What exercises have the greatest effect on blood pressure?

  • All exercises are good for blood pressure. Based on recommendations made a few years ago, we always say that aerobic exercise brings the most benefits to cardiovascular health.
  • The research team conducted a systematic review and network meta-analysis of 270 randomized controlled clinical trials published between 1990 and February 2023, involving almost 16,000 people.
  • They concluded that isometric exercises, that is, those that involve muscles held in tension for 10 to 60 seconds but without joint movement, are those that achieve the greatest effects in reducing systolic values ​​and diastolic pressure.
  • Isometric (static) exercise is more effective in lowering blood pressure than aerobic exercise. This helps us in our daily practice to advise our patients about the types of exercises that can bring more benefits to the health of the cardiovascular system.

Arterial hypertension is a major modifiable risk factor for morbidity and mortality. Blood pressure within optimal levels is linearly associated with a reduced risk of cardiovascular disease.

Physical exercise is a highly effective non-pharmacological measure for reducing cardiovascular risk and mortality. Plus, it’s free..

All types of exercise are good for cardiovascular health and blood pressure control in particular.

Aerobic-type exercise, such as jogging or cycling, is generally considered to have the greatest benefits for cardiovascular health. That is why we most often recommend this method in daily practice to our patients.

However, current blood pressure exercise recommendations are based on old data and should be updated to possibly include other methods such as HIIT (high intensity interval training) and isometric exercises..

New review of exercise and its effect on blood pressure

A group of British researchers conducted a systematic review and network meta-analysis of the effect of all relevant exercise regimens on resting blood pressure to establish optimal exercise prescribing practice.

These included randomized controlled trials published between 1990 and February 2023, in particular all relevant articles that reported reductions in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) after exercise for ≥ 2 weeks. group without intervention.

All protocols were divided into one of the following 5 main categories of exercise regimens:

  • Aerobic exercise (eg, walking, running, cycling)
  • Dynamic Resistance Training (RT)
  • Blended learning (CT or blended learning)
  • High Intensity Interval Training (HIIT)

In this review, HIIT is defined as “short episodic bouts of high-intensity exercise separated by short periods of recovery at a lower intensity.”

Aerobic interval training AIT consisted of 4×4 minute low intensity protocols. It includes:

  • Speed ​​Interval Training (SIT, with “sprints” or sprints)
  • Aerobic Interval Training (AIT)
  • Isometric exercises

They typically use 4 x 2 minute contraction protocols separated by 1 to 4 minute rest intervals performed three times a week.

It includes:

  • Handlebar or isometric arm press (IHG or isometric handlebar). It is generally recommended to apply a force equivalent to 30% of the maximum voluntary contraction.
  • Isometric leg extension (ILE)
  • Squat or “wall squat” (IWS or isometric wall squat)

According to the European Society of Hypertension/European Society of Cardiology (ESC/ESH)5 guidelines, SBP and DBP status subgroups were classified as normotension, prehypertension or hypertension with values ​​equal to 130/85 mmHg. Art. 130–139. / 85–89 mm Hg or >140/90 mmHg respectively.

Results: what did they find in this study?

The final analysis included 270 randomized controlled trials with a total sample size of 15,827 participants.

Pairwise analysis demonstrated significant reductions in SBP and DBP at rest after exercise:

  • Aerobic (-4.49/-2.53 mmHg, p0.001)
  • Dynamic resistance training (-4.55/-3.04 mmHg, p0.001)
  • Combined training (-6.04/-2.54 mmHg, p0.001)
  • HIIT (-4.08/-2.50 mmHg, p0.001)
  • Isometric training (-8.24/-4.00 mmHg, p0.001)

To compare treatment effects, they used the Surface Under the Cumulative Rank Curve (SUCRA), a simple average rank transformation that is used to create a hierarchy of treatments and takes into account both the location and variance of all relative treatment effects.

As shown in the network meta-analysis, in order of effectiveness ranking, the type of exercise that had the greatest effect was training with:

  • Isometric exercises (SUCRA, 98.3%)
  • Blended learning (SUCRA, 75.7%).
  • Dynamic strength training (SUCRA, 46.1%).
  • Aerobic training (SUCRA, 40.5%).
  • High Intensity Interval Training (HIIT) (SUCRA, 39.4%).

Meta-analysis of the secondary network showed that isometric wall squats and running are the most effective sub-modes for reducing SBP and DBP, respectively.

Conclusions: What does this study give us?

This large systematic review and network meta-analysis of 270 randomized controlled trials demonstrates the best practice in prescribing exercise for resting blood pressure control.

Several exercise regimens improve resting blood pressure, especially isometric exercise.

The results of this analysis should form the basis for future recommendations on exercise for the prevention and treatment of hypertension.


(1). https://bjsm.bmj.com/content/early/2023/07/02/bjsports-2022-106503



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