Sports Medicine

, Volume 36, Issue 2, pp 109–116 | Cite as

The Anti-Hypertensive Effects of Exercise

Integrating Acute and Chronic Mechanisms
  • Mark Hamer
Leading Article


It is anticipated that hypertension will afflict up to a third of the worldwide population by the year 2025. Therefore, cost-effective treatment strategies are essential to control this disease. Exercise has been associated with anti-hypertensive benefits, but despite extensive research the optimal exercise dose (training frequency, intensity and time) required to lower blood pressure and maintain normotensive status remains unclear. This article explores the interrelationships between acute and chronic mechanisms that have been linked to the anti-hypertensive benefits of exercise and proposes that the optimal exercise dosage may depend on the interplay between these mechanisms and the effects of exercise on independent risk markers of hypertension. Therefore, the correct exercise dose for the treatment of hypertension should be prescribed on an individual basis. Future work should examine post-exercise hypotension effects in relation to exercise training in hypertensive populations and both acute and longitudinal training studies should be conducted that incorporate independent risk factors of hypertension as co-variables into their analysis on blood pressure effects.


Exercise Training Sympathetic Nerve Activity Acute Exercise Chronic Exercise Chronic Exercise Training 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Pescatello LS, Franklin BA, Fagard R, et al. American College of Sports Medicine position stand: exercise and hypertension. Med Sci Sports Exerc 2004 Mar; 36 (3): 533–553PubMedCrossRefGoogle Scholar
  2. 2.
    Pescatello LS, Kulikowich JM. The aftereffects of dynamic exercise on ambulatory blood pressure. Med Sci Sports Exerc 2001 Nov; 33 (11): 1855–1861PubMedCrossRefGoogle Scholar
  3. 3.
    Jennings GL, Deakin G, Korner P, et al. What is the dose-response relationship between exercise training and blood pressure? Ann Med 1991 Aug; 23 (3): 313–318PubMedCrossRefGoogle Scholar
  4. 4.
    Meredith IT, Jennings GL, Esler MD, et al. Time-course of the antihypertensive and autonomic effects of regular endurance exercise in human subjects. J Hypertens 1990 Sep; 8 (9): 859–866PubMedCrossRefGoogle Scholar
  5. 5.
    Pescatello LS, Fargo AE, Leach CN, et al. Short-term effect of dynamic exercise on arterial blood pressure. Circulation 1991 May; 83 (5): 1557–1561PubMedCrossRefGoogle Scholar
  6. 6.
    Folsom AR, Prineas RJ, Kaye S A, et al. Incidence of hypertension and stroke in relation to body fat distribution and other risk factors in older women. Stroke 1990 May; 21 (5): 701–706PubMedCrossRefGoogle Scholar
  7. 7.
    Haapanen N, Miilunpalo S, Vuori I, et al. Association of leisure time physical activity with the risk of coronary heart disease, hypertension and diabetes in middle-aged men and women. Int J Epidemiol 1997 Aug; 26 (4): 739–747PubMedCrossRefGoogle Scholar
  8. 8.
    MacDonald JR. Potential causes, mechanisms, and implications of post exercise hypotension. J Hum Hypertens 2002 Apr; 16 (4): 225–236PubMedCrossRefGoogle Scholar
  9. 9.
    Halliwill JR. Mechanisms and clinical implications of post-exercise hypotension in humans. Exerc Sport Sci Rev 2001 Apr; 29 (2): 65–70PubMedCrossRefGoogle Scholar
  10. 10.
    Whelton SP, Chin A, Xin X, et al. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002 Apr 2; 136 (7): 493–503PubMedCrossRefGoogle Scholar
  11. 11.
    Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension 2005; 46 (4): 667–675PubMedCrossRefGoogle Scholar
  12. 12.
    Narkiewicz K, Somers VK. Endurance training in mild hypertension: effects on ambulatory blood pressure and neural circulatory control. Blood Press Monit 1997; 2: 229–235PubMedGoogle Scholar
  13. 13.
    Chen HI, Li HT, Chen CC. Physical conditioning decreases norepinephrine-induced vasoconstriction in rabbits: possible roles of norepinephrine-evoked endothelium-derived relaxing factor. Circulation 1994 Aug; 90 (2): 970–975PubMedCrossRefGoogle Scholar
  14. 14.
