Sports Medicine

, Volume 30, Issue 3, pp 193–206 | Cite as

The Role of Exercise Training in the Treatment of Hypertension

An Update
  • James M. HagbergEmail author
  • Jung-Jun Park
  • Michael D. Brown
Review Article


Hypertension is a very prevalent cardiovascular (CV) disease risk factor in developed countries. All current treatment guidelines emphasise the role of nonpharmacological interventions, including physical activity, in the treatment of hypertension. Since our most recent review of the effects of exercise training on patients with hypertension, 15 studies have been published in the English literature. These results continue to indicate that exercise training decreases blood pressure (BP) in approximately 75% of individuals with hypertension, with systolic and diastolic BP reductions averaging approximately 11 and 8mm Hg, respectively. Women may reduce BP more with exercise training than men, and middle-aged people with hypertension may obtain greater benefits than young or older people. Low to moderate intensity training appears to be as, if not more, beneficial as higher intensity training for reducing BP in individuals with hypertension. BP reductions are rapidly evident although, at least for systolic BP, there is a tendency for greater reductions with more prolonged training. However, sustained BP reductions are evident during the 24 hours following a single bout of exercise in patients with hypertension.


Diastolic Blood Pressure Angiotensin Converting Enzyme Exercise Training Leave Ventricular Hypertrophy Blood Pressure Reduction 
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  1. 1.
    Brown M, Hagberg J. Does exercise training play a role in the treatment of essential hypertension? J Cardiovasc Risk 1995; 2: 296–302PubMedCrossRefGoogle Scholar
  2. 2.
    Dengel DR, Hagberg JM, Pratley RE, et al. Improvements in blood pressure, glucose metabolism, and lipoprotein lipids after aerobic exercise plus weight loss in obese, hypertensive middle-aged men. Metabolism 1998; 47: 1075–82PubMedCrossRefGoogle Scholar
  3. 3.
    Motoyama M, Sunami Y, Kinoshita F, et al. Blood pressure lowering effect of low intensity aerobic training in elderly hypertensive patients. Med Sci Sports Exerc 1998; 30: 818–23PubMedCrossRefGoogle Scholar
  4. 4.
    Kohno K, Matsuoka H, Takenaka K, et al. Renal depressor mechanisms of physical training in patients with essential hypertension. Am J Hypertens 1997; 10: 859–68PubMedCrossRefGoogle Scholar
  5. 5.
    Tanaka H, Bassett Jr DR, Howley ET, et al. Swimming training lowers the resting blood pressure in individuals with hypertension. J Hypertens 1997; 15: 651–7PubMedCrossRefGoogle Scholar
  6. 6.
    Ishikawa K, Ohta T, Zhang J, et al. Influence of age and gender on exercise training-induced blood pressure reduction in systemic hypertension. Am J Cardiol 1999; 84: 192–6PubMedCrossRefGoogle Scholar
  7. 7.
    Dengel DR, Galecki AT, Hagberg JM, et al. The independent and combined effects of weight loss and aerobic exercise on blood pressure and oral glucose tolerance in older men. Am J Hypertens 1998; 11: 1405–12PubMedCrossRefGoogle Scholar
  8. 8.
    Higashi Y, Sasaki N, Nakagawa K, et al. Daily aerobic exercise improves reactive hyperemia in patients with essential hypertension. Hypertension 1999; 33: 591–7PubMedCrossRefGoogle Scholar
  9. 9.
    Moreira WD, Fuchs FD, Ribeiro JP, et al. The effects of two aerobic training intensities on ambulatory blood pressure in hypertensive patients: results of a randomized trial. J Clin Epidemiol 1999; 52: 637–42PubMedCrossRefGoogle Scholar
  10. 10.
    Kokkinos P, Narayan P, Colleran J, et al. Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension. N Engl J Med 1995; 333: 1462–7PubMedCrossRefGoogle Scholar
  11. 11.
