- Exercising with High Blood Pressure: Is it safe?
- When might exercise be unsafe for someone with high blood pressure?
- How much exercise should someone with high blood pressure do?
- Exercising when you have high blood pressure
- “Exercise Hypertension” Occurs When Cells Can’t “Relax,” Hopkins Researchers Find
- Weights or Cardio: Which is Better for Tackling High Blood Pressure?
- Fitness Experts Share Top Workouts for People With High Blood Pressure
- Exercise to Fight Hypertension
- 4 Blood-Pressure-Lowering Workouts
- Exercise ‘as good as medicine’ for controlling high blood pressure
- Where did the story come from?
- What kind of research was this?
- What did the research involve?
- What were the basic results?
- How did the researchers interpret the results?
- Links to the headlines
- Links to the science
- Can exercise lower blood pressure as effectively as drugs?
- Findings indicate similar effects
- More exercise is beneficial
- How Much Exercise Do I Need to Lower My Blood Pressure?
- The New Guidelines On High Blood Pressure
- How Exercise Affects Blood Pressure
- How Much Exercise To Lower Blood Pressure
- What to know about blood pressure rates after exercising
Exercising with High Blood Pressure: Is it safe?
Certain exercises, Professor MacGregor goes on to say, are not as helpful (or as safe) for those with high blood pressure.
‘For example, you should not do any activity that is very intensive for short periods of time.’
Sprinting and lifting heavy weights are examples of this.
‘These kinds of exercises may quickly raise your blood pressure, and put unwanted strain on your heart and blood vessels.’ Professor MacGregor adds.
Someone who has high blood pressure and wants to incorporate strength training into their routine can do so by performing simple repetition exercises with lighter weights (using 1kg or 2kg dumbbells for example); but should stay away from heavier weights, at least until their blood pressure is under control.
When might exercise be unsafe for someone with high blood pressure?
The heart will need to work harder during physical activity, in order to get blood and oxygen to the muscles being worked. As such, exercise can temporarily increase blood pressure and heart rate, which is why some people with high blood pressure will need to be careful about the exercise they do.
Those with hypertension who want to lower their blood pressure through exercise then should speak to their doctor before starting, to ensure that the activities they intend to undertake are the most suitable. In some cases, a healthcare professional may want to use medication to try and bring blood pressure under control before recommending exercise.
Professor MacGregor advises that those with very high blood pressure should not start a new activity without first speaking to their doctor.
Every individual is different, but Blood Pressure UK recommends that those whose blood pressure is:
- between 140/90 and 179/99 should be able to safely increase activity levels on their own
- between 180/100 and 199/109 should consult a doctor first
- over 200/110 should not undertake any new activity, and speak to their doctor for advice.
How much exercise should someone with high blood pressure do?
Following the guidelines for adults set out by the NHS (150 minutes of moderate intensity exercise per week) is a good foundation for lowering blood pressure.
So for someone brisk walking, half an hour a day, five days a week is a good place to start and gradually build up from. Someone might then increase this to an hour a day, and then later try a portion of their walking regime into a slow jog.
As Professor MacGregor explains:
‘An adult should have 30 minutes of moderate exercise five times a week. Moderate exercise should be enough to make you feel warmer and breathe harder, but you should still be able to talk without panting between words.’
If you’re training with a partner, they can help you determine how intense your current activity level is by initiating a ‘talk test’, and vice versa. Someone performing moderate intensity exercise will still be able to hold a conversation (whereas someone performing vigorous exercise won’t).
‘The main thing is to be active,’ Professor MacGregor adds, ‘whether it’s walking more and not using the car for short journeys, taking the stairs and not the lift or getting off the bus one stop earlier. Remember, you can take further action yourself to lower your blood pressure by eating less salt, more fruit and vegetables and being a healthy weight.’
You can find more information on exercising with high blood pressure, as well as a range of other helpful resources, over on the Blood Pressure UK website.
Exercising when you have high blood pressure
(HealthDay)—High blood pressure is a serious risk factor for heart disease, stroke and other life-threatening medical conditions. While many people need medication and dietary changes to control their blood pressure, exercise is a key component of nearly every management plan.
Scientists know that exercise causes the body to adapt in ways that lower blood pressure, but there’s no single formula guaranteed to work for everyone. However, there are general guidelines regarding four key aspects of exercise.
Frequency: Aim to do aerobic exercise on a daily basis and strength training twice a week (on non-consecutive days to allow for muscle repair).
Intensity: Aim for moderate intensity exercise to start. For aerobic workouts, that means reaching between 60% and 70% of your maximum target heart rate (or 220 minus your age). Evidence suggests that higher intensity exercise can result in greater reduction of high blood pressure, but at the moment the risks aren’t clear.
Duration: Aim for at least 30 minutes of aerobic activity a day, increasing to 60 minutes if possible. If time or ability is a problem, work out in 10-minute segments that add up to your daily total. Strength training should target all major muscle groups using weight that enables you to complete two to three sets of 10 to 12 reps each.