    Delp MD, McAllister RM, Laughlin MH. Exercise training alters aortic vascular reactivity in hypothyroid rats. Am J Physiol 1995 Apr; 268 (4 Pt 2): H1428–H1435PubMedGoogle Scholar
  15. 15.
    Spier S A, Laughlin MH, Delp MD. Effects of acute and chronic exercise on vasoconstrictor responsiveness of rat abdominal aorta. J Appl Physiol 1999 Nov; 87 (5): 1752–1757PubMedGoogle Scholar
  16. 16.
    Martin WH, Spina RJ, Korte E, et al. Effects of chronic and acute exercise on cardiovascular beta-adrenergic responses. J Appl Physiol 1991 Oct; 71 (4): 1523–1528PubMedGoogle Scholar
  17. 17.
    Maeda S, Miyauchi T, Kakiyama T, et al. Effects of exercise training of 8 weeks and detraining on plasma levels of endothelium-derived factors, endothelin-1 and nitric oxide, in healthy young humans. Life Sci 2001 Jul 20; 69 (9): 1005–1016PubMedCrossRefGoogle Scholar
  18. 18.
    Jungersten L, Ambring A, Wall B, et al. Both physical fitness and acute exercise regulate nitric oxide formation in healthy humans. J Appl Physiol 1997 Mar; 82 (3): 760–764PubMedGoogle Scholar
  19. 19.
    Kingwell BA, Sherrard B, Jennings GL, et al. Four weeks of cycle training increases basal production of nitric oxide from the forearm. Am J Physiol 1997 Mar; 272 (3 Pt 2): H1070–H1077PubMedGoogle Scholar
  20. 20.
    Huonker M, Halle M, Keul J. Structural and functional adaptations of the cardiovascular system by training. Int J Sports Med 1996 Nov; 17 Suppl. 3: S164–S172PubMedCrossRefGoogle Scholar
  21. 21.
    Wijnen JA, Kuipers H, Kool MJ, et al. Vessel wall properties of large arteries in trained and sedentary subjects. Basic Res Cardiol 1991; 86 Suppl. 1: 25–29PubMedGoogle Scholar
  22. 22.
    Dinenno FA, Tanaka H, Monahan KD, et al. Regular endurance exercise induces expansive arterial remodelling in the trained limbs of healthy men. J Physiol 2001 Jul 1; 534 (Pt 1): 287–295PubMedCrossRefGoogle Scholar
  23. 23.
    Cameron JD, Dart AM. Exercise training increases total systemic arterial compliance in humans. Am J Physiol 1994 Feb; 266 (2 Pt 2): H693–H701PubMedGoogle Scholar
  24. 24.
    Mohiaddin RH, Underwood SR, Bogren HG, et al. Regional aortic compliance studied by magnetic resonance imaging: the effects of age, training, and coronary artery disease. Br Heart J 1989 Aug 62 (2): 90–96CrossRefGoogle Scholar
  25. 25.
    Vaitkevicius PV, Fleg JL, Engel JH, et al. Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 1993 Oct; 88 (4 Pt 1): 1456–1462PubMedCrossRefGoogle Scholar
  26. 26.
    Ferrier KE, Waddell TK, Gatzka CD, et al. Aerobic exercise training does not modify large-artery compliance in isolated systolic hypertension. Hypertension 2001 Aug; 38 (2): 222–226PubMedCrossRefGoogle Scholar
  27. 27.
    Stewart KJ, Bacher AC, Turner KL, et al. Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med 2005 Apr 11; 165 (7): 756–762PubMedCrossRefGoogle Scholar
  28. 28.
    Halliwill JR, Taylor JA, Eckberg DL. Impaired sympathetic vascular regulation in humans after acute dynamic exercise. J Physiol 1996 Aug 15; 495 (Pt 1): 279–288PubMedGoogle Scholar
  29. 29.
    Halliwill JR, Dinenno FA, Dietz NM. Alpha-adrenergic vascular responsiveness during postexercise hypotension in humans. J Physiol 2003 Jul 1; 550 (Pt 1): 279–286PubMedCrossRefGoogle Scholar
  30. 30.
    Convertino VA. Evidence for altered alpha-adrenoreceptor responsiveness after a single bout of maximal exercise. J Appl Physiol 2003 Jul; 95 (1): 192–198PubMedGoogle Scholar
  31. 31.
