In my ongoing pursuit to stay informed about the latest developments in the world of physiotherapy and healthcare, I recently came across a fascinating study that I believe holds significant implications for the wider population.


The study I’m referring to delves into the vital question of which exercise regimen could be a game-changer in the battle against high blood pressure. Hypertension, a condition affecting over 1.4 billion people worldwide, stands as a prominent contributor to illness and mortality.


While medications are commonly prescribed for its management, they are not without drawbacks, including side effects, economic burdens, and poor adherence rates. In light of these challenges, non-pharmacological approaches, particularly exercise training, are gaining attention.


Historically, conventional wisdom has favored traditional aerobic exercise as the cornerstone of exercise recommendations for blood pressure control. This approach typically involves a commitment of 150 minutes of moderately intense continuous exercise per week.


However, recent research has revealed promising alternatives, such as high-intensity interval training and isometric (static) exercises, which may offer even more substantial improvements. This shift in perspective prompts a critical question: What exercise regimen is optimal for managing blood pressure? The answer to this question carries far-reaching implications for developing exercise guidelines at a population level.


In this endeavor to explore the effectiveness of various exercise modes, the authors of the study conducted a comprehensive large-scale analysis. Their aim was to investigate the impact of different exercise training modes on resting blood pressure, with the goal of identifying the most effective practices for hypertension management.


Their Approach:

In the pursuit of a comprehensive analysis, they embarked on a thorough systematic search of randomized controlled trials, focusing on exercise interventions lasting at least two weeks. They categorized training protocols into five primary exercise modes for comparison: Aerobic Exercise


Training, Dynamic Resistance Training, Combined (Aerobic with Dynamic Resistance) Training, High-Intensity Interval Training, and Isometric Exercise Training. Each category was further subdivided to explore specific exercise types, including Walking, Running, Cycling, Sprint Interval Training, Aerobic Interval Training, Isometric Handgrip, Isometric Leg Extension, and Isometric Wall Squat.


Their analysis involved pairwise examinations of each primary and secondary exercise mode, with additional attention to baseline blood pressure. They also conducted Bayesian network meta-analyses to facilitate comparisons of exercise modes that hadn’t been directly compared in head-to-head randomized controlled trials.


Tgeir analytical journey included moderator and sensitivity analyses to ensure robust findings.


The Results of Exercise on Lowering Blood Pressure :

Their final analysis encompassed 270 randomized controlled trials, with a pooled sample size of 15,827 participants. The results were illuminating, demonstrating significant reductions in resting systolic (sBP) and diastolic (dBP) blood pressure for all primary exercise modes.


Here are the key findings:


  • Aerobic exercise training: -4.49 mmHg (sBP), -2.53 mmHg (dBP)
  • Dynamic resistance training: -4.55 mmHg (sBP), -3.04 mmHg (dBP)
  • Combined training: -6.04 mmHg (sBP), -2.54 mmHg (dBP)
  • High-intensity interval training: -4.08 mmHg (sBP), -2.50 mmHg (dBP)
  • Isometric exercise training: -8.24 mmHg (sBP), -4.00 mmHg (dBP)


In the network meta-analyses, isometric exercise training emerged as the most effective mode, with a surface under the cumulative ranking curve (SUCRA) value of 98.3%.


Combined training followed at 75.7%, dynamic resistance training at 46.1%, aerobic exercise training at 40.5%, and high-intensity interval training at 39.4%. In our secondary analyses, isometric wall squat and running stood out as the most effective sub-modes for reducing sBP and dBP.


Key Takeaways:

In summary, their findings highlight the effectiveness of multiple exercise modes, including aerobic, dynamic resistance, combined, high-intensity interval, and isometric training, in reducing resting sBP and dBP. Among these, isometric exercise training shines as the most potent mode.


The isometric exercises examined in this work typically involve a wall squat, handgrip squeeze, or leg extension, often performed in three weekly sessions, each consisting of four two-minute intervals separated by two-minute rest periods.


These insights provide a data-driven foundation for shaping new exercise guidelines aimed at preventing and treating high blood pressure.


As a dedicated physiotherapist, my goal is to bridge the gap between cutting-edge research and practical applications in the field of healthcare. These findings offer promise, paving the way for evidence-based exercise prescriptions that can transform the landscape of blood pressure management.



British Journal of Sports Medicine

Author information:

Jamie J Edwards, Jamie M O’Driscoll