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Exercise and Hypertension

Author: Stan Reents, PharmD
Original Posting: 05/06/2007 12:37 PM
Last Revision: 09/24/2017 12:44 PM

The prevalence of hypertension (high blood pressure) in the US continues to increase:

The most recent stats come from the ongoing NHANES survey: Currently, 85.7 million US adults 20 yrs or older have hypertension. Stated another way, hypertension affects about 34% of adults in the US! (Benjamin EJ, et al. 2017)

That's 3 times the number of adults who currently have diabetes!


NUMBER OF ADULTS IN THE US
WITH HYPERTENSION
DATA SOURCE
36.8 million adults 2007 Milken Institute (2003 data)
77.9 million adults 2007-2010 NHANES Survey
85.7 million adults 2011-2014 NHANES Survey

But wait, the story gets even worse:

The Framingham Heart Study revealed the risk of developing hypertension in roughly 1300 subjects 55-65 years old who did not currently have high blood pressure. In this study, more than half of the 55-year-olds and about two-thirds of the 65-year-olds developed hypertension within the ensuing 10 years (Vasan RS, et al. 2002). The authors concluded that "the residual lifetime risk for hypertension for middle-aged and elderly individuals is 90%." Yes, that's right: NINETY PERCENT!

This is absolutely staggering. What this says is that, once you reach retirement age, you almost certainly will develop hypertension later in your life...if you haven't already. This is very ominous because hypertension increases the risk for other major medical conditions such as kidney failure, stroke, and heart disease.

EXERCISE COUNSELING NEEDS TO IMPROVE

Why is this "epidemic" of hypertension happening? Has our medical community let us down? Clearly, health care professionals are screening for it: the results of a survey in 2000 showed that hypertension was the most common primary care diagnosis in the US with 35 million office visits (Cherry DK, et al. 2002).

But when it comes to exercise counseling, physicians aren't doing as much as they should. Despite the fact that the nurse takes your blood pressure at every single office visit, how often has your own personal physician actually discussed the benefits of exercise with you? Not just in general terms, but I mean sitting down and having an honest face-to-face conversation that goes something like: "Dan, you need to exercise more. What I want you to do is walk 30-45 minutes per day five days per week, and I want you to start today."

The sad fact is that most physicians don't have these discussions with their patients (Ma J, et al. 2004). Physicians aren't trained to provide exercise counseling. Further, managed care limits the amount of time physicians spend with each patient so, often, it's just easier to write a prescription and toss the patient a pamphlet.

To be painfully honest, we should really blame ourselves. We simply don't take care of our health like we should. We don't exercise enough, and we eat salty, high-fat foods. Two-thirds of Americans are overweight. Following a healthy diet, losing weight, and, especially, exercising regularly not only lowers blood pressure, but, quite possibly, could prevent hypertension from ever developing.

So, with that in mind, let’s review how exercise affects blood pressure.

"NORMAL" BLOOD PRESSURE

What is normal blood pressure? Actually, it’s better to ask, what is the "optimum" or "desired" BP? For some people, their "normal" blood pressure (ie., their typical day-to-day BP) may actually be too high.

For many years, desirable blood pressure was considered to be 120/80 (systolic/diastolic) and treatment was instituted when BP was 140/90 or higher. However, as BP increases from 115/75 to 185/115 mm Hg, each 20/10 BP increment doubles the risk of cardiovascular events like heart attack (myocardial infarction), heart failure, stroke and kidney disease (JAMA May 21, 2003).

Aerobically-fit individuals typically demonstrate a lower resting BP than out-of-shape people. This is not harmful, nor unusual. The circulatory system overall improves as aerobic fitness improves: The heart is stronger. It pumps more blood per stroke. And more oxygen is extracted from the blood. Oxygen uptake is higher in an athlete than in a sedentary person. More blood ejected per beat, combined with better oxygen uptake both contribute to a lower resting blood pressure and a slower resting heart rate. (see additional articles in the LIBRARY for separate discussions on these topics).