Type: Effective aerobic activities that are easy to start with are walking, cycling and swimming. Strength training can be done with free weights, weight machines, stretchy resistance bands and/or your own bodyweight (pushups, for instance).
Working with your doctor on your exercise plan is a must. He or she may suggest testing to determine your ideal target heart rate during vigorous activity. If you’re on high blood pressure medication, you’ll want to make sure that it doesn’t affect your ability to exercise.
Is interval training the fountain of youth? More information: The American Heart Association has a complete guide to exercising with hypertension online.
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“Exercise Hypertension” Occurs When Cells Can’t “Relax,” Hopkins Researchers Find
Johns Hopkins Medicine
Office of Communications and Public Affairs
Media Contact: Joanna Downer
410-614-5105; [email protected]
April 6, 2004
“EXERCISE HYPERTENSION” OCCURS WHEN CELLS CAN’T “RELAX,” HOPKINS RESEARCHERS FIND
— Same mechanism may be at work in developing heart disease
So-called “exercise hypertension,” an abnormally high spike in blood pressure experienced by generally healthy people during a workout, is a known risk factor for permanent and serious high blood pressure at rest. But who gets it, and why, has been largely unknown.
Now, Johns Hopkins scientists say they have reason to believe that the problem is rooted in the failure of cells that line the blood vessels to allow the arteries to expand to accommodate increased blood flow during exertion.
“Our study shows that this impaired ability of the endothelial cells, which control large blood vessel relaxation, is a potential cause of exercise hypertension,” says Kerry J. Stewart, Ed.D., lead study author and director of clinical exercise physiology at Hopkins. “Because as many as 90 percent of adults are at risk for developing high blood pressure, knowing this may point to a cellular target for preventive therapies.”
Normally during exercise, blood pressure increases to push the flow of oxygen-rich blood throughout the body. However, in some individuals, the response to exercise is exaggerated. Instead of reaching a systolic (upper number) blood pressure of around 200 mmHg at maximal exercise, they spike at 250 mmHg or higher.
For the study, published in the April issue of the American Journal of Hypertension, the investigators evaluated 38 men and 44 women ages 55 to 75 who had untreated mild hypertension but were otherwise healthy. Their blood pressures at rest ranged from 130 to 159 mmHg systolic (the upper number) and 85 to 99 mmHg diastolic (the lower number).
To measure endothelial function, the researchers first used ultrasound to measure the size of a large artery in the arm. Next they put a tight blood pressure cuff on one of the subjects’ arms for five minutes to stop blood flow to the arm, then deflated the cuff, causing a surge of blood flow. They then repeated the artery size measurement, comparing it to the resting measure of the artery. The ability of the blood vessels to expand under these conditions is an indicator of endothelial function.
In a second test, they examined blood vessel stiffness — a marker of early heart disease — by using ultrasound to measure how fast blood traveled from arteries in the subjects’ necks to their legs with each heart beat. Because stiff blood vessels do not absorb any of the pressure behind the blood flow, the faster the blood travels, the more stiff the vessel is. They compared these readings with blood pressure measures taken at rest and while the participants walked to maximal effort on a treadmill.
In their analysis, researchers found that higher blood pressures in response to exercise were associated with poorer blood vessel expansion in the arm following the cuff test, suggesting that the endothelial cells failed to dilate enough to handle the extra blood flow. There was no correlation between the stiffness of blood vessel walls or resting blood pressure with increased blood pressure during exercise.
Impaired endothelial function is not solely related to high blood pressure, Stewart adds. It also is associated with aging, menopause, high cholesterol, smoking and diabetes, and may be a common process for developing heart disease among all of these risk factors.
“It’s too early to recommend that people have exercise tests just to measure their blood pressures,” Stewart says. “However, careful attention should be paid to exercise blood pressure if measured as part of a medical evaluation, or during a workout at a gym, since it may be a warning that your resting blood pressure may also increase.”
The study was supported by the National Institutes of Health and the Johns Hopkins Bayview General Clinical Research Center. Study coauthors were Jidong Sung, Harry Silber, Jerome Fleg, Mark Kelemen, Katherine Turner, Anita Bacher, Devon Dobrosielski, James DeRegis, Edward Shapiro, and Pamela Ouyang.
– -JHMI- –
Stewart, Kerry et al., “Exaggerated Exercise Blood Pressure is Related to Impaired Endothelial Vasodilator Function,” American Journal of Hypertension, April 2004;17(4):314-320.
On the Web:
Johns Hopkins’ Division of Cardiology
American Journal of Hypertension
Weights or Cardio: Which is Better for Tackling High Blood Pressure?
If you’ve been diagnosed with high blood pressure, then your doctor will likely have issued you with a treatment plan to help keep the condition in check. This may involve eating a reduced-fat diet, cutting down on salt, limiting alcohol consumption, and where applicable, stopping smoking. In certain cases, a doctor may also issue prescription treatment, such as ACE inhibitors or diuretics, or even a drug containing a combination of both, to bring blood pressure levels down.
