The Role of Exercise


As indicated in Treatment Options, research indicates that aerobic and resistance training is highly beneficial in reducing blood pressure (BP).

Aerobic Training
Majority of studies have shown that regular aerobic exercise and high levels of fitness (VOmax) is highly effective in reduce BP and protect against the future development of hypertension in men. Research has indicated a strong link between hypertension and a sedentary lifestyle, with findings suggesting that the risk of hypertension was 60-70% higher for sedentary men than for the most active men. In addition, an association of risk of hypertension was significant with total amount of time and intensity of physical activity for men [1] [2] . As the duration of a walk to work increases, the risk of the incidence of hypertension also reduces. Interestingly, regular exercise, even only once a week, decreased the risk of hypertension compared to those that reported regular exercise less than once a week [3] .
Fagard determined that on a population average, hypertensive patients, that undertook an aerobic exercise program, reduced their systolic BP by 7mm Hg and diastolic BP by 6mm Hg[4] . These reductions are compelling considering that lowering systolic BP by 5mm Hg reduces all-cause mortality by 7%, death due to stroke by 14% and death due to coronary heart disease by 9%.

Research has long been carried out to determine the impact of interval versus continuous aerobic exercise. Studies indicate that both interval and continuous exercise significantly decrease blood pressure, however only interval training significantly decreases arterial stiffness [5] . Arterial stiffness is an important factor, as previous research indicates that arterial stiffness is associated with hypertension [6] [7] .

Resistance Training

Resistance training refers to training programmes that involve strength, weight, static and/or isometric exercises designed specifically to increase muscular strength, power and/or endurance[8] .

Traditionally aerobic training intervention has been recommended as a Blood Pressure (BP) lowering mechanism for people with hypertension. However, more and more studies are being untaken to investigate the beneficial effects of resistance training on BP.

Moderate-intensity resistance training is an important component of a well-rounded exercise program for the prevention, treatment and control of hypertension[9] . A meta-analysis by Fagard, compiled data from several studies published up to December 2003[10] . The studies involved 341 participants and duration ranged from 6 to 26 weeks. Results showed that the overall effect of resistance training was a decrease of 3.2 mmHg in systolic BP and a decrease of 3.5 mmHg in diastolic BP. A more recent study by Collier and colleagues investigated the effects of a four week resistance exercise training program on BP, arterial stiffness and blood flow in pre- and stage-1 hypertensives[11] . Results found a 3.5 mmHg decrease in systolic BP and a 3.7 mmHg decrease in diastolic BP, which support the findings of Fagard (2006). Further, the study by Collier and colleagues also identified an increase in vascular stiffness and a large blood flow increase. However, the increases in blood flow may be compensatory to the increases in stiffness. A further study by Shaw investigated the effects of an 8 week resistance training program on BP and Resting Heart Rate (RHR)[12] . Results found similar BP decreases to previous studies but could not identify a significant decrease in RHR. [13]

Aerobic vs. Resistance Training
Currently, minimal research has compared aerobic to resistance training, however available research has indicated that aerobic exercising groups increase their fitness considerably more than resistance training groups, however findings indicated that both groups significantly decreased their systolic blood pressure by the same amount (approximately 9mm Hg) [14] . Thus, both methods of exercise training seem equally effective. Ideally, hypertensive patients should aim to undertake both forms of training to achieve variation in their program and reduce the risk of monotony.

Please go to Exercise Prescription for a Recommended Exercise Program


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    Hayashi, T., Tsumara, K., Suematsu, C., Okada, K., Fujii, S., and Endo, G. (1999). Walking to work and the risk for hypertension in men: the Osaka health survey. Annals of Internal Med; 130:21-26.
  2. ^ Haapanen, N, Miilunpalo, S., Vuori, I., Oja, P., Pasanen, M. (1997). Association of leisure time physical activity with the risk of coronary heart disease, hypertension and diabetes in middle-aged men and women. International Journal of Epidemiology; 26(4): 739-747. doi: 10.1093/ije/26.4.739
  3. ^ Haapanen, N, Miilunpalo, S., Vuori, I., Oja, P., Pasanen, M. (1997). Association of leisure time physical activity with the risk of coronary heart disease, hypertension and diabetes in middle-aged men and women. International Journal of Epidemiology; 26(4): 739-747. doi: 10.1093/ije/26.4.739
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    Fagard RH (2001). Exercise characteristics and the blood pressure response to dynamic physical training. Medicine & Science in Sport & Exercise; 33:S484-492.
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    Guimaraes, G., Ciolac, E., Carvalho, V., D’Avila, V., Bortolotto, L., Bocchi, E. (2010). Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. The Japanese Society of Hypertension. 210; 33: 627-632. Doi:10.1038/hr.2010.42
  6. ^ Rowe, J. (1987). Clinical consequences of age-related impairments in vascular compliance. American Journal of Cardiology; 60:68-71.
  7. ^ Hodes, R., Lakatta, E., McNeill, C. (1995). Another modified risk factor for cardiovascular disease? Some evidence points to arterial stiffness. Journal of American Geriatric Society; 43: 581-582.
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    Fagard, R. (2006). Exercise is good for your blood pressure: effects of endurance training and resistance training. Clinical and Experimental Pharmacology and Physiology, 33: 853–856.
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    Contractor, A. & Gordon, N. Cited from: Ehrman, J. K., Gordon, P. M., Visich, P. S., & Keteyian, S. J. (2009). Clinical Exercise Physiology. Human Kinetics.
  10. ^ Fagard, R. (2006). Exercise is good for your blood pressure: effects of endurance training and resistance training. Clinical and Experimental Pharmacology and Physiology, 33: 853–856.
  11. ^ Collier, S.R., Kanaley, J.A., Carhart, R Jr., Frechette, V., Tobin, M.M., Luckenbaugh, A.N., & Fernhall, B. (2008). Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives. Journal of Human Hypertension, 22: 678-686.
  12. ^ Shaw, B.S. (2010). Resting cardiovascular function improvements in adult men following resistance training. African Journal for Physical, Health Education, Recreation and Dance, 16(3): 402-410.
  13. ^ Collier, S.R., Kanaley, J.A., Carhart, R Jr., Frechette, V., Tobin, M.M., Luckenbaugh, A.N., & Fernhall, B. (2008). Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives. Journal of Human Hypertension, 22: 678-686.
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    Blumenthal, J., Siegel, W., Appelbaum, M. (1991). Failure of exercise to reduce blood pressure in patients with mild hypertension. JAMA; 266(15): 2098-2104. Doi: 10.1001/jama.1991.03470150070033