IMMEDIATE EFFECTS OF EXERCISE ON BLOOD PRESSURE

Studies of the effects of exercise on hypertension have been conducted since the 1970s and several reviews of these studies have been published. But first, let's make a distinction between the immediate effects of a single exercise session on blood pressure vs. the long-term effects of regular exercise on hypertension.

Regarding the immediate effects, blood pressure can fluctuate across a wide range depending on the activity at the time:

Immediate Effects of Aerobic Exercise on Blood Pressure

During aerobic exercise, heart rate increases dramatically, but blood pressure typically remains fairly stable. And, when aerobic exercise ends abruptly, say, after a long run, blood pressure can drop noticeably. This is thought to be due to pooling of blood in the legs (ie., less blood return to the heart). This explains why some runners feel light-headed right after the end of a hard run.

If this happens to you, here are some suggestions:

  • Avoid standing still or sitting down immediately after a long run or bike ride. Continue to walk around for several minutes. The massaging action of your leg muscles will help maintain blood return to the heart.
  • Drink plenty of fluids.
  • Eat something salty. Sodium helps your circulatory system hold on to fluids and this, in turn, helps to maintain blood pressure.

Immediate Effects of Resistance Exercise on Blood Pressure

During extreme effort, BP can briefly rise to astronomical readings. For example, pressures as high as 480/350 have been documented in the brachial artery of a body-builder during a leg-press exercise (MacDougall JD, et al. 1985).

LONG-TERM EFFECTS OF EXERCISE ON BLOOD PRESSURE

Research on the long-term effects of exercise on blood pressure will be grouped as either aerobic exercise or resistance exercise. Examples of aerobic exercise include walking, running, biking, swimming, playing tennis, etc....anything that gets the arms and legs moving and gets the heart rate up for a sustained period of time. Resistance exercise is mostly thought of as weight-lifting, but working out with stretch bands and push-ups, sit-ups, pull-ups, squats, etc. also qualify as resistance exercise.

In 2002, an extensive review of the medical literature showed that aerobic exercise lowered BP not only in hypertensive patients, but also in normotensive patients, overweight subjects, and normal weight subjects. The average drop in blood pressure was 3.9/2.6 (systolic/diastolic) points. When only hypertensive patients were analyzed, the average drop was 4.9/3.7 (Whelton SP, et al. 2002). A Japanese study was even more impressive: aerobic exercise lowered BP by as much as 20/10 (systolic/diastolic) after 20 weeks (Kiyonaga A, et al. 1985).

Here are some specifics:

Running

In a study from the University of Florida, running 2 miles/day every day for 3 months lowered blood pressure in 101 out of 105 patients with hypertension (Cade R, et al. 1984). In another study, jogging (target HR was 60-70% of age-adjusted maximum) 60 minutes per day, twice weekly for 3 years, produced a satisfactory BP-lowering response (Ketelhut RG, et al. 2004).

Cycling

In the HERITAGE Family study, subjects rode an exercise bike 3 days per week for 20 weeks. The intensity started at "moderate" exercise (55% VO2max) for 30 minutes and increased to "vigorous" exercise (75% VO2max) for 50 minutes during the study. At the conclusion, blood pressure wasn't reduced very much (the drop was less than 1 point for both systolic and diastolic). However, this doesn't suggest that cycling is ineffective for lowering blood pressure. In this study, the initial BP of the subjects was not substantially elevated and this was felt to be the explanation for the relatively minor response (Wilmore JH, et al. 2001).

Swimming

Fewer studies have documented the long-term effects of swimming on hypertension, however, that does not mean that it should be ignored. On the contrary, swimming is an ideal cardiovascular exercise for people with knee pain or hip problems, or others who have trouble with walking or jogging.

HOW VIGOROUS SHOULD AEROBIC EXERCISE BE?

In one study, overweight, sedentary subjects underwent 45 minutes of aerobic exercise at 70-85% of their personal heart rate reserve. The aerobic activity was either biking, jogging, or walking, and this was performed 3-4 times per week for 6 months. At the end of the study, this aerobic exercise program lowered both systolic and diastolic BP by 6 points (Georgiades A, et al. 2000).

This is an impressive response, but exercising at 70-85% of heart rate reserve is pretty tough for many people. How effective is less vigorous exercise?

