As the worldwide prevalence of hypertension continues to increase, the primary prevention of hypertension has become an important global public health initiative. Physical activity is commonly recommended as an important lifestyle modification that may aid in the prevention of hypertension. Recent epidemiologic evidence has demonstrated a consistent, temporal, and dose-dependent relationship between physical activity and the development of hypertension. Experimental evidence from interventional studies has further confirmed a relationship between physical activity and hypertension as the favorable effects of exercise on blood pressure reduction have been well characterized in recent years. Despite the available evidence strongly supporting a role for physical activity in the prevention of hypertension, many unanswered questions regarding the protective benefits of physical activity in high-risk individuals, the factors that may moderate the relationship between physical activity and hypertension, and the optimal prescription for hypertension prevention remain. We review the most recent evidence for the role of physical activity in the prevention of hypertension and discuss recent studies that have sought to address these unanswered questions.
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Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.
Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association. Hypertension. 2013;61:1360–83.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.
Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA, et al. American college of sports medicine position stand. Exercise and hypertension. Med Sci Sports Exerc. 2004;36:533–53.
Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288:1882–8.
Paffenbarger Jr RS, Thorne MC, Wing AL. Chronic disease in former college students. VIII. Characteristics in youth predisposing to hypertension in later years. Am J Epidemiol. 1968;88:25–32.
Boyer JL, Kasch FW. Exercise therapy in hypertensive men. JAMA. 1970;211:1668–71.
Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–31.
Howley ET. Type of activity: resistance, aerobic and leisure versus occupational physical activity. Med Sci Sports Exerc. 2001;33:S364–9.
Pate RR, O’Neill JR, Lobelo F. The evolving definition of “sedentary”. Exerc Sport Sci Rev. 2008;36:173–8.
Carnethon MR, Evans NS, Church TS, Lewis CE, Schreiner PJ, Jacobs Jr DR, et al. Joint associations of physical activity and aerobic fitness on the development of incident hypertension: coronary artery risk development in young adults. Hypertension. 2010;56:49–55.
Chase NL, Sui X, Lee DC, Blair SN. The association of cardiorespiratory fitness and physical activity with incidence of hypertension in men. Am J Hypertens. 2009;22:417–24.
Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302:401–11.
Asferg C, Mogelvang R, Flyvbjerg A, Frystyk J, Jensen JS, Marott JL, et al. Interaction between leptin and leisure-time physical activity and development of hypertension. Blood Press. 2011;20:362–9.
Jae SY, Heffernan KS, Yoon ES, Park SH, Carnethon MR, Fernhall B, et al. Temporal changes in cardiorespiratory fitness and the incidence of hypertension in initially normotensive subjects. Am J Hum Biol. 2012;24:763–7.
Palatini P, Bratti P, Palomba D, Saladini F, Zanatta N, Maraglino G. Regular physical activity attenuates the blood pressure response to public speaking and delays the development of hypertension. J Hypertens. 2010;28:1186–93.
Pouliou T, Ki M, Law C, Li L, Power C. Physical activity and sedentary behaviour at different life stages and adult blood pressure in the 1958 British cohort. J Hypertens. 2012;30:275–83.
Salman RA, Al-Rubeaan KA. Incidence and risk factors of hypertension among Saudi type 2 diabetes adult patients: an 11-year prospective randomized study. J Diabetes Complications. 2009;23:95–101.
Sun Z, Zheng L, Detrano R, Zhang X, Xu C, Li J, et al. Incidence and predictors of hypertension among rural Chinese adults: results from Liaoning province. Ann Fam Med. 2010;8:19–24.
Thawornchaisit P, de Looze F, Reid CM, Seubsman SA, Sleigh AC. Thai Cohort Study T. Health risk factors and the incidence of hypertension: 4-year prospective findings from a national cohort of 60 569 Thai Open University students. BMJ open. 2013;3:e002826.