One other measure someone with hypertension can take to improve their health is to implement a programme of exercise. However, knowing what type of exercise is going to be most beneficial in reducing blood pressure isn’t always straightforward; and how severe the condition is also an important factor to consider.
Most types of exercise fall into one of two main categories: cardiovascular and strength training; and both of these have their own specific benefits depending on what you want to achieve.
But which is more preferable for someone looking to treat hypertension, or even preemptively limit the risk of it developing?
Lifting weights is a popular exercise for those looking to increase muscle mass, but it can also help to improve bone density and, when done correctly, strengthen tissue around the joints.
However, what effect does weight lifting have on hypertension?
Because this type of exercise can actually temporarily increase blood pressure (sometimes a sharp spike), it certainly isn’t suitable for those with uncontrolled levels, which would be 180/110 or higher.
Those with a blood pressure of 140/90 or above should also discuss weight training with their doctor beforehand, as it may be necessary to employ certain precautions.
These may include:
- Breathing smoothly and consistently when lifting, and not holding your breath
- Taking care to use correct form
- Opting to use lighter weights and perform more repetitions, as opposed to using heavier weights and performing less repetitions
- Allowing your body to sufficiently rest between sets, and switching between leg and upper body exercises
If undertaken correctly and consistently, weight training can have a beneficial effect on blood pressure over time, and reduce the risk of hypertension developing; however, it is important to keep correct practice in mind, particularly if you know your blood pressure is high.
Otherwise known as aerobic exercise, cardiovascular training includes activities such as:
- and swimming.
The aim of these exercises is to improve heart health and circulation, and they can also play a key role in aiding weight loss (being overweight or obese significantly increases your likelihood of developing high blood pressure).
A meta-study of over 100 analyses conducted by the American Heart Association suggested that, although both had positive long-term effects, cardiovascular training was more conducive to lowering blood pressure than weight training.
So how much should you do?
Again, if you have high blood pressure, it’s best to talk to your doctor first. In any case, if you aren’t used to exercise, it’s better to start small and build up slowly. It’s also of crucial importance for those with high blood pressure to both warm up prior to and warm down following an exercise session, to allow the body to become accustomed to the activity.
For healthy adults between 19 and 64, the NHS recommends a combination of both cardio and weight training. This would consist of 150 minutes of moderate aerobic activity per week: this might be an activity such as walking or cycling, split into 30-minute sessions over five days; and strength exercises on two or more days per week.
The NHS also provides guidelines on vigorous activities such as jogging, running, swimming or playing football or tennis, and says that 75 minutes of exercise at this level is equivalent to 150 minutes of moderate activity; however, as mentioned above, if you have high blood pressure you should consult your doctor for advice on these beforehand.
A Word on Isometric Hand Grips
The above-mentioned review of studies carried out by the AHA also discovered evidence to suggest that isometric exercises in particular, such as squeezing handgrips or rubber balls, had a significant effect on reducing blood pressure. However, they also stated that more analysis needed to be carried out in this area to determine the credibility of this theory.
While cardiovascular training has been recognised as the more beneficial activity type for high blood pressure, it’s important to consider your own expectations before embarking on an exercise programme:
- Talk to your doctor first.
- Ease yourself in. Make sure you warm up before and warm down after a session.
- Don’t exercise ‘in bulk’. Try to spread your exercise out across the week into manageable sessions.
- Give your body enough time to rest. Take at least two days off a week.
Page last reviewed: 25/10/2019
Aerobic exercise refers to any sustained body movement that gets your blood pumping. Aerobic exercise increases the efficiency of your cardiovascular system, which, in turn, lowers blood pressure–by five points or more. A good rule of thumb: When aerobic activity makes you breathe hard, you’re working effectively.
But you don’t have to start training for a marathon to see results. You can start slowly. Use these suggestions to incorporate aerobic body movement into your daily life.
- Go for a walk. A dose of sunshine and fresh air is good for your mood as well as your heart. Short on time? Even a 10-minute walk can be a great de-stressor–work it into your lunch hour.
- Dance! Sure, you can sign up for salsa lessons, but you also can also get moving in the privacy of your own home.
- Play a team sport. Basketball, volleyball, and softball leagues offer camaraderie and competition. Tennis and racquetball require you to make an appointment for matches, holding you accountable for showing up.
- Play with your kids. Whether in your own backyard or at a local park, get moving outside. Play tag, run around and generally find your inner child. It will be good for all of you.
- Pick up any activity you used to love. Remember when you biked all over town as a kid? Or when you went swimming at the community pool every summer? How about the time you hiked around Europe? Rediscover the activities you loved, and take them up again. You’ll be more likely to stick with activities that you know and love.
How Often: Aim for at least 30 minutes of aerobic activity daily, most days of the week. If you’re just starting out, work toward that goal on your own pace.
