities that aren't available in major databases. Third, the review used narrative synthesis instead of meta-analysis because the studies had different designs, types of interventions, durations of time, and outcome measures. Under these circumstances, narrative synthesis is suitable, but it is fundamentally more interpretive and less statistically rigorous, hence heightening the risk of subjective bias in the synthesis of findings. The methodological diversity of the included studies, spanning randomised controlled trials, quasi-experimental designs, and single-arm studies, further limited the comparability of the findings. Additionally, numerous included studies were deficient in blinding, standardised outcome measures, or confidence intervals, hence constraining the capacity to statistically compare effect sizes and evaluate internal validity. Lastly, the lack of cross-sectional or qualitative research may have missed significant contextual insights, like cultural attitudes, challenges to adherence, and behavioural motivators that affect African communities' engagement in physical exercise. As a result, the findings of this study offer reliable evidence endorsing exercise as a strategy for hypertension management; however, they must be interpreted with caution due to these methodological constraints. Conclusion This systematic review aims to assess the impact of physical activity interventions on the prevention and control of high blood pressure in African adults. The results show that people with high blood pressure can reduce their systolic and, to a lesser extent, diastolic blood pressure by engaging in moderate-intensity aerobic exercises such as brisk walking and aerobic dance on a regular basis. These advantages were apparent across various intervention durations and were significantly enhanced when exercise was combined with pharmaceutical treatment or administered over prolonged periods. The review also showed that exercise is not only a good way to treat high blood pressure without drugs, but it is also a long-term, low-cost, and culturally appropriate way to do so in African communities and healthcare settings. Although several studies had limitations with their methods, the overall data support the use of structured exercise programs as part of interventions that prevent and control high blood pressure. To reduce the growing problem of high blood pressure across the continent, public health programs and clinical guidelines should put a lot of emphasis on encouraging physical exercise. Incorporating exercise therapies into national health policies and primary care services has significant potential to enhance cardiovascular health outcomes and decrease premature death associated with hypertension in African adults. Declarations Authors Contribution All authors contributed to the review process. Precious Ebube Anyakorah : Conceptualisation, Protocol development, Data Synthesis, Data Extraction, Critical appraisal, Project coordination, and Writing - Review editing. David Chinaecherem Innocent : Study screening, data extraction, and critical appraisal. Promise Somtochukwu Chukwuemeka: Original draft preparation, Study screening. Chiamaka Judith Ezenwa: Data Synthesis, Writing - Review editing Juliet Chinaza Anuwe: Project coordination Joakin Chidozie Nwaokoro: Supervision Velly Alero Emina: Original draft preparation Final Approval of the Manuscript All authors Ethics Approval and Consent to Participate Not Applicable Consent to Publish All authors Availability of Data and Materials Data will be made available upon request by the corresponding author. Competing Interests All authors have declared that they have no competing interests Funding No funds were received for this study Acknowledgements Not Applicable Clinical Trial Number Not Applicable References World Health Organisation. Cardiovascular diseases (CVDs). [Internet]. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds ). Update AS. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139–596. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–37. World Health Organis. Hypertension. 2023; Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension Ampofo AG, Khan E, Ibitoye MB. Understanding the role of educational interventions on medication adherence in hypertension: A systematic review and meta-analysis. Heart Lung. 2020;49(5):537–47. Kayima J, Wanyenze RK, Katamba A, Leontsini E, Nuwaha F. Hypertension awareness, treatment and control in Africa: a systematic review. BMC Cardiovasc Disord. 2013;13(1):54. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al. Sedentary behavior research network (SBRN)–terminology consensus project process and outcome. Int J Behav Nutr Phys activity. 2017;14(1):75. Bashir M, Yahaya A, Muhammad M, Yusuf AH. Prevalence of Prehypertension in Nigeria: a Systemic Review and Meta-analysis. Int J Epidemiol Health Sci. 2021;2(Continuous). Blair SN, Cheng Y, Holder JS. Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc. 2001;33(6):S379–99. Palatini P, Cornelissen V. Impact of Exercise on Cardiovascular Risk Factors: Arterial Hypertension. Textbook Sports Exerc Cardiol. 2020;719–45. Friedenreich CM, Ryder-Burbidge C, McNeil J. Physical activity, obesity and sedentary behavior in cancer etiology: epidemiologic evidence and biologic mechanisms. Mol Oncol. 2021;15(3):790–800. Ampofo AG, Khan E, Ibitoye MB. Understanding the role of educational interventions on medication adherence in hypertension: A systematic review and meta-analysis. Heart Lung. 2020;49(5):537–47. WHO IwHO. Cancer country profiles – 2020 [Internet]. 2020. Available from: https://www.who.int/publications/m/item/cancer-country-profiles-2020f Akinlua JT, Meakin R, Umar AM, Freemantle N. Current prevalence pattern of hypertension in Nigeria: A systematic review. PLoS ONE. 2015;10(10):e0140021. Ainsworth B. Blending Physical Activity, Fitness, and Health and Public Health in Kinesiology. Kinesiol Rev. 2023;13(1):93–9. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40–6. Richter RR, Austin TM. Using MeSH (medical subject headings) to enhance PubMed search strategies for evidence-based practice in physical therapy. Phys Ther. 2012;92(1):124–32. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906. Critical Appraisal Skills Programme. CASP randomised controlled trial checklist. 2018. Nahwera L, Boit EK, Nsibambi CA, Maghanga M, Wachira LJ. Effects of aerobic dance on systolic blood pressure in stage one hypertensive adults in Uganda. BMJ Open Sport Exerc Med. 2025;11(2). Nahwera L, Boit EK, Nsibambi CAN, Maghanga M, Wachira L. joy. Effects of a 12-week aerobic dance programme on diastolic blood pressure in stage one hypertensive adults. Turkish J Kinesiol. 2024;10(4):232–40. Maruf FA, Akinpelu AO, Salako BL, Akinyemi JO. Effects of aerobic dance training on blood pressure in individuals with uncontrolled hypertension on two antihypertensive drugs: a randomized clinical trial. J Am Soc Hypertens. 2016;10(4):336–45. Daimo M, Mandal S, Mahmud M, Mathıvanan D. Effect of aerobic exercise on blood pressure in men with hypertension: A randomized controlled study. Turkish J Kinesiol. 2020;6(1):32–9. Opoku B. Effects of Aerobic exercises on Fasting blood glucose and Blood pressure in patients with Type 2 diabetes living with Hypertension in Ghana. 2021. Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension. 2011;58(5):950–8. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136(7):493–503. Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ. 2013;347:f5577. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA. Exercise and hypertension. Med Sci Sports Exerc. 2004;36(3):533–53. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am heart association. 2013;2(1):e004473. Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Curr Hypertens Rep. 2013;15(6):659–68. Pescatello LS, MacDonald HV, Lamberti L, Johnson BT. Exercise for hypertension: a prescription update integrating existing recommendations with emerging research. Curr Hypertens Rep. 2015;17:1–10. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":41339,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA Flow Diagram \u003c/strong\u003e(19)\u003cstrong\u003e Demonstrating the Study Selection Process\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7781986/v1/76a22be14c93bba276a44ebb.png"},{"id":97135160,"identity":"e78ddc7c-ad7b-4251-bb2c-5d840966cdaa","added_by":"auto","created_at":"2025-12-01 09:23:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1431487,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7781986/v1/268acd12-72a7-445c-9719-fa36929d39b7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA Systematic Review of the Impact of Physical Activities in the Prevention and Control of High Blood Pressure Among Adults in Africa\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe World Health Organisation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) defines hypertension as systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140 mmHg and/or diastolic pressure\u0026thinsp;\u0026ge;\u0026thinsp;90 mmHg. The criteria agree with global clinical thresholds, although the American Heart Association (AHA) proposed a stricter categorisation, defining hypertension at \u0026ge;\u0026thinsp;130/80 mmHg, which lowers the diagnostic threshold and raises concerns about overdiagnosis versus early care (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Mills et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) proposed that this adjustment by the AHA may overstate prevalence figures, whereas WHO's criteria are considered pragmatic for global surveillance. According to reports, hypertension affects around 1.28\u0026nbsp;billion adults worldwide, with Africa having the highest prevalence at approximately 46% of the adult population, exceeding the global average of 31% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Ampofo et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and Kayima et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) argue that hypertension in Africa is frequently undetected and undertreated, highlighting a systemic deficiency in preventive healthcare, and physical activity has been largely accepted as a key component of non-pharmacological intervention for addressing modifiable risk factors.\u003c/p\u003e\u003cp\u003eWHO (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) defines physical activity as any skeletal muscle movement that results in energy expenditure, and recommends that adults engage in at least 150\u0026ndash;300 minutes of moderate-intensity aerobic activity each week. In contrast, \"exercise\" refers to structured, repetitive, and goal-oriented physical activity (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Sedentary behaviour, on the other hand, refers to waking activities like sitting or reclining that require little energy expenditure, often less than 1.5 METs (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Bashir et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and Blair et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) discussed that a clear knowledge of these distinctions is critical, as even light-to-moderate exercises like brisk walking or home chores have considerable cardiovascular benefits, particularly in low-resource African contexts where gym-based routines are less accessible. Palatini and Cornelissen (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) found that aerobic exercise lowers systolic and diastolic blood pressure by 5\u0026ndash;7 mmHg, a result comparable to medication in moderate hypertension, and as a result, the role of physical activity encompasses both prevention and control, which must be defined. Friedenreich et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) argued that primary prevention tries to prevent illness beginning through lifestyle changes before risk factors emerge, whereas secondary prevention focuses on early detection and care to slow progression. In hypertension, prevention comprises community awareness, food restriction, and physical exercise, whereas control includes medication adherence, periodic screening, and behaviour adjustment (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In line with this, lifestyle change acts as both an intervention and a management strategy, especially in African contexts where pharmacological availability is limited and exercise is widely accepted (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Thus, there is a significant confluence between public health education and behavioural change, as highlighted by WHO (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) in its Global NCD Action Plan, which includes physical exercise as a key behavioural risk reduction approach.\u003c/p\u003e\u003cp\u003eThe rationale for performing this systematic analysis stems from important gaps in the available research on the function of physical activity in preventing and managing hypertension in African adult populations. Akinlua et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) discussed that, despite the fact that hypertension is a primary cause of morbidity and mortality in Africa, most present therapies are biomedical in nature, with insufficient incorporation of culturally relevant, lifestyle-based approaches such as physical activity. While global data strongly support exercise as an effective blood pressure-lowering technique, there is a lack of region-specific syntheses that contextualise these findings within the African sociocultural and infrastructural background. Ainsworth, (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) opine that physical activity patterns in Africa differ significantly from those in Western contexts; for example, regular walking, subsistence farming, traditional dance, and communal labour are all common but under-represented in global databases, and the lack of comprehensive evaluation of these novel approaches jeopardises their potential inclusion into national noncommunicable disease (NCD) preventive strategies. Furthermore, previous reviews frequently aggregate data across other areas, concealing intra-African heterogeneity in lifestyle, urbanisation, and socioeconomic determinants of health (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This systematic review seeks to fill a significant gap by gathering and synthesising empirical evidence relevant to African adults, stratifying findings by nation, activity type, and methodological quality. The major aim of this systematic review is to assess the impact of physical activities in the prevention and control of high blood pressure among adults in Africa\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eEligibility Criteria\u003c/h2\u003e\u003cp\u003eIn this review, the population consists of persons aged 18 and above who live in African countries, independent of their hypertension status at baseline. The Intervention encompasses all forms of structured or unstructured physical activity, including aerobic exercise, walking, community-based exercise programs, and culturally relevant activities such as farming or dance. Individuals with sedentary lives or those who have received other therapies (e.g., pharmaceutical or nutritional interventions) make up the Comparison group. Changes in systolic and diastolic blood pressure are the major outcomes of interest; additional outcomes include the incidence or prevalence of hypertension, BMI fluctuations, cardiovascular risk, and adherence to physical activity programs. The review will only include quantitative research, such as randomised controlled trials (RCTs), quasi-experimental studies, cohort studies, and case-control studies, with cross-sectional studies omitted unless they provide longitudinal inference. To preserve methodological rigour, only original peer-reviewed studies published in English in the last 10 to 15 years will be considered. Grey literature, such as unpublished reports, short communications, preprints, magazines, and non-empirical papers, is omitted to improve the quality and replicability of results. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1.0\u003c/span\u003e shows the inclusion and exclusion criteria for this review\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1.0\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInclusion and Exclusion Criteria\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEligibility Item\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInclusion Criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExclusion Criteria\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePopulation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdults aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years residing in any African country, with or without hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudies involving children, adolescents (\u0026lt;\u0026thinsp;18 years), or non-African populations\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAny form of structured/unstructured physical activity (e.g., walking, aerobic exercise, farming, dance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudies not involving physical activity or using only pharmacological/dietary interventions\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComparison\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSedentary lifestyle or alternative interventions (e.g., medication, no intervention)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo comparison or irrelevant comparators (e.g., unrelated behavioural therapies)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary: Changes in systolic/diastolic BP; Secondary: Hypertension incidence, BMI, cardiovascular risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudies not reporting BP or relevant cardiovascular/anthropometric outcomes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStudy Design\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuantitative studies only: RCTs, quasi-experimental, cohort, case-control (with longitudinal inference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCross-sectional without longitudinal data, qualitative studies, mixed methods, case reports, editorials, reviews\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePublication Type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOriginal, peer-reviewed journal articles, dissertations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreprints, unpublished reports, short communications, grey literature, magazines, conference abstracts\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStudy Period\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudies published within the past 10\u0026ndash;15 years (2010\u0026ndash;2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudies published before 2010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLanguage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnglish\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-English language publications\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSearch Strategy\u003c/h3\u003e\n\u003cp\u003eThe search strategy for this systematic review was broad and structured, and utilised five key databases: PubMed, Scopus, CINAHL, Web of Science, and African Index Medicus (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). To improve the precision and relevance of retrieved articles, Medical Subject Headings (MeSH) phrases were combined with primary keywords drawn from the review's core themes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The core keywords are \"physical activity\", \"exercise\", \"aerobic activity\", \"hypertension\", \"high blood pressure\", \"adults\", and \"Africa\". Boolean operators like AND, OR, and NOT were used to link and filter search queries, assuring logical links between concepts. To improve search yield, truncation symbols (e.g., activ to capture activity, activities), wildcards (e.g., wom?n to capture woman and women), and proximity operators (e.g., NEAR/n) were used where allowed by database syntax. This technique assisted in retrieving studies that utilised different terminologies but addressed similar issues. Furthermore, the reference lists of relevant papers were manually inspected to discover possibly eligible studies that were not found during the original computerised database search, assuring data saturation and reducing selection bias. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2.0\u003c/span\u003e below illustrates the detailed search strategy.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2.0\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSearch Strategy\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary Keywords\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSearch Strings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBoolean Operator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDatabases Searched\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical activity, Exercise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(\u0026ldquo;Physical activity\u0026rdquo; OR \u0026ldquo;Exercise\u0026rdquo; OR \u0026ldquo;Aerobic activity\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePubMed, Scopus, CINAHL, Web of Science, AIM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension, High blood pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(\u0026ldquo;Hypertension\u0026rdquo; OR \u0026ldquo;High blood pressure\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePubMed, Scopus, CINAHL, Web of Science, AIM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdults\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(\u0026ldquo;Adults\u0026rdquo; OR \u0026ldquo;middle-aged\u0026rdquo; OR \u0026ldquo;older adults\u0026rdquo; OR \u0026ldquo;\u0026ge;18 years\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePubMed, Scopus, CINAHL, Web of Science, AIM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfrica\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(\u0026ldquo;Africa\u0026rdquo; OR \u0026ldquo;Nigeria\u0026rdquo; OR \u0026ldquo;Kenya\u0026rdquo; OR \u0026ldquo;South Africa\u0026rdquo; OR \u0026ldquo;Ghana\u0026rdquo; OR \u0026ldquo;Sub-Saharan Africa\u0026rdquo; OR \u0026ldquo;North Africa\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePubMed, Scopus, CINAHL, Web of Science, AIM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCombined strategy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(\u0026ldquo;Physical activity\u0026rdquo; OR \u0026ldquo;Exercise\u0026rdquo; OR \u0026ldquo;Aerobic activity\u0026rdquo;) AND (\u0026ldquo;Hypertension\u0026rdquo; OR \u0026ldquo;High blood pressure\u0026rdquo;) AND (\u0026ldquo;Adults\u0026rdquo;) AND (\u0026ldquo;Africa\u0026rdquo; OR countries)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePubMed, Scopus, CINAHL, Web of Science, AIM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eStudy Selection\u003c/h3\u003e\n\u003cp\u003eThe study selection process is an essential component of systematic reviews, since it ensures that included research is thoroughly checked for relevance and methodological suitability. The references retrieved from the database search were exported to EndNote reference management software (version X9), which automatically removed duplicates. The initial title and abstract screening were performed, followed by the full text screening. Two independent reviewers screened and selected the studies, and discrepancies were addressed through discussion. However, to ensure transparency and methodological integrity, the entire selection process was monitored and displayed using the PRISMA flow diagram (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), which visually sums up the number of studies identified, screened, excluded, and eventually included.\u003c/p\u003e\n\u003ch3\u003eData Extraction\u003c/h3\u003e\n\u003cp\u003eIn this review, data extraction was carried out using Microsoft Excel, which proved to be a solid platform for systematically arranging and managing study-specific information. A standardised data extraction form was created in Excel and tested on a subset of papers to ensure consistency, accuracy, and completeness among reviewers. Extracted data items included the author(s) name, year of publication, country of study, study design, target population characteristics (e.g., age, gender, health status), sample size, type and duration of physical activity intervention, comparison or control group, outcome measures such as changes in systolic and diastolic blood pressure, and, where reported, effect size or statistical significance of findings. Two independent reviewers performed the data extraction of the included studies, and discrepancies were addressed through discussion. This organised extraction technique simplified the synthesis of comparable evidence from various research and guaranteed that all included articles were appraised using a consistent set of metrics.\u003c/p\u003e\n\u003ch3\u003eRisk of Bias\u003c/h3\u003e\n\u003cp\u003eThe Critical Appraisal Skills Programme (CASP) checklist was employed for this review because it can be used for a variety of study types, including RCTs, cohorts, and quasi-experimental studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). It enables organised judgement without requiring substantial statistical knowledge, making it both accessible and replicable. The CASP checklist is divided into three sections: study validity (e.g., clarity of the research aim, appropriateness of design, recruitment strategy), methodological rigour, and results relevance (e.g., data analysis, precision of findings, and applicability to context). Two independent reviewers assessed the quality of the included studies, and discrepancies were addressed through discussion. This approach is consistent with the primary purpose of this review: to synthesise strong, context-specific evidence on the impact of physical exercise in hypertension prevention among African adults, while critically evaluating the methodological strength of each included study.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Synthesis\u003c/h2\u003e\u003cp\u003eData synthesis in systematic reviews is the act of combining findings from individual studies to reach relevant conclusions about a research subject. Narrative synthesis, also known as textual or topic synthesis, is a non-statistical approach that works well with a variety of study designs and outcomes. Also, narrative synthesis enables researchers to investigate relationships, contexts, and methodological variations, resulting in a more comprehensive and nuanced understanding of findings. For this review, a narrative synthesis approach was used. This choice was made due to methodological and contextual heterogeneity among included research, such as differences in physical activity kinds, outcome measures, and African regional contexts, which disallowed statistical meta-analysis. Narrative synthesis was used to systematically assess and thematically organise data across studies, emphasising trends, contradictions, and knowledge gaps.