Fitness as treatment for high blood pressure

High blood pressure, also known as hypertensionHeart is the main risk factor in developing cardiovascular disease, heart failure and can even lead to a heart attack. Hypertension is diagnosed when systolic pressure is >140mmHg and/or diastolic pressure is >90mmHg when there are no co morbidities such as diabetes or kidney diseases. A systolic and diastolic pressure of <120 and <80 is considered a healthy blood pressure independent of age. Hypertension can have many causes, but often the cause can not be determined, which is known as primary or essential hypertension. Hypertension is usually treated with medicine like diuretics, beta blockers or ACE-inhibitors. However recently another form of treatment is recommended by doctors, which is physical activity and training. This article reviews literature investigating the effects of fitness as treatment for high blood pressure. Studies on cardiovascular of resistance exercise in people with hypertension will be evaluated and determined whether these training forms have a place in the treatment of hypertension.

Cardiovascular exercise

Hypertension is in essence a disorder in the cardiovascular system. It is therefore not surprising that cardiovascular exercise is an effective means of lower blood pressure. Much research has been performed to the effects of cardiovascular exercise on hypertension. A study performed by Cornelissen et al. patients with elevated blood pressure were divided into two training groups. One group trained at low intensity at 33% of Heart Rate Reserve (HRR) and the other high intensity group trained at 66% of HRR. After 10 weeks of training both groups had lowered both systolic and diastolic blood pressure at rest, but no difference between groups was found. During exercise blood pressure did decrease more in the high intensity group. In research performed by Braith et al. healthy adults aged 60-79 years blood pressure also decreased as a result of cardiovascular training. Overall reductions of 4% in systolic and 5% in diastolic pressure were found in hypertension patients. In healthy people these values were 2% and 1% respectively. In light of the results above it can be concluded that cardiovascular training is an effective means to reduce blood pressure in hypertension patients.

Resistance Exercise

Although less apparent than cardiovascular exercise, resistance exercise is an effective method to lower blood pressure as well. In a study performed by carter et al resistance exercise lowered blood pressure in healthy young males. Cornelissen and Fagard stated in their review that resistance exercise at moderate to high intensity was very effective in lowering blood pressure in hypertension patients. Resistance exercise also had a significant effect on vascular wall quality, which not only lowers blood pressure but reduces risk of cardiovascular disease as well.


Much research has been performed to evaluate the effectiveness of cardiovascular and resistance training in treating hypertension. Both these training forms are effective means to reduce blood pressure and these reductions are, according to Cornelissen et al. large enough to reduce risk of cardiovascular disease considerably in both hypertension patients and healthy persons. Moreover they conclude that these training forms can be advised as a treatment option for hypertension. Okamoto eet al and Cornelissen et al. both conclude that both resistance and cardiovascular exercise certainly can be performed safely in patients with mild hypertension.

Resistance and cardiovascular exercise lower blood pressure through several mechanisms. Firstly activity of the sympatic nervous system is decreased, which causes smooth muscle tissue in the vascular wall to relax and in doing so cause vasodilatation and a corresponding lowering in blood pressure. Both cardiovascular training and resistance exercise have these effects, although there still is some debate over the role resistance exercise plays in this.

Another blood pressure lowering effect of both training forms is the improvement in vascular wall quality, resulting in less stiff arteries. A positive side effect is, because arteriosclerosis is reduced, the chance a small portion of the plaque formed by this process is torn loose into the bloodstream causing a stroke or heart attack is reduced greatly. The increase in vascular wall quality is most pronounced after resistance training, but cardiovascular exercise can also be effective provided the intensity is high enough.

Aside from these physiological effects, both resistance training as cardiovascular exercise have positive effects on body composition, strength, maximum oxygen uptake and daily functioning. In addition they are also beneficial in preventing and treating the effects of several chronic diseases such as diabetes mellitus type 2, cardiovascular disease and chronic obstructive pulmonary disease.


Both resistance training and cardiovascular exercise are effective and safe methods to achieve significant reductions in blood pressure in patients suffering from moderate hypertension. These forms of training reduce the risk of cardiovascular disease in both hypertension patients and healthy persons and have many positive side effects such as improvement of body composition and increases in strength and aerobic endurance. Furthermore it can effectively be applied next to therapy using medicines, which not only reduces blood pressure greatly, but also reduces or removes underlying causes and risk factors such as being overweight, obese and the quality of blood vessels.


-Braith, R.W. Pollock, M.L., Lowenthal, D.T., Graves, J.E., Limacher, M.C. Moderate- and High-Intensity Exercise Lowers Blood Pressure in Normotensive Subjects 60-79 Years of Age. American Journal of Cardiology, 1994, 73, 1124-1128.

-Carter, J.R., Ray, C.A., Downs, E.M., Cooke, W.H. Strength training reduces arterial blood pressure but not sympathetic neural activity in young normotensive subjects. Journal of Applied Physiology, 2003, 94, 2212-2216.

-Cornelissen, V.A., Fagard, R.H. Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials. Journal of Hypertension 2005, 23, 251-259.

-Cornelissen, V.A., Arnout, J., Holvoet, P., Fagard, R.H. Influence of exercise at lower and higher intensity on blood pressure and cardiovascular risk factors at older age. Journal of Hypertension 2009, 27, 753-762.

-Fagard, R.H. Exercise is good for your blood pressure: effects of endurance training and resistance training. Clinical and Experimental Pharmacology and Physiology 2006, 33, 853-856.

-Heffernan, K.S., Fahs, C.A., Iwamoto, G.A., Jae, S.Y., Wilund, K.R., Woods, J.A., Fernhall, B. Resistance exercise training reduces central blood pressure and improves microvascular function in African American and white men. Atherosclerosis, 2009, 207, 1, 220-226.

-Kelley, G.A., Kelley, K.A., Tran, Z.V. Aerobic Exercise and Resting Blood Pressure: A Meta-Analytic Review of Randomized Controlled Trials. Preventive Cardiology, 4, 2, 73-80.

-NHG-Standaard Cardiovasculair risicomanagement. Houten: Bohn Stafleu van Loghum, 2006.

-Okamoto, T., Masuhara, M., Ikuta, K. Effect of low-intensity resistance training on arterial function. European Journal of Applied Physiology, 2011, 111, 743-748.

-Pescatello, L.S., Franklin, B.A., Fagard, R., Farquhar, W.B., Kelley, G.A., Ray, C.A. Exercise and Hypertension. American College of Sports Medicine Position Stand. Medicine & Science in Sports & Exercise, 2004, 36, 3, 533-553.

-Ross, M.D. The Influence of an Acute Bout of Resistance Exercise on Circulating Endothelial Prgenitor Cells and Endothelial Microparticles in Trained Men. Waterford Institute of Technology, 2011.

-Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure NIH Publication No 03 – 5233, December 2003.