Most people don’t need medical clearance to start exercising. However, if you have cardiovascular disease or have any concerns about whether it’s safe for you to exercise, then consult your health care provider first.
Celebrity personal trainer Scott Parker has been touched by hypertension for as long as he can remember. While Parker never had high blood pressure himself, he has seen firsthand what it’s like to deal with it on a daily basis. He remembers learning how to use a blood pressure cuff when he was just 6 years old as his father dealt with dangerous hypertension. He would help his dad put the cuff on and became very knowledgeable about all the medications his father took. Parker says he can’t recall a time when his dad wasn’t on at least five different medications.
His father’s blood pressure would hit astronomical highs, and he was admitted to the hospital several times when Parker was just a kid. Now, at 88, his father needs dialysis three days a week to manage kidney failure that is the result of long-term hypertension.
“I grew up in a household that was very sensitive to high blood pressure, so I didn’t eat a lot of sodium and drank a lot of water,” Parker says. “Now that I’m in the fitness profession, I understand how to help people. A lot of hypertension can be prevented and diminished through lifestyle changes, diet, and especially, exercise.”
Exercise to Fight Hypertension
Nearly 1 in 3 adults — 75 million Americans — has high blood pressure, according to the Centers for Disease Control and Prevention. While eating healthier and reducing sodium intake are great ways to lower your blood pressure, exercise is a crucial and potentially fun way to fight hypertension.
For instance, the American Heart Association recommends that people with high blood pressure and high cholesterol carry out an average of 40 minutes of moderate- to vigorous-intensity workouts three or four days each week.
There are a number of benefits to simple physical activity. A small study published in the journal Hypertension looked at exercise’s impact on blood pressure in 50 people — 29 women and 21 men — with resistant hypertension (a reading of 140/90 in spite of a treatment of three or more concurrent drugs). The participants were assigned to an 8- to 12-week treadmill-walking exercise program while their blood pressure was monitored around the clock. The participants found their systolic and diastolic blood pressures lowered as a result of the treadmill regimen.
The study showed that exercise can lower blood pressure even in people who normally have a suboptimal response to medical treatment.
For those who like lifting weights, there’s good news: Strength training can also help in the management of hypertension. One small 2012 study in the Journal of Human Hypertension looked at 15 middle-aged men who had high blood pressure and had previously exercised less than two hours each week. After two weeks of weight training three times a week (involving repetitions of basic resistance exercises, like leg presses, bicep curls, and chest presses, among others), these men experienced an average systolic blood pressure reduction of 16 mm Hg (millimeters of mercury is the unit for measuring blood pressure).
Jonathan Olivencia, a personal trainer at Mercedes Club, a health and fitness club in New York City, suggests that a combination of cardiovascular and strength training is the best way to help manage hypertension.
“Aerobic exercise increases the heart’s efficiency and vein elasticity,” Olivencia says. For aerobic activity, he suggesting shooting for at least 30 minutes five days a week, and for strength training, at least two or three times a week to maintain bone density and muscle mass.
RELATED: 7 Ways Strength Training Boosts Your Health and Fitness
4 Blood-Pressure-Lowering Workouts
Although not every form of exercise might be right for you, there are a number of ways you can stay active to keep your blood pressure down. Here are four options:
1. Go for a Swim.
Both Olivencia and Parker say swimming is a good, low-impact form of cardio that’s accessible to most people, especially seniors. A study published in The American Journal of Cardiology found that swimming reduced systolic blood pressure by an average of nine points in 60-year-olds who engaged in swimming three or four times a week over the course of 12 weeks.
2. Take a Walk.
Parker says that a lot of people who are intimidated by the idea of a gym workout can just go for a simple brisk walk. And research backs this. One study published in 2013 in the journal Arteriosclerosis, Thrombosis, and Vascular Biology looked at the benefits of walking on heart health. By looking at data on 33,060 runners in the National Runners’ Health Study and 15,045 walkers in the National Walkers’ Health Study, the researchers found that the same amount of energy that a person uses for moderate-intensity brisk walking and vigorous-intensity running actually resulted in similar reductions in high blood pressure, high cholesterol, and diabetes risks.
Over a six-year time frame, it was found that walkers had a 7.2 percent risk reduction in hypertension, a 7.0 percent risk reduction in high cholesterol, 12.3 percent risk reduction in diabetes.
Parker currently leads a group of seven women, including his mom, for a walk every Saturday morning. “We walk about 1.5 to 2 miles each week,” he says, adding that exercising in a group is especially beneficial. “Exercising with two or three other people on a regular basis makes it less of a chore and more of a fun social thing.”
3. Ride a Bike.
Parker says that a morning bike ride is a big part of his routine and one that he emphasizes with his clients.
“Something like a simple 30 to 35 minute bike ride can get your heart pumping, could get you outside, and could boost your cardiovascular health in a fun way,” he adds.
Olivencia adds that fitness routines coupling aerobic exercise, like biking, with resistance training, like lifting weights, could reap benefits for people dealing with hypertension.
