{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T02:54:12Z","timestamp":1788144852396,"version":"build-2803163510"},"reference-count":62,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R020981\/2"],"award-info":[{"award-number":["MR\/R020981\/2"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hypertensive disorders of pregnancy (HDP) are the most common medical complication in pregnancy, affecting approximately 10\u201315% of pregnancies worldwide. HDP are a major cause of maternal and perinatal morbidity and mortality, and each year, worldwide, around 70,000 mothers and 500,000 babies die because of HDP. Up-to-date high-quality systematic reviews quantifying the role of exercise and the risks of developing HDP are currently lacking. Physical exercise is considered to be safe and beneficial to pregnant women. Supervised exercise has been shown to be safe and to be more beneficial than unsupervised exercise in the general population, as well as during pregnancy in women with obesity and diabetes. Therefore, we undertook a systematic review and meta-analysis to investigate the effects of women performing supervised exercise during pregnancy compared to a control group (standard antenatal care or unsupervised exercise) on the development of HDP. We searched Medline, Embase, CINHAL, and the Cochrane Library, which were searched from inception to December 2021. We included only randomized controlled trials (RCTs) investigating the development of HDP compared to a control group (standard antenatal care or unsupervised exercise) in pregnant women performing supervised exercise. Two independent reviewers selected eligible trials for meta-analysis. Data collection and analyses were performed by two independent reviewers. The PROSPERO registration number is CRD42020176814. Of 6332 articles retrieved, 16 RCTs met the eligibility criteria, comparing a total of 5939 pregnant women (2904 pregnant women in the intervention group and 3035 controls). The risk for pregnant women to develop HDP was significantly reduced in the intervention compared to the control groups, with an estimated pooled cumulative incidence of developing HDP of 3% in the intervention groups (95% CI: 3 to 4) and of 5% in the control groups (95% CI: 5 to 6), and a pooled odds ratio (OR) comparing intervention to control of 0.54 (95% CI:0.40 to 0.72, p &lt; 0.001). A combination of aerobic and anaerobic exercise, or yoga alone, had a greater beneficial effect compared to performing aerobic exercise only (mixed-OR = 0.50, 95% CI:0.33 to 0.75, p = 0.001; yoga-OR = 0.28, 95% CI:0.13 to 0.58, p = 0.001); aerobic exercise only-OR = 0.87, 95% CI:0.55 to 1.37, p = 0.539). Pregnancy is an opportunity for healthcare providers to promote positive health activities, thus optimizing the health of pregnant women with potential short- and long-term benefits for both mother and child. This systematic review and meta-analysis support a beneficial effect of either structured exercise (combination of aerobic, strength, and flexibility workouts) or yoga for preventing the onset of HDP. Yoga, considered a low-impact physical activity, could be more acceptable and safer for women in pregnancy in reducing the risk of developing HDP.<\/jats:p>","DOI":"10.3390\/jcm11030793","type":"journal-article","created":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T09:59:21Z","timestamp":1643709561000},"page":"793","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7848-5189","authenticated-orcid":false,"given":"Marianna","family":"Danielli","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8417-9700","authenticated-orcid":false,"given":"Clare","family":"Gillies","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre, Leicester General Hospital, Leicester LE5 4PW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roisin Clare","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Emily","family":"Melford","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip Newton","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Yates","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre, Leicester General Hospital, Leicester LE5 4PW, UK"},{"name":"National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester LE5 4PW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamlesh","family":"Khunti","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre, Leicester General Hospital, Leicester LE5 4PW, UK"},{"name":"NIHR Applied Research Collaboration\u2014East Midlands (ARC-EM), Leicester General Hospital, Leicester LE5 4PW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5836-0613","authenticated-orcid":false,"given":"Bee Kang","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK"},{"name":"Diabetes Research Centre, Leicester General Hospital, Leicester LE5 4PW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1161\/CIRCRESAHA.118.313276","article-title":"Preeclampsia: Pathophysiology, challenges, and perspectives","volume":"124","author":"Rana","year":"2019","journal-title":"Circ. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2050312119843700","DOI":"10.1177\/2050312119843700","article-title":"Hypertension in pregnancy: Pathophysiology and treatment","volume":"7","author":"Braunthal","year":"2019","journal-title":"SAGE Open Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Wang, W., Xie, X., Yuan, T., Wang, Y., Zhao, F., Zhou, Z., and Zhang, H. (2021). Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: A population-based study. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-03809-2"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1002\/path.2719","article-title":"Pre-eclampsia: Fitting together the placental, immune and cardiovascular pieces","volume":"221","author":"James","year":"2010","journal-title":"J. Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Vata, P.K., Chauhan, N.M., Nallathambi, A., and Hussein, F. (2015). Assessment of prevalence of preeclampsia from dilla region of ethiopia. BMC Res. Notes, 8.","DOI":"10.1186\/s13104-015-1821-5"},{"key":"ref_6","unstructured":"(NICE) National Institute for Health and Care Excellence (2021, December 15). Hypertension in Pregnancy: Diagnosis and Management [Nice Guidelines n. 133]. Available online: https:\/\/www.nice.org.uk\/guidance\/ng133."},{"key":"ref_7","first-page":"229","article-title":"Progression of gestational hypertension to preeclampsia","volume":"82","year":"2014","journal-title":"Ginecol. Obs. Mex"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/ijgo.12802","article-title":"The international federation of gynecology and obstetrics (figo) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention","volume":"145","author":"Poon","year":"2019","journal-title":"Int. J. Gynaecol. Obstet. Off. Organ Int. Fed. Gynaecol. Obstet."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10654-013-9762-6","article-title":"Cardiovascular disease risk in women with pre-eclampsia: Systematic review and meta-analysis","volume":"28","author":"Brown","year":"2013","journal-title":"Eur. J. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1093\/emph\/eox004","article-title":"Time from pre-eclampsia diagnosis to delivery affects future health prospects of children","volume":"2017","author":"Hollegaard","year":"2017","journal-title":"Evol. Med. Public Health"},{"key":"ref_11","unstructured":"(2021, December 15). Guidance from the Department of Health of the Physical Activity and Pregnancy Infographic, Available online: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/829894\/5-physical-activity-for-pregnant-women.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1515\/jbcpp-2016-0117","article-title":"Comparison of structured and unstructured physical activity training on predicted vo2max and heart rate variability in adolescents\u2014A randomized control trial","volume":"28","author":"Sharma","year":"2017","journal-title":"J. Basic Clin. Physiol. Pharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"187","DOI":"10.15406\/mojor.2016.05.00184","article-title":"Effects of supervised training compared to unsupervised training on physical activity, muscular endurance, and cardiovascular parameters","volume":"5","author":"Fennell","year":"2016","journal-title":"MOJ Orthop. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1123\/jpah.8.3.309","article-title":"Safety and efficacy of supervised strength training adopted in pregnancy","volume":"8","author":"Poudevigne","year":"2011","journal-title":"J. Phys. Act. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.diabet.2009.04.008","article-title":"Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant women","volume":"35","author":"Ong","year":"2009","journal-title":"Diabetes Metab."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1249\/MSS.0000000000000587","article-title":"Home-based exercise improves fitness and exercise attitude and intention in women with gdm","volume":"47","author":"Halse","year":"2015","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1016\/j.wombi.2017.10.004","article-title":"Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomised controlled trial","volume":"31","author":"Kokic","year":"2018","journal-title":"Women Birth"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e12428","DOI":"10.1111\/cob.12428","article-title":"The safety and efficacy of supervised exercise on pregnant women with overweight\/obesity: A systematic review and meta-analysis of randomized controlled trials","volume":"11","author":"Muhammad","year":"2021","journal-title":"Clin. Obes."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., G\u00f8tzsche, P.C., Ioannidis, J.P.A., Clarke, M., Devereaux, P.J., Kleijnen, J., and Moher, D. (2009). The prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med., 6.","DOI":"10.2427\/5768"},{"key":"ref_20","unstructured":"Higgins, J., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M., and Welch, V. (2021, December 15). Cochrane Handbook for Systematic Reviews of Interventions. Available online: https:\/\/training.cochrane.org\/handbook."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"Rob 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The cochrane collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_24","first-page":"647","article-title":"Hydrotherapy reduces arterial stiffness in pregnant women with chronic hypertension","volume":"114","author":"Linhares","year":"2020","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/10641950701826778","article-title":"A comparison of walking versus stretching exercises to reduce the incidence of preeclampsia: A randomized clinical trial","volume":"27","author":"Yeo","year":"2008","journal-title":"Hypertens Pregnancy"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"109","DOI":"10.12965\/jer.1836524.262","article-title":"Effect of stretching exercises versus autogenic training on preeclampsia","volume":"15","author":"Awad","year":"2019","journal-title":"J. Exerc. Rehabil."