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eOverview of Search Process\u003c/h2\u003e\u003cp\u003eA search through electronic databases such as PubMed, Scopus, CINAHL, Web of Science, AIM yielded a total of 1114 studies. Following record de-duplication and study screening, 198 studies were eligible for full text screening, and studies were excluded based on the predetermined eligibility criteria leaving 5 studies which met the review\u0026rsquo;s inclusion criteria. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the PRISMA flow chart, which shows the study selection process and reasons for exclusion of studies.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.2 Characteristics of Included Studies\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of five studies were included for the synthesis of this review. These studies were conducted across different African countries. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3.0\u003c/span\u003e details the characteristics of the five included studies.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3.0\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of Included Studies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor (Year)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCountry of Study\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudy Aim(s)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSample Size and Population Characteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStudy Design and Methodology\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIntervention (Type and Duration of Physical Activity)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComparison or Control Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eOutcome Measures\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMain Findings\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNahwera et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUganda (Kyambogo University Medical Centre, Kampala)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTo evaluate the effect of a 12-week supervised aerobic dance exercise programme on systolic blood pressure among adults diagnosed with stage-one hypertension.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;36 randomized (18 intervention, 18 control); adults with stage-one hypertension; mixed gender (~\u0026thinsp;50% female in intervention group); age range: 30\u0026ndash;59 years.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOpen-label randomized parallel-group trial; allocation by coin toss with sealed-envelope concealment; standardized blood pressure measurement using mercury sphygmomanometer; pre- and post-intervention assessments.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSupervised moderate-intensity aerobic dance programme for 12 weeks, 3 sessions per week, 45 minutes per session (warm-up, 30-minute aerobic phase, cool-down).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eControl group maintained usual activities (no organized exercise) with weekly follow-up contact.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePrimary: Systolic blood pressure (mmHg). Secondary: Sex- and age-stratified changes in systolic blood pressure.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSystolic blood pressure significantly reduced in the intervention group (143.83\u0026thinsp;\u0026plusmn;\u0026thinsp;6.38 \u0026rarr; 136.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.19 mmHg; Δ\u0026thinsp;\u0026minus;\u0026thinsp;7.50; p\u0026thinsp;=\u0026thinsp;0.002) compared to the control group (137.61\u0026thinsp;\u0026plusmn;\u0026thinsp;6.40 \u0026rarr; 139.56\u0026thinsp;\u0026plusmn;\u0026thinsp;9.95 mmHg; Δ\u0026thinsp;+\u0026thinsp;1.95; ns). Both males and females improved, with slightly greater reduction among females.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNahwera et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUganda (Kyambogo University Medical Centre, Kampala)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTo determine whether a 12-week supervised aerobic dance programme leads to reductions in diastolic blood pressure and whether gender influences the effect among adults with stage-one hypertension.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;36 completed (18 intervention, 18 control); adults with stage-one hypertension; intervention: 9 females/9 males; control: 6 females/12 males; age range: 30\u0026ndash;59 years.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRandomized parallel-group trial; blood pressure assessed using standardized sphygmomanometer; paired and independent-samples t-tests applied for analysis.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSupervised aerobic dance at 40\u0026ndash;60% heart-rate reserve, for 12 weeks, 3 sessions/week, 45 minutes/session, including warm-up, aerobic, strengthening, and relaxation phases; intensity monitored using heart-rate checks.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUsual daily activities (no exercise intervention) with weekly follow-up phone calls.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePrimary: Diastolic blood pressure (mmHg). Secondary: Gender-stratified differences in diastolic blood pressure.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eThe aerobic-dance programme led to a non-significant overall reduction in diastolic blood pressure (\u0026minus;\u0026thinsp;1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.59 mmHg) compared to control (\u0026minus;\u0026thinsp;0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59 mmHg; p\u0026thinsp;=\u0026thinsp;0.275). Female participants showed a larger mean reduction than males.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaruf et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNigeria (Ibadan/Nnewi)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTo investigate whether the addition of supervised aerobic dance exercise to standard antihypertensive drug therapy enhances blood-pressure control and reduces the number of required medications in adults with mild-to-moderate hypertension.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;120 newly-diagnosed mild-to-moderate hypertensives randomized; 88 completed (45 intervention\u0026thinsp;+\u0026thinsp;drugs; 43 drugs-only control); participants had uncontrolled hypertension on two antihypertensive drugs.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12-week double-blind randomized clinical trial; intervention group received coamilozide\u0026thinsp;+\u0026thinsp;amlodipine plus aerobic dance; control received drug therapy only; data analyzed on an intention-to-treat basis.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSupervised aerobic dance added to drug therapy; 12 weeks, sessions spaced\u0026thinsp;\u0026ge;\u0026thinsp;24 hours apart with progressively increased tempo (session duration not reported).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDrug therapy alone (coamilozide\u0026thinsp;+\u0026thinsp;5/10 mg amlodipine).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePrimary: Systolic and diastolic blood pressure (mmHg). Secondary: Rate of blood-pressure control (\u0026lt;\u0026thinsp;140/90 mmHg); number of drugs required post-intervention.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eAerobic dance combined with drug therapy achieved greater blood-pressure reduction (SBP\u0026thinsp;\u0026minus;\u0026thinsp;7.1 mmHg; DBP\u0026thinsp;\u0026minus;\u0026thinsp;1.7 mmHg) and higher control rates (53.9% vs 35.3%) than drug-only treatment. More participants reduced to a single antihypertensive drug (20.3% vs 11.1%).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDaimo et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthiopia (Hawassa \u0026amp; Mekelle)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTo examine the effects of a 16-week moderate-intensity aerobic exercise programme on systolic and diastolic blood pressure among adult males with stage-one hypertension.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;24 male participants with stage-one hypertension; mean age\u0026thinsp;=\u0026thinsp;38\u0026thinsp;\u0026plusmn;\u0026thinsp;4 years; randomized to exercise (n\u0026thinsp;=\u0026thinsp;12) or control (n\u0026thinsp;=\u0026thinsp;12).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRandomized controlled parallel-group study; baseline and post-intervention (16 weeks) measurements; analysis by paired and independent t-tests using SPSS v20.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSupervised moderate-intensity brisk walking for 16 weeks, 3 sessions/week.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eControl group continued usual daily routines (no physical-activity intervention).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eResting systolic and diastolic blood pressure (mmHg).