5 things you didn’t know about exercise and high blood pressure.

Since I am on a cardiovascular roll, I thought I’d keep going.

One of the most frustrating things I experience as a scientist of human mechanics is the constant mis-prescription of exercise that is happening everywhere.

You know how, when someone points something out, like an annoying trait someone has, or like when you learn a new word, or like when you get a new car, you hear/see it everywhere? It’s like that. (It’s like, annoying, right?)

I cannot escape poor movement science information. It punches me in the face when reading any “health” magazine, stabs me in the ears when I listen to any radio or television segment on exercise, and, unfortunately, I often out of the mouths of professionals.

A few posts back I mentioned a bit about the intensity of exercise (over 60% of peak) increasing turbulent flow (read here), a precursor for arterial plaque accumulation. Big deal. Huge deal. Especially for those of you out there who think that the more you work your heart, the healthier your heart will be.

Nope. This is not correct, and it is really frustrating when I see people at the prescription counter for their blood pressure meds who are regularly doing intense to very intense exercise. Most of you out there may be aware that high blood pressure (HBP) is a major public health issue (and you who are on the meds are not “cured” of your HBP – you still have it.) In fact, the American College of Sports Medicine states:

“Hypertension (HTN), one of the most common medical disorders, is associated with an increased incidence of all-cause and cardiovascular disease (CVD) mortality.”

Because many of you are using exercise to deal with or prevent HBP, I thought I’d clarify a few things for ya’all.

1. The correct exercise intensity for those with medicated or unmedicated HBP is moderate, or 40-60%, NOT 70-85%.

You’ve heard that walking is super-hyper-awesomely beneficial to your health, right? One of the reasons it is so beneficial is you get all the benefits of movement (a symmetrical, whole-body pattern of muscle contraction, fully weight bearing on the skeleton, increased circulation and oxygen distribution) without the plaque increasing turbulent flow that comes with greater intensities.

According to the American College of Sports Medicine (ACSM) “The intensity of the exercise is directly related to the hemodynamic response and myocardial VO2[oxygenation].” What’s this about turbulent flow from exercise and increased CV risk factors? Read here.

2. Resistance exercise lowers blood pressure and has additional benefits to “cardio.”

Strengthening your body is not just about being a beefcake.* Nor does resistance exercise need to look like lifting weights. In fact, using your body weight as resistance gets you much more of the BP-lowering effect as well as uses way more energy (aka “burns more calories”). Pilates, yoga, calisthenics, martial arts, cross-fit, etc. are all good options, but you need to keep the intensity 40-60% to get the healthy-heart benefit.

(BUT, even if you do a lot of BP-lowering whole-body resistance training, you still have to walk. EVERY HUMAN needs to be walking at least 3 miles a day.)

Why does it work? The more muscle you innervate, the more the blood leaves the big tubes (the arteries) and flows into the capillaries of the working muscle. When you take a tube (artery) and remove some of the fluid (blood), it drops the pressure.

Simple. Easy. Inexpensive. Like me.

Just kidding,

I’m not that simple.

3. More exercise (above the daily 40-60% walk and whole-body resistance training) is not better.

Medical literature has demonstrated that excessive training, or “chronic exercise” (think marathon running) can actually precipitate a heart attack in certain individuals. What causes it? Researchers aren’t sure. It may be the abrupt change in heart rate, or the temporary oxygen deficiency at the heart-cell level. Or a billion other things. What increases the risk?


Already having coronary disease.

The intensity of exercise. (See #1)

4. If you ARE taking a medication for HBP, using a heart rate monitor to gauge intensity doesn’t work very well.

Blood pressure meds can often alter the natural hemodynamics of exercise, so you can be working at a high intensity but you won’t actually create a measurable increase on your measuring tool. It is much better to go with a self-gauge or perceived rate of exertion (PRE). If you feel like you are struggling but your tool shows that you are “flying safe,” trust your gut and bring down the intensity until you can talk comfortably to the person next to you, but not down so low that you find yourself on the couch eating potato chips.

It’s all about balance.

5. “The risk of cardiovascular complications and orthopedic injuries is higher and adherence to an exercise program is lower with higher-intensity exercise programs.”

Or said another way — If you taking exercise for heart and joint health (as opposed to competition), lower intensity is more better.

I just typed “more better.”  For reals.

And, P.S. I chose for #5 a quote from the ACSM’s Guidelines for Exercise Testing and Prescription because some of the greatest offenders of bad exercise prescription are professional exercise prescribers.

MOVEMENT or HEALTH PROFESSIONALS, please read the abundant scientific information on exercise. Exercise is actually a very intense science. If you are training others in exercise, read the text books, find the literature for yourself, and be smart. Don’t make reading CARDIO magazine or BodyBuilders.com (sorry if that’s a real website — I was just making one up) your continuing education.