Back in 2016, the American Heart Association highlighted two separate studies, which were published concurrently, looking at the effects of biking on heart health. One of the studies, published in the journal Circulation, looked at 45,000 Danish adults between ages 50 and 65 who biked as part of their day-to-day routines for both recreation and commuting. After 20 years of follow-up, the researchers found that cyclists had about 11 to 18 percent fewer heart attacks than those who had never hopped on bike for fun or to get to work.
The second of the studies, published in the Journal of the American Heart Association, showed that 20,000 Swedish adults in their forties through sixties who biked to work were less likely than those who didn’t bike to have obesity, high cholesterol, prediabetes, and high blood pressure. These, of course, are all major risk factors for heart disease. The people were studied over 10 years, and their commuting habits, cholesterol levels, weight changes, blood pressure, and blood glucose were all recorded.
At the start of the study, these people were reported to be 15 percent less likely to have obesity, 13 percent less likely to have high blood pressure, 15 percent less likely to have high cholesterol, and 12 percent less likely to have prediabetes or diabetes compared with those who didn’t bike. People who continued biking or took up biking over the course of the study had a collective 39 percent lower risk of obesity, an 11 percent lower risk of high blood pressure, an 18 percent lower risk of diabetes, and a 20 percent lower risk of having high cholesterol at the end of the follow-up period.
4. Hit the Gym.
The gym is a great place to go if you’re looking for exercise options. Most contain a mixture of cardio and strength-training machines that you can adjust to your particular skill level.
Olivencia suggests doing a mixture of upper body, lower body, and core exercises to maximize the circulation of your blood and the number of muscles you’re working out.
For people who are 50 and up, a safe practice is a “peripheral heart action system,” Olivencia says. It alternates lower body exercises with upper body exercises and core. This method helps with high blood pressure because it helps the blood circulate to different areas of the body to avoid localizing. “At the same time, you’re able to create a safe circuit style of training, which we know is great for fat loss and blood sugar control,” he explains.
Olivencia adds that older people looking for a safe workout should avoid the supine position for extended periods of times. This means you don’t want to be on your back, like while doing a bench press, for too long. In your workouts, “alternate positions to avoid blood from localizing and the possibility of getting light-headed from a sudden change in positioning,” he adds.
Both trainers note that people should consult with their doctors about the best way to lower their blood pressure and which exercises are safe to try.
“I always emphasize three things: stay hydrated, eat more greens, and move around each day,” Parker says.
Exercise ‘as good as medicine’ for controlling high blood pressure
“Swimming, walking or lifting weights in the gym ‘treats high blood pressure as well as drugs’,” reports the Mail Online.
High blood pressure (also called hypertension) is common among older people and can increase the risk of heart attacks and strokes. Many people take one or more medicines to keep blood pressure under control.
Researchers carried out a review of 391 studies and trials which had looked into the effects of either blood pressure medicines or exercise programmes on blood pressure. When they compared the effects of the 2 different interventions, they found exercise produced similar results to medicines for people with high blood pressure.
The study adds to evidence that exercise is a good way to keep blood pressure under control. However, the researchers found no studies that directly compared medicines with exercise programmes, meaning the results rely on indirect comparisons between groups of people that may have been quite different. This makes it harder to rely on the results.
As the Mail Online rightly points out, you should never stop taking a prescribed medicine for high blood pressure without first seeking advice from a health professional. But increasing your activity levels could help enhance the protective effects of any medication.
Find out more about recommended exercise levels for adults.
Where did the story come from?
The researchers who carried out the study were from the London School of Economics and Political Science, University of Bristol and University of Oxford in the UK, University of Bern in Switzerland, University of Pennsylvania and Stanford University School of Medicine in the US. The researchers had funding from the Higher Educational Funding Council for England, the Medical Research Council (UK) and the Swiss National Science Foundation.
The study was published in the peer-reviewed British Journal of Sports Medicine on an open access basis so is free to read online.
The UK media’s reporting of the study was reasonably accurate and balanced. Most reports included warnings from the researchers that people should not stop taking blood pressure medicines.
However, not all reports made it clear that the trials involving exercise were smaller, and often included people who did not have high blood pressure. Both these factors make the results less reliable.
What kind of research was this?
This was a network meta-analysis of randomised controlled trials (RCTs).
A meta-analysis pools results of trials, usually looking at the same intervention and outcome. A network meta-analysis is a way of comparing results of trials of different interventions, in this case exercise and medicines, when they have not been compared directly in trials.
What did the research involve?
Researchers searched for the most up to date meta-analyses of trials of blood pressure medicines, and of exercise programmes that measured effect on systolic blood pressure. (Systolic pressure is the pressure of blood as it is pumped out of the heart and through the blood vessels). They also looked for additional RCTs of exercise programmes, published since the most recent meta-analyses.
They didn’t look for more recent RCTs of blood pressure medicines, as the meta-analyses were considered up to date and no new drugs had come onto the market since the meta-analyses were carried out, so it was unlikely there would be new evidence.