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eExercise group achieved significant reductions in systolic (\u0026minus;\u0026thinsp;7.1 mmHg) and diastolic (\u0026minus;\u0026thinsp;5.6 mmHg) blood pressure (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both); control group showed no significant changes.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpoku (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGhana (Korle Bu Teaching Hospital \u0026ndash; National Diabetes Management and Research Centre, Accra)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTo assess the impact of an 8-week brisk-walking exercise programme on blood-pressure control, fasting blood-glucose levels, and functional fitness among adults with type 2 diabetes mellitus and co-existing hypertension.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;60 adults (52 females, 8 males) diagnosed with type 2 diabetes mellitus and hypertension.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle-arm controlled (participants served as their own controls) pre\u0026ndash;post intervention study; supervised sessions conducted for 8 weeks; pre- and post-assessments of physiological and functional parameters.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBrisk walking programme, 8 weeks, 3 sessions/week, 45 minutes/session, including\u0026thinsp;\u0026asymp;\u0026thinsp;5-minute warm-up and cool-down.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo separate control group; baseline served as within-participant control.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eFasting blood glucose, systolic blood pressure, diastolic blood pressure, and functional fitness (6-minute walk, 30-second chair-stand, 3-minute step test).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSignificant reductions in fasting blood glucose and both systolic and diastolic blood pressure were observed. Functional-fitness performance improved across all tests after the intervention.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eQuality Assessment\u003c/h2\u003e\u003cp\u003eThe CASP Randomised Controlled Trial checklist was employed to assess the quality of the included studies, and they had moderate to high methodological quality. Studies were appraised using yes, no, and can\u0026rsquo;t tell in each domain. \u0026ldquo;Yes\u0026rdquo; was awarded 1 point, \u0026ldquo;No\u0026rdquo; was given 0, while \u0026ldquo;Not clear\u0026rdquo; was given 0.5. Studies that scored 9\u0026ndash;11 were graded \u0026ldquo;High quality\u0026rdquo;, Studies that scored below 7 were graded \u0026ldquo;Low quality\u0026rdquo;, while studies scoring 7\u0026ndash;8 were graded \u0026ldquo;Medium quality\u0026rdquo;. According to Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4.0\u003c/span\u003e below, the studies scored from 7 to 10.5 indicate a moderate to high quality. Four trials were appropriately randomised, explicitly articulated their objectives, and included all participants; however, the majority lacked blinding, hence presenting a possible risk of bias. The Nigerian study conducted by Maruf et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) was the only study to implement double blinding. Although the effect sizes were explicitly provided, the majority of studies failed to include confidence intervals, hence constraining the precision of the results. The interventions and outcomes were suitable and clinically significant, with findings applicable to local populations. The Opoku (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) study, due to its non-randomised design, exhibited a higher risk of bias. Overall, the studies provide reliable evidence that physical activity effectively lowers blood pressure among the African population, although the methodological shortcomings, such as the lack of blinding and insufficient statistical reporting, reduce their rigour.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4.0\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCritical Appraisal of Included Studies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQ1 Focused issue?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ2 Randomisation?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ3 Accounted for all participants?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQ4 Blinding (patients, staff, assessors)?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eQ5 Groups similar at start?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eQ6 Equal treatment aside from intervention?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eQ7 Size of effect clear?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ8 Precision (e.g., CIs reported)?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eQ9 Applicability to local population?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eQ10 All clinically important outcomes considered?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eQ11 Benefits worth costs/harms?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eOverall Quality\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNahwera et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) \u0026ndash; Uganda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCan't tell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCan't tell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e9/11 (High quality)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNahwera et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) \u0026ndash; Uganda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCan't tell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCan't tell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e9/11 (High quality)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaruf et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) \u0026ndash; Nigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCan't tell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e10.5/11 (High quality)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDaimo et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) \u0026ndash; Ethiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCan't tell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e9.5/11 (High quality)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpoku (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) \u0026ndash; Ghana (non-RCT)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCan't tell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCan't tell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e7/11 (Moderate quality)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eFindings\u003c/h2\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003eEffectiveness of Physical Activity Interventions in Reducing Blood Pressure\u003c/h2\u003e\u003cp\u003eThe five included studies showed that physical activity interventions, especially aerobic dance and brisk walking, can reduce blood pressure in African adults with hypertension. However, the advantages are not always the same or as strong. In a randomised controlled trial conducted in Nigeria, Maruf et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) discovered that participants who engaged in aerobic dance alongside pharmacological therapy attained a mean reduction of 7.1 mmHg in systolic blood pressure (SBP) and 1.7 mmHg in diastolic blood pressure (DBP), surpassing the drug-only control group and demonstrating high blood pressure control rates. This shows that exercise and medications work better together than either one alone. Likewise, Nahwera et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) documented a notable reduction of 7.5 mmHg in systolic blood pressure (SBP) following a 12-week supervised aerobic dance program, compared to a marginal increase in the control group (p\u0026thinsp;=\u0026thinsp;0.002). This underscores the efficacy of moderate-intensity exercise as a standalone non-pharmacological intervention.\u003c/p\u003e\u003cp\u003eConversely, Nahwera et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), investigating the identical intervention with an emphasis on diastolic blood pressure (DBP), reported a non-significant mean reduction of 1.5 mmHg, indicating that enhancements in diastolic measures may necessitate prolonged or more rigorous exercise procedures. Daimo et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) corroborated this interpretation, documenting significant intra-group decreases of 7.1 mmHg (SBP) and 5.6 mmHg (DBP) after 16 weeks of brisk walking, suggesting that extended interventions may produce more profound diastolic effects. Finally, Opoku (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) reported substantial pre-post reductions in both SBP and DBP following an eight-week brisk-walking program for people with type-2 diabetes and hypertension; however, the lack of a control group limits causal inferences.