It turns out that plain old walking can lower blood pressure. In one study of post-menopausal women, walking 3-km/day for 24 weeks lowered systolic BP by 6 points (Moreau KL, et al. 2001). A review of 16 other studies showed that walking produced an average drop in blood pressure of 3/2 (systolic/diastolic) points after 25 weeks (Kelley GA, et al. 2001).

In summary, all types of aerobic exercise are beneficial for hypertension. However, resistance exercise may not be...

EFFECTIVENESS OF RESISTANCE EXERCISE

At least 11 studies have evaluated the effectiveness of resistance exercise on hypertension (Pescatello LS, et al. 2004). These studies are not consistent in their findings. In 2000, a review of this literature showed that resistance exercise was effective: at rest, both systolic and diastolic BP decreased by an average of 3 points (Kelley GA, et al. 2000).

As mentioned above, blood pressures as high as 480/350 have been documented during weight-lifting. So, does this mean that weight-lifting is bad for people with hypertension?

Answer: It can be. We'll look at this issue in 2 ways: how resistance exercise affects the heart, and how it affects the arteries...

EFFECT OF DIFFERENT TYPES OF EXERCISE ON THE HEART

Actually, resistance exercise and aerobic exercise both place high demands on the heart: During aerobic exercise, heart rate increases dramatically, while blood pressure increases only slightly. The opposite pattern occurs during resistance exercise: blood pressure increases to astronomical readings, but heart rate increases only slightly.

An increase in either measurement (ie., blood pressure, or, heart rate) will increase demand on the heart. To compare the impact of each form of exercise on the heart, something called the "rate-pressure product" [ie., (heart rate) x (blood pressure)] is calculated. This value can often be higher for aerobic exercise than for resistance exercise. This means that the demands on the heart can be greater for aerobic exercise than for resistance exercise (Stewart KJ. 2000).

EFFECT OF DIFFERENT TYPES OF EXERCISE ON VASCULAR COMPLIANCE

Vascular compliance is an assessment of not only how "flexible" your blood vessels are, but, also, how readily they can expand and contract on demand. Vascular compliance gets worse (decreases) with aging. This is not good.

It is important to know that performing only resistance exercise will lead to stiffer arteries (reduced vascular compliance) after several months. What's happening here is that the walls of your arteries are responding to the extremely high pressures that occur during weight-lifting. The body is making the artery walls stronger, but, in the process, they also become stiffer. Although it is a protective response, it's an undesirable one because arteries need to be flexible so that they can expand and contract when necessary.

On the other hand, aerobic exercise keeps your arteries healthy and flexible. This is why aerobic exercise is preferred over resistance exercise for maintaining a healthy blood pressure.

BEST EXERCISES FOR HYPERTENSION

So, what type of exercise is best for people with hypertension?

The short answer is: any type of "aerobic" exercise.

Aerobic exercise is generally defined as anything that requires you to move your arms and/or legs and gets your heart rate up and keeps it up for a while. Examples are numerous. It could be walking, jogging, biking, swimming, line-dancing, Zumba, etc. Basketball, soccer, volleyball, and all forms of racquet sports also qualify, though these sports entail periods of no activity.

An extensive review of the literature (54 studies) published in 2002 suggested that both aerobic exercise and resistance exercise can be beneficial in hypertension (Whelton SP, et al. 2002). Aerobic exercise should be emphasized, with some resistance exercise included. A combination of aerobic exercise (eg., 45 minutes of treadmill, stationary cycling, or stair-stepper exercise) with 7 different weight-lifting exercises 3 days per week was evaluated in elderly subjects (ages 55-75 yrs). This regimen produced a modest (2.2 mmHg) drop in diastolic BP after 6 months (Stewart KJ, et al. 2005). This drop in BP may not seem like much. However, combining resistance exercise with aerobic exercise will provide health benefits beyond simply lowering blood pressure. For example, weight-lifting will increase bone density and may help with posture and activities of daily living.

OFFICIAL EXERCISE RECOMMENDATIONS FOR PEOPLE WITH HYPERTENSION

The idea of "prescribing" exercise as a treatment for some health conditions is getting more and more attention by the medical community. However, until recently, there really wasn't a consensus on what worked best for hypertension.