Thomas F, Bean K, London G, Danchin N, Pannier B. Incidence of arterial hypertension in French population after 60 years. Ann Cardiol Angeiol. 2012;61:140–4.
Hill AB. The environment and disease: Association or causation? Proc R Soc Med. 1965;58:295–300.
Lee DC, Sui X, Church TS, Lavie CJ, Jackson AS, Blair SN. Changes in fitness and fatness on the development of cardiovascular disease risk factors hypertension, metabolic syndrome, and hypercholesterolemia. J Am Coll Cardiol. 2012;59:665–72.
US Department of Health and Human Services. 2008 Physical activity guidelines for Americans: Be active, healthy, and happy! 2008. http://www.health.gov/paguidelines/. Accessed 10 June 2013.
Warburton DE, Charlesworth S, Ivey A, Nettlefold L, Bredin SS. A systematic review of the evidence for Canada’s Physical Activity Guidelines for Adults. Int J Behav Nutr Phys Act. 2010;7:39.
• Pavey TG, Peeters G, Bauman AE, Brown WJ. Does vigorous physical activity provide additional benefits beyond those of moderate? Med Sci Sports Exerc. 2013; doi:10.1249/MSS.0b013e3182940b91. This large prospective study assessed whether vigorous physical activity provides additional benefits in the prevention of hypertension above those that accrue from moderate intensity physical activity. Interestingly, they report that vigorous physical activity does not provide additional benefits in the prevention of hypertension above those from moderate intensity activity alone.
•• Williams PT, Thompson PD. Walking versus running for hypertension, cholesterol, and diabetes mellitus risk reduction. Arterioscler Thromb Vasc Biol. 2013;33:1085-91. This highly publicized, large propsective study provides some of the best available answers to the important question as to what intensity of exercise is required to reduce hypertension risk. Using data jointly from National Runners’ Health Study II and the National Walkers’ Health Study investigators report that walking and running provide similar risk reductions for the prevention of hypertension.
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39:1423–34.
Julius S, Nesbitt SD, Egan BM, Weber MA, Michelson EL, Kaciroti N, et al. Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med. 2006;354:1685–97.
Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet. 2001;358:1682–6.
Guo X, Zou L, Zhang X, Li J, Zheng L, Sun Z, et al. Prehypertension: a meta-analysis of the epidemiology, risk factors, and predictors of progression. Tex Heart Inst J. 2011;38:643–52.
Kim SJ, Lee J, Jee SH, Nam CM, Chun K, Park IS, et al. Cardiovascular risk factors for incident hypertension in the prehypertensive population. Epidemiol Health. 2010;32:e2010003.
Zheng L, Sun Z, Zhang X, Xu C, Li J, Hu D, et al. Predictors of progression from prehypertension to hypertension among rural Chinese adults: results from Liaoning Province. Eur J Cardiovasc Prev Rehabil. 2010;17:217–22.
Faselis C, Doumas M, Kokkinos JP, Panagiotakos D, Kheirbek R, Sheriff HM, et al. Exercise capacity and progression from prehypertension to hypertension. Hypertension. 2012;60:333–8.
Wang NY, Young JH, Meoni LA, Ford DE, Erlinger TP, Klag MJ. Blood pressure change and risk of hypertension associated with parental hypertension: the Johns Hopkins Precursors Study. Arch Intern Med. 2008;168:643–8.
• Shook RP, Lee DC, Sui X, Prasad V, Hooker SP, Church TS, et al. Cardiorespiratory fitness reduces the risk of incident hypertension associated with a parental history of hypertension. Hypertension. 2012;59:1220-4. This prospective study is the first to demonstrate the protective effects of physical activity among a population with a family history of hypertension, suggesting that physical activity could mitigate any genetic predisposition to hypertension development.
Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet. 2012;380:601–10.
Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55:2895–905.
Proper KI, Singh AS, van Mechelen W, Chinapaw MJ. Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Am J Prev Med. 2011;40:174–82.