\u003c/p\u003e\u003cp\u003eThe findings indicate that moderate-intensity aerobic exercise, conducted three times weekly for 12\u0026ndash;16 weeks, significantly lowers systolic blood pressure, with more consistency than diastolic outcomes. The efficacy of integrated pharmaceutical and exercise therapies (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and the duration-dependent outcomes (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) highlight the necessity of organised, prolonged physical activity programs for optimum hypertension control in African populations.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eInfluence of Intervention Type, Intensity, and Duration on Blood Pressure Outcomes\u003c/h2\u003e\u003cp\u003eThe studies showed that the type, intensity, and duration of physical activity interventions had a significant impact on blood pressure outcomes in African adults. Nahwera et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) showed that a 12-week moderate-intensity aerobic dance program caused a statistically significant drop of \u0026minus;\u0026thinsp;7.5 mmHg in systolic blood pressure (SBP) compared to a small rise in the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.002). This suggests that exercises based on culture and rhythm can yield cardiovascular benefits. Nonetheless, intensity and program duration were critical factors influencing the outcome. In Nahwera et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), the same 12-week aerobic dance intervention resulted in a reduction of DBP by merely \u0026minus;\u0026thinsp;1.5 mmHg, with no statistical significance, indicating that diastolic enhancements may necessitate greater intensity or extended interventions.\u003c/p\u003e\u003cp\u003eOn the other hand, Daimo et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) found that 16 weeks of supervised brisk walking led to significant drops in both SBP (\u0026minus;\u0026thinsp;7.1 mmHg) and DBP (\u0026minus;\u0026thinsp;5.6 mmHg). This means that longer and more progressive programs help the body adapt to changes in blood flow. Opoku (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) noted substantial reductions in both SBP and DBP after an eight-week brisk walking regimen for persons with diabetes and hypertension, however its short duration constrained their sustainability.\u003c/p\u003e\u003cp\u003eThe data together indicates that moderate-intensity aerobic therapies, particularly those with a length of 12 weeks or more, are the most successful, with duration being more significant than intensity alone. Dance-based routines, particularly those incorporating local music (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), enhanced adherence and enjoyment, whereas extended walking programs (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) yielded enduring decreases in pressure. These findings highlight the necessity of culturally appropriate, prolonged, and progressive exercise treatments for effective hypertension management in African adults.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eGender and Age Differences in the Response to Physical Activity\u003c/h2\u003e\u003cp\u003eGender and age were identified as significant, but inconsistently reported, factors influencing blood pressure responses to physical exercise in the examined studies. The Ugandan studies conducted by Nahwera et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) yielded the most definitive sex-stratified assessments. In the 2025 trial, both males and females engaged in a 12-week moderate-intensity aerobic dancing intervention had reductions in systolic blood pressure (SBP), with females demonstrating a slightly higher mean decrease (\u0026minus;\u0026thinsp;9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.81 mmHg) compared to males (\u0026minus;\u0026thinsp;6.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59 mmHg).\u003c/p\u003e\u003cp\u003eThe Nahwera et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) companion study also revealed that females exhibited a more pronounced, albeit statistically non-significant, decrease in diastolic blood pressure (DBP) relative to males, indicating possible physiological or behavioural disparities affecting cardiovascular responses. These findings suggest that women may demonstrate more vascular compliance and more reliable adherence to supervised exercise programs, hence improving their responsiveness to aerobic training. In contrast, Daimo et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) studied solely male participants in Ethiopia, documenting substantial decreases in both SBP (\u0026minus;\u0026thinsp;7.1 mmHg) and DBP (\u0026minus;\u0026thinsp;5.6 mmHg) following a 16-week brisk walking regimen.\u003c/p\u003e\u003cp\u003eEven while this sample's homogeneity makes it hard to compare genders, the size of the reduction was similar to or higher than what was seen in research with both men and women. This suggests that exercise benefits men as long as they stick to it and the program lasts long enough. Maruf et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) did not separate outcomes by sex or age; nonetheless, their sample of middle-aged individuals (mean age\u0026thinsp;\u0026asymp;\u0026thinsp;40 years) demonstrated clinically significant improvements, highlighting that adults of all ages can get decreases in blood pressure through structured aerobic activity.\u003c/p\u003e\u003cp\u003eOverall, the results show that both men and women benefit from moderate-intensity exercise, but women may see bigger or earlier improvements. Age-related variables were inadequately examined; nonetheless, the convergence of results among people aged 30 to 59 suggests that middle-aged populations experience consistent advantages, with responsiveness appearing to correlate more with program adherence and length than with chronological age.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eIntegration of Physical Activity with Pharmacological and Lifestyle Management\u003c/h2\u003e\u003cp\u003eThree studies elucidated the synergistic effects of exercise on antihypertensive treatment and lifestyle modification. The most compelling evidence comes from Maruf et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) in Nigeria, where the addition of supervised aerobic dance to co-amilozide and amlodipine therapy resulted in more significant reductions in systolic (\u0026minus;\u0026thinsp;7.1 mmHg) and diastolic blood pressure (\u0026minus;\u0026thinsp;1.7 mmHg) compared to pharmacological treatment alone, along with higher control rates (53.9% vs 35.3%) and a reduced necessity for multiple medications. This underscores the supplementary function of physical activity as a non-pharmacological supplement to conventional therapy. Likewise, the Ethiopian study conducted by Daimo et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) demonstrated that participants on stable monotherapy who participated in 16 weeks of moderate-intensity brisk walking (three sessions per week) exhibited significant reductions in both systolic (\u0026minus;\u0026thinsp;7.1 mmHg) and diastolic blood pressure (\u0026minus;\u0026thinsp;5.6 mmHg) compared to non-exercising controls. This supports the idea that exercise may be beneficial with medicine, but the lack of information on dose changes or adherence makes it harder to say for sure that this is the case. The Ethiopian intervention was longer and more structured than the Nigerian one, which may explain why it had greater effects on diastolic blood pressure.\u003c/p\u003e\u003cp\u003eConversely, the Ghanaian single-arm trial conducted by Opoku (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), which included adults with type 2 diabetes and hypertension, exhibited substantial reductions in both blood pressure after eight weeks of brisk walking, suggesting potential advantages for comprehensive chronic disease management. Nevertheless, in the absence of a control group or drug-use monitoring, the impact of treatment remains conjectural. In summary, Maruf et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) presents the most compelling evidence of pharmacologic-exercise synergy, whereas Daimo et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and Opoku (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) highlight the need for continuous physical activity in maintaining blood pressure stability in medicated individuals. Overall, the studies indicate that exercise improves medication effectiveness and may decrease drug dependence, although more robust trials with adherence monitoring are necessary.