John, 52 years old, was diagnosed with hypertension two years ago. He takes his medication regularly, but always asks at his appointments: "Doctor, besides the medicine, what exercise should I do to really lower my blood pressure?" This question is so common that I decided to bring to you what the most current science shows on the subject.*

"The data and clinical case cited in this article are fictitious and are purely illustrative, serving to facilitate understanding of the topic addressed."

For a long time, the standard answer was "walking or running". And that's not wrong – aerobic exercise really does help control blood pressure. But one of the largest scientific reviews ever conducted on the subject, published in 2023 in the British Journal of Sports Medicine, brought information that surprised even the medical community: it's not aerobic exercise that reduces resting blood pressure the most, it's isometric exercise.

What the science found

Researchers gathered and analysed 270 randomised clinical trials, totalling almost 16,000 participants, comparing five types of training:

  • Aerobic exercise (walking, running, cycling, swimming)
  • Dynamic resistance training (traditional strength training)
  • Combined training (aerobic + strength training)
  • High-intensity interval training (HIIT)
  • Isometric exercise (static muscle contraction, without movement, such as holding a position)

All types reduced resting blood pressure, which was already expected. But when researchers ranked which method is most effective, isometric exercise came in first place by a wide margin, for both systolic and diastolic blood pressure.

Why isometric exercise stood out

Isometric is the type of exercise where you contract the muscle and hold the position still, without moving the joint. The most studied examples are:

  • Wall sit (wall squat): back against the wall, knees at 90 degrees, as if sitting in an invisible chair.
  • Isometric handgrip: squeezing a dynamometer or firm object with your hand, sustaining the force for a set time.
  • Isometric leg extension: static contraction of the quadriceps against resistance.

Among these, the wall sit was identified as the most effective sub-method for reducing systolic blood pressure.

How this type of exercise works in the body:

  • Post-exercise hypotension: after sustained contraction, blood vessels relax more markedly, prolonging the drop in blood pressure.
  • Improved endothelial function: the inner wall of blood vessels becomes more efficient at dilating and contracting.
  • Reduction in peripheral vascular resistance: less "resistance" for blood to circulate.
  • Modulation of the autonomic nervous system: reduced sympathetic activity, which lowers heart rate and resting blood pressure.

Comparing results between exercise types

Directly, the average reduction in systolic/diastolic blood pressure was:

  • Isometric: more pronounced reductions, well above other methods
  • Combined training (aerobic + strength training): second place
  • Traditional strength training: relevant effect, especially on diastolic pressure
  • Aerobic: consistent effect, but less than previously thought
  • HIIT: also effective, but showed the smallest relative impact among the five

It is important to emphasise: this does not mean that walking or running doesn't work – it does work, and continues to be recommended by all cardiovascular health guidelines. What the evidence shows is that, if the goal is more pronounced reduction in resting blood pressure, isometric training has proved superior.

How to do it in practice

A common protocol used in studies, and which can serve as an initial reference (always with medical clearance):

  • Frequency: 3 times per week
  • Structure: 4 sets of isometric contraction of approximately 2 minutes each, with 1 to 4 minutes rest interval between sets
  • Intensity: moderate level of effort (not to be performed at maximum strength)
  • Programme duration: benefits typically appear after 4 to 8 weeks of regular practice

A comprehensive and balanced approach, aligned with international physical activity guidelines, combines:

  • 150 minutes per week of moderate-intensity aerobic exercise (or 75 minutes of vigorous intensity)
  • 2 sessions per week of muscle strengthening
  • Inclusion of isometric exercises such as wall sits, 2 to 3 times per week

Points of attention

  • People with very poorly controlled blood pressure, severe cardiovascular disease or other specific conditions should undergo medical assessment before starting isometric exercises, as sustained contraction can acutely raise blood pressure during the effort (even though it reduces resting blood pressure in the long term).
  • Physical exercise is a complementary tool, it does not replace medication when it is necessary.
  • The recommendation of "which exercise to do" should always be individualised, considering age, physical conditioning and other associated conditions.

This content is exclusively informative and educational in nature, not replacing consultation, diagnosis or treatment by a healthcare professional. Before starting any exercise programme, especially if you have hypertension or another cardiovascular condition, seek individualised medical guidance.

Dr. Rebeca Soares Andrade CRM - GO 39335