},{"key":"ref_27","first-page":"10","article-title":"Effects of antenatal yoga on maternal stress and clinical outcomes in north indian women: A randomised controlled trial","volume":"20","author":"Bhartia","year":"2019","journal-title":"J. Indian Acad. Clin. Med. (JIACM)"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"649.e1-8","DOI":"10.1016\/j.ajog.2015.11.039","article-title":"Exercise during pregnancy protects against hypertension and macrosomia: Randomized clinical trial","volume":"214","author":"Barakat","year":"2016","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/AOG.0b013e31825de592","article-title":"Effect of a physical exercise program during pregnancy on uteroplacental and fetal blood flow and fetal growth: A randomized controlled trial","volume":"120","author":"Silva","year":"2012","journal-title":"Obs. Gynecol"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s12966-017-0632-6","article-title":"A randomized controlled trial of exercise during pregnancy on maternal and neonatal outcomes: Results from the pamela study","volume":"14","author":"Hallal","year":"2017","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"170","DOI":"10.3109\/10641955.2015.1122036","article-title":"Effect of regular exercise on blood pressure in normotensive pregnant women. A randomized controlled trial","volume":"35","author":"Haakstad","year":"2016","journal-title":"Hypertens Pregnancy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1891\/2156-5287.3.3.165","article-title":"The effect of integrated yoga on labor outcome: A randomized controlled study","volume":"3","author":"Maharana","year":"2013","journal-title":"Int. J. Childbirth"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1249\/MSS.0b013e318267ad67","article-title":"Exercise in pregnancy: Effect on fitness and obstetric outcomes-a randomized trial","volume":"44","author":"Price","year":"2012","journal-title":"Med. Sci. Sports. Exerc."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Perales, M., Valenzuela, P.L., Barakat, R., Cordero, Y., Pel\u00e1ez, M., L\u00f3pez, C., Ruilope, L.M., Santos-Lozano, A., and Lucia, A. (2020). Gestational exercise and maternal and child health: Effects until delivery and at post-natal follow-up. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020379"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.ypmed.2012.07.020","article-title":"The effects of yoga in prevention of pregnancy complications in high-risk pregnancies: A randomized controlled trial","volume":"55","author":"Rakhshani","year":"2012","journal-title":"Prev. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"39","DOI":"10.4103\/0973-6131.105945","article-title":"Effect of the integrated approach of yoga therapy on platelet count and uric acid in pregnancy: A multicenter stratified randomized single-blind study","volume":"6","author":"Jayashree","year":"2013","journal-title":"Int. J. Yoga"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"362","DOI":"10.3325\/cmj.2013.54.362","article-title":"The effect of maternal exercise during pregnancy on abnormal fetal growth","volume":"54","year":"2013","journal-title":"Croat Med. J."},{"key":"ref_38","first-page":"293","article-title":"Effect of exercise on blood pressure in pregnant women with a high risk of gestational hypertensive disorders","volume":"45","author":"Yeo","year":"2000","journal-title":"J. Reprod. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/j.mayocp.2013.07.020","article-title":"Supervised exercise-based intervention to prevent excessive gestational weight gain: A randomized controlled trial","volume":"88","author":"Ruiz","year":"2013","journal-title":"Mayo Clin. Proc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/AOG.0b013e3182393f86","article-title":"Regular exercise during pregnancy to prevent gestational diabetes: A randomized controlled trial","volume":"119","author":"Stafne","year":"2012","journal-title":"Obstet. Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.ajog.2017.01.037","article-title":"A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women","volume":"216","author":"Wang","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"857047","DOI":"10.1155\/2013\/857047","article-title":"Maternal and perinatal outcomes of exercise in pregnant women with chronic hypertension and\/or previous preeclampsia: A randomized controlled trial","volume":"2013","author":"Kasawara","year":"2013","journal-title":"ISRN Obstet. Gynecol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1177\/1559827613498204","article-title":"Guidelines for physical activity during pregnancy: Comparisons from around the world","volume":"8","author":"Evenson","year":"2014","journal-title":"Am. J. Lifestyle Med."