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review found that structured, moderate-intensity aerobic exercise performed three times a week for 8 to 16 weeks consistently lowered blood pressure in African adults. The effects were most significant and most consistent on systolic blood pressure (SBP) in randomised controlled settings (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The direction and intensity of these effects roughly correspond with international syntheses. For instance, meta-analyses of randomised studies indicate average training-induced reductions of approximately 3\u0026ndash;5 mmHg in systolic blood pressure (SBP) and 2\u0026ndash;3 mmHg in diastolic blood pressure (DBP) across various locations and modalities (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Several African trials in this study notably achieved significant SBP decreases at the upper end (\u0026thinsp;\u0026asymp;\u0026thinsp;\u0026minus;\u0026thinsp;7 mmHg), possibly indicating a higher baseline risk and robust supervision/adherence.\u003c/p\u003e\u003cp\u003eThe Nigerian double-blind RCT by Maruf et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) showed that exercise had an additive impact when taken with co-amilozide and amlodipine, which improved blood pressure control rates and made it possible to reduce the daily dosage of the drugs. This adds to the growing body of evidence that exercise can be just as beneficial as some pharmacological treatments for specific outcomes and that it argues for regular care (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In contrast, the Ethiopian RCT (with male participants on stable monotherapy) employed a longer, progression-based brisk-walking protocol (16 weeks) and recorded significant reductions in both SBP and DBP (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This underscores duration and progressive overload as critical factors for diastolic responsiveness, an observation supported by meta-analytic subgroup patterns indicating that longer endurance programs produce greater effects (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Ugandan studies utilising culturally tailored aerobic dance over 12 weeks showed a considerable reduction in SBP (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), although they exhibited only a little, statistically insignificant change in DBP in a concurrent study (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). These contradictory DBP results are consistent with global evidence indicating that decreases in DBP are generally lower and occasionally less stable than changes in SBP, particularly over shorter interventions (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Mechanistically, endurance exercise decreases blood pressure by reducing sympathetic tone and enhancing endothelial function; the impact magnitude is influenced by dosage (minutes per week), intensity (moderate versus vigorous), and development (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Ghana single-arm study (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) demonstrated significant pre\u0026ndash;post reductions in blood pressure and fasting glucose levels in patients with type 2 diabetes mellitus and hypertension. However, the lack of a control group prevents causal inference; nonetheless, its pragmatic, supervised brisk-walking model highlights real-world feasibility. When compared to guideline-level recommendations, the observed BP deltas align with the American College of Sports Medicine's recommendations for moderate-intensity aerobic exercise for at least 150 minutes per week, which is expected to lower BP by about 5\u0026ndash;7 mmHg in hypertensive adults and maintain post-exercise hypotension (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Additionally, prospective epidemiology indicates a dose-response preventive benefit of regular physical exercise on the onset of hypertension (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), underscoring the public health significance of scalable programs (e.g., walking, culturally rooted dancing).\u003c/p\u003e\u003cp\u003eThere are still some important methodological gaps. First, blinding was infrequent (except Maruf et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), which introduced the possibility of performance/detection bias; second, precision reporting (confidence intervals) was frequently inadequate, hindering cross-study comparisons; third, adherence and implementation metrics (session attendance, progression achieved) were inconsistently reported, restricting external validity. These flaws are not exclusive to African trials and reflect those noted in the international literature (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFuture African trials would benefit from CONSORT-conformant reporting, uniform intensity quantification (e.g., heart-rate reserve or rating of perceived exertion), and explicit medication/adherence objectives to clarify de-prescribing potential. In summary, the African randomised evidence aligns directionally with international meta-analyses and guidelines: supervised, moderate-intensity aerobic programs (\u0026ge;\u0026thinsp;12 weeks) consistently reduce SBP and variably decrease DBP, with more pronounced effects when duration and progression are sufficient and when exercise is combined with pharmacotherapy. Scaling culturally customised, supervised models may optimise adherence and real-world impact.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eImplications of Findings to Practice and Policy\u003c/h2\u003e\u003cp\u003eThe results of this review have important effects on both public health policy and clinical practice in Africa. The continuous evidence demonstrates that moderate-intensity physical activity, especially aerobic dance and brisk walking, lowers blood pressure, highlighting the necessity of including structured exercise programs in hypertension therapy regimens at the primary healthcare level. Healthcare professionals, such as nurses and community health workers, must be educated in recommending and monitoring exercise as a non-pharmacological intervention in conjunction with medication, particularly for individuals with mild to moderate hypertension.\u003c/p\u003e\u003cp\u003eFrom a policy standpoint, Ministries of Health and local governments ought to formulate national guidelines that advocate for physical exercise as both a preventive and therapeutic approach, in accordance with World Health Organisation (WHO) recommendations for non-communicable disease (NCD) management. Policies should also promote the creation of community-based exercise programs, such as walking groups or aerobics sessions that are tailored to different cultures, to make it easier for adults to become involved and stick with it. Working with groups like education, urban planning, and sports can help create a supportive environment, including safe walking pathways and places to play, that make physical activity a normal part of daily life. Lastly, public health campaigns and workplace wellness programs that encourage people to be active could reduce the number of hypertensive-related morbidities, lower healthcare expenditures, and help Africa reach Sustainable Development Goal (SDG) 3 on health and well-being.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eRecommendations for Future Research\u003c/h2\u003e\u003cp\u003eSubsequent study should concentrate on extensive, multicenter randomised controlled trials involving various African communities to enhance the evidence about the long-term efficacy of physical activity in managing blood pressure. Research should utilise standardised exercise protocols, explicitly defined intensity levels, and extended follow-up periods (exceeding 16 weeks) to assess persistent alterations in blood pressure and patterns of adherence. Future research should investigate gender and age disparities in physiological responses to exercise and analyse the impact of socio-cultural factors, such as beliefs, motivation, and environmental constraints, on participation and outcomes. Researchers should also look into how exercise works with other lifestyle modifications, such as dietary changes, stress management, and quitting smoking, to see if they have any synergistic effects. Importantly, future research should utilise mixed-method techniques, incorporating qualitative views to elucidate patient experiences and obstacles to exercise adherence. Lastly, there is an urgent need for economic evaluations to find out how cost-effective it is to put physical activity programs in place at the community and primary healthcare levels. This will give policymakers in African countries with limited resources the information they need to make decisions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eEven though this systematic review followed the PRISMA guidelines for reporting and used the CASP checklist to ensure the methods were sound, there were still limitations with its structure and implementation. First, the review was confined to quantitative studies published in English from 2010 to 2025, potentially introducing language and publication bias by omitting pertinent studies conducted in other languages or found in other grey literature, including conference proceedings and institutional reports. This limitation may have constrained the