Using Exercise to Treat Hypertension

You have high blood pressure. In addition to prescribing medication, your doctor says that you should eat healthy and exercise. Will exercise really help? How much exercise is needed to lower blood pressure? Eat healthy and exercise? What does that mean exactly? Your doctor means well and genuinely wants you to do these things. Between checking your blood pressure, ordering labs and medication, and, oh yeah there is that rash you wanted them to look at, there just is not enough time to fit in a personalized fitness and nutrition prescription in your visit.

Despite the lack of counseling on exercise in the clinic, exercise is an important part of a treatment plan for hypertension. The American Heart Association recommends lifestyle changes as a first line treatment for hypertension for people with mild hypertension (1). That's because exercise lowers blood pressure naturally. Making lifestyle changes, such as exercising, can help reduce how much blood pressure medicine a person may need, and it can reduce the risk of other cardiometabolic diseases such as diabetes, obesity, and hyperlipidemia.

How much should I exercise if I have high blood pressure?

The American College of Sports Medicine (ACSM) recommends getting over 150 min per week of low, moderate, or vigorous exercise, with a focus on moderate (2). That could be going for a brisk walk for 30 min 5-7 days per week. The important thing, is that you choose something that you enjoy so that you are more likely to do it. Or if you get bored of doing the same thing, mix it up and choose different activities through out the week. Check out the examples below.

Examples of moderate aerobic physical activity (3)

• Brisk walking (2.5 miles per hour)

• Riding a bike (less than 10 mph on flat terrain)

• Recreational swimming

• Raking leaves

• Tennis (doubles)

• Active forms of yoga (for example, Vinyasa or power yoga)

• Ballroom or line dancing

• General yard work and home repair work

• Water aerobics

Examples of vigorous aerobic physical activity (3)

• Jogging or running

• Swimming laps

• Tennis (singles)

• Vigorous dancing

• Bicycling faster than 10 miles per hour

• Jumping rope

• Heavy yard work (digging or shoveling, with heart rate increases)

• Hiking uphill or with a heavy backpack

• High-intensity interval training (HIIT)

• Vigorous step aerobics or kickboxing

The ACSM also recommends dynamic resistance exercises 2-3 times per week on non consecutive days at a moderate intensity (60-80% of 1 rep max) (2).  The exercises should include 2-3 sets of 10-12 reps for 8-10 exercises that include upper an lower body exercises (2). In addition to lowering your blood pressure, resistance training increases lean body mass (muscle mass), muscular strength, and muscular endurance. It can also help reduce the risk of falls in older adults and help reduce the risk of osteoporosis.

Examples of dynamic resistance training

• Free weights (i.e. dumbbells)

• Machine weights

• Resistance bands

• Body weight exercises

How often should I exercise to lower my blood pressure?

You should aim for exercising every day or almost every day with a goal of accumulating over 150 min per week. Why should you exercise every day instead of cramming it all in on the weekend? Because a single session of exercise can lower your blood pressure for up to 24 hours after the exercise session (2) This is known as post exercise hypotension (PEH). If you do all the exercise over the course of a 2 consecutive days you will have several days during the week that you don't get that PEH benefit of lowering your blood pressure. If you are exercising every day, or most days, you will have more days with a lower blood pressure. The other down side to compressing it into 2 consecutive days is that you are more likely to get an injury.

How much will exercise lower my blood pressure?

Improvements in blood pressure with exercise varies among research studies. A 2013 systematic review showed that aerobic exercise lowered systolic blood pressure by 8 mmHg and diastolic blood pressure by 5 mmHg in patients with hypertension (4). But according to a scientific statement from the American Heart Association, aerobic exercise lowered systolic blood pressure by 4 mmHg and diastolic blood pressure by 2 mmHg and for dynamic resistance training blood pressure was lowered by 2 mmHg systolic blood pressure and by 3 mmHg diastolic blood (1). The good news is that exercise lowers blood pressure more in people with higher baseline blood pressures (5). Assuming you have been cleared to exercise, the higher your blood pressure, the more blood pressure lowering benefit you may gain from exercising. Aerobic exercise and dynamic resistance training are both effective in lowering blood pressure (5).

