High blood pressure: which sport and which values?

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Regular exercise can lower high blood pressure in the long term. So far, endurance sports have been considered the best form of training. But an evaluation of 34 overview studies has shown that in some cases strength training works better. For which patients this applies and how it actually works, talked to the Basel sports medicine specialist Prof. Henner Hanssen.

Prof. Henner Hanssen

Prof. Henner Hanssen heads the Preventive Sports Medicine and Systems Physiology department at the Department of Sport, Exercise and Health at the University of Basel

Prof. Hanssen, endurance training has so far been considered particularly effective for lowering blood pressure. In the course of your study, however, you found that different types of training are particularly effective, depending on the blood pressure values.

Personalized training could actually be useful. For people with high blood pressure, i.e. with systolic values ​​from 140 mmHg, endurance training is the most effective method. But for people with so-called highly normal values ​​and high-risk patients with still healthy blood pressure, various forms of strength training seem more effective.

Let's start with high blood pressure. How much endurance training does it take to lower the values?

The World Health Organization recommends at least 150 minutes of low to moderate intensity exercise per week. This also applies to high blood pressure patients. However, the effect of a training session of 30 minutes, for example, only lasts for about 24 hours - then the blood pressure rises again. So it naturally makes sense that, just as you often have to take a drug once a day, you should also do the exercise therapy once a day.

Does more training bring more?

The duration of the training already has an influence, but the relationship is not linear. So twice the training time does not mean twice as much reduction. Nevertheless, there is a crucial relationship between dose and effect.

For some patient groups, however, strength training seems to be more effective: They have found that people with so-called highly normal blood pressure between 130 and 139 mmHg benefit more from strength training than from endurance training.

That's right. To do this, we looked at several well-made meta-analyzes. It has been shown that dynamic strength training, such as squats, push-ups or dumbbell training, lowers the blood pressure of people with highly normal blood pressure more significantly than endurance training.

That is remarkable. But why is that?

We do not know exactly, so far we have only observed this effect. This may have something to do with the interval nature of the training. With these exercises you raise your blood pressure again and again for a short time, then it recovers again. This seems to be more efficient for people with high blood pressure levels. For these individuals, increasing blood flow and heart rate doesn't seem as critical as it is with cardio training.

How much effort does it take to do this?

You try to generate the same amount of energy that you need for endurance training. But that is done quickly. Three sets of ten repetitions in the moderate range are sufficient. To do this, use around 50 percent of your maximum strength. How much that is can be determined by a trainer or sports medicine specialist. This also takes about half an hour with breaks, for example when larger muscle groups are used.

They have reported that for non-white people, weight training is actually more effective than endurance training in lowering blood pressure.

Right, for People of Color dynamic strength training is overall the better way to achieve good blood pressure values ​​- not just for those with high normal blood pressure. We do not yet know why this is so. But it's very interesting, because it shows us that we haven't understood all the mechanisms yet.

And then there is another group: people at an increased risk of high blood pressure, but who have normal values. They recommend isometric training. What does it mean exactly?

These are holding exercises that increase the tension in the muscle. You stay in certain positions instead of moving, as is the case with dynamic strength training.

Do you have any examples?

When you crouch down and lean against the wall and hold it. Or when you hold a tennis ball pressed together. Or go into the push-ups and stay there. You can also put your knees on, otherwise it will be too sporty for most patients. Depending on the exertion, you hold the respective position for ten to 15 seconds.

What exactly is that supposed to do? These people already have normal blood pressure values ​​anyway.

The values ​​then go down a bit. Above all, you lower your risk of developing high blood pressure in the following years more significantly than with other forms of training. However, the data situation here is not as clear as it is for endurance training for high-pressure patients and dynamic strength training for people with highly normal values.

Who has to be careful, despite normal values?

For example, isometric training might be suitable for people who are obese or women who developed high blood pressure during pregnancy. Both groups are at high risk of developing high blood pressure. But anyone who has parents with high blood pressure could also benefit from it.

How do you explain a possible effect?

It could be that an atypical everyday stress or exercise brings more in the situation than other forms of training. But that's all still hypothetical. As far as the mechanisms are concerned, we are still a bit blank in the professional world.

How exactly does the lowering of blood pressure through exercise work?

The arteries become more flexible again and they are widened. This reduces the resistance to blood flow, especially that in the smallest blood vessels. This lowers blood pressure. The decisive factor, however, is that the positive stress stimulus causes both the heart and the blood vessels to adapt to the stress in the subsequent regeneration phase. Then the blood pressure drops in the long term.

How quickly does the effect appear?

In people with what is known as endothelial dysfunction, the function of the blood vessels can return to normal within ten weeks. The decisive effect is the increase in shear stress, known in specialist circles as "shear stress". It results from the force with which the blood flow acts on the vessel walls. The endothelial cells, which line the inner walls of the blood vessels and play a key role in regulating blood pressure, react to this.

What effect can I achieve with exercise?

The effect is roughly equivalent to the reduction in blood pressure that can be expected from a single drug. As already mentioned, endurance training is most effective for high blood pressure. It can lower blood pressure systolic, i.e. when the heart presses blood into the body, by 7 mmHg, and by 4.5 mmHg diastolic when the heart expands again.

That doesn't sound like a lot.

In many cases, exercise is not enough and the patient must also take antihypertensive drugs. But sport makes an important contribution. In addition, these are average values. On an individual basis, physical activity can reduce blood pressure more significantly in some patients. A possible weight loss can also have a positive effect on blood pressure.

Some hypertensive patients may be worried about stress. Because exertion also increases blood pressure.

Right. The heart has to increase its performance during physical exertion in order to pump more blood into the circulation. This increases the current blood pressure. That is why high blood pressure patients should also have their individual load limit determined by a doctor with a load test before training. This includes recording an electrocardiogram and measuring blood pressure during exercise.

Training every day - is that even feasible for the untrained?

A patient with hypertension drives more or less permanently in 5th gear. For someone who is completely untrained, 150 minutes a week would actually be overwhelming and overworking. Instead, you get on, for example, once or twice a week with five minutes of brisk walking once or twice a day. Then you increase the frequency and duration of the units over months in order to slowly get into the target range of 150 minutes per week.

When overwhelmed, there is often a loss of motivation and finally surrender.

In fact, it's about a lifestyle change. That is why it is important to slowly increase the workload with untrained people. It is crucial that you adjust your rhythm of life so that you can actually devote half an hour a day to physical activity. The willingness of patients to implement exercise therapy - so-called compliance - is the greatest challenge in sports and exercise medicine. If you start slowly, it's better to stick with it.

And that is necessary in the long run.

Exercise therapy is a lifelong companion, especially if someone has essential hypertension, i.e. one for which no clear cause can be found. But we're not talking about the need to have to do structured athletic training every day. You don't have to wear your running shoes every day and reach a certain heart rate. The main thing is to do something every day. For example, spending an hour doing sports every now and then on a Sunday is of little use. On the other hand, more physical activity during the day has been shown to have positive effects on health.

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