In 2002, the National High Blood Pressure Education Program (Whelton PK, et al. 2002) recommended:

"regular aerobic physical activity such as brisk walking at least 30 min/day on most days of the week".

In 2004, the American College of Sports Medicine, one of the leading research organizations regarding the physiologic effects of exercise, published their latest recommendations regarding exercise and hypertension (Pescatello LS, et al. 2004). Here they are:

The recommended exercise "prescription" for hypertension consists of the following 4 elements, represented by the acronym "FITT": frequency, intensity, time, and type.

  • Frequency: exercise should occur on most, preferably all, days of the week.
  • Intensity: exercise intensity should be moderate (ie., 40-60% of VO2max).
  • Time: duration of exercise should be at least 30 minutes per day; this can be achieved in one continuous session, or, a sum total of smaller periods of exercise throughout the day.
  • Type: endurance (aerobic) exercise is preferred, but resistance exercise should not be ignored.

If we reduced all this technical language down to more simple terms, it might be something like this:

walk briskly for 30-45 minutes per day, 5-7 days per week.

SHOULD PEOPLE WITH HYPERTENSION AVOID RESISTANCE EXERCISE?

As discussed above, when people perform resistance exercise for a long time without any accompanying aerobic exercise, the compliance of their blood vessels gets worse. But resistance exercise does not have to be avoided by people with hypertension. If you like resistance exercise, make sure to also perform some type of aerobic exercise regularly, too.

The American Heart Association recommends resistance exercise in the range of 30-60% of maximum effort in patients with hypertension. The American College of Sports Medicine also recommends resistance exercise for people with hypertension. However, if you choose to do only one type of exercise, aerobic exercise is preferred.

EXERCISING WHILE TAKING BLOOD PRESSURE MEDICATIONS

If you are taking medications for hypertension, do NOT begin a new exercise program without discussing your plans with your physician. Having said that, many physicians are not well-versed on the issues that may arise regarding exercising while taking blood pressure medications. One reason is because how drugs and exercise interact are largely unknown.

The topic of exercising while taking drug therapy for hypertension is too complex to review here. Keep in mind that there are over 200 unique prescription drugs for the treatment of hypertension on the US market. Even reviewing them categorically (eg., diuretics, beta-blockers, ACE inhibitors, calcium-channel blockers, etc.) would be a lengthy discussion. However, one issue worth noting is that beta-blockers are often not a good choice for exercisers due to their interference with energy utilization and inhibitory effects on exercise heart rate (Reents S, 2000). Some clinicians feel that beta-blockers should be the last choice for patients who wish to exercise (Houston MC. 1992).

(My text -- Sport and Exercise Pharmacology -- is the only book ever published describing what happens when people exercise while still taking prescription drugs. Generally, this book is intended for academics, graduate students in exercise physiology, and health care professionals. SR.)

Regular Exercise Reduces the Need For Blood Pressure Medications

Some studies have shown that regular exercise can reduce or even eliminate the need for antihypertensive medications (Ketelhut RG, et al. 2004). For example:

Running: In the University of Florida study, a daily running program made it possible for 24 out of 105 patients to completely discontinue their need for blood pressure medications (Cade R, et al. 1984).

Stationary Cycling: An exercise program was evaluated in hemodialysis patients. Patients rode a stationary bike during dialysis. Initially, the average length of an exercise session was 17 minutes, but, gradually, these patients worked up to 45 minutes per session. After 6 months, half of the patients were able to reduce their need for BP medications. The researchers determined an overall reduction of 36% in the use of medications for high blood pressure which yielded a drug therapy costs savings of $885/year per patient (Miller BW, et al. 2002). This is impressive because it is often difficult to control blood pressure in patients with kidney disease.

Walking: An evaluation of walking revealed that as the distance and intensity of a walking session increased, the need for blood pressure drugs decreased (Williams PT. 2008).