thoroughness of the evidence base, particularly as numerous African studies are disseminated in local or French-language journals. Second, only publications that had been peer-reviewed and dissertations were included. This may have left out important research on interventions in specific areas or communities that aren't available in major databases. Third, the review used narrative synthesis instead of meta-analysis because the studies had different designs, types of interventions, durations of time, and outcome measures. Under these circumstances, narrative synthesis is suitable, but it is fundamentally more interpretive and less statistically rigorous, hence heightening the risk of subjective bias in the synthesis of findings. The methodological diversity of the included studies, spanning randomised controlled trials, quasi-experimental designs, and single-arm studies, further limited the comparability of the findings. Additionally, numerous included studies were deficient in blinding, standardised outcome measures, or confidence intervals, hence constraining the capacity to statistically compare effect sizes and evaluate internal validity. Lastly, the lack of cross-sectional or qualitative research may have missed significant contextual insights, like cultural attitudes, challenges to adherence, and behavioural motivators that affect African communities' engagement in physical exercise. As a result, the findings of this study offer reliable evidence endorsing exercise as a strategy for hypertension management; however, they must be interpreted with caution due to these methodological constraints.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis systematic review aims to assess the impact of physical activity interventions on the prevention and control of high blood pressure in African adults. The results show that people with high blood pressure can reduce their systolic and, to a lesser extent, diastolic blood pressure by engaging in moderate-intensity aerobic exercises such as brisk walking and aerobic dance on a regular basis. These advantages were apparent across various intervention durations and were significantly enhanced when exercise was combined with pharmaceutical treatment or administered over prolonged periods. The review also showed that exercise is not only a good way to treat high blood pressure without drugs, but it is also a long-term, low-cost, and culturally appropriate way to do so in African communities and healthcare settings. Although several studies had limitations with their methods, the overall data support the use of structured exercise programs as part of interventions that prevent and control high blood pressure. To reduce the growing problem of high blood pressure across the continent, public health programs and clinical guidelines should put a lot of emphasis on encouraging physical exercise. Incorporating exercise therapies into national health policies and primary care services has significant potential to enhance cardiovascular health outcomes and decrease premature death associated with hypertension in African adults.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the review process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrecious Ebube Anyakorah\u003c/strong\u003e: Conceptualisation, Protocol development, Data Synthesis, Data Extraction, Critical appraisal, Project coordination, and Writing - Review editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDavid Chinaecherem Innocent\u003c/strong\u003e: Study screening, data extraction, and critical appraisal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePromise Somtochukwu Chukwuemeka:\u0026nbsp;\u003c/strong\u003eOriginal draft preparation, Study screening.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChiamaka Judith Ezenwa:\u0026nbsp;\u003c/strong\u003eData Synthesis, Writing - Review editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJuliet Chinaza Anuwe:\u0026nbsp;\u003c/strong\u003eProject coordination\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJoakin Chidozie Nwaokoro:\u0026nbsp;\u003c/strong\u003eSupervision\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVelly Alero Emina:\u0026nbsp;\u003c/strong\u003eOriginal draft preparation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinal Approval of the Manuscript\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be made available upon request by the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have declared that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds were received for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organisation. 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J Clin Epidemiol. 2016;75:40\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRichter RR, Austin TM. Using MeSH (medical subject headings) to enhance PubMed search strategies for evidence-based practice in physical therapy. Phys Ther. 2012;92(1):124\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCritical Appraisal Skills Programme. CASP randomised controlled trial checklist. 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNahwera L, Boit EK, Nsibambi CA, Maghanga M, Wachira LJ. Effects of aerobic dance on systolic blood pressure in stage one hypertensive adults in Uganda. 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BMJ. 2013;347:f5577.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA. Exercise and hypertension. Med Sci Sports Exerc. 2004;36(3):533\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am heart association. 2013;2(1):e004473.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiaz KM, Shimbo D. Physical activity and the prevention of hypertension. Curr Hypertens Rep. 2013;15(6):659\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePescatello LS, MacDonald HV, Lamberti L, Johnson BT. Exercise for hypertension: a prescription update integrating existing recommendations with emerging research. Curr Hypertens Rep. 2015;17:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Physical activity, hypertension, blood pressure, aerobic exercise, Africa, prevention, lifestyle intervention","lastPublishedDoi":"10.21203/rs.3.rs-7781986/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7781986/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHypertension is still one of the main causes of morbidity and mortality in Africa, largely driven by sedentary lifestyles and limited access to preventive healthcare. Physical activity has been recognised as a cost-effective, non-pharmacological approach for the management of hypertension. Nonetheless, evidence from African populations continues to be disjointed. This study aimed to assess the impact of physical activity in the prevention and control of high blood pressure in adults in Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive review was performed utilising studies published from 2010 to 2025 sourced from PubMed, Scopus, CINAHL, Web of Science, and African Index Medicus. Retrieved studies were screened based on pre-determined eligibility criteria. Data were extracted according to key variables, including study design, intervention type, duration, outcome measures, and key findings. The CASP checklist for randomised controlled trials was employed to assess the methodological quality of the studies that were included. Studies were synthesised using a narrative synthesis approach.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFive studies satisfied the inclusion criteria. The results repeatedly demonstrated that moderate-intensity aerobic exercises, especially brisk walking and aerobic dance, substantially reduced systolic blood pressure, with lesser albeit favourable impacts on diastolic blood pressure. Interventions lasting 12 to 16 weeks or longer and those that included medication led to the most significant results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsistent, moderate-intensity physical activity significantly reduces blood pressure and ought to be included in hypertension care and preventive programs in Africa. The results show that there is a need for national policies that encourage community-based fitness programs and more large-scale studies to look at long-term and gender-specific impacts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePROSPERO Registration Number: \u003c/strong\u003eCRD420251131467.\u003c/p\u003e","manuscriptTitle":"A Systematic Review of the Impact of Physical Activities in the Prevention and Control of High Blood Pressure Among Adults in Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 16:25:55","doi":"10.21203/rs.3.rs-7781986/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fc1a8015-b16c-4e47-81d4-5c35ea66d451","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T09:23:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 16:25:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7781986","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7781986","identity":"rs-7781986","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}