Skip to main content

Exercise in Hypertension

A Clinical Review

Abstract

The current exercise prescription for the treatment of hypertension is: cardiovascular mode, for 20–60 minutes, 3–5 days per week, at 40–70% of maximum oxygen uptake (V̇O2max). Cardiovascular exercise training is the most effective mode of exercise in the prevention and treatment of hypertension. Resistance exercise is not the preferred mode of exercise treatment, but can be incorporated into an exercise regime provided the diastolic blood pressure response is within safe limits. It is inconclusive whether durations longer than 30 minutes produce significantly greater reductions in blood pressure. A frequency of three exercise sessions per week has been considered to be the minimal frequency for blood pressure reduction. Higher frequencies tended to produce greater reductions, although not significantly different. Evidence still exists that high intensity exercise (>75% V̇O2max) may not be as effective as low intensity exercise (<70% V̇O2max) in reducing elevated blood pressures. Exercise can be effective without a change in bodyweight or body fat. Bodyweight or body fat loss and anti-hypertensive medications do not have an added effect on blood pressure reduction associated with exercise. β-blockade is not the recommended anti-hypertensive medication for effective exercise performance in non-cardiac patients. Not all hypertensive patients respond to exercise treatment. Differences in genetics and pathophysiology may be responsible for the inability of some hypertensive patients to respond to exercise. Ambulatory technology may allow advances in individualising a more effective exercise prescription for low-responders and non-responders.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. World Health Organization. Primary prevention of essential hypertension. World Health Organization Technical Report Series 686. Geneva: World Health Organization, 1983

    Google Scholar 

  2. Nicholls MG. Effects of non-pharmacologic therapy. Clin Exp Hypertens A 1990; 12: 709–28

    PubMed  Article  CAS  Google Scholar 

  3. Fletcher GF, Blair SN, Blumenthal J. American Heart Association. Medical statements, statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology. Circulation 1992; 86: 340–4

    PubMed  Article  CAS  Google Scholar 

  4. American Heart Association. Medical statements, exercise standards: a statement for health professionals from the American Heart Association. Circulation 1990; 82: 2286–322

    Article  Google Scholar 

  5. American College of Sports Medicine. Position stand: physical activity, physical fitness and hypertension. Med Sci Sports Exerc 1993; 25: i–x

    Google Scholar 

  6. United States Department of Health and Human Services, Centers for Disease Control and Prevention, and National Center for Chronic Disease Prevention and Health Promotion, editors. Physical activity and health: a report of the surgeon general. Atlanta (GA): United States Department of Health and Human Services, 1996

    Google Scholar 

  7. National Institutes of Health. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1998; 157: 2413–6

    Google Scholar 

  8. Pate RR, Pratt M, Blair SN. Physical activity and public health. JAMA 1995; 273: 402–7

    PubMed  Article  CAS  Google Scholar 

  9. Martin JE, Dubbert PM. The role of exercise in prevention and moderation of blood pressure elevation. Bibl Cardiol 1987; 41: 120–42

    PubMed  CAS  Google Scholar 

  10. Wilcox RG, Bennett T, Brown AM, et al. Is exercise good for high blood pressure? BMJ 1982; 285: 767–9

    PubMed  Article  CAS  Google Scholar 

  11. Kenney LW, Zambraski EJ. Physical activity in human hypertension: a mechanisms approach. Sports Med 1984; 1: 459–73

    PubMed  Article  CAS  Google Scholar 

  12. Hagberg JM, Seals DR. Exercise training and hypertension. Acta Med Scand Suppl 1987; 711: 131–6

    Google Scholar 

  13. Seals DR, Hagberg JM. The effect of exercise training on human hypertension: a review. Med Sci Sports Exerc 1984; 1: 207–15

    Google Scholar 

  14. Tipton CM. Exercise, training and hypertension. Exerc Sport Sci Rev 1984; 12: 254–306

    Article  Google Scholar 

  15. Tipton CM. Exercise training and hypertension: an update. In: Holloszy JO, editor. Exercise and sport sciences reviews. Baltimore (MD): Williams & Wilkins, 1991: 447–506

    Google Scholar 

  16. Fagard RH, Tipton CM. Physical activity, fitness, and hypertension. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness, and health. Champaign (IL): Human Kinetics Publishers, 1994: 633–668