Exercises to avoid when you have hypertension

In the absence of other medical conditions and no symptoms of chest pain or shortness of breath, it is generally safe for people with hypertension to start exercising at low to moderate intensities. Start with light activity and gradually progress to moderate. If you experience chest pain, chest tightness, or excessive shortness of breath, stop exercising and call 9-1-1. If you are interested in doing vigorous exercise, you should get cleared with a medical professional first.

Exercise is a great way to help lower your blood pressure, but there are some exercises that should be avoided. These include isometric exercises, lifting very heavy weights, or any exercise that causes you to do a valsava maneuver. Isometric exercises are effective at lowering blood pressure (6). However, certain isometric exercises can cause blood pressure to increase to unsafe levels during the exercise (7). What is an isometric exercise? An isometric exercise is an exercise where the muscle is contracted, but the muscle length stays the same. Examples include wall sits, planks, and hand grip contraction. Isometric exercise can be a part of an exercise program to lower blood pressure, but it should be done under the guidance of a medical fitness professional, such as an exercise physiologist or physical therapist.

Performing a valsava meneuver is an unsafe practice when doing an exercise even if you don't have hypertension. A valsava maneuver is when you hold your breath during the exercise which sky rockets your blood pressure during the exercise. Even if you do not hold your breath, lifting very heavy loads can cause your blood pressure to go very high. If you have hypertension you should lift no more than a moderately heavy weight or resistance for an exercise and avoid strenuous exercises. It is always important to breath through your exercises instead of holding your breath.

Overall, exercise can help lower blood pressure and benefit your life in numerous ways. If you'd like to explore more about how exercise and nutrition can help your hypertension, book an appointment with Cyclone Wellness today! Your wellness is our passion! We look forward to hearing from you soon.

References

(1) Barone Gibbs B, Hivert MF, Jerome GJ, Kraus WE, Rosenkranz SK, Schorr EN, Spartano NL, Lobelo F; American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Physical Activity as a Critical Component of First-Line Treatment for Elevated Blood Pressure or Cholesterol: Who, What, and How?: A Scientific Statement From the American Heart Association. Hypertension. 2021 Aug;78(2):e26-e37. doi: 10.1161/HYP.0000000000000196. Epub 2021 Jun 2. PMID: 34074137.

(2) Pescatello LS, MacDonald HV, Lamberti L, Johnson BT. Exercise for Hypertension: A Prescription Update Integrating Existing Recommendations with Emerging Research. Curr Hypertens Rep. 2015 Nov;17(11):87. doi: 10.1007/s11906-015-0600-y. PMID: 26423529; PMCID: PMC4589552.

(3) Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, George SM, Olson RD. The Physical Activity Guidelines for Americans. JAMA. 2018 Nov 20;320(19):2020-2028. doi: 10.1001/jama.2018.14854. PMID: 30418471; PMCID: PMC9582631.

(4) Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013 Feb 1;2(1):e004473. doi: 10.1161/JAHA.112.004473. PMID: 23525435; PMCID: PMC3603230.

(5) Pescatello LS, Buchner DM, Jakicic JM, Powell KE, Kraus WE, Bloodgood B, Campbell WW, Dietz S, Dipietro L, George SM, Macko RF, McTiernan A, Pate RR, Piercy KL; 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE*. Physical Activity to Prevent and Treat Hypertension: A Systematic Review. Med Sci Sports Exerc. 2019 Jun;51(6):1314-1323. doi: 10.1249/MSS.0000000000001943. PMID: 31095088.

(6) Edwards JJ, Coleman DA, Ritti-Dias RM, Farah BQ, Stensel DJ, Lucas SJE, Millar PJ, Gordon BDH, Cornelissen V, Smart NA, Carlson DJ, McGowan C, Swaine I, Pescatello LS, Howden R, Bruce-Low S, Farmer CKT, Leeson P, Sharma R, O'Driscoll JM. Isometric Exercise Training and Arterial Hypertension: An Updated Review. Sports Med. 2024 Jun;54(6):1459-1497. doi: 10.1007/s40279-024-02036-x. Epub 2024 May 19. PMID: 38762832; PMCID: PMC11239608.

(7) Wiles JD, Taylor K, Coleman D, Sharma R, O'Driscoll JM. The safety of isometric exercise: Rethinking the exercise prescription paradigm for those with stage 1 hypertension. Medicine (Baltimore). 2018 Mar;97(10):e0105. doi: 10.1097/MD.0000000000010105. PMID: 29517686; PMCID: PMC5882444.