The Best Exercise to Reduce Blood Pressure
The following statements are true:
High blood pressure is one of the leading predictors of heart disease and premature death.
Getting sufficient exercise will prolong your life more than any other lifestyle intervention.
And, lo and behold: these two variables are related.
It may not be groundbreaking news that exercise can reduce blood pressure.
What you may not know is:
How effective is exercise for reducing blood pressure?
What is the most effective kind of exercise to reduce blood pressure?
Research has come a long way on this subject, and the answer to both questions may surprise you.
That said, this article will cover:
What is high blood pressure?
Why is high blood pressure dangerous?
What kind of exercise is best for reducing blood pressure?
Why does exercise decrease blood pressure?
Thoughts and theories
Protocols
Disclaimer
This is article is not medical advice and is being published for educational purposes only.
If you are concerned about or dealing with high blood pressure, please consult with your primary care physician or another healthcare provider about beginning a plan.
As I will discuss, this can be a big problem; a problem that many people don’t know they have until it is too late.
What is blood pressure?
First things first: let’s make sure we’re up to speed on the thing we’re measuring.
Blood pressure is the amount of force exerted on the walls of your heart, arteries, veins, and the rest of your circulatory system.
It’s reported in two numbers:
Systolic blood pressure (top, bigger number)
Diastolic blood pressure (bottom, smaller number)
Your systolic blood pressure (SBP) is the pressure in your cardiovascular system when the heart is at peak contraction (the highest pressure in the cycle).
Your diastolic blood pressure (DBP) is the pressure when your heart is at its most relaxed (the lowest pressure in the cycle).
In other words, your blood pressure is constantly moving up and down between your systolic and diastolic numbers.
Your circulatory system doesn’t spend an equal amount of time at each, though.
It spends a bit more time near the diastolic. Plus, blood pressure drops as your blood gets closer to returning to the heart.
So the Mean Arterial Pressure (MAP) is another metric that’s often calculated to estimate the average pressure across the entire system.
This is calculated as: MAP = [(SBP - DBP)/3] + DBP.
This specific pressure gradient matters.
If pressure didn’t drop as blood traveled throughout your circulatory system, there would be nothing to force blood to move in a single direction.
Moreover, if your blood pressure gets too low, your blood may not be able to reach the organs it needs to deliver oxygen.
This is the case with orthostatic hypotension, where blood pressure drops upon standing and causes light-headedness.
Why is high blood pressure dangerous?
As a preface: there is nuance here, because the cause of increased blood pressure affects how meaningful it is.
In other words, it doesn’t just matter THAT your blood pressure is high; it matters WHY as well.
In most instances, though, high blood pressure is harmful for the following reasons:
Imagine you did 7 hard sets of bicep curls every single day without ever giving them a day to recover.
In other words, you placed a load on them that was greater than their capacity to recover.
You’d expect that eventually they’d undergo an injury from being overtrained.
This is essentially what happens to your blood vessels when your blood pressure is too high for too long.
They undergo ‘overuse injuries’ day in and day out. [3]
They try to adapt by becoming less elastic and stiffer to contain the pressure, but this often leads to even higher blood pressure.
This damage to the vessel walls takes much longer and is much less noticeable than what would happen to your biceps, but the metaphor still works well enough.
A similar situation happens to the heart itself. [4]
Your heart is a muscle that must contract to move blood through the system.
When blood pressure is increased, the heart has to contract against greater resistance.
At a certain point, it may be working harder than it can recover from.
If any plaque or blood clot is present in the circulatory system, high blood pressure increases the risk that it gets dislodged and blocks circulation somewhere downstream: leading to a heart attack, stroke, or pulmonary embolism. [5]
These aren’t events people are immune to just because they are healthy otherwise.
Zach Bitter, a person who has run numerous 100 mile races, posted on X about experiencing a blood clot in their leg (Deep Venous Thrombosis, DVT) after a 12-hour flight.
There are many other ways high blood pressure can harm your health that go beyond what was listed here.
The final, and most important, point I want to leave you with is that you won’t necessarily “feel” high blood pressure.
There isn’t a set of symptoms that’s commonly reported, and in many cases the first “symptom” is the one that results in death.
For this reason, high blood pressure is often called the “silent killer.”
What kind of exercise is best for reducing blood pressure?
Edwards et al. [1] recently published a network meta-analysis of randomized control trials (study of studies) that provides the most up-to-date answer to this question.
The findings are somewhat surprising, but very practical.
The different forms of exercise tested, and the specific mode of each exercise type, include:
Low-moderate intensity aerobic exercise, including:
walking
running
cycling
Dynamic resistance training (normal weight training)
Combined training (weight training + cardio)
High intensity interval training, including:
Aerobic interval training
Sprint interval training
Isometric exercise training, including:
Isometric hand grip training
Isometric holds on leg extension
Wall squats
Every form of exercise decreased blood pressure. This was true in people with and without high blood pressure.
However, some were much more effective than others.
For decreasing systolic blood pressure (top number), the most effective exercises (in order) were:
Wall squats (-10.47 mmHg)
Isometric leg extensions (-10.05 mmHg)
Isometric grip training (-7.1 mmHg)
Cycling (-6.88 mmHg)
Running (-6.83 mmHg)
Combined training (-6.04 mmHg)
Sprint interval training (-5.26 mmHg)
Dynamic resistance training (-4.55 mmHg)
Walking (-2.85 mmHg)
Aerobic interval training (-1.97 mmHg)
For decreasing diastolic blood pressure (bottom number), the most effective exercises (in order) were:
Running (-5.67 mmHg)
Wall squats (-5.33 mmHg)
Isometric leg extension (-4.63 mmHg)
Isometric grip training (-3.46 mmHg)
Sprint interval training (-3.29 mmHg)
Cycling (-3.20 mmHg)
Dynamic resistance training (-3.04 mmHg)
Aerobic interval training (-2.60 mmHg)
Combined training (-2.54 mmHg)
Walking (-1.44 mmHg)
All of this data was collected in people with high blood pressure and normal blood pressure.
