From the Guidelines
Patients with hypertension should engage in moderate-intensity aerobic exercise for at least 150 minutes per week, complemented with low- or moderate-intensity dynamic or isometric resistance training 2-3 times a week, to reduce blood pressure and cardiovascular disease risk. This recommendation is based on the most recent and highest quality study, the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
Key Components of the Exercise Regimen
- Moderate-intensity aerobic exercise, such as brisk walking, cycling, or swimming, for at least 150 minutes per week
- Low- or moderate-intensity dynamic or isometric resistance training, such as weightlifting or bodyweight exercises, 2-3 times a week
- Aim for a stable and healthy BMI (20-25 kg/m2) and waist circumference values (<94 cm in men and <80 cm in women) to reduce blood pressure and cardiovascular disease risk
Importance of Monitoring and Safety Precautions
- Monitor blood pressure before and after exercise
- Stop immediately if experiencing chest pain, severe shortness of breath, dizziness, or if systolic pressure exceeds 180 mmHg or diastolic exceeds 110 mmHg
- Inform doctor about exercise plans, especially if taking blood pressure medications like beta-blockers
Additional Considerations
- Stay hydrated and avoid exercising in extreme temperatures
- Consider working with a fitness professional who has experience with cardiovascular conditions to develop a safe and effective routine
- Regular physical activity can help lower blood pressure over time by strengthening the heart, reducing vascular resistance, and improving overall cardiovascular health, as supported by previous studies 1.
From the Research
Initial Exercise Regimen for Hypertension
The initial exercise regimen for a patient with hypertension can be constructed based on the following guidelines:
- Moderate-intensity aerobic exercise for at least 30 minutes on most days of the week, or resistance exercise on 2-3 days a week 2, 3, 4
- Exercise sessions can be continuous for 30 minutes or composed of at least 10 minutes of short exercise duration to a daily total of 30 minutes 2
- Brisk walking is an easy, inexpensive, simple, and effective way of exercise that can be recommended 2
- Stretching may also be effective in reducing blood pressure, and in some cases, may be superior to brisk walking 5
Exercise Intensity and Duration
- Moderate intensity aerobic exercise (40% to <60% of VO2 Reserve) for 30 minutes or more of continuous or accumulated physical activity per day 4
- Higher-intensity aerobic exercise (up to 70% of maximal oxygen consumption) does not produce a greater hypotensive effect compared to moderate-intensity aerobic exercise 6
- High-intensity intermittent exercise (>70% of maximal oxygen uptake) can significantly reduce office and ambulatory blood pressure of hypertensive individuals 6
Additional Considerations
- Regular exercise can decrease blood pressure by 5 mmHg, which can lead to a decrease in mortality due to coronary heart disease, stroke, and all-cause mortality 2
- Exercise is a cornerstone therapy in reducing cardiovascular risk and in the prevention, treatment, and control of hypertension 3
- Professionals with expertise in exercise prescription may provide additional benefit to patients with high cardiovascular risk or in whom more intense exercise training is planned 3