    Google Scholar 

  17. 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; 136(7): 493–503

    PubMed  Google Scholar 

  18. Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2000; 35(3): 838–43

    PubMed  Article  CAS  Google Scholar 

  19. Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension: an update. Sports Med 2000; 30(3): 193–206

    PubMed  Article  CAS  Google Scholar 

  20. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc 2001; 33(6): S484–92

    PubMed  CAS  Google Scholar 

  21. Petrella RJ. How effective is exercise training for the treatment of hypertension? Clin J Sport Med 1998; 8(3): 224–31

    PubMed  Article  CAS  Google Scholar 

  22. Haskell WL. Health consequences of physical activity: understanding and challenges regarding dose-response. Med Sci Sports Exerc 1994; 26: 649–60

    PubMed  Article  CAS  Google Scholar 

  23. American College of Sports Medicine. Position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc 1990; 22: 265–74

    Google Scholar 

  24. Astrand PO, Rodahl K. Textbook of work physiology. New York: McGraw-Hill Book Company, 1986

    Google Scholar 

  25. Pescatello LS, Fargo AE, Leach Jr CN, et al. Short-term effect of dynamic exercise on arterial blood pressure. Circulation 1991; 83(5): 1557–61

    PubMed  Article  CAS  Google Scholar 

  26. Wallace JP, Bogle PG, King BA, et al. The magnitude and duration of ambulatory blood pressure reduction following acute exercise. J Hum Hypertens 1999; 13: 361–6

    PubMed  Article  CAS  Google Scholar 

  27. Choquette G, Furguson RJ. Blood pressure reduction in ‘borderline’ hypertensives following physical training. CMAJ 1973; 108: 699–703

    CAS  Google Scholar 

  28. Connie CC, Graves JE, Pollock ML, et al. Effect of exercise training on blood pressure in 70 to 79-yr-old men and women. Med Sci Sports Exerc 1991; 23: 505–11

    Google Scholar 

  29. Gilders RM, Voner C, Dudley GA. Endurance training and blood pressure in normotensive and hypertensive adults. Med Sci Sports Exerc 1989; 21: 629–36

    PubMed  CAS  Google Scholar 

  30. Hagberg JM, Ehsani AA, Goldring D, et al. Effect of weight training on blood pressure and hemodynamics in hypertensive adolescents. J Pediatr 1984; 104: 147–51

    PubMed  Article  CAS  Google Scholar 

  31. Hagberg JM, Montain SJ, Martin WH. Blood pressure and hemodynamic responses after exercise in older hypertensives. J Appl Physiol 1987; 63: 270–6

    PubMed  CAS  Google Scholar 

  32. Marceau M, Kouame N, Lacourciere Y, et al. Effects of different training intensities on 24-hour blood pressure in hypertensive subjects. Circulation 1993; 88: 2803–11

    PubMed  Article  CAS  Google Scholar 

  33. Van Hoof R, Hespel P, Fagand R, et al. Effects of endurance training on blood pressure at rest, during exercise and during 24 hours in sedentary men. Am J Cardiol 1989; 63: 945–9

    PubMed  Article  Google Scholar 

  34. Moreau KL. Increased daily walking lowers blood pressure in postmenopausal women. Med Sci Sports Exerc 2001; 33: 1825–31

    PubMed  Article  CAS  Google Scholar 

  35. Kenney MJ, Seals DR. Postexercise hypotension. Key features, mechanisms, and clinical significance. Hypertension 1993; 22: 635–64

    Article  Google Scholar 

  36. Blair SN, Kohl III HW, Paffenbarger Jr RS, et al. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA 1989; 262: 2395–401

    PubMed  Article  CAS  Google Scholar 

  37. American College of Sports Medicine. Guidelines for exercise testing and prescription. 3rd ed. Philadelphia (PA): Lea & Febiger, 1986

    Google Scholar 

  38. Fardy PS. Isometric exercise and the cardiovascular system. Phys Sportsmed 1981; 9: 43–53

    Google Scholar 

  39. Kenney LW, editor. 40. ACSM’s guidelines for exercise testing and prescription. 6th ed. Philadelphia (PA): Lippencott, Williams & Wilkins, 2000

    Google Scholar 

  40. Inbar G, Wallace JP, Jastremski C. Interaction of intensity and duration on acute postexercise blood pressure reduction [abstract]. J Cardiopulm Rehabil 1991; 11: 320