The effects tended to be greater in those with higher blood pressure compared to those with lower.
General themes
Isometric training is any exercise where you’re holding a weight against gravity but not moving through a range of motion.
The classic example is the plank. In this exercise, numerous muscles are contracting and working hard, but they are not moving a weight through any range of motion.
In this study, the isometric exercises included a wall squat, a leg extension (where a specific part of the range of motion was held), and grip training.
Isometric training was the most effective kind of exercise for reducing blood pressure. This was especially true for systolic blood pressure.
Within the isometric exercises that were tested, another theme emerged:
Exercises that used a) bigger muscles and b) a higher number of different muscles produced greater reductions in blood pressure.
Wall squat > Isometric leg extension > isometric grip training
Before we move on, it’s important to understand just how effective isometric training was for lowering blood pressure.
It was just as powerful as, and in some cases better than, single-drug pharmaceutical intervention. [2]
When multiple medications are used to target blood pressure from different angles, they tend to have a more potent effect.
However, exercise has none of the side effects of these drugs—and it has 1,000 other benefits beyond blood pressure reduction.
Cardio performed second best, but only at low to moderate intensities.
When it was pushed to true high intensities, there was less benefit.
When it was very low intensity (walking), there was the least benefit.
Cardio was also more effective at reducing blood pressure with lower-frequency training.
In other words, if you were going to do 120 minutes of cardio across the week, it would be more beneficial to do 40 minutes 3x/week instead of 20 minutes 6x/week.
While normal weight training did produce clinically significant reductions in blood pressure, it was more effective when combined with cardio.
Why does exercise decrease blood pressure?
There are numerous mechanisms that produce the blood pressure-lowering effect of exercise.
The first, and potentially most impactful, is an improvement in autonomic tone of the nervous system.
Your autonomic nervous system has two main categories: sympathetic and parasympathetic.
Your sympathetic is termed the “fight or flight” division because it’s responsible for more stress-related functions.
Your parasympathetic is termed the “rest and digest” division because it’s responsible for more relaxed and recovery-related activities.
With exercise, and isometric training in particular, there is decreased sympathetic input and increased parasympathetic input to your blood vessels, helping them relax overall. [6]
In response to exercise, your blood vessels also produce more nitric oxide. [7]
This compound promotes your blood vessels widening in diameter.
That increase in space within the blood vessel lowers pressure, because volume and pressure are inversely related.
Moreover, your blood vessels adapt to exercise, similar to how a bicep adapts to bicep curls.
They increase in elasticity and strength, allowing them to be healthier overall.
There are many others I could describe, but the outcome is the same.
Resistance throughout your circulatory system decreases, so blood has less to travel against.
Thus, blood pressure is reduced.
Thoughts, theories, and protocols
Isometric training performed the best, but only three different isometric exercises were trained.
In addition, in the studies that tested isometric training, the researchers had subjects perform only the single exercise being tested.
For instance, in the studies testing the effects of wall squats, the training protocol was as follows:
4 sets of 2 minutes
2 minute rest in between sets
3x/week
This approach is helpful for research purposes to identify specific cause-effect relationships. It also produces great results for a mere 45 minutes across the week, showing just how effective exercise actually is.
That said, I think this can be built upon.
Say an untrained person with increased blood pressure wanted to use exercise to address this problem.
A more robust, well-rounded isometric protocol might look like:
Plank superset with Supermans
Side planks
Wall squat superset with hamstring bridge
Glute bridge hold superset with isometric push-up (knee or standard)
All performed for two sets with 1:00 rest in between sets, with the duration of holds progressed over time.
Presumably, this would also be performed 3x/week on non-consecutive days.
As mentioned earlier, the general trend was that isometric exercises that utilized bigger muscles and a greater number of different muscles produced more benefits.
Theoretically, then, this sort of session may provide an even more potent effect.
At the very least, a much greater number of muscles are being trained beyond just the quadriceps and glutes, and would still take less than ~20 minutes per session to complete.
Moreover, moderate intensity aerobic exercise (cycling and running) performed second best.
This was especially true when it was performed 3x/week compared to higher frequencies.
The predominant mechanisms through which aerobic exercise reduces blood pressure differ from how isometric training does.
Therefore, it’s possible that combining the two would have an additive effect, providing an even greater benefit than the sum of their parts.
Taking this approach, an example weekly schedule could be:
Monday: Isometric training
Tuesday: Aerobic training
Wednesday: Isometric training
Thursday: Aerobic training
Friday: Isometric training
Saturday: Aerobic training
Sunday: Off
It’s worth acknowledging that a combined strength + endurance approach is an ideal goal structure for a variety of other health reasons.
Thus, even if I’m wrong about there being an additive effect between these two forms of exercise—and the benefit remains similar to what has been reported so far—there are a plethora of other benefits you’d see from this approach beyond blood pressure reduction.
Final points
In most instances, lowering blood pressure should be approached multiple different angles.
Exercise should be just one of those approaches.
That said, it is arguably the most potent approach from a lifestyle perspective. If you need to choose between exercise, sleep, nutrition, stress management, etc.: exercise isn’t a bad first pick.
Again, though, over time the other angles should be incorporated into the plan.