These studies are summarized in the table below:


EXERCISE RESULTS COST SAVINGS SOURCE
• Running 2 miles/day
for 3 months
24 of 105 patients
were able to
d/c all BP drugs
(cost savings
not assessed)
Cade R, 1984
• Riding a stationary bike
during dialysis for 6 months
54% of patients
were able to
reduce their drug therapy
$885/year
per patient
Miller BW, 2002
• Walking longer exercise sessions
and
more intense exercise
led to a reduction
in BP meds
(cost savings
not assessed)
Williams PT. 2008

CAN REGULAR EXERCISE PREVENT HYPERTENSION?

At the beginning of this discussion, I mentioned the extremely discouraging statistic that suggests the risk of developing hypertension as you get older is 90%. The immediate next question is: is there any evidence that regular exercise will, in fact, prevent hypertension? And the answer is yes!

Paffenbarger et al. studied Harvard alumni and found that those who did not engage in "vigorous sports activity" were at a 35% greater risk of hypertension than those who did. In this study, they defined "vigorous" activity as running, swimming, handball, tennis, cross-country skiing, etc. (Paffenbarger R, et al. 1983).

This 1983 Harvard alumni study found that vigorous exercise, but not light exercise, helped to reduce the risk of developing hypertension in later life. However, another study, in Japanese men, showed that walking for only 20 min/day successfully lowered the long-term risk of developing hypertension (Hayashi T, et al. 1999).

WHO SHOULD NOT EXERCISE?

As previously mentioned, do not begin a new exercise program without checking with your personal physician, especially if you have any form of cardiovascular disease.

Further, if you are currently taking medication to lower your blood pressure, generally, you should avoid strenuous exercise until the drug therapy has brought your blood pressure into a more normal range. This is very important if you are older, or, if your blood pressure is very high.

Specifically, do not exercise if:

• Your resting BP is > 200/110

• During exercise, your BP increases higher than 220/115

And if you develop chest pain during exercise, stop immediately!

QUESTIONS

Q: Dietary changes vs. exercise: which is more effective for lowering blood pressure in hypertension?

ANSWER: Diet and exercise are often lumped together by the medical community. But, which is more effective for hypertension? First, let's make a distinction between "diet modification" and "dieting". "Diet modification" is represented by changes to the diet (such as restricting sodium) without trying to lose weight. "Dieting", of course, means reducing calorie intake in order to achieve weight loss.

Dietary Modification: For years, physicians have instructed their patients with hypertension to limit their intake of salt/salty foods. Official recommendations such as the Dietary Guidelines for Americans state that sodium intake should be limited to: "not more than 2300 mg/day in healthy adults; not more than 1500 mg/day in patients with hypertension".

However, this strategy doesn't lower BP very much. In one study, the drop in BP (systolic/diastolic) was only 1.7/0.9 (JAMA 1992), and in a review of 13 other studies, the average drop was only 3.6/2.0 (Grobbee DE, et al. 1986). Nevertheless, even small drops in systolic BP are still significant because the risk of stroke and heart disease are reduced when large populations are studied. Also, black patients with hypertension should limit their intake of sodium as they seem to be more sensitive to its effects.

In general, it's wise to reduce salt intake if you have hypertension. But when you have perspired heavily over several hours, you need to make sure you take-in enough sodium. This is an entirely different topic and is discussed in "Why Sports Nutrition Is Different".

It turns out that the ratio of sodium to potassium in your diet may be more important than simply reducing your sodium intake (Cook NR, et al. 2009). This is likely one reason why a diet high in fruits and vegetables can lower blood pressure. The DASH diet, the Portfolio diet, the Nutritarian diet, and the Mediterranean diet have all been shown to be useful in lowering blood pressure. All 4 of these diets are plant-based diets.

In fact, there's evidence that, the more you exercise, the less you need to be concerned about reducing your sodium consumption! (Rebholz CM, et al. 2012).

Dieting (ie., weight loss): Simply losing weight helps to lower BP in many patients with hypertension. Weight loss has been shown to be more effective in lowering blood pressure than a variety of dietary modifications (JAMA 1992). In fact, some researchers believe that controlling obesity might alleviate as much as 48% of the hypertension in whites and 28% of the hypertension in blacks (El-Atat F, et al. 2003).

