Strength Training With High Blood Pressure: What to Know

The Physical Activity Guidelines for Americans say both aerobic and muscle-strengthening activity are beneficial for people with hypertension, and that people with hypertension should work with their health care provider as they increase activity because medication may need adjusting. The National Heart, Lung, and Blood Institute (NHLBI), part of NIH, adds that even a small amount of activity helps. Your own plan should come from your provider.

1. Hypertension basics

The Guidelines call hypertension one of the most common, costly, and preventable risk factors for cardiovascular disease, and the most prevalent chronic condition among adults.

NHLBI's treatment page (last updated April 30, 2024) says research suggests that getting systolic blood pressure below 120 mm Hg can reduce the risk of serious complications. Your provider decides what target is right for you.

2. Both kinds of exercise help

The Guidelines are clear that both aerobic and muscle-strengthening activities are beneficial for people with hypertension. Physical activity has therapeutic benefits by helping to reduce blood pressure, and it also lowers the risk of dying from cardiovascular disease.

There is a striking detail here: the Guidelines say the benefits of physical activity are actually greater in people with hypertension than in people with normal blood pressure. As a result, about 90 minutes a week of moderate-intensity activity, or the equivalent amount of vigorous activity, helps substantially lower the risk of heart disease in people with hypertension. Moving toward more activity brings even more benefit.

3. Even small amounts count

NHLBI lists regular physical activity among the heart-healthy lifestyle changes for high blood pressure and says studies show it can help lower and control blood pressure. It adds that even a small amount helps, like walking for 10 minutes each day, and that reducing how much time you sit can also help you reach your blood pressure goal.

The Guidelines add a related point: a single session of moderate-to-vigorous activity can reduce blood pressure on the day you do it.

4. Talk to your provider, and why it matters for medication

The Guidelines include a specific caution for this group: people with hypertension should work with their health care provider as they increase physical activity, because adjustments to medication may be needed. NHLBI similarly advises asking your provider what level of activity is right for you before starting a new exercise program.

That is not a reason to avoid exercise. It is a reason to tell your provider your plan, so that if your blood pressure falls as your fitness improves, your treatment can keep pace.

5. What the sources do and do not say about lifting

Neither source prescribes specific lifts, sets, or loads for hypertension, so questions about how heavy to lift belong with your provider. What they do say:

• Ask first. NHLBI advises asking your provider what level of activity is right for you before starting an exercise program.
• Small amounts count. NHLBI's example is walking for 10 minutes each day.
• Less sitting helps. NHLBI says reducing the time you sit each day can also help you reach your blood pressure goal.
• Tell your provider your plan. The Guidelines say medication adjustments may be needed as activity increases.

6. The rest of the lifestyle picture

NHLBI pairs physical activity with other heart-healthy changes that make exercise more effective:

• The DASH eating plan, which NHLBI-funded research found, combined with a low-salt diet, can be as effective as medicines in lowering high blood pressure.
• Limiting alcohol.
• Aiming for a healthy weight. For adults with overweight or obesity, losing even 3% to 5% of body weight can improve blood pressure.
• Quitting smoking.
• Managing stress and getting 7 to 9 hours of sleep a day.

NHLBI's advice for making it stick: change one habit at a time, and add another once the first feels comfortable.

7. Key takeaways

• Both aerobic and muscle-strengthening activity help lower blood pressure, according to the Guidelines.
• The benefit is greater in people with hypertension; about 90 minutes a week of moderate activity substantially lowers heart disease risk.
• NHLBI says even a 10-minute daily walk and less sitting can help.
• Work with your provider as activity increases, because blood pressure medication may need adjusting.
• Neither source gives lifting loads for hypertension, so ask your provider before starting.

This article is general information, not medical advice. Talk with a doctor or physical therapist before starting a new exercise routine, especially if you have a health condition or injury.