    Article  Google Scholar 

  41. Jennings G, Nelson L, Nestel P, et al. The effects of changes in physical activity on major cardiovascular risk factors, hemodynamics, sympathetic function, and glucose utilization in man: a controlled study of four levels of activity. Circulation 1986; 73: 30–40

    PubMed  Article  CAS  Google Scholar 

  42. MacDonald JR, MacDougall JD, Hogben CD. The effects of exercise duration on post-exercise hypotension. J Hum Hypertens 2000; 14: 125–9

    PubMed  Article  CAS  Google Scholar 

  43. Nelson L, Jennings GL, Esler MD, et al. Effect of changing levels of physical activity on blood-pressure and haemodynamics in essential hypertension. Lancet 1986; II: 473–6

    Article  Google Scholar 

  44. Posner JD, Gorman KM, Windsor-Landsberg L, et al. Low to moderate intensity endurance training in healthy older adults: physiological responses after four months. J Am Geriatr Soc 1992; 40: 1–7

    PubMed  CAS  Google Scholar 

  45. Okumiya K, Matsubayashi K, Wada T, et al. Effects of exercise on neurobehavioral function in community-dwelling older people more than 75 years of age. J Am Geriatr Soc 1996; 44: 569–72

    PubMed  CAS  Google Scholar 

  46. Hagberg JM, Montain SJ, Martin III WH, et al. Effect of exercise training in 60–69 year-old persons with essential hypertension. Am J Cardiol 1989; 4: 348–53

    Article  Google Scholar 

  47. Tashiro E, Miura W, Koga M. Crossover comparison between the depressor effects of low and high work rate exercise in mild hypertension. Clin Exp Pharmacol Physiol 1993; 20: 689–96

    PubMed  Article  CAS  Google Scholar 

  48. Rogers MW, Probst MM, Gruber JJ, et al. Differential effects of exercise training intensity on blood pressure and cardiovascular responses to stress in borderline hypertensive humans. J Hypertens 1966; 14: 1369–75

    Article  Google Scholar 

  49. Moreira WD, Fuchs FD, Ribeiro JP, et al. The effects of two aerobic training intensities on ambulatory blood pressure in hypertensive patients: results of randomized trial. J Clin Epidemiol 1999; 52: 637–42

    PubMed  Article  CAS  Google Scholar 

  50. Matsusaki M, Ikeda M, Tashiro E. Influence of work load of aerobic exercise in hypertension. Circulation 1992; 19: 471–9

    CAS  Google Scholar 

  51. Tipton CM, Matthes RD, Marcus KD, et al. Influences of exercise intensity, age, and medication on resting systolic blood pressure of SHR populations. J Appl Physiol 1983; 55: 1305–10

    PubMed  CAS  Google Scholar 

  52. Panel E. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med 1998; 158: 1855–67

    Article  Google Scholar 

  53. Blair D, Habicht JP, Sims EA, et al. Evidence for an increased risk for hypertension with centrally located body fat and the effect of race and sex on this risk. Am J Epidemiol 1984; 119: 526–40

    PubMed  CAS  Google Scholar 

  54. Hartz AJ, Rupley DC, Rimm AA. The association of girth measurements with disease in 32,856 women. Am J Epidemiol 1984; 119: 71–80

    PubMed  CAS  Google Scholar 

  55. Iso H, Kiyama M, Naito Y, et al. The relation of body fat distribution and body mass index with haemoglobin Alc, blood pressure and blood lipids in urban Japanese men. Int J Epidemiol 1991; 20: 88–94

    PubMed  Article  CAS  Google Scholar 

  56. Kalkhoff RK, Hartz AH, Rupley D, et al. Relationship of body fat distribution to blood pressure, carbohydrate tolerance, and plasma lipids in healthy obese women. J Lab Clin Med 1983; 102: 621–7

    PubMed  CAS  Google Scholar 

  57. 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(12): 1405–2

    PubMed  Article  CAS  Google Scholar 

  58. Gordon NF, Scott CB, Levine BD. Comparison of single vs multiple lifestyle interventions: are the antihypertensive effects of exericse training and diet-induced wieght loss additive? Am J Cardiol 1997; 79(6): 763–7

    PubMed  Article  CAS  Google Scholar 

  59. American College of Sports Medicine: appropriate intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 2001; 33(12): 2145–56

    Google Scholar 

  60. Bouchard C, Rankinen T. Individual differences in response to regular physical activity. Med Sci Sports Exerc 2001; 33 (6 Suppl.): S446–51

