Non pharmacological interventions in the form of lifestyle modifications form an important part of management of high blood pressure. For pre-hypertension, currently they are the only intervention recommended. They are used as an adjunct therapy for the management of hypertension along with antihypertensive drugs. Regular exercise is one of the most important steps in lifestyle modifications for management of high blood pressure. Regular aerobic exercise has been clearly proven to play an important role in prevention of hypertension also. Exercises are also recommended in management of low blood pressure; thus regular exercise tends to normalize the blood pressure.

Table 1: Exercise for High Blood Pressure

Exercise training results in reduction of blood pressure in nearly 3/4^th of the people with high blood pressure. Research has found that on an average, regular exercise reduces systolic blood pressure by 11 mm Hg and diastolic blood pressure by 8 mm Hg. Relatively better response is observed in women as compared to men. Exact mechanism of blood pressure reduction by exercise is not fully known yet, but most likely it is through interaction of numerous mechanisms.

Previously there have been some controversies regarding effectiveness of exercise in resistant hypertension (defined as blood pressure above 140/90 mm Hg despite use of 3 antihypertensive drugs). However, recent research suggests that regular exercise is effective in such cases also.

As per the current recommendations, the exercises should be ideally done on all days of the week for a minimum of 30 minutes. The exercises need not be high intensity, as low to moderate intensity exercises have been found to be as effective as high intensity exercises. The blood pressure reduction appears quickly with the start of regular exercise and with prolonged and regular exercise, further improvement in blood pressure is observed. The exercise type should be aerobic endurance training (e.g. Cycling, Swimming, Running, etc.) and can be supplemented by resistance or strength training. However, resistance or strength training alone is not effective in reducing the blood pressure and is not recommended if done as the only form of exercise.

Other than improving blood pressure readings, regular exercise has numerous other health benefits. It also improves blood lipid profile and insulin sensitivity. Regular exercise improves physical performance, helps in reducing weight in overweight or obese individuals and aids in prevention of numerous joint diseases. Overall regular exercise has a greatly beneficial effect on the health of an individual with almost no adverse effects. Only caveat is that people at high risk of cardiovascular diseases (family history, middle and older age, any previous cardiovascular event, occasional chest pain, pain in legs on walking, extremely high blood pressure [>180/105 mm Hg] etc.) should first get evaluated for exercise fitness and start exercise based on the recommendations of a physician. People with extremely high blood pressure should not start exercise training unless the blood pressure has been reduced by anti-hypertensive drugs. One should immediately seek medical help and stop further exercises if experiencing any symptoms during exercise (e.g. chest pain, dizziness, extreme shortness of breath, etc.)