Aerobic, Resistance and Combined Exercise Lowers High Blood Pressure

Posted on by Jesse Santiano, M.D.

This article presents a study that showed that different exercises could lower blood pressure similarly.

The research was made to answer the question. What exercise is the best to lower blood pressure? Is it aerobic or weight lifting, or should they be combined?

Forty-two participants, age 54 ± 11 years, with a resting blood pressure (SBP/DBP) of 137 ± 9/86 ± 6 mmHg were included. They were divided into:

  • Aerobic Training (AT) (n = 14, 40 minutes of cycling, 50–75% heart rate reserve)
  • Resistance Training (RT) (n = 14, 6 resistance exercises, four sets of 12 repetitions, 60% maximum strength)
  • Combined Training (CT) (n = 14, 2 sets of 12 repetitions of resistance training  + 20 minutes of aerobic exercise.

All participants performed a 40-minute exercise session twice a week for eight weeks.

Blood pressure and Flow Mediated Dilation (FMD) were measured at the beginning and end of the study. FMD is explained below.

Arteries are prone to injuries

Blood vessels must always be clean to ensure adequate blood flow to the whole body. There should be no clots or inflammation. It should be smooth so that blood will not clot.

However, everyday life exposes us to substances that can damage the inner lining or the endothelium. High blood sugar, high fat intake, excessive polyunsaturated oils like canola and grapeseed oils, smoking, pollution, and many more, as shown in the image below, can hurt the endothelium.

Source: Physical Exercise Protects Against Endothelial Dysfunction in Cardiovascular and Metabolic Diseases. J Cardiovasc Transl Res. 2022 Jun;15(3):604-620.

Flow Mediated Dilatation

Flow Mediated Dilation (FMD) is a method to find out if the arteries, particularly the endothelium, are healthy. It requires the use of a blood pressure cuff and an ultrasound machine.

The blood pressure cuff squeezes the upper arm and arteries to limit blood flow. As the pressure is released, the dilation of the arteries is measured by ultrasound.

The diameter at baseline and upon dilation is a measure of the health of the endothelium. More about the endothelium at – The Magical Endothelium

Results

Blood pressure was reduced in all three groups after eight weeks of exercise training.

  • Aerobic Training  resulted in a 5.1 mmHg decrease in Systolic Blood Pressure (SBP)
  • Resistance Training lowered the SBP by 4.0 mmHg
  • Combined Training decreased the Diastolic Blood Pressure by 3.2 mmHg 

Flow Mediated Dilation improved in all by:

  • Aerobic Training increased the FMD by 3.2% 
  • Resistance Training Increased FMD by 4.0%
  • Combined Training increased the FMD by 6.8%

Comment

The FMD increase of 3.2 to 6.8% may sound small but recall Poiseuille’s Law which states that blood flow (Q) is directly proportional to the radius (r) raised to the fourth power. Any increase in the diameter dramatically increases the blood flow!

The increase in the diameter of the arteries also lessens the arterial resistance to the heart and makes the heart work less. Less work means less oxygen demand and a lower heart attack risk.

Less work due to lower blood pressure also avoids heart enlargement, which can lead to heart failure.

The study was only eight weeks long. The improvement would probably be better if it is longer. In their discussion, the blood pressure in some subjects increased again after one month without exercise.

That is why exercise should be part of a lifestyle, not just for a short period. Skeletal muscle is essential as we get older. Sarcopenia or small muscles increases the risk of frailty in advanced age. Plus, it leads to insulin resistance.

Sarcopenia: The Scourge of Aging

This is why resistance training should be included on top of aerobic exercises. As they say, you lose it if you don’t use it.

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References: 

  1. Pedralli ML, Marschner RA, Kollet DP, Neto SG, Eibel B, Tanaka H, Lehnen AM. Different exercise training modalities produce similar endothelial function improvements in individuals with prehypertension or hypertension: a randomized clinical trial Exercise, endothelium, and blood pressure. Sci Rep. 2020 May 6;10(1):7628. doi: 10.1038/s41598-020-64365-x. Erratum in: Sci Rep. 2020 Jun 24;10(1):10564. PMID: 32376984; PMCID: PMC7203179.
  2. Gao J, Pan X, Li G, Chatterjee E, Xiao J. Physical Exercise Protects Against Endothelial Dysfunction in Cardiovascular and Metabolic Diseases. J Cardiovasc Transl Res. 2022 Jun;15(3):604-620. doi: 10.1007/s12265-021-10171-3. Epub 2021 Sep 17. PMID: 34533746; PMCID: PMC8447895.

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