The researchers divided the medicines group into 5 types of drug: ACE inhibitors, angiotensin-2 receptor blockers, beta blockers, calcium channel blockers and diuretics, and into high or low doses.
They divided exercise into endurance (aerobic exercise such as walking, jogging and swimming), resistance (strength training such as using weights) or a combination of both. They also categorised exercise as high, moderate or low intensity.
For each study, the researchers looked at the difference between systolic blood pressure at the start and at the end of the study, for people who’d had the intervention (exercise or medicine) compared to the control group (no exercise or placebo). They used this figure to calculate the average change in blood pressure that could be attributed to the intervention.
They then compared the average change in blood pressure across the different groups (exercise, different types of exercise, medicines, different types of medicines).
Many people in the exercise studies did not have high blood pressure, or had only slightly raised blood pressure. All the people in the medicine studies had high blood pressure.
Because of this, the researchers looked separately at the effects of exercise on people with high blood pressure only (140mmHg or over).
What were the basic results?
The researchers included 197 studies looking at exercise (with 10,461 participants) and 194 studies looking at medicines (with 29,281 participants). None of the studies directly compared exercise with medicines. Only 56 of the exercise studies (with 3,508 participants) included people with high blood pressure.
Taking all the participants together:
However, looking just at people with high blood pressure:
- average drop in blood pressure attributable to exercise was 8.96mmHg (95% CI -10.27 to -7.64 )
This indicated there was no difference in effectiveness of exercise and medicines in this group.
All types of exercise and all types of medication worked better than the control groups to lower blood pressure. Programmes which combined endurance and resistance exercise seemed to have the biggest effect.
Studies involving exercise were more likely to be subject to bias, however, because of a lack of blinding (people in the groups knew whether they were the exercise or control groups).
How did the researchers interpret the results?
The researchers said their study showed evidence of “modest but consistent reductions in systolic blood pressure across diverse populations and settings” which “appear similar to that of commonly used antihypertensive medications” among people with high blood pressure.
This summary of research adds to evidence that exercise can be a powerful tool to reduce and control blood pressure. It should encourage everyone to do enough physical activity to keep blood pressure at healthy levels.
The results do not mean, however, that people should ditch their blood pressure medication. Lowering blood pressure by exercise takes time and may require more sustained exercise than many people are used to. Anyone taking blood pressure medicines who wants to try to control blood pressure by exercise should talk to their GP first, so they can plan this properly.
The review has a number of limitations. Most importantly, the included studies don’t compare exercise and medicines directly, which makes it hard to rely on the indirect comparison between the 2 interventions. Participants in the exercise and medicine studies were quite different from each other – for example, people in the medicine studies had higher blood pressure and were older – so we don’t know how well the results translate from one group to another.
As the researchers point out, many people currently taking blood pressure medication are on several medicines and have a number of illnesses. This makes it hard to know what sort of exercise, what intensity and duration, they could routinely do to help control their blood pressure. The review also found problems of bias in many of the exercise studies.
None of the drawbacks detract from the conclusion that exercise helps to reduce blood pressure, and people should include physical activity in their daily routine.
Find out more about recommended exercise levels for adults.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
Exercise is just as good as pills for lowering high blood pressure, study reveals
The Sun, 19 December 2018
Swimming, walking or lifting weights in the gym ‘treats high blood pressure as well as drugs’
Mail Online, 19 December 2018
Exercise as effective as drugs in lowering high blood pressure – study
ITV News, 19 December 2018
Exercise could be as good as drugs at cutting high blood pressure
The Daily Telegraph, 18 December 2018
Exercise as good as medicine in bringing blood pressure down
The Times (subscription required), 19 December 2018
Links to the science
Naci H, Salcher-Konrad, Dias S, et al.
How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure
British Journal of Sports Medicine. Published online December 18 2018
Can exercise lower blood pressure as effectively as drugs?
One such change is to take regular, structured exercise that can be of several types:
- endurance exercises, such as walking, jogging, or swimming
- high-intensity interval training, involving short bursts of intensive exercise
- dynamic resistance, including strength training
- isometric resistance, such as the plank exercise
- a combination of endurance and resistance exercises
However, no studies have yet compared the effectiveness of physical activity in lowering blood pressure with that of antihypertensive medication.
A new study in the British Journal of Sports Medicine — a BMJ publication — aims to address this gap in the literature.
Findings indicate similar effects
Since there are no studies that directly compare the effects of blood pressure medication with those of structured exercise, the study analyzed the data of various research projects that focused on one or other of these approaches.
The researchers — from institutions across Europe and the U.S., including the London School of Economics and Political Science in the United Kingdom, and the Stanford University School of Medicine in California — explain that structured exercise helps lower systolic blood pressure, which measures the blood pressure in the blood vessels as the heart beats.
