What exercises can help reduce blood pressure (hypertension)?

Exercise Recommendations to Reduce Blood Pressure

Engage in aerobic exercise for at least 150 minutes per week (30-60 minutes per session, 5-7 days per week) at moderate-to-vigorous intensity, supplemented with resistance training 2-3 days per week for optimal blood pressure reduction. 1

Primary Exercise Prescription: Aerobic Activity

Aerobic exercise has the strongest evidence for blood pressure reduction and should be the foundation of your exercise prescription. 1

Specific Aerobic Exercise Parameters:

• Frequency: 3-4 sessions per week minimum, ideally 5-7 days per week 1
• Duration: 30-60 minutes per session (can be broken into 10-minute bouts throughout the day) 1
• Intensity: Moderate-to-vigorous (approximately 60-85% of predicted maximal heart rate) 1, 2
• Type: Brisk walking, cycling, or swimming—activities involving rhythmic lower limb movements 3, 4
• Total weekly target: At least 150 minutes per week 1

Expected Blood Pressure Reduction:

• Systolic BP: Decreases by 2-5 mm Hg (up to 10.5 mm Hg in some studies) 1, 5
• Diastolic BP: Decreases by 1-4 mm Hg (up to 7.6 mm Hg in some studies) 1, 5
• Clinical significance: A 5 mm Hg reduction in systolic BP decreases coronary heart disease mortality by 9%, stroke mortality by 14%, and all-cause mortality by 7% 3

Supplementary Exercise: Resistance Training

Add resistance training 2-3 days per week to complement aerobic exercise, though the evidence for blood pressure reduction is less robust than for aerobic activity. 1, 6

Specific Resistance Training Parameters:

• Frequency: 2-3 days per week (non-consecutive days) 1, 6
• Type: Dynamic resistance training (weight-lifting, circuit training) rather than isometric exercises 1, 6
• Structure: 8-10 different exercises targeting major muscle groups 6
• Sets/Repetitions: 3-4 sets of 8-12 repetitions at approximately 70% of 1 maximal repetition 1, 2
• Supervision: Generally requires guidance from an exercise professional, especially when starting 1

Expected Blood Pressure Reduction:

• Systolic/Diastolic BP: Decreases by approximately 4 mm Hg in hypertensive individuals, 2 mm Hg in normotensive individuals 1

Implementation Strategy

Starting the Program:

• Begin gradually with low intensity and short duration, progressively increasing over several weeks 1, 5
• Warm up at the start and cool down at the end of each session 1
• Maintain proper breathing technique during resistance exercises to avoid excessive blood pressure spikes 6

Critical Safety Consideration:

For individuals with severe hypertension (≥160/100 mm Hg), blood pressure must be controlled with medication before initiating intensive resistance training. 6 Aerobic exercise can be started at lower intensities even with elevated blood pressure. 7

Monitoring:

• Monitor blood pressure response to exercise, especially when beginning a new program 6
• Post-exercise hypotension (BP decrease lasting up to 24 hours after exercise) is expected and beneficial 3

Combining with Other Lifestyle Modifications

Exercise works synergistically with other lifestyle interventions and should not be prescribed in isolation. 1, 6

Concurrent Interventions:

• Dietary sodium reduction to <1500 mg/day (expect additional 5 mm Hg reduction) 1
• Weight loss if overweight (expect 1 mm Hg reduction per kg lost) 1
• DASH diet (expect additional 5 mm Hg reduction) 1
• Alcohol moderation (≤2 drinks/day for men, ≤1 drink/day for women) 1

Common Pitfalls to Avoid

• Don't recommend resistance training alone for hypertension management—aerobic exercise has superior evidence 1, 5
• Don't prescribe isometric exercises (like sustained handgrip) as primary therapy—evidence is least robust 1
• Don't allow patients to skip warm-up/cool-down periods—these reduce cardiovascular stress 1
• Don't forget to assess for severe uncontrolled hypertension before prescribing intensive exercise 6
• Avoid beta-blockers interfering with exercise prescription when possible, as they may blunt heart rate response 4

Evidence Quality Note

The 2021 Circulation Research guidelines 1 provide the most current comprehensive recommendations, with aerobic exercise having "best evidence" and resistance training having "evidence less robust." The 2013-2014 AHA/ACC guidelines 1 rated aerobic exercise evidence as "high strength" with moderate-to-vigorous intensity showing consistent blood pressure reductions across all populations including those with established hypertension.