    Ketelhut RG, Franz IW, Scholze J. Efficacy and position of endurance training as a non-drug therapy in the treatment of arterial hypertension. J Hum Hypertens 1997; 11: 651–5PubMedCrossRefGoogle Scholar
  12. 12.
    Fish AF, Smith BA, Frid DJ, et al. Step treadmill exercise training and blood pressure reduction in women with mild hypertension. Cardiovasc Nurs 1997; 12: 4–12Google Scholar
  13. 13.
    Zanettini R, Bettega D, Agostoni O, et al. Exercise training in mild hypertension: effects on blood pressure, left ventricular mass and coagulation factor VII and fibrinogen. Cardiology 1997; 88: 468–73PubMedCrossRefGoogle Scholar
  14. 14.
    Nho H, Tanaka K, Watanabe H, et al. Exercise training in female patients with a family history of hypertension. Eur J Appl Physiol 1998; 78: 1–6CrossRefGoogle Scholar
  15. 15.
    Gordon N, Scott C, Levine B. Comparison of single versus multiple lifestyle interventions: are the antihypertensive effects of exercise training and diet-induced weight loss additive? Am J Cardiol 1997; 79: 763–7PubMedCrossRefGoogle Scholar
  16. 16.
    Akinpelu A. Responses of the African hypertensive to exercise training: preliminary observations. J Hum Hypertens 1990; 4: 74–6PubMedGoogle Scholar
  17. 17.
    Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Sixth report of the Joint National Committee. Washington, DC: National Institutes of Health, 1997Google Scholar
  18. 18.
    Hagberg J, Blair S, Ehsani A, et al. Position stand: physical activity, physical fitness, and hypertension. Med Sci Sports Exerc 1993; 25: i–xGoogle Scholar
  19. 19.
    Kaplan N. Clinical hypertension. 5th ed. Baltimore (MD): Williams & Wilkins, 1990Google Scholar
  20. 20.
    Tipton C, Matthes R, Marcus K, et al. Influences of exercise intensity, age, and medication on resting blood pressure in SHR populations. J Appl Physiol 1983; 55: 1305–10PubMedGoogle Scholar
  21. 21.
    Fitzgerald W. Labile hypertension and jogging: new diagnostic tool or spurious discovery? BMJ 1981; 282: 542–4PubMedCrossRefGoogle Scholar
  22. 22.
    Kenny MJ, Seals DR. Postexercise hypotension: key features, mechanisms, and clinical significance. Hypertension 1993; 22: 653–64CrossRefGoogle Scholar
  23. 23.
    Hagberg J, Montain S, Martin W. Blood pressure and hemodynamic responses following exercise in older hypertensives. J Appl Physiol 1987; 63: 270–6PubMedGoogle Scholar
  24. 24.
    Brownley KA, West SG, Hinderliter AL, et al. Acute aerobic exercise reduces ambulatory blood pressure in borderline hypertensive men and women. Am J Hypertens 1996; 9: 200–6PubMedCrossRefGoogle Scholar
  25. 25.
    Taylor-Tolbert N, Dengel D, Brown M, et al. Ambulatory blood pressure after acute exercise in older men with essential hypertension. Am J Hypertens 2000; 13 (1 Pt 1): 44–51PubMedCrossRefGoogle Scholar
  26. 26.
    Zee RYL, Lou YK, Lyn R, et al. Association of a polymorphism of the angiotensin I-converting enzyme gene with essential hypertension. Biochem Biophys Res Comm 1992; 184: 9–15PubMedCrossRefGoogle Scholar
  27. 27.
    Turner ST, Boerwinkle E, Sing CF. Context-dependent associations of the ACE I/D polymorphism with blood pressure. Hypertension 1999; 34: 773–8PubMedCrossRefGoogle Scholar
  28. 28.
    O’Donnell CJ, Lindpaintner K, Larson MG, et al. Evidence for association and genetic linkage of the angiotensin-converting enzyme locus with hypertension and blood pressure in men but not women in the Framingham Heart Study. Circulation 1998; 97: 1766–72PubMedCrossRefGoogle Scholar
  29. 29.
    Jeunemaitre X, Soubrier F, Kotelevtsev Y. Molecular basis of human hypertension: role of angiotensinogen. Cell 1992; 71: 169–80PubMedCrossRefGoogle Scholar
  30. 30.
    Kunz R, Kreutz R, Beige J, et al. Association between the angiotensinogen 235T-variant and essential hypertension in whites. Hypertension 1997; 30: 1331–7PubMedCrossRefGoogle Scholar
  31. 31.