},{"key":"ref_44","unstructured":"National Institute of Health and Care Excellence (2022, January 27). Antenatal Care. Clinical Guideline [NG201]. Published Date: 19 August 2021. Available online: https:\/\/www.nice.org.uk\/guidance\/ng201."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/00132585-200210010-00004","article-title":"Exercise in pregnancy: How safe is it?","volume":"10","author":"Arena","year":"2002","journal-title":"Sports Med. Arthrosc. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e6370","DOI":"10.7717\/peerj.6370","article-title":"Physical activity during pregnancy and its influence on delivery time: A randomized clinical trial","volume":"7","year":"2019","journal-title":"PeerJ"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"12915","DOI":"10.1038\/s41598-018-30925-5","article-title":"Exercise in pregnancy: 1-year and 7-year follow-ups of mothers and offspring after a randomized controlled trial","volume":"8","author":"Chiavaroli","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1249\/01.MSS.0000147627.35139.DC","article-title":"The role of regular physical activity in preeclampsia prevention","volume":"36","author":"Weissgerber","year":"2004","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1161\/HYPERTENSIONAHA.112.194050","article-title":"Impact of exercise training on preeclampsia: Potential preventive mechanisms","volume":"60","author":"Genest","year":"2012","journal-title":"Hypertension"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/j.1523-536X.2010.00407.x","article-title":"Physical activity and hypertensive complications during pregnancy: Findings from 2004 to 2006 north carolina pregnancy risk assessment monitoring system","volume":"37","author":"Martin","year":"2010","journal-title":"Birth"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1093\/aje\/kwn189","article-title":"Recreational physical activity and the risk of preeclampsia: A prospective cohort of norwegian women","volume":"168","author":"Magnus","year":"2008","journal-title":"Am. J. Epidemiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"373041","DOI":"10.1155\/2015\/373041","article-title":"Effects of yoga on utero-fetal-placental circulation in high-risk pregnancy: A randomized controlled trial","volume":"2015","author":"Rakhshani","year":"2015","journal-title":"Adv. Prev. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1249\/MSS.0b013e31817cab1","article-title":"A prospective analysis of recreational physical activity and preeclampsia risk","volume":"40","author":"Rudra","year":"2008","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1249\/MSS.0000000000001941","article-title":"Benefits of physical activity during pregnancy and postpartum: An umbrella review","volume":"51","author":"Dipietro","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1097\/EDE.0000000000000036","article-title":"Physical activity and the risk of preeclampsia: A systematic review and meta-analysis","volume":"25","author":"Aune","year":"2014","journal-title":"Epidemiology"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1136\/bjsports-2018-099355","article-title":"Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: A systematic review and meta-analysis","volume":"52","author":"Davenport","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"3495","DOI":"10.1080\/14767058.2018.1481037","article-title":"Diet and exercise for preeclampsia prevention in overweight and obese pregnant women: Systematic review and meta-analysis","volume":"32","author":"Syngelaki","year":"2019","journal-title":"J. Matern. Fetal. Neonatal. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1007\/s10995-013-1316-8","article-title":"Leisure time physical activity and the risk of pre-eclampsia: A systematic review","volume":"18","author":"Wolf","year":"2013","journal-title":"Matern. Child Health J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e009358","DOI":"10.1161\/JAHA.118.009358","article-title":"Increased muscle mass protects against hypertension and renal injury in obesity","volume":"7","author":"Butcher","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_60","first-page":"23","article-title":"Device-guided breathing to lower blood pressure: Case report and clinical overview","volume":"8","author":"Elliott","year":"2006","journal-title":"MedGenMed"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/S0753-3322(00)80065-7","article-title":"Adrenocortical responses to psychological stress and risk for hypertension","volume":"54","author":"Arnett","year":"2000","journal-title":"Biomed Pharm."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1089\/acm.2013.0139","article-title":"Effects of hatha yoga on blood pressure, salivary \u03b1-amylase, and cortisol function among normotensive and prehypertensive youth","volume":"20","author":"Sieverdes","year":"2014","journal-title":"J. Altern. Complement. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/793\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:12:39Z","timestamp":1760134359000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/793"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,1]]},"references-count":62,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11030793"],"URL":"https:\/\/doi.org\/10.3390\/jcm11030793","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,1]]}}}