So, when comparing diet vs. exercise for the management of hypertension, the best approach is a combination of: (a) proper diet (salt and calorie restriction, ample consumption of fruits and vegetables), (b) weight loss, and (c) regular exercise. Dieting is beneficial if weight is lost, since, treating obesity helps to lower blood pressure. However, dieting does not strengthen the heart, lungs, muscles, and bones; only exercise can do this.

"STEPS" YOU SHOULD TAKE

To have a beneficial effect on lowering your blood pressure, you don't have to endure punishing amounts of exercise. Plain old walking is good enough to attain a blood-pressure-lowering effect. Even cutting the grass, if you use a push mower, qualifies.

Keep these points in mind:

• First, if you have high blood pressure, or any form of cardiovascular disease, do NOT engage in strenuous exercise without being evaluated by your physician.

• Emphasize aerobic exercise, though, once your blood pressure is under control, don't ignore resistance exercise.

• If you are overweight or obese, lose that weight.

• Consume a plant-based diet. Some people with hypertension may not be able to reduce their blood pressure enough with aerobic exercise alone. Combining aerobic exercise with a plant-based diet may be more effective.

Hypertension is a disease that generally persists for life. But, evidence shows that regular exercise, combined with weight loss (if you are overweight), and limiting your intake of salty foods can help to lower an elevated blood pressure. Further, exercise improves other cardiovascular problems, too (Stewart KJ. 2002).

More importantly, these lifestyle elements may actually prevent hypertension from ever developing in the first place. So, get out there!

FOR MORE INFORMATION

Web Sites:

American Heart Association www.AmericanHeart.org: This site contains good information on hypertension and other cardiovascular diseases.

Centers for Disease Control and Prevention (CDC) www.CDC.gov: There is a ton of useful public health information on this site.

National Heart, Lung, and Blood Institute www.nhlbi.nih.gov: The National Heart, Lung, and Blood Institute is a division of Health and Human Services. This site contains a lot of useful information on hypertension. The NHLBI also coordinates the National High Blood Pressure Education Program, which originated in 1972.

Books:

The American College of Sports Medicine has published Complete Guide to Fitness & Health. Chapter 15 covers High Blood Pressure.

Readers may also be interested in these reviews:

EXPERT HEALTH and FITNESS COACHING

Stan Reents, PharmD, is available to speak on this and many other exercise-related topics. (Here is a downloadable recording of one of his Health Talks.) He also provides a one-on-one Health Coaching Service. Contact him through the Contact Us page.

REFERENCES

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Cade R, Mars D, Wagemaker H, et al. Effect of aerobic exercise training on patients with systemic arterial hypertension. Am J Med 1984;77:785-790.  Abstract

Cherry DI, Woodwell DA. National Ambulatory Medical Care Survey: 2000 summary. Advance Data 2002;328:1-32.  Abstract

Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report. JAMA 2003;289:2560-2572.  Abstract

Cook NR, Obarzanek E, Cutler JA, et al. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention (TOHP) Follow-Up Study. Arch Intern Med 2009;169:32-40. Abstract

El-Atat F, Aneja A, Mcfarlane S, et al. Obesity and hypertension. Endocrinol Metab Clin North Am 2003;32:823-854.  Abstract

Georgiades A, Sherwood A, Gullette EC, et al. Effects of exercise and weight loss on mental stress-induced cardiovascular responses in individuals with high blood pressure. Hypertension 2000;36:171-176.  Abstract

Grobbee DE, Hofman A. Does sodium restriction lower blood pressure? Br Med J 1986;293:27-29.  Abstract

Hayashi T, Tsumura K, Suematsu C, et al. Walking to work and the risk for hypertension in men: the Osaka Health Survey. Ann Intern Med 1999;130:21-26.  Abstract

Houston MC. Exercise and hypertension: maximizing the benefits in patients receiving drug therapy. Postgrad Med 1992;92:139-150.  Abstract

Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: a meta-analysis of randomized controlled trials. Hypertens 2000;35:838-843.  Abstract

Kelley GA, Kelley KS, Tran ZV. Walking and resting blood pressure in adults: a meta-analysis. Prev Med 2001;33(2 pt 1):120-127.  Abstract