    Staessen JA, Kuznetsova T, Wang JG, et al. M235T angiotensinogen gene polymorphism and cardiovascular renal risk. J Hypertens 1999; 17: 9–17PubMedCrossRefGoogle Scholar
  32. 32.
    Hagberg JM, Ferrell RE, Dengel DR, et al. Exercise training-induced blood pressure and plasma lipid improvements in hypertensives may be genotype dependent. Hypertension 1999; 34: 18–23PubMedCrossRefGoogle Scholar
  33. 33.
    Brown M, Moore G, Korytkowski M, et al. Improvement of insulin sensitivity by short-termexercise training in hypertensive African American women. Hypertension 1997; 30: 1549–53PubMedCrossRefGoogle Scholar
  34. 34.
    Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Fifth report of the Joint National Committee. Arch Intern Med 1988; 148: 1023–38CrossRefGoogle Scholar
  35. 35.
    Wood P, Stefanick M. Exercise, fitness, and atherosclerosis. In: Bouchard C, Shephard RJ, Stephens T, et al., editors. Exercise, fitness, and health. Champaign (IL): Human Kinetics, 1990: 409–23Google Scholar
  36. 36.
    Tanabe Y, Sasaki J, Urata H, et al. Effect of mild aerobic exercise on lipid and apolipoprotein levels in patients with essential hypertension. Jpn Heart J 1988; 29: 199–206PubMedCrossRefGoogle Scholar
  37. 37.
    Bonnano J, Lies J. Effects of physical training on coronary risk factors. Am J Cardiol 1974; 33: 760–3CrossRefGoogle Scholar
  38. 38.
    Kelemen M, Effron M, Valenti S, et al. Exercise training combined with antihypertensive drug therapy. JAMA 1990; 263: 2766–71PubMedCrossRefGoogle Scholar
  39. 39.
    Sasaki J, Urata H, Tanabe Y, et al. Mild exercise therapy increases serum high density lipoprotein2 cholesterol levels in patients with essential hypertension. Am J Med Sci 1989; 297: 220–3PubMedCrossRefGoogle Scholar
  40. 40.
    Dubbert PM, Martin JE, Cushman WC, et al. Endurance exercise in mild hypertension: effects on blood pressure and associated metabolic and quality of life variables. J Hum Hypertens 1994; 8: 265–72PubMedGoogle Scholar
  41. 41.
    Dengel D, Pratley R, Hagberg J, et al. Impaired insulin sensitivity and maximal responsiveness in older hypertensive men. Hypertension 1994; 23: 320–4PubMedCrossRefGoogle Scholar
  42. 42.
    Ferraninni E, Buzzigoli G, Bonadonna R, et al. Insulin resistance in essential hypertension. N Engl J Med 1987; 317: 350–7CrossRefGoogle Scholar
  43. 43.
    Hagberg J, Montain S, Martin W, et al. Effect of exercise training on 60 to 69 year old persons with essential hypertension. Am J Cardiol 1989; 64: 348–53PubMedCrossRefGoogle Scholar
  44. 44.
    Bursztyn M, Ben-Ishay D, Shochina M, et al. Disparate effects of exercise training on glucose tolerance and insulin levels and on ambulatory blood pressure in hypertensive patients. Hypertension 1983; 11: 1121–5Google Scholar
  45. 45.
    Baglivo H, Fabregues H, Burrieza RC, et al. Effect of moderate physical training on left ventricular mass in mild hypertensive persons. Hypertension 1990; 15: 1153–6CrossRefGoogle Scholar
  46. 46.
    Koren MJ, Devereux RB. Mechanism, effects, and reversal of left ventricular hypertrophy in hypertension. Curr Opin Nephrol Hypertens 1993; 2 (1): 87–95CrossRefGoogle Scholar
  47. 47.
    Koren MJ, Devereux RB, Casale PN, et al. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991; 114: 345–52PubMedGoogle Scholar
  48. 48.
    Anderson KM, Wilson W, Odell PM, et al. An updated coronary risk profile. Circulation 1997; 83: 356–62CrossRefGoogle Scholar
  49. 49.
    Holloszy J, Schultz J, Kusnierkiewicz J, et al. Effects of exercise on glucose tolerance and insulin resistance: brief review and some preliminary results. Acta Med Scand 1986; 711: 55–65Google Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • James M. Hagberg
    • 1
    Email author
  • Jung-Jun Park
    • 1
  • Michael D. Brown
  1. 1.Department of KinesiologyUniversity of MarylandCollege ParkUSA

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