Beunza JJ, Martinez-Gonzalez MA, Ebrahim S, Bes-Rastrollo M, Nunez J, Martinez JA, et al. Sedentary behaviors and the risk of incident hypertension: the SUN Cohort. Am J Hypertens. 2007;20:1156–62.
Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116:572–84.
• Maslow AL, Sui X, Colabianchi N, Hussey J, Blair SN. Muscular strength and incident hypertension in normotensive and prehypertensive men. Med Sci Sports Exerc. 2010;42:288-95. This study is the first propsective study to investigate the relationship between muscular strength (an attribute developed from resistance training) and incident hypertension. Investigators report that men in the high-strength group had a lower risk for incident hypertension. Interaction analyses further showed that for each level of cardiorespiratory fitness higher levels of muscular strength provided additive protection against the development of hypertension, suggesting that supplementing aerobic exercise with resistance training may be beneficial in the prevention of hypertension.
Sarzynski MA, Rankinen T, Sternfeld B, Fornage M, Sidney S, Bouchard C. SNP-by-fitness and SNP-by-BMI interactions from seven candidate genes and incident hypertension after 20 years of follow-up: the CARDIA Fitness Study. J Hum Hypertens. 2011;25:509–18.
Cohen L, Curhan GC, Forman JP. Influence of age on the association between lifestyle factors and risk of hypertension. J Am Soc Hypertens. 2012;6:284–90.
•• Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2:e004473. This systematic review and meta-analysis provides the most up-to-date information on the effects of exercise training on blood pressure among published randomized controlled trials. Investigators comprehensively review the effects of aerobic exercise training, resistance training, and combined training among all hypertension subgroups.
Cornelissen VA, Buys R, Smart NA. Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis. J Hypertens. 2013;31:639–48.
Huang G, Shi X, Gibson CA, Huang SC, Coudret NA, Ehlman MC. Controlled aerobic exercise training reduces resting blood pressure in sedentary older adults. Blood Press. 2013. doi:10.3109/08037051.2013.778003.
Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension. 2011;58:950–8.
Rossi A, Moullec G, Lavoie KL, Bacon SL. Resistance training, blood pressure, and meta-analyses. Hypertension. 2012;59:e22–3.
Rossi AM, Moullec G, Lavoie KL, Gour-Provencal G, Bacon SL. The evolution of a Canadian Hypertension Education Program recommendation: the impact of resistance training on resting blood pressure in adults as an example. Can J Cardiol. 2013;29:622–7.
Åstrand P-O, Rodahl K. Textbook of work physiology: physiological bases of exercise. 2nd ed. McGraw-Hill series in health education, physical education, and recreation. New York: McGraw-Hill; 1977.
Corrick KL, Hunter GR, Fisher G, Glasser SP. Changes in vascular hemodynamics in older women following 16 weeks of combined aerobic and resistance training. J Clin Hypertens. 2013;15:241–6.
Sousa N, Mendes R, Abrantes C, Sampaio J, Oliveira J. A randomized 9-month study of blood pressure and body fat responses to aerobic training versus combined aerobic and resistance training in older men. Exp Geront. 2013;48:727–33.
Ciolac EG. High-intensity interval training and hypertension: maximizing the benefits of exercise? Am J Cardiovasc Dis. 2012;2:102–10.
Gibala MJ, Little JP, Macdonald MJ, Hawley JA. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol. 2012;590:1077–84.
Wisloff U, Ellingsen O, Kemi OJ. High-intensity interval training to maximize cardiac benefits of exercise training? Exerc Sport Sci Rev. 2009;37:139–46.
Kessler HS, Sisson SB, Short KR. The potential for high-intensity interval training to reduce cardiometabolic disease risk. Sports Med. 2012;42:489–509.
Ciolac EG, Bocchi EA, Bortolotto LA, Carvalho VO, Greve JM, Guimaraes GV. Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypertens Res. 2010;33:836–43.