Ketelhut RG, Franz IW, Scholze J. Regular exercise as an effective approach in antihypertensive therapy. Med Sci Sports Exerc 2004;36:4-8.  Abstract

Kiyonaga A, Arakawa K, Tanaka H, et al. Blood pressure and hormonal responses to aerobic exercise. Hypertension 1985;7:125-131.  Abstract

Klag MJ, Whelton PK, Randall BL, et al. Blood pressure and end-stage renal disease in men. N Engl J Med 1996;334:13-18.  Abstract

Ma J, Urizar GG, Alehegn T, et al. Diet and physical activity counseling during ambulatory care visits in the United States. Prev Med 2004;39:815-822.  Abstract

MacDougall JD, Tuxen D, Sale DG, et al. Arterial blood pressure response to heavy resistance exercise. J Appl Physiol 1985;58:785-790.  Abstract

Miller BW, Cress CL, Johnson ME, et al. Exercise during hemodialysis decreases the use of antihypertensive medications. Am J Kid Dis 2002;39:828-833. Abstract

Moreau KL, Degarmo R, Langley J, et al. Increasing daily walking lowers blood pressure in postmenopausal women. Med Sci Sports Exerc 2001;33:1825-1831.  Abstract

Paffenbarger R, Wing AL, Hyde RT, et al. Physical activity and incidence of hypertension in college alumni. Am J Epidemiol 1983;117:245-257.  Abstract

Pescatello LS, Franklin BA, Fagard R, et al. Exercise and hypertension. Med Sci Sports Exerc 2004;36;533-553.  Abstract ***This is the official ACSM Position Stand. A major revision is expected in 2018.***

Prospective Studies Collaboration. Cholesterol, diastolic blood pressure, and stroke. Lancet 1995;346:1647-1653.  Abstract

Rebholz CM, Gu D, Chen J, et al. Physical activity reduces salt sensitivity of blood pressure. Am J Epidemiology 2012;176:S106-S113. Abstract

Reents S. Sport and Exercise Pharmacology 2000, Human Kinetics, Champaign, IL.  Abstract

Stewart KJ. Exercise guidance in hypertension. Phys Sportsmed 2000;28:81-82.  (no abstract)

Stewart KJ. Exercise training and the cardiovascular consequences of type 2 diabetes and hypertension. JAMA 2002;288:1622-1631.  Abstract

Stewart KJ, Bacher AC, Turner KL, et al. Effect of exercise on blood pressure in older persons. Arch Intern Med 2005;165:756-762.  Abstract

Trials of Hypertension Prevention Collaborative Research Group. The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. JAMA 1992;267:1213-1220.  Abstract

Vasan RS, Beiser A, Seshadri S, et al. Residual lifetime risk for developing hypertension in middle-aged women and men. JAMA 2002;287:1003-1010.  Abstract

Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension. Clinical and public health advisory from the National High Blood Pressure Education Program. JAMA 2002;288:1882-1888.  Abstract

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Williams PT. Relationship of distance run per week to coronary heart disease risk factors in 8283 male runners. The National Runners' Health Study. Arch Intern Med 1997;157:191-198. Abstract

Williams PT. Reduced diabetic, hypertensive, and cholesterol medication use with walking. Med Sci Sports Exerc 2008;40:433-443. Abstract

Williams PT, Franklin B. Vigorous exercise and diabetic, hypertensive, and hypercholesterolemia medication use. Med Sci Sports Exerc 2007;39:1933-1941. Abstract

Wilmore JK, Stanforth PR, Gagnon J, et al. Heart rate and blood pressure changes with endurance training: The HERITAGE Family Study. Med Sci Sports Exerc 2001;33:107-116.  Abstract

ABOUT THE AUTHOR



Stan Reents, PharmD, is a former healthcare professional. He is a member of the American College of Lifestyle Medicine (ACLM), a member of the American College of Sports Medicine (ACSM) and holds current certifications from ACSM (Health & Fitness Specialist), ACE (Health Coach) and has been certified as a tennis coach by USTA. He is the author of Sport and Exercise Pharmacology (published by Human Kinetics) and has written for Runner's World magazine, Senior Softball USA, Training and Conditioning and other fitness publications.




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