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Evidence for the Role of Isometric Exercise Training in Reducing Blood Pressure: Potential Mechanisms and Future Directions

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Abstract

Hypertension, or the chronic elevation in resting arterial blood pressure (BP), is a significant risk factor for cardiovascular disease and estimated to affect ~1 billion adults worldwide. The goals of treatment are to lower BP through lifestyle modifications (smoking cessation, weight loss, exercise training, healthy eating and reduced sodium intake), and if not solely effective, the addition of antihypertensive medications. In particular, increased physical exercise and decreased sedentarism are important strategies in the prevention and management of hypertension. Current guidelines recommend both aerobic and dynamic resistance exercise training modalities to reduce BP. Mounting prospective evidence suggests that isometric exercise training in normotensive and hypertensive (medicated and non-medicated) cohorts of young and old participants may produce similar, if not greater, reductions in BP, with meta-analyses reporting mean reductions of between 10 and 13 mmHg systolic, and 6 and 8 mmHg diastolic. Isometric exercise training protocols typically consist of four sets of 2-min handgrip or leg contractions sustained at 20–50 % of maximal voluntary contraction, with each set separated by a rest period of 1–4 min. Training is usually completed three to five times per week for 4–10 weeks. Although the mechanisms responsible for these adaptations remain to be fully clarified, improvements in conduit and resistance vessel endothelium-dependent dilation, oxidative stress, and autonomic regulation of heart rate and BP have been reported. The clinical significance of isometric exercise training, as a time-efficient and effective training modality to reduce BP, warrants further study. This evidence-based review aims to summarize the current state of knowledge regarding the effects of isometric exercise training on resting BP.

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Acknowledgments

The authors would like to thank Dr. Tony Baross for assistance in preparing the table. No funding was received to assist in the preparation, editing or approval of this review. Dr. Millar has received modest speaking and travel honoraria from ZonaHealth (2010–2012) [Boise, ID, USA]. Dr. Millar is supported by a Canadian Institutes of Health Research (CIHR) research fellowship. Dr. Cornelissen is supported as a postdoctoral research fellow by Research Foundation Flanders (FWO). Dr. Araujo is supported by Brazilian (CNPq) and State of Rio de Janeiro (FAPERJ) research scholarships.

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Authors and Affiliations

  1. Division of Cardiology, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada

    Philip J. Millar

  2. Department of Kinesiology, University of Windsor, Windsor, ON, Canada

    Cheri L. McGowan

  3. Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium

    Véronique A. Cornelissen

  4. Exercise and Sport Sciences Graduate Program, Gama Filho University, Rio de Janeiro, Brazil

    Claudio G. Araujo

  5. Department of Sport Science, Tourism and Leisure, Canterbury Christ Church University, North Holmes Road, Canterbury, CT1 1QU, Kent, UK

    Ian L. Swaine

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Correspondence to Ian L. Swaine.

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Millar, P.J., McGowan, C.L., Cornelissen, V.A. et al. Evidence for the Role of Isometric Exercise Training in Reducing Blood Pressure: Potential Mechanisms and Future Directions. Sports Med 44, 345–356 (2014). https://doi.org/10.1007/s40279-013-0118-x

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