Now go and take a walk, ok.

*Now that I’ve typed it, beefcake is a pretty creepy word.

And don’t just take my word for it…

American College of Sports Medicine Position Paper, Exercise and Hypertension

FRANKLIN, B. A., M. H. WHALEY, and E. T. HOWLEY (Eds.).

ACSM’s Guidelines for Exercise Testing and Prescription,6thEd. Baltimore: Lippincott Williams & Wilkins, 2000.

KELLEY, G. A., and K. S. KELLEY. Progressive resistance exercise

and resting blood pressure: a meta-analysis of randomized con-

trolled trials. Hypertens. 35:838 – 843, 2000.

KELLEY, G. A., K. S. KELLEY, and Z. V. TRAN. Aerobic exercise

and resting blood pressure: a meta-analytic review of random-

ized, controlled trials. Prev. Cardiol. 4:73– 80, 2001.

KELLEY, G. A., K. S. KELLEY, and Z. V. TRAN. Walking and

resting blood pressure in adults: a meta-analysis. Prev. Med.

33:120 –127, 2001.

KELLEY, G. A., and K. K. SHARPE. Aerobic exercise and resting

blood pressure in older adults: a meta-analytic review of ran-

domized controlled trials. J. Gerontol. A Biol. Sci. Med. Sci.

56:M298 –M303, 2001.



hypotension is sustained during subsequent bouts of mild exer-

cise and simulated activities of daily living. J. Hum. Hypertens.

KIVELOFF B., and O. HUBER. Brief maximal isometric exercise in

hypertension. J. Am. Geriatr. Soc. 19:1006 –1012, 1971. in humans. Hypertens. 18:575–582, 1991.

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27 thoughts on “5 things you didn’t know about exercise and high blood pressure.

  1. Thank you very much for those helpful tips. I have added your link to my post on ‘Healthy Aging – natural therapy for healthy blood pressure’.

  2. Katy – any chance you’d tackle the abundent fallacies about bed rest and pregnancy esp. in regards to hypertension? True story the OBs put a woman on bed rest due to elevated BP at 31 weeks. She had “permission” to have sex but not to walk outside her house. Sigh.

  3. Another awesome post. Thanks, Katy!

    Now earlier you have said that humans were designed to walk 4-6 miles a day. Why do you write 3 miles here?


    1. @Yvonne – 4-6 miles for optimal, whole-body function (with some days making a super-long 10 mile trek) but if we are just looking at those trying to improve CV function, starting with three is excellent! But you, YOU go walk 7 🙂

      1. I think I know what you’ll say but … can you address the SPEED of walking that’s optimal. Should we be power walking or is “just above a stroll” speed acceptable if you’re getting the mileage in?

        Thanks Katy!

        1. The speed of walking would be an individual prescription — what ever it took you to get to 40-60% (these are relative numbers that are affected by level of health, age, body mass, type of terrain, etc.) – Katy

  4. What do you think about the Peak 8 type exercise with the super high intensity for 30 sec or so and a pause for 90 sec. I can see myself doing some damage with the high intensity part. I have some damage to shoulders and knees and lower back. I also have a bit of a problem with high blood pressure. I’m 70 but want to be in good shape.

    1. Terry – you are talking about Dr. Mercola’s program, no? I think that he is following a prescription for fitness (performance) and not one for health. The difference is very subtle, but important. I would recommend that you define “in shape”, with all of the variables you are interested in affecting to make the best decision… – Katy

  5. Hi Katy, thank you for this interesting post and the useful recommendations. I just wonder which are the mechanics that make too intense exercise so dangerous for people with high blood pressure? Is it the plaque accumulation which lowers the diameter of the arterias?

    I forgot everything about my high-school science classes, but your blog makes me want to learn these things again.

    Sorry for my bad English. Greatings from Germany,


    1. Alexandra: I would speculate that the onset of exercise perpetuates a turbulent flow in the long term, and in the more short term (just before an cardiac incident) the burst of flow when going from sedentary to high intensity is enough to dislodge a plaque causing a blockage or be the “straw that broke the camel’s back”.

      1. Thanks! Just to clarify… this burst of flow is more powerful when you already have high blood pressure? And another question… is there any difference in the blood physics between arteries and veins? I mean do the same principles apply to thrombosis?

        1. @Alexandra – No, it’s not more powerful or any different if you have HBP, which is why I don’t think high intensity is “healthy” for anyone. It is required, however, if you are taking exercise for fitness or performance as opposed to health. It’s not as dangerous if you don’t have HBP because the negative effects are accumulative — similar to smoking. It takes awhile for the damage to show up.