In the current study, they looked at the data from 194 clinical trials that focused on antihypertensive drugs and their impact on systolic blood pressure, and another 197 clinical trials, looking at the effect of structured exercise on blood pressure measurements. In total, these trials collected information from 39,742 participants.
Dr. Huseyin Naci — from the Department of Health Policy at the London School of Economics and Political Science — and colleagues conducted several sets of analyses on the data from the trials.
First, they compared the effects of all types of antihypertensive drugs with those of all kinds of exercise. Then, they looked at specific drug types versus specific types of exercise. Finally, they compared the impact of different exercise intensities with those of different drug dosages.
In the first instance, the investigators conducted these analyses by using data from healthy participants with normal blood pressure. Then, they repeated them with data from individuals with high blood pressure only.
They found that antihypertensive drugs were more effective in lowering blood pressure than structured exercise in the case of the general population. However, when they looked specifically at people with high blood pressure, they saw that exercise was as effective as most blood-lowering medication.
Moreover, the study authors concluded that there is “compelling evidence that combining endurance and dynamic resistance training was effective in reducing .”
More exercise is beneficial
Still, the research team cautions that they based their analyses on many small-scale trials, and others should replicate their results with more extensive studies.
Dr. Naci and colleagues also strongly advise against giving up on antihypertensive medication and replacing it with exercise.
“We don’t think, on the basis of our study, that patients should stop taking their antihypertensive medications,” the researcher says in a podcast in which he speaks about the current research.
“But,” Dr. Naci adds, “we hope that our findings will inform evidence-based discussions between clinicians and their patients.”
The lead researcher notes that many people in the U.S. and throughout Europe lead sedentary lives and that they would benefit from taking more exercise.
At the same time, however, he emphasizes that doctors should make sure their patients can adhere to prescribed exercise regimens.
“It’s one thing to recommend that physicians start prescribing exercise to their patients, but we also need to be cognizant of the resource implications and ensure that the patients that have been referred to exercise interventions can adhere to them and so really derive benefit.”
Dr. Huseyin Naci
How Much Exercise Do I Need to Lower My Blood Pressure?
There’s no way to avoid sounding alarmist about it: 46 percent of Americans now have hypertension, the number one risk factor for cardiovascular disease, according to revised guidelines by the American College of Cardiology and the American Heart Association (AHA) Task Force on Clinical Practice Guidelines.
Exercise isn’t the only answer, but a continuous workout regimen can lower blood pressure in the average by five to eight mmHg. University of Connecticut Blood Pressure Researcher Linda Pescatello, Ph.D. explains what that means for you and your blood pressure.
The New Guidelines On High Blood Pressure
Under the old guidelines, you had to have a blood pressure reading of 140 or 90 mmHg (millimeters of mercury, a unit of pressure). The former number is systolic pressure, the maximum pressure of a heartbeat; The latter is diastolic pressure, the pressure between beats. Thirty-two percent of Americans exceeded one or both of the old pressure figures. But now, the American Heart Association segments hypertension into stage one (130-139 or 80-89), and stage two (140+ or 90+). Pescatello says that the new guidelines are meant to increase awareness of the problem of high blood pressure. “Most of these people with hypertension who do hit the lower threshold can be treated with a lifestyle intervention, such as physical activity and dietary changes,” she says.
Even if you’re active every day, you could still be at risk for hypertension. Fixed risk factors, according to the AHA, include “psychosocial stress, premature birth, low birth weight, chronic kidney disease, family history, increased age, low socioeconomic status, male sex, and obstructive sleep apnea.” For people with hypertension, Pescatello recommends a home blood pressure monitor, which can cost less than $100. “It can tell you a lot of good information about your own blood pressure,” she says, “which you can share with a physician when you go in for your yearly physical.”
Exercise is shown to lower blood pressure. Check out Aaptiv’s workouts here.
How Exercise Affects Blood Pressure
Since 1988, Pescatello’s research has focused on the acute, or daily, effects of exercise on blood pressure. In 1991, she published her breakthrough study, which found that that participants’ blood pressure was lower on days when they exercised. The effect, called post-exercise hypotension, reduced mean arterial pressure for 12.7 hours for people with high blood pressure. For those with hypertension, 30 minutes of cycling lowered blood pressure for the entire day.
Post-exercise hypotension also mediates daily blood pressure spikes. “It’s called circadian variation,” Pescatello says. “Blood pressure will be highest in the morning upon waking, and spikes during the day have to do with a surge in sympathetic nervous stimulation or arousal.” Basically, our stressors—problems at work, conflicts with partners, a long line at Starbucks—won’t raise our blood pressure as much if we’ve exercised that morning.
Blood pressure will return to baseline the following day, but continuous daily exercise is what lowers blood pressure in the long run. “Structural adaptations begin to happen that will lower blood pressure, due to exercise training,” Pescatello says. “Those changes have been shown to happen within three to five days.” Over a period of months, exercise can lower the average person’s blood pressure by five to eight mmHg. “If your blood pressure is 134/82,” she says, “by exercise alone, you’re going to get out of the hypertensive range.”