    Brownley KA, Hinderliter AL, West SG, et al. Sympathoadrenergic mechanisms in reduced hemodynamic stress responses after exercise. Med Sci Sports Exerc 2003 Jun; 35 (6): 978–986PubMedCrossRefGoogle Scholar
  32. 32.
    Collins HL, DiCarlo SE. Attenuation of postexertional hypotension by cardiac afferent blockade. Am J Physiol 1993 Oct; 265 (4 Pt 2): H1179–H1183PubMedGoogle Scholar
  33. 33.
    Bennett T, Wilcox RG, Macdonald IA. Post-exercise reduction of blood pressure in hypertensive men is not due to acute impairment of baroreflex function. Clin Sci (Lond) 1984 Jul; 67 (1): 97–103Google Scholar
  34. 34.
    Convertino VA. Baroreflex-mediated heart rate and vascular resistance responses 24h after maximal exercise. Med Sci Sports Exerc 2003 Jun; 35 (6): 970–977PubMedCrossRefGoogle Scholar
  35. 35.
    Halliwill JR, Minson CT, Joyner MJ. Effect of systemic nitric oxide synthase inhibition on postexercise hypotension in humans. J Appl Physiol 2000 Nov; 89 (5): 1830–1836PubMedGoogle Scholar
  36. 36.
    Lockwood JM, Pricher MP, Wilkins BW, et al. Postexercise hypotension is not explained by a prostaglandin-dependent peripheral vasodilation. J Appl Physiol 2005 Feb; 98 (2): 447–453PubMedCrossRefGoogle Scholar
  37. 37.
    Lockwood JM, Wilkins BW, Halliwill JR. HI receptor-mediated vasodilatation contributes to postexercise hypotension. J Physiol 2005 Mar; 563 (Pt 2): 633–642PubMedCrossRefGoogle Scholar
  38. 38.
    Harvey PJ, Morris BL, Kubo T, et al. Hemodynamic after-effects of acute dynamic exercise in sedentary normotensive postmenopausal women. J Hypertens 2005 Feb; 23 (2): 285–292PubMedCrossRefGoogle Scholar
  39. 39.
    Senitko AN, Charkoudian N, Halliwill JR. Influence of endurance exercise training status and gender on postexercise hypotension. J Appl Physiol 2002 Jun; 92 (6): 2368–2374PubMedGoogle Scholar
  40. 40.
    Pescatello LS, Guidry MA, Blanchard BE, et al. Exercise intensity alters postexercise hypotension. J Hypertens 2004 Oct; 22 (10): 1881–1888PubMedCrossRefGoogle Scholar
  41. 41.
    Quinn TJ. Twenty-four hour, ambulatory blood pressure responses following acute exercise: impact of exercise intensity. J Hum Hypertens 2000 Sep; 14 (9): 547–553PubMedCrossRefGoogle Scholar
  42. 42.
    Hagberg JM, Brown MD. Does exercise training play a role in the treatment of essential hypertension? J Cardiovasc Risk 1995 Aug; 2 (4): 296–302PubMedCrossRefGoogle Scholar
  43. 43.
    Abramson JL, Vaccarino V. Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults. Arch Intern Med 2002 Jun 10; 162 (11): 1286–1292PubMedCrossRefGoogle Scholar
  44. 44.
    Adamopoulos S, Parissis J, Kroupis C, et al. Physical training reduces peripheral markers of inflammation in patients with chronic heart failure. Eur Heart J 2001 May; 22 (9): 791–797PubMedCrossRefGoogle Scholar
  45. 45.
    You T, Berman DM, Ryan AS, et al. Effects of hypocaloric diet and exercise training on inflammation and adipocyte lipolysis in obese postmenopausal women. J Clin Endocrinol Metab 2004 Apr; 89 (4): 1739–1746PubMedCrossRefGoogle Scholar
  46. 46.
    Niskanen L, Laaksonen DE, Nyyssonen K, et al. Inflammation, abdominal obesity, and smoking as predictors of hypertension. Hypertension 2004 Dec; 44 (6): 859–865PubMedCrossRefGoogle Scholar
  47. 47.