          The blood physics are the same arteries and veins but the veins have lower pressures naturally, which reduces any negative impact of haemodynamic changes. – Katy

  6. Thanks for putting all this info in one great concise spot! I couldn’t even get through the article once without stopping (5 times) to send it people I know who need this information!!! Awesome!

  7. Thanks for this article!

    In case you’re interested – the thing that makes us see something *every*where once we’ve been exposed to it is called your reticular activator. You’d be surprised how useful it can be to know the name. I use it all the time. 😉

    1. AWESOME. I love it. And you know what’s REALLY weird? I’ve been seeing the term “reticular activator” everywhere!!!

      1. what’s really weird is that noticing something all over the place after it’s brought to my attention happens to me all the time and i’d always wondered about it. so when i read this last week, i opened another tab to search for ‘reticular activator’. i got lost in all my open tabs, and DID NOT see it again! i just remembered about it today and looked it up. but it’s weird that that is the thing that i see once and DO NOT see again?!?

  8. Just re-read post and replies. I am always glad to see trusted validation for practicing yoga since I have been going to class 2-3 x per week for years (and years…). One class I attend, a Hatha yoga class, goes through your entire body in each class and you a get little something for each part—a stretch or a strengthening or both-even your feet and forearms..! I feel so good after that class. I have been relying on my own subjective physical and mental experience of the forms of exercise I do to validate it.

    Question: What do you think about this latest recommendation of 15 minute walk every day? Or, that any exercise is good exercise, i.e. better than nothing. I’ve even seen 5 minute walks a day recommended. What about the idea of taking a 30 minute walk per day in 10 minute segments?

    Thank you for your blog.

  9. Katy,

    I’m having a hard time buying this one. I understand that intensity is an important factor to consider when dealing with folks that have HBP, however, completely avoiding intensities over 60% seems a little hasty. Arterial plaque formation is multi-factorial in its cause. Perhaps it’s a question of the dose making the poison? i.e.-the frequency of intense activity vs. lower intensity activity.

    As a fitness professional, i know that exercise intensity needs to be handled delicately and progressively, as many folks in America do way too much anaerobic work and not enough general, low-level movement throughout their day. However, i can see how brief, high-intensity work can be very beneficial to the cardiovascular system (and other systems) as well as the ability to handle stress. And i’m not sure what you mean by “turbulent flow” and i don’t recall that phenomena being cited in the literature you posted. Finally, i believe one of the studies you posted has a protocol consisting of resistance training at 90% of 1RM. At any rate, i enjoy your blog and your thoughtfulness in your posts. Thanks for getting me thinking.



    1. No worries. I’m trying to flesh this out more in my next book as mechanobiology isn’t in most people’s curriculum. Turbulent flow isn’t from a study, it’s a hemodynamics term — you can find it (should find it!) in any cardiovascular textbook. My recommendations for people to work at lower intensities is not specific to the human but to the human with arterial walls that have adapted to chronic stillness. The poor mobility at the muscular level trickles to the mobility of the arterial wall, which means that as blood velocity changes (which is does during high-intensity) the wall is no longer naturally able to respond w/vasodilation that would keep the wall-particle interaction to a minimum. Chronic arterial stiffness + regular surging is like an arterial repetitive injury. My official ExRx is not to avoid intense exercise forever, but to address the microadaptations at the cellular level first (mobility, alignment, etc.) so that exercise does less harm. I do agree that the body needs stress, just not in the way it is currently done (fitness, without considering mechanical consequence or function) if disease-free longevity is the goal. Thanks for the comment. I get how it must come across! More food for thought: As a fitness trainer instructing someone (imaginary) with medicated blood pressure (which reduces the inability for a heart to respond to an increase in load) how would you have any idea of *actual* load to the arterial and cardiac system since HR monitors are not accurate with this population? And what (researched) benefits would you be after for this specific population, by stressing the heart without removing the resistance the heart is operating under?

  10. Thanks for the thorough response, Katy. I tangled with this concept when i read Tom Cowan’s discussion on how the “Heart is not a Pump” (http://fourfoldhealing.com/2005/02/01/the-heart-does-not-pump/). In line with this new(er) look at mechanobiology and mechanotransduction, it makes sense that the body’s alignment and movement profile are paramount to cardiovascular functioning. Especially considering our understanding of solid-state biochemistry, load to a cell can alter gene expression, substrate production, etc. It’s not just a chemical issue, but a mechanical one.

    My paradigm has definitely changed to encompass more low-intensity ‘cadiovascular’ work and functional mobility training on the front end to help. However, down the line, i do see some value in adding well-placed bursts of intense activity for those who are ready. I definitely think that there needs to be an anaerobic/aerobic balance which many overdo (and thus burnout or get injured). Thanks for keeping the wheels turning and i look forward to your next book.

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