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How Much Exercise To Lower Blood Pressure
For about two decades, the FITT Principle has been the standard of healthy and sustainable physical activity. Pescatello says the FITT recommendation for people with hypertension is an excellent guide for aerobic and resistance training. It goes like this:
Frequency: Aerobic: 5-7 days per week; resistance: 2-3 days per week
Intensity: Aerobic: moderate; resistance: 60-70 percent of 1-rep maximum (40-50 percent of 1-rep max for beginners)
Time: Aerobic: At least 30 minutes; resistance: 2-4 sets of 8-12 reps for each major muscle group
Type: Aerobic: Prolonged, rhythmic activities using major muscle groups; resistance: resistance machines, free weights, or bodyweight
Cross-training really counts.
Cardiovascular exercise was the long-preferred modality for overall health and lowering blood pressure. But in recent years, resistance and concurrent training (cardiovascular and resistance) have become recognized as similarly effective. A 2017 meta-analysis of 64 studies found that moderate-intensity dynamic resistance training reduced blood pressure by five to six mmHg for hypertensive adults and two to three mmHg for prehypertensive adults. Dynamic is the keyword. “In a bicep curl, the muscle is shortening and then lengthen during contraction,” Pescatello says. That’s a dynamic move. A non-dynamic, or static, movement would be a plank.
The blood pressure-lowering results from the resistance training meta-analysis came from an average of 14 weeks of dynamic resistance training, performed an average of three days per week. Unfortunately, the specifics of load, intensity, recovery, and duration weren’t reported well enough to levy a recommendation on a specific resistance training routine.
A similar 2016 meta-analysis of concurrent training offers more routine-specific information. In studies where blood pressure examination was the primary outcome, concurrent training reduced both systolic and diastolic blood pressure. Participants did aerobic exercise at 55 percent of maximal oxygen consumption and dynamic resistance training at 60 percent of one-rep maximum for an average of one hour three days per week for 20 weeks.
Harder intensities and longer durations will yield better results. The most important thing, Pescatello says, is consistency. “The larger issue here is long-term adherence,” she says. “Most people can tolerate a lesser intensity and more frequency and duration. Long-term, you’ll accumulate the same health benefits.”
The bottom line is that it’s possible to lower blood pressure with exercise – especially with a workout app like Aaptiv.
What to know about blood pressure rates after exercising
To reduce high blood pressure, a person can try:
- increasing levels of physical activity and exercise
- losing weight
- changing the diet
- quitting smoking
- taking blood pressure medication
Increasing physical activity and exercise
Many people have jobs that involve sitting for long periods. In their free time, a person may also prefer sedentary activities, such as watching television or playing computer games. Some studies have found a link between a sedentary lifestyle and hypertension.
One of the best ways to prevent or resolve hypertension is to be as physically active as possible.
A 2016 meta-analysis investigated the immediate effects of exercise on blood pressure. The analysis, which included 65 studies, found that blood pressure readings were significantly lower following exercise.
This reduction was greater in:
- people who were already physically active
- people who did not take medication to control hypertension
Physical activity can also help with losing weight, and losing 3–5% of body weight can help lower blood pressure, according to the National Heart, Lung, and Blood Institute.
In terms of the intensity of exercise, researchers have found that intense and moderate physical activity are equally effective at reducing blood pressure. This means that a person may still benefit from shorter or less intense exercise sessions.
While any amount of physical activity is helpful, the official recommendations for adults are:
Aerobic activity, such as walking or running:
- A person should do at least 150–300 minutes of moderate activity or 75–150 minutes of vigorous activity per week.
Share on PinterestMuscle strengthening is an important element of any exercise routine.
- A person should work to strengthen all major muscle groups on 2 or more days per week.
Doing more than the recommended amount of moderate exercise may bring additional benefits. Ideally, a person should be engaging in moderate physical activity throughout the week.
Also, studies have found that people with good cardiorespiratory fitness have a lower risk of developing hypertension.
However, it is worth noting that 20–25% of people with hypertension do not have lower blood pressure after exercise.
The following are other methods of reducing high blood pressure:
Changing the diet
Anyone looking to lower their blood pressure may benefit from:
Reducing sodium intake
The Centers for Disease Control and Prevention (CDC) recommend that people eat no more than 2,300 milligrams of salt, or sodium, per day.
Following the DASH diet
The Dietary Approaches to Stop Hypertension (DASH) diet involves eating plenty of:
- whole grains
- lean proteins
- vegetable oils
The DASH diet involves avoiding:
- saturated fats
- full-fat products
- sweetened products
Moderating alcohol consumption
The CDC define a moderate alcohol intake as having up to two alcoholic drinks a day for men and up to one per day for women.
Taking blood pressure medications
When lifestyle changes alone do not bring blood pressure readings within a healthy range, the doctor may prescribe medications, such as:
- calcium channel blockers
- angiotensin converting enzyme inhibitors, better known as ACE inhibitors