Nybo L, Sundstrup E, Jakobsen MD, Mohr M, Hornstrup T, Simonsen L, et al. High-intensity training versus traditional exercise interventions for promoting health. Med Sci Sports Exerc. 2010;42:1951–8.
Tjonna AE, Stolen TO, Bye A, Volden M, Slordahl SA, Odegard R, et al. Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents. Clin Sci (Lond). 2009;116:317–26.
Buchan DS, Ollis S, Young JD, Thomas NE, Cooper SM, Tong TK, et al. The effects of time and intensity of exercise on novel and established markers of CVD in adolescent youth. Am J Hum Biol. 2011;23:517–26.
de Araujo AC C, Roschel H, Picanco AR, do Prado DM, Villares SM, de Sa Pinto AL, et al. Similar health benefits of endurance and high-intensity interval training in obese children. PloS One. 2012;7:e42747.
Cocks M, Shaw CS, Shepherd SO, Fisher JP, Ranasinghe AM, Barker TA, et al. Sprint interval and endurance training are equally effective in increasing muscle microvascular density and eNOS content in sedentary males. J Physiol. 2013;591:641–56.
Tjonna AE, Leinan IM, Bartnes AT, Jenssen BM, Gibala MJ, Winett RA, et al. Low- and high-volume of intensive endurance training significantly improves maximal oxygen uptake after 10-weeks of training in healthy men. PloS One. 2013;8:e65382.
Murphy MH, Blair SN, Murtagh EM. Accumulated versus continuous exercise for health benefit: a review of empirical studies. Sports Med. 2009;39:29–43.
Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007;298:2296–304.
Soroush A, Der Ananian C, Ainsworth BE, Belyea M, Poortvliet E, Swan PD, et al. Effects of a 6-month walking study on blood pressure and cardiorespiratory fitness in US and Swedish adults: ASUKI Step Study. Asian J Sports Med. 2013;4:114–24.
van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med. 2012;172:494–500.
Swift DL, Johannsen NM, Tudor-Locke C, Earnest CP, Johnson WD, Blair SN, et al. Exercise training and habitual physical activity: a randomized controlled trial. Am J Prev Med. 2012;43:629–35.
Di Blasio A, Ripari P, Bucci I, Di Donato F, Izzicupo P, D’Angelo E, et al. Walking training in postmenopause: effects on both spontaneous physical activity and training-induced body adaptations. Menopause. 2012;19:23–32.
Moraes-Silva IC, Mostarda C, Moreira ED, Silva KA, dos Santos F, de Angelis K, et al. Preventive role of exercise training in autonomic, hemodynamic, and metabolic parameters in rats under high risk of metabolic syndrome development. J Appl Physiol. 2013;114:786–91.
Araujo AJ, Santos AC, Souza KD, Aires MB, Santana-Filho VJ, Fioretto ET, et al. Resistance training controls arterial blood pressure in rats with L-NAME- induced hypertension. Arq Bras Cardiol. 2013;100:339–46.
Feairheller DL, Park JY, Rizzo V, Kim B, Brown MD. Racial differences in the response to shear stress in human umbilical vein endothelial cells. Vasc Health Risk Manag. 2011;7:425–31.
Brown MD, Feairheller DL. Are there race-dependent endothelial cell responses to exercise? Exerc Sport Sci Rev. 2013;41:44–54.
This work was supported by a National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) Diversity Supplement awarded to Keith M. Diaz (P01-HL047540-19S1).
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Keith M. Diaz declares that he has no conflict of interest.
Daichi Shimbo has received grants from NIH.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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Diaz, K.M., Shimbo, D. Physical Activity and the Prevention of Hypertension. Curr Hypertens Rep 15, 659–668 (2013). https://doi.org/10.1007/s11906-013-0386-8
- Physical activity
- Blood pressure
- Resistance training
- Endurance training