Which exercises are best for blood pressure control?

Research suggests isometric exercises are more effective at lowering blood pressure

New study finds isometric exercises more effective than aerobic exercise for blood pressure control. Getty Images

Isometric exercises, such as wall sits and planks, are the leading type of workout for reducing blood pressure, a analysis from the British Journal of Sports Medicine suggests.

The wall sit is a stationary exercise where the person leans against a wall, sliding down until the thighs are parallel to the floor, then holds the position for a set period, strengthening leg and core muscles.

The plank is a bodyweight exercise in which the person maintains a position similar to a push-up, but with weight on the forearms, holding a straight body line from head to feet, thereby engaging and strengthening the core.

Isometric exercises involve muscle engagement without noticeable movement.

However, the research also reveals other forms of physical activity such as cardio (aerobic exercise), dynamic resistance training (such as squats, press-ups and weights), and high-intensity interval training (HIIT) as effective means of blood-pressure control.

The researchers involved suggest that the existing exercise guidelines for the prevention and treatment of high blood pressure be revisited.

They base their advice on the fact that while previous studies have shown a connection between exercise and significant reductions in blood pressure, the mainstay recommendation has been aerobic exercises such as walking, running and cycling.

The current recommendations have largely been formed on the basis of older data, not accounting for newer forms of exercise such as HIIT and isometric training. As a result, they may be outmoded.

To bring this information up to date, researchers undertook a systematic survey of research databases.

They were specifically looking for clinical trials reporting the effects on resting blood pressure of an exercise training intervention lasting two weeks or longer.

The types of exercise in the interventions were categorised as aerobic (cardio); dynamic resistance training; a combination of these; HIIT; and isometric exercises.

A healthy resting blood pressure – measured in millimetres of mercury, mm/HG – per the researchers is a reading below 130/85 mmHg. Pre-high blood pressure is set at 130-139/85-89 mmHg, and high blood pressure is anything over 140/90 mmHg.

Systolic blood pressure (the first number in a reading) refers to the arterial pressure when the heart beats, and diastolic blood pressure (the second number) is the arterial pressure between beats.

The final analysis consisted of 270 random controlled trials published between 1990 and February 2023, involving a combined total of 15,827 participants.

This comprehensive analysis found that all the exercise categories led to significant reductions in resting systolic and diastolic blood pressure.

Isometric exercise training emerged as the leader, leading to the most substantial drops in systolic and diastolic blood pressure.

The numerical reductions in blood pressure were as follows: aerobic exercise training reduced blood pressure by 4.49/2.53 mmHg; dynamic resistance training by 4.55/3.04 mmHg; combined training by 6.04/2.54 mmHg; HIIT by 4.08/2.50 mmHg; and isometric exercise training by a remarkable 8.24/4 mmHg.

In terms of efficacy, isometric exercise training topped the charts at 98 per cent for reducing systolic blood pressure.

This was followed by combined training (76 per cent), dynamic resistance training (46 per cent), aerobic exercise training (40.5 per cent), and HIIT (39 per cent).

The most effective individual exercises for reducing systolic and diastolic blood pressure turned out to be isometric wa squats (90.5 per cent) and aerobic running (91 per cent), respectively.

Overall, isometric exercise was the most effective for reducing both elements of blood pressure.

The researchers confidently concluded: “Overall, isometric exercise training is the most effective mode in reducing both systolic and diastolic blood pressure.

“These findings provide a comprehensive data-driven framework to support the development of new exercise guideline recommendations for the prevention and treatment of arterial hypertension.”