    Sesso HD, Buring JE, Rifai N, et al. C-reactive protein and the risk of developing hypertension. JAMA 2003 Dec 10; 290 (22): 2945–2951PubMedCrossRefGoogle Scholar
  48. 48.
    Verma S, Yeh ET. C-reactive protein and atherothrombosis: beyond a biomarker: an actual partaker of lesion formation. Am J Physiol Regul Integr Comp Physiol 2003 Nov; 285 (5): R1253–R1256PubMedGoogle Scholar
  49. 49.
    Wang CH, Li SH, Weisel RD, et al. C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle. Circulation 2003 Apr 8; 107 (13): 1783–1790PubMedCrossRefGoogle Scholar
  50. 50.
    Rahmouni K, Correia ML, Haynes WG, et al. Obesity-associated hypertension: new insights into mechanisms. Hypertension 2005 Jan; 45 (1): 9–14PubMedGoogle Scholar
  51. 51.
    Kohno K, Matsuoka H, Takenaka K, et al. Depressor effect by exercise training is associated with amelioration of hyperinsu-linemia and sympathetic overactivity. Intern Med 2000 Dec; 39 (12): 1013–1019PubMedCrossRefGoogle Scholar
  52. 52.
    Carroll D, Ring C, Hunt K, et al. Blood pressure reactions to stress and the prediction of future blood pressure: effects of sex, age, and socioeconomic position. Psychosom Med 2003 Nov-Dec; 65 (6): 1058–1064PubMedCrossRefGoogle Scholar
  53. 53.
    Matthews KA, Katholi CR, McCreath H, et al. Blood pressure reactivity to psychological stress predicts hypertension in the CARDIA study. Circulation 2004 Jul 6; 110 (1): 74–78PubMedCrossRefGoogle Scholar
  54. 54.
    Markovitz JH, Matthews KA, Whooley M, et al. Increases in job strain are associated with incident hypertension in the CARDIA Study. Ann Behav Med 2004 Aug; 28 (1): 4–9PubMedCrossRefGoogle Scholar
  55. 55.
    Davidson K, Jonas BS, Dixon KE, et al. Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study? Coronary Artery Risk Development in Young Adults. Arch Intern Med 2000 May 22; 160 (10): 1495–1500PubMedCrossRefGoogle Scholar
  56. 56.
    Jonas BS, Franks P, Ingram DD. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I epidemiologic follow-up study. Arch Fam Med 1997 Jan–Feb; 6 (1): 43–49PubMedCrossRefGoogle Scholar
  57. 57.
    Ussher M, West R, Taylor A, et al. Exercise interventions for smoking cessation. Cochrane Database Syst Rev 2005 Jan 25; (1): CD002295PubMedGoogle Scholar
  58. 58.
    Hamer M, Taylor A, Steptoe A. The effect of acute aerobic exercise on stress related blood pressure responses: a systematic review and meta-analysis. Biol Psychol 2006 Feb; 71 (2): 183–190PubMedCrossRefGoogle Scholar
  59. 59.
    Crews DJ, Landers DM. A meta-analytic review of aerobic fitness and reactivity to psychosocial stressors. Med Sci Sports Exerc 1987 Oct; 19 (5 Suppl.): S114–S120PubMedGoogle Scholar
  60. 60.
    Lane JD, Pieper CF, Phillips-Bute BG, et al. Caffeine affects cardiovascular and neuroendocrine activation at work and home. Psychosom Med 2002 Jul–Aug; 64 (4): 595–603PubMedCrossRefGoogle Scholar
  61. 61.
    Dunn AL, Trivedi MH, O’Neal HA. Physical activity dose-response effects on outcomes of depression and anxiety. Med Sci Sports Exerc 2001 Jun; 33 (6 Suppl.): S587–S597PubMedGoogle Scholar
  62. 62.
    Maier SF, Watkins LR. Cytokines for psychologists: implications of bidirectional immune-to-brain communication for understanding behavior, mood, and cognition. Psychol Rev 1998 Jan; 105 (1): 83–107PubMedCrossRefGoogle Scholar
  63. 63.
    Flory JD, Manuck SB, Matthews KA, et al. Serotonergic function in the central nervous system is associated with daily ratings of positive mood. Psychiatry Res 2004 Nov 30; 129 (1): 11–19PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Department of Epidemiology and Public HealthUniversity College LondonLondonEngland

Personalised recommendations