    PubMed  CAS  Google Scholar 

  61. Kinoshita A, Urata H, Tanabe Y. What types of hypertensives respond better to mild exercise therapy. J Hypertens 1988; 6Suppl. 4: S631–3

    CAS  Google Scholar 

  62. Pescatello LS, Kulikowich JM. The after effects of dynamic exercise on ambulatory blood pressure. Med Sci Sports Exerc 2001; 33: 1855–1

    PubMed  Article  CAS  Google Scholar 

  63. Wallace JP, Inbar G, Stager JM, et al. Hemodynamic determinants of blood pressure reduction following exercise [abstract]. J Cardiopulm Rehabil 1995; 15: 361

    Google Scholar 

  64. Ades PA, Gunther PG, Meyer WL, et al. Cardiac and skeletal muscle adaptations to training in systemic hypertension and effects of beta blockade (metoprolol and propranolol). Am J Cardiol 1990; 66(5): 591–6

    PubMed  Article  CAS  Google Scholar 

  65. Nami R, Mondillo S, Agricola E, et al. Aerobic exercise training fails to reduce blood pressure in nondipper-type hypertension. Am J Hypertens 2000; 13: 593–600

    PubMed  Article  CAS  Google Scholar 

  66. Jennings G, Nelson L, Dewar E. Antihypertensive and haemodynamic effects of one year’s regular exercise. J Hypertens 1986; 4Suppl. 6: S659–61

    Google Scholar 

  67. Reiling MJ, Clayton-Bare LA, Chase PB, et al. Effects of low-level exercise training (et) on resting and ambulatory blood pressure (bp) in older persons with hypertension [abstract]. Physiologist 1988; 31: A158

    Google Scholar 

  68. Reiling MJ, Bare LA, Chase PB, et al. Influence of regular exercise on 24-hour blood pressure (BP24) in middle aged and older persons with mild essential hypertension (EH). Med Sci Sports Exerc 1990; 22: S48

    Google Scholar 

  69. DePlaen JE, Detry JM. Hemodynamic effects of physical training in established arterial hypertension. Acta Cardiol 1980; 35: 179–88

    CAS  Google Scholar 

  70. Johnson WP, Grover JA. Hemodynamic and metabolic effects of physical training in four patients with essential hypertension. CMAJ 1967; 96: 842–7

    CAS  Google Scholar 

  71. Nomura G, Kumagai K, Tidonkhwa K, et al. Physical training in essential hypertension: alone and in combination with dietary salt restriction. J Cardiac Rehabil 1984; 4: 469–75

    Google Scholar 

  72. Urata H, Tanabe Y, Kiyonaga A, et al. Antihypertensive and volume-depleting effects of mild exercise on essential hypertension. Hypertension 1987; 9: 245–52

    PubMed  Article  CAS  Google Scholar 

  73. Bogle PG, Wallace JP, Jastremski C. Immediate post-exercise hemodynamic changes in hypertensive adults [abstract]. Med Sci Sports Exerc 1998; 30Suppl. 5: S241

    Google Scholar 

  74. Rankinen T, Rice T, Perusse L, et al. NOS3 Glu298Asp genotype and blood pressure response to endurance training: The HERITAGE Family Study. Hypertension 2000; 36(5): 885–9

    PubMed  Article  CAS  Google Scholar 

  75. Rankinen T, An P, Rice T, et al. Genomic scan for exercise blood pressure in health, risk factors, exercise training and genetics (HERITAGE) Family Study. Hypertension 2001; 38(1): 30–7

    PubMed  Article  CAS  Google Scholar 

  76. Rice T, Rankinen T, Chagnon YC, et al. Genomewide linkage scan of resting blood pressure: HERITAGE Family Study. Hypertension 2002; 39(6): 1037–43

    PubMed  Article  CAS  Google Scholar 

  77. Rice T, An P, Gagnon J, et al. Heritability of HR and BP response to exercise training in the HERITAGE Family Study. Med Sci Sports Exerc 2002; 34(6): 972–9

    PubMed  Article  Google Scholar 

  78. 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(1): 18–23

    PubMed  Article  CAS  Google Scholar 

  79. Wilmore JH, Stanforth PR, Gagnon J, et al. Heart rate and blood pressure changes with endurance training: The HERITAGE Family Study. Med Sci Sports Exerc 2001; 33(1): 107–16

    PubMed  CAS  Google Scholar 

  80. Kelemen MH, Effron MB, Valenti SA, et al. Exercise training combined with antihypertensive drug therapy. Effects on lipids, blood pressure, and left ventricular mass. JAMA 1990; 263: 2766–71

    PubMed  Article  CAS  Google Scholar 

  81. Stewart KJ, Effron MB, Valenti SA, et al. Effects of diltiazem or propranolol during exercise training of hypertensive men. Med Sci Sports Exerc 1990; 22: 171–7

    PubMed  CAS  Google Scholar 

  82. Gordon NF, Duncan JJ. Effect of beta-blockers on exercise physiology: implications for exercise training. Med Sci Sports Exerc 1991; 23: 668–76

    PubMed  CAS  Google Scholar 

  83. Duncan JJ, Vaandrager H, Farr JE. Effect of intrinsic sympathomimetic activity on serum lipids during exercise training in hypertensive patients receiving chronic B-Blocker therapy. J Cardiopulm Rehabil 1989; 9: 110–4

    Article  Google Scholar 

  84. Chick TW, Halperin AK, Gacek EM. Effect of antihypertensive medications on exercise performance: a review. Med Sci Sports Exerc 1988; 20: 447–54

    PubMed  CAS  Google Scholar 

  85. Pool PE, Seagren SC, Salel AF, et al. Effects of diltiazem on serum lipids, exercise performance and blood pressure: randomized, double-blind, placebo-controlled evaluation for systemic hypertension. Am J Cardiol 1985; 56: 86H–91H

    PubMed  Article  CAS  Google Scholar 

  86. Sommers VK, Conway J, Coats A, et al. Postexercise hypotension is not sustained in normal and hypertensive humans. Hypertension 1991; 18: 211–5

    Article  Google Scholar 

  87. Roltsch MH. Acute resistive exercise does not affect ambulatory blood pressure in young adult men and women. Med Sci Sports Exerc 2001; 33: 881–6

    PubMed  Article  CAS  Google Scholar 

  88. Southard DR, Hart L. Case report: the influence on blood pressure during daily activities of a single session of aerobic exercise. Behav Med 1991; 17(3): 135–42

    PubMed  Article  CAS  Google Scholar 

  89. Blumenthal JA, Siegel WC, Appelbaum M. Failure of exercise to reduce blood pressure in patients with mild hypertension. JAMA 1991; 266: 2098–104

    PubMed  Article  CAS  Google Scholar 

  90. White WB. Analysis of ambulatory blood pressure data in antihypertensive drug trials. J Hypertens 1991;9Suppl. 1: S27–32

    CAS  Google Scholar 

  91. Pickering TG. Clinical applications of ambulatory blood pressure monitoring: the white coat syndrome. Clin Invest Med 1991; 14: 212–7

    PubMed  CAS  Google Scholar 

  92. Staessen JA, Thijs L, Fagard R, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. JAMA 1999; 282: 539–46

    PubMed  Article  CAS  Google Scholar 

  93. Materson BJ, Preston RA. Classic therapeutic trials in hypertension: were patients vulnerable to unsuppressed peak morning blood pressure? Am J Hypertens 1991; 4: 449S–53S

    PubMed  CAS  Google Scholar 

  94. Park S, Lehmkuhl LA, Tanner DA, et al. Effects of exercise treatment on ambulatory blood pressure and diurnal variation in nocturnal nondipping hypertension [abstract]. Med Sci Sports Exerc 2002; 34: S12

    Google Scholar 

  95. Wallace JP, Park SJ, Lehmkuhl LA, et al. Do nocturnal dippers and non-dippers respond similarly to exercise treatment for hypertension? Med Sci Sports Exerc. In press

  96. Park SJ, Black KN, Weaver VR, et al. Is evening exercise more effective than evening exercise in reducing blood pressure in nocturnal non-dipping hypertension [abstract]. Med Sci Sports Exerc. 2003; 35: S174

    Google Scholar 

Download references

Acknowledgements

The authors have provided no information on sources of funding or on conflicts of interest directly relevant to the content of this review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Janet P. Wallace.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wallace, J.P. Exercise in Hypertension. Sports Med 33, 585–598 (2003). https://doi.org/10.2165/00007256-200333080-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-200333080-00004

Keywords

  • Resistance Training
  • Resistance Exercise
  • Exercise Treatment
  • Blood Pressure Reduction
  • Ambulatory Blood Pressure Monitoring